Abstract：
UNASSIGNED: To assess, from a United States (US) payer\'s perspective, the cost-effectiveness of gels designed to separate the endometrial surfaces (intrauterine spacers) placed following intrauterine surgery.
UNASSIGNED: A decision tree model was developed to estimate the cost-effectiveness of intrauterine spacers used to facilitate endometrial repair and prevent the formation (primary prevention) and reformation (secondary prevention) of intrauterine adhesions (IUAs) and associated pregnancy- and birth-related adverse outcomes. Event rates and costs were extrapolated from data available in the existing literature. Sensitivity analyses were conducted to corroborate the base case results.
UNASSIGNED: In this model, using intrauterine spacers for adhesion prevention led to net cost savings for US payers of $2,905 per patient over a 3.5-year time horizon. These savings were driven by the direct benefit of preventing procedures associated with IUA formation ($2,162 net savings) and the indirect benefit of preventing pregnancy-related complications often associated with IUA formation ($3,002). These factors offset the incremental cost of intrauterine spacer use of $1,539 based on an assumed price of $1,800 and the related increase in normal deliveries of $931. Model outcomes were sensitive to the probability of preterm and normal deliveries. Budget impact analyses show overall cost savings of $19.96 per initial member within a US healthcare plan, translating to $20 million over a 5-year time horizon for a one-million-member plan.
UNASSIGNED: There are no available data on the effects of intrauterine spacers or IUAs on patients\' quality of life. Resultingly, the model could not evaluate patients\' utility related to treatment with or without intrauterine spacers and instead focused on costs and events avoided.
UNASSIGNED: This analysis robustly demonstrated that intrauterine spacers would be cost-saving to healthcare payers, including both per-patient and per-plan member, through a reduction in IUAs and improvements to patients\' pregnancy-related outcomes.
Every year, women in the United States (US) undergo surgery to treat intrauterine abnormalities to maintain or improve the uterus’ ability to support fetal development and result in a term delivery. Despite the benefits of these procedures, damage caused to the endometrium (uterine lining) is associated with a risk of adherence of the endometrial cavity surfaces with scar tissue known as intrauterine adhesions (IUAs).Damage to the endometrium and the resulting IUAs may be associated with infertility, light or absent menstruation, pregnancy loss, and other pregnancy-related complications. Treating these conditions within the US healthcare system consumes resources and adds costs for healthcare payers (public and private insurance providers).To facilitate endometrial repair and to reduce or prevent IUAs, researchers have developed materials to place within the endometrial cavity following surgery to separate the endometrial surfaces during the early healing period. These intrauterine “spacers” are intended to improve patients’ subsequent clinical outcomes and save money for healthcare payers. It is unknown whether these improved clinical outcomes offset the cost of the routine use of spacers following “at-risk” procedures that involve the endometrial cavity.We developed a model designed to determine the cost-effectiveness of an intrauterine spacer by quantifying improvements in clinical outcomes and the resultant cost savings for patients undergoing uterine surgeries with or without spacers. Our model predicted that routinely using such spacers following at-risk procedures would improve patient outcomes and reduce costs to US payers.
UNASSIGNED: A decision tree model was developed to estimate the cost-effectiveness of intrauterine spacers used to facilitate endometrial repair and prevent the formation (primary prevention) and reformation (secondary prevention) of intrauterine adhesions (IUAs) and associated pregnancy- and birth-related adverse outcomes. Event rates and costs were extrapolated from data available in the existing literature. Sensitivity analyses were conducted to corroborate the base case results.
UNASSIGNED: In this model, using intrauterine spacers for adhesion prevention led to net cost savings for US payers of $2,905 per patient over a 3.5-year time horizon. These savings were driven by the direct benefit of preventing procedures associated with IUA formation ($2,162 net savings) and the indirect benefit of preventing pregnancy-related complications often associated with IUA formation ($3,002). These factors offset the incremental cost of intrauterine spacer use of $1,539 based on an assumed price of $1,800 and the related increase in normal deliveries of $931. Model outcomes were sensitive to the probability of preterm and normal deliveries. Budget impact analyses show overall cost savings of $19.96 per initial member within a US healthcare plan, translating to $20 million over a 5-year time horizon for a one-million-member plan.
UNASSIGNED: There are no available data on the effects of intrauterine spacers or IUAs on patients\' quality of life. Resultingly, the model could not evaluate patients\' utility related to treatment with or without intrauterine spacers and instead focused on costs and events avoided.
UNASSIGNED: This analysis robustly demonstrated that intrauterine spacers would be cost-saving to healthcare payers, including both per-patient and per-plan member, through a reduction in IUAs and improvements to patients\' pregnancy-related outcomes.
Every year, women in the United States (US) undergo surgery to treat intrauterine abnormalities to maintain or improve the uterus’ ability to support fetal development and result in a term delivery. Despite the benefits of these procedures, damage caused to the endometrium (uterine lining) is associated with a risk of adherence of the endometrial cavity surfaces with scar tissue known as intrauterine adhesions (IUAs).Damage to the endometrium and the resulting IUAs may be associated with infertility, light or absent menstruation, pregnancy loss, and other pregnancy-related complications. Treating these conditions within the US healthcare system consumes resources and adds costs for healthcare payers (public and private insurance providers).To facilitate endometrial repair and to reduce or prevent IUAs, researchers have developed materials to place within the endometrial cavity following surgery to separate the endometrial surfaces during the early healing period. These intrauterine “spacers” are intended to improve patients’ subsequent clinical outcomes and save money for healthcare payers. It is unknown whether these improved clinical outcomes offset the cost of the routine use of spacers following “at-risk” procedures that involve the endometrial cavity.We developed a model designed to determine the cost-effectiveness of an intrauterine spacer by quantifying improvements in clinical outcomes and the resultant cost savings for patients undergoing uterine surgeries with or without spacers. Our model predicted that routinely using such spacers following at-risk procedures would improve patient outcomes and reduce costs to US payers.
摘要：
■评估，从美国(美国)付款人的角度来看，设计用于分离子宫内膜表面的凝胶(子宫内间隔器)的成本效益在子宫内手术后立即放置。
开发了一个决策树模型来评估宫内间隔器的成本效益，该间隔器用于促进子宫内膜修复，防止宫腔粘连（IUA）的形成（一级预防）和改造（二级预防）以及相关的妊娠和分娩不良结局。根据现有文献中的数据推断事件发生率和费用。进行了敏感性分析以证实基本情况的结果。
■在这个模型中，在3.5年的时间范围内,使用宫内间隔器预防粘连可为美国付款人节省每名患者2,905美元的净成本.这些节省是由预防与IUA形成相关的程序的直接收益（净节省2,162美元）和预防通常与IUA形成相关的妊娠相关并发症的间接收益（3,002美元）推动的。这些因素抵消了宫内间隔器使用的增量成本1539美元，这是基于假设价格1800美元和正常交付的相关增加931美元。模型结果对早产和正常分娩的概率敏感。预算影响分析显示，在美国医疗保健计划中，每位初始成员的总体成本节省为19.96美元。在5年的时间范围内转化为2000万美元的100万会员计划。
■没有关于宫内间隔区或宫内避孕对患者生活质量影响的可用数据。结果，该模型无法评估与使用或不使用宫内间隔器治疗相关的患者效用,而是关注成本和避免的事件.
■这项分析有力地表明，子宫内间隔器将为医疗保健提供者节省成本，包括每位患者和每个计划成员，通过减少IUA和改善患者妊娠相关结局。
每年,美国女性（US）接受手术治疗宫内异常，以维持或改善子宫支持胎儿发育并导致足月分娩的能力。尽管这些程序有好处，对子宫内膜（子宫内膜）造成的损伤与子宫内膜腔表面与瘢痕组织（称为宫腔粘连（IUA））的粘附风险有关。对子宫内膜和由此产生的IUA的损害可能与不孕症有关，轻微或月经缺失，怀孕失败,和其他妊娠相关并发症。在美国医疗保健系统内治疗这些疾病会消耗资源，并增加医疗保健支付者（公共和私人保险提供商）的成本。为了促进子宫内膜修复并减少或预防IUAs，研究人员开发了在手术后放置在子宫内膜腔内的材料，以在早期愈合期间分离子宫内膜表面。这些子宫内“间隔物”旨在改善患者的后续临床结果并为医疗保健支付者节省资金。尚不清楚这些改善的临床结果是否抵消了在涉及子宫内膜腔的“有风险”手术后立即常规使用间隔物的成本。我们开发了一种模型，旨在通过量化临床结局的改善以及在有或没有间隔的情况下接受子宫手术的患者的成本节约来确定子宫内间隔器的成本效益。我们的模型预测，在有风险的程序后常规使用这种间隔物将改善患者的预后并降低美国付款人的成本。
开发了一个决策树模型来评估宫内间隔器的成本效益，该间隔器用于促进子宫内膜修复，防止宫腔粘连（IUA）的形成（一级预防）和改造（二级预防）以及相关的妊娠和分娩不良结局。根据现有文献中的数据推断事件发生率和费用。进行了敏感性分析以证实基本情况的结果。
■在这个模型中，在3.5年的时间范围内,使用宫内间隔器预防粘连可为美国付款人节省每名患者2,905美元的净成本.这些节省是由预防与IUA形成相关的程序的直接收益（净节省2,162美元）和预防通常与IUA形成相关的妊娠相关并发症的间接收益（3,002美元）推动的。这些因素抵消了宫内间隔器使用的增量成本1539美元，这是基于假设价格1800美元和正常交付的相关增加931美元。模型结果对早产和正常分娩的概率敏感。预算影响分析显示，在美国医疗保健计划中，每位初始成员的总体成本节省为19.96美元。在5年的时间范围内转化为2000万美元的100万会员计划。
■没有关于宫内间隔区或宫内避孕对患者生活质量影响的可用数据。结果，该模型无法评估与使用或不使用宫内间隔器治疗相关的患者效用,而是关注成本和避免的事件.
■这项分析有力地表明，子宫内间隔器将为医疗保健提供者节省成本，包括每位患者和每个计划成员，通过减少IUA和改善患者妊娠相关结局。
每年,美国女性（US）接受手术治疗宫内异常，以维持或改善子宫支持胎儿发育并导致足月分娩的能力。尽管这些程序有好处，对子宫内膜（子宫内膜）造成的损伤与子宫内膜腔表面与瘢痕组织（称为宫腔粘连（IUA））的粘附风险有关。对子宫内膜和由此产生的IUA的损害可能与不孕症有关，轻微或月经缺失，怀孕失败,和其他妊娠相关并发症。在美国医疗保健系统内治疗这些疾病会消耗资源，并增加医疗保健支付者（公共和私人保险提供商）的成本。为了促进子宫内膜修复并减少或预防IUAs，研究人员开发了在手术后放置在子宫内膜腔内的材料，以在早期愈合期间分离子宫内膜表面。这些子宫内“间隔物”旨在改善患者的后续临床结果并为医疗保健支付者节省资金。尚不清楚这些改善的临床结果是否抵消了在涉及子宫内膜腔的“有风险”手术后立即常规使用间隔物的成本。我们开发了一种模型，旨在通过量化临床结局的改善以及在有或没有间隔的情况下接受子宫手术的患者的成本节约来确定子宫内间隔器的成本效益。我们的模型预测，在有风险的程序后常规使用这种间隔物将改善患者的预后并降低美国付款人的成本。
