Cost-effectiveness of routine transoesophageal echocardiography during cardiac surgery: a discrete-event simulation study
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journal contribution
posted on 2024-06-04, 04:00 authored by JM Dieleman, PS Myles, L Bulfone, Sandra Younie, B van Zaane, D McGiffin, Marj MoodieMarj Moodie, Lan GaoLan Gao© 2019 British Journal of Anaesthesia 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.
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British Journal of AnaesthesiaVolume
124Pagination
136-145Location
Oxford, Eng.Publisher DOI
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0007-0912eISSN
1471-6771Language
engPublication classification
C1 Refereed article in a scholarly journalIssue
2Publisher
Oxford UniversityUsage metrics
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