卫生技术评估提供了一种评估技术属性的手段,安全,功效,成本效益,以及新技术的道德/法律/社会影响。卫生技术评估的一个重要组成部分是成本效益分析(CEA),这可以使用基于模型的CEA执行。这项研究使用CEA模型比较了新型韧带增强装置与标准技术的成本效益,以初步修复完整的尺侧副韧带(UCL)撕裂。
开发了一种需要急性手术修复的完整UCL撕裂模型,从社会角度比较标准技术初次修复和使用韧带增强装置修复的成本效益。主要结果包括质量调整生命年(QALYs),成本,净货币收益(NMB)和增量NMB。使用CAD$50,000/QALY的成本效益阈值来比较这两种技术。进行了灵敏度分析以评估参数不确定度,特别是设备成本的影响,下班时间,并发症的可能性,和术后结果。
标准技术的NMB为42,598加元,使用韧带增强装置进行修复的NMB为41,818加元。标准技术是完整UCL撕裂的主要修复的首选策略。单向敏感性分析表明,如果个人在<18天(基本情况为23天)内恢复工作,则韧带增强装置具有成本效益。当成本低于50加元,并且返回工作的时间差至少为1天时,该设备也受到青睐。
我们的模型表明,引入新的健康技术可能会带来巨大的成本,和某些条件,比如早些时候重返工作岗位,必须满足一些设备是一个具有成本效益的选择。这项研究提供了一个示例,说明基于模型的CEA如何成为评估新型设备成本效益的有用工具。
经济/决策分析II.
Health technology assessment provides a means to assess the technical properties, safety, efficacy, cost-effectiveness, and ethical/legal/social impact of a novel technology. An important component of health technology assessment is the cost-effectiveness analysis (CEA), which can be performed using model-based CEA. This study used the CEA model to compare the cost-effectiveness of a novel ligament augmentation device with the standard technique for primary repair of complete ulnar collateral ligament (UCL) tears.
A model was developed for complete UCL tear requiring acute surgical repair, comparing the cost-effectiveness of standard technique primary repair and repair using a ligament augmentation device from a societal perspective. Primary outcomes included quality-adjusted life years (QALYs), cost, net monetary benefit (NMB) and incremental NMB. A cost-effectiveness threshold of CAD $50,000/QALY was used to compare the 2 techniques. Sensitivity analyses were conducted to assess the parameter uncertainty, specifically the impact of device cost, time off work, probability of complication, and postoperative outcome.
The NMB for the standard technique was CAD $42,598, and the NMB for repair using the ligament augmentation device was CAD $41,818. The standard technique was the preferred strategy for primary repair of complete UCL tears. One-way sensitivity analyses demonstrated that the ligament augmentation device became cost-effective if individuals return to work in <18 days (base
case 23 days). The device was also favored when the cost was less than CAD $50 and the difference in time to return to work was at least 1 day.
Our model demonstrates that there may be significant costs associated with the introduction of novel health technologies, and certain conditions, such as an earlier return to work, must be met for some devices to be a cost-effective option. This study provides an example of how model-based CEA is a useful tool to assess the cost-effectiveness of a novel device.
Economic/Decision Analysis II.