基于决策树模型的痔上黏膜结扎疗法和RPH术治疗Ⅱ-Ⅲ度脱垂性痔病的成本-效果分析

Decision tree model-based cost-effectiveness analysis of ligation for prolapsed hemorrhoids versus Ruiyun procedure for hemorrhoids for gradeⅡtoⅢprolapsed hemorrhoids

目的评价痔上黏膜结扎疗法和RPH术治疗Ⅱ-Ⅲ度脱垂性痔病的成本-效果。方法基于2018年5月至2021年6月上海中医药大学附属普陀医院的一项随机对照研究,该研究选择接受痔上黏膜结扎疗法或RPH术治疗的66例Ⅱ-Ⅲ度脱垂性痔病患者作为研究对象,随机分为研究组(n=33,行痔上黏膜结扎疗法治疗)和对照组(n=33,行RPH术治疗),收集两组患者住院医疗成本和临床疗效等临床资料。利用Treeage Pro 2011软件建立决策树模型,计算质量调整生命年(QALYs)、成本-效果比(CER)和增量成本-效果比(ICER),并进行单因素敏感性分析和概率性敏感性分析。结果研究组的治愈率高于对照组(P<0.05)。研究组的住院医疗成本低于对照组(P<0.05),但效果与对照组相近(P>0.05);研究组的CER低于对照组(P<0.05),即研究组具有较好的成本-效果比。ICER为-119019.6元/QALYs,说明研究组更具有成本-效果优势。敏感性分析结果与基础分析结果一致。结论痔上黏膜结扎疗法治疗Ⅱ-Ⅲ度脱垂性痔病较RPH术更具有成本-效果优势,具有一定的临床推广价值。

Objectives To evaluate the cost-effectiveness of ligation for prolapsed hemorrhoids versus Ruiyun procedure for hemorrhoids for gradeⅡtoⅢprolapsed hemorrhoids.Methods A cost-effectiveness model was built on a randomized controlled trial conducted at the Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine between May 2018 and June 2021.In this trial,66 patients with gradeⅡtoⅢprolapsed hemorrhoids were randomly assigned to the treatment group(n=33,receiving ligation for prolapsed hemorrhoids)and the control group(n=33,receiving Ruiyun procedure for hemorrhoids).Costs of hospitalization,and clinical data such as effectiveness were collected.A decision tree model was built with the Treeage Pro 2011.Model outputs included quality adjusted life years(QALYs),cost-effectiveness ratio(CER),and incremental cost-effectiveness ratio(ICER).One-way sensitivity analyses and probabilistic sensitivity analyses were performed.Results Cure rate was significantly higher in the treatment group than in the control group(P<0.05).Compared to the control group,the treatment group had significantly lower hospitalization costs(P<0.05)but similar QALYs gains(P>0.05).CER in the treatment group was significantly lower than that in the control group(P<0.05),indicating ligation for prolapsed hemorrhoids is more cost-effective.ICER was-119,019.6 RMB/QALYs,indicates that the treatment group has a cost-effectiveness advantage.Sensitivity analyses showed similar results to base-case model results.Conclusion Compared with Ruiyun procedure for hemorrhoids,ligation for prolapsed hemorrhoids has a cost-effectiveness advantage.It has certain value of clinical promotion.