腹腔镜与开放手术治疗小儿疝的成本-效益分析

目的从全社会的角度对本地区腹腔镜与开放手术两种方法用于小儿疝的治疗成本和收益进行对比，为眉山市医保部门决策的制定提供理论支持，为患者根据自身需求选择手术方式提供科学依据。 方法从2017年1月至12月眉山市人民医院诊治的小儿疝患者中，选取年龄1～3岁的患儿共144例进行分析。经济成本分析包括住院费用、手术费用和其他费用三个部分，疗效评价采用质量调整寿命年（QALY）。 结果开放手术组治疗小儿腹股沟疝的平均费用为3918.346元，腹腔镜手术组为4764.809元；开放手术组的QALY为0.345，腹腔镜手术组为0.380；与开放手术相比，腹腔镜手术治疗小儿疝的增量成本效益比为1159.738元/年；敏感性分析得出，对成本效益比（C/E）的影响最大的是器械耗材费，其次是麻醉费和手术费；临界值分析得出，当腹腔镜组术中耗材器械使用费降至912.082元时，2组患者的C/E相当。 结论腹腔镜手术相比开放手术虽然花费更高，但其同时会给患儿带来更大的获益，从分析的结果来看，腹腔镜手术应该作为治疗小儿疝的首选手术方式。

Cost-effectiveness analysis of laparoscopy and open surgery in the treatment of pediatric hernia

ObjectiveOur research compares the cost and benefit of laparoscopy and open surgery in the treatment of pediatric hernia in local area from social perspective. The purpose of our study is to provide the theories for the decision-making of the health insurance department in Meishan, providing the scientific basis for the patients to choose the surgical method according to their own needs. MethodsFrom January 2017 to December 2017, clinical data of 144 children aged from 1 to 3 were analyzed retrospectively. Costs include hospitalization, surgery, and other expenses. And efficacy evaluation is converted into quality- adjusted life years (QALY) gained. ResultsThe average cost of open surgery group was 3918.346 yuan, while laparoscopic group was 4764.809 yuan. The QALY was 0.345 in open surgery group and 0.380 in laparoscopic group. Compared with open surgery, the incremental cost-benefit ratio (ICER) of laparoscopic hernia treatment was 1159.738 yuan/QALY. Sensitivity analysis showed that the cost of equipment was the most influential factor in our study, followed by anesthesia and surgery costs. Criticality analysis showed that the cost-effectiveness ratio (C/E) would be equivalent between the two groups when the costs of equipment fall to 912.082 yuan. ConclusionAlthough laparoscopic surgery is more expensive than open surgery, it is still the preferred surgical choice for pediatric hernia because of the favorable benefits it offers.