腦下垂體瘤行切除手術之成本效果分析

目的：比較腦下垂體瘤患者行顯微鏡經蝶竇手術及經鼻內視鏡手術治療成本、效果及成本效果分析之差異。方法：以回溯性次級資料分析，資料來源為某醫學中心住院與門診資料，研究對象以2009年至2016年診斷為腦下垂體瘤接受顯微鏡經蝶竇手術或經鼻內視鏡手術切除手術患者，為減少樣本偏差，利用傾向分數配對法，兩組各取104人，以卡方檢定、獨立樣本t檢定方法做統計學上的分析。結果：經鼻內視鏡手術醫療總費用較高，達顯著差異（p＜.0005）。效果分析中住院天數、門診次數、併發症、再開刀與再入院次數皆無顯著差異（p＞.05），但唯有經鼻內視鏡手術手術時間較長，達顯著差異（p＜.0005），手術的增量成本效果比值皆小於三倍國民生產毛額，皆具有成本效益。結論：經鼻內視鏡手術醫療總成本較高，成本達顯著差異，在效果指標中，此手術的效果無顯著差異（p＞.05），成本效果分析中顯微鏡經蝶竇手術具成本效果。

關鍵字

腦下垂體瘤；顯微鏡經蝶竇手術；經鼻內視鏡手術；成本效果分析

並列摘要

Objectives: The purpose of this study was to investigate the cost effectiveness analysis of the surgical treatments for the pituitary tumors, microscopic transsphenoidal pituitary surgery and endoscopic transsphenoidal pituitary surgery. Methods: The study examined the medical records of a southern medical center from 2009 to 2016. The chi-square test and independent t-test were used to describe the variables and analysis of the difference between the two surgeries. In accordance with the propensity score to balance the differences in the distribution of the interference factors in the two groups. Two groups each had 104 people. Then cost the effectiveness evaluation index was used to analyze the cost effectiveness of the two surgical methods. Results: The results of the study were that the total cost of medical surgery for endoscopic sinus surgery was significantly higher than that of microscopic transsphenoidal surgery (p＜.0005), On the other hand, it reveals there were no significant in average hospital stay in days, the number of outpatient visits in the three months, complications, the second operation, hospital readmission were examined by the transsphenoidal surgery and transnasal endoscopic sinus surgery. (P＞.05), but the operative time was significantly higher than that of the endoscopic sinus surgery (P＜.0005). The incremental cost-effectiveness ratio (ICER) of the two modes of operation is less than three times the gross national product (GDP), cost-effectives respective fields. Conclusions: The two surgical methods no significant difference (p＞.05), the cost-effectiveness analysis showed the choice of microscopic transsphenoidal surgery with cost effective.

並列關鍵字

pituitary tumor ； microscopic transsphenoidal pituitary surgery ； endoscopic transnasal pituitary surgery ； cost effectiveness analysis

參考文獻

Gao, Y., Zhong, C., Wang, Y., Xu, S., Guo,Y., Dai, C., ...Jiang, J. (2014). Endoscopic versus microscopic transsphenoidal pituitary adenoma surgery: a meta-analysis. World journal of surgical oncology, 12(1), 94. doi: 10.1186/1477-7819-12-94

Jethwa, P. R., Patel, T. D., Hajart, A. F., Eloy, J. A., Couldwell, W. T., & Liu, J. K. (2016). Cost-Effectiveness Analysis of Microscopic and Endoscopic Transsphenoidal Surgery Versus Medical Therapy in the Management of Microprolactinoma in the United States. World Neurosurgery, 87, 65-76. doi: 10.1016/j.wneu.2015.10.090

Karppinen, A., Kivipelto, L., Vehkavaara, S., Ritvonen, E., Tikkanen, E., Kivisaari, R., ... & Niemelä, M. (2015). Transition from microscopic to endoscopic transsphenoidal surgery for nonfunctional pituitary adenomas. World neurosurgery, 84(1), 48-57. doi: 10.1016/j.wneu.2015.02.024.

McLaughlin, N., Martin, N. A., Upadhyaya, P., Bari, A. A., Buxey, F., Wang, M. B., ... & Bergsneider, M. (2014). Assessing the cost of contemporary pituitary care. Neurosurgical focus, 37(5), E7. doi: 10.3171/2014.8.FOCUS14445

Oosmanally, N., Paul, J. E., Zanation, A. M., Ewend, M. G., Senior, B. A., & Ebert, C. S. (2011). Comparative analysis of cost of endoscopic endonasal minimally invasive and sublabial-transseptal approaches to the pituitary. International Forum Of Allergy & Rhinology, 1(4), 242-249. doi: 10.1002/alr.20048

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腦下垂體瘤行切除手術之成本效果分析

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