Kuznietsova Victoria, Woodward Robert S
Medtronic Advanced Energy, LLC, Portsmouth, NH, USA; Department of Economics, Peter T. Paul College of Business and Economics, University of New Hampshire, Durham, NH, USA.
Department of Economics, Peter T. Paul College of Business and Economics, University of New Hampshire, Durham, NH, USA; Department of Health Management and Policy, College of Health and Human Services, University of New Hampshire, Durham, NH, USA.
Value Health. 2018 Mar;21(3):283-294. doi: 10.1016/j.jval.2017.03.002. Epub 2017 Oct 31.
The use of cost-effectiveness analysis for medical devices has proven to be challenging because of the existence of the learning effects in the device-operator interactions. The need for the relevant analytical framework for assessing the economic value of such technologies has been recognized.
To present a modified difference-in-differences (DID) cost-effectiveness methodology that facilitates visualization of a new health technology's learning curve.
Using the Premier Perspective database (Premier Inc., Charlotte, NC), we examined the impact of physicians adopting a bipolar sealer (BPS) to control blood loss in primary unilateral total knee arthroplasties on hospital lengths of stay and total hospitalization costs when compared with two control groups. In our DID approach, we substituted month-from-adoption for the calendar-month-of-adoption in both graphical representations and ordinary least-squares regression results to estimate the effect of the BPS.
The results clearly demonstrated a learning curve associated with the adoption of the BPS technology. Although the reductions in length of stay were immediate, the first postadoption year costs increased by $1335 (extrahospital controls) to $1565 (within-hospital controls). Importantly, and also consistent with a learning curve hypothesis, these initial higher costs were offset by subsequent cost savings in the second and third years postadoption.
The presented modified DID approach is a suitable and versatile analytical tool for economic evaluation of a slowly diffusing medical device or health technology. It provides a better understanding of the potential learning effects associated with relevant interventions.
由于设备与操作人员交互中存在学习效应，事实证明对医疗设备进行成本效益分析具有挑战性。人们已经认识到需要有相关分析框架来评估此类技术的经济价值。
提出一种改进的双重差分（DID）成本效益方法，以促进对新卫生技术学习曲线的可视化。
利用Premier Perspective数据库（Premier公司，北卡罗来纳州夏洛特），我们研究了与两个对照组相比，在初次单侧全膝关节置换术中采用双极电凝器（BPS）控制失血对住院时间和总住院费用的影响。在我们的DID方法中，在图形表示和普通最小二乘回归结果中，我们用采用后的月份代替采用的日历月份，以估计BPS的效果。
结果清楚地表明了与采用BPS技术相关的学习曲线。虽然住院时间立即缩短，但采用后的第一年成本增加了1335美元（院外对照）至1565美元（院内对照）。重要的是，这也与学习曲线假说一致，这些最初较高的成本在采用后的第二年和第三年被随后的成本节省所抵消。
所提出的改进DID方法是一种适用于缓慢扩散的医疗设备或卫生技术经济评估的通用分析工具。它能更好地理解与相关干预措施相关的潜在学习效应。
