Huynh Lynn, Yermakov Sander, Davis Matthew, Campbell Romaine, Cleveland Mark, Farraye Francis A, Yenikomshian Mihran
a a Analysis Group , Boston , MA , USA.
b b Braintree Laboratories , Braintree , MA , USA.
J Med Econ. 2016;19(4):356-63. doi: 10.3111/13696998.2015.1125907. Epub 2015 Dec 21.
The study aimed to (1) develop a cost model for colonoscopy preparation among patients referred for colonoscopy using split-dose reduced-volume oral sulfate solution (OSS) and generic polyethylene glycol with electrolytes solution (PEG-ELS), (2) examine cost savings associated with OSS vs PEG-ELS, and (3) assess the robustness of the cost model.
Efficacy of each agent was based on the results of a 541-patient clinical trial comparing OSS to PEG-ELS. Cleansing agent and colonoscopy procedure costs were calculated from OptumHealth Reporting & Insights claims data for 2010-Q12013. In the model, patients' colonoscopies were tracked over a 25 or 35 year time period until the patients reached age 75. The difference per patient per year (PPPY) in total cleansing agent and colonoscopy procedure costs over the time horizon between the OSS and PEG-ELS cohort was calculated. One-way sensitivity analyses were conducted to test the robustness of the cost model.
The model showed lower cost for OSS patients over the time horizon. Total PPPY costs were $280.34 for the OSS cohort and $296.36 for the PEG-ELS cohort, resulting in a cost saving of $16.01 PPPY for the OSS cohort. This was due primarily to OSS patients having fewer colonoscopies (OSS: 0.158 vs PEG-ELS: 0.170 PPPY). Over the time horizon, cost savings of $4 763 335 were observed among 10, 000 OSS patients. Cost savings switched from OSS to PEG-ELS cohort in four cases: (1) base-case cost of a completed colonoscopy decreased by 75%, (2) base-case cost of OSS increased to over $143 per usage, (3) all non-completers were lost to follow-up, and (4) OSS bowel preparation quality dropped below PEG-ELS to 70%.
From a payer's perspective, the model showed that the use of OSS as the cleansing agent resulted in potential cost savings compared with PEG-ELS. Cost savings under OSS remained under various sensitivity analyses.
本研究旨在（1）为接受结肠镜检查的患者建立使用分剂量减量口服硫酸盐溶液（OSS）和普通聚乙二醇电解质溶液（PEG-ELS）进行结肠镜检查准备的成本模型；（2）研究与PEG-ELS相比，OSS的成本节约情况；（3）评估成本模型的稳健性。
每种制剂的疗效基于一项541例患者的临床试验结果（该试验比较了OSS和PEG-ELS）。清洁制剂和结肠镜检查程序成本根据OptumHealth报告与洞察部门2010年第一季度至2013年第一季度的理赔数据计算得出。在模型中，对患者的结肠镜检查情况进行了25年或35年的跟踪，直至患者年满75岁。计算了OSS组和PEG-ELS组在整个时间范围内每位患者每年（PPPY）清洁制剂和结肠镜检查程序总成本的差异。进行了单向敏感性分析以测试成本模型的稳健性。
该模型显示，在整个时间范围内，OSS组患者的成本较低。OSS组的PPPY总成本为280.34美元，PEG-ELS组为296.36美元，OSS组PPPY成本节约16.01美元。这主要是因为OSS组患者进行结肠镜检查的次数较少（OSS组：0.158次/PPPY，PEG-ELS组：0.170次/PPPY）。在整个时间范围内，10000例OSS患者中观察到成本节约4763335美元。在四种情况下，成本节约情况从OSS组转变为PEG-ELS组：（1）完成结肠镜检查的基础成本降低75%；（2）OSS的基础成本增加到每次使用超过143美元；（3）所有未完成检查的患者失访；（4）OSS肠道准备质量降至PEG-ELS以下，为70%。
从支付方的角度来看，该模型显示，与PEG-ELS相比，使用OSS作为清洁制剂可节省潜在成本。在各种敏感性分析下，OSS的成本节约情况依然存在。
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