腹腔镜与开放腹膜前疝修补手术治疗成人腹股沟疝的成本效益分析

目的从成本-效益角度对比分析腹腔镜与开放腹膜前疝修补手术在成人腹股沟疝中的应用情况。 方法纳入2019年1-12月在眉山市人民医院诊治的单侧腹股沟疝患者132例,患者自主选择手术方式,开放手术组52例,腹腔镜手术组80例。成本费用计算包括住院费用、手术费用、其他费用;使用《欧洲五维健康量表（EQ-5D）中文版》在术后1 d、7 d、15 d分别对患者进行获益评价,并据此计算质量调整生命年（QALYs）,进而计算和分析成本效益比（C/E）及增量成本效益比（ICER）。 结果开放手术组的平均总费用为7742.72元,腹腔镜手术组的平均总费用为12 866.56元。开放手术组和腹腔镜组的QALYs在第1天分别为0.501±0.178/0.692±0.106,第7天为0.673±0.123/0.814±0.042,差异均有统计学意义;第15天时QALYs分别为0.809±0.046/ 0.821±0.040,差异无统计学意义。腹腔镜组在第1天的ICER为3138.76（元/QALYs）;第7天时的ICER为4301.8（元/QALYs）;敏感性分析得出腹腔镜组在第1天和第7天C/E变化影响最大的费用是材料费;临界值分析显示如果材料费下降到5082.32元或3752.68元时腹腔镜组和开放组分别在第1天和第7天的C/E相当。 结论腹腔镜腹股沟疝手术后第1天和第7天时患者生活质量要高于开放手术患者,在第15天时二者没有差异。腹腔镜手术治疗腹股沟疝虽然费用较高,但是对于提高生活质量来说是相对值得的。

Cost-effectiveness analysis of laparoscopic and open preperitoneal surgery for adult inguinal hernia

ObjectiveTo compare the application of laparoscopic and open preperitoneal hernia repair in adult inguinal hernia from the perspective of cost-effectiveness. MethodsA total of 132 patients with unilateral inguinal hernia diagnosed and treated in Meishan People's Hospital from January to December 2019 were included. The patients independently selected the surgical methods, including 52 patients in the open operation group and 80 patients in the laparoscopic operation group. The cost calculation included hospitalization expenses, operation expenses and other expenses. The benefit evaluation of patients was carried out using the EuroQuol-5D (EQ-5D) on the 1st day, the 7th day and the 15th day after operation, and the quality-adjusted life years (QALYs) were calculated accordingly. And then calculate the cost-effectiveness ratio (C/E) and the incremental cost-effectiveness ratio (ICER). ResultsThe average total cost of the open operation group was ￥7742.72, and the average total cost of the laparoscopic group was ￥12866.56. The QALYs of the open preperitoneal operation group and laparoscopic group were 0.501±0.178/0.692±0.106 on the 1st day, 0.673± 0.123/0.814±0.042 on the 7th day, respectively. The differences were statistically significant. But the QALYs of the patients on the 15th day was 0.809±0.046/0.821±0.040, respectively. The differences were not statistically significant; the ICER of the laparoscopic operation group on the 1st day was ￥3138.76/QALYs; the ICER of the 7th day was ￥4301.8/QALYs; the sensitivity analysis showed that the cost of the C/E change in the laparoscopic group on both the 1st day and the 7th day was material expenses. The critical value analysis showed that if the material cost dropped to ￥5082.32 or ￥3752.68, the C/E of the laparoscopic group and the open group were the same on the 1st day and the 7th day, respectively. ConclusionOn the 1st and 7th days after laparoscopic inguinal hernia surgery, the quality of life of patients was higher than that of patients undergoing open surgery, and there was no difference between them on the 15th day. Although laparoscopic surgery for inguinal hernia is expensive, the extra cost is "worth" it to improve the quality of life.