血流储备分数异常的稳定型冠心病患者PCI治疗的效价评估

Cost-Effectiveness of percutaneous coronary Intervention in patients with stable coronary artery disease and abnormal fractional flow reserve

研究背景血流储备分数(FFR)研究发现,同药物治疗组比较,至少一支冠脉FFR≤0.80的稳定型冠心病患者接受PCI治疗后,再次进行血流重建的概率减少,然而异常FFR指导的PCI术费用以及对于生活质量的影响并不明确。方法采用EQ-5D健康量表评估患者基线和治疗30天后效价,同时假设以月为单位效益改善来推断一年线性下降曲线,进而预测生活质量调整后的生存时间。结果根据一年的累计费用计算增加的效价比率。初期异常FFR指导的PCI治疗组费用明显高于药物治疗组(59670元vs 23970元,P<0.01),然而在治疗初期两组间费用差值在随访结束后显著降低(36880元vs.$15230元,P<0.01),主要是由于药物治疗组再次血运重建费用增加。治疗一个月后,PCI组患者效益较药物治疗组显著改善(0.055 vs 0.003,P<0.001)。结论 FFR异常的临界病变的稳定型冠心病患者进行PCI治疗能改善临床效果,同时后继治疗较单纯药物治疗组更加经济。

Objective：Background The fractional flow reserve（FFR）trials demonstrated a significant reduction in sub-sequent coronary revascularization among patients with stable coronary artery disease and at least 1 coronary lesion with a FFR ≤0. 80 who were randomized to percutaneous coronary intervention（PCI）compared with best medical therapy. The economic and quality - of - life implications of PCI in the setting of an abnormal fractional flow reserve are unknown. Methods：We assessed patient utility using the EQ - 5D health survey at baseline and 1 month and projected quality - adjusted life - years assuming a linear decline over 1 years in the 1 - monthutility improvements. Results：We cal-culated the incremental cost - effectiveness ratio based on cumulative costs over 12 months. Initial costs were significantly higher for PCI in the setting of an abnormal fractional flow reserve than with medical therapy（ ￥ 59670 vs. ￥ 23970,P 〈0. 01）,but the ￥ 36880 difference narrowed over 1 - year follow - up to ￥ 15230（P 〈 0. 001）,mostly because of the cost of subsequent revascularization procedures. Patient utility was improved more at 1 month with PCI than with medical therapy （0. 054 versus 0. 001 units,P 〈 0. 001）. Conclusions：PCI of coronary lesions with reduced FFR improves outcomes and appears economically attractive compared with best medical therapy among patients with stable coronary artery disease.