经导管主动脉瓣置换术对比外科主动脉瓣置换术治疗主动脉瓣狭窄的卫生经济学评价模型比较

Comparison of health economics evaluation models of TAVR versus SAVR in the treatment of aortic stenosis

目的:为中国主动脉瓣狭窄(aortic stenosis, AS)疾病领域的卫生经济学评价研究的模型构建提供参考。方法:系统检索国内外经导管主动脉瓣置换术(transcatheter aortic valve replacement, TAVR)对比外科主动脉瓣置换术(surgical aortic valve replacement, SAVR)治疗AS的卫生经济学评价研究文献,对研究中模型问题描述、类型与结构设计和参数设定进行比较和分析。结果:共纳入来自12个国家的20项研究。所有研究均采用成本-效用分析方法评价TAVR对比SAVR治疗不同外科手术风险重度AS的经济性。研究主要构建决策树模型和马尔科夫模型,根据模型类型及结构特点可分为6类。70%的研究中模型的临床参数来源为PARTNER系列试验。结论:目前研究中的模型提供了较为清晰的决策分析框架,未来中国研究可以其为基础,并结合当前医疗系统和干预措施的特点构建模型。

OBJECTIVE To provide reference for the model construction of health economics evaluation research in the field of aortic stenosis disease in China.METHODS The health economics evaluation research literature of transcatheter aortic valve replacement(TAVR) versus surgical aortic valve replacement(SAVR)in the treatment of aortic stenosis as at home and abroad was systematically searched, and the description of model questions, techniques, structural development and parameter setting in the study were compared and analyzed.RESULTS A total of 20 cost-utility analysis studies from 12 countries were included, which evaluated the economics of TAVR versus SAVR in the treatment of severe aortic stenosis with different surgical risks.Decision tree model and Markov model were mainly constructed in all studies, which could be divided into six categories according to the techniques and development characteristics.Clinical parameters of models in 70% of the studies were derived from PARTNER trials.CONCLUSION Models in the present studies provide a clear framework for decision-making analysis, which can be used as a basis for future research in China.The new model needs to be constructed in accordance with the characteristics of the local healthcare system and intervention measures.