对怀疑急性冠状动脉综合征的早期非侵入性心脏检测的成本效益
Aniket A Kawatkar1, Praveen Thokala2, Steve Goodacre2
1Research and Evaluation Department, Kaiser Permanente Southern California, Pasadena, California, USA.
概括
对于疑似急性冠状动脉综合征 (ACS) 的急诊部早期非侵入性心脏检测 (NIT) 增加了初始成本,但证明是具有成本效益的. 这种策略可以降低死亡或非致命心肌梗塞 (MI) 的风险,特别是在高风险患者中.
科学领域:
- 心脏病学 心脏病学
- 卫生经济学 卫生经济学
- 紧急医疗 紧急医疗
背景情况:
- 早期非侵入性心脏检测 (NIT) 是急诊室 (ED) 工作中疑似急性冠状动脉综合征 (ACS) 的标准.
- 早期NIT对风险分层的成本效益,以防止未来非致命的心肌梗塞 (MI) 或死亡需要评估.
研究的目的:
- 计算早期采用NIT的成本效益,以便在疑似ACS患者提交ED的患者中进行风险分层.
- 评估早期NIT对长期成本和质量调整寿命年 (QALYs) 的影响.
主要方法:
- 在南加利福尼亚州凯泽永久医院 (Kaiser Permanente Southern California) 进行了一项多中心回顾性队列研究.
- 现有的成本效益模型被调整为估计长期成本和QALYs.
- 该研究包括89,387名患者,其中19%接受了早期NIT.
主要成果:
- 早期的NIT增加了每名患者的总成本2357美元,主要是由于ED访问费用指数更高.
- 早期NIT与1年随访时死亡/非致命性MI (-3.7%绝对风险差异) 的综合风险显著降低.
- 从付款人的角度来看,早期NIT的成本效益比为每QALY获得的5268美元.
结论:
- 对于疑似ACS的ED早期NIT增加了初始医疗保健成本,但由于显著的临床益处,成本效益高.
- 早期的NIT对于低风险和中等风险的患者来说具有成本效益,对于高风险的患者来说是一个主要的策略 (节省成本和QALY).
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