急性非ST段抬高型心肌梗死介入治疗与药物保守治疗的成本-效果分析

Cost-Effectiveness Analysis of Invasive Versus Conservative Treatment in Patients with Acute Non-ST-Segment Elevation Myocardial Infarction

目的探讨急性非ST段抬高型心肌梗死(NSTEMI)介入治疗与药物保守治疗的成本-效果。方法选取2013年1月至2014年12月广东省第二人民医院心内科和中山大学孙逸仙纪念心内科确诊的153例NSTEMI患者作为研究对象,其中行介入治疗102例,药物保守治疗51例,运用成本-效果分析法对两种治疗方案的临床效果和医疗成本进行药物经济学评价。结果介入治疗组患者住院期间再发心绞痛、心力衰竭、心律失常、脑卒中发生率均明显低于药物保守治疗组,差异均有统计学意义(均P<0.05);介入治疗组患者住院期间总成本明显高于药物保守治疗组,差异有统计学意义(P<0.05);随访1年,介入治疗组患者心源性病死的发生率明显低于药物保守治疗组,避免联合主要终点事件发生率,总成本均明显高于药物保守治疗组,差异均有统计学意义(均P<0.05);成本-效果分析显示,介入治疗组明显高于药物保守治疗组,差异有统计学意义(P<0.05)。结论介入治疗具有一定优势,能够降低住院期间不良心血管事件和随访1年主要终点事件发生率,但从药物经济学角度考虑,短期内药物保守治疗比介入治疗更具有经济性。

Objective To investigate the cost effectiveness of interventional therapy and drug conservative treatment in patients with acute non ST segment elevation myocardial infarction（NSTEMI）.Methods Select the December January 2013 to 2014 Department of Cardiology;the second people＇s Hospital of Guangdong Province and Zhongshan University Sun Yat Sen Memorial heart medicine diagnosis of 153 patients with NSTEMI patients as the research object,the interventional treatment of 102 cases,51 cases underwent conservative treatment with drugs, using cost- effectiveness analysis of two therapeutic schemes in the treatment of clinical effect and medical cost of pharmacoeconomic evaluation.Results The intervention group of hospitalized patients with recurrent angina,heart failure,arrhythmia and stroke were significantly lower than that in drug treatment group,the differences were statistically significant（P〈0.05）;the intervention group was significantly higher than the total cost of hospitali- zation in patients with conservative medical treatment group,the difference was statistically significant（P〈0.05）;1 years of follow-up,the intervention group of patients with cardiogenic mortality was significantly lower than the conservative treatment group,the incidence of the primary endpoint to avoid joint,the total cost was significantly higher than that in medicine group,the differences were statistically significant（P〈0.05）;cost effectiveness analysis showed that the intervention group was significantly higher than that of drug the conservative treatment group,the difference was statistically significant（P〈0.05）.Conclusion Interventional treatment has certain advantages,can reduce the incidence of hospitalization during adverse cardiovascular events and followed up 1 year endpoint,but considered from the viewpoint of pharmaceutical economics,short-term drug conservative treatment is a better cost effectiveness than interventional treatment.