在复发性消化性溃疡出血中，内镜下夹闭术具有成本效益。
Over-the-scope clips are cost-effective in recurrent peptic ulcer bleeding.
机构信息
Department of Medicine II, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Department of Gastroenterology and Oncology, Klinikum Ludwigsburg, Ludwigsburg, Germany.
出版信息
United European Gastroenterol J. 2019 Nov;7(9):1226-1233. doi: 10.1177/2050640619871754. Epub 2019 Sep 25.
BACKGROUND
A recent prospective randomised controlled trial ('STING') showed superiority of over-the-scope clips compared to standard treatment in recurrent peptic ulcer bleeding. Cost-effectiveness studies on haemostasis with over-the-scope clips have not been reported so far.
OBJECTIVE
The aim of this study was to investigate whether the higher efficacy of the over-the-scope clips treatment outweighs the higher costs of the device compared to standard clips.
METHODS
For the analysis, the study population of the STING trial was used. Costs for the hospital stay in total as well as treatment-related costs were obtained. The average cost-effectiveness ratio, representing the mean costs per designated outcome, and the incremental cost-effectiveness ratio, expressing the additional costs of a new treatment strategy per difference in outcome were calculated. The designated outcome was defined as successful haemostasis without rebleeding within seven days, which was the primary endpoint of the STING trial. Average cost-effectiveness ratio and incremental cost-effectiveness ratio were calculated for total costs of the hospital stay as well as the haemostasis treatment alone. The cost-effectiveness analysis is taken from the perspective of the care provider. Total costs and treatment-related costs per patient were 13,007.07 € in the standard group vs 12,808.56 € in the over-the-scope clip group ( = 0.812) and 2084.98 € vs 1984.71 € respectively ( = 0.663). The difference was not statistically significant. Total costs per successful haemostasis (average cost-effectiveness ratio) were 30,677.05 € vs 15,104.43 € and 4917.41 € vs 2340.46 € for the haemostasis treatment. The additional costs per successful haemostasis with over-the-scope clip treatment (incremental cost-effectiveness ratio) is -468.18 € for the whole treatment and -236.49€ for the haemostasis treatment.
CONCLUSIONS
Over-the-scope clip treatment is cost-effective in recurrent peptic ulcer bleeding.
背景
最近的一项前瞻性随机对照试验（“STING”）表明，在复发性消化性溃疡出血中，内镜下套扎器优于标准治疗。目前尚未报道过内镜下套扎器止血的成本效益研究。
目的
本研究旨在探讨与标准夹相比，内镜下套扎器治疗的更高疗效是否超过了设备的更高成本。
方法
本研究使用了 STING 试验的研究人群。获得了总住院费用和治疗相关费用。计算了平均成本效果比（代表指定结果的平均成本）和增量成本效果比（表示新治疗策略每增加一个结果的额外成本）。指定的结果定义为 7 天内无再出血的成功止血，这是 STING 试验的主要终点。计算了总住院费用和单独止血治疗的平均成本效果比和增量成本效果比。成本效果分析从提供者的角度出发。标准组的每位患者总费用和治疗相关费用分别为 13007.07 欧元和 12808.56 欧元（ = 0.812）和 2084.98 欧元和 1984.71 欧元（ = 0.663）。差异无统计学意义。每例成功止血的总费用（平均成本效果比）分别为 30677.05 欧元和 15104.43 欧元，以及 4917.41 欧元和 2340.46 欧元，用于止血治疗。内镜下套扎器治疗每例成功止血的额外成本（增量成本效果比）为 -468.18 欧元，用于整个治疗和 -236.49 欧元，用于止血治疗。
结论
内镜下套扎器治疗复发性消化性溃疡出血具有成本效益。
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