标准经皮肾镜碎石术与迷你经皮肾镜碎石术的微观成本效益分析:加拿大一家医疗机构的经验。

IF 1.9 4区 医学 Q3 UROLOGY & NEPHROLOGY Cuaj-Canadian Urological Association Journal Pub Date : 2024-06-01 DOI:10.5489/cuaj.8679
Ahmed Shoeib, Ailsa Gan, James Watterson, Brian Blew, Nicholas R Paterson
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引用次数: 0

摘要

简介:微型经皮肾镜取石术(mPCNL)被认为是标准肾镜取石术(sPCNL)的替代方案,可用于治疗特定的结石。研究表明,mPCNL 的无结石率相当,并有可能减少并发症和缩短住院时间。这两种手术的相关费用对加拿大的医疗机构来说都是一个挑战,因为需要购置设备和持续使用一次性用品。本研究的目的是比较这两种手术在我院的成本效益:方法:我们开发了一个决策树分析模型来比较两种手术的成本和结果。主要结果包括对总资本、手术和住院费用的评估。通过对 2020 年 1 月至 2022 年 6 月期间 20 例 1-2.5 厘米结石的 mPCNL 和 84 例 sPCNL 手术进行回顾性分析,并辅以医院内部支出记录和文献结果数据,得出了围手术期和术后参数的成本和结果。结果显示,每名患者的总成本约为 1.5 美元:sPCNL和mPCNL每名患者的估计总成本分别为7427.05美元和5036.29美元,在无结石率相当的情况下,mPCNL可节省成本2390.76美元。mPCNL 的资本成本(95 116.00 美元)高于 sPCNL(78 517.00 美元),但 mPCNL 的每次手术成本(2504.48 美元)低于 sPCNL(3335.72 美元)。如果考虑手术和住院费用,总费用的每例成本回归值为 5.51 例,如果仅考虑手术费用,回归值为 20 例:结论:尽管前期成本较高,但在加拿大的医疗机构中,mCPNL 可能是一种有效的、具有成本效益的结石治疗方法,可替代 sPCNL,为临床和经济带来益处。
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Micro cost-effectiveness analysis of standard vs. mini percutaneous nephrolithotomy A single Canadian institution's experience.

Introduction: Mini-percutaneous nephrolithotomy (mPCNL ) has been described as an alternative to standard nephrolithotomy (sPCNL ) for select stones. Studies suggest that mPCNL has comparable stone-free rates, with potential for decreased complications and shorter hospital stay. Costs associated with both procedures present a challenge to Canadian institutions due to capital acquisitions of equipment and ongoing disposables. The objective of this study was to compare the cost-effectiveness of both procedures at our institution.

Methods: A decision tree analytic model was developed to compare costs and outcomes of both procedures. Primary outcomes included assessment of total capital, operative, and hospitalization costs. Cost and outcome of peri- and postoperative parameters were obtained using a retrospective analysis of 20 mPCNL and 84 sPCNL procedures on 1-2.5 cm stones between January 2020 and June 2022, and supplemented with internal hospital expenditure records and literature outcome data. Descriptive statistics and regression models were performed.

Results: The estimated total cost-per-patient was $7427.05 and $5036.29 for sPCNL and mPCNL, respectively, resulting in cost-savings of $2390.76 in favor of mPCNL, with a comparable stone-free rate. The savings were due to lower costs associated with complications and hospital stay. mPCNL had higher capital costs ($95 116.00) compared to sPCNL ($78 517.00), but per-procedure operative costs were lower for mPCNL ($2504.48) compared to sPCNL ($3335.72). Cost-per-case regression of total costs intersected at 5.51 cases when accounting for operative and hospitalization costs, and at 20 cases when only considering operative costs.

Conclusions: Despite higher upfront costs, mCPNL may represent a valid, cost-effective alternative to sPCNL for select stones due to clinical and economic benefits in Canadian institutions.

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来源期刊
Cuaj-Canadian Urological Association Journal
Cuaj-Canadian Urological Association Journal 医学-泌尿学与肾脏学
CiteScore
2.80
自引率
10.50%
发文量
167
审稿时长
>12 weeks
期刊介绍: CUAJ is a a peer-reviewed, open-access journal devoted to promoting the highest standard of urological patient care through the publication of timely, relevant, evidence-based research and advocacy information.
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