Ekman Mattias, Sjögren Iwar, James Stefan
Stockholm Health Economics, Stockholm, Sweden.
Scand Cardiovasc J. 2006 Feb;40(1):17-24. doi: 10.1080/14017430500296323.
To analyse the cost-effectiveness of Taxus compared to a bare-metal stent in patients with coronary artery disease in the Swedish healthcare setting.
A decision-analytic model combining clinical data on revascularization rates with Swedish unit costs for medical resources and utility data from the literature.
For patients of moderate risk, the average cost per patient at 12 months is 72,200 SEK for Taxus and 66,900 SEK for a bare-metal stent, while the average cost for high risk patients is nearly equivalent (73,000 vs. 71,700 SEK). The cost per revascularization avoided is generally favourable, while the incremental cost per QALY gained varies depending on the assumptions made; from 2,351,000 SEK for patients of moderate risk at 12-months to cost saving at 24 months for high risk patients. Budget impact scenarios at 12 months are cost-neutral.
The Taxus stent is cost-effective in high risk patients, particularly at 24 months. Although it may be less cost-effective for the general population, there is still a substantial offset of initial procedure costs through lower rate of repeat revascularizations.
在瑞典医疗环境下，分析与裸金属支架相比，紫杉醇洗脱支架用于冠心病患者的成本效益。
一个决策分析模型，将血运重建率的临床数据与瑞典医疗资源单位成本以及文献中的效用数据相结合。
对于中度风险患者，12个月时紫杉醇洗脱支架每位患者的平均成本为72,200瑞典克朗，裸金属支架为66,900瑞典克朗，而高风险患者的平均成本几乎相当（73,000瑞典克朗对71,700瑞典克朗）。避免每次血运重建的成本总体上较为有利，而每获得一个质量调整生命年的增量成本则因所作假设而异；从中度风险患者12个月时的2,351,000瑞典克朗到高风险患者24个月时的成本节省。12个月时的预算影响情景是成本中性的。
紫杉醇洗脱支架在高风险患者中具有成本效益，尤其是在24个月时。虽然对普通人群而言其成本效益可能较低，但通过较低的重复血运重建率，初始手术成本仍有大幅抵消。
