药物洗脱支架的社会经济学分析

Social economics analysis of drug-eluting stents

目的：对于目前国内药物洗脱支架（DES）在临床普遍使用的现象进行社会经济学分析,为我国DES和金属裸支架（BMS）的科学合理使用提供依据.方法：运用成本效果分析方法分析比较了唐都医院心内科冠心病患者在经皮冠状动脉介入治疗（PCI）中植入DES相对于BMS的相关医疗成本开支的成本效果,以2006年国家统计局公布的我国居民人均年收入为标准,初步估测中国居民个人支付相关医疗费用的情况.结果：随着植入支架个数（1根或2根）和中国各地居民所享受的医保制度不同,植入DES较BMS增加的医疗费用相当于2006年中国城镇居民人均年可支配收入的0.80~1.32倍,2006年中国农民年纯收入的7.03~12.20倍.按照DES减少靶血管血运重建（TVR）率不同,植入1根或2根支架时,为避免一次TVR事件,中国城镇居民和农民需额外支付的医疗费用为人民币9720~59 500元和38 000~205 833元.结论：就中国医疗保障体系和国民的个人支付能力而言,BMS可能不应该过早地退出心血管介入领域.

AIM：To give some suggestions about the reasonable use of drug-eluting stents（DES） and bare metal stents（BMS）,through analyzing the overuse of DES in China from the point of social economics.METHODS：Evaluate the cost-effectiveness of DES from the decreased rate of the target vessel revascularization（TVR） compared with BMS and the residents＇ ability of paying for medical cost according to the average personal income in 2006,published by National Statistics Department.RESULTS：With the number of DES and the different social medical insurance,the increased medical cost was equal to 0.80-1.32 times of urban per capita disposable income for the urban employees with the basic medical insurance and 7.03-12.20 times of rural per capita net income for the farmers with the new rural cooperatives medical care.According to the different TVR rate decreased,the number of DES implanted and social medical insurance,the urban employees and the farmers had to pay $9 720-59 500 RMB and $38 000-205 833 RMB to avoid per TVR.CONCLUSION：BMS should be used more in clinical practice under our present health care system and the residents＇ ability of paying for medical cost.