急性心肌梗死治疗过程中进口与国产药物支架应用的经济效益分析

Cost-effectiveness analysis of domestic and imported drug eluting stents in patients undergoing treatment of acute myocardial infarction

目的调查和分析在急性心肌梗死患者治疗过程中,国产与进口药物支架的临床应用效果、安全性和产生费用。方法 2007年1月—2009年6月,采用病案回顾及电话随访的方法,获取上海市两家医院440例接受国产药物支架(n=318,国产支架组)或进口药物支架(n=122,进口支架组)治疗的急性心肌梗死患者的资料。以功效性、安全性和经济学指标作为因变量,以患者其他相关因素作为自变量,进行两组间比较和分析。结果两组患者住院期间病死率及随访1年内病死率、再发心脏病比例、再次接受冠状动脉造影术(CAG)或冠状动脉介入术(PC I)的比例比较,差异无统计学意义(P>0.05);进口支架组人均置入支架总费用和单个支架费用均显著高于国产支架组(P<0.001);有医疗保险患者人均自付支架费用明显低于无医疗保险患者(P<0.05);有或无医疗保险患者的人均自付支架费用,进口支架组均显著高于国产支架组(P<0.05)。结论与进口药物支架比较,国产药物支架具有更高的性价比。相关部门可通过提高进口药物支架的共付率使患者选择更加经济的治疗方案,同时推进国产药物支架的应用。

Objective To investigate the clinical effects,safety and cost of domestic and imported drug eluting stents in patients undergoing treatment of acute myocardial infarction. Methods The data of 440 patients undergoing treatment of acute myocardial infarction with domestic drug eluting stents（n=318,domestic stent group） or imported drug eluting stents（n=122,imported stent group） in two hospitals of Shanghai were obtained by chart review and telephone follow-up from January 2007 to June 2009.Comparison and analysis were conducted in two groups with effect,safety and economic parameters as dependent variables and the other related factors of patients as independent variables. Results There was no significant difference in mortality during hospitalization,mortality in one year of follow-up,percent of recurrence of myocardiopathy and percent of a second conventional coronary angiography（CAG） or a second percutaneous coronary intervention between two groups（P〉0.05）.The cost of drug eluting stents per person and cost of each drug eluting stent in imported stent group were significantly higher than those of domestic stent group（P〈0.001）.Patients with medical insurance paid much less for drug eluting stents per person than those without medical insurance（P〈0.05）.No matter with medical insurance or not,patients in imported stent group paid much more for drug eluting stents per person than those in domestic stent group（P〈0.05）. Conclusion Domestic drug eluting stents have better cost-effective properties than imported drug eluting stents in treatment of acute myocardial infarction.Higher payment ratio should be implemented on imported drug eluting stents for a more widely use of domestic drug eluting stents.