Cohen D J, Baim D S
Charles A. Dana Research Institute, Boston, Massachusetts, USA.
J Invasive Cardiol. 1995;7 Suppl A:36A-42A.
In today's health care climate, decisions about new technologies need to reflect measures of cost as well as clinical benefit. By estimating the cost-effectiveness ratio for a new treatment compared to a current standard (e.g., stenting as compared to conventional PTCA), it is possible to decide whether the new treatment represents an efficient use of limited health care resources. In this analysis, stenting carried a $2500 greater in-hospital cost, which was partially defrayed by a $1900 savings in follow-up costs due to reductions in abrupt closure and restenosis. The net $600 increase in cumulative costs for stenting "bought" additional quality-adjusted life expectancy at a cost-effectiveness ratio of $33,700/QALY over conventional angioplasty, giving stenting a cost-effectiveness comparable to many other accepted medical therapies. Any future reduction in stent costs (e.g., by reducing length of stay or vascular complications) would improve this estimate of relative cost-effectiveness.
在当今的医疗环境中，关于新技术的决策需要同时考虑成本和临床效益。通过估算一种新治疗方法与当前标准（如支架置入术与传统经皮冠状动脉腔内血管成形术相比）的成本效益比，可以决定新治疗方法是否有效利用了有限的医疗资源。在这项分析中，支架置入术的住院成本高出2500美元，由于急性闭塞和再狭窄的减少，后续成本节省了1900美元，部分抵消了这一差异。支架置入术累计成本净增加600美元，以每质量调整生命年33700美元的成本效益比“换取”了额外的质量调整预期寿命，使支架置入术的成本效益与许多其他被认可的医学疗法相当。未来支架成本的任何降低（如通过缩短住院时间或减少血管并发症）都将改善这种相对成本效益的估计。
