中国急性缺血性脑卒中血管内治疗的成本效益：来自山东半岛的证据。

Cost-effectiveness of endovascular treatment for acute ischemic stroke in China: evidence from Shandong Peninsula.

作者信息

Han Lu, Lan Kuixu, Kou Dejian, Meng Zehua, Feng Jin, Maitland Elizabeth, Nicholas Stephen, Wang Jian

机构信息

Dong Fureng Institute of Economic and Social Development, Wuhan University, Wuhan, China.

The Affiliated Hospital of Qingdao University, Qingdao, China.

出版信息

Health Econ Rev. 2024 Jun 5;14(1):37. doi: 10.1186/s13561-024-00513-7.

DOI:10.1186/s13561-024-00513-7

PMID:38836982

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11154974/

Abstract

BACKGROUND

Recently, the endovascular treatment (EVT) of acute ischemic stroke has made significant progress in many aspects. Intravenous thrombolysis (IVT) is usually recommended before endovascular treatment in clinical practice, but the value of the practice is controversial. The latest meta-analysis evaluation was that the effect of EVT versus EVT plus IVT did not differ significantly. The cost-effectiveness analysis of EVT plus IVT needs further analysis. This study assesses the health benefits and economic impact of EVT plus IVT in Shandong Peninsula of China.

METHOD

We followed a cross-section design using the Chinese-Shandong Peninsula public hospital database between 2013 and 2023. The real-world costs and health outcomes were collected through the Hospital Information System (HIS) and published references. We calculated incremental cost-effectiveness ratios (ICERs) from the perspective of Chinese healthcare using the complex decision model to compare the costs and effectiveness between EVT versus EVT + IVT. One-way and Monte Carlo probabilistic sensitivity analyses were performed to assess the robustness of the economic evaluation model.

RESULTS

EVT alone had a lower cost compared with EVT + IVT whether short-term or long-term. Until 99% dead of AIS patients, the ICER per additional QALY was RMB696399.30 over the willingness-to-pay (WTP) threshold of 3× gross domestic product (GDP) per capita in Shandong. The probabilistic sensitivity analysis of 3 months, 1 year and long-term horizons had a 97.90%, 97.43% and 96.89% probability of cost-effective treatment under the WTP threshold (1×GDP). The results of the one-way sensitivity analysis showed that direct treatment costs for EVT alone and EVT + IVT were all sensitive to ICER.

CONCLUSIONS

EVT alone was more cost-effective treatment compared to EVT + IVT in the Northeast Coastal Area of China. The data of this study could be used as a reference in China, and the use of the evaluation in other regions should be carefully considered.

摘要

背景

近年来，急性缺血性卒中的血管内治疗（EVT）在诸多方面取得了显著进展。在临床实践中，血管内治疗前通常推荐静脉溶栓（IVT），但这种做法的价值存在争议。最新的荟萃分析评估显示，单纯EVT与EVT联合IVT的效果差异不显著。EVT联合IVT的成本效益分析需要进一步研究。本研究评估了在中国山东半岛EVT联合IVT的健康效益和经济影响。

方法

我们采用横断面设计，使用2013年至2023年中国山东半岛公立医院数据库。通过医院信息系统（HIS）和已发表的参考文献收集实际成本和健康结果。我们使用复杂决策模型从中国医疗保健的角度计算增量成本效益比（ICER），以比较单纯EVT与EVT联合IVT之间的成本和效果。进行单向和蒙特卡洛概率敏感性分析，以评估经济评估模型的稳健性。

结果

无论短期还是长期，单纯EVT的成本均低于EVT联合IVT。在山东，直到急性缺血性卒中（AIS）患者99%死亡时，每增加一个质量调整生命年（QALY）的ICER超过人均国内生产总值（GDP）3倍的支付意愿（WTP）阈值，为人民币696399.30元。3个月、1年和长期的概率敏感性分析显示，在WTP阈值（1×GDP）下，具有成本效益治疗的概率分别为97.90%、97.43%和96.89%。单向敏感性分析结果表明，单纯EVT和EVT联合IVT的直接治疗成本对ICER均敏感。