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晚期内血管血栓切除术的成本效益与临床试验环境和现实世界的最佳医疗管理
Johanna Maria Ospel1,2, Charlotte Zerna3, Emma Harrison4
1Department of Diagnostic Imaging, Foothills Medical Centre, University of Calgary, Calgary, AB, Canada.
概括
在最初的分析中,大血管封闭性中风的晚期内血管治疗 (EVT) 是具有成本效益的. 然而,经过对患者差异进行调整后,其成本效益在临床试验中降低,而在现实环境中则不存在.
科学领域:
- 神经学 神经学
- 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:
- 大血管堵塞 (LVO) 卒中通常需要及时干预.
- 晚期时间窗口内血管治疗 (EVT) 的成本效益仍然是一个研究领域.
- 将临床试验数据与现实世界的证据进行比较对于治疗评估至关重要.
研究的目的:
- 为了评估LVO中风的晚期时间窗口EVT的成本效益.
- 在临床试验中与现实环境中比较EVT的成本效益.
- 确定基线患者特征对EVT成本效益的影响.
主要方法:
- 利用了ESCAPE随机试验和前性ESCAPE-LATE队列研究的数据.
- 采用马尔科夫状态过渡模型来估计寿命成本和质量调整寿命年 (QALY).
- 进行了未调整和调整的分析,考虑了修改的兰金表 (mRS) 评分和基线因素.
主要成果:
- 未经调整的分析表明,晚期EVT在两种情况下都是具有成本效益的.
- 经过调整后的分析显示,临床试验环境中的成本效益有限 (49.9%-61.6%的可接受性).
- 调整后的分析表明,在现实环境中没有成本效益 (32.9%-42.6%的可接受性).
结论:
- 晚期EVT对于LVO中风显示成本效益,特别是当基线患者差异没有考虑时.
- 根据基线变量进行调整会降低EVT晚期观察到的成本效益.
- 在不仔细调整患者选择偏差的情况下,晚期EVT的实际成本效益可能会被高估.
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