颈动脉内膜剥脱术与支架置入术治疗颈动脉狭窄的卫生经济学评价  

The Health Economics Evaluation of Carotid Endarterectomy and Stent Implantation for Carotid Artery Stenosis

作　　者：刘洪章 杜炎秋 刘瑾瑜 崔世军[2] 郭大乔 刘翼[4] 黄葭燕[1] LIU Hong-zhang;DU Yan-qiu;LIU Jing-yu;CUI Shi-jun;GUO Da-qiao;LIU Yi;HUANG Xiayan(National Health Commission Key Laboratory of Health Technology Assessment,School of Public Health,Fudan University,Shanghai,200032,China;不详)

机构地区：[1]复旦大学公共卫生学院、国家卫生健康委员会卫生技术评估重点实验室,上海200032 [2]首都医科大学宣武医院血管外科,北京100053 [3]复旦大学附属中山医院血管外科,上海200032 [4]四川大学华西医院神经外科,成都610041

出　　处：《中国卫生经济》2023年第5期80-85,共6页Chinese Health Economics

摘　　要：目的:评价颈动脉内膜剥脱术和颈动脉支架置入术治疗颈动脉狭窄患者的经济学价值,为临床决策提供参考。方法:通过专家访谈,确认两种术式的标准流程,进而计算出两种术式的直接医疗成本。通过系统综述的方式确定各个效果指标的初始值和范围。由此构建出决策树模型,对两种术式进行成本-效果分析和概率敏感性分析。结果:在各个指标上,颈动脉内膜剥脱术的成本效果比均低于颈动脉支架置入术。敏感性分析结果显示,在手术后脑卒中发生率、短暂性脑缺血发生率、再狭窄发生率和高灌注综合征发生率上,颈动脉内膜剥脱术比颈动脉支架置入术占绝对优势的概率均大于85%。在手术后局部血肿、脑出血和心肌梗死发生率上,颈动脉内膜剥脱术比颈动脉支架置入术并没有绝对优势。结论:颈动脉内膜剥脱术相比颈动脉支架置入术有较好的经济性,建议临床医生在充分考虑患者的实际病情下,使用颈动脉内膜剥脱术进行治疗。此外,应采取相关行动,积极推广颈动脉内膜剥脱术,提高颈动脉狭窄患者的生命质量,改善健康状况。Objective:To evaluate the economic value of carotid endarterectomy and carotid stent implantation in the treatment of patients with carotid artery stenosis,and to provide references for clinical decision-making.Methods:Through expert interviews,the standard procedures of the two procedures were confirmed to calculate the direct medical costs of the two procedures were calculated.The initial value and range of each effect index were determined by systematic review.The decision tree model was constructed to analyze the cost-effectiveness and probability sensitivity of these two operations.Results:In all indicators,the cost-effectiveness ratio of carotid endarterectomy was lower than that of carotid stent implantation.The results of sensitivity analysis showed that in the incidence of stroke,transient cerebral ischemia,restenosis and hyperperfusion syndrome after surgery,the probability of carotid endarterectomy taking an absolute advantage over carotid stenting was more than 85%.In terms of the incidence of local hematoma,cerebral hemorrhage and myocardial infarction after surgery,carotid endarterectomy had no absolute advantage over carotid stenting.Conclusion:Carotid endarterectomy is more economical than stent implantation.It is recommended that clinicians should use endarterectomy for treatment under full consideration of the actual condition of patients.In addition,relevant actions should be taken to actively promote carotid endarterectomy to improve the quality of life and health of patients with carotid artery stenosis.

关 键 词：颈动脉内膜剥脱术 颈动脉支架置入术 成本-效果分析 决策树模型 

分 类 号：R1-9[医药卫生—公共卫生与预防医学] F224.95[经济管理—国民经济]