经导管主动脉瓣置换术与外科主动脉瓣置换术治疗重度主动脉瓣狭窄的全球成本效益：系统回顾与元分析》。

IF 5.8 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Canadian Journal of Cardiology Pub Date : 2024-12-01 DOI:10.1016/j.cjca.2024.10.009

Xinyan Zhou MM , Xirui Duan MM , Lishi Shao MD , Na Tan MM , Shuaiyan Zuo MM , Haiyan Shan MM , Guocheng Li MM , Xiaolan Du MM , Ujen Duwal Shrestha MM , Tengfei Ke MD , Feifei Zhou MM , Han Ma MM , Yiming Xu MM , Zhiqiang Ouyang MD , Chengde Liao MD

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引用次数: 0

摘要

背景介绍经导管主动脉瓣置换术（TAVR）是重度主动脉瓣狭窄（AS）患者的一种创伤较小的治疗选择；然而，其在中低手术风险患者中的经济效益仍存在争议，且因国家而异。我们对 TAVR 与手术主动脉瓣置换术（SAVR）的经济效益进行了系统性回顾比较：我们检索了六个数据库，包括 PubMed、Medline、Scopus、Web of Science、Embase 和 Clinical Trials，以寻找从开始到 2023 年 10 月期间，在中低手术风险的无症状 AS 患者中，使用不同瓣膜类型的 TAVR 和 SAVR 的经济效益的随机对照试验。我们提取了质量调整生命年（QALYs）和增量成本效益比（ICER）的数据，并将ICER转换为2023年的美元汇率：15项研究符合纳入标准，总体质量从中级到高级不等。其中，14 项研究发现 TAVR 具有成本效益，而一项在发展中国家进行的研究发现 TAVR 不具有成本效益。当调整到 2023 年美元时，每 QALY 收益的 ICER 值从 3,669 美元到 340,038 美元不等：结论：在中低度 AS 患者中，TAVR 似乎是一种替代 SAVR 的经济有效的方法。在所有研究中，与 SAVR 相比，TAVR 可显著提高 QALY。由于 TAVR 是一种昂贵的手术，其成本效益取决于每个国家的 ICER 和支付意愿阈值。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Global Cost-Effectiveness of Transcatheter vs Surgical Aortic Valve Replacement in Severe Aortic Stenosis: A Systematic Review and Meta-analysis

Backgroud

Transcatheter aortic valve replacement (TAVR) is a less invasive treatment option for patients with severe aortic valve stenosis (AS); however, its economic benefits in patients with low to intermediate surgical risk remain controversial and vary by country. We conducted a systematic review to compare the economic benefits of TAVR vs surgical aortic valve replacement (SAVR).

Methods

We searched 6 databases, including PubMed, Medline, Scopus, Web of Science, Embase, and Clinical Trials for randomised controlled trials on the economic benefits of TAVR with different valve types and SAVR in symptomatic AS patients with low to intermediate surgical risk, from inception to October 2023. We extracted data on quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER), with ICER converted to 2023 US dollars.

Results

Fifteen studies met the inclusion criteria, with the overall quality ranging from intermediate to high. Among these, TAVR was found to be cost-effective in 14 studies, whereas in 1 study conducted in a developing country, TAVR was not cost-effective. When adjusted to 2023 USD, the ICER values ranged from $3,669 to $340,038 per QALY gained.

Conclusions

TAVR appears to be a cost-effective alternative to SAVR in patients with low- to intermediate-risk AS. In all studies, TAVR was associated with a significant increase in QALYs compared with SAVR. Because it is an expensive procedure, the cost-effectiveness of TAVR depends on each country’s ICER and willingness-to-pay threshold.

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来源期刊

Canadian Journal of Cardiology 医学-心血管系统

CiteScore

9.20

自引率

8.10%

发文量

546

审稿时长

32 days

期刊介绍： The Canadian Journal of Cardiology (CJC) is the official journal of the Canadian Cardiovascular Society (CCS). The CJC is a vehicle for the international dissemination of new knowledge in cardiology and cardiovascular science, particularly serving as the major venue for Canadian cardiovascular medicine.