Cirugía de las hernias: efectividad y coste para el sostenimiento del sistema sanitario / Hernia surgery: effectiveness and cost for the maintenance of the health system

Resumen Introducción: Las hernias son patologías muy frecuentes en un Servicio de Cirugía General (SCG); su tratamiento y costes son muy diferentes, dependiendo del cirujano, si hay hospitalización (CH) o cirugía mayor ambulatoria (CMA). Objetivo principal es el estudio de costes-resultados y de coste-efectividad de las hernias de pared abdominal (no pericolostómicas) realizadas por el SCG. Materiales y Método: Estudio descriptivo, longitudinal, observacional y retrospectivo. Intervenidas 370 hernias de pared abdominal, del 1 de octubre de 2015 al 30 de septiembre de 2016; seguimiento postquirúrgico hasta el 30 de octubre 2016 (1 a 12 meses). Resultados: 79,4% varones, media 59,95 años, 51,90% ASA II, 55,8% anestesia local, 59,72% hernias inguinales, 36,94% hernias inguinales unilaterales indirectas, 55,17 minutos por intervención, 54,44% por CMA, 4,77 días de estancia media en ingresados. Complicaciones perioperatorias 2,3%, tempranas 4,8% (5 reintervenciones) y tardías 12,8% (3 reintervenciones por recidiva). Altas 95,41%, tiempo medio 6,59 semanas. Coste de material de 109,87 € (hernia inguinal simple) hasta 370,41 € (eventración). Coste mediana quirófano 338,80 €. Coste/día CMA 807,30 € y con ingreso 1056,03 €. Mediana coste de hernia inguinal simple 422,69 € y de eventración 709,89 €. Mediana coste por complicación de hernia inguinal 1405,81 € y de eventración 8350,88 €. Mediana coste por proceso con CMA 1213,98 € y con ingreso 3689,80 €. Conclusión: Intervenciones de hernia inguinal unilateral simple, crural y umbilical, con técnica libre de tensión, material protésico, sin drenaje, CMA, anestesia local (con/sin sedación) y sin complicaciones resultan las más coste-efectivas (mejor relación coste-benefcio y coste-efectividad).

Introduction: Hernias are very frequent pathologies in a General Surgery Service (GSS); its treatment and costs are very different, depending on the surgeon, if there is admission (SH) or major outpatient surgery (MOS). A) Main objective. Study costs of (non-pericolostomic) abdominal wall hernia surgical procedures in the GSC (cost-outcome ratio and the cost-efectiveness). Materials and Method: Descriptive, longitudinal, observational and retrospective study. Abdominal wall hernias treated between 1st October, 2015 and 30th September, 2016; after surgery follow up until 30th October, 2016 (1 to 12 months). In total 370 hernia surgeries were performed. Results: 79.4% of males, mean 59.95 years, 51.90% of ASA II, 55.8% local anesthesia, 59.72% inguinal hernias, 36.94% indirect unilateral inguinal hernias, 55.17 minutes for surgeon, 54.44% for MOS, 4.77 days of average stay in admitted patients. Perioperative complications 2.3%, early 4.8% (with 5 reoperations) and late 12.8% (3 reinterventions due to relapse). 95.41% discharge, mean time 6.59 weeks. Material costs vary from €109.87 (simple inguinal hernia) to €370.41 (eventrations). Median surgery room cost €338.80. Cost/day MOS €807.30 and with income €1056.03. Median cost of simple inguinal hernia €422.69 and eventration €709.89. Median cost due to inguinal hernia complication €1405.81 and eventration €8350.88. Median cost per process MOS € 1213.98 and that of SH €3689.80. Conclusion: The interventions of simple unilateral inguinal hernia, crural and umbilical, using a tension-free technique, prosthetic material, without drainage, MOS, local anesthesia (with/without sedation) and without complications are the most cost-efective (better cost-beneft and cost-efectiveness ratio).

Costo-efectividad de la ketanserina vs sulfadiazina de plata micronizada ehn el paciente con pie diabético / Cost-effectiveness of the ketanserin vs sulfadiazine on the patient with diabetic foot

Objetivo. Determinar el costo-efectividad de la ketanserina vs sulfadiazina en el paciente con pie diabético. Material y método. Estudio de costo efectividad en pacientes con pie diabético, se integraron dos grupos, los manejados con ketanserina (n=50) y los manejados con sulfadiazina (n=30), se incluyeron a todos los que acudieron al servicio. El costo contempló los insumos para la curación y el medicamento. La efectividad se midió con la reducción de la lesión medida en centímetros y el porcentaje de pacientes curados. Se realizó análisis incremental. Resultados. El costo del centímetro cuadrado de curación en ketanserina es de $22,43 US y en sulfadiazina $120,44 US. La proyección del costo a 5000 pacientes con una lesión de 10 centímetros es $1.121.651 US en ketanserina y $6.021.787 US en sulfadiazina de plata. Conclusión. En el manejo del pie diabético la relación costo-efectividad de la ketanserina es mejor que la sulfadiazina.

Objective. Determine the cost-efectiveness of the ketanserin vs. sulfadiazine on the patient with diabetic foot. Methodology. Study of the cost efectiveness on patients with diabetic foot, there were integrated two groups; the ones managed with ketanserin (n=50), and the ones managed with sulfadiazine (n=30), all that came to the service were included. Te cost contemplates the inputs for the cure and the medication. Te efectiveness was measured with the reduction of the injury measured in centimeters and the cured patient’s percent. Sensitivity and incremental analysis was performed. Results. Te cost of square centimeter of healing in ketanserin is $22.43 US and in the sulfadiazine $120.44 US. Te cost of 5000 patients whit an 10 centimeter injury is $1,121,651 US in ketanserin and $6,021,787 US in sulfadiazine. Conclusion. Te relation cost-efectiveness of the ketanserin is better than the sulfadiazine one in the management of the diabetic foot.

Cost-effectiveness analysis on Imipenem-Cilastatin Sodium and Meropenem for severe infection / 中国综合临床

Objective To evaluate the economic effects of Imipenem-Cilastatin Sodium and Meropenem for severe infection.Methods The therapeutic effects and costs of the two therapeutic schemes for severe infection were evaluated by using cost-minimization analysis.Results The total effective rates of Imipenemcilastatin group and Meropenem group in the treatment severe infection were 93.33％ (28/30) and 85.71％ (24/28),the difference were not statistically significant (x2 =4.89,P =0.082).The cost-effectiveness ratio (C/E) were 40.35 and 71.69 respectively.The cost of every unit increment of effectiveness for Meropenem group were 312.16 Yuan,more than that of the Imipenem-cilastatin group.Conclusion Cost-effectiveness ratio of Imipenem-cilastatin is superior to that of Meropenem,and Imipenem-cilastatin has obvious pharmacoeconomics advantage over Meropenem for severe infections.

On the Medical Fees Review

With remarkable advances in medicine, the total bill of health care expenditure in Korea continues to rise at an ever increasing rate. Under the health insurance, however, to provide the appropriate medical care in limited resources and finite economy, efficient ways of approach to medical services are needed. One of them is to weigh the justification of sophisticated application of medical practice, taking into consideration both cost and effectiveness. Sice medical services have indispensable relation to health insurance, both sides should try to make good companion in order to accomplish the ultimate goal of health improvement and everythhing about health insurance. Especially the basic principles of medical fees review must be kept in mind.