Caruba Thibaut, Chevreul Karine, Zarca Kevin, Cadier Benjamin, Juillière Yves, Dubourg Olivier, Sabatier Brigitte, Danchin Nicolas
AP-HP, hôpital européen Georges-Pompidou, Pharmacie, 20, rue Leblanc, 75015 Paris, France.
AP-HP, Hôtel-Dieu, URC Eco, 1, place du parvis Notre-Dame, 75004 Paris, France; Inserm, ECEVE, U1123, Paris, France.
Arch Cardiovasc Dis. 2015 Nov;108(11):576-88. doi: 10.1016/j.acvd.2015.06.006. Epub 2015 Oct 1.
Few studies have analyzed the cost of treatment of chronic angina pectoris, especially in European countries.
To determine, using a modeling approach, the cost of care in 2012 for 1year of treatment of patients with stable angina, according to four therapeutic options: optimal medical therapy (OMT); percutaneous coronary intervention with bare-metal stent (PCI-BMS); PCI with drug-eluting stent (PCI-DES); and coronary artery bypass graft (CABG).
Six different clinical scenarios that could occur over 1year were defined: clinical success; recurrence of symptoms without hospitalization; myocardial infarction (MI); subsequent revascularization; death from non-cardiac cause; and cardiac death. The probability of a patient being in one of the six clinical scenarios, according to the therapeutic options used, was determined from a literature search. A direct medical cost for each of the therapeutic options was calculated from the perspective of French statutory health insurance.
The annual costs per patient for each strategy, according to their efficacy results, were, in our models, €1567 with OMT, €5908 with PCI-BMS, €6623 with PCI-DES and €16,612 with CABG. These costs were significantly different (P<0.05). A part of these costs was related to management of complications (recurrence of symptoms, MI and death) during the year (between 3% and 38% depending on the therapeutic options studied); this part of the expenditure was lowest with the CABG therapeutic option.
OMT appears to be the least costly option, and, if reasonable from a clinical point of view, might achieve appreciable savings in health expenditure.
很少有研究分析慢性心绞痛的治疗成本，尤其是在欧洲国家。
采用建模方法确定2012年稳定型心绞痛患者1年治疗的护理成本，依据四种治疗方案：最佳药物治疗（OMT）；裸金属支架经皮冠状动脉介入治疗（PCI-BMS）；药物洗脱支架经皮冠状动脉介入治疗（PCI-DES）；冠状动脉旁路移植术（CABG）。
定义了1年内可能出现的六种不同临床情况：临床成功；无症状复发且未住院；心肌梗死（MI）；后续血运重建；非心脏原因死亡；心脏死亡。根据所使用的治疗方案，通过文献检索确定患者处于六种临床情况之一的概率。从法国法定医疗保险的角度计算每种治疗方案的直接医疗成本。
在我们的模型中，根据疗效结果，每种策略每位患者的年度成本分别为：OMT为1567欧元，PCI-BMS为5908欧元，PCI-DES为6623欧元，CABG为16612欧元。这些成本有显著差异（P<0.05）。这些成本的一部分与该年度并发症（症状复发、MI和死亡）的管理有关（根据所研究的治疗方案，在3%至38%之间）；这部分支出在CABG治疗方案中最低。
OMT似乎是成本最低的选择，如果从临床角度合理，可能会在医疗支出方面实现可观的节省。
