Department of Healthcare Economics and Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
J Cardiol. 2023 Apr;81(4):356-363. doi: 10.1016/j.jjcc.2022.09.011. Epub 2022 Sep 28.
Percutaneous coronary intervention (PCI), one of the most prevalent techniques of revascularization, is a procedure that remarkably improves treatment outcomes. However, it consumes large amounts of medical resources and has resulted in an increased socioeconomic burden due to the increasing number of target patients. In recent years, there have been sporadic discussions, both in Japan and other countries, regarding the optimization of interventions and the perspective of medical economics. Based on this, previous studies on PCI-related cost-effectiveness were reviewed in order to consider the current level of medical economics regarding PCI. Using the databases MEDLINE and EMBASE, a survey involving data from original articles and systematic reviews was conducted from January 2010 to August 2022. Conditions were not imposed on the evidence level due to the paucity of studies, although field studies were prioritized over simulation studies. The macro medical economics of acute myocardial infarction treatment, which is the primary target of PCI, were generally at an average level when compared to those in other countries; however, there is room for further improvement in Japan's performance. Revascularization in a population with multivessel coronary artery disease showed that coronary artery bypass graft surgery tended to be more cost-effective than PCI in the long-term setting. However, it was suggested that PCI may be more cost-effective in patients with SYNTAX Score ≤22 or left main artery disease. A cost-effectiveness report for stable angina patients was not in favor of PCI over medical therapy. Moreover, there were some reports showing the medical economic superiority of early myocardial ischemia evaluation, and it was foreseen that active selection of patients will contribute to the improvement of the overall cost-effectiveness of PCI. In order to further improve the socioeconomic significance of PCI in the future, it is necessary to aim for harmony between clinical practice and health economics.
经皮冠状动脉介入治疗（PCI）是最常见的血运重建技术之一，它显著改善了治疗效果。然而，由于目标患者数量的增加，它消耗了大量的医疗资源，并导致了社会经济负担的增加。近年来，日本和其他国家都有零星的讨论，涉及干预措施的优化和医学经济学的观点。基于此，回顾了与 PCI 相关的成本效益的先前研究，以考虑当前 PCI 相关医学经济学的水平。使用 MEDLINE 和 EMBASE 数据库，对 2010 年 1 月至 2022 年 8 月的原始文章和系统评价数据进行了调查。由于研究较少，没有对证据水平施加条件，但优先考虑现场研究而不是模拟研究。PCI 的主要目标是急性心肌梗死治疗的宏观医学经济学，与其他国家相比，一般处于平均水平；然而，日本仍有进一步提高的空间。多血管病变患者的血运重建表明，在长期情况下，冠状动脉旁路移植术比 PCI 更具成本效益。然而，有研究表明，对于 SYNTAX 评分≤22 或左主干疾病的患者，PCI 可能更具成本效益。稳定性心绞痛患者的成本效益报告并不支持 PCI 优于药物治疗。此外，还有一些报告显示早期心肌缺血评估具有医学经济学优势，可以预见积极选择患者将有助于提高 PCI 的总体成本效益。为了进一步提高 PCI 在未来的社会经济效益，有必要在临床实践和健康经济学之间实现和谐。
