评估使用视频胶囊内镜监测克罗恩病的临床和经济后果。
Evaluating the clinical and economic consequences of using video capsule endoscopy to monitor Crohn's disease.
作者信息
Saunders Rhodri, Torrejon Torres Rafael, Konsinski Lawrence
机构信息
Coreva Scientific, Freiburg, Germany.
Illinois Gastroenterology Group, Elgin, IL, USA.
出版信息
Clin Exp Gastroenterol. 2019 Aug 12;12:375-384. doi: 10.2147/CEG.S198958. eCollection 2019.
BACKGROUND
To assess the cost and patient impact of using small bowel and colon video capsule endoscopy (SBC) for scheduled monitoring of Crohn's disease (CD).
METHODS
An individual-patient, decision-analytic model of the CD care pathway was developed given current practice and expert input. A literature review informed clinical endpoints with data from peer-reviewed literature. Four thousand simulated CD patients were extrapolated from summary patient data from the Project Sonar Database. Two monitoring scenarios were assessed in this population. The first scenario represented common monitoring practice (CMP) for CD (ileocolonoscopy plus imaging), while in the second scenario patients were converted to disease monitoring using SBC. The cost-effectiveness of using SBC was assessed over 20 years. The cost of switching 50% of patients to SBC was assessed over 5 years for a health-plan including 12,000 patients with CD. Uncertainty of results was assessed using probabilistic sensitivity analysis.
RESULTS
All patient groups showed increased quality of life with SBC versus CMP, with the highest gain in active symptomatic patients. Over 20 years, SBC reduced costs ($313,367 versus $320,015), increased life expectancy (18.15 versus 17.9 years) and increased quality of life (8.7 versus 8.0 QALY), making it a cost-effective option. SBC was cost-effective in 71% of individuals and 78% of populations including 50 patients. A payer implementing SBC in 50% of patients over 5 years could expect a decreased cost of monitoring (-$469 mean per patient) and surgery (-$698), but increased costs for active treatments (+$717). The discounted mean annual cost of care using CMP was $22,681 per patient over 5 years. The annual savings were $1135 per SBC-patient. The total savings for the payer over 5 years were $36.5 million.
CONCLUSION
SBC is likely to be a cost-effective and cost-saving strategy for monitoring CD in the US.
背景
评估使用小肠和结肠视频胶囊内镜检查（SBC）对克罗恩病（CD）进行定期监测的成本及对患者的影响。
方法
根据当前实践和专家意见，建立了CD护理路径的个体患者决策分析模型。通过对同行评审文献数据进行文献综述，确定临床终点。从声纳项目数据库的汇总患者数据中推断出4000名模拟CD患者。在该人群中评估了两种监测方案。第一种方案代表CD的常规监测实践（CMP）（回结肠镜检查加影像学检查），而在第二种方案中，患者改用SBC进行疾病监测。评估了20年内使用SBC的成本效益。对于一个包括12000名CD患者的健康计划，评估了5年内将50%的患者转换为SBC的成本。使用概率敏感性分析评估结果的不确定性。
结果
与CMP相比，所有患者组使用SBC后的生活质量均有所提高，有症状的活跃患者获益最大。在20年期间，SBC降低了成本（313367美元对320015美元），提高了预期寿命（18.15年对17.9年），并提高了生活质量（8.7质量调整生命年对8.0质量调整生命年），使其成为一种具有成本效益的选择。SBC在71%的个体和78%的包括50名患者的人群中具有成本效益。在5年内，支付方将50%的患者采用SBC，预计监测成本（每位患者平均减少469美元）和手术成本（减少698美元）会降低，但积极治疗的成本会增加（增加717美元）。使用CMP的5年期间，每位患者的贴现平均年度护理成本为22681美元。每位使用SBC的患者每年节省1135美元。支付方在5年内的总节省为3650万美元。
结论
在美国，SBC可能是监测CD的一种具有成本效益且节省成本的策略。
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