OBJECTIVES:To assess the lifetime costs and cost-effectiveness of 5 endovascular interventions to treat superficial femoral arterial disease. DESIGN:A model-based health economic evaluation. An existing decision analytical model was used, with updated effectiveness data taken from the literature, and updated costs based on purchasing prices. SETTING:UK and German healthcare perspectives were considered. PARTICIPANTS:Patients with intermittent claudication of the femoropopliteal arteries eligible for endovascular treatment. METHODS:UK and German healthcare perspectives were considered, as were different strategies for re-intervention. INTERVENTIONS:Percutaneous transluminal angioplasty (PTA) with bail-out bare metal stenting (assumed to represent the existing standard of care, and 4 alternatives: primary bare metal stents, drug-eluting stents, drug-eluting balloons (DEBs) and biomimetic stents). PRIMARY OUTCOME MEASURES:The incremental cost-effectiveness ratio between 2 treatments, defined as the incremental costs divided by the incremental quality-adjusted life years (QALYs). RESULTS:Use of a biomimetic stent, BioMimics 3D, was always estimated to dominate the other interventions, having lower lifetime costs and greater effectiveness, as measured by QALYs. Of the remaining interventions, DEBs were always the most effective, and PTA the least effective. There was uncertainty in the cost-effectiveness results, with key drivers being the costs and effectiveness of the biomimetic stent along with the costs of DEBs. CONCLUSIONS:All 4 of the alternatives to PTA were more effective, with the biomimetic stent being the most cost-effective. As there was uncertainty in the results, and all of the interventions have different mechanisms of action, all 4 may be considered to be alternatives to PTA.

译文

目的:评估5种用于治疗股浅动脉疾病的血管内干预措施的终生成本和成本效益。
设计:基于模型的健康经济评估。使用现有的决策分析模型,从文献中获取更新的有效性数据,并根据购买价格更新成本。
地点:考虑了英国和德国的医疗保健观点。
对象:符合条件的股dication动脉间歇性lau行的患者。
方法:考虑英国和德国的医疗保健观点,以及不同的重新干预策略。
干预措施:经皮腔内血管成形术(PTA)与纾困裸金属支架(假定代表现有的医疗标准,以及4种替代方法:主要的裸金属支架,药物洗脱支架,药物洗脱球囊(DEB)和仿生支架) 。
主要观察指标:两种治疗之间的增量成本-效果比,定义为增量成本除以增量质量调整生命年(QALYs)。
结果:仿生支架BioMimics 3D的使用始终被估计占主导地位,据QALYs测算,该仿生支架具有较低的生命周期成本和更高的有效性。在其余的干预措施中,DEB总是最有效的,而PTA效果最差。成本效益结果存在不确定性,主要驱动因素是仿生支架的成本和有效性以及DEB的成本。
结论:PTA的所有4种替代方案均更有效,其中仿生支架最为经济。由于结果存在不确定性,并且所有干预措施均具有不同的作用机制,因此可以认为所有这四种干预都是PTA的替代方案。

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