OBJECTIVES The general anesthetic sevoflurane is being repurposed as a topical analgesic for painful chronic wounds. We conducted a Bayesian cost-effectiveness analysis (CEA) comparing the addition of domiciliary topical sevoflurane to conventional analgesics (SEVOFLURANE, n = 38) versus conventional analgesics alone (CONVENTIONAL, n = 26) for the treatment of nonrevascularizable painful leg ulcers in an outpatient Pain Clinic of a Spanish tertiary hospital. METHODS We used real-world data collected from charts to conduct this CEA from a public healthcare perspective and with a one-year time horizon. Costs of analgesics, visits and admissions were considered, expressed in €2016. Analgesic effectiveness was measured with SPID (Sum of Pain Intensity Difference). A Bayesian regression model was constructed, including "treatment" and baseline characteristics for patients ("arterial hypertension") and ulcers ("duration", "number", "depth", "pain") as covariates. The findings were summarized as a cost-effectiveness plane and a cost-effectiveness acceptability curve. One-way sensitivity analyses, a re-analysis excluding those patients who died or suffered from leg amputation, and an extreme scenario analysis were conducted to reduce uncertainty. RESULTS Compared to CONVENTIONAL, SEVOFLURANE was associated with a 46% reduction in costs, and the mean incremental effectiveness (28.15±3.70 effectiveness units) was favorable to SEVOFLURANE. The estimated probability for SEVOFLURANE being dominant was 99%. The regression model showed that costs were barely influenced by any covariate, whereas effectiveness was noticeably influenced by "treatment". All sensitivity analyses showed the robustness of the model, even in the extreme scenario analysis against SEVOFLURANE. CONCLUSIONS SEVOFLURANE was dominant over CONVENTIONAL as it was less expensive and much more effective.

中文翻译：

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局部外用七氟醚治疗疼痛性腿部溃疡的成本效益分析。

目标 全身麻醉剂七氟醚被重新用作慢性疼痛伤口的局部镇痛剂。我们进行了贝叶斯成本效益分析 (CEA)，比较了在常规镇痛药（SEVOFLURANE，n = 38）与单独使用常规镇痛药（CONVENTIONAL，n = 26）的基础上添加家庭外用七氟醚治疗门诊患者不可血管重建的疼痛性腿部溃疡西班牙三级医院疼痛门诊。方法 我们使用从图表中收集的真实世界数据，从公共医疗保健的角度和一年的时间范围内进行 CEA。考虑了镇痛剂、就诊和入院的费用，以 2016 年欧元表示。镇痛效果用 SPID（疼痛强度差异总和）测量。构建了贝叶斯回归模型，包括“治疗” 患者的基线特征（“动脉高血压”）和溃疡（“持续时间”、“数量”、“深度”、“疼痛”）作为协变量。研究结果概括为成本效益平面和成本效益可接受曲线。进行了单向敏感性分析、排除那些死亡或腿部截肢患者的重新分析以及极端情景分析，以减少不确定性。结果 与传统药物相比，七氟醚的成本降低了 46%，并且平均增量有效性（28.15±3.70 个有效性单位）有利于七氟醚。七氟醚占优势的估计概率为 99%。回归模型显示成本几乎不受任何协变量的影响，而有效性明显受到“治疗”的影响。所有敏感性分析都显示了模型的稳健性，即使在针对七氟醚的极端情景分析中也是如此。结论七氟醚比传统药物占优势，因为它更便宜且更有效。