School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Am J Cardiol. 2021 Oct 1;156:44-51. doi: 10.1016/j.amjcard.2021.06.034. Epub 2021 Jul 27.
Clinical trials have shown that radial access percutaneous coronary intervention (PCI) is associated with improved patient outcomes compared to femoral artery access. However, few studies have evaluated the cost-effectiveness of radial access PCI. This analysis sought to evaluate the cost-effectiveness of transradial versus transfemoral access PCI for patients with acute coronary syndrome (ACS) using data from the Minimizing Adverse Hemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox (MATRIX) trial. A decision analytic Markov model was constructed from an Australian health care perspective with a 2 year time horizon. The model simulated recurrent cardiovascular disease and death post PCI among a hypothetical cohort of 1000 individuals with ACS. Population and efficacy data were based on the MATRIX trial. Cost and utility data were drawn from published sources. Over a 2-year time horizon, radial access was predicted to save 12 (discounted) quality adjusted life years (QALYs) compared with femoral access PCI. Cost savings (discounted) amounted to AUD $51,305. Hence from a health economic point of view, radial access PCI was dominant over femoral access PCI. Sensitivity analyses supported the robustness of these findings. Radial access PCI is likely to be associated with both better outcomes and lower costs compared to femoral access PCI over 2 years post procedure. In conclusion, these findings support radial access being the preferred approach in PCI for ACS.
临床试验表明，与股动脉入路相比，经桡动脉入路行经皮冠状动脉介入治疗（PCI）与改善患者预后相关。然而，很少有研究评估经桡动脉入路 PCI 的成本效益。本分析旨在使用 Minimizing Adverse Hemorrhagic Events by Transradial Access Site and Systemic Implementation of Angiox（MATRIX）试验的数据，评估急性冠状动脉综合征（ACS）患者经桡动脉与经股动脉入路行 PCI 的成本效益。从澳大利亚医疗保健的角度出发，使用 2 年时间范围构建决策分析马尔可夫模型。该模型模拟了 PCI 后假定的 1000 名 ACS 个体中复发性心血管疾病和死亡的情况。人群和疗效数据基于 MATRIX 试验。成本和效用数据来自已发表的来源。在 2 年时间范围内，与股动脉入路 PCI 相比，经桡动脉入路预计可节省 12 个（折现）质量调整生命年（QALY）。成本节省（折现）为 51305 澳元。因此，从健康经济学的角度来看，经桡动脉 PCI 优于股动脉 PCI。敏感性分析支持这些发现的稳健性。与股动脉入路 PCI 相比，经桡动脉入路 PCI 在术后 2 年内可能具有更好的疗效和更低的成本。总之，这些发现支持在 ACS 的 PCI 中首选经桡动脉入路。
