瑞士手部移植强制意外保险计划的卫生技术评估

The health technology assessment of the compulsory accident insurance scheme of hand transplantation in Switzerland.

作者信息

Brügger U, Plessow R, Hess S, Caballero A, Eichler K, Meyer V, von Wartburg U

机构信息

Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland

Winterthur Institute of Health Economics, Zurich University of Applied Sciences, Winterthur, Switzerland.

出版信息

J Hand Surg Eur Vol. 2015 Nov;40(9):914-23. doi: 10.1177/1753193414559463. Epub 2014 Nov 18.

DOI:10.1177/1753193414559463

PMID:25409115

Abstract

UNLABELLED

Recently the decision-making committee of the compulsory Swiss accident insurance scheme needed to make a basic decision as to whether to fund hand transplantation under that scheme or not. A Health Technology Assessment was commissioned to inform decision-making and gain experience with applicability of the method. The following were main findings from various domains. Compared with prosthesis fitting, the outcome of hand transplantation is satisfactory for function and sensibility. Complications due to immunosuppression are frequent, sometimes severe and potentially life-shortening. The direct medical costs over the entire life span calculated for a 35-year-old unilaterally amputated base case patient were CHF 528,600 (EUR 438,500) higher than for a prosthesis. There are challenging ethical, legal and organizational issues. The committee decided not to reimburse hand transplantation for ethical reasons. The Health Technology Assessment has been shown to be a useful tool for decision-making in the context of Swiss accident insurance.

LEVEL OF EVIDENCE

IV.

摘要

未标注

最近，瑞士强制性事故保险计划的决策委员会需要做出一项基本决定，即是否在该计划下为手部移植提供资金。委托进行了一项卫生技术评估，以辅助决策并积累该方法适用性的经验。以下是来自各个领域的主要发现。与假肢装配相比，手部移植的功能和感觉结果令人满意。免疫抑制引起的并发症很常见，有时很严重，甚至可能缩短寿命。为一名35岁单侧截肢的基础病例患者计算的整个生命周期的直接医疗费用比假肢高出528,600瑞士法郎（438,500欧元）。存在具有挑战性的伦理、法律和组织问题。委员会出于伦理原因决定不为手部移植提供报销。事实证明，卫生技术评估是瑞士事故保险背景下决策的有用工具。