Amfizem tedavisinde farklı volüm küçültücü tedavi metodlarının maliyet analizlerinin tek merkezli karşılaştırması

Amaç: Amfizem hastalarında volüm küçültme amacıyla uygulanan endobronşial valf, endobronşial coil uygulaması ve volüm küçültücü cerrahi yöntemlerinin işlem öncesi ve işlem sonrası bir yıllık süreçteki maliyet analizleri yapılarak, birbirleri ile karşılaştırması amaçlandı.Gereç ve Yönem: Hastanemizde amfizem nedeni ile endobronşial valf uygulanan 11, endobronşial Coil uygulanan 9 ve volüm küçültücü cerrahi uygulanan 7 hastanın prosedürden önceki bir yıl, prosedür ve prosedür sonrası 1 yıllık süreçte ki tüm hastane maliyetleri, solunum fonksiyon testi ve 6 dakika yürüme testi sonucu verileri hastanemiz veri tabanından girilerek elde edildi. Bulgular: Araştırma grubunun tamamı 27 hasta olup, yaş aralığı 40-72, median yaş 57, yaş ortalaması 57.1 ± standart sapması 8.8 yıldır. valf, coil ve volüm küçültücü cerrahi müdahale sonrasında Amfizem hastalarının; SFT FEV1% değerlerinde sırasıyla %54.0, 44.4 ve 24.6 (total %41.1) artış, 6 MWT değerlerinde sırasıyla %85.7, 78.7 ve 34.1 (total %69.8) artış görülmüştür. Amfizem hastalarına yapılan müdahalelerin maliyeti incelendiğinde, Valf (12943.6 $) ve Coil (11328.9 $)’in Volüm Küçültücü cerrahi (2444.3 $) yönteme göre yaklaşık 5 kat daha pahalı olduğu görülmüştür. Sonuç: İşlem maliyeti olarak en ekonomik metod volüm küçültücü cerrahidir.

A single center comparison of cost analyses of different volume reduction therapy methods in the treatment of emphysema

Purpose: The aim of this study was to evaluate and compare preoperative and postoperative one year-cost analyses of endobronchial valve and enbronchial coil practices and volume-reduction surgical methods applied for the purpose of reducing volume in the patients with emphysema. Material and Methods: All the data regarding the one-year-preoperative and postoperative hospital costs of the patients in our hospital, 11 of whom received an endobronchial valve, 9 of whom received an endobronchial coil and 7 of whom underwent a volume reduction-surgery due to emphysema, were obtained along with the data of the respiratory function test and  6-minute walking test results by accessing into the database of our hospital. Results: The entire research group consisted of 27 patients. Following valve and coil and the volume reduction-surgical intervention, there had been an increase in SFT FEV1% values of the patients with emphysema by 54.0%, 44.4% and 24.6%, respectively, whereas another increase was observed in their six-minute walking distances values by 85.7%, 78.7% and 34.1%, respectively. When the costs of the interventions on emphysema were analyzed, valve ($12943.6) and coil ($11328.9) practices were seen to be almost 5 times more costly than the Volume-reduction surgical treatment ($2444.3). Conclusions: The most economical method in terms of transaction costs is the volume-reduction surgery. 

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  • 11. Zeltsman D. Current readings: Redefining minimally invasive: uniportal video-assisted thoracic surgery. Semin Thorac Cardiovasc Surg. 2014;26:249-54.
  • 12. Slebos DJ, Klooster K, Ernst A, Herth FJ, Kerstjens HA. Bronchoscopic Lung Volume Reduction Coil treatment of patients with severe heterogeneous emphysema. Chest. 2012;142:574-82.
  • 13. Venuta F, Anile M, Diso D, Carillo C, De Giacomo T, D'Andrilli A et al. Long-term follow-up after bronchoscopic lung volume reduction in patients with emphysema. Eur Respir J. 2012;39:1084-9.
  • 14. Ramsey SD, Berry K, Etzioni R, Kaplan RM, Sullivan SD, Wood DE. Cost effectiveness of lung 1. Vestbo J, Hurd SS, Agustí AG, Jones PW, Vogelmeier C, Anzueto A et Al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease GOLD executive summary. Am J Respir Crit Care Med. 2013;187:347-65.
  • 2. Mannino DM, Buist AS. Global burden of COPD: risk factors, prevalence, and future trends. Lancet. 2007;370: 765-73.
  • 3. Ambrosino N, Simonds A. The clinical management in extremely severe COPD. Respir Med. 2007;101:1613-24.
  • 4. Fishman A, Martinez F, Naunheim K, Piantadosi S, Wise R, Ries A et al. National Emphysema Treatment Trial Research Group. A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema. N Engl J Med. 2003;348:2059-73.
  • 5. Naunheim KS, Wood DE, Krasna MJ, DeCamp MM Jr, Ginsburg ME, et el. National Emphysema Treatment Trial Research Group. Predictors of operative mortality and cardiopulmonary morbidity in the National Emphysema Treatment Trial. J Thorac Cardiovasc Surg. 2006;13:43–53.
  • 6. Gompelmann D, Eberhardt R, Herth FJF. Endoscopic lung volume reduction. A European perspective. Ann Am Thorac Soc. 2013;10:657–66.
  • 7. Herth FJF, Eberhardt R, Gompelmann D, Ficker JH, Wagner M, Ek L et al. Radiological and clinical outcomes of using ChartisTM to plan endobronc ial valve Treatment. Eur Respir J. 2013;41:302–08. 8. Brantigen OC, Mueller E, Kress MB. A surgical approach to pulmonary emphysema. Am Rev Respir Dis. 1959;80:194-206.
  • 9. Snider GL. Reduction pneumoplasty for giant bullous emphysema: implications for surgical treatment of nonbullous emphysema. Chest 1996;109:540-8.
  • 10. Cooper JD, Trulock EP, Triantafillou AN, Patterson GA, Pohl MS, Deloney PA et al. Bilateral pneumectomy (volume reduction) for chronic obstructive pulmonary disease. J Thorac Cardiovasc Surg. 1995;109:106-19.
  • 11. Zeltsman D. Current readings: Redefining minimally invasive: uniportal video-assisted thoracic surgery. Semin Thorac Cardiovasc Surg. 2014;26:249-54.
  • 12. Slebos DJ, Klooster K, Ernst A, Herth FJ, Kerstjens HA. Bronchoscopic Lung Volume Reduction Coil treatment of patients with severe heterogeneous emphysema. Chest. 2012;142:574-82.
  • 13. Venuta F, Anile M, Diso D, Carillo C, De Giacomo T, D'Andrilli A et al. Long-term follow-up after bronchoscopic lung volume reduction in patients with emphysema. Eur Respir J. 2012;39:1084-9.
  • 14. Ramsey SD, Berry K, Etzioni R, Kaplan RM, Sullivan SD, Wood DE. Cost effectiveness of lung