Costa Rodrigo, Pedra Carlos A C, Ribeiro Marcelo, Pedra Simone, Ferreira-Da-Silva André Luis, Polanczyk Carisi, Berwanger Otávio, Biasi Alexandre, Ribeiro Rodrigo
Hospital do Coração da Associação do Sanatório Sírio, Sao Paulo, Brazil.
Expert Rev Cardiovasc Ther. 2014 Nov;12(11):1369-78. doi: 10.1586/14779072.2014.967216. Epub 2014 Oct 4.
Cost-effectiveness (CE) studies of percutaneous (PC) versus surgical (SC) atrial septal defect closure are lacking.
A systematic literature review in children and a CE analysis based on a model of long-term outcomes were performed. Direct costs of PC and SC were US$8700 (defined arbitrarily) and US$5700 (actually paid), respectively. Three-times the Brazilian GDI (US$28,700) per year of life saved (with a discount rate of 5%) was used as a limit for willingness-to-pay.
PC had a high (US$104,500) incremental CE ratio despite lower complication rates, shorter hospital stay and better (nonsignificant) adjusted life expectancy. PC would be cost-effective if it cost US$6400 or SC had an 8% loss of utility or its indirect costs were US$2250. Costs of PC should be reduced to be cost-effective in the Brazilian public health system. Indirect costs and impact on quality of life should be further assessed.
经皮（PC）与外科（SC）房间隔缺损封堵术的成本效益（CE）研究尚缺。
开展了一项针对儿童的系统文献综述，并基于长期预后模型进行成本效益分析。PC和SC的直接成本分别为8700美元（任意定义）和5700美元（实际支付）。将每年挽救生命的三倍巴西人均国内生产总值（28700美元，贴现率为5%）用作支付意愿的上限。
尽管PC的并发症发生率较低、住院时间较短且调整后的预期寿命较好（无统计学意义），但其增量成本效益比仍较高（104500美元）。如果PC的成本为6400美元，或者SC的效用损失为8%，或者其间接成本为2250美元，那么PC将具有成本效益。在巴西公共卫生系统中，PC的成本应降低才能具有成本效益。应进一步评估间接成本及其对生活质量的影响。
