Foote A J, Moore K H
Calvary Hospital, Canberra and Australian National University, Australian Capital Territory, St George Hospital, Sydney, New South Wales, Australia.
Aust N Z J Obstet Gynaecol. 2007 Jun;47(3):240-6. doi: 10.1111/j.1479-828X.2007.00726.x.
To determine the cost-effectiveness of four urogynaecological treatments.
Two prospective trials were performed in which 205 women with urinary incontinence underwent urogynaecological treatments. The cost incurred and the improvement in quality of life (QOL) as a result of treatment was calculated as cost/quality-adjusted life year (QALY) and then ranked in order of cost-effectiveness.
The Nurse Continence Advisor (NCA) group (N = 73) and the Urogynaecologist (UG) group (N = 72) both had significant improvements in leaks per week and incontinence score. QOL improvement was also similar (1.5% vs 1.2%). The economic data found a similar improvement in pad usage costs ($A2.90 vs $A3.52). The clinician costs were significantly lower for the NCA group ($A60.00 vs $A105.00) (P < 0.0001). The cost per QALY was significantly lower for the NCA group ($A28,009 vs $A35,312) (P = 0.03). Both groups had significant improvements in pad testing and leaks per week. The cure/improvement rates were also similar at three months (100% vs 89%). There was no significant difference in the improvement in QOL between the laparoscopic colposuspension (LC) and open colposuspension (OC) groups (2.09% vs 1.54%). The economic data found a similar improvement in pad usage costs ($A11.74 vs $A16.17). The theatre costs were significantly higher for the LC group ($A403.45 vs $A266.94) (P < 0.0001), however the overall costs were significantly lower ($A4,668 vs $A6,124) (P < 0.0001). The cost/QALY was lower for the LC group ($A63,980 vs $A134,069), however this did not reach significance.
Overall, on comparison of the cost/QALY's, conservative treatment of urinary incontinence by a NCA was the most cost-effective.
确定四种泌尿妇科治疗方法的成本效益。
进行了两项前瞻性试验，205名尿失禁女性接受了泌尿妇科治疗。计算治疗产生的成本和生活质量（QOL）改善情况，以成本/质量调整生命年（QALY）表示，然后按成本效益排序。
护士尿失禁顾问（NCA）组（N = 73）和泌尿妇科医生（UG）组（N = 72）每周漏尿和尿失禁评分均有显著改善。生活质量改善情况也相似（1.5%对1.2%）。经济数据显示护垫使用成本改善情况相似（2.90澳元对3.52澳元）。NCA组的临床医生成本显著更低（60.00澳元对105.00澳元）（P < 0.0001）。NCA组每QALY成本显著更低（28,009澳元对35,312澳元）（P = 0.03）。两组在护垫测试和每周漏尿方面均有显著改善。三个月时的治愈/改善率也相似（100%对89%）。腹腔镜阴道悬吊术（LC）组和开放式阴道悬吊术（OC）组的生活质量改善无显著差异（2.09%对1.54%）。经济数据显示护垫使用成本改善情况相似（11.74澳元对16.17澳元）。LC组的手术成本显著更高（403.45澳元对266.94澳元）（P < 0.0001），但总体成本显著更低（4,668澳元对6,124澳元）（P < 0.0001）。LC组的成本/QALY更低（63,980澳元对134,069澳元），但未达到显著差异。
总体而言，比较成本/QALY，由护士尿失禁顾问对尿失禁进行保守治疗最具成本效益。
