Value-based surgical care (outcomes relative to costs) is frequently touted, but outcomes and costs are rarely measured together.
During an 18-month period, 122 children with perforated appendicitis at a tertiary referral children\'s hospital were treated using an evidence-based CPG. Clinical outcomes and costs for the CPG cohort were compared with patients in the 30-month period before CPG implementation (n = 191 children).
With CPG-directed care, intra-abdominal abscess rate decreased from 0.24 to 0.10 (adjusted risk ratio 0.44, 95% confidence interval [CI] 0.26-0.75). The rate of any adverse event decreased from 0.30 to 0.23 (adjusted risk ratio 0.82, 95% CI 0.58-1.17). Mean total hospital costs per patient (hospital accounting system) decreased from $16,466 to $10,528 (adjusted absolute difference-$5451, 95% CI -$7755 to -$3147), leading to estimated adjusted total savings of $665,022 during the study period. Costs obtained from the PHIS database also showed reduction with CPG-directed care (-$6669, 95% CI -$8949 to -$4389 per patient). In Bayesian cost-effectiveness analyses, likelihood that CPG was the dominant strategy was 91%.
An evidence-based CPG increased the value of surgical care for children with perforated appendicitis by improving outcomes and lowering costs. Hospital cost accounting data and pre-existing cost data within the PHIS database provided similar results.
基于价值的外科护理(相对于成本的结果)经常被吹捧,但是结果和成本很少一起衡量。
在18个月期间,122例穿孔性阑尾炎患儿在三级转诊儿童医院接受了基于证据的CPG治疗。将CPG队列的临床结果和成本与CPG实施前30个月的患者进行比较(n=191名儿童)。
通过CPG指导的护理,腹内脓肿发生率从0.24降至0.10(调整后风险比0.44,95%置信区间[CI]0.26-0.75).任何不良事件的发生率从0.30降至0.23(调整后的风险比0.82,95%CI0.58-1.17)。每位患者的平均总住院费用(医院会计系统)从$16,466下降至$10,528(调整后的绝对差异-$5451,95%CI-$7755至-$3147),在研究期间,估计调整后的总节余为665,022美元。从PHIS数据库获得的费用也显示CPG指导的护理减少(-6669美元,95%CI-8949美元至-4389美元/患者)。在贝叶斯成本效益分析中,CPG是主导策略的可能性为91%。
基于证据的CPG通过改善预后和降低成本,增加了穿孔性阑尾炎患儿手术护理的价值。医院成本核算数据和PHIS数据库中预先存在的成本数据提供了类似的结果。