动脉内关节切除术是否具有成本效益? 对有症状和无症状患者的分析
1Section for Clinical Epidemiology, Brigham and Women's Hospital, Boston, MA 02115, USA. keaney@hsph.harvard.edu
Circulation
|November 1, 1996
概括
Carotid Endarterectomy (CE) 为症状患者提供了有利的成本效益. 对于无症状患者,成本效益有所不同,这凸显了需要仔细考虑手术风险和成本的必要性.
科学领域:
- 血管外科 血管外科
- 卫生经济学 卫生经济学
- 临床决策 临床决策
背景情况:
- 以前的NASCET和ACAS等试验证明了CE在降低中风风险方面的有效性.
- 然而,这些具有里程碑意义的研究并没有评估CE的经济影响.
研究的目的:
- 与医疗治疗相比,评估动脉内关节切除术 (CE) 的成本效益.
- 分析CE的经济价值,对于症状和无症状的患有动脉狭窄症的患者.
主要方法:
- 马尔科夫模型是基于NASCET和ACAS试验数据开发的.
- 经过质量调整的预期寿命和直接医疗费用被计算为CE与医疗治疗.
- 关键参数包括手术中风风险,药物治疗中风风险和术后风险降低.
主要成果:
- 对于症状患者,增量成本效益比 (ICER) 为每QALY获得的4100美元,远低于50000美元/QALY.
- 对于无症状患者,ICER为每QALY获得的52700美元,但对术后风险和治疗成本等参数敏感.
- 假设的变化表明在特定条件下,无症状患者的潜在ICER低于50000美元/QALY.
结论:
- Carotid Endarterectomy (CE) 与其他医疗干预相比,显示出有利的成本效益.
- 对于无症状患者来说,CE的经济效益对外科手术期间的风险和成本假设很敏感,需要个性化评估.
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