与房室旁路相关的室上性心律失常治疗的成本效益：导管消融、手术切断和药物治疗的比较。

The cost-effectiveness of treatment of supraventricular arrhythmias related to an accessory atrioventricular pathway: comparison of catheter ablation, surgical division and medical treatment.

作者信息

Weerasooriya H R, Murdock C J, Harris A H, Davis M J

机构信息

University of Western Australia.

出版信息

Aust N Z J Med. 1994 Apr;24(2):161-7. doi: 10.1111/j.1445-5994.1994.tb00552.x.

DOI:10.1111/j.1445-5994.1994.tb00552.x

PMID:8042944

Abstract

BACKGROUND

Treatment alternatives for patients with incapacitating supraventricular arrhythmias related to an accessory atrioventricular pathway include transcatheter radiofrequency (RF) ablation, surgical division and long-term antiarrhythmic therapy (medical).

AIM

The aim of this study was to compare in terms of cost and efficacy, transcatheter, surgical and medical treatment of patients with incapacitating supraventricular arrhythmias resulting from an accessory pathway.

METHODS

The study population consisted of 52 patients who underwent transcatheter RF ablation (20 consecutive patients), surgical treatment (20) and medical treatment (12). Two types of economic analysis were used. In all groups, a resource based costing method was used and in the medical and surgical treatment groups, a diagnostic related group (DRG) based costing method was used.

RESULTS

Eighteen out of 20 (90%) patients who underwent catheter ablation remained asymptomatic during 8.4 +/- 1.6 months of follow-up. All surgically treated patients remained asymptomatic during 54 +/- 15 months of follow-up. Only one of the 12 patients in the medical treatment group remained completely free of symptoms during the mean 58 +/- 23 month follow-up period. The mean cost (1992 Australian dollars) per patient, calculated on the basis of actual resources used (with a DRG based costing given in brackets), was $2746 +/- $800 for catheter ablation, $12141 +/- $4465 ($12880 +/- $3998) for surgical treatment and $1713 +/- $748 ($1967 +/- $33) for medical treatment. The total cost of management over 20 years is estimated to be: $2911 for catheter ablation, $17467 for surgery and $4959 for medical treatment.

CONCLUSIONS

In the long term transcatheter RF ablation is the most cost-effective treatment strategy for patients with incapacitating supraventricular arrhythmias related to an accessory pathway.

摘要

背景

对于因房室旁路导致的严重室上性心律失常患者，治疗选择包括经导管射频（RF）消融、手术切断以及长期抗心律失常治疗（药物治疗）。

目的

本研究旨在比较经导管、手术及药物治疗因旁路导致的严重室上性心律失常患者的成本和疗效。

方法

研究人群包括52例接受经导管RF消融（连续20例患者）、手术治疗（20例）和药物治疗（12例）的患者。采用了两种经济分析方法。在所有组中，使用基于资源的成本核算方法，在药物和手术治疗组中，使用基于诊断相关组（DRG）的成本核算方法。

结果

20例接受导管消融的患者中有18例（90%）在8.4±1.6个月的随访期间无症状。所有接受手术治疗的患者在54±15个月的随访期间均无症状。药物治疗组12例患者中只有1例在平均58±23个月的随访期内完全无症状。根据实际使用资源计算的每位患者平均成本（1992澳元，括号内为基于DRG的成本核算），导管消融术为2746±800美元，手术治疗为12141±4465美元（12880±3998美元），药物治疗为1713±748美元（1967±33美元）。20年管理的总成本估计为：导管消融术2911美元，手术17467美元，药物治疗4959美元。