ABSTRACT

Background: Three-dimensional anatomic models have been used for surgical planning and simulation in pediatric congenital heart surgery. This research is the first to evaluate the potential cost-effectiveness of 3D anatomic models with the intent to guide surgeons and decision makers on its use.

Method: A decision tree and subsequent Markov model with a 15-year time horizon was constructed and analyzed for nine cardiovascular surgeries. Epidemiological, clinical, and economic data were derived from databases. Literature and experts were consulted to close data gaps. Scenario, one-way, threshold, and probabilistic sensitivity analysis captured methodological and parameter uncertainty.

Results: Incremental costs of using anatomical models ranged from −366€ (95% credibility interval: −2595€; 1049€) in the Norwood operation to 1485€ (95% CI: 1206€; 1792€) in atrial septal defect repair. Incremental health-benefits ranged from negligible in atrial septal defect repair to 0.54 Quality Adjusted Life Years (95% CI: 0.06; 1.43) in truncus arteriosus repair. Variability in the results was mainly caused by a temporary postoperative quality-adjusted life years gain.

Conclusion: For complex operations, the implementation of anatomic models is likely to be cost-effective on a 15 year time horizon. For the right indication, these models thus provide a clinical advantage at an acceptable cost.

摘要

背景：三维解剖模型已被用于小儿先天性心脏手术的手术计划和模拟。这项研究首次评估了 3D 解剖模型的潜在成本效益，旨在指导外科医生和决策者使用它。

方法：构建并分析了九个心血管手术的决策树和随后的具有 15 年时间范围的马尔可夫模型。流行病学、临床和经济数据来自数据库。查阅文献和专家以缩小数据差距。情景、单向、阈值和概率敏感性分析捕获了方法论和参数的不确定性。

结果：使用解剖模型的增量成本从 Norwood 手术的 -366 欧元（95% 可信区间：-2595 欧元；1049 欧元）到房间隔缺损修复的 1485 欧元（95% CI：1206 欧元；1792 欧元）不等。增加的健康益处范围从房间隔缺损修复中可以忽略不计，到动脉干修复中 0.54 质量调整生命年（95% CI：0.06；1.43）。结果的可变性主要是由暂时的术后质量调整生命年增加引起的。

结论：对于复杂的手术，解剖模型的实施在 15 年的时间范围内可能具有成本效益。对于正确的适应症，这些模型因此以可接受的成本提供临床优势。