艾司氯胺酮用于脊柱手术麻醉的成本-效益分析

Cost-benefit Analysis of S(+)-ketamine for Spinal Surgery Anesthesia

目的 基于已有的药理作用机制评估包含艾司氯胺酮的麻醉方案相对于不包含的麻醉方案对于减少脊柱手术后阿片类药物使用结局事件的影响,并评价包含艾司氯胺酮麻醉方案的经济性。方法 采用系统评价和药物经济学评价的方法分析包含艾司氯胺酮的麻醉方案对于阿片类药物使用的影响,并使用决策树模型计算脊柱手术中使用艾司氯胺酮的麻醉方案相对于不使用艾司氯胺酮的麻醉方案的净效益,同时进行敏感性分析。结果 脊柱手术中包含艾司氯胺酮的麻醉方案相比不包含艾司氯胺酮的麻醉方案能平均降低36.76(95%CI:22.74~50.78)mg的术后吗啡使用量。使用艾司氯胺酮方案1、方案2和方案3相对于不使用艾司氯胺酮的方案而言净效益分别为2 212.10元、1 970.22元和1 319.01元,敏感性分析表明基础分析结果具有较好的稳定性。结论 包含艾司氯胺酮的麻醉方案相对不包含艾司氯胺酮的麻醉方案而言具有经济性。

Objective To conduct health economic evaluation of the anesthesia plan with S(+)-ketamine comparing to the plan without S(+)-ketamine for spinal surgery anesthesia. Methods Systematic review for the impact of the inclusion of S(+)-ketamine into the spinal surgery anesthesia plan on the consumption of opioid medicines.The decision tree model was used to calculate the net benefit of the anesthesia regimen using S(+)-ketamine compared with the anesthesia regimen without S(+)-ketamine in spinal surgery, and sensitivity analysis was performed. Results The anesthesia plan with S(+)-ketamine can reduce the consumption of opioid medicines by 36.76(95%CI: 22.74~50.78)mg comparing to the plan without S(+)-ketamine. And the net benefits of the inclusion of S(+)-ketamine in three different plans are 2 212.10 CNY, 1 970.22 CNY, and 1 319.01 CNY.Sensitivity analysis shows that the results of basic analysis are stable. Conclusion The anesthesia scheme with S(+)-ketamine is economical compared with the anesthesia scheme without S(+)-ketamine.