在患有严重症状性大动脉狭窄症的患者中进行跨导管大动脉置换的成本效益分析:一项前性多中心研究
Makoto Amaki1, Kensuke Moriwaki2, Michikazu Nakai3
1Department of Heart Failure and Transplant, Division of Heart Failure, National Cerebral and Cardiovascular Center, Japan.
Journal of cardiology
|August 5, 2023
概括
在日本,选择患者进行过导管大动脉置换 (TAVR) 提高了成本效益. 这种方法对所有患者来说比TAVR更经济,优化了严重大动脉狭窄治疗的资源配置.
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:
- 严重的症状性大动脉狭窄症 (AS) 需要治疗,但跨导管大动脉置换 (TAVR) 的好处并不普遍.
- 在日本人口中研究TAVR的成本效益对于优化医疗保健资源配置至关重要.
研究的目的:
- 评估不同TAVR策略的成本效益,在一个日本队列严重症状AS.
- 确定患者选择标准,最大限度地提高TAVR的好处.
主要方法:
- 一项前性多中心研究招募了110名症状严重的AS患者接受TAVR.
- 在TAVR前和6个月后评估了生活质量 (QOL);确定了非响应者.
- 模拟了三种治疗模式:保守的,所有人的TAVR,以及对选定的响应者的TAVR.
主要成果:
- 针对特定患者的TAVR策略产生了2,342,175日元/QALY的增量成本效益比 (ICER),低于5,000,000日元/QALY的门.
- 所有患者的TAVR策略的ICER为5,765,800日元/QALY,超过了值.
- 较高的TAVR前QOL和临床脆弱度量预测了不响应.
结论:
- 选择可能响应者的TAVR策略比治疗日本所有患者更具成本效益.
- 这种选择患者的方法优化了TAVR的好处,特别是对于脆弱的个体,并改善了资源配置.
- 该战略支持将干预措施指向那些最有可能获得改善生活质量的群体.
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