Panaccione R, Gregor J C, Reynolds R P, Preiksaitis H G
Division of Gastroenterology, Department of Medicine, The University of Western Ontario, London, Ontario, Canada.
Gastrointest Endosc. 1999 Oct;50(4):492-8. doi: 10.1016/s0016-5107(99)70071-4.
Pneumatic dilatation or intrasphincteric botulinum toxin injection provide effective symptom relief for patients with achalasia. Although intrasphincteric botulinum toxin injection is simple and safe, its efficacy may be short-lived. Pneumatic dilatation lasts longer, but esophageal perforation is a risk. We compared treatment costs for pneumatic dilatation and intrasphincteric botulinum toxin injection using a decision analysis model to determine whether the practical advantages of intrasphincteric botulinum toxin injection outweigh the economic impact of the need for frequent re-treatment.
Probability estimates for intrasphincteric botulinum toxin injection were derived from published reports. Probability estimates for the pneumatic dilatation strategy were obtained by retrospective review of our 10-year experience using the Rigiflex dilator. Direct, "third-party payer" costs were determined in Canadian dollars.
Intrasphincteric botulinum toxin injection was significantly more costly at $5033 compared with $3608 for the pneumatic dilatation strategy, yielding an incremental cost of $1425 over the 10-year period considered. Sensitivity analysis showed that pneumatic dilatation is less expensive across all probable ranges of costs and probability estimates. The intrasphincteric botulinum toxin injection strategy is less costly if life-expectancy is less than 2 years.
Intrasphincteric botulinum toxin injection is more costly than pneumatic dilatation for the treatment of achalasia. The added expense of frequent re-treatment with intrasphincteric botulinum toxin injection outweighs the potential economic benefits of the safety of the procedure, unless life-expectancy is 2 years or less.
气囊扩张术或括约肌内注射肉毒杆菌毒素可为贲门失弛缓症患者有效缓解症状。尽管括约肌内注射肉毒杆菌毒素操作简单且安全，但其疗效可能是短暂的。气囊扩张术的疗效持续时间更长，但存在食管穿孔的风险。我们使用决策分析模型比较了气囊扩张术和括约肌内注射肉毒杆菌毒素的治疗成本，以确定括约肌内注射肉毒杆菌毒素的实际优势是否超过频繁再次治疗所需的经济影响。
括约肌内注射肉毒杆菌毒素的概率估计值来自已发表的报告。气囊扩张术策略的概率估计值通过回顾我们使用Rigiflex扩张器的10年经验获得。直接的“第三方支付者”成本以加元确定。
括约肌内注射肉毒杆菌毒素的成本显著更高，为5033美元，而气囊扩张术策略的成本为3608美元，在考虑的10年期间产生的增量成本为1425美元。敏感性分析表明，在所有可能的成本范围和概率估计中，气囊扩张术成本更低。如果预期寿命小于2年，括约肌内注射肉毒杆菌毒素策略的成本更低。
对于贲门失弛缓症的治疗，括约肌内注射肉毒杆菌毒素比气囊扩张术成本更高。除非预期寿命为2年或更短，否则括约肌内注射肉毒杆菌毒素频繁再次治疗的额外费用超过了该操作安全性的潜在经济益处。
Zotero 插件