急性心筋梗塞後の定期的な冠動脈血管検査の費用対効果について
K M Kuntz1, J Tsevat, L Goldman
1Section for Clinical Epidemiology, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA. keaney@hsph.harvard.edu
Circulation
|September 1, 1996
まとめ
急性心筋梗塞 (AMI) の後の冠動脈動脈造影は,特定の患者のサブグループ,特に重度のアンギナまたは以前の心臓発作を有する患者にとって費用対効果的です. この戦略は,初期医療療法のみと比較して,好ましい結果をもたらします.
科学分野:
- 心臓病学 心臓病学
- 健康経済学 医療経済学
- 臨床的意思決定について
背景:
- 冠動脈血管撮影は,急性心筋梗塞 (AMI) の後の標準的な治療法ですが,その必要性は特定の患者グループでは不明です.
- AMI管理のための費用対効果の高い戦略を特定することは,リソースの割り当てにとって極めて重要です.
研究 の 目的:
- 様々な急性心筋梗塞 (AMI) 患者のサブグループで,通常の冠動脈血管検査の費用対効果と初期医療療法の効果を評価する.
- AMI後の冠動脈血管撮影の最適なタイミングと使用に関する臨床的意思決定を伝えるために.
主な方法:
- 臨床試験と文献から集められたデータを用いて意思決定分析モデルを開発した.
- 2つの管理戦略について,品質調整された平均寿命と生涯経費が推定されました.
- データソースには,費用に関するMedicare Part Aと,生活の質の調整に関する患者調査が含まれています.
主要な成果:
- アンジオグラフィーのコスト効率の割合は,1万7千ドルから,品質調整した寿命年当たり100万ドル以上であった.
- 重度の心筋梗塞後アンギナまたは運動耐性テスト (ETT) で陽性であったサブグループは,50,000ドル/QALY未満の比率を示しました.
- 以前のAMIを患った患者は,ETTの結果が陰性であっても,QALYあたり5万ドル未満の費用対効果も示しました.
結論:
- 定期的な冠動脈動脈造影は,選択された急性心筋梗塞 (AMI) 患者のサブグループに費用対効果的です.
- この発見は,重度のアンギナ,陽性ETT,または以前のAMIを有する患者の血管撮影の使用を支持します.
- この戦略は,これらの特定の集団における他の冠動脈疾患の治療法と好意的に比較されます.
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