Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands.
Trauma TopCare, Elisabeth-TweeSteden Ziekenhuis, Tilburg, the Netherlands; Department of Radiology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, the Netherlands.
J Vasc Interv Radiol. 2022 Apr;33(4):392-398.e4. doi: 10.1016/j.jvir.2021.12.011. Epub 2021 Dec 14.
To demonstrate that splenic artery embolization (SAE) is more cost-effective than splenectomy from a societal perspective in the Netherlands.
Patient-level data obtained from the SPLENIQ study were used to populate a health economic model and were supplemented with expert opinion when necessary. Propensity score matching was used to correct for baseline differences in injury severity scores. The health economic model consisted of 3 health states (complications after intervention, SAE failure, and recovery) and a dead state. Model outcomes were incremental quality-adjusted life years (QALYs) and incremental costs of SAE over splenectomy. The Dutch health economic guidelines were followed. The model used a lifetime time horizon. Uncertainty was assessed using probabilistic sensitivity analysis and scenario analyses.
Patients undergoing SAE had a higher life expectancy than patients undergoing splenectomy. Incremental QALYs were 3.1 (mostly explained by difference in life expectancy), and incremental costs were €34,135 (explained by costs related to medical consumption and lost productivity in additional life years), leading to an incremental cost-effectiveness ratio of €11,010 per QALY. SAE was considered cost-effective in >95% of iterations using a threshold of €20,000 per QALY.
SAE results in more QALYs than splenectomy. Intervention costs for SAE are lower than that for splenectomy, but medical consumption and productivity costs in later years are higher for SAE due to better survival. SAE was found to be cost-effective compared with splenectomy under appropriate Dutch cost-effectiveness thresholds.
从社会角度证明，在荷兰，脾动脉栓塞术（SAE）比脾切除术更具成本效益。
使用来自 SPLENIQ 研究的患者水平数据来填充健康经济模型，并在必要时补充专家意见。使用倾向评分匹配来纠正损伤严重程度评分的基线差异。健康经济模型由 3 种健康状态（干预后并发症、SAE 失败和恢复）和死亡状态组成。模型结果是增量质量调整生命年（QALY）和 SAE 相对于脾切除术的增量成本。遵循荷兰健康经济学指南。模型使用了终生时间范围。使用概率敏感性分析和情景分析来评估不确定性。
接受 SAE 的患者比接受脾切除术的患者具有更高的预期寿命。增量 QALYs 为 3.1（主要由预期寿命差异解释），增量成本为 34,135 欧元（由医疗消费相关成本和额外生命年限的生产力损失解释），导致增量成本效益比为每 QALY 11,010 欧元。在使用 20,000 欧元/QALY 的阈值时，SAE 在超过 95%的迭代中被认为具有成本效益。
SAE 比脾切除术产生更多的 QALYs。SAE 的干预成本低于脾切除术，但由于生存更好，SAE 在后期的医疗消费和生产力成本更高。在适当的荷兰成本效益阈值下，与脾切除术相比，SAE 具有成本效益。
