Předběžné modelování odchylky nákladů pro porovnání autologní intraovariální plazmy bohaté na trombocyty a standardní hormonální substituční terapie při menopauze


Authors: Sills S. E. 1,2;  Tan L. S. 3,4
Authors‘ workplace: San Clemente, California, USA ;  Escondido, California, USA ;  Montréal, Quebec, Canada ;  Reproductive Research Section, FertiGen/ CAG 1;  Department of Obstetrics and Gynecology, Palomar Medical Center 2;  OriginElle Fertility Clinic 3;  Department of Obstetrics and Gynecology, McGill University Health Centre 4
Published in: Ceska Gynekol 2022; 87(1): 28-34
Category: Original Article
doi: 10.48095/cccg202228

Overview

Úvod: Příznaky menopauzy a hormonální substituční terapie (HRT) patří mezi nejčastější důvody, proč pacientky přichází ke gynekologovi. Ačkoli ve vyspělých zemích v průběhu života HRT užívá nejméně polovina všech žen, s léčbou jsou spojena rizika a doporučené postupy se různí. Větší povědomí o rizicích HRT při dlouhodobém užívání vyvolalo zájem o „bezpečnější alternativy“. Do popředí se tak dostalo zmírnění příznaků menopauzy pomocí autologního intraovariálního podání plazmy bohaté na trombocyty (OPRP), jehož vhodnost a nákladovou efektivitu je však nutné prozkoumat. Metody: Kumulativní roční náklady na pacientku byly na základě údajů o HRT a OPRP z USA porovnány pomocí stochastického modelování metodou Monte Carlo. Výsledky: Střední hodnota ± SD nákladů na pacientku pro HRT, zahrnující úvodní konzultaci a opakované vydání v lékárně, byla odhadnuta jako 576 ± 246 USD za rok. Ačkoli OPRP nemá lékárenskou složku, odhadované 4 návštěvy v průběhu jednoho roku v rámci udržování OPRP zahrnují ultrazvuk, flebotomii / zpracování vzorku, chirurgické vybavení a náklady na inkubaci / laboratoř. Střední hodnota ± SD nákladů pro OPRP byla 8 719 ± 4 911 USD za rok (p < 0,0001 vs. HRT, T-test). Horní hranice odhadu pro roční náklady na HRT a OPRP byla 1 341 USD, resp. 22 232 USD. Závěr: Ačkoli jsou HRT a OPRP v léčbě menopauzy podobně účinné a bezpečné, výrazně se liší v nákladové efektivitě. Pro většinu pacientek by OPRP byla pravděpodobně příliš komplexní, invazivní a drahá na to, aby mohla konkurovat HRT. Ačkoli je OPRP pro vybrané pacientky s menopauzou, které se zdráhají podstoupit HRT, zajímavou a s opatrností i užitečnou metodou, širší použití této léčby neplodnosti se v porovnání se standardními možnostmi HRT, které jsou momentálně na trhu, nezdá být  efektivní.

Klíčová slova:

menopauza – alternativní léčba – plazma bohatá na trombocyty – náklady na zdravotní péči


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