Supplementary material: Cost–effectiveness analysis of Avance allograft for the treatment of peripheral nerve injuries in the USA

These are peer-reviewed supplementary tables and figure for the article 'Cost–effectiveness analysis of Avance allograft for the treatment of peripheral nerve injuries in the USA' published in the Journal of Comparative Effectiveness Research.Figure S1: Markov model structureTable S1: Transition probabilities and clinical complication ratesTable S2: Cost distribution for nerve repair surgery procedureTable S3: Cost input parameters included in the economic modelAim: Peripheral nerve injury (PNI) is a debilitating condition with significant associated morbidity, and which places a substantial socioeconomic burden on healthcare systems worldwide. Recently, allograft has emerged as a viable surgical alternative to autograft for the treatment of PNI. This study evaluated the cost effectiveness of allograft (Avance R ? Nerve Graft) compared with autograft for the peripheral nerve repair, from a US payer perspective. Methods: A Markov cohort model was developed to consider the treatment pathways followed by a patient population undergoing a single transected nerve repair with either allograft, or autograft. The marginal difference in meaningful recovery (MR) (effectiveness), and costs, between the two groups were estimated over a lifetime horizon. Deterministic and probabilistic sensitivity analyses (PSA) were performed to consider the uncertainty surrounding the base-case input parameter values and their effect on the overall incremental cost–effectiveness ratio (ICER). Results: The base-case analysis indicates that there is a small difference in the average probability of MR between the two groups (75.15% vs 70.46%; +4.69% with allograft). Allograft also results in cost savings ($12,677 vs $14,023; -$-1346 with allograft) compared with autograft. Deterministic sensitivity analysis shows that the costs of the initial surgical procedures are the main drivers of incremental cost, but that the intervention is likely to be cost saving compared with autograft regardless of the parameter variations made. Conclusion: The use of allograft with the Avance Nerve Graft has the potential to be a cost-effective alternative to autograft for the surgical treatment of PNI in the USA.

本数据集包含发表在《比较效果研究杂志》上的文章《美国应用 Avance 同种异体移植治疗周围神经损伤的成本效益分析》的同行评审补充表格和图表。图 S1：马尔可夫模型结构表 S1：转移概率和临床并发症发生率表 S2：神经修复手术程序的成本分布表 S3：经济模型中包含的成本输入参数目标：周围神经损伤（PNI）是一种致残性疾病，其关联的发病率显著，并给全球医疗保健系统带来了巨大的社会经济负担。近年来，同种异体移植作为一种可行的手术替代方案，已应用于PNI的治疗。本研究从美国支付者视角评估了同种异体移植（Avance R ? 神经移植）与自体移植相比在周围神经修复方面的成本效益。方法：开发了一个马尔可夫队列模型，以考虑接受单一横断神经修复手术的患者群体采用同种异体移植或自体移植的治疗途径。估计了两组在终身时间范围内的有意义恢复（MR）（有效性）和成本之间的边际差异。进行了确定性敏感性分析和概率敏感性分析（PSA），以考虑基线输入参数值的不确定性和它们对整体增量成本效益比（ICER）的影响。结果：基线分析表明，两组平均MR发生概率之间存在微小差异（75.15% 对 70.46%；同种异体移植增加 4.69%）。与自体移植相比，同种异体移植还导致成本节约（12,677 美元对 14,023 美元；同种异体移植节约 -1,346 美元）。确定性敏感性分析显示，初始手术程序的成本是增量成本的主要驱动因素，但无论参数变化如何，干预措施相对于自体移植而言很可能具有成本节约效应。结论：使用 Avance 神经移植的同种异体移植在美国治疗 PNI 手术方面具有成为成本效益替代方案的可能性。