帕金森病脑深部电刺激术联合药物治疗的卫生经济学评估

Health economic evaluation of deep brain stimulation combination with medical therapy in Parkinson's disease

目的:探讨脑深部电刺激术(DBS)术后联合药物治疗帕金森病(PD)对比术前药物治疗是否具有成本效果优势。方法:回顾性纳入80例PD患者,经自身对照设计,分为手术组和药物组。术后问卷随访,获取有关费用资料。应用统一帕金森病评分量表运动部分(UPDRSⅢ)和39项帕金森病生活质量问卷(PDQ-39)评估疗效,从中国医疗卫生系统角度对不同费用情境下的两种疗法进行成本效果分析,判断其经济性。结果:DBS术后运动功能和生活质量较术前显著改善(P<0.05)。术后第1年的年均医疗成本达226371.41元,是术前单纯用药的28.5倍,且每提升1%运动功能和生活质量疗效的额外成本均远超支付意愿阈值(WTP)。若不考虑手术和耗材费用累积负担或仅考虑术前术后药物费用,则增量成本效果比(ICER)_(运动功能)分别为487.5元/%和-5959.17元/%,ICER_(生活质量)分别为1483.1元/%和-18129.3元/%,均低于WTP,显示出经济性。结论:短期来看,DBS联合药物治疗相较单纯用药不具经济性;长期来看,DBS疗法能降低后续治疗费用并改善患者生存质量,具有成本效果优势。

Objective:To investigate whether postoperative combination with medical therapy after deep brain stimulation(DBS)in Parkinson's disease(PD)has cost-effectiveness advantages compared with preoperative medical treatment alone.Methods:80 patients with PD were enrolled retrospectively.It was conducted a self-controlled design and divided the operation group and the medication group respectively.The relevant expenditure was obtained by questionnaire survey after operation.The efficacy was assessed by the UPDRSⅢand PDQ-39.It was performed the cost-effectiveness analysis of two strategies under mutiple scenarios from the perspective of the Chinese healthcare system,determining whether it had an economic advantage.Results:Motor function and quality of life improved significantly after DBS(P<0.05).The average annual cost of operation group in the first year was 226371.41 yuan,which was 28.5 times that of medication group.The incremental costs for each 1%gain in motor function and quality of life were far exceeded the threshold of willingness-to-pay.Without considering the costs of surgery and consumables or only considering the drug costs,the incremental cost per motor function gain was 487.5 yuan/%and-5959.17 yuan/%respectively,while that of per quality of life improvement was separately 1483.1 yuan/%and-18129.3 yuan/%.The resules were far below the threshold,showing economic attraction.Conclusion:In a short-term,DBS beared a heavier economic burden than medication,absenting cost-effective advantage.However,from a long-term perspective,DBS was likely to reduce follow-up treatment costs and enhance survival benefits,which defined as a cost-effective strategy.