中国急性缺血性脑卒中血管内治疗的成本效益:来自山东半岛的证据。

IF 2.7 3区 经济学 Q1 ECONOMICS
Lu Han, Kuixu Lan, Dejian Kou, Zehua Meng, Jin Feng, Elizabeth Maitland, Stephen Nicholas, Jian Wang
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引用次数: 0

摘要

背景:近年来,急性缺血性卒中的血管内治疗(EVT)在许多方面取得了重大进展。临床上通常建议在血管内治疗前进行静脉溶栓(IVT),但这种做法的价值存在争议。最新的荟萃分析评估结果显示,EVT 与 EVT 加 IVT 的效果没有明显差异。EVT加IVT的成本效益分析需要进一步分析。本研究评估了 EVT 加 IVT 在中国山东半岛的健康效益和经济影响:方法:我们采用横断面设计,使用中国-山东半岛公立医院数据库,时间跨度为 2013 年至 2023 年。通过医院信息系统(HIS)和公开发表的参考文献收集真实世界的成本和健康结果。我们从中国医疗保健的角度出发,使用复杂决策模型计算了增量成本效益比(ICER),以比较 EVT 与 EVT + IVT 的成本和有效性。为了评估经济评估模型的稳健性,我们进行了单向和蒙特卡罗概率敏感性分析:无论是短期还是长期,单纯 EVT 的成本均低于 EVT + IVT。在山东省,在人均国内生产总值(GDP)3倍的支付意愿(WTP)阈值下,AIS患者99%死亡前,每增加一个QALY的ICER为696399.30元。对 3 个月、1 年和长期的概率敏感性分析结果显示,在 WTP 临界值(1×GDP)下,治疗具有成本效益的概率分别为 97.90%、97.43% 和 96.89%。单向敏感性分析结果显示,单纯 EVT 和 EVT + IVT 的直接治疗成本对 ICER 都很敏感:结论:在中国东北沿海地区,单纯 EVT 比 EVT + IVT 更具成本效益。结论:在中国东北沿海地区,与 EVT + IVT 相比,EVT 单独治疗更具成本效益,该研究数据可作为中国的参考,在其他地区使用该评估结果时应慎重考虑。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Cost-effectiveness of endovascular treatment for acute ischemic stroke in China: evidence from Shandong Peninsula.

Background: Recently, the endovascular treatment (EVT) of acute ischemic stroke has made significant progress in many aspects. Intravenous thrombolysis (IVT) is usually recommended before endovascular treatment in clinical practice, but the value of the practice is controversial. The latest meta-analysis evaluation was that the effect of EVT versus EVT plus IVT did not differ significantly. The cost-effectiveness analysis of EVT plus IVT needs further analysis. This study assesses the health benefits and economic impact of EVT plus IVT in Shandong Peninsula of China.

Method: We followed a cross-section design using the Chinese-Shandong Peninsula public hospital database between 2013 and 2023. The real-world costs and health outcomes were collected through the Hospital Information System (HIS) and published references. We calculated incremental cost-effectiveness ratios (ICERs) from the perspective of Chinese healthcare using the complex decision model to compare the costs and effectiveness between EVT versus EVT + IVT. One-way and Monte Carlo probabilistic sensitivity analyses were performed to assess the robustness of the economic evaluation model.

Results: EVT alone had a lower cost compared with EVT + IVT whether short-term or long-term. Until 99% dead of AIS patients, the ICER per additional QALY was RMB696399.30 over the willingness-to-pay (WTP) threshold of 3× gross domestic product (GDP) per capita in Shandong. The probabilistic sensitivity analysis of 3 months, 1 year and long-term horizons had a 97.90%, 97.43% and 96.89% probability of cost-effective treatment under the WTP threshold (1×GDP). The results of the one-way sensitivity analysis showed that direct treatment costs for EVT alone and EVT + IVT were all sensitive to ICER.

Conclusions: EVT alone was more cost-effective treatment compared to EVT + IVT in the Northeast Coastal Area of China. The data of this study could be used as a reference in China, and the use of the evaluation in other regions should be carefully considered.

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来源期刊
CiteScore
3.90
自引率
4.20%
发文量
59
审稿时长
13 weeks
期刊介绍: Health Economics Review is an international high-quality journal covering all fields of Health Economics. A broad range of theoretical contributions, empirical studies and analyses of health policy with a health economic focus will be considered for publication. Its scope includes macro- and microeconomics of health care financing, health insurance and reimbursement as well as health economic evaluation, health services research and health policy analysis. Further research topics are the individual and institutional aspects of health care management and the growing importance of health care in developing countries.
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