Colonna Alexander L, Bellows Brandon K, Enniss Toby M, Young Jason B, McCrum Marta, Nunez Jade M, Nirula Raminder, Nelson Richard E
University of Utah, Department of Surgery, 30 N 1900 E, Salt Lake City, UT 84132.
University of Utah, School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132.
Surg Open Sci. 2020 Jan 23;2(2):75-80. doi: 10.1016/j.sopen.2019.12.003. eCollection 2020 Apr.
Transversus abdominis plane block with liposomal bupivacaine has been studied as an effective method of reducing the need for postoperative opioids and increasing same-day discharge rates. However, less is known about the cost-effectiveness of this strategy relative to opioids alone for hernia repair. We performed an economic evaluation of these strategies using a computer simulation model.
A decision tree was constructed to determine cost-effectiveness as measured by incremental cost-effectiveness ratios per quality-adjusted life-year. Base-case costs, quality-adjusted life-year values, and probabilities were derived from published studies and Medicare fee schedules. For input parameters for which we could not find values in the published literature, we used expert opinion. A 1-month time horizon was selected to focus on the immediate postoperative period. Finally, we performed 1-way, 2-way, and probabilistic sensitivity analyses.
The liposomal bupivacaine transversus abdominis plane block was a dominant strategy yielding a $456.75 decrease in cost and an 0.1 increase in quality-adjusted life-years relative to opioids alone. In 1-way sensitivity analysis of cost incremental cost-effectiveness ratio, values were most sensitive to variations in the amount saved by same-day discharge and the cost of bupivacaine. In probabilistic sensitivity analyses, transversus abdominis plane strategy was cost-effective at a willingness-to-pay threshold of $50,000/quality-adjusted life-year in 94.5% of iterations and at a willingness-to-pay threshold of $100,000/quality-adjusted life-year in 97.1% of iterations.
The use of liposomal bupivacaine transversus abdominis plane block resulted in cost savings and improved quality-adjusted life-years in base-case analyses and was cost-effective at conventional willingness-to-pay thresholds in the majority of iterations in probabilistic sensitivity analyses.
脂质体布比卡因腹横肌平面阻滞已被研究作为一种有效方法，可减少术后阿片类药物的使用需求并提高当日出院率。然而，相对于单纯使用阿片类药物进行疝修补术，该策略的成本效益鲜为人知。我们使用计算机模拟模型对这些策略进行了经济评估。
构建决策树以确定成本效益，通过每质量调整生命年的增量成本效益比来衡量。基础成本、质量调整生命年值和概率来自已发表的研究和医疗保险费用表。对于我们在已发表文献中找不到值的输入参数，我们采用了专家意见。选择1个月的时间范围以关注术后即刻阶段。最后，我们进行了单因素、双因素和概率敏感性分析。
相对于单纯使用阿片类药物，脂质体布比卡因腹横肌平面阻滞是一种占优策略，成本降低456.75美元，质量调整生命年增加0.1。在成本增量成本效益比的单因素敏感性分析中，值对当日出院节省的金额和布比卡因成本的变化最为敏感。在概率敏感性分析中，腹横肌平面策略在支付意愿阈值为50,000美元/质量调整生命年时，94.5%的迭代中具有成本效益；在支付意愿阈值为100,000美元/质量调整生命年时，97.1%的迭代中具有成本效益。
在基础案例分析中，使用脂质体布比卡因腹横肌平面阻滞可节省成本并改善质量调整生命年，在概率敏感性分析的大多数迭代中，在传统支付意愿阈值下具有成本效益。
