Le Andre, Thavorn Kednapa, Lasso Andrea, Kilty Shaun J
Department of Otolaryngology-Head and Neck Surgery.
School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
Laryngoscope. 2018 Aug;128(8):1778-1782. doi: 10.1002/lary.27081. Epub 2018 Jan 4.
OBJECTIVES/HYPOTHESIS: To evaluate the cost-effectiveness of Floseal, a topically applied hemostatic agent, and nasal packing for the management of epistaxis in Canada.
Outcomes research, a cost-utility analysis.
We developed a Markov model to compare the costs and health outcomes of Floseal with nasal packing over a lifetime horizon from the perspective of a publicly funded healthcare system. A cycle length of 1 year was used. Efficacy of Floseal and packing was sought from the published literature. Unit costs were gathered from a hospital case costing system, whereas physician fees were extracted from the Ontario Schedule of Benefits for Physician Services. Results were expressed as an incremental cost per quality-adjusted life year (QALY) gained. A series of one-way sensitivity and probabilistic sensitivity analyses were performed.
From the perspective of a publicly funded health are system, the Floseal treatment strategy was associated with higher costs ($2,067) and greater QALYs (0.27) than nasal packing. Our findings were highly sensitive to discount rates, the cost of Floseal, and the cost of nasal packing. The probabilistic sensitivity analysis suggested that the probability that Floseal treatment is cost-effective reached 99% if the willingness-to-pay threshold was greater than $120,000 per QALY gained.
Prior studies have demonstrated Floseal to be an effective treatment for anterior epistaxis. In the Canadian healthcare system, Floseal treatment appears to be a cost-effective treatment option compared to nasal packing for anterior epistaxis.
2c Laryngoscope, 1778-1782, 2018.
目的/假设：评估局部应用止血剂弗洛塞尔（Floseal）和鼻腔填塞术在加拿大治疗鼻出血的成本效益。
结果研究，一项成本效用分析。
我们建立了一个马尔可夫模型，从公共资助的医疗保健系统的角度比较弗洛塞尔与鼻腔填塞术在一生时间范围内的成本和健康结果。使用的周期长度为1年。从已发表的文献中寻找弗洛塞尔和填塞术的疗效。单位成本从医院病例成本核算系统收集，而医生费用则从安大略省医生服务福利表中提取。结果表示为每获得一个质量调整生命年（QALY）的增量成本。进行了一系列单向敏感性分析和概率敏感性分析。
从公共资助的医疗保健系统的角度来看，与鼻腔填塞术相比，弗洛塞尔治疗策略的成本更高（2067美元），QALY更多（0.27）。我们的研究结果对贴现率、弗洛塞尔的成本和鼻腔填塞术的成本高度敏感。概率敏感性分析表明，如果支付意愿阈值大于每获得一个QALY 120,000美元，弗洛塞尔治疗具有成本效益的概率达到99%。
先前的研究表明弗洛塞尔是治疗前位鼻出血的有效方法。在加拿大医疗保健系统中，与鼻腔填塞术治疗前位鼻出血相比，弗洛塞尔治疗似乎是一种具有成本效益的治疗选择。
2c 《喉镜》，2018年，第1778 - 1782页。
