Terjesen Christoffer Lilja, Kovaleva Julia, Ehlers Lars
University Hospital of North Norway, Tromsø, Norway.
Center for Medical Analysis, Herentals, Belgium.
Pharmacoecon Open. 2017 Jun;1(2):133-141. doi: 10.1007/s41669-017-0012-9.
Bronchoscopic procedures are common in the clinical setting, with estimates indicating 500,000 are undertaken per year in the USA alone. These procedures are generally regarded as safe. Unfortunately, a risk of cross-contamination between patients, with possible subsequent infection, is associated with the re-usable technology typically used in these procedures.
Our objective was to conduct an early cost-effectiveness analysis (CEA) of single-use flexible video bronchoscope technology compared with the current reusable technology in a US hospital intensive care setting.
We conducted a CEA to determine an incremental cost-effectiveness ratio (ICER), and constructed a decision analytic model based on the best available evidence from a literature search and a Delphi panel. We also conducted several one- and two-way sensitivity analyses and a probabilistic sensitivity analysis to illuminate the uncertainty associated with the estimates.
The literature search showed ample evidence of risk, albeit little of it was quantifiable. Estimates from the Delphi method found approximately a 3% risk of cross-contamination and approximately a 21% risk of subsequent infection. Pneumonia was estimated as the most likely manifestation of infection. The CEA showed a saving of $US118 per procedure and elimination of 0.7% of the risk of infection with the single-use technology. Relevant sensitivity analyses generally validated this result.
This study suggests that implementation of the single-use technology in the intensive care unit is cost effective in most scenarios. However, this result should be interpreted with caution because of the lack of certain knowledge on this particular topic.
支气管镜检查在临床环境中很常见，据估计仅在美国每年就有50万例。这些检查通常被认为是安全的。不幸的是，这些检查中通常使用的可重复使用技术存在患者之间交叉污染的风险，并可能随后引发感染。
我们的目的是在美国医院重症监护环境中，对一次性使用的柔性视频支气管镜技术与当前的可重复使用技术进行早期成本效益分析（CEA）。
我们进行了成本效益分析以确定增量成本效益比（ICER），并基于文献检索和德尔菲小组的最佳现有证据构建了决策分析模型。我们还进行了几次单因素和双因素敏感性分析以及概率敏感性分析，以阐明与估计相关的不确定性。
文献检索显示了大量风险证据，尽管其中很少是可量化的。德尔菲法的估计发现交叉污染风险约为3%，随后感染风险约为21%。肺炎被估计为最可能的感染表现。成本效益分析显示，使用一次性技术每次检查可节省118美元，并消除0.7%的感染风险。相关敏感性分析总体上验证了这一结果。
本研究表明，在大多数情况下，在重症监护病房实施一次性技术具有成本效益。然而，由于对这一特定主题缺乏某些知识，这一结果应谨慎解读。
