颈动脉狭窄内膜剥脱术与支架置入术卫生经济学评价的系统综述及meta分析  

Systematic Review and Meta-analysis of Health Economic Evaluation of Carotid Endarterectomy Versus Carotid Artery Stenting

作　　者：肖耀文 龚迎光[1] 邢雪峰 杨耀国 XIAO Yaowen(Union Office,Beijing Fiendship Hospital,Capital Medical University,Beijing,100050,China)

机构地区：[1]首都医科大学附属北京友谊医院工会办公室,北京100050 [2]中国人民解放军北京卫戍区朝阳第一退休干部休养所门诊部,北京100012 [3]首都医科大学附属北京安贞医院血管外科中心,首都医科大学血管外科学系,北京100029

出　　处：《医学与社会》2025年第1期126-132,共7页Medicine and Society

基　　金：中国脑卒中高危人群干预适宜技术研究及推广项目,编号为GN-2018R0004。

摘　　要：目的:比较颈动脉内膜剥脱术(CEA)与支架置入术(CAS)2种术式在治疗颈动脉狭窄患者中的经济性,为临床决策提供参考。方法:检索PubMed、EMBASE、Springer Link、Cochrane Library、Web of Science、中国知网、万方7个数据库,检索时限为建库起至2023年12月,收集比较CEA与CAS的卫生经济学评价的中英文文献,提取文献特征及卫生经济学评价数据进行系统综述及meta分析。结果:研究共纳入10篇文献。其中7篇高质量文献,3篇中等质量文献。7篇文献支持CEA具有更高经济性,2篇文献认为CEA与CAS相当,1篇支持CAS在治疗高手术风险患者中有更高经济性。Meta分析结果显示,在手术成本、长期累积成本、质量调整生命年3项指标上,均支持CEA优于CAS,标准均数差分别为-2.46(95%CI:-4.22,-0.71;P=0.006)、-4.26(95%CI:-6.44,-2.08;P=0.0001)、-1.26(95%CI:-2.23,-0.29;P=0.01)。结论:CEA在手术成本、长期累积成本、增量成本效果比值、质量调整生命年上可能优于CAS。从整体来看,CEA较CAS有更高的经济性,但仍需更多规范的卫生经济学评价进一步佐证。Objective:To compare the economic efficiency of carotid endarterectomy(CEA)and carotid artery stenting(CAS)in treating patients with carotid artery stenosis,so as to provide insights for clinical decision-making.Methods:A systematic search was conducted in seven databases:PubMed,EMBASE,Springer Link,Cochrane Library,Web of Science,China National Knowledge Infrastructure(CNKI),and Wanfang,covering literature from inception to December 2023.Studies comparing the health economic evaluations of CEA and CAS in both Chinese and English were included.Literature characteristics and evaluation metrics were extracted for systematic review and meta-analysis.Results:A total of 10 studies were included.Among them,7 were high-quality studies and 3 were of moderate quality.Seven studies supported the economic advantage of CEA,2 indicated equivalence between CEA and CAS,and 1 supported CAS for high-surgical-risk patients.Meta-analysis results showed that CEA outperformed CAS in terms of surgical costs,long-term cumulative costs,and quality-adjusted life years(QALYs),with standardized mean differences of-2.46(95%CI:-4.22,-0.71;P=0.006),-4.26(95%CI:-6.44,-2.08;P=0.0001),and-1.26(95%CI:-2.23,-0.29;P=0.01),respectively.Conclusion:CEA may be superior to CAS in terms of surgical costs,long-term cumulative costs,incremental cost-effectiveness ratio,and QALYs.Overall,CEA appears to be more economically efficient than CAS,but further rigorous health economic evaluations are needed to corroborate these findings.

关 键 词：卫生经济学评价 颈动脉狭窄 内膜剥脱术 支架置入术 

分 类 号：R-05[医药卫生] R195