药物洗脱支架治疗稳定型冠状动脉疾病患者的成本效益分析。
Cost-effectiveness of drug-eluting stents in patients with stable coronary artery disease.
机构信息
Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Douliu, Taiwan.
出版信息
J Formos Med Assoc. 2011 Feb;110(2):109-14. doi: 10.1016/S0929-6646(11)60017-X.
BACKGROUND/PURPOSE: Drug-eluting stents (DESs) have been shown to reduce in-stent restenosis and target vessel revascularization (TVR) in large clinical trials. We conducted this study to elucidate the differences in the cost and clinical outcome of DESs and bare metal stents (BMSs).
METHODS
We retrospectively analyzed the clinical data and costs of patients with stable angina treated with coronary stents from September 2003 to January 2005 at the National Taiwan University Hospital, Taipei, Taiwan.
RESULTS
We enrolled 186 patients treated with DESs and 194 patients treated with BMSs. The use of DESs is associated with a lower rate of TVR compared with that with BMSs (12%vs. 22%, p = 0.011). Compared with the BMS group, the overall costs were significantly higher in the DES group (NT$352,495 ± 140,408 vs. NT$298,947 ± 131,289, p<0.001). The incremental cost to avoid one TVR at 2 years was NT$546,444 (95% confidence interval: NT$151,071-2,565,793).
CONCLUSION
The use of DESs reduces the rate of TVR at 2 years after intervention, but is probably not cost-effective compared with BMSs in patients with stable coronary artery disease.
背景/目的：药物洗脱支架（DES）已被证明可降低大型临床试验中的支架内再狭窄和靶血管血运重建（TVR）的发生率。我们进行这项研究旨在阐明 DES 和金属裸支架（BMS）的成本和临床结果的差异。
方法
我们回顾性分析了 2003 年 9 月至 2005 年 1 月在台湾台北国立台湾大学医院接受冠状动脉支架治疗的稳定型心绞痛患者的临床数据和成本。
结果
我们纳入了 186 例接受 DES 治疗的患者和 194 例接受 BMS 治疗的患者。与 BMS 相比，DES 的 TVR 发生率较低（12%对 22%，p = 0.011）。与 BMS 组相比，DES 组的总费用明显更高（新台币 352,495 ± 140,408 元对新台币 298,947 ± 131,289 元，p<0.001）。避免 2 年内发生一次 TVR 的增量成本为新台币 546,444 元（95%置信区间：新台币 151,071-2,565,793 元）。
结论
与 BMS 相比，DES 可降低稳定型冠状动脉疾病患者介入治疗后 2 年内 TVR 的发生率，但可能在成本效益方面并不优于 BMS。
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