PDF(Pubmed)
Abstract：
Aim: Posterior cranial fossa (PCF) surgery is associated with complications, including cerebrospinal fluid (CSF) leakage. Dural sealants such as polyethylene glycol (PEG)-based hydrogels and fibrin glue can prevent CSF leaks, with evidence suggesting PEG hydrogels may outperform fibrin glue. However, the budget impact of using PEG hydrogels in PCF surgeries in Europe is unclear. Materials & methods: A decision tree was developed based on a previous US model, to assess the budget impact of switching from fibrin glue to PEG hydrogel in PCF surgery across five European countries. Input costs were derived from published sources for the financial year 2022/2023. Health outcomes, including CSF leaks, were considered. Results: The model predicted that using PEG hydrogel instead of fibrin glue in PCF surgery can lead to cost savings in five European countries. Cost savings per patient ranged from EUR 419 to EUR 1279, depending on the country. Sensitivity analysis showed that the incidence of CSF leaks and pseudomeningoceles had a substantial impact on the model\'s results. Conclusion: PEG hydrogels may be a cost-effective alternative to fibrin glue in PCF surgery. The model predicted that cost savings would be mainly driven by a reduction in the incidence of postoperative CSF leaks, resulting in reduced reliance on lumbar drains, reparative surgery and shortened hospital stays.
摘要：
目的：后颅窝（PCF）手术与并发症有关，包括脑脊液（CSF）漏。硬脑膜密封剂如聚乙二醇（PEG）基水凝胶和纤维蛋白胶可以防止脑脊液渗漏，有证据表明PEG水凝胶可能优于纤维蛋白胶。然而,在欧洲PCF手术中使用PEG水凝胶的预算影响尚不清楚。材料与方法：基于以前的美国模型开发了决策树，评估在五个欧洲国家的PCF手术中从纤维蛋白胶转换为PEG水凝胶的预算影响。投入成本来自2022/2023财政年度的公布来源。健康结果,包括脑脊液泄漏，被考虑。结果：该模型预测，在PCF手术中使用PEG水凝胶代替纤维蛋白胶可以节省五个欧洲国家的成本。每位患者节省的费用从419欧元到1279欧元不等，具体取决于国家。敏感性分析显示，脑脊液渗漏和假性脑膜膨出的发生率对模型的结果有很大影响。结论：PEG水凝胶可能是PCF手术中替代纤维蛋白胶的一种经济有效的替代方法。该模型预测，成本节约将主要由术后脑脊液漏发生率的降低驱动。减少了对腰椎管的依赖，修复手术和缩短住院时间。
