Department of Applied Economics, Faculty of Economics, University of Castilla La Mancha, Albacete, Spain.
Department of Hospital Pharmacy, Torrecárdenas Hospital Complex, Almería, Spain.
PLoS One. 2021 Sep 20;16(9):e0257494. doi: 10.1371/journal.pone.0257494. eCollection 2021.
The general anesthetic sevoflurane is being repurposed as a topical analgesic for painful chronic wounds. We conducted a Bayesian cost-effectiveness analysis (CEA) comparing the addition of domiciliary topical sevoflurane to conventional analgesics (SEVOFLURANE, n = 38) versus conventional analgesics alone (CONVENTIONAL, n = 26) for the treatment of nonrevascularizable painful leg ulcers in an outpatient Pain Clinic of a Spanish tertiary hospital.
We used real-world data collected from charts to conduct this CEA from a public healthcare perspective and with a one-year time horizon. Costs of analgesics, visits and admissions were considered, expressed in €2016. Analgesic effectiveness was measured with SPID (Sum of Pain Intensity Difference). A Bayesian regression model was constructed, including "treatment" and baseline characteristics for patients ("arterial hypertension") and ulcers ("duration", "number", "depth", "pain") as covariates. The findings were summarized as a cost-effectiveness plane and a cost-effectiveness acceptability curve. One-way sensitivity analyses, a re-analysis excluding those patients who died or suffered from leg amputation, and an extreme scenario analysis were conducted to reduce uncertainty.
Compared to CONVENTIONAL, SEVOFLURANE was associated with a 46% reduction in costs, and the mean incremental effectiveness (28.15±3.70 effectiveness units) was favorable to SEVOFLURANE. The estimated probability for SEVOFLURANE being dominant was 99%. The regression model showed that costs were barely influenced by any covariate, whereas effectiveness was noticeably influenced by "treatment". All sensitivity analyses showed the robustness of the model, even in the extreme scenario analysis against SEVOFLURANE.
SEVOFLURANE was dominant over CONVENTIONAL as it was less expensive and much more effective.
全身麻醉剂七氟醚正被重新用于治疗疼痛的慢性伤口的局部镇痛药。我们进行了一项贝叶斯成本效益分析（CEA），比较了将家庭局部七氟醚加入常规镇痛剂（SEVOFLURANE，n = 38）与单独使用常规镇痛剂（CONVENTIONAL，n = 26）治疗西班牙一家三级医院门诊疼痛诊所的非再血管化疼痛性腿部溃疡的效果。
我们使用从图表中收集的真实世界数据，从公共医疗保健的角度进行了这项 CEA，并设定了一年的时间范围。考虑了镇痛剂、就诊和住院的费用，以 2016 年欧元表示。镇痛效果通过 SPID（疼痛强度差值总和）进行衡量。构建了一个贝叶斯回归模型，包括“治疗”和患者的基线特征（“高血压”）以及溃疡的特征（“持续时间”、“数量”、“深度”、“疼痛”）作为协变量。结果总结为成本效益平面和成本效益接受曲线。进行了单因素敏感性分析、排除了那些死亡或腿部截肢的患者的重新分析以及极端情况分析，以降低不确定性。
与 CONVENTIONAL 相比，SEVOFLURANE 与成本降低 46%相关，且平均增量有效性（28.15±3.70 个有效单位）对 SEVOFLURANE 有利。SEVOFLURANE 占主导地位的概率估计为 99%。回归模型显示，成本几乎不受任何协变量的影响，而有效性明显受到“治疗”的影响。所有敏感性分析均表明该模型具有稳健性，即使在针对 SEVOFLURANE 的极端情况分析中也是如此。
SEVOFLURANE 比 CONVENTIONAL 更具优势，因为它更便宜且更有效。
