Fattore Giovanni, Landolina Maurizio, Bontempi Luca, Cacciatore Giuseppe, Curnis Antonio, Gulizia Michele, Padeletti Luigi, Mazzei Luigi, Tavazzi Luigi
Facoltà di Economia Aziendale, Università degli Studi Parthenope, Napoli, Istituto di Pubblica Amministrazione e Sanità, e CeRGAS, Università degli Studi Bocconi, Milano.
Ital Heart J Suppl. 2005 Dec;6(12):796-803.
Several clinical trials show that cardiac resynchronization therapy (CRT) in patients with moderate-severe heart failure increases survival, improves quality of life and reduces hospital admissions. The high cost of this new technology, incurred by health organizations at the moment of the implant, requires to assess whether its use is economically rational for the Italian Health Service. The paper summarizes evidences of the impact of CRT on the use of hospital resources and on quality of life, and presents a model to calculate incremental costs per quality adjusted life years (QALYs) gained in patients with moderate-severe heart failure treated with optimal medical therapy. The model is based on efficacy data drawn from clinical trials and on other information concerning the Italian context collected and validated by a team of experts from Assobiomedica and the Italian Federation of Cardiology. The model estimates that the incremental cost per QALY gained attributable to CRT is Euro 63,225 if all effects (years of life gained, increased quality of life and reduction of hospital costs) are censored at the end of the first year after the implant and Euro 21,720 if all effects are censored at the end of the third year. Cost-effectiveness of CRT is thus strongly dependent upon the duration of its effects: longer benefits of the therapy compensate initial costs and thus make the technology more cost-effective. In order to get better estimates of the economic profile of CRT it is required to collect more precise data from routine practice on survival, quality of life and hospital resources. The model presented can be easily adapted to take into account new evidence and to calculate cost per QALY gained in regional and local contexts.
多项临床试验表明,中重度心力衰竭患者接受心脏再同步治疗(CRT)可提高生存率、改善生活质量并减少住院次数。这项新技术在植入时由卫生机构承担的高昂成本,要求评估其使用对意大利医疗服务来说在经济上是否合理。本文总结了CRT对医院资源使用和生活质量影响的证据,并提出了一个模型,用于计算接受最佳药物治疗的中重度心力衰竭患者每获得一个质量调整生命年(QALY)的增量成本。该模型基于从临床试验中得出的疗效数据以及由Assobiomedica和意大利心脏病学联合会的专家团队收集并验证的有关意大利情况的其他信息。该模型估计,如果在植入后的第一年末对所有效果(延长的生命年、提高的生活质量和降低的医院成本)进行审查,CRT每获得一个QALY的增量成本为63,225欧元;如果在第三年末对所有效果进行审查,则为21,720欧元。因此,CRT的成本效益在很大程度上取决于其效果的持续时间:治疗的长期益处可弥补初始成本,从而使该技术更具成本效益。为了更准确地估计CRT的经济状况,需要从日常实践中收集关于生存率、生活质量和医院资源的更精确数据。所提出的模型可以很容易地进行调整,以考虑新的证据,并计算在区域和地方背景下每获得一个QALY的成本。