Prasad Deepa, Steinberg Joni, Snyder Christopher
1Division of Pediatric Cardiology,The Congenital Heart Collaborative,UH Rainbow Babies and Children's Hospital,Cleveland,OH,USA.
2Department of Global Health Management & Policy,Tulane University of Public Health and Tropical Medicine,New Orleans,LA,USA.
Cardiol Young. 2018 May;28(5):725-729. doi: 10.1017/S104795111800029X. Epub 2018 Mar 6.
IntroductionNewborn atrial flutter can be treated by medications, pacing, or direct current cardioversion. The purpose is to compare the cost-effectiveness of digoxin, pacing, and direct current cardioversion for the treatment of atrial flutter in neonates.Materials and methodsA decision tree model was developed comparing the efficacy and cost of digoxin, pacing, and direct current cardioversion based on a meta-analysis of published studies of success rates of cardioversion of neonatal atrial flutter (age<2 months). Patients who failed initial attempt at cardioversion progressed to the next methodology until successful. Data were analysed to assess the cost-effectiveness of these methods with cost estimates obtained from 2015 Medicare reimbursement rates.
The cost analysis for cardioversion of atrial flutter found the most efficient method to be direct current cardioversion at a cost of $10 304, pacing was next at $11 086, and the least cost-effective was digoxin at $14 374. The majority of additional cost, regardless of method, was from additional neonatal ICU day either owing to digoxin loading or failure to covert. Direct current cardioversion remains the most cost-effective strategy by sensitivity analyses performed on pacing conversion rate and the cost of the neonatal ICU/day. Direct current cardioversion remains cost-effective until the assumed conversion rate is below 64.6%.
The most cost-efficient method of cardioverting a neonate with atrial flutter is direct current cardioversion. It has the highest success rates based on the meta-analysis, shorter length of stay in the neonatal ICU owing to its success, and results in cost-savings ranging from $800 to $4000 when compared with alternative approaches.
引言
新生儿心房扑动可通过药物、起搏或直流电复律进行治疗。目的是比较地高辛、起搏和直流电复律治疗新生儿心房扑动的成本效益。
材料和方法
基于对已发表的新生儿心房扑动（年龄<2个月）复律成功率的荟萃分析，开发了一个决策树模型，比较地高辛、起搏和直流电复律的疗效和成本。初次复律尝试失败的患者进入下一种方法，直至成功。利用从2015年医疗保险报销率获得的成本估计值对数据进行分析，以评估这些方法的成本效益。
心房扑动复律的成本分析发现，最有效的方法是直流电复律，成本为10304美元，其次是起搏，为11086美元，最不具成本效益的是地高辛，为14374美元。无论采用何种方法，大部分额外成本都来自因使用地高辛负荷或复律失败导致的新生儿重症监护病房额外住院天数。通过对起搏转化率和新生儿重症监护病房每日成本进行敏感性分析，直流电复律仍然是最具成本效益的策略。在假定的转化率低于64.6%之前，直流电复律仍然具有成本效益。
对新生儿心房扑动进行复律最具成本效益的方法是直流电复律。根据荟萃分析，它具有最高的成功率，由于其成功，在新生儿重症监护病房的住院时间较短，与其他方法相比可节省800至4000美元的成本。
