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Abstract：
To determine the incremental cost-effectiveness of a clinical practice guideline (CPG) compared with \"usual care\" for treatment of perforated appendicitis in children. Secondary objective was to compare cost analyses using hospital accounting system data versus data in the Pediatric Health Information System (PHIS).
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.
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.
摘要：
确定与“常规护理”相比，临床实践指南（CPG）用于治疗儿童穿孔性阑尾炎的增量成本效益。次要目标是比较使用医院会计系统数据与儿科健康信息系统（PHIS）中的数据的成本分析。
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。
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。
