Abstract：
BACKGROUND: Early video-assisted thorascopic surgery (VATS) is the recommended intervention for retained hemothorax in trauma patients. Alternative options, such as lytic therapy, to avoid surgery remain controversial. The purpose of this decision analysis was to assess expected costs associated with treatment strategies.
METHODS: A decision tree analysis estimated the expected costs of three initial treatment strategies: 1) VATS, 2) intrapleural tissue plasminogen activator (TPA) lytic therapy, and 3) intrapleural non-TPA lytic therapy. Probability parameters were estimated from published literature. Costs were based on National Inpatient Sample data and published estimates. Our model compared overall expected costs of admission for each strategy. Sensitivity analyses were conducted to explore the impact of parameter uncertainty on the optimal strategy.
RESULTS: In the base case analysis, using TPA as the initial approach had the lowest total cost (U.S. $37,007) compared to VATS ($38,588). TPA remained the optimal initial approach regardless of the probability of complications after VATS. TPA was an optimal initial approach if TPA success rate was >83% regardless of the failure rate with VATS. VATS was the optimal initial strategy if its total cost of admission was <$33,900.
CONCLUSIONS: Lower treatment costs with lytic therapy does not imply significantly lower total cost of trauma admission. However, an initial approach with TPA lytic therapy may be preferred for retained traumatic hemothorax to lower the total cost of admission given its high probability of avoiding the operating room with its resultant increased costs. Future studies should identify differences in quality of life after recovery from competing interventions.
METHODS: A decision tree analysis estimated the expected costs of three initial treatment strategies: 1) VATS, 2) intrapleural tissue plasminogen activator (TPA) lytic therapy, and 3) intrapleural non-TPA lytic therapy. Probability parameters were estimated from published literature. Costs were based on National Inpatient Sample data and published estimates. Our model compared overall expected costs of admission for each strategy. Sensitivity analyses were conducted to explore the impact of parameter uncertainty on the optimal strategy.
RESULTS: In the base case analysis, using TPA as the initial approach had the lowest total cost (U.S. $37,007) compared to VATS ($38,588). TPA remained the optimal initial approach regardless of the probability of complications after VATS. TPA was an optimal initial approach if TPA success rate was >83% regardless of the failure rate with VATS. VATS was the optimal initial strategy if its total cost of admission was <$33,900.
CONCLUSIONS: Lower treatment costs with lytic therapy does not imply significantly lower total cost of trauma admission. However, an initial approach with TPA lytic therapy may be preferred for retained traumatic hemothorax to lower the total cost of admission given its high probability of avoiding the operating room with its resultant increased costs. Future studies should identify differences in quality of life after recovery from competing interventions.
摘要：
背景：早期电视辅助胸腔镜手术（VATS）是创伤患者保留血胸的推荐干预措施。备选方案,比如溶解疗法，避免手术仍然存在争议。此决策分析的目的是评估与治疗策略相关的预期成本。
方法：决策树分析估计了三种初始治疗策略的预期成本：1）VATS，2）胸膜内组织纤溶酶原激活物（TPA）溶解疗法，和3)胸膜内非TPA裂解治疗。根据已发表的文献估计概率参数。费用基于全国住院患者样本数据和公布的估计。我们的模型比较了每种策略的总体预期入场费。进行了敏感性分析，以探讨参数不确定性对最优策略的影响。
结果：在基本情况分析中，与VATS（38,588美元）相比，使用TPA作为初始方法的总成本最低（37,007美元）。无论VATS术后并发症的可能性如何，TPA仍然是最佳的初始方法。无论VATS的失败率如何，如果TPA成功率>83％，则TPA是最佳的初始方法。如果VATS的总入场费<33,900美元，则VATS是最佳的初始策略。
结论：溶解疗法的治疗费用较低并不意味着创伤住院总费用显著降低。然而,考虑到保留的外伤性血胸有很高的避免手术室的可能性,TPA裂解治疗的初始方法可能是优选的,以降低入院的总成本.未来的研究应该确定从竞争性干预措施中恢复后生活质量的差异。
方法：决策树分析估计了三种初始治疗策略的预期成本：1）VATS，2）胸膜内组织纤溶酶原激活物（TPA）溶解疗法，和3)胸膜内非TPA裂解治疗。根据已发表的文献估计概率参数。费用基于全国住院患者样本数据和公布的估计。我们的模型比较了每种策略的总体预期入场费。进行了敏感性分析，以探讨参数不确定性对最优策略的影响。
结果：在基本情况分析中，与VATS（38,588美元）相比，使用TPA作为初始方法的总成本最低（37,007美元）。无论VATS术后并发症的可能性如何，TPA仍然是最佳的初始方法。无论VATS的失败率如何，如果TPA成功率>83％，则TPA是最佳的初始方法。如果VATS的总入场费<33,900美元，则VATS是最佳的初始策略。
结论：溶解疗法的治疗费用较低并不意味着创伤住院总费用显著降低。然而,考虑到保留的外伤性血胸有很高的避免手术室的可能性,TPA裂解治疗的初始方法可能是优选的,以降低入院的总成本.未来的研究应该确定从竞争性干预措施中恢复后生活质量的差异。
