BACKGROUND & AIMS: OBJECTIVES:Medical device companies are under growing pressure to provide health-economic evaluations of their products. Cost-effectiveness analyses are commonly undertaken as a one-off exercise at the late stage of development of new technologies; however, the benefits of an iterative use of economic evaluation during the development process of new products have been acknowledged in the literature. Furthermore, the use of Bayesian methods within health technology assessment has been shown to be of particular value in the dynamic framework of technology appraisal when new information becomes available in the life cycle of technologies. METHODS:In this study, we set out a methodology to adapt these methods for their application to directly support investment decisions in a commercial setting from early stages of the development of new medical devices. RESULTS AND CONCLUSIONS:Starting with relatively simple analysis from the very early development phase and proceeding to greater depth of analysis at later stages, a Bayesian approach facilitates the incorporation of all available evidence and would help companies to make better informed choices at each decision point.

背景与目标： 目标：医疗器械公司面临越来越大的压力，要求对其产品进行健康经济评估。在新技术开发的后期，成本效益分析通常是一次性的活动；但是，文献已经认识到在新产品开发过程中反复使用经济评估的好处。此外，当在技术生命周期中可获得新信息时，在健康技术评估中使用贝叶斯方法已被证明在技术评估的动态框架中具有特殊价值。
方法：在这项研究中，我们提出了一种方法，以适应这些方法的应用，以从新医疗器械开发的早期阶段就直接支持商业环境中的投资决策。
结果与结论：贝叶斯方法从很早的开发阶段开始就进行相对简单的分析，然后在以后的阶段进行更深入的分析，这有助于整合所有可用的证据，并有助于公司在每个决策点做出更明智的选择。

BACKGROUND & AIMS: :Background: The incorporation of spillover effects in health economic research is recognized by regulatory agencies as useful for valuing health interventions and technologies. To date, spillover effects are not universally used within economic evaluations and conceptual definitions of spillover effects are vague within the context of health economics research. Materials & methods: In an effort to enhance awareness of spillover effects for health economic evaluations, a concept analysis using Walker and Avant's approach was performed to elucidate the key attributes, definitions, antecedents and consequences of spillover effects across a range of disciplines. Results: Key attributes included lack of intention, positive and negative impacts, and two entity/domain involvement. Antecedents included an initial action and desired outcome. Consequences involved spillovers across industries, work life to personal life domains, patient to family member domains and across healthcare markets. Conclusion: The analysis provides greater clarification around the dimensions of spillover effects and reveals opportunities to enhance methodological approaches to assessing spillovers.

背景与目标： ：背景：溢出效应被纳入卫生经济研究中，被监管机构认可，对于评估卫生干预措施和技术很有用。迄今为止，溢出效应尚未在经济评估中普遍使用，并且溢出效应的概念定义在卫生经济学研究的背景下含糊不清。材料和方法：为了增强对卫生经济评估的溢出效应的认识，使用了Walker和Avant的方法进行了概念分析，以阐明跨学科的溢出效应的关键属性，定义，前因和后果。结果：关键属性包括缺乏意图，正面和负面影响以及两个实体/域参与。前因包括初步行动和期望的结果。后果涉及跨行业溢出，工作生活到个人生活领域，患者到家庭成员领域以及整个医疗市场。结论：该分析为溢出效应的范围提供了更清晰的说明，并揭示了增强评估溢出效应的方法学方法的机会。

BACKGROUND & AIMS: :Improving health through better nutrition of the population may contribute to enhanced efficiency and sustainability of healthcare systems. A recent expert meeting investigated in detail a number of methodological aspects related to the discipline of nutrition economics. The role of nutrition in health maintenance and in the prevention of non-communicable diseases is now generally recognised. However, the main scope of those seeking to contain healthcare expenditures tends to focus on the management of existing chronic diseases. Identifying additional relevant dimensions to measure and the context of use will become increasingly important in selecting and developing outcome measurements for nutrition interventions. The translation of nutrition-related research data into public health guidance raises the challenging issue of carrying out more pragmatic trials in many areas where these would generate the most useful evidence for health policy decision-making. Nutrition exemplifies all the types of interventions and policy which need evaluating across the health field. There is a need to start actively engaging key stakeholders in order to collect data and to widen health technology assessment approaches for achieving a policy shift from evidence-based medicine to evidence-based decision-making in the field of nutrition.

背景与目标： ：通过更好的人口营养改善健康状况可能有助于提高医疗保健系统的效率和可持续性。最近的一次专家会议详细调查了与营养经济学学科有关的许多方法论方面。现在，人们普遍认识到营养在维持健康和预防非传染性疾病中的作用。但是，那些试图控制医疗保健支出的人的主要范围往往集中在现有慢性疾病的管理上。在选择和制定营养干预措施的结果测量指标时，确定其他相关的测量指标和使用环境将变得越来越重要。将与营养有关的研究数据转化为公共卫生指南提出了一个挑战性的问题，即在许多领域进行更务实的试验，这些试验将为卫生政策决策提供最有用的证据。营养体现了需要在整个卫生领域进行评估的所有干预措施和政策类型。有必要开始积极与主要利益相关者进行接触，以收集数据并扩大卫生技术评估方法，以实现营养领域从循证医学向循证决策的政策转变。

BACKGROUND & AIMS: :This paper elucidates the challenges surrounding the economics of some popular obesity-related policy proposals. Solid economic justifications for anti-obesity policies are often lacking, and evidence suggests policies like fat and soda taxes or restrictions on food stamp spending are unlikely to substantively affect obesity prevalence. In short, many of the same factors that make obesity such a complicated and multifaceted issue extend to the economic analysis of public health policies.

背景与目标： ：本文阐明了一些与肥胖相关的流行政策建议在经济学上的挑战。通常缺乏针对肥胖症政策的可靠经济依据，证据表明，诸如脂肪和苏打税或限制食品券消费的政策不太可能对肥胖症患病率产生实质性影响。简而言之，使肥胖症成为一个复杂而多方面的问题的许多因素都涉及公共卫生政策的经济分析。

BACKGROUND & AIMS: :With data from 15 species in eight families of tropical dry forest trees, we provide evidence of coordination between the stem and leaf economic spectra. Species with low-density, flexible, breakable, hydraulically efficient but cavitationally vulnerable wood shed their leaves rapidly in response to drought and had low leaf mass per area and dry mass content. In contrast, species with the opposite xylem syndrome shed their costlier but more drought-resistant leaves late in the dry season. Our results explain variation in the timing of leaf shedding in tropical dry forests: selection eliminates combinations such as low-productivity leaves atop highly vulnerable xylem or water-greedy leaves supplied by xylem of low conductive efficiency. Across biomes, rather than a fundamental trade-off underlying a single axis of trait covariation, the relationship between leaf and stem economics is likely to occupy a wide space in which multiple combinations are possible.

背景与目标： ：利用来自八个热带干旱林木科的15种物种的数据，我们提供了茎叶经济谱之间协调的证据。具有低密度，柔韧性，易碎性，水力效率高但易受气蚀影响的木材，由于干旱而迅速脱落，并且每单位面积的叶片质量和干燥质量含量较低。相反，在干燥季节后期，具有相反木质部综合症的物种脱落了昂贵但抗干旱的叶片。我们的结果解释了热带干旱森林中叶片脱落时间的变化：选择消除了诸如脆弱的木质部顶部的低生产力叶片或导电效率低的木质部提供的水贪婪叶片等组合。在整个生物群落中，叶片经济与茎经济学之间的关系可能占据着广阔的空间，在其中可能存在多种组合，而不是在性状协变的单轴基础上进行基本权衡。

BACKGROUND & AIMS: :This paper reviews the history of modelling for cervical cancer vaccination. We provide an interpretation and summary of conclusions pertaining to the usefulness of different models, the predicted epidemiological impact of vaccination and the cost-effectiveness of adolescent, catch-up and sex-specific vaccination strategies. To date, model results predict a critical role for vaccination in reducing the burden of cervical disease, with cost-effectiveness being consistently shown across studies using a common threshold of US $50,000 per QALY, but further clinical and epidemiological data are required to confirm these findings. Through this paper, we aim to provide useful insights for decision-makers as they examine how to best evaluate the potential impact of vaccines against cervical cancer and determine how to best incorporate vaccination into practice.

背景与目标： ：本文回顾了宫颈癌疫苗接种模型的历史。我们提供了有关以下结论的解释和总结：不同模型的有效性，疫苗的流行病学预测影响以及青少年，追赶和针对特定性别的疫苗接种策略的成本效益。迄今为止，模型结果预测疫苗接种在减轻子宫颈疾病负担中的关键作用，成本效益在每项QALY 50,000美元的通用阈值的研究中始终得到证实，但需要进一步的临床和流行病学数据来证实这些发现。通过本文，我们旨在为决策者提供有用的见解，帮助他们了解如何最好地评估疫苗对宫颈癌的潜在影响，并确定如何将疫苗接种最佳地应用于实践。

BACKGROUND & AIMS: :The phenomenon of missed nursing care is endemic across all sectors. Nurse leaders have drawn attention to the implications of missed care for patient outcomes, with calls to develop clear political, methodological, and theoretical approaches. As part of this call, we describe three structural theories that inform frameworks of missed care: systems theory, economic theory, and neoliberal politics. The final section provides commentary on the strengths and limitations of these three theories, in the light of structuration theory and calls to balance this research agenda by reinstating nurse agency and examining the interactions between nurses as agents and the health systems as structures. The paper argues that a better understanding of variations in structure-agency interaction across the healthcare system might lead to more effective interventions at strategic leverage points.

背景与目标： ：缺少护理的现象在所有部门都是地方性的。护士领导者已引起人们的关注，即缺少护理对患者结果的影响，并呼吁制定明确的政治，方法和理论方法。作为此次电话会议的一部分，我们描述了三种结构理论，这些理论为失踪护理的框架提供了信息：系统理论，经济理论和新自由主义政治。最后一部分根据结构化理论对这三种理论的优势和局限性进行了评论，并呼吁通过恢复护士机构并检查护士作为代理人与卫生系统作为结构之间的相互作用来平衡这一研究议程。该论文认为，更好地理解整个医疗保健系统中结构-机构互动的变化可能会导致在战略杠杆点采取更有效的干预措施。

BACKGROUND & AIMS: :The increasing prevalence of diabetes and prediabetes makes the cost of diabetes care a pressing concern. Nurses in all settings play a critical role in helping to reduce the cost of diabetes not only for individual patients but ultimately for the health care system. This article focuses on four main issues related to the economic impact of diabetes for patients and health systems: (1) overall estimates of the direct and indirect costs of diabetes and its associated complications, (2) the impact of cost on diabetes care and health outcomes, (3) the ways in which federal- and state-mandated insurance for persons with diabetes is being used to promote more cost-effective and high-quality diabetes care, and (4) the use of cost-effectiveness analysis to evaluate interventions designed to prevent diabetes or diabetes-related complications.

背景与目标： ：糖尿病和前驱糖尿病的患病率上升，使糖尿病护理的费用成为迫切关注的问题。在所有环境中，护士都在帮助降低糖尿病成本方面发挥着至关重要的作用，不仅可以降低单个患者的糖尿病成本，而且可以最终降低医疗保健系统的成本。本文关注与糖尿病对患者和卫生系统的经济影响有关的四个主要问题：（1）糖尿病及其相关并发症的直接和间接费用的总体估算，（2）费用对糖尿病护理和健康的影响结果，（3）使用联邦和州规定的糖尿病患者保险来促进更具成本效益和高质量的糖尿病护理的方式，以及（4）使用成本效益分析来评估干预措施旨在预防糖尿病或与糖尿病相关的并发症。

BACKGROUND & AIMS: :Some species are valued for their direct usefulness to society, through immediate financial returns from market activities such as harvesting or ecotourism. But many are valued for their passive usefulness, i.e., their mere existence contributes to supporting, regulating or cultural environmental services that support human well-being. Hence, there is inherent social value to conserving such species as natural assets. However, such species are seldom priced as natural assets, and thus not accounted for in sustainability wealth measures because deriving non-market prices is challenging. We overcome this limitation by presenting a new approach for natural asset pricing of species with passive value that can be incorporated into national sustainability wealth accounting. We explicitly consider the relationship between prevailing institutions, species interactions, and ecosystem dynamics. Our approach is illustrated with the case of threatened woodland caribou in the Alberta Oil Sands. We show that conservation can be considered an investment while destructive activities can lead to a loss or conservation debt; and forgoing destructive activities can be considered a capital gain, increasing future wealth. Our approach reveals that caribou conservation in Alberta is leading to a conservation debt on the order of CA$800 million.

背景与目标： 通过市场活动（例如收获或生态旅游）的即时财务回报，某些物种因其对社会的直接有用性而受到重视。但是许多人因其被动的有用性而受到重视，即，他们的单纯存在有助于支持，规范或支持人类福祉的文化环境服务。因此，保护​​这类物种作为自然资产具有内在的社会价值。但是，此类物种很少被定价为自然资产，因此，由于推算非市场价格具有挑战性，因此并未在可持续性财富衡量中予以考虑。我们通过提出一种新方法来对具有被动价值的物种进行自然资产定价，从而克服了这一局限，可以将其纳入国家可持续性财富会计中。我们明确考虑了主要机构，物种相互作用和生态系统动力学之间的关系。我们的方法以艾伯塔省油砂林地受威胁的北美驯鹿为例。我们表明，养护可以被视为一项投资，而破坏性活动却可能导致损失或养护债务；放弃破坏性活动可以视为一种资本收益，可以增加未来的财富。我们的方法表明，艾伯塔省的驯鹿养护活动导致养护债务达8亿加元左右。

BACKGROUND & AIMS: OBJECTIVE:This study aimed to identify the 10 most frequent pediatric orthopaedic injuries requiring hospitalization in the United States, the major causes of these injuries, and their economic burden to health care cost. METHODS:The 2006 Kids' Inpatient Database (KID) (age range, 0-20 years) was used to determine the 10 most frequent pediatric orthopaedic injuries requiring hospitalization. The injuries were identified by ICD-9-CM codes 800.0-999.9 and external cause of injury codes (E-codes). Discharges were weighted to produce national estimates according to average age at admission, hospital charges, and length of stay. RESULTS:The 2 populations accounting for the highest total hospitalization charges (USD) for pediatric orthopaedic injury were young children with femur fractures (11 years of age, 20%, $32 441 per visit) and adolescents with vertebral fractures (17 years of age, 8%, $53 992 per visit). But the most common injuries requiring hospitalization were femur (11 years of age; 20%) and humerus (8 years of age; 18%) fractures. The most costly injuries, vertebral and pelvic injuries, were largely related to motor vehicle accidents (11.7% and 14.4%, respectively). In contrast, humerus and radius fractures had a high rate of playground-related injuries (21.9% and 11.3%, respectively). None of the causes accounted for more than 25% of the total incidence for the 10 most common injuries identified in this study. CONCLUSIONS:Identification of the patients responsible for the majority of the hospitalization charges for pediatric injuries will enable institutions to better plan their budgets on the basis of the local incidence.

背景与目标： 目的：本研究旨在确定在美国需要住院的十种最常见的小儿骨科损伤，这些损伤的主要原因以及它们对医疗保健成本的经济负担。
方法：使用2006年儿童住院数据库（KID）（年龄范围0-20岁）确定需要住院的10例最常见的小儿骨科损伤。伤害由ICD-9-CM代码800.0-999.9和外部伤害原因代码（E代码）标识。根据入院时的平均年龄，住院费用和住院时间，对出院时间进行加权以得出全国估计。
结果：儿童骨科损伤总住院费（USD）最高的2个人群是股骨骨折的幼儿（11岁，20％，每次就诊$ 32 441）和青少年的椎骨骨折（17岁， 8％，每次访问$ 53 992）。但是最需要住院的伤害是股骨（11岁； 20％）和肱骨（8岁； 18％）骨折。损失最大的是椎骨和骨盆损伤，主要与机动车事故有关（分别为11.7％和14.4％）。相比之下，肱骨和radius骨骨折的操场相关伤害发生率较高（分别为21.9％和11.3％）。在本研究中确定的10种最常见伤害中，没有一种原因占总发病率的25％以上。
结论：确定负责小儿伤害的大部分住院费用的患者，将使各机构可以根据当地发生率更好地计划预算。

BACKGROUND & AIMS: :Health insurance has evolved, over time, due to changing public needs, changing supplier offerings, and advances in technology. Understanding the motivations for change and the effects on radiology practice can help our leadership respond appropriately.

背景与目标： 随着时间的推移，由于不断变化的公共需求，不断变化的供应商产品和技术进步，健康保险已经得到了发展。了解改变的动力及其对放射学实践的影响可以帮助我们的领导者做出适当的反应。

BACKGROUND & AIMS: :Objective: To provide an overview of comparative effectiveness research (CER) methodology and discuss the challenges of health economics and outcomes research (HEOR) in wound care. Approach: Narrative description of HEOR methodology with supporting references. Results: With the increasing costs of clinical trials, the use of observational studies in a real-world setting will be essential. Wound care clinicians should understand the importance of proper methods for conducting CER studies. Propensity score methods and marginal structural modeling can create a "quasi-randomized" environment for measuring wound closure and can help drive informed decision-making. In wound care, a paucity of HEOR information is available with great reluctance to use this information by payers, the Food and Drug Administration, the Centers for Medicare & Medicaid Services, and other agencies. Furthermore, a limited amount of high-quality retrospective data to measure wound care outcomes exist. The U.S. Wound Registry is one of few data sources that accurately reports on outcomes for all wound types and is a Qualified Clinical Data Registry. Innovation and Conclusions: Several CER approaches in observational studies provide sufficiently detailed information to help decision-makers make informed choices about wound care products regarding efficacy in the real-world setting. Using CER and cost-effectiveness studies succinctly needs to be incorporated if progress is to be made in improving wound care outcomes and reducing cost.

背景与目标： ：目的：提供比较有效性研究（CER）方法的概述，并讨论健康经济学和结局研究（HEOR）在伤口护理方面的挑战。方法：对HEOR方法论的叙述性描述，并带有辅助性参考文献。结果：随着临床试验成本的增加，在现实环境中使用观察性研究将至关重要。伤口护理临床医生应了解进行CER研究的正确方法的重要性。倾向评分方法和边缘结构建模可以创建用于测量伤口闭合的“准随机”环境，并有助于推动明智的决策。在伤口护理中，可用的HEOR信息很少，付款人，食品和药物管理局，医疗保险和医疗补助服务中心以及其他机构极不愿意使用此信息。此外，还存在数量有限的高质量回顾性数据来衡量伤口护理的效果。美国伤口登记处是准确报告所有伤口类型结局的少数数据来源之一，并且是合格的临床数据登记处。创新与结论：观察研究中的几种CER方法可提供足够详细的信息，以帮助决策者就现实世界中的功效对伤口护理产品做出明智的选择。如果要在改善伤口护理效果和降低成本方面取得进展，则必须简洁地使用CER和成本效益研究。

BACKGROUND & AIMS: :Hemodialysis central venous catheter (CVC) use is associated with the highest morbidity, mortality, and cost of all types of hemodialysis vascular access. CVC-related infection drives much of the cost associated with CVC use. The magnitude of the cost associated with CVC-related infection varies depending on the type and severity of that infection; however, estimates of the total direct and indirect costs associated with hospitalizations due to hemodialysis CVC-related infections range from 17,000 USD to 32,000 USD per episode. Thus, it is critically important, to not only have effective strategies to limit CVC-related infection but also evaluate whether these strategies are an efficient use of resources. Prophylactic strategies can be considered economically efficient only if the value of its implementation and the corresponding drop in infection rate offer greater value than standard care. The optimal CVC-related infection prophylaxis strategy should work to limit infection risk with minimal risk, inconvenience, and discomfort to the patient, and at minimal cost. The aim of this review was to examine the clinical and economic impact of some commonly described interventions used for CVC infection prophylaxis.

背景与目标： ：血液透析中心静脉导管（CVC）的使用与所有类型的血液透析血管通路的最高发病率，死亡率和成本相关。与CVC相关的感染驱动了与CVC使用相关的大部分成本。与CVC相关的感染相关的费用规模因该感染的类型和严重性而异。然而，与血液透析CVC相关感染导致的住院相关的总直接和间接费用估计为每集17,000美元至32,000美元。因此，至关重要的是，不仅要制定有效的策略来限制与CVC相关的感染，而且还要评估这些策略是否是对资源的有效利用。预防策略只有在其实施价值和相应的感染率下降提供比标准护理更大的价值时，才能被认为具有经济效益。最佳的CVC相关感染预防策略应以最小的风险，给患者带来的不便，不便和不适感来限制感染风险。这篇综述的目的是研究用于预防CVC感染的一些通常描述的干预措施的临床和经济影响。

BACKGROUND & AIMS: :A recent resurgence of interest in formal optimisation theory has begun to improve our understanding of how variations in stomatal conductance and photosynthetic capacity control the response of whole plant photosynthesis and growth to the environment. However, mesophyll conductance exhibits similar variation and has similar impact on photosynthesis as stomatal conductance; yet, the role of mesophyll conductance in the economics of photosynthetic resource use has not been thoroughly explored. In this article, we first briefly summarise the knowledge of how mesophyll conductance varies in relation to environmental factors that also affect stomatal conductance and photosynthetic capacity, and then we use a simple analytical approach to begin to explore how these important controls on photosynthesis should mutually co-vary in a plant canopy in the optimum. Our analysis predicts that when either stomatal or mesophyll conductance is limited by fundamental biophysical constraints in some areas of a canopy, e.g. reduced stomatal conductance in upper canopy leaves due to reduced water potential, the other of the two conductances should increase in those leaves, while photosynthetic capacity should decrease. Our analysis also predicts that if mesophyll conductance depends on nitrogen investment in one or more proteins, then nitrogen investment should shift away from Rubisco and towards mesophyll conductance if hydraulic or other constraints cause chloroplastic CO2 concentration to decline. Thorough exploration of these issues awaits better knowledge of whether and how mesophyll conductance is itself limited by nitrogen investment, and about how these determinants of photosynthetic CO2 supply and demand co-vary among leaves in real plant canopies.

背景与目标： ：最近对形式最优化理论的兴趣重新兴起，开始使我们对气孔导度和光合能力的变化如何控制整株植物的光合作用和生长对环境的响应的理解有所提高。然而，叶肉电导率表现出相似的变化，并且对光合作用的影响与气孔电导率相似。但是，尚未深入探讨叶肉电导在光合资源利用经济学中的作用。在本文中，我们首先简要总结了有关叶肉电导率如何与也会影响气孔电导率和光合作用能力的环境因素有关的知识，然后我们使用一种简单的分析方法来探讨这些重要的光合作用控制应如何相互配合。 -以最佳的植物冠层变化。我们的分析预测，在冠层的某些区域，例如气孔或叶肉电导受到基本生物物理限制的情况下。由于水势降低，上冠层叶片气孔导度降低，这两种叶片中的另一种应增加，而光合能力应降低。我们的分析还预测，如果叶肉电导率取决于对一种或多种蛋白质的氮素投资，那么如果水力或其他限制因素导致叶绿体CO2浓度下降，则氮素投资应从Rubisco转向叶肉素体电导率。对这些问题的透彻探索有待于更好地了解叶肉电导率本身是否以及如何受到氮素投资的限制，以及这些光合作用CO2供求决定因素如何在实际植物冠层的叶片之间变化的知识。

BACKGROUND & AIMS: OBJECTIVES:To evaluate in peripheral arterial disease two strategies of antiplatelet therapy (clopidogrel and aspirin) in terms of number of ischemic stroke and hemorrhagic events, to estimate the losses of chances after no-choice of the most favorable strategy and the impact of these losses of chances in terms of days of hospitalizations, to estimate the cost-effectiveness ratio of the most effective and best tolerated strategy. METHOD:The number of patients to be treated to avoid one critical event (ischemic and hemorrhagic events) was calculated from the results of the annual rates established by the CAPRIE trial conducted in a population of French patients with peripheral arterial disease. This number of patients to treat was then extrapolated to the entire French population of peripheral arterial disease patients. The absolute numbers of critical events avoided with clopidogrel in France defined the losses of chances in the case of no-choice of this drug. Estimates in terms of days of hospitalization and cost-effectiveness ratio (in euro per life year gained) were based on data from the French Medical Information System. RESULTS:The number of patients to treat to avoid one ischemic event was 87 and the number of patients to treat to avoid one major hemorrhagic event was 149. In the peripheral arterial disease population, the numbers of ischemic and hemorrhagic events generated by non-treatment with clopidogrel was estimated at 3761 and 2191, respectively i.e. a total of 5952 events per year. These events included: 2025 myocardial infarctions, 1157 ischemic strokes, 579 deaths of vascular origin and 2191 digestive hemorrhages, requiring 60,394 hospitalization days. The cost-effectiveness ratio of clopidogrel was 10,393 euro per life year gained, and was much lower than commonly accepted cost-effective thresholds in Europe, which are around 30,000 euro per life year gained. CONCLUSION:The choice of clopidogrel in patients with peripheral arterial disease improves the prevention of subsequent events (ischemic and hemorrhagic events) with a cost-effectiveness ratio 2 to 3 times lower than the European thresholds accepted by the World Health Organization and avoids 1 day of hospitalization for 5.4 treated patients.

背景与目标： 目的：就缺血性中风和出血事件的数量，评估外周动脉疾病中两种抗血小板治疗的策略（氯吡格雷和阿司匹林），以估计不采取最有利策略的机会丧失的机会以及这些损失的影响住院天数的机会，以评估最有效和最佳耐受策略的成本效益比。
方法：根据CAPRIE试验在法国患有外周动脉疾病的人群中进行的年率计算，计算出避免发生一种严重事件（缺血性和出血性事件）的患者人数。然后将这个要治疗的患者人数推算到整个法国的外周动脉疾病患者群体中。在法国，使用氯吡格雷避免的严重事件的绝对数量定义了在不选择这种药物的情况下机会的丧失。住院天数和成本效益比（以每生命年获得的欧元计算）的估算是基于法国医疗信息系统的数据得出的。
结果：避免发生一种缺血性事件的患者人数为87名，避免发生一种重大出血性事件的患者人数为149名。在外周动脉疾病人群中，未经治疗而引起的缺血性和出血性事件的数量估计使用氯吡格雷的人数分别为3761和2191，即每年总计5952个事件。这些事件包括：2025例心肌梗塞，1157例缺血性中风，579例血管源性死亡和2191例消化性出血，需要60,394天的住院治疗。氯吡格雷的成本效益比为每生命年10,393欧元，远低于欧洲公认的成本效益阈值，即每生命年30,000欧元。
结论：外周动脉疾病患者选择氯吡格雷可改善对随后事件（缺血性和出血性事件）的预防，其成本效益比世界卫生组织认可的欧洲阈值低2至3倍，并避免1天5.4例患者住院治疗。