在低风险和中等风险的中国患者中进行主动脉置换的成本效益与严重主动脉缩症
Jin Peng1,2,3,4, Xinglong Zheng5, Minghuan Jiang1,2,3,4,6
1Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy (J.P., M.J., X.Y., Y.M., M.F., Y.F.), Xi'an Jiaotong University, China.
Circulation. Cardiovascular quality and outcomes
|March 18, 2025
概括
在中国,对于严重的大动脉狭窄患者来说,与外科大动脉置换 (SAVR) 相比,无论是通用过导管大动脉置换 (TAVR) 还是基于风险的策略都不具有成本效益. 对于这些患者群体来说,通用SAVR仍然是最具成本效益的方法.
科学领域:
- 心脏病学 心脏病学
- 卫生经济学 卫生经济学
- 医疗技术评估 医疗技术评估
背景情况:
- 超导管大动脉置换 (TAVR) 是作为手术大动脉置换 (SAVR) 的替代方案进行辩论的.
- 重症大动脉狭窄症的管理需要评估成本效益,特别是在像中国这样的各种医疗保健系统中.
- 风险分层对于优化大动脉狭窄的治疗策略至关重要.
研究的目的:
- 评估TAVR与SAVR在中国重度大动脉狭窄的低风险和中等风险患者的成本效益.
- 为了比较通用SAVR,通用TAVR和基于风险的策略 (低风险的SAVR,中等风险的TAVR).
- 确定在中国医疗保健背景下最经济可行的大动脉置换策略.
主要方法:
- 采用了结合决策树和马尔科夫模型的决策分析模型.
- 临床投入来源于元分析;使用成本数据采用西省的索赔 (2019-2021);用EuroQoL-5D测量生活质量.
- 灵敏度分析 (单向和概率蒙特卡洛模拟) 评估了模型的稳定性.
主要成果:
- 通用TAVR产生的质量调整寿命年 (QALY) 是最多的,但成本最高.
- 与普遍SAVR相比,基于风险的策略和通用TAVR超过了支付意愿的门.
- 通用SAVR显示了89.81%的成本效益概率,明显高于TAVR策略.
结论:
- 无论是基于风险的策略还是通用TAVR都与中国低风险和中等风险患者的通用SAVR相比没有成本效益.
- 在这种人群中,通用SAVR仍然是重症大动脉狭窄的首选经济有效策略.
- 显著降低TAVR门成本可能会改变成本效益的发现.
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