Cost-Effectiveness Analysis of Endovascular Versus Open Surgical Repair of Acute Abdominal Aortic Aneurysms Based on Worldwide Experience
Cost-Effectiveness Analysis of Endovascular Versus Open Surgical Repair of Acute Abdominal Aortic Aneurysms Based on Worldwide Experience
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DOI：
10.1583/09-2941.1
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发表时间：
2010-04-01
影响因子：
2.6
通讯作者：
Boyle, Jonathan R.
中科院分区：
文献类型：
--
作者：
Hayes, Paul D.;Sadat, Umar;Boyle, Jonathan R.
目的：对腹主动脉瘤破裂（AAA）的血管内与开放手术修复进行经济评价。方法：血管内动脉瘤修复（EVAR）目前正在接受国家临床卓越研究所的评估。为了帮助进行这一评估，在紧急情况下使用了一个健康经济模型来分析EVAR与OSR在非破裂AAAs选择性治疗中的成本效益。730例EVAR患者的基本病例数据来自我们最近发表的22项研究荟萃分析，其中7040例急性AAA（破裂或有症状）患者接受了紧急EVAR或OSR治疗。这些数据反映了患者的平均年龄为70岁。假设时间跨度为30年并采用全因死亡率的基本情况模型进行了一系列单向敏感性分析。使用10,000个蒙特卡罗模拟进行了多变量分析。结果：EVAR在基本病例分析中占主导地位，EVAR的平均累积成本为17,422英镑（26,133美元），OSR的平均累积成本为18,930英镑（28,395美元）[-1508英镑（2262美元）差异]。EVAR的平均质量调整生命年(QALYs)/患者为3.09，OSR为2.49（差0.64）。与OSR相比，EVAR具有成本效益，阈值为20,000至30,000英镑（30,000至45,000美元）/QALY。在单一的联合试验中，开放式手术修复为患者提供的qaly比EVAR更多。敏感性分析表明，结果对住院和重症监护时间、血液制品的使用以及EVAR装置的成本最为敏感，这是主要的成本驱动因素。结论：虽然英国国家临床卓越研究所并没有设定治疗不被资助的绝对上限，但3万英镑（4.5万美元）通常被认为是可接受的上限。在这个水平上，EVAR几乎100%有可能是AAA破裂的一种经济有效的治疗方法。17:174 - 182
Purpose: To present an economic evaluation of endovascular versus open surgical repair of ruptured abdominal aortic aneurysms (AAA).Methods: Endovascular aneurysm repair (EVAR) is currently being appraised by the National Institute for Clinical Excellence. To aid in this appraisal, a health economic model developed to demonstrate the cost-effectiveness of EVAR for elective treatment of non-ruptured AAAs versus OSR was used for an analysis in the emergency setting. The base case data on 730 patients undergoing EVAR was extracted from our recently published 22-study meta-analysis of 7040 patients presenting with acute AAA (ruptured or symptomatic) treated with either emergency EVAR or OSR. These data reflected a patient population with an average age of 70 years. The base case model, which assumed a time horizon of 30 years and applied all-cause mortality rates, was subjected to a number of 1-way sensitivity analyses. A multivariate analysis was undertaken using 10,000 Monte-Carlo simulations.Results: EVAR dominated OSR in the base case analysis, with a mean cumulative cost/patient of 17,422 pound ($26,133) for EVAR and 18,930 pound ($28,395) for OSR [-1508 pound ($2262) difference]. The mean quality-adjusted life years (QALYs)/patient was 3.09 for EVAR versus 2.49 for OSR (0.64 difference). EVAR was cost-effective compared with OSR at a threshold value of 20,000 pound to 30,000 pound ($30,000-$45,000)/QALY. In no single combination tested did open surgical repair provide the patient with more QALYs than EVAR. Sensitivity analyses demonstrated that the results were most sensitive to length of hospital and intensive care stays, use of blood products, and the cost of the EVAR device, which were the main cost drivers.Conclusion: While the UK's National Institute for Clinical Excellence does not set an absolute limit at which treatments would not be funded, 30,000 pound ($45,000) is generally regarded as the upper limit of acceptability. At this level, there is almost a 100% probability that EVAR is a cost-effective treatment for ruptured AAA. J Endovasc Ther. 2010;17:174-182