早期向中度大动脉狭窄症患者提供跨导管大动脉置换:量化成本和收益 - - 一个基于马尔科夫模型的模拟研究
Dieu Nguyen1, Tom Marwick2, Marj Moodie3
1Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University Faculty of Health, Geelong, Victoria, Australia dieu.nguyen@deakin.edu.au.
BMJ open
|November 22, 2023
概括
对中度大动脉狭窄症 (MAS) 进行早期跨导管大动脉植入 (TAVI) 提供了显著的好处,包括增加质量调整寿命年和获得寿命年. 预计这项干预措施将在澳大利亚医疗保健系统中具有成本效益.
科学领域:
- 心脏病学 心脏病学
- 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:
- 大动脉狭窄 (AS) 是一种常见的获得性心脏膜疾病.
- 过导管大动脉植入 (TAVI) 已在严重的AS中取得成功,引发了对中度AS (MAS) 应用的兴趣.
研究的目的:
- 评估早期TAVI与MAS患者的医疗管理相比的长期成本效益.
- 评估不同患者吸收率对早期TAVI的成本效益的影响.
主要方法:
- 使用马尔科夫微模拟模型来模拟长期结果.
- 数据来源于国际文献,澳大利亚医疗保健系统的具体成本.
- 这项研究分析了1万名65岁以上的假设MAS患者.
主要成果:
- 早期MAS患者的TAVI导致医疗费用增加,但带来了更大的好处,包括每人平均增加3.02个QALY或3.99个生命年.
- 增量成本效益比 (ICUR) 在不同场景中从每QALY获得的$10,867到$11,926不等.
- 敏感性分析表明,在A50,000/QALY的支付意愿值下,成本效益的概率为100%.
结论:
- 适度大动脉狭窄的早期TAVI可能是一个具有成本效益的干预措施.
- 观察到的好处甚至在假设重复门更换的情况下仍然存在.
- 来自正在进行的随机对照试验的进一步数据将完善对TAVI在MAS中的益处的理解.
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