Golán L, Simek S, Linhart A, Cahlík T, Palecek T, Lubanda J C, Korínek J, Beran S, Aschermann M
II. interní klinika 1. lékarské fakulty UK a VFN, Praha.
Vnitr Lek. 2003 Feb;49(2):97-102.
Primary angioplasty (PTCA) or intravenous thrombolysis are the recommended treatment of acute myocardial infarction. According to results of clinical investigations however primary PTCA provides a more favourable short-term as well as long-term prognosis. As this method is much more expensive we were interested in its cost-effectiveness as compared with cheaper intravenous thrombolysis.
We constructed an decision analysis model (programme DATA 3.5, TreeAge Software) to compare the strategy of primary PTCA and intravenous thrombolysis in acute myocardial infarction. Probabilities of clinical outcomes were obtained from a long-term randomized clinical trial (Zijlstra et al. NEJM, 1999). The relative risk of death in PTCA was 0.54, rehospitalization 0.52 and reinfarction 0.27. The costs of PTCA (100,000,- crowns), of streptokinase thrombolysis (4000,- crowns) and hospitalization (2820,- crowns) were estimated from costs of the catheterization laboratory and information obtained from health insurance companies. We assumed that the subsequent costs of treatment and quality of life after the first infarction were the same in both strategies. In patients with reinfarction we anticipated a reduced quality of life (coefficient of life quality 0.9). The average effect of treatment and costs of both strategies were evaluated in the course of five years. As an acceptable cost-effectiveness (ratio of difference in costs and effect) we considered costs up to 200,000,- crowns per one gained year of life.
In the basic analysis we revealed that after 5 years the strategy of primary PTCA is more expensive (125,000,- crowns vs. 4500,- crowns) but has a greater effect, i.e. a longer life span (4.38 vs. 3.81) adjusted to quality of life). The cost-effectiveness (ratio of difference in costs and effect) expressing the costs of one gained year of life when using primary PTCA as compared with thrombolysis was despite the high cost of PTCA acceptable and amounted to 140,350,- crowns. Analysis of the sensitivity of the model confirmed the stability of favourable cost-effectiveness within a wide range of costs and therapeutic effect.
Primary PTCA is in acute myocardial infarction a cost-effective strategy) providing effect for an acceptable cost) despite the markedly higher costs of the procedure.
直接经皮冠状动脉腔内血管成形术（PTCA）或静脉溶栓是急性心肌梗死的推荐治疗方法。然而，根据临床研究结果，直接PTCA在短期和长期预后方面都更有利。由于这种方法成本高得多，我们对其与成本较低的静脉溶栓相比的成本效益感兴趣。
我们构建了一个决策分析模型（DATA 3.5程序，TreeAge软件），以比较急性心肌梗死中直接PTCA和静脉溶栓的策略。临床结果的概率来自一项长期随机临床试验（齐尔斯特拉等人，《新英格兰医学杂志》，1999年）。PTCA治疗的死亡相对风险为0.54，再次住院风险为0.52，再梗死风险为0.27。PTCA的成本（100,000克朗）、链激酶溶栓的成本（4000克朗）和住院成本（2820克朗）是根据导管实验室的成本以及从健康保险公司获得的信息估算的。我们假设两种策略中首次梗死后的后续治疗成本和生活质量相同。对于再梗死患者，我们预计其生活质量会降低（生活质量系数为0.9）。在五年期间评估了两种策略的平均治疗效果和成本。作为可接受的成本效益（成本差异与效果的比率），我们认为每获得一年生命的成本最高为200,000克朗。
在基础分析中，我们发现5年后直接PTCA策略成本更高（125,000克朗对4500克朗），但效果更好，即调整生活质量后的寿命更长（4.38对3.81）。尽管PTCA成本高昂，但与溶栓相比，使用直接PTCA时每获得一年生命的成本效益（成本差异与效果的比率）是可接受的，为140,350克朗。模型的敏感性分析证实了在广泛的成本和治疗效果范围内，有利的成本效益具有稳定性。
在急性心肌梗死中，直接PTCA是一种具有成本效益的策略（以可接受的成本产生效果），尽管该手术成本明显更高。
