经皮冠状动脉支架置入术后随访性有创冠状动脉造影的成本效益：日本真实世界观察性队列研究。
Cost-effectiveness of follow-up invasive coronary angiography after percutaneous coronary stenting: a real-world observational cohort study in Japan.
机构信息
Department of Cardiovascular Biology and Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan.
Abbvie GK, Minato-ku, Tokyo, Japan.
出版信息
BMJ Open. 2022 Aug 30;12(8):e061617. doi: 10.1136/bmjopen-2022-061617.
OBJECTIVES
Follow-up invasive coronary angiography (FUICA) after percutaneous coronary intervention (PCI) has been shown to increase the rate of early coronary revascularisation without reducing the incidence of subsequent myocardial infarction or death. However, no studies have evaluated the cost-effectiveness of FUICA in patients after coronary stenting. Therefore, this study aimed to evaluate the cost-effectiveness of FUICA after PCI.
DESIGN
Retrospective observational cohort study.
SETTING
497 hospitals.
PARTICIPANTS AND INTERVENTIONS
Overall, 558 patients who underwent coronary artery stenting between April 2014 and March 2015 were matched and included in the invasive angiographic follow-up (AF) group (n=279), in which patients underwent FUICA 6-12 months after PCI, or in the clinical follow-up alone group (CF; n=279) using propensity scores.
PRIMARY AND SECONDARY OUTCOME MEASURES
The primary endpoint was the composite outcome of death, myocardial infarction, urgent coronary revascularisation, stroke or hospitalisation for the heart failure. The secondary endpoints included all-cause death, non-fatal myocardial infarction, urgent revascularisation, coronary artery bypass grafting, stroke, hospitalisation for the heart failure and any coronary revascularisation after a minimum of 6 months of follow-up.
RESULTS
Costs were calculated as direct medical expenses based on medical fee billing information. The cumulative 3-year incidence of the primary endpoint was 5.3% in the AF group and 4.7% in the CF group (HR 1.02; 95% CI 0.47 to 2.20; p=0.98). The total incremental cost at the 3-year endpoint in the AF group was US$1874 higher than that in the CF group (US$8947±US$5684 vs US$7073±US$6360; p≤0.001).
CONCLUSIONS
FUICA increased the costs but did not improve clinical benefits. Thus, FUICA is not economically more attractive than CF alone.
TRIAL REGISTRATION NUMBER
UMIN000039768.
目的
经皮冠状动脉介入治疗（PCI）后的有创冠状动脉造影（FUICA）随访已被证明可提高早期冠状动脉血运重建的比率，而不降低随后心肌梗死或死亡的发生率。然而，尚无研究评估 FUICA 在冠状动脉支架置入术后患者中的成本效益。因此，本研究旨在评估 PCI 后 FUICA 的成本效益。
设计
回顾性观察性队列研究。
地点
497 家医院。
参与者和干预措施
共有 558 例于 2014 年 4 月至 2015 年 3 月接受冠状动脉支架置入术的患者接受匹配并纳入血管造影随访（AF）组（n=279），其中患者在 PCI 后 6-12 个月接受 FUICA，或仅接受临床随访（CF；n=279），采用倾向评分法。
主要和次要结局测量
主要终点是死亡、心肌梗死、紧急冠状动脉血运重建、卒中和心力衰竭住院的复合结局。次要终点包括全因死亡、非致死性心肌梗死、紧急血运重建、冠状动脉旁路移植术、卒中和心力衰竭住院以及至少 6 个月随访后的任何冠状动脉血运重建。
结果
成本根据医疗费用计费信息计算为直接医疗费用。AF 组的 3 年累积主要终点发生率为 5.3%，CF 组为 4.7%（HR 1.02；95%CI 0.47 至 2.20；p=0.98）。在 3 年终点时，AF 组的总增量成本比 CF 组高 1874 美元（AF 组为 8947±5684 美元，CF 组为 7073±6360 美元；p≤0.001）。
结论
FUICA 增加了成本，但没有改善临床获益。因此，与单独 CF 相比，FUICA 在经济上没有吸引力。
临床试验注册号
UMIN000039768。
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