中間リスクの重度の大動脈狭窄症の患者におけるトランスキャセター対手術による大動脈弁置換の費用対効果
Suzanne J Baron1, Kaijun Wang1, John A House2
1Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (S.J.B., K.W., E.A.M., D.J.C.).
Circulation
|December 28, 2018
まとめ
トランスキャテーターによる大動脈弁置換 (TAVR) は,重度の大動脈狭窄症 (AS) の中等リスクの患者に費用対効果が高く,手術による大動脈弁置換 (SAVR) よりも長期的に良い結果と低コストを提供します. これはTAVRを潜在的に好ましい治療戦略にしています.
科学分野:
- 心臓病科
- 健康 経済
- 医療技術
背景:
- 中等リスクの患者における重度の大動脈狭窄症 (AS) は,経管大動脈弁置換 (TAVR) と手術による大動脈弁置換 (SAVR) の間の治療上のジレンマを提示する.
- 過去の研究では,この集団におけるTAVRとSAVRの2年生存率と脳卒中率が類似していることが示されています.
- TAVRの費用対効果は,SAVRと比較して,中等リスクのAS患者にとって重要な臨床問題です.
研究 の 目的:
- 中間手術リスクの重度の大動脈狭窄症の患者におけるTAVRとSAVRの生涯費用対効果を評価する.
- TAVRとSAVRの間で得られた医療費と品質調整寿命 (QALY) を比較する.
主な方法:
- PARTNER 2試験では,中等リスクのAS患者2032人をTAVR (SAPIEN XT) またはSAVRにランダムに分けました.
- 2つのTAVR装置の比較を可能にしたレジストリで,さらに1078人の患者がTAVR (SAPIEN 3) を受けた.
- マルコフモデルは,試験中の費用,メディケアの請求データ,ヘルスケア・ユーティリティ (EQ-5D) および生存データを統合して,米国のヘルスケアシステムの観点から,終身費用効果を推定した.
主要な成果:
- TAVR (XTとS3の両方) は,より高い手続費にもかかわらず,SAVRと比較して著しく低いフォローアップコストをもたらしました.
- 総寿命コストはTAVRで8,000~10,000ドル低く,品質調整生存期は0.15~0.27年増加すると予測された.
- TAVR (S3) はブートストラップ複製品の97%でSAVRに経済的に優れていることが判明し,優れた価値を示しています.
結論:
- トランスキャテーターによる大動脈弁置換 (TAVR) は,米国保健医療システムにおける中等リスクのAS患者の間では,手術による大動脈弁置換 (SAVR) よりも経済的に優位であると予測されています.
- TAVRは品質調整された寿命の改善と 長期的なコストの削減の両方を提供します
- これらの発見は,臨床的および経済的要因の両方を考慮して,TAVRが好ましい治療戦略である可能性を示唆しています.
関連する概念動画
Aortic Regurgitation I: Introduction
604
IntroductionAortic regurgitation is characterized by the backward flow of blood from the aorta into the left ventricle during diastole and arises from the improper closure of the aortic valve. This condition results in left ventricular volume overload and can stem from both acute and chronic etiologies, each contributing uniquely to the disease's progression and symptomatology.Acute and Chronic CausesAcute aortic regurgitation often results from events that suddenly impair the integrity of the...
604
Aortic Regurgitation III: Medical Management
442
Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
442
Aortic Regurgitation IV: Nursing Management
316
A nurse managing a patient with aortic regurgitation begins with a comprehensive assessment, including a review of the patient's medical history, family history, and lifestyle factors. During the cardiac examination, the nurse listens for heart sounds and checks for signs of valve abnormalities. The nurse also observes for symptoms such as dyspnea, orthopnea, and paroxysmal nocturnal dyspnea and assesses the patient's endurance and daily activity tolerance.Based on the findings, the nurse...
316
Aortic Regurgitation II: Clinical Features and Diagnostic Tests
516
Aortic valve regurgitation (AR) occurs when the aortic valve fails to close properly, allowing blood to flow backward from the aorta into the left ventricle. This backflow can result in two distinct clinical presentations: acute and chronic AR, each characterized by its own set of symptoms and physical findings.Acute Aortic RegurgitationAcute AR presents with a sudden onset of severe symptoms. Patients typically experience profound dyspnea (shortness of breath), chest pain, and signs of left...
516
Pharmacodynamics in Geriatric Patients: Effects of Age
236
Age-related pharmacokinetic changes are extensively documented, but understanding age-related pharmacodynamic alterations is relatively limited. This knowledge gap can be partly attributed to the complexity of developing appropriate measures of drug responses compared to bioanalytical methods for determining drug concentrations.Most information regarding age-related differences in human pharmacodynamics originates from cross-sectional studies. However, these studies assume that observed mean...
236
The Intermediate Value Theorem
272
The Intermediate Value Theorem is a foundational result in calculus that guarantees the existence of solutions within certain intervals for continuous functions. Formally, the Intermediate Value Theorem states that if a function f is continuous on the closed interval [a, b], and if N is any value between f(a) and f(b), then there exists at least one c ∈ (a, b) such that f(c) = N. This theorem is instrumental in proving the existence of roots and in analyzing the behavior of continuous...
272


