每搏量变异度指导的围手术期血流动力学优化的成本分析——对SVVOPT试验结果的经济评估
Cost analysis of the stroke volume variation guided perioperative hemodynamic optimization - an economic evaluation of the SVVOPT trial results.
作者信息
Benes Jan, Zatloukal Jan, Simanova Alena, Chytra Ivan, Kasal Eduard
机构信息
Department of Anaesthesia and Intensive Care Medicine, Charles University Medical School and Teaching Hospital, Alej svobody 80, 304 60 Plzen, Czech Republic.
出版信息
BMC Anesthesiol. 2014 May 22;14:40. doi: 10.1186/1471-2253-14-40. eCollection 2014.
BACKGROUND
Perioperative goal directed therapy (GDT) can substantially improve the outcomes of high risk surgical patients as shown by many clinical studies. However, the approach needs initial investment and can increase the already very high staff workload. These economic imperatives may be at least partly responsible for weak adherence to the GDT concept. A few models are available for the evaluation of GDT cost-effectiveness, but studies of real economic data based on a recent clinical trial are lacking. In order to address this we have performed a retrospective analysis of the data from the "Intraoperative fluid optimization using stroke volume variation in high risk surgical patients" trial (ISRCTN95085011).
METHODS
The health-care payers perspective was used in order to evaluate the perioperative hemodynamic optimization costs. Hospital invoices from all patients included in the trial were extracted. A direct comparison between the study (GDT, N = 60) and control (N = 60) groups was performed. A cost tree was constructed and major cost drivers evaluated.
RESULTS
The trial showed a significant improvement in clinical outcomes for GDT treated patients. The mean cost per patient were lower in the GDT group 2877 ± 2336€ vs. 3371 ± 3238€ in controls, but without reaching a statistical significance (p = 0.596). The mean cost of all items except for intraoperative monitoring and infusions were lower for GDT than control but due to the high variability they all failed to reach statistical significance. Those costs associated with clinical care (68 ± 177€ vs. 212 ± 593€; p = 0.023) and ward stay costs (213 ± 108€ vs. 349 ± 467€; p = 0.082) were the most important differences in favour of the GDT group.
CONCLUSIONS
Intraoperative fluid optimization with the use of stroke volume variation and Vigileo/FloTrac system showed not only a substantial improvement of morbidity, but was associated with an economic benefit. The cost-savings observed in the overall costs of postoperative care trend to offset the investment needed to run the GDT strategy and intraoperative monitoring.
TRIAL REGISTRATION
ISRCTN95085011.
背景
围手术期目标导向治疗（GDT）已被多项临床研究证明可显著改善高危手术患者的预后。然而，该方法需要初始投资，且会增加本就很高的医护工作量。这些经济因素可能至少部分导致了对GDT理念的依从性较差。目前有一些模型可用于评估GDT的成本效益，但缺乏基于近期临床试验的真实经济数据研究。为解决这一问题，我们对“高危手术患者术中利用每搏量变异进行液体优化”试验（ISRCTN95085011）的数据进行了回顾性分析。
方法
采用医疗保健支付方的视角来评估围手术期血流动力学优化成本。提取了该试验中所有患者的医院发票。对研究组（GDT，N = 60）和对照组（N = 60）进行了直接比较。构建了成本树并评估了主要成本驱动因素。
结果
该试验表明GDT治疗的患者临床结局有显著改善。GDT组患者的人均成本较低，为2877 ± 2336欧元，而对照组为3371 ± 3238欧元，但未达到统计学显著性（p = 0.596）。除术中监测和输液外，GDT组所有项目的平均成本均低于对照组，但由于变异性较大，均未达到统计学显著性。与临床护理相关的成本（68 ± 177欧元 vs. 212 ± 593欧元；p = 0.023）和病房停留成本（213 ± 108欧元 vs. 349 ± 467欧元；p = 0.082）是有利于GDT组的最重要差异。
结论
术中利用每搏量变异和Vigileo/FloTrac系统进行液体优化不仅显著改善了发病率，还带来了经济效益。术后护理总成本中观察到的成本节约趋势抵消了实施GDT策略和术中监测所需的投资。
试验注册号
ISRCTN95085011。
Zotero 插件