Department of Urology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama.
School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama.
Neurourol Urodyn. 2018 Aug;37(6):1931-1936. doi: 10.1002/nau.23533. Epub 2018 Feb 28.
To identify the costs of replacing an entire malfunctioning AUS device versus an individual component at the time of device malfunction.
Decision analysis was performed by analyzing the costs associated with revising a malfunctioning artificial urinary sphincter using one of two techniques: either individual or entire device replacement. Costs were determined by including actual institutional costs. Model assumptions were based on a summary of published literature and were created based on a time horizon of 0-5 years since the original, primary AUS was placed, and models were created for malfunction of each individual component. Sensitivity analysis was done adjusting for costs of the device and failure rates.
Total costs to replace an individual component were $8330 for the pump, $7611 for the cuff, and $5599 for the balloon, while entire device replacement cost $15 069. Over a 5-year time horizon the cost per patient for replacement of a balloon, pump, or cuff were $14 407, $17 491, and $15 212, respectively, versus $18 001 if the entire device was replaced. To be less costly to replace the entire device, balloon, pump, and cuff failure rates would need to be >55%, >25%, or >37.5% during the first 2 years after placement.
In the event of failure of the artificial urinary sphincter, cost analysis demonstrates that removal and replacement of the entire device is more expensive than replacement of a malfunctioning component at any point up to 5 years after initial AUS placement.
确定在设备出现故障时更换整个有故障的 AUS 装置与更换单个部件的成本。
通过分析使用两种技术（单个部件或整个装置更换）来修复有故障的人工尿道括约肌的相关成本，进行决策分析。成本通过包括实际机构成本来确定。模型假设基于已发表文献的总结，并基于原始主要 AUS 放置后 0-5 年的时间范围创建，并且为每个单独部件的故障创建了模型。通过调整设备成本和故障率进行敏感性分析。
更换单个部件的总成本为泵 8330 美元，袖带 7611 美元，球囊 5599 美元，而整个装置更换成本为 15069 美元。在 5 年的时间范围内，更换球囊、泵或袖带的每位患者的成本分别为 14407 美元、17491 美元和 15212 美元，而如果更换整个装置，则为 18001 美元。要使更换整个装置的成本更低，在最初放置 AUS 后的前 2 年内，球囊、泵和袖带的故障发生率需要超过 55%、25%或 37.5%。
在人工尿道括约肌出现故障的情况下，成本分析表明，在最初放置 AUS 后的 5 年内，更换整个有故障的装置比更换单个有故障的部件更昂贵。
