慢性四肢威胁性缺血的内血管和开放手术的成本效益
medRxiv : the preprint server for health sciences
|October 3, 2025
概括
开放式外科绕道比慢性四肢威胁性缺血症 (CLTI) 的内血管治疗更具成本效益,提供更好的生存率和质量调整寿命年 (QALYs). 需要进一步的研究来确定受益于特定方法的患者子组.
科学领域:
- 血管外科 血管外科
- 卫生经济学 卫生经济学
- 临床试验分析
背景情况:
- 慢性四肢威胁性缺血症 (CLTI) 管理包括内血管 (Endo) 或开放式外科绕道 (Bypass) 重血管化.
- BEST-CLI试验提供了数据来比较这些方法.
研究的目的:
- 评估内血管治疗与CLTI的开放外科绕道治疗的成本效益.
- 使用来自BEST-CLI试验的数据进行全面分析.
主要方法:
- 开发了一个个人级别的连续时间马尔科夫模型,将来自BEST-CLI的临床事件纳入其中.
- 直接从试验数据中推导出结果率和健康公用事业;来自医疗保险索赔的成本.
- 计算的增量成本效益比率,质量调整的寿命年 (QALYs) 和5年和10年的净货币收益.
主要成果:
- 在5年内,绕道手术的平均成本较低,存活率与内血管治疗相比较.
- 血管内治疗在每年获得的生命成本方面被Bypass主导.
- 平均QALY相似,每QALY获得的增量成本为263,973美元,用于内血管治疗与旁路治疗.
结论:
- 绕道手术是基本病例分析中首选的策略,用于传统支付意愿值的生存和QALY.
- 概率灵敏度分析显示了大量的不确定性,表明55%的机会绕过更具成本效益.
- 未来的研究应该确定每个方法最终具有成本效益的子组.
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