Projected long-term costs of coronary stenting in multivessel coronary disease based on the experience of the Bypass Angioplasty Revascularization Investigation (BARI).
Projected long-term costs of coronary stenting in multivessel coronary disease based on the experience of the Bypass Angioplasty Revascularization Investigation (BARI).
复制标题
根据旁路血管成形术血运重建研究 (BARI) 的经验，预测多支冠状动脉疾病中冠状动脉支架置入术的长期成本。
DOI：
10.1067/mhj.2000.109915
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发表时间：
2000
影响因子：
4.8
通讯作者：
Hlatky,MA
中科院分区：
文献类型：
--
作者：
Yock,CA;Boothroyd,DB;Owens,DK;Winston,C;Hlatky,MA
背景：目前大多数经皮冠状动脉血管重建术都采用支架。目前尚不清楚支架置入术的初始成本是否会通过减少昂贵的并发症和重复血运重建术来偿还，特别是对于多血管疾病患者。方法为了预测使用冠状动脉支架、血管成形术或搭桥手术治疗多支冠状动脉疾病患者的长期成本，我们基于搭桥血管成形术重建术（BARI）随机试验记录的冠状动脉搭桥术（CABG）和经皮腔内冠状动脉成形术（PTCA）的结果建立了一个决策模型。我们研究了两种临床策略：PTCA结果不理想的临时支架置入和所有符合血管造影条件的病变的原发性支架置入。CABG的费用也被更新以反映当代的实践。结果：与传统PTCA（- 1742美元，或- 3.4%）或现代CABG（- 832美元，或- 1.7%）相比，临时支架置入术在4年期间的预计成本更低，主要是因为PTCA后紧急CABG的减少。相比之下，与PTCA（+ 333美元，或+0.7%）或当代CABG（+ 1243美元，或+2.5%）相比，初级支架置入术在4年期间的预计成本更高，主要是因为初始手术成本更高。当我们在单向和双向敏感性分析中系统地改变模型的关键参数时，这些结果并没有实质性的改变。结论多支血管疾病患者的初级支架植入术比冠脉搭桥有更高的预期长期成本。相比之下，多血管疾病的临时支架置入策略比PTCA或CABG的预期成本更低。（美国心脏杂志2000；140:556-64。）
BackgroundStents are now used in the majority of percutaneous coronary revascularization procedures. It is not clear whether the higher initial cost of stenting is later repaid by reducing costly complications and repeat revascularization procedures, especially for patients with multivessel disease.MethodsTo project the long-term costs of using coronary stents, angioplasty, or bypass surgery to treat patients with multivessel coronary artery disease, we developed a decision model based on the outcomes documented in the Bypass Angioplasty Revascularization Investigation (BARI) randomized trial of coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA). We studied 2 clinical strategies: provisional stenting of suboptimal PTCA results and primary stenting of all angiographically eligible lesions. The cost of CABG was also updated to reflect contemporary practice.ResultsProvisional stenting had lower projected costs over a 4-year period than either traditional PTCA (–$1742, or –3.4%) or contemporary CABG (–$832, or –1.7%), mostly because of reductions in emergency CABG after PTCA. In contrast, primary stenting had higher projected costs over a 4-year period than either PTCA (+$333, or +0.7%) or contemporary CABG (+$1243, or +2.5%), mainly because of the higher initial procedure costs. These results were not substantially altered when we systematically varied the key parameters of the models in 1-way and 2-way sensitivity analyses.ConclusionsA primary stenting strategy in patients with multivessel disease has higher projected long-term costs than CABG. In contrast, a provisional stenting strategy in multivessel disease has lower projected costs than either PTCA or CABG. (Am Heart J 2000;140:556-64.)