Adang E M, Engel G L, Rutten F F, Geerdes B P, Baeten C G
Department of Health, Organization, Policy and Economics, Faculty of Health Sciences, University of Maastricht, The Netherlands.
Dis Colon Rectum. 1998 Jun;41(6):725-33; discussion 733-4. doi: 10.1007/BF02236259.
This study evaluates the cost-effectiveness of dynamic graciloplasty for intractable fecal incontinence.
The costs and effects of dynamic graciloplasty were measured in a prospective, longitudinal study and in a clinical trial. Forty-three patients with intractable fecal incontinence were evaluated before and after dynamic graciloplasty. Costs were obtained from the hospital information system and from patient-oriented questionnaires. We compared the costs of a dynamic graciloplasty with the costs of a colostomy. Colostomy costs were evaluated using a group of seven patients who had a stoma in place for incontinence for several years. Sensitivity analyses were included.
Total direct costs of lifelong dynamic graciloplasty were $31,733 (United States dollars), costs of lifelong conventional treatment were $12,180 (United States), and costs of colostomy, including lifelong stoma care, were $71,576 (United States). The clinical success rate of dynamic graciloplasty was 74 percent. Quality of life after successful dynamic graciloplasty was better than with conventional treatment.
We found that dynamic graciloplasty was more expensive than conventional treatment but resulted in a significantly higher quality of life. Stoma treatment was the least attractive alternative regarding both costs and effects. The Dutch Health Insurance Executive Board recommended reimbursement for the dynamic graciloplasty procedure.
本研究评估动态股薄肌成形术治疗顽固性大便失禁的成本效益。
在一项前瞻性纵向研究和一项临床试验中测量动态股薄肌成形术的成本与效果。对43例顽固性大便失禁患者在动态股薄肌成形术前后进行评估。成本数据来自医院信息系统和面向患者的问卷调查。我们将动态股薄肌成形术的成本与结肠造口术的成本进行了比较。结肠造口术成本通过一组7例因失禁已造口数年的患者进行评估。纳入了敏感性分析。
动态股薄肌成形术终身的总直接成本为31,733美元，终身传统治疗成本为12,180美元，结肠造口术（包括终身造口护理）成本为71,576美元。动态股薄肌成形术的临床成功率为74%。动态股薄肌成形术成功后的生活质量优于传统治疗。
我们发现动态股薄肌成形术比传统治疗成本更高，但生活质量显著更高。造口治疗在成本和效果方面是最不具吸引力的选择。荷兰健康保险执行委员会建议报销动态股薄肌成形术。
