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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Surg. 1995;109:106-19.
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invasive: uniportal video-assisted thoracic surgery.
Semin Thorac Cardiovasc Surg. 2014;26:249-54.
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HA. Bronchoscopic Lung Volume Reduction Coil
treatment of patients with severe heterogeneous
emphysema. Chest. 2012;142:574-82.
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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