Rob Hainsworth, Martin Eden, Jonathan Ghosh, Vivak Hansrani, Steven Rogers, Charles McCollum, Gabriel Rogers, Katherine Payne
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引用次数: 0
Abstract
Objective: Unexplained chronic pain in the female pelvis (CPFP) affects 7% of people indicating female sex in the UK. Evidence suggests that pelvic venous incompetence (PVI) could explain CPFP and that coil embolisation could provide relief. The aims of this study were to indicate (1) the cost effectiveness of detecting and treating PVI in people experiencing unexplained CPFP, and (2) the maximum value of further research, suggesting suitable areas.
Methods: A decision tree compared standard care (regular prescribed analgesia) with an intervention comprising transvaginal duplex ultrasound to screen for PVI, venography to confirm the diagnosis, and coil embolisation treatment. The population was people experiencing unexplained CPFP. A UK National Health Service perspective and 2021 - 22 price year were used. Ten years of health costs and health related quality of life (HRQoL) effects for eligible 40 year olds were simulated. Evidence reviews informed diagnostic accuracy, health service usage, and unit costs. A single centre randomised controlled trial informed all other parameters. Probabilistic analysis incorporated parameter uncertainty in cost effectiveness estimates. Deterministic sensitivity analysis indicated drivers of uncertainty. Value of information methods measured the value of eliminating all relevant uncertainties, given uptake predictions. The main outcome measures were incremental cost and quality adjusted life years (QALYs) for the intervention compared with analgesia, the incremental cost effectiveness ratio (ICER), and expected value of perfect information.
Results: The mean ICER for the intervention was £4 558/QALY gained, and the probability that the ICER was within the UK cost effectiveness threshold (£20 000/QALY gained) was 90%. The expected value of perfect information about all model parameters was £46 M. All deterministic sensitivity analysis scenarios met the threshold, except the smallest plausible HRQoL effect of (resolving) CPFP.
Conclusion: Detecting and treating PVI causing CPFP appears cost effective, but more primary research would be valuable to reduce decision uncertainty. Uncertainty in the HRQoL estimate for unexplained CPFP appeared to contribute most to decision uncertainty.
期刊介绍：
The European Journal of Vascular and Endovascular Surgery is aimed primarily at vascular surgeons dealing with patients with arterial, venous and lymphatic diseases. Contributions are included on the diagnosis, investigation and management of these vascular disorders. Papers that consider the technical aspects of vascular surgery are encouraged, and the journal includes invited state-of-the-art articles.
Reflecting the increasing importance of endovascular techniques in the management of vascular diseases and the value of closer collaboration between the vascular surgeon and the vascular radiologist, the journal has now extended its scope to encompass the growing number of contributions from this exciting field. Articles describing endovascular method and their critical evaluation are included, as well as reports on the emerging technology associated with this field.
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