罗斯手术或机械大动脉,这是一个18岁的最好的终身选择? 一个决策分析分析
Kunaal S Sarnaik1, Samuel M Hoenig1, Nadia H Bakir2
1Case Western Reserve University School of Medicine, Cleveland, Ohio.
JTCVS open
|February 29, 2024
概括
罗斯手术对于年轻人来说优于机械大动脉置换 (mAVR),提供更好的生存率,更少的并发症和更好的生活质量. 这种门手术选项提供了更大的长期成本效益.
科学领域:
- 心血管外科心血管外科
- 决策分析 决策分析
- 卫生经济学 卫生经济学
背景情况:
- 在年轻成年人中,大动脉置换 (AVR) 由于长期风险和对生活质量的影响而带来挑战.
- 将机械AVR (mAVR) 和罗斯手术进行比较,需要对终身结果进行全面评估.
研究的目的:
- 为了比较mAVR与年轻成年人罗斯手术的终身门相关结果.
- 评估每个AVR策略的成本效益.
主要方法:
- 使用马尔科夫模型的决策树微模拟被采用.
- 蒙特卡洛模拟 (n=20,000) 模拟了死亡率,质量调整寿命年 (QALYs) 和假设的18岁患者的成本.
- 敏感性分析确定了增量成本效益比率 (ICER) 的关键决定因素.
主要成果:
- 罗斯手术显示了较低的20年死亡率 (16.3%与23.2%) 和更好的免于中风和严重出血.
- 终身QALY (28.3对23.5) 和成本 (54,233对507,240美元) 偏好了罗斯手术.
- ICER表示,mAVR每获得QALY额外花费95,345美元.
结论:
- 对于需要AVR的年轻成年人来说,罗斯手术优于mAVR.
- 从门相关的发病率,死亡率和改善的成本效益的优越自由支持罗斯手术.
- 自体移植/输出管道疾病和晚期死亡被确定为敏感性分析中的关键因素.
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