Long-term cost-effectiveness analysis of endovascular versus open repair for abdominal aortic aneurysm based on four randomized clinical trials
Long-term cost-effectiveness analysis of endovascular versus open repair for abdominal aortic aneurysm based on four randomized clinical trials
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DOI：
10.1002/bjs.9464
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发表时间：
2014-05-01
影响因子：
9.6
通讯作者：
Greenhalgh, R. M.
中科院分区：
文献类型：
--
作者：
Epstein, D.;Sculpher, M. J.;Greenhalgh, R. M.
背景关于腹主动脉瘤(AAA)的选择性血管内修补术(EVAR)与开放修补术(AAA)的经济学评价，对于EVAR是否具有成本效益得出了不同的结论。本文回顾了目前的证据基础，并根据EVAR-1、DREAM、OVER和ACE四个随机临床试验的结果进行了最新的成本-效果分析。方法使用马尔可夫模型从英国的角度估计终身成本，并根据四个试验的结果计算质量调整寿命年(QALY)。模型中包含的结果包括：手术成本、监测成本、再干预成本、与健康相关的生活质量、与动脉瘤相关的死亡率和其他原因死亡率。结果基于EVAR-1、DREAM或ACE试验结果的模型没有发现EVAR在英国使用的阈值(每QALY高达30 000 GB)具有成本效益。根据基于Over试验的模型，EVAR似乎具有成本效益。这些结果似乎对试验间隔期以外事件的替代模型情景稳健。结论在欧洲中心进行的试验中，这些分析没有发现EVAR与开放修复相比在长期内具有成本效益。根据在美国进行的Over试验，EVAR确实似乎具有成本效益。在将经济评估结果从一个国家转移到另一个国家时必须谨慎行事。
BackgroundA number of published economic evaluations of elective endovascular aneurysm repair (EVAR)versusopen repair for abdominal aortic aneurysm (AAA) have come to differing conclusions about whether EVAR is cost-effective. This paper reviews the current evidence base and presents up-to-date cost-effectiveness analyses in the light of results of four randomized clinical trials: EVAR-1, DREAM, OVER and ACE.MethodsMarkov models were used to estimate lifetime costs from a UK perspective and quality-adjusted life-years (QALYs) based on the results of each of the four trials. The outcomes included in the model were: procedure costs, surveillance costs, reintervention costs, health-related quality of life, aneurysm-related mortality and other-cause mortality. Alternative scenarios about complications, reinterventions and deaths beyond the trial were explored.ResultsModels based on the results of the EVAR-1, DREAM or ACE trials did not find EVAR to be cost-effective at thresholds used in the UK (up to £30 000 per QALY). EVAR seemed cost-effective according to models based on the OVER trial. These results seemed robust to alternative model scenarios about events beyond the trial intervals.ConclusionThese analyses did not find that EVAR is cost-effective compared with open repair in the long term in trials conducted in European centres. EVAR did appear to be cost-effective based on the OVER trial, conducted in the USA. Caution must be exercised when transferring the results of economic evaluations from one country to another.