Goyert Nik, Eeson Gareth, Kagedan Daniel J, Behman Ramy, Lemke Madeline, Hallet Julie, Mittmann Nicole, Law Calvin, Karanicolas Paul J, Coburn Natalie G
*Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada †Sunnybrook Research Institute, Toronto, Ontario, Canada ‡Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada §Institute of Health Policy, Management, and Evaluation, Toronto, Ontario, Canada.
Ann Surg. 2017 Jan;265(1):2-10. doi: 10.1097/SLA.0000000000001889.
To determine the cost-effectiveness of perioperative administration of pasireotide for reduction of pancreatic fistula (PF).
PF is a major complication following pancreaticoduodenectomy (PD), associated with significant morbidity and healthcare-related costs. Pasireotide is a novel multireceptor ligand somatostatin analogue, which has been demonstrated to reduce the incidence of PF following pancreas resection; however, the drug cost is significant. This study sought to estimate the cost-effectiveness of routine administration of pasireotide to patients undergoing PD, compared with no intervention from the perspective of the hospital system.
A decision-analytic model was developed to compare costs for perioperative administration of pasireotide versus no pasireotide. The model was populated using an institutional database containing all PDs performed 2002 to 2012 at a single institution, including data regarding clinically significant PF (International Study Group on Pancreatic Fistula Grade B or C) and hospital-related inpatient costs for 90 days following PD, converted to 2014 $USD. Relative risk of PF associated with pasireotide was estimated from the published literature. Deterministic and probabilistic sensitivity analyses were performed to test robustness of the model.
Mean institutional cost of index admissions was $67,417 and $31,950 for patients with and without PF, respectively. Pasireotide was the dominant strategy, associated with savings of $1685, and a mean reduction of 1.5 days length of stay. Univariate sensitivity analyses demonstrated cost-savings down to a PF rate of 5.6%, up to a relative risk of PF of 0.775, and up to a drug cost of $2817. Probabilistic sensitivity analysis showed 79% of simulations were cost saving.
Pasireotide appears to be a cost-saving treatment following PD across a wide variation of clinical and cost scenarios.
确定围手术期使用帕西瑞肽减少胰瘘（PF）的成本效益。
PF是胰十二指肠切除术（PD）后的主要并发症，与显著的发病率和医疗相关成本有关。帕西瑞肽是一种新型多受体配体生长抑素类似物，已被证明可降低胰腺切除术后PF的发生率；然而，药物成本高昂。本研究旨在从医院系统的角度评估，与不进行干预相比，对接受PD的患者常规使用帕西瑞肽的成本效益。
建立一个决策分析模型，比较围手术期使用帕西瑞肽与不使用帕西瑞肽的成本。该模型使用一个机构数据库的数据进行填充，该数据库包含2002年至2012年在单一机构进行的所有PD手术，包括关于临床显著PF（国际胰瘘研究组B级或C级）的数据，以及PD后90天的医院相关住院成本，并换算为2014年美元。从已发表的文献中估计与帕西瑞肽相关的PF相对风险。进行确定性和概率敏感性分析以检验模型的稳健性。
有PF和无PF患者的首次入院平均机构成本分别为67417美元和31950美元。帕西瑞肽是主要策略，可节省1685美元，平均住院时间缩短1.5天。单因素敏感性分析表明，PF发生率低至5.6%、PF相对风险高达0.775以及药物成本高达2817美元时仍可节省成本。概率敏感性分析显示，79%的模拟结果是节省成本的。
在广泛的临床和成本情况下，帕西瑞肽似乎是PD术后一种节省成本的治疗方法。
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