Wu YingXing, Jin Ruyun, Gao Guangqiang, Grunkemeier Gary L, Starr Albert
Providence Heart and Vascular Institute, Providence Health System, Portland, Ore 97225, USA.
J Thorac Cardiovasc Surg. 2007 Mar;133(3):608-13. doi: 10.1016/j.jtcvs.2006.10.044.
With increased life expectancy and improved technology, valve replacement is being offered to increasing numbers of elderly patients with satisfactory clinical results. By using standard econometric techniques, we estimated the relative cost-effectiveness of aortic valve replacement by drawing on a large prospective database at our institution. By using aortic valve replacement as an example, this introductory report paves the way to more definitive studies of these issues in the future.
From 1961 to 2003, 4617 adult patients underwent aortic valve replacement at our service. These patients were provided with a prospective lifetime follow-up. As of 2005, these patients had accumulated 31,671 patient-years of follow-up (maximum 41 years) and had returned 22,396 yearly questionnaires. A statistical model was used to estimate the future life years of patients who are currently alive. In the absence of direct estimates of utility, quality-adjusted life years were estimated from New York Heart Association class. The cost-effectiveness ratio was calculated by the patient's age at surgery.
The overall cost-effectiveness ratio was approximately 13,528 dollars per quality-adjusted life year gained. The cost-effectiveness ratio increased according to age at surgery, up to 19,826 dollars per quality-adjusted life year for octogenarians and 27,182 dollars per quality-adjusted life year for nonagenarians.
Given the limited scope of this introductory study, aortic valve replacement is cost-effective for all age groups and is very cost-effective for all but the most elderly according to standard econometric rules of thumb.
随着预期寿命的延长和技术的进步，越来越多的老年患者接受了瓣膜置换术，临床效果令人满意。通过使用标准的计量经济学技术，我们利用本机构的一个大型前瞻性数据库估算了主动脉瓣置换术的相对成本效益。以主动脉瓣置换术为例，本 introductory report 为未来对这些问题进行更确定性的研究铺平了道路。
1961年至2003年，4617例成年患者在我们科室接受了主动脉瓣置换术。这些患者接受了前瞻性的终身随访。截至2005年，这些患者累计随访了31671患者年（最长41年），并返回了22396份年度问卷。使用统计模型估算目前存活患者的未来生命年数。在缺乏直接效用估计的情况下，根据纽约心脏协会分级估算质量调整生命年数。成本效益比按患者手术时的年龄计算。
总体成本效益比约为每获得一个质量调整生命年13528美元。成本效益比根据手术时的年龄增加，八旬老人每质量调整生命年高达19826美元，九旬老人每质量调整生命年高达27182美元。
鉴于本 introductory study 的范围有限，根据标准的计量经济学经验法则，主动脉瓣置换术对所有年龄组都具有成本效益，除了最年长的患者外，对所有患者都非常具有成本效益。
