Long-term cost-effectiveness of alternative management strategies for patients with life-threatening ventricular arrhythmias. Electrophysiologic Study versus Electrocardiographic Monitoring (ESVEM) Investigators.
Long-term cost-effectiveness of alternative management strategies for patients with life-threatening ventricular arrhythmias. Electrophysiologic Study versus Electrocardiographic Monitoring (ESVEM) Investigators.
复制标题
对于危及生命的室性心律失常患者的替代管理策略的长期成本效益。
DOI：
10.1016/s0895-4356(96)00331-9
复制
发表时间：
1997
影响因子：
7.2
通讯作者：
Mason,JW
中科院分区：
文献类型：
--
作者：
Hlatky,MA;Boothroyd,DB;Johnstone,IM;Marcus,FI;Hahn,E;Hartz,V;Mason,JW
背景在电生理研究与心电图监测（ESVEM）试验中，由霍尔特监测和电生理研究指导的系列抗心律失常药物试验具有相似的临床结局，而使用索他洛尔治疗的患者结局有所改善。本研究的目的是比较长期的成本效益，这些管理alternatives.MethodsPatients在ESVEM试验被链接到计算机化的文件，无论是卫生保健财务管理局或退伍军人事务部。总住院费用和生存时间超过五年的后续使用精算方法进行测量，成本效益counted.ResultsPatients随机治疗指导下的电生理研究有更多的住院，更高的成本，和成本效益比为162,500美元，每生命年增加相比，指导下的治疗霍尔特监测。与随机分配到其他药物的患者相比，随机分配到索他洛尔组的患者住院次数更少，费用更低，生存率更高，索他洛尔是成本效果分析中的主导策略。发现有效药物的患者住院次数更少，费用更低，生存期更长。这些发现是强大的敏感性分析和引导replication.ConclusionsSerial药物测试指导下的电生理研究有一个不利的成本效益比相对于霍尔特监测，而索他洛尔是成本效益相对于其他抗抑郁药物。
BackgroundSerial antiarrhythmic drug testing guided by Holter monitoring and electrophysiologic study had similar clinical outcomes in the Electrophysiologic Study versus Electrocardiographic Monitoring (ESVEM) trial, while patients treated with sotalol had improved outcomes. The purpose of this study was to compare long-term cost-effectiveness of these management alternatives.MethodsPatients in the ESVEM trial were linked to computerized files of either the Health Care Finance Administration or the Department of Veterans Affairs. Total hospital costs and survival time over five year follow-up were measured using actuarial methods, and cost-effectiveness was calculated.ResultsPatients randomized to therapy guided by electrophysiologic study had more hospital admissions, higher costs, and a cost-effectiveness ratio of $162,500 per life year added compared with therapy guided by Holter monitoring. Patients randomized to sotalol had fewer hospitalizations, lower costs, and better survival than patients randomized to other drugs, and sotalol was a dominant strategy in the cost-effectiveness analysis. Patients for whom an effective drug was found had fewer hospital admissions, lower costs, and longer survival. These findings were robust in sensitivity analyses and in bootstrap replications.ConclusionsSerial drug testing guided by electrophysiologic study had an unfavorable cost-effectiveness ratio relative to Holter monitoring, while sotalol was cost-effective relative to other antiarrhythmic drugs.