CAG和PCI术后使用Angio-Seal血管闭合器的成本效果分析

Study on the cost-effectiveness analysis on using Angio-Seal vascular closure device after CAG or PCI

目的:研究冠状动脉造影(CAG)和冠心病介入治疗(PCI)术后使用Angio-Seal血管闭合器的成本效果。方法:回顾性分析CAG/PCI患者术后采用徒手压迫237例(徒手压迫组)和Angio-Seal血管闭合器97例(闭合器组)两种方法止血的情况,并进行成本效果分析:以直接医疗收费代替成本,以术后穿刺部位血管并发症(包括出血、股动脉血肿、假性动脉瘤、血栓形成和栓塞事件)的发生和经济负担为直接效果进行评价;以减少状态-特质焦虑问卷(STAI)评分和缩短患者术后下床活动时间为间接效果进行评价,并计算成本效果比。结果:通过直接效果计算得出徒手压迫组平均成本费用比闭合器组减少3778.60元,平均经济负担比闭合器组增加了123.53元。通过间接效果计算得出每减少STAI问卷(状态焦虑)1分的成本为154.97元,每减少1h下床活动时间的成本为198.71元。成本效果比显示:闭合器组平均每预防1例出血的费用与徒手压迫组的费用比为77.64∶1,每预防1例股动脉血肿的费用比为32.18∶1,每预防1例假性动脉瘤的费用比为60.72∶1,每预防1例血栓形成和栓塞时间的费用比为54.22∶1。结论:CAG/PCI术后使用Angio-Seal血管闭合器属于高成本投入低收益产出策略,临床上应以患者自愿为原则使用。

Objective： To study on the cost-effectiveness analysis on using Angio-Seal vascular closure device after CAG/PCI. Methods： Retrospective analysis of the manual compression method and the Anglo-Seal vascular closure method after coronary angiography （CAG） and percutaneous coronary intervention （PCI） was done. Cost-effective analysis （CEA） was used to assess this program. Using the direct hospitalization cost, numbers of the periphery blood vessel complications （hemorrhage, the femoral artery haematoma, the pseudo aneurism, the event of thrombogenesis and embolism） and its economic burden were used to evaluate the direct effect of CEA. The State-Trait Anxiety Inventory and the time of out-of-bed activity after the operation were used to evaluate the indirect effect of CEA. Calculating the cost-effectiveness rate. Results： Data from the direct effect of CEA showed that： the average cost of manual compression group is ￥3 778.60 less than Angio-Seal vascular closure device group. However the average economic burden is ￥123.53 more. Data from the indirect effect of CEAshowedthat： investing every ￥156.68, one score of the State Anxiety Inventory could be reduced; investing every ￥199. 12; one hour of out-of-bed activity could be advanced. The cost for one hemorrhage, femoral artery haematoma, pseudo aneurism or event of thrombogenesis in Angio-Seal vascular closure device group were 77.64, 32. 18, 60. 72, 54.22 times respectively of manual compression group. Conclusion： Using Angio-Seal vascular closure device after CAG/ PCI seemed to be a high cost input and low-effect output strategy, so we should base on desire of patient to use it.