Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo.
Circ J. 2019 Jun 25;83(7):1498-1505. doi: 10.1253/circj.CJ-19-0148. Epub 2019 Jun 5.
The cost-effectiveness of percutaneous coronary intervention (PCI) for ischemic heart disease is undetermined in Japan. The aim of this study was to analyze the cost-effectiveness of PCI compared with medical therapy for ST-elevation myocardial infarction (STEMI) and angina pectoris (AP) in Japan.
We used Markov models for STEMI and AP to assess the costs and benefits associated with PCI or medical therapy from a health system perspective. We estimated the incremental cost-effectiveness ratio (ICER), expressed as quality-adjusted life-years (QALY), and ICER <¥5 m per QALY gained was judged to be cost-effective. The impact of PCI on cardiovascular events was based on previous publications. In STEMI patients, the ICER of PCI over medical treatment was ¥0.97 m per QALY gained. The cost-effectiveness probability of PCI was 99.9%. In AP patients, the ICER of fractional flow reserve (FFR)-guided PCI over medical treatment was ¥4.63 m per QALY gained. The cost-effectiveness probability of PCI was 50.4%. The ICER of FFR-guided PCI for asymptomatic patients was ¥23 m per QALY gained.
In STEMI patients, PCI was cost-effective compared with medical therapy. In AP patients, FFR-guided PCI for symptomatic patients could be cost-effective compared with medical therapy. FFR-guided PCI for asymptomatic patients with myocardial ischemia was not cost-effective.
经皮冠状动脉介入治疗（PCI）在日本用于缺血性心脏病的成本效益尚不确定。本研究旨在分析与药物治疗相比，PCI 在日本治疗 ST 段抬高型心肌梗死（STEMI）和心绞痛（AP）的成本效益。
我们使用 Markov 模型来评估 STEMI 和 AP 患者从健康系统角度来看，接受 PCI 或药物治疗的成本和获益。我们估算了增量成本效益比（ICER），表示为质量调整生命年（QALY），ICER<¥5 百万日元/QALY 被认为是具有成本效益的。PCI 对心血管事件的影响基于以前的出版物。在 STEMI 患者中，PCI 优于药物治疗的 ICER 为每 QALY 增加 0.97 百万日元。PCI 的成本效益概率为 99.9%。在 AP 患者中，FFR 指导的 PCI 优于药物治疗的 ICER 为每 QALY 增加 4.63 百万日元。PCI 的成本效益概率为 50.4%。FFR 指导的 PCI 用于无症状患者的 ICER 为每 QALY 增加 23 百万日元。
在 STEMI 患者中，与药物治疗相比，PCI 具有成本效益。在 AP 患者中，FFR 指导的 PCI 用于有症状患者可能比药物治疗更具成本效益。FFR 指导的无症状心肌缺血患者的 PCI 不具有成本效益。
