Barrett B J, Parfrey P S, Foley R N, Detsky A S
Division of Clinical Epidemiology, Memorial University of Newfoundland, St. John's, Canada.
Med Decis Making. 1994 Oct-Dec;14(4):325-35. doi: 10.1177/0272989X9401400403.
A decision tree model was used to estimate the incremental cost per quality-adjusted life year (QALY) of low- as opposed to high-osmolality contrast media for cardiac angiography. Analyses were done from the viewpoints of a third-party payer and society using data from a randomized trial and the literature. Assuming low-osmolality media reduce the risk of myocardial infarction and stroke, the incremental cost per QALY gained with these media is $17,264 in high-risk or $47,874 in low-risk patients for a third-party payer. From a societal viewpoint, the corresponding costs are $649 and $35,509. These estimates are sensitive to the cost and volume of the contrast medium employed and to the estimate of reduction in severe adverse events with low-osmolality media. The authors conclude that, in the context of restricted budgets, limiting the use of low-osmolality media to high-risk patients is justifiable, as the incremental cost per QALY in high-risk patients may be reasonable and it is not certain that low-osmolality media prevent severe or fatal events. A considerable reduction in the cost per QALY gained is possibly by minimizing the volume of contrast medium used.
采用决策树模型来估计在心脏血管造影中，使用低渗对比剂而非高渗对比剂时每质量调整生命年（QALY）的增量成本。利用一项随机试验的数据和文献，从第三方支付者和社会的角度进行了分析。假设低渗对比剂可降低心肌梗死和中风的风险，对于第三方支付者而言，高危患者使用这些对比剂每获得一个QALY的增量成本为17,264美元，低危患者则为47,874美元。从社会角度来看，相应成本分别为649美元和35,509美元。这些估计对所用对比剂的成本和用量以及低渗对比剂降低严重不良事件的估计较为敏感。作者得出结论，在预算有限的情况下，将低渗对比剂的使用限制于高危患者是合理的，因为高危患者每QALY的增量成本可能是合理的，而且低渗对比剂不一定能预防严重或致命事件。通过尽量减少对比剂的用量，有可能大幅降低每获得一个QALY的成本。
