Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
J Vasc Interv Radiol. 2010 May;21(5):677-84. doi: 10.1016/j.jvir.2010.01.014. Epub 2010 Mar 27.
Percutaneous image-guided techniques are associated with less tissue trauma and morbidity than open surgical techniques. Interventional radiology has received significant health care investment. The purpose was to determine the cost effectiveness of inserting implantable venous access devices (IVADs) by interventional radiologic means versus conventional operating room surgery in pediatric patients with cancer.
In a retrospective cohort analysis, patients presenting with a new tumor diagnosis and receiving a first-time IVAD in January to June 2000 (operative group; n = 30) and January to June 2004 (interventional group; n = 30) were included. A societal costing perspective was adopted. Costs included labor, materials, equipment, inpatient wards, parent travel, and parental productivity losses for 30 days after insertion. Severe complications related to IVAD insertion were microcosted. Costs related to cancer therapy were not included. Incremental cost-effectiveness analysis and sensitivity analysis were performed.
Interventional patients were older (7.3 years vs 4.1 years; P = .01). There were no significant differences between groups in sex, American Society of Anesthesiologists score, or length of hospital stay. Interventional radiologic procedures were shorter (84.9 minutes vs 112.8 minutes; P = 0.01). Interventional radiologic insertion was slightly less costly than operative insertion (Can$622,860 and Can$627,005 per 30-patient group, respectively) and more effective in reducing the complication rate (two vs eight complications per group, respectively; P = .039). The results were sensitive to the cost of operating the operating room.
Interventional radiology was slightly less costly than operative IVAD insertion and resulted in fewer serious complications. It should be considered for IVAD insertions in pediatric patients with cancer.
与开放式手术相比，经皮影像引导技术造成的组织创伤和发病率更小。介入放射学已获得大量医疗保健投资。本研究旨在确定通过介入放射学方法与传统手术室手术为癌症患儿插入植入式静脉接入装置（IVAD）的成本效益。
在回顾性队列分析中，纳入了 2000 年 1 月至 6 月（手术组；n=30）和 2004 年 1 月至 6 月（介入组；n=30）期间首次接受 IVAD 的新诊断肿瘤患儿。采用社会成本视角。成本包括劳动力、材料、设备、住院病房、父母旅行以及插入后 30 天父母的生产力损失。对与 IVAD 插入相关的严重并发症进行微观成本核算。不包括癌症治疗相关成本。进行增量成本效益分析和敏感性分析。
介入组患者年龄较大（7.3 岁比 4.1 岁；P=0.01）。两组在性别、美国麻醉医师协会评分或住院时间方面无显著差异。介入放射学操作时间较短（84.9 分钟比 112.8 分钟；P=0.01）。介入放射学插入术的成本略低于手术插入术（每组 30 例分别为 622,860 加元和 627,005 加元），并且在降低并发症发生率方面更有效（每组分别为 2 例和 8 例并发症；P=0.039）。结果对手术室运营成本敏感。
与手术 IVAD 插入术相比，介入放射学的成本略低，且严重并发症更少。对于癌症患儿的 IVAD 插入术，应考虑介入放射学。
