不同时期中医药干预治疗冠心病心绞痛的成本-效果分析比较

Cost-effectiveness analysis of treatment of coronary heart disease angina pectoris with Chinese medicine in different periods

目的评价中医药不同时期干预治疗冠心病慢性稳定性心绞痛的成本-效果。方法采集于2019年1月1日—12月31日北京市26家公立医院HIS中的冠心病慢性稳定性心绞痛患者数据,根据不同的治疗方案,设对照组和试验组。对照组为西医基础治疗,试验组在西医治疗基础上加任一种中医治疗方式(中药治疗或中医外治法)。试验组再按照中医药干预的时间节点分为中医药前期、中期、后期干预各组,对照组纳入患者32例,试验组共纳入患者177例,其中前期干预96例,中期干预44例,后期干预37例。采用倾向性得分匹配(PSM)平衡各组例数,并比较对照组与其他3组的临床疗效和成本,在此基础上进行成本-效果分析。结果PSM匹配后前期、中期、后期干预组的临床总有效率均为100%,匹配的对照组的总有效率分别为93.75%、90.91%、93.75%。PSM后,中医药前期、中期、后期干预组的平均治疗费用分别为14752.51、12684.28、16226.96元,平均住院时间分别为9.81、11.56、8.91 d;匹配后对照组平均治疗费用分别为8907.98、7420.56、8740.09元,平均住院时间分别为5.88、6.27、5.69 d。各组治疗费用中以中医药后期干预组成本最高,以对照组成本最低。中医药前期、中期、后期干预的平均成本-效果比(C/E)分别为147.53、126.84、162.27。相较各自匹配的对照组,中医药前期、中期、后期干预组的增量成本-效果比(ICER)分别为935.12、579.07、1197.90。结论相较前期与后期干预,中医药中期干预ICER最低,其成本-效果在中医药各干预阶段中最具优势。

Objective To evaluate the cost-effectiveness of traditional Chinese medicine intervention in treatment of chronic stable angina pectoris in coronary heart disease at different stages.Method Data of patients with chronic stable angina pectoris caused by coronary heart disease were collected from 26 public hospitals in Beijing from January 1 to December 31,2019.According to different treatment plans,a control group and an experimental group were set up.The control group received basic Western medicine treatment,while the experimental group received either traditional Chinese medicine treatment or external treatment based on Western medicine treatment.The experimental group was further divided into pre-intervention,mid-intervention,and postintervention groups based on the time nodes of traditional Chinese medicine intervention.The control group included 32 patients,and the experimental group included a total of 177 patients,including 96 pre-intervention cases,44 mid-intervention cases,and 37 post-intervention cases.Using propensity score matching(PSM)to balance the number of cases in each group,and comparing the clinical efficacy and cost between the control group and the other three groups,a cost-effectiveness analysis was conducted on this basis.Results The total clinical effective rates of pre-intervention,mid-intervention,and post-intervention group after PSM matching were all 100%,while the total effective rates of the matched control group were 93.75%,90.91%,and 93.75%,respectively.After PSM,the average treatment costs for pre-intervention,mid-intervention,and post-intervention group were 14752.51 yuan,12684.28 yuan,and 16226.96 yuan,respectively,with an average hospital stay of 9.81 days,11.56 days,and 8.91 days.After matching,the average treatment costs of the control group were 8907.98 yuan,7420.56 yuan,and 8740.09 yuan,respectively,and the average hospitalization time was 5.88 days,6.27 days,and 5.69 days,respectively.Among the treatment costs of each group,the post-intervention group with traditional Chinese medicine had the highest cost,while the control group had the lowest cost.The average cost-effectiveness ratio(C/E)of pre-intervention,mid-intervention,and post-intervention group were 147.53,126.84,and 162.27,respectively.Compared to the matched control groups,the incremental cost-effectiveness ratios(ICER)of pre-intervention,mid-intervention,and post-intervention group were 935.12,579.07,and 1197.90,respectively.Conclusion Compared with pre-intervention,the mid-term intervention of traditional Chinese medicine(TCM)has the lowest ICER,and its costeffectiveness is the most advantageous among all intervention stages of TCM.