对治疗与对脊柱骨底型多利切切动脉瘤成像监测的成本效益分析
Journal of neurosurgery
|January 30, 2026
概括
早期治疗是表现为症状的脊柱骨干多利切切动脉瘤的最具成本效益的策略,比定期的随访提供更好的结果. 监控只有在非常低风险的情况下才具有成本效益.
科学领域:
- 神经外科 神经外科
- 血管神经学 血管神经学
- 卫生经济学 卫生经济学
背景情况:
- 脊椎基多利科切卡动脉瘤是一种罕见的脑内动脉瘤,预后不佳.
- 高发病率和死亡率与缺血性中风,质量效应和破裂出血有关.
- 症状性动脉瘤往往需要治疗.
研究的目的:
- 确定对多利瘤动脉瘤最具成本效益的管理策略.
- 为了比较即时治疗与各种随访间隔.
- 分析成本,影响和净货币收益.
主要方法:
- 使用马尔科夫决策模型来比较管理策略.
- 数据是从现有的文献中提取的.
- 进行了灵敏度分析 (确定性和概率分析),以评估模型的稳定性.
主要成果:
- 立即治疗 (开放式手术或内血管) 是最具成本效益的策略,产生最高的净货币效益.
- 这一发现在所有灵敏度分析中保持稳定,成本效益可接受度为97%.
- 只有当中风,出血,生长或破裂的风险非常低时,才可以考虑每6个月或每年进行一次随访.
结论:
- 只有当每年缺血风险低于3.3%时,MR血管学监测才是具有成本效益的,六个月间隔是优越的.
- 随着风险的增加,预防性治疗提供了更高的净货币收益.
- 患者和动脉瘤特定因素,包括治疗风险,在决策中至关重要.
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