Kwan Sharon W, Allison Stephen K, Gold Laura S, Shin David S
Comparative Effectiveness, Cost, and Outcomes Research Center, Department of Radiology, University of Washington, Seattle, Washington; Department of Interventional Radiology, University of Washington Medical Center, 1959 NE Pacific Street, Seattle, WA 98195.
Department of Interventional Radiology, University of Washington Medical Center, 1959 NE Pacific Street, Seattle, WA 98195.
J Vasc Interv Radiol. 2018 Dec;29(12):1705-1712. doi: 10.1016/j.jvir.2018.08.019. Epub 2018 Nov 2.
To compare relative cost-effectiveness of serial large-volume paracentesis (LVP) and transjugular intrahepatic portosystemic shunt (TIPS) creation for treatment of refractory ascites.
A decisional Markov model was developed to estimate payer cost and quality-adjusted life-ears (QALYs) associated with LVP and TIPS treatment strategies for cirrhotic patients with refractory ascites. Survival estimates were derived from an individual patient-level meta-analysis of prospective randomized clinical trials. Health utilities for potential health states were derived from a prospective study of patients with cirrhosis. Cost data were derived from national representative claims databases (MarketScan and Medicare) and included reimbursement amounts for relevant procedures, hospitalizations, and outpatient pharmaceutical costs. One-way and probabilistic sensitivity analyses were performed.
LVP resulted in 1.72 QALYs gained at a cost of $41,391, whereas TIPS resulted in 2.76 QALYs gained at a cost of $100,538. Incremental cost-effectiveness ratio of TIPS versus LVP was $57,003/QALY. At a willingness-to-pay ratio of $100,000/QALY, TIPS has a 62% probability of being acceptable compared with LVP.
This study suggests that TIPS should be considered cost-effective in a country that places a relatively high value on health improvements but less so in countries with lower levels of health care resources.
比较连续性大量腹腔穿刺放液（LVP）和经颈静脉肝内门体分流术（TIPS）治疗顽固性腹水的相对成本效益。
建立决策马尔可夫模型，以估计肝硬化顽固性腹水患者采用LVP和TIPS治疗策略的支付方成本和质量调整生命年（QALY）。生存估计值来自前瞻性随机临床试验的个体患者水平荟萃分析。潜在健康状态的健康效用值来自对肝硬化患者的前瞻性研究。成本数据来自全国代表性索赔数据库（MarketScan和医疗保险），包括相关手术、住院和门诊药品费用的报销金额。进行了单因素和概率敏感性分析。
LVP以41391美元的成本获得了1.72个QALY，而TIPS以100538美元的成本获得了2.76个QALY。TIPS与LVP相比的增量成本效益比为57003美元/QALY。在支付意愿比为100000美元/QALY的情况下，与LVP相比，TIPS有62%的概率被认为是可接受的。
本研究表明在一个对健康改善相对重视的国家，TIPS应被视为具有成本效益，但在医疗资源水平较低的国家则不然。
