척추수술 환자에서 지혈제 매트릭스의 단독사용과 젤라틴/트롬빈에 추가사용시의 비용-결과 분석

Cost-consequence Analysis of a Hemostatic Matrix Alone vs. in Combination use with Gelatin/Thrombin for Spine Surgery Patients in Korea

BACKGROUND Various types of hemostatic agents are used for bleeding management during surgery. Gelatin- thrombin based active flowable hemostatic matrix (FLOSEAL？？) is used in bleedings not effectively controlled or uncontrollable by ligature or general procedures. OBJECTIVES This study was performed to compare economic outcome of FLOSEAL？？ alone(F) use to gelatin/thrombin+FLOSEAL？？(G/T+F) combined use for hemostasis during spinal surgery. METHODS A cost-consequence model was used from a medical institution perspective in Korea. Clinical outcome parameters were derived from US-based observational study literature. Costs included in this analysis were direct medical cost such as hemostatic agents, hospitalization and blood transfusion costs and opportunity cost of operating room. Cost difference between groups were presented, and one-way sensitivity analyses for variability of clinical input parameters were performed. RESULTS F group reduced the length of hospitalization by 0.45 days and operating time by 39 minutes compared to G/T+F group. Consequently the volume of hemostatic agents and the number of patients requiring transfusions are reduced as well. The clinical outcomes resulted in cost savings approximately ￦642,620 per spinal surgery in F group compared to G/T+F group in a tertiary hospital base. CONCLUSIONS F alone use is dominant strategy comparing to G/T+F combined use for the purpose of hemostasis during spinal surgery process.