Cardiac Surgery Unit, Careggi Hospital, Florence, Italy.
J Thorac Cardiovasc Surg. 2011 Nov;142(5):1062-73. doi: 10.1016/j.jtcvs.2011.02.013. Epub 2011 Apr 13.
Cost-effectiveness of heart surgery for elderly patients is still poorly defined. We evaluated outcome, quality of life (QoL), cost, and cost-effectiveness of octogenarians undergoing cardiac surgery.
One thousand six hundred forty octogenarians undergoing various cardiac surgical procedures were prospectively studied between January 1998 and January 2009 and compared with similar patients aged 70 to 79 years. Several questionnaires were used to assess QoL. Six hundred age- and sex- matched healthy octogenarians and three hundred forty patients older than 80 years with medically treated valvular or coronary artery disease were healthy and unoperated control groups, respectively. In-hospital costs were obtained from the hospital's financial accounting department and cost-effectiveness was estimated and expressed as cost/QoL-adjusted life year (QALY) and cost-effectiveness ratio.
Significant improvements occurred in elderly patients in Role Physical (P < .001), Bodily Pain (P < .001), General Health (P = .004), Social Functioning (P < .001), and Role Emotional (P < .001), whereas Physical Functioning, Vitality, and Mental Health did not change (difference not signficant). Total direct costs were $5293 higher in the octogenarian group. Cost-effectiveness was $1391/QALY for elderly surgical patients, $516/QALY for younger cardiac surgical patients (P < .001 vs elderly), $897/QALY for untreated control group, and $641/QALY for healthy control group (P < .001 vs elderly surgical patients). The cost-effectiveness ratio for octogenarians was $94,426.
Our findings confirm that cardiac surgery in elderly patients remains controversial from a cost-effectiveness standpoint, making econometric analysis an important component for any future evaluation of novel cardiovascular therapies. Our findings need to be confirmed by additional multicenter studies.
高龄患者心脏手术的成本效益仍未明了。我们评估了行心脏手术的 80 岁以上患者的预后、生活质量（QoL）、成本和成本效益。
1998 年 1 月至 2009 年 1 月间，前瞻性研究了 1640 例行各种心脏手术的 80 岁以上患者，并与年龄 70-79 岁相似患者进行比较。使用了几种问卷来评估 QoL。600 名年龄和性别匹配的 80 岁以上健康者和 340 名接受药物治疗的瓣膜或冠状动脉疾病且未经手术的 80 岁以上患者分别为健康未手术对照组和有治疗组。住院费用来自医院财务会计部门，成本效益采用每 QoL 调整生命年（QALY）和成本效益比来评估和表示。
老年患者在角色身体功能（Role Physical）（P <.001）、躯体疼痛（Bodily Pain）（P <.001）、总体健康状况（General Health）（P =.004）、社会功能（Social Functioning）（P <.001）和角色情绪（Role Emotional）（P <.001）方面有显著改善，而身体功能（Physical Functioning）、活力（Vitality）和心理健康（Mental Health）没有变化（差异无统计学意义）。80 岁以上患者组的总直接费用高出 5293 美元。老年手术患者的成本效益为 1391 美元/QALY，年轻心脏手术患者为 516 美元/QALY（P <.001 比老年），未经治疗的对照组为 897 美元/QALY，健康对照组为 641 美元/QALY（P <.001 比老年手术患者）。80 岁以上患者的成本效益比为 94426 美元。
我们的研究结果证实，从成本效益的角度来看，高龄患者心脏手术仍然存在争议，使得计量经济学分析成为任何未来心血管治疗新方法评估的重要组成部分。我们的研究结果需要通过额外的多中心研究来证实。
