BACKGROUND The aim of this study was to simulate and compare the healthcare and economic outcomes associated with routine use of intraoperative transoesophageal echocardiography (TOE) in patients undergoing cardiac surgery with those associated with a scenario where TOE is not routinely used. METHODS The impact of TOE on surgical decision-making was estimated through a systematic literature review. Individual short-term morbidity and mortality estimates were generated by application of the Society of Thoracic Surgeons risk calculator. Long-term event rates, unit costs, and utility weights were sourced from published literature and expert opinion. A discrete-event simulation model was then constructed to simulate both the in-hospital and post-discharge outcomes for patients undergoing cardiac surgery. Robustness of the base case results was examined through deterministic and probabilistic sensitivity analyses. An incremental cost-effectiveness ratio of €30 000 per quality-adjusted life-year gained was assumed to represent acceptable cost-effectiveness. RESULTS Routine use of intraoperative TOE was associated with lower costs and higher benefits per patient, which indicates that use of TOE is a dominant strategy. The intervention resulted in the avoidance of 299 cardiac complications, 20 strokes, and 11 all-cause deaths per 10 000 patients. Routine intraoperative TOE was associated with an increased occurrence of bleeding owing to more valvular surgery and subsequent long-term anticoagulation. CONCLUSIONS Routine intraoperative TOE is a cost-effective procedure for patients undergoing cardiac surgery, leading to lower overall costs. It was associated with a decrease in long-term complications including stroke, cardiac complications, and death, although there was a slight increase in extracranial bleeding events.

中文翻译：

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心脏手术中常规经食道超声心动图的成本效益：一项离散事件模拟研究。

背景技术这项研究的目的是模拟和比较在进行心脏手术的患者中与常规使用术中经食管超声心动图（TOE）相关的医疗保健和经济结果，以及与常规不使用TOE的情况相关的健康和经济结果。方法通过系统的文献综述，评估TOE对手术决策的影响。个体短期发病率和死亡率估算是通过应用胸外科医师协会风险计算器得出的。长期事件发生率，单位成本和公用事业权重来自已发表的文献和专家的意见。然后构建离散事件模拟模型，以模拟接受心脏手术的患者的院内和出院后结局。通过确定性和概率敏感性分析检查了基本案例结果的稳健性。假定每增加一个质量调整生命年，增加的成本效益比为30,000欧元，这是可接受的成本效益。结果术中常规使用TOE可以降低成本并提高每位患者的获益，这表明TOE的使用是主要策略。干预措施每10 000名患者避免了299例心脏并发症，20例中风和11例全因死亡。常规的术中TOE与由于瓣膜手术和随后的长期抗凝治疗引起的出血增加有关。结论常规术中TOE对进行心脏手术的患者而言是一种经济有效的方法，可降低总体成本。