Maruri F, Azziz R
Department of Obstetrics and Gynecology, University of Alabama, Birmingham 35233.
Fertil Steril. 1993 Mar;59(3):487-98. doi: 10.1016/s0015-0282(16)55787-2.
To review the process by which technology is assessed in the United States and to use the principles elicited to compare laparotomy versus laparoscopy for the treatment of ectopic pregnancies (EPs).
Patients with an EP documented in 1987 in the United States.
Determining and reviewing the applicability, safety, efficacy, cost-effectiveness, cost-benefit, and availability of laparoscopic surgery for an EP.
Laparoscopic surgery is applicable to at least 80% of patients, representing some 70,400 women in 1987. Safety and efficacy of laparoscopy are comparable with laparotomy, with the exception of a possible increase in the frequency of persistent EPs, if a conservative procedure is performed endoscopically. Dollar for dollar laparoscopy is more cost-effective than laparotomy for the treatment of EPs, with reduced hospitalization and recovery time, and improved cosmesis. Cost-benefit analysis indicates a savings of $105,600,000.00 in direct hospitalization costs and $65,000,000.00 in increased employer or patient income, because of a more rapid return to work time. Furthermore, savings in decreased home care requirements could not be calculated. The use of laparoscopic surgery in all potential candidates with an EP in 1987 would have resulted in an increased expenditure of $28,160,000.00 annually for additional equipment and $3,520,000.00 for the repeat laparotomies required to treat the excess number of persistent EPs. The expense of training physicians and operating room staffs in this technique could not be quantified. Overall, availability of this procedure was felt to be considerably less than 30% of affected patients.
Overall, the use of laparoscopic surgery in all eligible (> or = 80%) patients with an EP in 1987 in the United States would have resulted in a savings of approximately $138,920,000.00 for that year alone. Currently, there is a tremendous deficiency in the availability of this cost-effective procedure, contributing to the escalating costs of medical care.
回顾美国评估技术的过程，并运用得出的原则比较剖腹手术与腹腔镜手术治疗异位妊娠（EP）的情况。
1987年在美国记录有异位妊娠的患者。
确定并回顾腹腔镜手术治疗异位妊娠的适用性、安全性、有效性、成本效益、成本效益比及可及性。
腹腔镜手术适用于至少80%的患者，1987年约为70400名女性。腹腔镜检查的安全性和有效性与剖腹手术相当，不过如果采用保守性内镜手术，持续性异位妊娠的发生率可能会有所增加。治疗异位妊娠时，腹腔镜手术在成本效益上比剖腹手术更高，住院时间和恢复时间缩短，美观度也更好。成本效益分析表明，直接住院费用节省了1.056亿美元，因恢复工作时间更快，雇主或患者收入增加了6500万美元。此外，家庭护理需求减少带来的节省无法计算。1987年若对所有可能的异位妊娠患者都采用腹腔镜手术，每年将额外增加2816万美元的设备支出，以及352万美元用于治疗额外的持续性异位妊娠所需的重复剖腹手术。培训医生和手术室工作人员掌握这项技术的费用无法量化。总体而言，该手术的可及性被认为远低于30%的受影响患者。
总体而言，1987年在美国对所有符合条件（≥80%）的异位妊娠患者使用腹腔镜手术，仅当年就可节省约1.3892亿美元。目前，这种具有成本效益的手术可及性严重不足，导致医疗费用不断攀升。
