[1]杨 锦,陈云玲,郭伟昌,等.泡沫硬化剂与传统手术治疗下肢大隐静脉曲张的卫生经济学比较[J].介入放射学杂志,2020,29(12):1235-1239.
 YANG Jin,CHEN Yunling,GUO Weichang,et al.Health economics of sclerotherapy with foam hardener versus traditional surgery in treating varicosis of great saphenous vein of lower extremities[J].journal interventional radiology,2020,29(12):1235-1239.
点击复制

泡沫硬化剂与传统手术治疗下肢大隐静脉曲张的卫生经济学比较()

PDF下载中关闭

分享到:

《介入放射学杂志》[ISSN:1008-794X/CN:31-1796/R]

卷:
29
期数:
2020年12
页码:
1235-1239
栏目:
临床研究
出版日期:
2020-12-25

文章信息/Info

Title:
Health economics of sclerotherapy with foam hardener versus traditional surgery in treating varicosis of great saphenous vein of lower extremities
作者:
杨 锦 陈云玲 郭伟昌 黄智勇 李昭辉
Author(s):
YANG Jin CHEN Yunling GUO Weichang HUANG Zhiyong LI Zhaohui.
North Sichuan Medical College, Nanchong, Sichuan Province 637000; Department of Vascular Surgery, Yibin Municipal First People’s Hospital, Yibin, Sichuan Province 644000, China
关键词:
【关键词】 下肢大隐静脉曲张 泡沫硬化疗法 大隐静脉高位结扎剥脱术 卫生经济学
文献标志码:
A
摘要:
【摘要】 目的 通过卫生经济学评价方法比较泡沫硬化剂疗法和大隐静脉高位结扎结合点式抽剥术治疗下肢大隐静脉曲张的成本和效果。方法 回顾性分析2017年1月至2018年10月宜宾市第一人民医院收治的120例大隐静脉曲张患者临床资料。根据治疗方式的不同分为泡沫硬化剂组(n=80)和传统手术组(n=40)。对比分析两组临床疗效、直接医疗成本、直接非医疗成本、间接成本和总成本及二次干预费用。结果 泡沫硬化剂组术中出血量、手术时间、术后住院时间、总住院时间及术后并发症均低于传统手术组(P<0.05)。泡沫硬化剂组直接医疗成本比例主要为手术费[(30.30±6.40)%]和药品费[(29.95±8.13)%],手术费显著高于传统手术组[(1 012.66±58.15)元对(823.59±342.43)元](P<0.001),但药品费[(1 132.22±754.89)元对(3 530.60±2 124.67)元]、材料费[(259.93±200.56)元对(1 575.73±507.95)元]、检查检验费[(704.19±212.60)元对(964.39±350.53)元]及治疗费[(460.28±330.45)元对(1 572.10±639.74)元]均显著低于传统手术组(P<0.001);传统手术组直接医疗成本以药品费为主,其比例显著高于泡沫硬化剂组[(38.80±12.18)%对(29.95±8.13)%](P<0.001)。泡沫硬化剂组直接医疗成本、直接非医疗成本、间接成本和总成本均显著低于传统手术组[(3 569.28±1 312.19)元对(8 466.41±2 911.25)元,(226.00±206.93)元对(521.75±219.31)元,(406.06±364.42)元对(914.24±375.16)元,(4 201.34±1 789.95)元对(9 902.40±3 368.38)元](P<0.001)。泡沫硬化剂组术后1年复发率(7.5%)高于传统手术(5%)(P>0.05),但再次干预平均成本显著低于传统手术组[(3 980.80±202.32)元对(11 434.28±481.77)元](P<0.001)。结论 泡沫硬化剂治疗大隐静脉曲张与传统手术相比,可明显降低患者成本,有助于在有限资源下提高社会效益和经济效益,是一种对医院和患者均有很大经济学价值的治疗方式。

参考文献/References:

[1] Oliveira R, Mazzucca A, Pachito D, et al. Evidence for varicose vein treatment: an overview of systematic reviews[J]. Sao Paulo Med, 2018, 136: 324- 332.
[2] 李 龙. 《慢性静脉疾病硬化疗法欧洲指南》解读[J]. 介入放射学杂志, 2016, 25:743- 749.
[3] Barstow C, Kassop D. Cardiovascular disease: chronic venous insu-fficiency and varicose veins[J]. FP Essent, 2019, 479: 16- 20.
[4] 王深明,武日东.中国下肢浅静脉曲张微创治疗的发展现状[J]. 中华普通外科学文献(电子版), 2015, 9:1- 4.
[5] 中华医学会外科学分会血管外科学组. 硬化剂治疗下肢静脉曲张(中国)专家指导意见(2016)[J]. 中国血管外科杂志(电子版), 2017, 9:11- 14.
[6] Tessari L, Cavezzi A, Frullini A. Preliminary experience with a new sclerosing foam in the treatment of varicose veins[J]. Dermatol Surg, 2001, 27: 58- 60.
[7] 朱化刚,邵拥军,周 静, 等. 美国下肢静脉曲张及慢性静脉疾病治疗指南解读[J]. 中华普通外科杂志, 2012, 27:258- 259.
[8] Zhang M, Qiu T, Bu X, et al. A national survey on management of varicose veins in China[J]. J Vasc Surg Venous Lymphat Disord, 2018, 6: 338- 346.
[9] Disselhoff BC, Buskens E, Kelder JC, et al. Randomised comparison of costs and cost- effectiveness of cryostripping and endovenous laser ablation for varicose veins: 2- year results[J]. Eur J Vasc Endovasc Surg, 2009, 37: 357- 363.
[10] Ding J, Mu X, Yuan Y, et al. Therapies of varicose veins: protocol for the reporting and methodological quality of pairwise meta- analyses[J]. Medicine(Baltimore), 2019, 98: e16042.
[11] Shingler S, Robertson L, Boghossian S, et al. Compression stockings for the initial treatment of varicose veins in patients without venous ulceration[J]. Cochrane Database Syst Rev, 2011: CD008819.
[12] Mundy L, Merlin T, Fitridge R, et al. Systematic review of endovenous laser treatment for varicose veins[J]. Br J Surg, 2005, 92: 1189- 1194.
[13] Lurie F, Creton D, Eklof B, et al. Prospective randomized study of endovenous radiofrequency obliteration(closure procedure) versus ligation and stripping in a selected patient population (EVOLVeS Study)[J]. J Vasc Surg, 2003, 38: 207- 214.
[14] Alder G, Lees T. Foam sclerotherapy[J]. Phlebology, 2015, 30: 18- 23.
[15] Guidelines/Outcomes Committee, Drak LA, Dinehart SM, et al. Guidelines of care for sclerotherapy treatment of varicose and telangiectatic leg veins[J]. J Am Acad Dermatol, 1996, 34: 523- 528.
[16] Onida S, Davies AH. Predicted burden of venous disease[J]. Phlebology, 2016, 31: 74- 79.
[17] 王思敏,徐 伟,崔子丹,等. 价值医疗导向的医保支付方式初探——以中美典型按价值付费项目为例[J]. 卫生经济研究, 2019, 36:9- 12.
[18] 李 琦.探析医保支付制度改革对医院管理的影响及应对[J].中国卫生标准管理, 2019, 10:15- 17.
[19] 马 赫, 刘 颖. 三甲医院超长住院日患者分布特征与改进措施研究[J]. 中国校医, 2019, 33:500- 504.
[20] 许 阳, 杨文惠,杜 颖. 岳阳市某医院患者直接医疗费用水平及影响因素研究[J]. 医学与社会, 2019, 32:76- 79.

相似文献/References:

[1]陈昆山,张 靖,申 刚,等.泡沫硬化治疗儿童淋巴管静脉畸形临床效果观察 [J].介入放射学杂志,2018,27(10):971.
 CHEN Kunshan,ZHANG Jing,SHEN Gang,et al.Foam sclerotherapy for lymphatic and venous malformations in children: observation of its clinical effect[J].journal interventional radiology,2018,27(12):971.
[2]牛传强,李海波,刘 浪,等.经皮硬化疗法治疗手部静脉畸形37例[J].介入放射学杂志,2018,27(09):832.
 NIU Chuanqiang,LI Haibo,LIU Lang,et al.Percutaneous sclerotherapy for the treatment of venous malformations of hand: clinical results in 37 patients[J].journal interventional radiology,2018,27(12):832.
[3]刘正立,何 旭,顾建平,等.X线透视导引下经皮大隐静脉高位缝扎结合泡沫硬化治疗原发性大隐静脉曲张113例效果分析[J].介入放射学杂志,2022,31(05):455.
 LIU Zhengli,HE Xu,GU Jianping,et al.Fluoroscopy-guided percutaneous high ligation of great saphenous vein combined with foam sclerotherapy for primary great saphenous varicose: analysis of its clinical efficacy in 113 patients[J].journal interventional radiology,2022,31(12):455.

备注/Memo

备注/Memo:
(收稿日期:2019- 12- 02)
(本文编辑:边 佶)
更新日期/Last Update: 2020-12-16