舒更葡糖与新斯的明逆转神经肌肉阻滞对住院费用影响的比较

舒更葡糖与新斯的明逆转神经肌肉阻滞对住院费用影响的比较

贵州医科大学     麻醉与心脏电生理课题组

翻译 :  佟睿     编辑 :  严旭    审校 :  曹莹

背景：肌松拮抗剂可促进术后神经肌肉功能的恢复，但药物昂贵。我们评估了舒更葡糖对医院医疗费用的影响。

方法：我们分析了2016至2021年间接受神经肌肉阻滞剂和两种拮抗剂逆转的79474名成年外科患者，以计算直接成本的差异。我们将我们的数据与医疗保健成本和利用项目-全国住院患者样本(HCUP-NIS)的数据进行匹配，以计算以美元计的总成本差异。根据ASA的身体状况和入院状况(门诊手术与住院治疗)定义围手术期风险概况。

结果：根据我们的注册数据分析，使用舒更葡糖与新斯的明相比，直接成本更低(成本降低1.3%；可信区间[CI]为95%，-0.5至-2.2%；P=0.002)。在与HCUP-NIS匹配的队列中，使用舒更葡糖导致总成本降低232美元(95%CI，-376美元至-88 美元；P=0.002)。亚组分析显示，在风险较低的患者中，舒更葡糖可降低总成本1042美元(95%CI，-1198美元至-884美元；P<0.001)。相比之下，在风险较高的患者(ASA≥3和术前住院时间更高)中，使用舒更葡糖增加了620美元的总成本(95%CI，377美元至865美元；P<0.001)。

结论：使用舒更葡糖对医疗费用的影响取决于患者的风险，而患者的风险是基于合并症和入院状态来确定的。我们观察到，在风险较低的患者中医护成本较低，而在严重并发症的住院外科患者中医护成本较高。

原始文献来源 ：  

Luca J. Wachtendorf, Tim M. Tartler, Elena Ahrens, et al. Comparison of the effects of sugammadex versus neostigmine for reversal of neuromuscular block on hospital costs of care. [J]Br J Anae 130 (2): 133-141 (2023), doi: 10.1016/j.bja.2022.10.015. 

Comparison of the effects of sugammadex versus neostigmine for reversal of neuromuscular block on hospital costs of care

Abstract

Background: Sugammadex reversal of neuromuscular block facilitates recovery of neuromuscular function after surgery, but the drug is expensive. We evaluated the effects of sugammadex on hospital costs of care.

Method: We analysed 79 474 adult surgical patients who received neuromuscular blocking agents and reversal from two academic healthcare networks between 2016 and 2021 to calculate differences in direct costs. We matched our data with data from the Healthcare Cost and Utilization Project-National Inpatient Sample (HCUPeNIS) to calculate differences in total costs in US dollars. Perioperative risk profiles were defined based on ASA physical status and admission status (ambulatory surgery vs hospitalisation).

Results: Based on our registry data analysis, administration of sugammadex vs neostigmine was associated with lower direct costs (-1.3% lower costs; 95% confidence interval [CI], -0.5 to -2.2%; P=0.002). In the HCUP-NIS matched cohort, sugammadex use was associated with US$232 lower total costs (95% CI, -US$376 to -US$88; P=0.002). Subgroup analysis revealed that sugammadex was associated with US$1042 lower total costs (95% CI, -US$1198 to -US$884; P<0.001) in patients with lower risk. In contrast, sugammadex was associated with US$620 higher total costs (95% CI, US$377 to US$865; P<0.001) in patients with a higher risk (American Society of Anesthesiologists physical status≥3 and preoperative hospitalisation).

Conclusion: The effects of using sugammadex on costs of care depend on patient risk, defined based on comorbidities and admission status. We observed lower costs of care in patients with lower risk and higher costs of care in hospitalised surgical patients with severe comorbidities.

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