RESUMO
In the last decade, there have clearly been important changes in the surgical approach of gastric cancer treatment due to an increased interest in the minimally invasive surgical approach (MIS). The higher cost of robotic surgery procedures remains an important issue of debate. The objective of the study is to compare the main operative and clinical outcomes and to assess the incremental cost-effectiveness ratios (ICERs) of the two techniques. This is a prospective cost-effectiveness and clinical study when comparing the robotic gastrectomy (RG) technique with open gastrectomy (OG) in gastric cancer. Outcome parameters included surgical and post-operative costs, quality-adjusted life years (QALY) and incremental cost per QALY gained or the incremental cost-effectiveness ratio (ICER). The incremental utility was 0.038 QALYs and the estimated ICER for patients was dominated by robotic approach. The probability that the robotic approach was cost effective was 94.04% and 94.20%, respectively, at a WTP threshold of 20,000 and 30,000 per QALY gained. RG for gastric cancer represents a cost-effective procedure compared with the standard OG.
Assuntos
Análise Custo-Benefício , Gastrectomia/economia , Gastrectomia/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/economia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Robóticos/economia , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias Gástricas/cirurgia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Anos de Vida Ajustados por Qualidade de Vida , Resultado do TratamentoRESUMO
The application of Tenax to the extraction of organic micro-pollutants such as pesticides and polychlorobiphenyls from waters has been studied, and it has been observed that also in the presence of other pollutants (oil, surface-active substances, etc.) the results obtained with an absorption column of Tenax-Celite are equivalent to those obtained with the continuous liquid-liquid extraction technique. For natural waters that contain solids in suspension that adsorb pesticides, it may be necessary to filter the water before extraction with Tenax and then to extract the suspended solids separately. Analyses of river and estuarine sea waters, filtered before extraction, showed the effectiveness of Tenax, and the extracts obtained for the pesticides analysis prove to be much less contaminated by interfering substances than the corresponding extracts obtained by the liquid-liquid technique.