非ST段抬高型急性冠脉综合征复杂冠脉病变血运重建方案的卫生经济学评价  

Health Economics Evaluation of Revascularization of Complex Coronary Lesions in Patients with Non-ST Segment Elevation Acute Coronary Syndrome

作　　者：贾雨晨 桑海强[1] 江耀辉 马慧慧 JIA Yu-chen;SANG Hai-qiang;JIANG Yao-hui;MA Hui-hui(Department of Cardiology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院心血管内科,河南郑州450052

出　　处：《河南医学研究》2020年第34期6342-6347,共6页Henan Medical Research

基　　金：河南省医学科技攻关项目(201602075)。

摘　　要：目的应用Markov模型对非ST段抬高型急性冠脉综合征(NSTE-ACS)复杂冠脉病变两种血运重建方案进行长期的卫生经济学评价。方法回顾性收集2018年1月1日至2019年12月31日郑州大学第一附属医院收治的202例NSTE-ACS复杂冠脉病变患者的临床资料。将接受冠状动脉旁路移植术(CABG)治疗的94例患者纳入CABG组。将接受经皮冠状动脉介入术(PCI)治疗的108例患者纳入PCI组。根据NSTE-ACS的转归,建立Markov模型,基于Markov模型进行长期的卫生经济学评价。结果基于Markov模型进行长期的卫生经济学分析得出,CABG组和PCI组累计的成本-效果分别为26165.91、26956.37元/QALYs,增量成本效果比(ICER)为33300.89元/QALYs。当设置支付意愿阈值(WTP)为2018年1倍人均GDP(64644.00元)时,CABG较PCI具有明显的经济学优势。结论在长期的卫生经济学分析中,CABG较PCI有成本-效果优势,更具有经济性。Objective To evaluate the long-term health economics of two revascularization schemes for complex coronary lesions in non-ST segment elevation acute coronary syndrome(NSTE-ACS)by Markov model.Methods The clinical data of 202 patients with complex coronary lesions in NSTE-ACS admitted to the First Affiliated Hospital of Zhengzhou University from January 1,2018 to December 31,2019 were collected retrospectively.Among the 202 patients,94 patients who received coronary artery bypass grafting(CABG)were enrolled in CABG group,and 108 patients who received percutaneous coronary intervention(PCI)were enrolled in PCI group.According to the outcome of NSTE-ACS,the Markov model was established,and the long-term health economic evaluation was carried out based on the Markov model.Results The long-term health economics analysis based on Markov model showed that the cumulative cost-effectiveness of CABG group and PCI group were 26165.91 and 26956.37 yuan/QALYs respectively,and the incremental cost-effectiveness ratio(ICER)was 33300.89 yuan/QALYs.When WTP was set to double GDP per capita in 2018(64644.00 yuan),CABG had obvious economic advantages over PCI.Conclusion In the long-term health economics analysis,CABG has a cost-effectiveness advantage and is more economical than PCI.

关 键 词：非ST段抬高型急性冠脉综合征 MARKOV模型 经皮冠状动脉介入术 冠状动脉旁路移植术 卫生经济学 

分 类 号：R956[医药卫生—药学]