预防肝硬化食管静脉曲张再出血的成本效果研究  

Cost-effectiveness analysis of preventing esophageal variceal rebleeding in liver cirrhosis

作　　者：李莹[1] 练晶晶[1] 罗添成[1] 曾于珍 陈世耀[1] 

机构地区：[1]复旦大学附属中山医院消化科 复旦大学循证医学中心,上海200032

出　　处：《中华消化杂志》2016年第2期113-118,共6页Chinese Journal of Digestion

基　　金：上海市科学技术委员会创新基金（15411950500）

摘　　要：目的比较内镜下食管曲张静脉套扎术（EVL）联合非选择性β受体阻滞剂与覆膜支架经颈静脉肝内门体分流术（TIPS）预防肝硬化门静脉高压食管静脉曲张再出血的成本效果，同时探索国内采用覆膜支架的成本效果阈值。方法根据临床实践和相关指南，运用TreeAge Pro Suite 2014建立六状态Markov模型，综合比较两种干预措施治疗后随访7年的成本效果。结局指标为直接花费、生命年、质量调整生命年（QALY）、增量成本效果比（ICER）。结果随访7年的基线研究结果显示，内镜下EVL联合非选择性β受体阻滞剂组期望花费为7 444.25美元/例，可获得1.98 QALY。覆膜支架TIPS组期望花费为13 151.69美元/例，可获得2.34 QALY。在第7年，ICER为16 001.74美元。基于中国的意愿性支付阈值（19 887.00美元）可以得出，覆膜支架TIPS较内镜下EVL联合非选择性β受体阻滞剂具有成本效果优势。覆膜支架价格≤5 401.52美元用于国内具有成本效果。单因素敏感性分析结果显示，内镜下EVL联合非选择性β受体阻滞剂组再出血率是对模型结果影响最大的因素，其次为覆膜支架TIPS的治疗花费。概率敏感性分析结果显示，在中国意愿性支付阈值为19 887.00美元时，83%的模拟显示覆膜支架TIPS具有成本效果。结论随访7年，对预防肝硬化食管静脉曲张再出血，覆膜支架TIPS较内镜下EVL联合非选择性β受体阻滞剂具有成本效果优势。Objective To compare cost-effectiveness between endoscopical esophageal variceal ligation （EVL） combined non-selective beta-receptor blocker strategies and covered-stents transiugular intrahepatic portosystemic shunt （cTIPS） in preventing esophageal variceal rebleeding in liver cirrhosis with portal hypertension. And to explore the threshold of cost-effectiveness in stents in China. Methods According to clinical practice and associated guidelines, a six state Markov-based decision analytic model was established with TreeAge Pro Suite 2014 to compare the cost-effectiveness between two interfering strategies after followed up for seven years. The parameters such as costs, life years （LY）, quality-adjusted life-years （QALY） and incremental cost-effectiveness ratio （ICER） were directed. Results The results of baseline research in the seven-year follow-up period indicated that the cost of endoscopical EVL combined non-selective beta-receptor blocker B was 7 444.25 United States dollar （USD）/each, and yielded 1.98 QALY. The expected cost of cTIPS was 13 151.69 USD/ each and could have 2. 34 QALY. In the 7th year, ICER was 16 001. 74 USD. Based on willingness-to-pay （WTP） threshold of China （19 887.00 USD）, cTIPS had better cost-effectiveness than endoscopical EVL combined non-selective beta-receptor blocker B. The price of covered stents less than 5 401.52 USD had cost-effectiveness. The results of single {actor sensitivity analysis indicated that rebleeding probability of endoscopical EVL combined non-selective beta-receptor blocker B group was the most influential factor in the result of model. The second important factor was the cost of cTIPS. The probabilistic sensitivity analysis reported cTIPS to be the optimal strategy at WTP of 19 887. 00 USD in 83% of the iterations. Conclusions Seven-year follow-up indicates that cTIPS may be a more cost-effective strategy than endoscopical EVL combined non-selective betareceptor blocker B in preventing esophageal variceal rebleeding. The price

关 键 词：门体分流术 经颈静脉肝内 覆膜支架 食管静脉曲张套扎术 非选择性β受体阻断剂 MARKOV模型 成本效果分析 概率敏感性分析 

分 类 号：R575.2[医药卫生—消化系统]