两种中心静脉输液技术的成本效果分析

doi:10.3761/j.issn.0254-1769.2021.04.016

摘要/Abstract

摘要：

目的比较PICC和植入式静脉输液港（implantable venous access port,PORT）从置管到拔管全程的成本-效果,为中长期中心静脉输液技术的选择提供卫生经济学依据。方法采用回顾性队列研究,便利地选取上海市某三级甲等医院2016年1月—2019年10月采用PICC进行静脉输液的444例患者及2013年1月—2019年10月采用PORT的477例患者为研究对象,采用成本-效果分析,从医院角度比较两组总留置时间段、留置3~6个月、6~9个月、9~12个月时的总成本、综合效果指数、成本-效果比。结果在总留置时间段、留置3~6个月、6~9个月、9~12个月时,PICC组的日均总成本或总成本均低于PORT组,差异具有统计学意义（P<0.001）;PICC组综合效果指数均略低于PORT组;PICC组的成本-效果比均低于PORT组;增量成本-效果比分别为543.50、234 411.00、120 092.25和109 164.00。结论当导管留置时间≤12个月时,PICC成本-效果优于PORT,从卫生经济学角度,优先推荐PICC作为中长期静脉输液通路。此外,增量成本-效果比可辅助决策,若支付意愿值高于增量成本-效果比,则PICC和PORT均为成本-效果可接受的方案;反之,则PICC成本-效果更佳。

关键词: 经外周静脉穿刺中心静脉导管, 植入式静脉输液港, 成本-效果分析, 卫生经济学评价, 护理

Abstract:

Objective To compare the cost-effectiveness of PICCs and PORTs from catheter insertion to removal,and to provide economic evidence to choose the more cost-effective central venous access devices（CVADs） for medium- to long-term use. Methods 444 patients who received medium- to long-term chemotherapy by PICCs in a tertiary hospital in Shanghai from January 2016 to October 2019 and 477 patients with PORTs in this hospital from January 2013 to October 2019 were included by convenience sampling method. Data was collected from a retrospective cohort study. A cost-effectiveness analysis was conducted from the hospital perspective to compare the total costs,effectiveness index,cost-effectiveness ratio and incremental cost-effectiveness ratio（ICER） of PICCs and PORTs in total dwelling time,3-6 month,6-9 month and 9-12 month dwelling time of subgroups respectively. Results For the total dwelling time,3-6 month,6-9 month and 9-12 month dwelling time,the average total cost per day or the average total cost were all significantly lower in PICCs than those in PORTs（P<0.001）. The effectiveness indexes were all slightly lower in PICCs than those in PORTs. The cost-effectiveness ratios were all lower in PICCs than those in PORTs. The ICERs were 543.50,234 411.00,120 092.25 and 109 164.00 respectively. Conclusion When catheter dwelling time was less than 12 months,PICCs were more cost-effective than PORTs. Therefore,PICCs should be recommended as the more cost-effective CVADs for medium- to long-term use from economic evaluation perspective. Furthermore,the ICER can be applied for decision-making. If the ICER was below the willingness-to-pay value,PICCs and PORTs were all acceptable cost-effective options;otherwise,PICCs were more cost-effective.

Key words: Peripherally Inserted Central Catheter, Implantable Venous Access Port, Cost-Effectiveness Analysis, Health Economic Evaluation, Nursing Care

王凯蓉,周英凤,张晓菊,陆箴琦,王丽英,薛嵋. 两种中心静脉输液技术的成本效果分析[J]. 中华护理杂志, 2021, 56(4): 574-580.

WANG Kairong,ZHOU Yingfeng,ZHANG Xiaoju,LU Zhenqi,WANG Liying,XUE Mei. A cost-effectiveness analysis of peripherally inserted central catheter versus totally implanted venous port[J]. Chinese Journal of Nursing, 2021, 56(4): 574-580.

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