Kupersmith J, Holmes-Rovner M, Hogan A, Rovner D, Gardiner J
Department of Medicine, College of Human Medicine, Michigan State University, East Lansing 48824.
Prog Cardiovasc Dis. 1995 Mar-Apr;37(5):307-46. doi: 10.1016/s0033-0620(05)80017-9.
Cost-effectiveness analyses were reviewed in the following diagnostic and treatment categories: acute myocardial infarction (MI) and diagnostic strategies for coronary artery disease (CAD), coronary artery bypass graft (CABG) surgery, percutaneous transluminal coronary angioplasty (PTCA), congestive heart failure (CHF), and arrhythmias. In the case of acute MI, coronary care units, as presently used, are rather expensive but could be made much more efficient with more effective triage and resource utilization; reperfusion via thrombolysis is cost-effective, as are beta-blockers and angiotensin-converting enzyme (ACE) inhibitors post-MI in appropriate patients. Cost-effectiveness of CAD screening tests depends strongly on the prevalence of disease in the population studied. Cost-effectiveness of CABG surgery depends on targeting; eg, it is highly effective for such conditions as left-main and three-vessel disease but not for lesser disease. PTCA appears to be cost-effective in situations where there is clinical consensus for its use, eg, severe ischemia and one-vessel disease, but requires further analysis based on randomized data; coronary stents also appear to be cost-effective. In preliminary analysis, ACE inhibition for CHF dominates, ie, saves both money and lives. Cardiac transplant appears to be cost-effective but requires further study. For arrhythmias, implantable cardioverter defibrillators are cost-effective, especially the transvenous device, in life-threatening situations; radiofrequency ablation is also cost-effective in patients with Wolff-Parkinson-White syndrome apart from asymptomatic individuals; and pacemakers have not been analyzed except in the case of biofascicular block, where results were variable depending on the situation and preceding tests.
急性心肌梗死（MI）及冠状动脉疾病（CAD）的诊断策略、冠状动脉旁路移植术（CABG）、经皮腔内冠状动脉成形术（PTCA）、充血性心力衰竭（CHF）和心律失常。对于急性心肌梗死，目前使用的冠心病监护病房成本相当高，但通过更有效的分诊和资源利用可提高效率；溶栓再灌注具有成本效益，心肌梗死后在合适患者中使用β受体阻滞剂和血管紧张素转换酶（ACE）抑制剂也具有成本效益。CAD筛查试验的成本效益在很大程度上取决于所研究人群中的疾病患病率。CABG手术的成本效益取决于目标人群；例如，对于左主干和三支血管病变等情况非常有效，但对较轻病变则不然。PTCA在临床达成使用共识的情况下似乎具有成本效益，如严重缺血和单支血管病变，但需要根据随机数据进行进一步分析；冠状动脉支架似乎也具有成本效益。在初步分析中，用于CHF的ACE抑制占主导地位，即既能省钱又能挽救生命。心脏移植似乎具有成本效益，但需要进一步研究。对于心律失常，植入式心脏复律除颤器具有成本效益，尤其是经静脉装置，在危及生命的情况下；除无症状个体外，射频消融对于预激综合征患者也具有成本效益；除了生物束支阻滞情况外，起搏器尚未进行分析，在生物束支阻滞情况下结果因情况和先前检查而异。
