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中华结直肠疾病电子杂志 ›› 2024, Vol. 13 ›› Issue (04) : 280 -287. doi: 10.3877/cma.j.issn.2095-3224.2024.04.003

论著

Changhai-AL-Prediction预测模型指导预防性造口合理实施的卫生经济学研究
周璐1, 温镕博1, 刘子璇1, 李奕飏1, 周乐其1, 朱晓明1, 龚海峰1, 高显华1, 楼征1, 刘连杰1, 郝立强1, 于冠宇1,(), 张卫1,()   
  1. 1. 200433 上海,海军军医大学第一附属医院(上海长海医院)肛肠外科
  • 收稿日期:2024-05-21 出版日期:2024-08-25
  • 通信作者: 于冠宇, 张卫
  • 基金资助:
    国家自然科学基金项目(82072750); 上海市卫健委临床研究专项(20224Y0348)

Health economics research of Changhai-AL-Prediction model to guide rational implementation of protective ostomy

Lu Zhou1, Rongbo Wen1, Zixuan Liu1, Yiyang Li1, Leqi Zhou1, Xiaoming Zhu1, Haifeng Gong1, Xianhua Gao1, Zheng Lou1, Lianjie Liu1, Liqiang Hao1, Guanyu Yu1,(), Wei Zhang1,()   

  1. 1. Department of Colorectal Surgery, Changhai Hospital, Naval Medical University, Shanghai 200433, China
  • Received:2024-05-21 Published:2024-08-25
  • Corresponding author: Guanyu Yu, Wei Zhang
引用本文:

周璐, 温镕博, 刘子璇, 李奕飏, 周乐其, 朱晓明, 龚海峰, 高显华, 楼征, 刘连杰, 郝立强, 于冠宇, 张卫. Changhai-AL-Prediction预测模型指导预防性造口合理实施的卫生经济学研究[J]. 中华结直肠疾病电子杂志, 2024, 13(04): 280-287.

Lu Zhou, Rongbo Wen, Zixuan Liu, Yiyang Li, Leqi Zhou, Xiaoming Zhu, Haifeng Gong, Xianhua Gao, Zheng Lou, Lianjie Liu, Liqiang Hao, Guanyu Yu, Wei Zhang. Health economics research of Changhai-AL-Prediction model to guide rational implementation of protective ostomy[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2024, 13(04): 280-287.

目的

开展Changhai-AL-Prediction与术者决策下的预防性造口方案的卫生经济学评价,为术者合理制定预防性造口方案提供参考。

方法

前瞻性收集2023年6月至2023年12月海军军医大学第一附属医院确诊为直肠腺癌且行直肠癌低位前切除术的患者200例,用Changhai-AL-Prediction预测模型模拟决策预防性造口方案并与实际的术者决策的预防性造口方案进行比较,构建决策树模型进行成本效果分析。

结果

术者决策组的期望成本为8 639 053.19元,Changhai-AL-Prediction预测模型决策组的期望成本为7 133 715.92元。术者决策组的决策准确率为36.5%,模型决策组的准确率为70.0%。增量成本效果比为-44 935.44。以200例患者为基准,即Changhai-AL-Prediction预测模型组每提升1%的预测准确率所需成本比术者决策组少花费44 935.44元。

结论

Changhai-AL-Prediction预测模型决策方案相较于术者决策方案可以做出更为精准的预防性造口决策,且更具有经济学优势。

Objective

To carry out the health economic evaluation between Changhai-AL-Prediction model after anterior resection for rectal cancer and the operator's decision-making preventive stoma plan in order to provide a best preventive stoma plan.

Methods

A prospective investigation of 200 rectal adenocarcinoma patients with low anterior resection in the First Affiliated Hospital of Naval Medical University was carried out from June 2023 to December 2023. The therapeutic effects of the two groups were compared and a decision tree model was constructed for cost-effectiveness analysis.

Results

The expected cost for the surgeon's decision-making group was 8 639 053.19 RMB, and the expected cost for the Changhai-AL-Prediction model after anterior resection for rectal cancer group was 7 133 715.92 RMB. The decision accuracy of the operator decision-making group is 36.5%, and the accuracy of the model decision-making group is 70.0%. The incremental cost-effectiveness ratio is -44 935.44. The cost of the model group is 44 935.44 RMB less than that of the surgeon's decision-making group for every 1% improvement in prediction accuracy.

Conclusion

Changhai-AL-Prediction model after anterior resection for rectal cancer can make more accurate preventive stoma decisions and has more economic advantages than the operator's decision plan.

表1 不同吻合口漏预测模型的预测效果
表2 200例患者的基线特征
表3 200例患者的预测指标
表4 术者决策及实际临床结果(%)
表5 Changhai-AL-Prediction模型预测及实际临床结果(%)
图1 术者决策下预防性造口的决策树模型
图2 Changhai-AL-Prediction预测模型模拟决策下预防性造口的决策树模型
表6 术者决策下决策树模型数据分析
表7 Changhai-AL-Prediction预测模型决策下数据分析
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