Kent David M, Vijan Sandeep, Hayward Rodney A, Griffith John L, Beshansky Joni R, Selker Harry P
Clinical Research and Health Policy Studies, Tufts-New England Medical Center/Tufts University School of Medicine, 750 Washington Street, Box 63, Boston, MA 02111, USA.
J Clin Epidemiol. 2004 Aug;57(8):843-52. doi: 10.1016/j.jclinepi.2004.01.008.
We sought to explore the patient-specific cost-effectiveness in a community-based sample for a therapy for which the average cost-effectiveness in a clinical trial has been well-described.
Based on a validated multivariate model, we generated predictions of the effectiveness and cost-effectiveness of t-PA compared to streptokinase on 921 consecutive patients who received thrombolytic therapy for acute myocardial infarction.
The average cost-effectiveness of t-PA was US dollar 40,140 per life-year saved. For the quartile of patients most likely to benefit, the incremental cost-effectiveness of t-PA was US dollar 15,396. However, only 44% of patients who received thrombolytic therapy had an estimated cost-effectiveness ratio below US dollar 50,000 per year of life saved; the ratio was greater than US dollar 100,000 in 37% of treated patients. Patients in the lowest quartile of expected benefit are, overall, more likely to be harmed than to benefit from t-PA.
Compared to the pattern of thrombolytic agent choice observed, targeting t-PA to the half of patients most likely to benefit could save 247 lives and US dollar 174 million nationally per year.
对于一种在临床试验中平均成本效益已得到充分描述的治疗方法，我们试图在一个基于社区的样本中探索患者特异性成本效益。
基于一个经过验证的多变量模型，我们对921例接受急性心肌梗死溶栓治疗的连续患者进行了预测，比较了t-PA与链激酶的有效性和成本效益。
t-PA的平均成本效益为每挽救一个生命年40,140美元。对于最有可能受益的四分位数患者，t-PA的增量成本效益为15,396美元。然而，接受溶栓治疗的患者中只有44%的估计成本效益比低于每年挽救一个生命年50,000美元；在37%的接受治疗的患者中，该比例大于100,000美元。总体而言，预期受益最低的四分位数患者更有可能受到伤害而不是从t-PA中受益。
与观察到的溶栓药物选择模式相比，将t-PA靶向最有可能受益的一半患者，每年在全国范围内可挽救247条生命并节省1.74亿美元。
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