针对接受血管造形术以抑制血栓的患者:一个成本效益和决策支持模型
W S Weintraub1, T D Thompson, S Culler
1Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA. bill@hp3.eushc.org
Circulation
|July 25, 2000
概括
糖蛋白IIb/IIIa抑制剂有效地预防高风险患者血管造形术后的不良事件. 针对性抗血小板治疗对于患有并发症可能性较高的患者来说可能具有成本效益.
科学领域:
- 心血管医学 心血管医学
- 卫生经济学 卫生经济学
- 干预心脏病学 干预心脏病学
背景情况:
- 糖蛋白IIb/IIIa抑制剂在预防高风险个体血管形成术后不良事件方面表现出有效性.
- 对这些患者来说,抗血小板治疗选择的成本效益仍然不确定.
研究的目的:
- 评估冠状动脉干预后针对性抗血小板治疗选择的成本效益.
- 确定最能从糖蛋白IIb/IIIa阻断剂治疗中受益的患者子组.
主要方法:
- 在1993年至1995年期间,对4962名接受冠状动脉干预的患者进行分析 (n=6062).
- 开发多变量模型来预测不良事件 (死亡,心肌梗塞,再血管化).
- 基于针对>5%事件概率的患者治疗的成本效益分析.
主要成果:
- 针对>5%事件概率的患者进行向治疗,并发症从6.39%降至5.37%.
- 这一策略使每位患者的费用增加了261美元,相当于每次预防事件的费用为25504美元.
- 当扩大患者选择标准时,每次预防事件的边际成本显著增加.
结论:
- 抗血小板治疗可能为接受血管塑性手术的高风险患者节省成本.
- 对低风险患者来说,治疗可能不具有成本效益.
- 预防中等风险患者的不良事件 (5-7%的事件概率) 可能是可以接受的.
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