Stanford University Medical Center, Lucile Packard Children's Hospital, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Palo Alto, CA 94304, USA.
Ann Surg. 2012 Jul;256(1):117-24. doi: 10.1097/SLA.0b013e3182445321.
Inflammatory bowel diseases are costly chronic gastrointestinal diseases. We aimed to determine whether immediate colectomy with ileal pouch-anal anastamosis (IPAA) after diagnosis of severe ulcerative colitis (UC) was cost-effective compared to the standard medical therapy.
We created a Markov model simulating 2 cohorts of 21-year-old patients with severe UC, following them until 100 years of age or death, comparing early colectomy with IPAA strategy to the standard medical therapy strategy. Deterministic and probabilistic analyses were performed.
Standard medical care accrued a discounted lifetime cost of $236,370 per patient. In contrast, early colectomy with IPAA accrued a discounted lifetime cost of $147,763 per patient. Lifetime quality-adjusted life-years gained (QALY-gained) for standard medical therapy was 20.78, while QALY-gained for early colectomy with IPAA was 20.72. The resulting incremental cost-effectiveness ratio (Δcosts/ΔQALY) was approximately $1.5 million per QALY-gained. Results were robust to one-way sensitivity analyses for all variables in the model. Quality-of-life after colectomy with IPAA was the most sensitive variable impacting cost-effectiveness. A low utility value of less than 0.7 after colectomy with IPAA was necessary for the colectomy with IPAA strategy to be cost-ineffective.
Under the appropriate clinical settings, early colectomy with IPAA after diagnosis of severe UC reduces health care expenditures and provides comparable quality of life compared to exhaustive standard medical therapy.
炎症性肠病是一种昂贵的慢性胃肠道疾病。我们旨在确定在诊断出严重溃疡性结肠炎（UC）后，立即进行结肠切除术联合回肠储袋肛管吻合术（IPAA）是否比标准药物治疗更具成本效益。
我们创建了一个马尔可夫模型，模拟了 21 岁患有严重 UC 的两组患者，在 100 岁或死亡之前对他们进行随访，比较早期结肠切除术联合 IPAA 策略与标准药物治疗策略。进行了确定性和概率性分析。
标准药物治疗的患者终生累计贴现成本为每人 236370 美元。相比之下，早期结肠切除术联合 IPAA 的患者终生累计贴现成本为每人 147763 美元。标准药物治疗的终生质量调整生命年（QALY-gained）为 20.78，而早期结肠切除术联合 IPAA 的 QALY-gained 为 20.72。增量成本效益比（Δcosts/ΔQALY）约为每 QALY-gained 增加 150 万美元。结果对模型中所有变量的单向敏感性分析均稳健。IPAA 后结肠切除术后的生活质量是影响成本效益的最敏感变量。IPAA 后结肠切除术后效用值低于 0.7 是使 IPAA 后结肠切除术策略不具有成本效益的必要条件。
在适当的临床环境下，在诊断出严重 UC 后立即进行结肠切除术联合 IPAA 可降低医疗保健支出，并提供与全面标准药物治疗相当的生活质量。
