儿童面部色素痣分期切除对比一期切除的成本-效果分析

目的 从临床及卫生经济学的角度评价儿童面部先天性色素痣一期切除手术和分期切除手术的效果,并进行成本-效果分析。 方法 回顾性分析2018年6月至2019年6月就诊于山东省立医院整形美容外科的面部先天性色素痣患儿的临床资料58例,按照手术方式将患儿分成一期切除组(30例)和分期切除组(28例)。收集术后6个月刀口瘢痕的长度、宽度和面积以评估手术效果,收集两组的直接成本和间接成本。应用增量成本效果比值(ICER)进行成本-效果分析。 结果 两组患者均顺利完成手术,一期切除组和分期切除组所产生的总治疗成本分别为7 824.52(6 620.51,8 445.64)元和14 769.99(13 971.52,14 769.99)元,分期切除组明显高于一期切除组(P<0.001)。术后瘢痕面积与术前色素痣面积相比,一期切除组减少0.29(0.10,0.79)cm²,分期切除组减少0.95(0.29,2.59)cm²,分期切除组明显高于一期切除组(P=0.02)。增量成本效果分析显示,一期切除组患者病损面积每减少1 cm²需花费26 981.10元,分期切除组病损面积每减少1 cm²需花费15 547.36元。 结论 分期切除面部先天性色素痣相比于一期切除,术后不额外增加瘢痕长度,而且在处理较宽的病损时,也不增加瘢痕宽度。分期切除虽然会给患者增加额外的成本,但是分期切除仍是一种ICER更优的手术治疗色素痣的方案。

Cost-effectiveness analysis of staged excision compared with one-stage excision of facial pigmented nevus in children

Objective To compare the clinical effectiveness of one-stage excision and staged excision in children with congenital facial nevus by using clinical health economics evaluation method and to evaluate their cost-effectiveness. Methods A retrospective analysis was performed on the clinical data of 58 children with congenital facial nevus who visited Shandong Provincial Hospital from June 2018 to June 2019. The patients were divided into one-stage excision group(n=30)and staged excision group(n=28)according to the surgical operation. The length, width and area of the scar six months after the surgery were collected to evaluate the effectiveness of the surgery. The direct, indirect costs of two groups were also collected. Cost-effectiveness was analyzed using incremental cost-effectiveness ratio(ICER). Results All the patients completed the operation successfully. The total cost of the staged excision group was significantly higher than that of the one-stage excision group ［14 769.99(13 971.52,14 769.99)yuan vs 7 824.52(6 620.51,8 445.64)yuan, P<0.001］. The postoperative area reduction of the scar in the staged excision group was 0.95(0.29,2.59)cm², which was higher than that in the one-staged group ［0.29(0.1,0.79)cm²; P=0.02］. The ICER analysis indicated that the patients in one-stage excision group spent 26 981.10 yuan for 1 cm² area reduction and the patients in staged excision group spent 15 547.36 yuan for 1 cm² area reduction. Conclusion Compared with the one-stage excision, the staged excision of congenital pigmented nevus on the face does not increase the length and width of the scar after the operation even for the wider lesions. Although staged excision increases extra costs for the patient, but it is still a better surgical treatment of pigmented nevi with a better ICER.