Ikeme Shelly, Weltert Luca, Lewis Kevin M, Bothma Gerhard, Cianciulli Daniela, Pay Nicole, Epstein Josh, Kuntze Erik
a Baxter Healthcare Corporation , Deerfield , IL , USA.
b European Hospital , Rome , Italy.
J Med Econ. 2018 Mar;21(3):273-281. doi: 10.1080/13696998.2017.1400977. Epub 2017 Dec 7.
A recent randomized controlled trial showed that patients undergoing ascending aorta surgery treated with HEMOPATCH to control bleeding had a significantly better hemostasis success rate than with dry or wet gauze compression or similar standard of care (SOC).
To compare the cost-effectiveness using two different agents for hemostasis (HEMOPATCH vs dry or wet gauze compression or similar SOC) in cardiac surgery from the European hospital perspective.
A literature-based cost-effectiveness model estimating average cost per successful hemostasis event was developed based on the hemostasis efficacy difference (HEMOPATCH = 97.6%, SOC = 65.8%, p < .001). Additional clinically significant end-points studied in the trial (blood transfusions and surgical revisions) were also analyzed. It was assumed that each surgery utilized two units of HEMOPATCH (dimensions of 4.5 × 9 cm) and two units of SOC. Product acquisition costs for HEMOPATCH and SOC were included along with outcome-related costs derived from the literature and inflation-adjusted to 2017 EUR and GBP. Results are presented for an average hospital with an annual case load of 574 cardiac surgeries. One-way and probabilistic sensitivity analyses were performed.
Considering only product acquisition cost, HEMOPATCH had an incremental cost-effectiveness ratio (ICER) of €1,659, €1,519, €1,623, and £1,725 per hemostasis success when compared to SOC for Italy, Spain, France, and the UK, respectively. However, when considering the cost and potential difference in the frequency of transfusions and revisions compared to SOC, the use of HEMOPATCH was associated with an annual reduction of six revisions and 60 transfusions, improving the ICER to €1,440, €1,222, €1,461, and £1,592, respectively. Sensitivity analysis demonstrated model robustness.
This analysis supports the use of HEMOPATCH over SOC in cardiac surgery in European hospitals to improve hemostasis success rates and potential cost offsets from reduced transfusions, complications, and surgical revisions.
最近一项随机对照试验表明，接受升主动脉手术的患者使用HEMOPATCH控制出血，其止血成功率显著高于使用干纱布或湿纱布压迫或类似标准治疗（SOC）。
从欧洲医院的角度比较心脏手术中使用两种不同止血剂（HEMOPATCH与干纱布或湿纱布压迫或类似SOC）的成本效益。
基于止血效果差异（HEMOPATCH = 97.6%，SOC = 65.8%，p <.001）建立了一个基于文献的成本效益模型，估计每次成功止血事件的平均成本。还分析了试验中研究的其他具有临床意义的终点指标（输血和手术修正）。假设每次手术使用两个单位的HEMOPATCH（尺寸为4.5×9厘米）和两个单位的SOC。纳入了HEMOPATCH和SOC的产品购置成本以及来自文献的与结果相关的成本，并根据通货膨胀率调整为2017年的欧元和英镑。给出了一家年心脏手术病例数为574例的普通医院的结果。进行了单向和概率敏感性分析。
仅考虑产品购置成本时相比于SOC，在意大利、西班牙、法国和英国，HEMOPATCH每次止血成功的增量成本效益比（ICER）分别为1659欧元、1519欧元、1623欧元和1725英镑。然而，考虑到与SOC相比输血和手术修正频率的成本及潜在差异，使用HEMOPATCH每年可减少6次手术修正和60次输血，ICER分别提高到1440欧元、1222欧元、1461欧元和1592英镑。敏感性分析表明模型具有稳健性。
该分析支持在欧洲医院的心脏手术中使用HEMOPATCH而非SOC，以提高止血成功率，并通过减少输血、并发症和手术修正实现潜在的成本抵消。
