对于股骨关节疾病的重血管化. 一个决策和成本效益分析
M G Hunink1, J B Wong, M C Donaldson
1Department of Health Sciences, University of Groningen, The Netherlands.
JAMA
|July 12, 1995
概括
对于股骨关节疾病,血管造形术是最好的,用于狭窄或闭塞与塞或狭窄与临界缺血症. 对关键性缺血症的闭塞而言,偏选绕道手术.
科学领域:
- 血管外科 血管外科
- 卫生经济学 卫生经济学
- 决策分析 决策分析
背景情况:
- 骨关节疾病显著影响患者的生活质量和医疗保健费用.
- 重新血管化的策略,包括皮肤透光血管造形术和绕道手术,旨在改善结果.
- 比较有效性和成本效益数据对于指导治疗决策至关重要.
研究的目的:
- 为了比较血管造形术的相对益处和成本效益,而不是对股骨关节疾病的绕道手术.
- 根据患者的特征和病变类型来评估治疗策略.
- 为了告知临床实践和医疗保健政策有关骨关节再血管化.
主要方法:
- 使用多态过渡模拟模型 (马尔科夫过程) 进行决策分析.
- 从医疗保健系统的角度进行成本效益分析.
- 关于死亡率,发病率,通透率和成本数据的文献综述.
主要成果:
- 初始血管整形改善了质量调整后的预期寿命,并降低了残疾塞或狭窄性临界缺血症患者的终身成本.
- 初始绕道手术改善了质量调整后的预期寿命,并降低了闭塞和严重缺血症患者的终身成本.
- 敏感性分析表明,如果其5年通透率超过30%,则优先进行血管造形术.
结论:
- 血管造形术是首选的初始复血管化策略,用于骨狭窄症或闭塞的患者,残疾的关节障碍或临界缺血与狭窄症.
- 绕道手术是关键性缺血症患者的股骨关闭的首选初始再血管化策略.
- 治疗选择应根据临床表现和病变特征进行个性化.
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