Cost-effectiveness analysis of domiciliary topical sevoflurane for painful leg ulcers.

<h4>Objectives</h4>The general anesthetic sevoflurane is being repurposed as a topical analgesic for painful chronic wounds. We conducted a Bayesian cost-effectiveness analysis (CEA) comparing the addition of domiciliary topical sevoflurane to conventional analgesics (SEVOFLURANE, n = 38...

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Autores principales:	Carmen Selva-Sevilla, F Dámaso Fernández-Ginés, Manuel Cortiñas-Sáenz, Manuel Gerónimo-Pardo
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/ebb5a191264c4f94a5e6f8849e731247
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spelling	oai:doaj.org-article:ebb5a191264c4f94a5e6f8849e7312472021-12-02T20:14:29ZCost-effectiveness analysis of domiciliary topical sevoflurane for painful leg ulcers.1932-620310.1371/journal.pone.0257494https://doaj.org/article/ebb5a191264c4f94a5e6f8849e7312472021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0257494https://doaj.org/toc/1932-6203<h4>Objectives</h4>The general anesthetic sevoflurane is being repurposed as a topical analgesic for painful chronic wounds. We conducted a Bayesian cost-effectiveness analysis (CEA) comparing the addition of domiciliary topical sevoflurane to conventional analgesics (SEVOFLURANE, n = 38) versus conventional analgesics alone (CONVENTIONAL, n = 26) for the treatment of nonrevascularizable painful leg ulcers in an outpatient Pain Clinic of a Spanish tertiary hospital.<h4>Methods</h4>We used real-world data collected from charts to conduct this CEA from a public healthcare perspective and with a one-year time horizon. Costs of analgesics, visits and admissions were considered, expressed in €2016. Analgesic effectiveness was measured with SPID (Sum of Pain Intensity Difference). A Bayesian regression model was constructed, including "treatment" and baseline characteristics for patients ("arterial hypertension") and ulcers ("duration", "number", "depth", "pain") as covariates. The findings were summarized as a cost-effectiveness plane and a cost-effectiveness acceptability curve. One-way sensitivity analyses, a re-analysis excluding those patients who died or suffered from leg amputation, and an extreme scenario analysis were conducted to reduce uncertainty.<h4>Results</h4>Compared to CONVENTIONAL, SEVOFLURANE was associated with a 46% reduction in costs, and the mean incremental effectiveness (28.15±3.70 effectiveness units) was favorable to SEVOFLURANE. The estimated probability for SEVOFLURANE being dominant was 99%. The regression model showed that costs were barely influenced by any covariate, whereas effectiveness was noticeably influenced by "treatment". All sensitivity analyses showed the robustness of the model, even in the extreme scenario analysis against SEVOFLURANE.<h4>Conclusions</h4>SEVOFLURANE was dominant over CONVENTIONAL as it was less expensive and much more effective.Carmen Selva-SevillaF Dámaso Fernández-GinésManuel Cortiñas-SáenzManuel Gerónimo-PardoPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 9, p e0257494 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Carmen Selva-Sevilla F Dámaso Fernández-Ginés Manuel Cortiñas-Sáenz Manuel Gerónimo-Pardo Cost-effectiveness analysis of domiciliary topical sevoflurane for painful leg ulcers.
description	<h4>Objectives</h4>The general anesthetic sevoflurane is being repurposed as a topical analgesic for painful chronic wounds. We conducted a Bayesian cost-effectiveness analysis (CEA) comparing the addition of domiciliary topical sevoflurane to conventional analgesics (SEVOFLURANE, n = 38) versus conventional analgesics alone (CONVENTIONAL, n = 26) for the treatment of nonrevascularizable painful leg ulcers in an outpatient Pain Clinic of a Spanish tertiary hospital.<h4>Methods</h4>We used real-world data collected from charts to conduct this CEA from a public healthcare perspective and with a one-year time horizon. Costs of analgesics, visits and admissions were considered, expressed in €2016. Analgesic effectiveness was measured with SPID (Sum of Pain Intensity Difference). A Bayesian regression model was constructed, including "treatment" and baseline characteristics for patients ("arterial hypertension") and ulcers ("duration", "number", "depth", "pain") as covariates. The findings were summarized as a cost-effectiveness plane and a cost-effectiveness acceptability curve. One-way sensitivity analyses, a re-analysis excluding those patients who died or suffered from leg amputation, and an extreme scenario analysis were conducted to reduce uncertainty.<h4>Results</h4>Compared to CONVENTIONAL, SEVOFLURANE was associated with a 46% reduction in costs, and the mean incremental effectiveness (28.15±3.70 effectiveness units) was favorable to SEVOFLURANE. The estimated probability for SEVOFLURANE being dominant was 99%. The regression model showed that costs were barely influenced by any covariate, whereas effectiveness was noticeably influenced by "treatment". All sensitivity analyses showed the robustness of the model, even in the extreme scenario analysis against SEVOFLURANE.<h4>Conclusions</h4>SEVOFLURANE was dominant over CONVENTIONAL as it was less expensive and much more effective.
format	article
author	Carmen Selva-Sevilla F Dámaso Fernández-Ginés Manuel Cortiñas-Sáenz Manuel Gerónimo-Pardo
author_facet	Carmen Selva-Sevilla F Dámaso Fernández-Ginés Manuel Cortiñas-Sáenz Manuel Gerónimo-Pardo
author_sort	Carmen Selva-Sevilla
title	Cost-effectiveness analysis of domiciliary topical sevoflurane for painful leg ulcers.
title_short	Cost-effectiveness analysis of domiciliary topical sevoflurane for painful leg ulcers.
title_full	Cost-effectiveness analysis of domiciliary topical sevoflurane for painful leg ulcers.
title_fullStr	Cost-effectiveness analysis of domiciliary topical sevoflurane for painful leg ulcers.
title_full_unstemmed	Cost-effectiveness analysis of domiciliary topical sevoflurane for painful leg ulcers.
title_sort	cost-effectiveness analysis of domiciliary topical sevoflurane for painful leg ulcers.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/ebb5a191264c4f94a5e6f8849e731247
work_keys_str_mv	AT carmenselvasevilla costeffectivenessanalysisofdomiciliarytopicalsevofluraneforpainfullegulcers AT fdamasofernandezgines costeffectivenessanalysisofdomiciliarytopicalsevofluraneforpainfullegulcers AT manuelcortinassaenz costeffectivenessanalysisofdomiciliarytopicalsevofluraneforpainfullegulcers AT manuelgeronimopardo costeffectivenessanalysisofdomiciliarytopicalsevofluraneforpainfullegulcers
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Cost-effectiveness analysis of domiciliary topical sevoflurane for painful leg ulcers.

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