Dissertation > Excellent graduate degree dissertation topics show

Health Economic Assessment on ERCP and Open Abdomen Operation in Treating Common Bile Duct Stone

Author: BaiXue
Tutor: TianWenHua；LiuFeng
School: Second Military Medical University
Course: Social Medicine and Health Management
Keywords: ERCP Common bile duct stones Laparotomy Quality of Life Cost - utility analysis
CLC: R657.4
Type: Master's thesis
Year: 2011
Downloads: 83
Quote: 0
Read: Download Dissertation

Abstract

Objective: With the start of the health care reform, the demand for medical services not only concerned about its effectiveness and safety, and more and more concerned about the economy. ERCP has been recognized as efficient, safe surgical treatment of choledocholithiasis. Endoscopic lithotripsy for common bile duct stones, was also more widely promote the application. The subject in the country for the first time ERCP treatment choledocholith and Health Economics, a prospective non-randomized study, aimed at establishing biliary disease surgical treatment costs cost - utility analysis method, comparative analysis of common bile duct stones ERCP stone surgery and laparotomy lithotomy evaluation of quality of life and health economic costs - utility value; prompted the hospital to ensure the quality of medical care, science and design of the common bile duct stone disease treatment program, the reasonable control of the medical expenses of the same disease, different patients with individualized treatment programs achieve a satisfactory outcome; same time can be extended to the treatment of other diseases, cost control, providing an important reference for government hospitals and health care costs reasonable compensation. Methods: The main subject of the quality of life scale research-based, cost - utility analysis methods in the study of health economics research and analysis. 1 Quality of Life in a tertiary level hospital in May 2010 to January 2011, the diagnosis of common bile duct stones and in accordance with the conditions of this study (two groups of patients with similar age, sex ratio, ASA physical status without significant difference; major acquisition evaluation indicators, including the duration of hospitalization, marital status, level of education, medical expenses Payment of 13) of the 216 patients with its stone surgery is divided into the ERCP group of (135) and laparotomy group (81 name). All patients were in the time of diagnosis, diagnosed after 6 weeks (after surgery), application GIQLI digestive disease quality of life scale and quality of life assessment. 2 weeks after surgery, 21 patients were lost to follow-total of 25 patients were lost to follow in the first six weeks after surgery, the total effective rate of 88.4%. Fee collection methods direct medical costs for patients during hospitalization is divided into six parts: ① drugs; ② check fee: Radiation testing (laboratory), special examination, endoscopy, X-ray fees, ECG cardiac function, etc. ; (3) treatment costs: including hospital expenses, medical fees, nursing care, blood transfusions, dressing fee, at their own expense materials, treatment of the sick room, materials, etc.; the ④ surgery: anesthesia fees, hand material fee, surgical fee, ECG, oxygen, etc.; ⑤ bed fee; ⑥: including meals. Indirect cost refers to the economic losses caused by the disease to the community, including patients and relatives' families during his illness, loss of the value of labor, calculated using the present value method. Patients of the indirect costs can not be accurately quantified, so the cost of parts only temporarily take the direct medical costs of patients during hospitalization calculated. 3. Costs - the utility analysis the quantitative indicators applications GIQLI digestion disease quality of life index. Evaluation of quality of life, and to compare the results of the two groups of patients; hospital days and hospital costs are also comparable. Stepwise multiple regression analysis of their impact factors. Finally, using the indirect measurement scale score conversion utility value for the cost - utility analysis to make the economics assessment. Results: 1. Survival the quality comparison ERCP group: the mean preoperative GIQLI index to 103.0 points, after two weeks the average GIQLI index was 113.4 points, six weeks after the average GIQLI index was 120.7 points; laparotomy group: preoperative the average GIQLI index 99.7 points, after 2 weeks the average GIQLI index was 107.2 points, six weeks after the average GIQLI index was 116.9 points; the average hospitalization time comparing ERCP group: the average length of stay (8.8 ± 6.5) days; laparotomy group: average hospitalization time (13.9 ± 6.7) days; average hospital cost comparison ERCP group: average hospital costs of $ (22460.8 ± 13015.8); laparotomy group: average hospital costs of $ (22915.9 ± 9469.2); 4. costs - Utility ( CUR) and incremental cost - utility (ICUR) compare ERCP group: CUR1 = 27,192.89 ICUR1 = 203,008.28; laparotomy group: CUR2 to 28,250.09 ICUR2 = 243,138.99. Conclusion: 1. Incision with traditional laparotomy the common bile duct lithotomy compared with ERCP common bile duct lithotomy more conducive to improve the quality of life of patients. With ERCP common bile duct lithotomy than traditional laparotomy the common bile duct the cut stone surgery costs low, significantly shorten the average length of stay. Cost - utility analysis methods established in this topic can easily calculate the utility value of the cost of the two surgical options, common bile duct lithotomy with ERCP patients than open common bile duct lithotomy lower hospital costs, postoperative recovery faster, the better.

Related Dissertations

CLC: > Medicine, health > Surgery > Of surgery > Abdominal surgery > Gallbladder, bile duct
© 2012 www.DissertationTopic.Net Mobile