Researchgroup Constipation and Faecal Incontinence, Department of Geriatrics, University Witten-Herdecke, Witten, Germany.
J Med Econ. 2012;15(4):758-65. doi: 10.3111/13696998.2012.670173. Epub 2012 Apr 3.
With the availability of several bowel cleansing agents, physicians and hospitals performing colonoscopies will often base their choice of cleansing agent purely on acquisition cost. Therefore, an easy to use budget impact model has been developed and established as a tool to compare total colon preparation costs between different established bowel cleansing agents.
The model was programmed in Excel and designed as a questionnaire evaluating information on treatment costs for a range of established bowel cleansing products. The sum of costs is based on National Health Service reference costs for bowel cleansing products. Estimations are made for savings achievable when using a 2-litre polyethylene glycol with ascorbate components solution (PEG+ASC) in place of other bowel cleansing solutions. Test data were entered into the model to confirm validity and sensitivity. The model was then applied to a set of audit cost data from a major hospital colonoscopy unit in the UK.
Descriptive analysis of the test data showed that the main cost drivers in the colonoscopy process are the procedure costs and costs for bed days rather than drug acquisition costs, irrespective of the cleansing agent. Audit data from a colonoscopy unit in the UK confirmed the finding with a saving of £107,000 per year in favour of PEG+ASC when compared to sodium picosulphate with magnesium citrate solution (NaPic+MgCit). For every patient group the model calculated overall cost savings. This was irrespective of the higher drug expenditure associated with the use of PEG+ASC for bowel preparation. Savings were mainly realized through reduced costs for repeat colonoscopy procedures and associated costs, such as inpatient length of stay.
The budget impact model demonstrated that the primary cost driver was the procedure cost for colonoscopy. Savings can be realized through the use of PEG+ASC despite higher drug acquisition costs relative to the comparator products. From a global hospital funding perspective, the acquisition costs of bowel preparations should not be used as the primary reason to select the preferred treatment agent, but should be part of the consideration, with an emphasis on the clinical outcome.
有了多种肠道清洁剂可供选择，进行结肠镜检查的医生和医院通常会纯粹根据采购成本选择清洁剂。因此，开发并建立了一种易于使用的预算影响模型，以比较不同肠道清洁剂的总结肠准备成本。
该模型在 Excel 中编程，设计为一个问卷，评估一系列已建立的肠道清洁剂产品的治疗成本信息。成本总和基于英国国家医疗服务体系（NHS）对肠道清洁剂产品的参考成本。使用含抗坏血酸成分的 2 升聚乙二醇（PEG+ASC）替代其他肠道清洁剂溶液时，可以节省多少成本。将测试数据输入模型以确认有效性和敏感性。然后将模型应用于英国一家主要医院结肠镜检查单位的一组审计成本数据。
测试数据的描述性分析表明，结肠镜检查过程中的主要成本驱动因素是手术成本和床位成本，而不是药物采购成本，与清洁剂无关。来自英国结肠镜检查单位的审计数据证实了这一发现，与使用含柠檬酸钠和镁的聚乙二醇钠溶液（NaPic+MgCit）相比，PEG+ASC 每年可节省 107000 英镑。对于每个患者群体，该模型都计算了总体成本节省。这与使用 PEG+ASC 进行肠道准备相关的更高药物支出无关。节省主要是通过减少重复结肠镜检查程序和相关成本（如住院时间）来实现的。
预算影响模型表明，主要成本驱动因素是结肠镜检查的手术成本。尽管与比较产品相比，PEG+ASC 的药物采购成本较高，但仍可通过使用 PEG+ASC 实现节省。从全球医院资金的角度来看，肠道准备的采购成本不应作为选择首选治疗药物的主要原因，而应作为考虑因素之一，重点是临床结果。
