疑似阑尾炎研究的质量保证和绩效改进项目的成本效益。
Cost effectiveness of the quality assurance and performance improvement project for suspected appendicitis study.
机构信息
Division of Pediatric General Surgery, McMaster University, Hamilton, Ontario, Canada; McMaster Children's Hospital, Hamilton, Ontario, Canada.
McMaster University, Michael G. DeGroote School of Medicine, Hamilton, Ontario, Canada.
出版信息
J Pediatr Surg. 2021 Sep;56(9):1528-1535. doi: 10.1016/j.jpedsurg.2020.09.006. Epub 2020 Sep 24.
INTRODUCTION
Appendicitis is the most common pediatric emergent surgical condition, with 77,000 American pediatric admissions costing $680 million US annually. Diagnosing appendicitis can be challenging. The prospective Quality Assurance and performance improvement project for suspected aPPEndicitis (QAPPE) study implemented a standardized appendicitis assessment pathway. This current study aims to assess the cost-effectiveness of the QAPPE pathway.
METHODS
QAPPE data (February 2018-January 2019) were compared to retrospective data from the year prior (January-December 2017). Patients aged <18, presenting with suspicion of appendicitis were identified using the emergency department patient database. Patients were excluded if they were transferred from an outside center or if appendicitis was not suspected. Study arms were compared using Student's t-test and assessed with standard costing techniques. The Incremental Cost-Effectiveness Ratio (ICER) was determined. Deterministic and probabilistic sensitivity analyses of the model were performed. Effectiveness was assessed by percent of negative appendectomies where alternate diagnosis was made intraoperatively or histologically. Significance was set at p < 0.05.
RESULTS
QAPPE (n = 247) and traditional care (n = 234) patients were compared. Traditional care had higher admission frequency and lower pediatric appendicitis score. Demographics between all included patients and those admitted were similar overall. Patient costs were $3656.32 (95% CI $2407-$5250) Canadian (CAD) for QAPPE and $3823.56 (95% CI $2604-$5451) CAD for traditional care. QAPPE was the dominant strategy in the base model and probabilistic simulation found it favored in 64.7% of model iterations with a willingness to pay of $70,000 CAD.
CONCLUSION
Using the QAPPE pathway to assess patients with suspected appendicitis reduced costs and improved effectiveness of patient care.
LEVEL OF EVIDENCE
简介
阑尾炎是最常见的儿科急诊手术病症，全美每年有 77000 名儿科患者入院，费用达 6.8 亿美元。阑尾炎的诊断具有一定挑战性。前瞻性的疑似阑尾炎质量保证和绩效改进项目（QAPPE）实施了标准化的阑尾炎评估路径。本研究旨在评估 QAPPE 路径的成本效益。
方法
比较了 QAPPE 数据（2018 年 2 月至 2019 年 1 月）和前一年（2017 年 1 月至 12 月）的回顾性数据。使用急诊科患者数据库确定年龄<18 岁、疑似阑尾炎的患者。如果患者从外院转来或疑似阑尾炎不成立，则将其排除在外。使用学生 t 检验比较研究组，并采用标准成本核算技术进行评估。确定增量成本效益比（ICER）。对模型进行确定性和概率敏感性分析。有效性通过术中或组织学诊断为其他疾病的阴性阑尾切除率来评估。以 p<0.05 为显著性标准。
结果
比较了 QAPPE（n=247）和传统治疗（n=234）患者。传统治疗组的住院频率更高，小儿阑尾炎评分更低。所有纳入患者和入院患者的总体人口统计学特征相似。QAPPE 患者的费用为 3656.32 加元（95%置信区间 2407-5250 加元），传统治疗组的费用为 3823.56 加元（95%置信区间 2604-5451 加元）。在基础模型中，QAPPE 是主导策略，概率模拟发现，在愿意支付 70000 加元的情况下，在模型迭代的 64.7%中，它更具优势。
结论
使用 QAPPE 路径评估疑似阑尾炎患者可降低成本并提高患者护理的有效性。
证据水平
2 级。
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