Zapata-Vázquez Rita Esther, Álvarez-Cervera Fernando José, Alonzo-Vázquez Felipe Manuel, García-Lira José Ramón, Granados-García Víctor, Pérez-Herrera Norma Elena, Medina-Moreno Manuel
Faculty of Medicine. Autonomous University of Yucatan. Merida, Yucatan, Mexico; High Specialty Medical Unit. Mexican Institute of Social Security. Merida, Yucatan, Mexico.
Neuroscience Department."Dr. Hideyo Noguchi" Regional Research Center. Autonomous University of Yucatan. Merida, Yucatan, Mexico.
Value Health Reg Issues. 2017 Dec;14:96-102. doi: 10.1016/j.vhri.2017.08.011. Epub 2017 Oct 16.
To conduct an economic evaluation of intracranial pressure (ICP) monitoring on the basis of current evidence from pediatric patients with severe traumatic brain injury, through a statistical model.
The statistical model is a decision tree, whose branches take into account the severity of the lesion, the hospitalization costs, and the quality-adjusted life-year for the first 6 months post-trauma. The inputs consist of probability distributions calculated from a sample of 33 surviving children with severe traumatic brain injury, divided into two groups: with ICP monitoring (monitoring group) and without ICP monitoring (control group). The uncertainty of the parameters from the sample was quantified through a probabilistic sensitivity analysis using the Monte-Carlo simulation method. The model overcomes the drawbacks of small sample sizes, unequal groups, and the ethical difficulty in randomly assigning patients to a control group (without monitoring).
The incremental cost in the monitoring group was Mex$3,934 (Mexican pesos), with an increase in quality-adjusted life-year of 0.05. The incremental cost-effectiveness ratio was Mex$81,062. The cost-effectiveness acceptability curve had a maximum at 54% of the cost effective iterations. The incremental net health benefit for a willingness to pay equal to 1 time the per capita gross domestic product for Mexico was 0.03, and the incremental net monetary benefit was Mex$5,358.
The results of the model suggest that ICP monitoring is cost effective because there was a monetary gain in terms of the incremental net monetary benefit.
基于小儿重型颅脑损伤患者的现有证据，通过统计模型对颅内压（ICP）监测进行经济学评估。
统计模型为决策树，其分支考虑了损伤的严重程度、住院费用以及创伤后前6个月的质量调整生命年。输入数据包括从33名重型颅脑损伤存活儿童样本中计算得出的概率分布，这些儿童被分为两组：接受ICP监测的组（监测组）和未接受ICP监测的组（对照组）。通过使用蒙特卡洛模拟方法的概率敏感性分析，对样本参数的不确定性进行了量化。该模型克服了样本量小、组间不均衡以及将患者随机分配至对照组（不进行监测）所面临的伦理困难等缺点。
监测组的增量成本为3934墨西哥比索，质量调整生命年增加了0.05。增量成本效益比为81062墨西哥比索。成本效益可接受性曲线在成本效益迭代的54%处达到最大值。对于支付意愿等于墨西哥人均国内生产总值1倍的情况，增量净健康效益为0.03，增量净货币效益为5358墨西哥比索。
该模型结果表明，ICP监测具有成本效益，因为在增量净货币效益方面有货币收益。
