近红外光局部脑氧与组织氧饱和度监测在心脏外科手术中应用的经济价值评估  

Evaluation of economic value of near-infrared spectroscopy for regional cerebral and tissue oxygen saturation monitoring in cardiac surgery

作　　者：谭宝滢 陈浩锐 余海[2] 宣建伟 TAN Bao-ying;CHEN Hao-rui;YU Hai;XUAN Jian-wei(Institute of Medical Economics,Shool of Pharmaceutical Sciences of Sun Yat-Sen University,Guangzhou 510006,China;Anesthesia&Operation Center,West China Hospital of Sichuan University,Chengdu 610041,China)

机构地区：[1]中山大学药学院医药经济研究所,广州510006 [2]四川大学华西医院麻醉科,成都610041

出　　处：《医疗卫生装备》2024年第12期82-88,共7页Chinese Medical Equipment Journal

摘　　要：目的:评估近红外光(near-infrared spectroscopy,NIRS)局部脑氧与组织氧饱和度监测(以下称“NIRS监测”)在心脏外科手术中应用的经济性。方法:基于中国医疗卫生体系,使用Microsoft Excel构建短期决策树模型,比较心脏外科手术患者使用NIRS监测和不使用NIRS监测的围手术期健康结局和成本,其中临床数据来源于已发表的荟萃分析文献,成本数据来源于已发表的文献和专家调研,模型输出指标为质量调整生命年(quality-adjusted life years,QALYs)、术后并发症事件发生人次数和成本。采用单因素敏感性分析和概率敏感性分析验证模型输出结果的稳健性。结果:基础分析结果显示,在30 d的研究时限内,在心外科手术中,与不使用NIRS监测相比,使用NIRS监测在增加0.0015 QALYs的同时避免了0.27人次术后并发症的发生,减少了1.61 d普通病房天数、0.41 d ICU住院天数,每次治疗可节省总成本为2425.30元。敏感性分析结果显示,模型输出结果稳健。结论:在心脏外科手术中,使用NIRS监测在减少术后并发症和降低医疗费用上展现了明显的临床和经济价值。Objective To assess the cost-effectiveness of near-infrared spectroscopy for regional cerebral and tissue oxygen saturation monitoring(NIRS)during cardiac surgery.Methods From the perspective of China's healthcare system,a short-term decision tree model was developed using Microsoft Excel to evaluate the perioperative health outcomes and costs of cardiac surgery patients using NIRS compared to those without using NIRS(non-NIRS).Clinical data were derived from published meta-analysis literature,and cost data were sourced from published literature and expert survey.The model output metrics involved in quality-adjusted life years(QALYs),number of postoperative complication events and cost.One-way and probability sensitivity analyses were applied to validating the robustness of results.Results Basic case analysis showed that compared to non-NIRS in cardiac surgery,using NIRS monitoring increased 0.0015 QALYs while avoiding 0.27 person-time postoperative complications(including postoperative delirium,postoperative cognitive impairment,acute kidney injury and death),reducing 1.61 days of general ward stay and 0.41 days of ICU stay and resulting in a total cost savings of 2425.30 CNY per treatment.Sensitivity analysis demonstrated the robustness of results.Conclusion NIRS monitoring has significant clini-cal and economic values in reducing postoperative complications and lowering medical costs in cardiac surgery.

关 键 词：心脏外科手术 近红外光 局部脑氧与组织氧饱和度监测 卫生经济学 经济学评价 无创脑监测 

分 类 号：R318[医药卫生—生物医学工程]