| Objective: The development of health technologies has not only improved people's quality of life,but also has led to an increase in medical expenses.How to configure high-precision equipment and solve the balance between the development of health technology and the cost of health has become an unavoidable issue for policy makers.This study was based on rapid evaluation method,the relevant parameters can be acquired through comparing the DVSS and traditional radical prostatectomy(open and endoscopic surgery)on safety,clinical effects,and economics.Taking Dalian City as an example,under current rate of prostatectomy,this paper analyzes the influence to medical fees by replacing traditional laparoscopic surgery with DVSS,and predict the DVSS impact on medical insurance funds under different reimbursement rates,which provides data support for medical insurance payment decision.At the same time,it could be a significant reference for promoting advanced technology such as DVSS in Dalian,in order to provide basis for health decision-making in Dalian.Method: Collecting and retrieving internal and external documents related,and analyzing the domestic development of radical prostatectomy,application of Da Vinci equipment,cost information,clinical safety,clinical effectiveness,economic efficiency,etc.Analysis of SR/Meta in quality assessment applied AMSTAR scale.Analyzing of the prospects of Da Vinci's surgical equipment application in Dalian by collecting opinions and suggestions of domestic clinical medical workers and hospital administrators on the indications of relevant technologies and equipment and applicable population,consulting relevant decision makers on the opinions and suggestions of large medical equipment payment policy,utilizing second-hand data from internal and external literature,including epidemiological data,clinical data of equipment application and usage cost data,etc.Result: 1.208 articles were chosen in the initial screening,193 left after de-screening,and 99 excluded according to the inclusion of exclusion criteria for titles and abstracts.We read though the 94 articles remained,among which 56 are on comparative studies,16 on SR/Meta-analysis,19 on review,5 on case introduction.Among those 30 articles included in the final stage,12 were on comparative study,15 on SR/Meta-analysis,and 3 on case introduction.2.Articles included: Five articles on clinical effect and economic analysis,and 28 on clinical effects in which 13 were on HTA study and 15 on system review.3.Quality evaluation of 15 included articles on SR analysis: 5 level A articles,7 level B articles,and 3 level C articles.4.A total of 5 articles reported the clinical effect and economic benefit of DVSS.DVSS has advantages in shortening hospitalization time and reducing blood loss.The recovery of urinary system function is superior to laparoscopy and laparotomy.5.The hospitalization and transfusion costs of the DVSS were lower than those of traditional laparoscopy and laparotomy,but the increase costs in equipment and its maintenance led to a rise in the total cost of hospitalization for the DVSS.6.The actual cost of laparoscopy is 46,000 yuan,and ratio patient paying on his own is 56.52%.There is currently no price policy for Da Vinci's surgical treatment in Dalian.According to Chinese literature,the rapid assessment of Da Vinci's equipment and accessories costs is 3,785 US dollars(approximately 24,000 RMB).If it increases 20,000 yuan on the basis of 46,000 yuan,which is price of the other provinces' Da Vinci robot surgery,the total cost would be 66,000 yuan.If the 20,000 relies on the patients,it is predicted that the out-of-pocket ratio of urban medicare patients is as high as 69.70%-75.76%.If reimbursement ratio of 30%-70% applied to the 20,000 RMB self-paid expenditure is adopted,the per capita self-paid expense increases 6,000 to 20,000 RMB.The current proportion of self-paid in urban medical insurance is between 48.48% and 60.61%,and the proportion of NCMS is between 54.55% and 66.67%.Compared with the actual compensation of laparoscopic costs,when the reimbursement ratio for the 20,000 RMB additional fee comes to 50%,which in turn leads to a 45.45% compensation ratio of the patient's medical insurance,that is the closest compensation ratio to 43.48%,the actual compensation ratio,for laparoscopic costs.Dalian has an expected demand of 150 people of Da Vinci surgical robot radical prostatectomy.Simulated by different scenarios,the cost of Dalian medical insurance compensation will increase 900,000 to 2.1 million in medical insurance expenditures,putting a certain pressure on the city's Medicare fund.Conclusion: Compared with traditional laparoscopy and laparotomy,DVSS has a good clinical effect in reducing blood loss,reducing severe complications and reducing postoperative recurrence rate.It also has advantages in controlling urine function and sexual function.In terms of effectiveness,different subjects lead to different results.The additional cost of robot-assisted surgery is mainly due to the increased cost of surgical equipment and maintenance of the robot.The cost of hospitalization and blood transfusion of Da Vinci surgery is lower than that of traditional laparoscopy and open surgery,and on the contrary the cost of machinery and equipment and maintenance is high,which is also the main reason for the increase of total hospitalization cost of Da Vinci surgery.The results of the budget impact analysis show that if “20,000 RMB Da Vinci equipment and its accessories costs” is adopted and with the same amount of compensation for health insurance,the proportion of patients paying on their own will be as high as 30%-70%,and per capita self-paid expense will increase 6,000 to 20,000 RMB.Dalian has an expected demand of 150 people of Da Vinci surgical robot radical prostatectomy,then the cost of Dalian medical insurance compensation will increase 0.9 to 2.1 million RMB in health care expenditure,putting a certain pressure on the city's medicare fund.Decision-making recommendations: In terms of government's decision-making, we recommend as following,using the current laparoscopic cost payment method,plus 20,000 RMB Da Vinci equipment and its accessories costs;the equipment configuration is one,which can basically meet the demand of medical service in Dalian;due to there is presently no condition for reimbursement of medical insurance,a continuous and complete health technology assessments are required. |
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