Sonnenberg A
Department of Medicine, Veterans Administration Medical Center, Milwaukee, Wisconsin.
Gastroenterology. 1989 Jun;96(6):1445-52. doi: 10.1016/0016-5085(89)90511-8.
Proximal gastric vagotomy and intermittent and maintenance therapy with H2-antagonists have all been claimed to be effective in long-term management of duodenal ulcer disease. The model of a Markov chain was used to compare their costs by a medical decision analysis. The high price of the initial procedure made proximal gastric vagotomy the most expensive therapy, its costs rising from +10,600 after 1 yr to +12,200 after 15 yr. The average costs of intermittent therapy per patient rose from +500 to +7500. Maintenance therapy cost as much as intermittent therapy but provided 8% and 4% more time spent free of ulcer relapse and pain, respectively. In a sensitivity analysis, the order of the therapeutic options regarding their cost-effectiveness remained robust to changes in the assumptions underlying the model. In a European health care system, the initial surgical procedure cost only one-seventh of the average annual income compared with two-thirds in the United States, and proximal gastric vagotomy turned out to be the cheapest therapy after 6 yr. These results suggest that maintenance therapy provides the best long-term management. Gastric surgery may represent a cost-effective measure of ulcer prevention in Europe but not in the United States.
近端胃迷走神经切断术以及使用H2拮抗剂进行间歇性和维持性治疗，均被宣称对十二指肠溃疡病的长期管理有效。通过医学决策分析，采用马尔可夫链模型来比较它们的成本。初始手术价格高昂，使得近端胃迷走神经切断术成为最昂贵的治疗方法，其成本从1年后的10,600英镑升至15年后的12,200英镑。每位患者间歇性治疗的平均成本从500英镑升至7500英镑。维持性治疗的成本与间歇性治疗相当，但分别使无溃疡复发和无痛的时间增加了8%和4%。在敏感性分析中，各治疗方案在成本效益方面的排序对模型所依据假设的变化保持稳健。在欧洲医疗体系中，初始外科手术成本仅占平均年收入的七分之一，而在美国则占三分之二，结果显示近端胃迷走神经切断术在6年后成为最便宜的治疗方法。这些结果表明维持性治疗提供了最佳的长期管理。胃手术在欧洲可能是一种具有成本效益的溃疡预防措施，但在美国并非如此。
