ObjectiveWe examined the cost‐effectiveness of conservative management (CM) compared to planned caesarean hysterectomy (CH) for placenta accreta spectrum (PAS).DesignA cost‐effectiveness analysis in a theoretical cohort of patients.SettingA decision analytic model.PopulationA theoretical cohort of 1000 pregnant patients with PAS greater than 20 weeks gestation.MethodsIn base case analysis, we assumed that between 20% and 40% of individuals would be eligible for CM. Model inputs were derived from the literature. Analysis was conducted from a healthcare system perspective with a 1 year analytic horizon. Outcomes included hysterectomy, surgical site infection (SSI), length of hospitalisation, intensive care unit (ICU) admission and death. An incremental cost‐effectiveness ratio (ICER) of $50 000 per quality‐adjusted life year (QALY) defined cost‐effectiveness. Sensitivity analyses were performed.Main Outcome MeasuresThe cost gained per life year and per QALY.ResultsFor base case estimates, CM was the cost‐saving strategy with an ICER of $9330.51 USD. Compared to CH, CM resulted in 905 fewer hysterectomies, 80 fewer instances of SSI and five fewer deaths. CM resulted in 149 more admissions with length of stay > 5 days and 25 more ICU admissions. In probabilistic sensitivity analysis, CM was the cost‐effective strategy in 71% of runs and the dominant strategy in 42% of runs.ConclusionsCM was the cost‐effective strategy for the management of PAS in greater than 70% of iterations of our model. Modelling demonstrated significant uncertainty in the comparative effectiveness of the two strategies, highlighting the need for prospective research evaluating the effectiveness of CM.

中文翻译：

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预期保守治疗与剖宫产子宫切除术治疗已知或疑似植入胎盘谱系的成本效益分析


目的我们检查了保守治疗 （CM） 与计划剖宫产子宫切除术 （CH） 相比对胎盘植入谱系 （PAS） 的成本效益。设计理论患者队列中的成本效益分析。设置决策分析模型。人群1000 名妊娠超过 20 周的 PAS 孕妇的理论队列。方法在基本案例分析中，我们假设 20% 到 40% 的个体有资格接受 CM。分析从医疗保健系统的角度进行，分析范围为 1 年。结局包括子宫切除术、手术部位感染 （SSI）、住院时间、重症监护病房 （ICU） 收治和死亡。每质量调整生命年 （QALY） 50 000 美元的增量成本效益比 （ICER） 定义了成本效益。进行敏感性分析。主要结局指标每个生命年和每个 QALY 增加的成本。结果对于基本情况估计，CM 是节省成本的策略，ICER 为 9330.51 美元。与 CH 相比，CM 导致子宫切除术减少 905 例，SSI 病例减少 80 例，死亡减少 5 例。CM 导致住院时间 > 5 天增加 149 例入院，ICU 入院人数增加 25 例。在概率敏感性分析中，CM 在 71% 的运行中是具有成本效益的策略，在 42% 的运行中是主导策略。结论在我们模型的超过 70% 的迭代中，CM 是管理 PAS 的具有成本效益的策略。建模表明两种策略的比较有效性存在显著的不确定性，突出了评估 CM 有效性的前瞻性研究的必要性。