How much does it cost to identify a critically ill child experiencing electrographic seizures?
How much does it cost to identify a critically ill child experiencing electrographic seizures?
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DOI：
10.1097/wnp.0000000000000170
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发表时间：
2015-06
期刊：
影响因子：
--
通讯作者：
Williams S
中科院分区：
文献类型：
--
作者：
Abend NS;Topjian AA;Williams S
危重儿童的脑电图性发作可以通过持续的脑电监测来识别。我们评估了四种脑电惊厥识别策略(无脑电监测和脑电监测1小时、24小时或48小时)的成本-效果。我们创建了一棵决策树，从社会的角度对变量之间的关系进行建模。为了为模型提供输入，我们估计了与脑电监测直接相关的可变成本，并回顾了文献以估计结果的概率。我们计算了递增的成本-效果比，以确定不同支付意愿值下的成本和效果之间的权衡。我们的分析发现，如果决策者愿意为每个患有脑电发作的危重儿童分别支付1,666美元、1,666-22,648美元和22,648美元，则首选的策略是对脑电监测1小时、24小时和48小时。48小时策略仅以高得多的成本发现了4%以上的儿童出现脑电发作。敏感性分析发现，当监测到有较高癫痫发作风险的儿童时，在较低的支付意愿值下，所有这三种策略都是可以接受的。我们的结果支持对危重儿童进行24小时监测，因为识别患有脑电发作的危重儿童的成本并不高。需要进一步的研究来更好地预测哪些儿童可能从48小时的脑电监测中受益，因为成本要高得多。
Electrographic seizures in critically ill children may be identified by continuous electroencephalographic (EEG) monitoring. We evaluated the cost-effectiveness of four electrographic seizure identification strategies (no EEG monitoring and EEG monitoring for 1 hour, 24 hours, or 48 hours). We created a decision tree to model the relationships among variables from a societal perspective. To provide input for the model, we estimated variable costs directly related to EEG monitoring from their component parts, and we reviewed the literature to estimate the probabilities of outcomes. We calculated incremental cost-effectiveness ratios to identify the tradeoff between cost and effectiveness at different willingness-to-pay values. Our analysis found that the preferred strategy was EEG monitoring for 1 hour, 24 hours, and 48 hours if the decision maker was willing to pay <$1,666, $1,666–$22,648, and >$22,648 per critically ill child identified with electrographic seizures, respectively. The 48 hour strategy only identified 4% more children with electrographic seizures at substantially higher cost. Sensitivity analyses found that all three strategies were acceptable at lower willingness-to-pay values when children with higher electrographic seizure risk were monitored. Our results support monitoring of critically ill children for 24 hours because the cost to identify a critically ill child with electrographic seizures is modest. Further study is needed to predict better which children may benefit from 48 hours of EEG monitoring since the costs are much higher.