在急诊室的急性胸痛分类中使用FRct:成本效益分析
Eleftherios Choustoulakis1,2, Bernard Cosyns3, Jeroen Sonck4,5
1Department of Cardiology, Universitair Ziekenhuis Brussel, Brussels, Belgium.
Acta cardiologica
|December 5, 2023
概括
基于CT的分量流量储备 (FFRct) 是一种成本有效的策略,用于诊断冠状动脉疾病 (CAD) 在急诊室的急性胸痛患者. 这种方法有助于避免不必要的侵入性手术,并改善生活质量.
科学领域:
- 心血管成像 - 心血管成像
- 卫生经济学 卫生经济学
- 诊断的准确性 诊断的准确性
背景情况:
- 急性胸痛是一种常见的急诊室表现,通常需要对冠状动脉疾病 (CAD) 进行评估.
- 目前的诊断途径包括冠状动脉计算机断层扫描血管造影 (CCTA) 和运动测试,这可能导致不必要的侵入性手术.
- 评估高级非侵入性成像技术的成本效益,如基于CT的分量流量储备 (FFRct),对于优化患者护理至关重要.
研究的目的:
- 建模和评估使用基于CT的分流储备 (FFRct) 在患有急性胸痛的低至中等风险的CAD患者的成本效益.
- 将FFRct结合的诊断策略与当前的临床常规进行比较.
主要方法:
- 从医疗保健的角度来看,采用了一个具有1年的时间地平线的决策树模型.
- 数据来源于文献和国家报告.
- 这项研究将两种基于FFRct的疗程与标准治疗 (CCTA + 运动测试) 进行了比较,对1000名患者的假设队列进行了比较.
主要成果:
- 在CCTA无结论时确定FFRct被证明是一个具有成本效益和占主导地位的策略,节省了198€/患者,避免了每1000名患者中154次不必要的侵入性冠状动脉血管造影 (UICA).
- 这一策略还提高了0.008 QALY/患者的生活质量 (QoL).
- 一个总是执行FFRct的策略只有在高值时才具有成本效益,成本更高,避免的uICAs更少.
结论:
- 在不确定的CCTA后使用FFRct的诊断策略对于急诊室患者具有急性胸痛和低至中等CAD概率的成本效益高.
- 建议进行进一步的临床试验,以调查FFRct在该患者群体中的灵敏度,特异性和QoL影响.
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