Volin Joshua, Daniel Joshua, Walter Brianna, Herndon Patrick, Tran Deanna, Blumline James, Spillinger Aviv, Karabon Patrick, Fletcher Craig, Folbe Adam, Hafron Jason
Oakland University William Beaumont School of Medicine, Oakland University, Rochester, MI, 48309, USA.
Department of Urology, William Beaumont Hospital, Royal Oak, MI, 48073, USA.
Int Urol Nephrol. 2023 Apr;55(4):823-833. doi: 10.1007/s11255-022-03452-6. Epub 2023 Jan 7.
To evaluate the cost-effectiveness of obtaining a preoperative type and screen (T/S) for common urologic procedures.
A decision tree model was constructed to track surgical patients undergoing two preoperative blood ordering strategies as follows: obtaining a preoperative T/S versus not doing so. The model was applied to the National (Nationwide) Inpatient Sample (NIS) data, from January 1, 2006 to September 30, 2015. Cost estimates for the model were created from combined patient-level data with published costs of a T/S, type and crossmatch (T/C), a unit of pRBC, and one unit of emergency-release transfusion (ERT). The primary outcome was the incremental cost per ERT prevented, expressed as an incremental cost-effectiveness ratio (ICER) between the two preoperative blood ordering strategies. A cost-effectiveness analysis determined the ICER of obtaining preoperative T/S to prevent an emergency-release transfusion (ERT), with a willingness-to-pay threshold of $1,500.00.
A total of 4,113,144 surgical admissions from 2006 to 2015 were reviewed. The overall transfusion rate was 10.54% (95% CI, 10.17-10.91) for all procedures. The ICER of preoperative T/S was $1500.00 per ERT prevented. One-way sensitivity analysis demonstrated that the risk of transfusion should exceed 4.12% to justify preoperative T/S.
Routine preoperative T/S for radical prostatectomy (rate = 3.88%) and penile implants (rate = .91%) does not represent a cost-effective practice for these surgeries. It is important for urologists to review their institution T/S policy to reduce inefficiencies within the preoperative setting.
评估在常见泌尿外科手术前进行血型鉴定和筛查（T/S）的成本效益。
构建决策树模型，以追踪接受两种术前血液订购策略的手术患者，具体如下：进行术前T/S检测与不进行该检测。该模型应用于2006年1月1日至2015年9月30日的全国（全美）住院患者样本（NIS）数据。模型的成本估计来自患者层面的综合数据以及已公布的T/S、血型鉴定和交叉配血（T/C）、一个单位的浓缩红细胞（pRBC）和一个单位的紧急释放输血（ERT）的成本。主要结果是预防每例ERT的增量成本，以两种术前血液订购策略之间的增量成本效益比（ICER）表示。成本效益分析确定了进行术前T/S以预防紧急释放输血（ERT）的ICER，支付意愿阈值为1500.00美元。
回顾了2006年至2015年期间共4,113,144例手术入院病例。所有手术的总体输血率为10.54%（95%CI，10.17 - 10.91）。术前T/S的ICER为每预防一例ERT 1500.00美元。单向敏感性分析表明，输血风险应超过4.12%才能证明术前T/S检测的合理性。
对于根治性前列腺切除术（发生率 = 3.88%）和阴茎植入术（发生率 = 0.91%），常规术前T/S检测对这些手术而言并非具有成本效益的做法。泌尿外科医生审查其机构的T/S政策以减少术前环节的低效率非常重要。
