Yaghoubi Mohsen, Aghayan Hamid Reza, Arjmand Babak, Emami-Razavi Seyed Hassan
School of Management and Medical Information Science, Iran University of Medical Sciences, Tehran, Iran.
Cell Tissue Bank. 2011 May;12(2):153-8. doi: 10.1007/s10561-009-9165-9. Epub 2009 Dec 2.
The clinical effectiveness of heart valve replacement surgery has been well documented. Mechanical and homograft valves are used routinely for replacement of damaged heart valves. Homograft valves are produced in our country but we import the mechanical valves. To our knowledge the cost-effectiveness of homograft valve has not been assessed. The objective of the present study was to compare the cost-effectiveness of homograft valve replacement with mechanical valve replacement surgery. Our samples were selected from 200 patients that underwent homograft and mechanical heart valve replacement surgery in Imam-Khomeini hospital (2000-2005). In each group we enrolled 30 patients. Quality of life was measured using the SF-36 questionnaire and utility was measured in quality-adjusted life years (QALYs). For each group we calculated the price of heart valve and hospitalization charges. Finally the cost-effectiveness of each treatment modalities were summarized as costs per QALYs gained. Forty male and twenty female participated in the study. The mean score of quality of life was 66.06 (SD = 9.22) in homograft group and 57.85 (SD = 11.30) in mechanical group (P < 0.05). The mean QALYs gained in homograft group was 0.67 more than mechanical group. The incremental cost-effectiveness ratio (ICER) revealed a cost savings of 1,067 US$ for each QALY gained in homograft group. Despite limitation of this introductory study, we concluded that homograft valve replacement was more effective and less expensive than mechanical valve. These findings can encourage healthcare managers and policy makers to support the production of homograft valves and allocate more recourse for developing such activities.
心脏瓣膜置换手术的临床有效性已有充分记录。机械瓣膜和同种异体瓣膜通常用于替换受损的心脏瓣膜。我国可生产同种异体瓣膜，但机械瓣膜需进口。据我们所知，同种异体瓣膜的成本效益尚未得到评估。本研究的目的是比较同种异体瓣膜置换与机械瓣膜置换手术的成本效益。我们的样本选自2000年至2005年在伊玛目·霍梅尼医院接受同种异体和机械心脏瓣膜置换手术的200名患者。每组纳入30名患者。使用SF - 36问卷测量生活质量，并以质量调整生命年（QALYs）衡量效用。我们计算了每组心脏瓣膜的价格和住院费用。最后，将每种治疗方式的成本效益总结为每获得一个QALY的成本。40名男性和20名女性参与了该研究。同种异体瓣膜组的生活质量平均得分为66.06（标准差= 9.22），机械瓣膜组为57.85（标准差= 11.30）（P < 0.05）。同种异体瓣膜组获得的平均QALY比机械瓣膜组多0.67。增量成本效益比（ICER）显示，同种异体瓣膜组每获得一个QALY可节省1067美元。尽管这项初步研究存在局限性，但我们得出结论，同种异体瓣膜置换比机械瓣膜更有效且成本更低。这些发现可鼓励医疗管理者和政策制定者支持同种异体瓣膜的生产，并为开展此类活动分配更多资源。
