下肢动脉定期全程修复防治糖尿病合并下肢动脉硬化闭塞症的成本效用预测分析

Predictive analysis of cost utility of lower extremity artery repair in prevention of diabetes and lower extremity arteriosclerosis obliterans

目的 分析下肢动脉定期全程修复防治糖尿病合并下肢动脉硬化闭塞症(ASO)的成本效用,论证下肢动脉全程修复治疗方案在社区糖尿病患者管理中的应用价值。方法 于2020年12月—2021年2月通过文献研究和上海市浦东医院血管外科专家咨询,进行糖尿病合并下肢动脉病变的状态分类、转移概率、成本、质量调整生命年等相关数据采集,建立糖尿病合并ASO马尔科夫模型,生成常规治疗和下肢动脉定期全程修复治疗下的队列数据,并结合治疗成本、质量调整生命年产出进行成本效用比较。结果 模拟样本为1 000例,常规治疗下,有18.5%(185例)的患者会在末期发生溃疡,截肢率为50.3%(503例),死亡率为36.7%(367例);下肢动脉定期全程修复治疗下,末期溃疡发生率在10%以下,截肢率为1.0%~4.9%,死亡率为0.7%~3.3%。定期进行下肢动脉全程修复治疗时,每位糖尿病患者在20年间的平均治疗成本比常规治疗高出397 476.8~706 237.5元,增量成本效用比为129 087.4~213 034.5元/质量调整生命年。结论 下肢动脉定期全程修复的增量成本效用比的最低值低于1倍的上海市2019年人均国内生产总值,最高值低于3倍的上海市2019年人均国内生产总值,值得纳入上海市糖尿病合并下肢动脉硬化闭塞症患者糖尿病足防治先进适宜技术范围。

Objective To analyse the cost-effectiveness of regular full-course repair of lower extremity arteries in the prevention and treatment of diabetes complicated with lower extremity arteriosclerosis obliterans(ASO),to demonstrate the application value of the full-course repair of lower extremity arteries in the management of diabetes patients in the community.Methods Literature research and consultation with Shanghai Pudong Hospital’s vascular surgery experts were conducted from December 2020 to February 2021.Status classification,transition probability,cost,quality-adjusted life year and other related data of diabetes complicated with lower extremity arterial disease were collected to establish diabetes combined with the Markov model of lower extremity ASO,generate cohort data under conventional treatment and regular full-course repair of lower extremity arteries and compare the cost-effectiveness of treatment costs and quality-adjusted life-year output.Results The simulated sample was 1 000 cases under conventional treatment,and 18.5%(185 cases) of patients developed ulcers in the terminal stage,with an amputation rate of 50.3%(503 cases) and a mortality rate of 36.7%(367 cases).Under regular full-course repair of lower limb arteries,the rate of terminal ulcers was less than 10%,the rate of amputation was 1.0%-4.9% and the mortality rate was between 0.7%-3.3%.When the lower extremity arterial repair treatment was performed regularly,the average treatment cost of each diabetic patient in 20 years was 397 476.8-706 237.5 yuan higher than that of conventional treatment,and the incremental cost-utility ratio was 129 087.4-213 034.5 yuan/quality-adjusted life year.Conclusion The lowest value of the incremental cost-utility ratio of regular full-course repair of lower extremity arteries is less than the GDP per capita of Shanghai in 2019,and the highest value is less than three times the GDP per capita of Shanghai in 2019,which is worthy of being included in the advanced and appropriate technology for prevention and treatment of diabetes foot in diabetes patients with lower limb ASO in Shanghai.