采用冠狀動脈搭橋術(shù)與經(jīng)皮冠狀動脈介入行高危患者血運重建的成本效益比較

摘要： <正>背景:一項退伍軍人事務部合作研究隨機將藥物難治性心肌缺血的高?；颊叻譃閮山M,分別接受采用經(jīng)皮冠狀動脈介入(PCI)和冠狀動脈搭橋術(shù)(CABG)的血運重建,這些患者大部分未參與過以前的試驗。本研究比較了這些高?；颊邔嵤㏄CI或CABG的成本效益。
BACKGROUND -A Department of Veterans Affairs Cooperative Study randomized high-risk patients with medically refractory myocardial ischemia, a group largely excluded from previous trials, to urgent revascularization with either percutaneous coronary intervention(PCI) or coronary artery bypass grafting(CABG). The present study examined the cost-effectiveness of PCI versus CABG for these high-risk patients. METHODS AND RESULTS -Of 454 patients at 16 Department of Veterans Affairs medical centers, 445 were available for the economic analysis(218 PCI and 227 CABG patients). Total costs were assessed at 3 and 5 years from the third-party payer's perspective, and effectiveness was measured by survival. After 3 years, average total costs were ＄63 896 for PCI versus ＄84 364 for CABG patients, a difference of ＄20 468(95%confidence interval[CI] ＄13 918 to ＄27 569). CIs were estimated by bootstrapping. Survival at 3 years was 0.82 for PCI versus 0.79 for CABG patients(P=0.34). Precision of the cost-effectiveness estimates were assessed by bootstrapping. PCI was less costly and more effective at 3 years in 92.6%of the bootstrap replications. After 5 years, average total costs were ＄81 790 for PCI versus ＄100 522 for CABG patients, a difference of ＄18 732(95%CI ＄9873 to ＄27 831),whereas survival at 5 years was 0.75 for PCI patients versus 0.70 for CABG patients(P=0.21). At 5 years, PCI remained less costly and more effective in 89.4%of the bootstrap replications. CONCLUSIONS -PCI was less costly and at least as effective for the urgent revascularization of medically refractory, high-risk patients over 5 years.