Sørensen Jan, Axelsen Susanne Maigaard
Centre for Applied Health Services Research and Technology Assessment, University of Southern Denmark, Denmark.
Acta Obstet Gynecol Scand. 2007;86(4):473-9. doi: 10.1080/00016340701207641.
The study's objective was to compare the cost of vaginal wall repair under local anesthesia, undertaken in either an inpatient or an outpatient regimen. The perspective used was that of a department of gynecology over the short and medium term.
The analysis was based on 2 consecutive cohorts of inpatients and outpatients treated in a Danish university hospital. Data on resource use were collected from clinical records and via a patient telephone survey. Salary and drug costs were estimated from national sources. Costs for consumables, complications and overnight stays were estimated from local data. The analysis compared the costs of inpatient and outpatient surgery relating to staff time, anesthesia, operation, recovery, overnight stays and complications. Multiple regression was employed to adjust for confounding variables.
The average cost was estimated to be 10,400 DKK per inpatient and 6,100 DKK per outpatient (2004 price level: 1 euro = 7.50 DKK). Costs relating to overnight stays and staff costs during operation were the largest contributors to the cost difference. Total cost was significantly associated with type of regimen (in- or outpatient), type of operation and complications. After adjustment for confounding variables, the cost difference was estimated at 3,700 DKK (95% bootstrap confidence interval: 2,500-5,000 DKK). The risk of complication was similar for the 2 regimens.
Vaginal wall repair under local anesthesia, undertaken in an outpatient regimen, appears to be less costly than in an inpatient regimen.
本研究的目的是比较在局部麻醉下进行阴道壁修复时，住院治疗方案与门诊治疗方案的费用。所采用的视角是妇科部门在短期和中期的视角。
该分析基于丹麦一家大学医院连续收治的两批住院患者和门诊患者。资源使用数据从临床记录中收集，并通过患者电话调查获取。工资和药品成本从国家来源估算。耗材、并发症和过夜住宿的成本从本地数据估算。该分析比较了住院手术和门诊手术在人员时间、麻醉、手术、恢复、过夜住宿和并发症方面的费用。采用多元回归来调整混杂变量。
估计每位住院患者的平均费用为10400丹麦克朗，每位门诊患者为6100丹麦克朗（2004年价格水平：1欧元 = 7.50丹麦克朗）。过夜住宿费用和手术期间的人员成本是造成成本差异的最大因素。总成本与治疗方案类型（住院或门诊）、手术类型和并发症显著相关。在调整混杂变量后，成本差异估计为3700丹麦克朗（95%自抽样置信区间：2500 - 5000丹麦克朗）。两种治疗方案的并发症风险相似。
在门诊治疗方案下进行局部麻醉的阴道壁修复，其费用似乎低于住院治疗方案。
