植入型心律转复除颤器对比药物管理一级预防心脏性猝死的成本效果分析

Cost-effectiveness of implantable cardioverter defibrillator therapy versus drug therapy in patients for primary prevention of sudden cardiac death in China

目的从卫生系统角度出发,评价植入型心律转复除颤器(ICD)与药物管理一级预防心脏性猝死的成本效果,为临床决策和政策决策提供参考。方法本研究为横断面研究,基于实际临床状态的转归构建马尔科夫模型,模拟疾病进展,并预测患者通过植入ICD和药物管理治疗后成本效果。患者特征、疗效、并发症和效用参数来源于已发表的文献。成本数据来源国内不同地区的15位临床医生的调查结果。对于每一种治疗,对总生命周期成本和质量调整生命年(QALY)进行建模,并计算增量成本效果比(ICER)。采用单因素敏感性和概率敏感性分析模型的不确定性。结果经过终生模型模拟,ICD相比于药物管理其增量成本效果比为182618元/QALY,约为我国人均国内生产总值(GDP)的2.1倍。因此,相比于较传统的药物管理,ICD预防心脏性猝死更具有成本效果优势。概率敏感性分析显示,ICD相比药物管理一级预防心脏性猝死更具有成本效果的概率为86.3%。结论中国预防心脏性猝死中,ICD的经济性价值优于药物管理,可以作为心脏性猝死一级预防的优选方案。

Objective To evaluate the cost-effectiveness of implantable cardioverter defibrillator(ICD)and drug administration in primary prevention of sudden cardiac death(SCD)from the perspective of Chinese health system,and to provide reference for clinical and policy decision making.Methods This was a cross-sectional study.A Markov model was developed to describe different health states of patients after treatment with ICD and drug therapy,and predict the cost of ICD and drug administration.The patient characteristics,efficacy,treatment complications and utilities were obtained from the literature.The costs were based on the tender price listed by government and the results of cost surveys of fifteen local clinicians from different demographic parts of China.For each therapy,the total lifetime costs and quality-adjusted life-years(QALY)were modelled,and the incremental cost-effectiveness ratio(ICER)was calculated.Deterministic and probabilistic sensitivity analyses were performed to assess the uncertainty of the model parameters.Results The incremental cost-effectiveness ratio of ICD compared to drug administration was 182618 yuan/QALY,about 2.1 times of Chinese gross domestic product(GDP)per capita.Referring to three times of Chinese GDP per capita(257100 yuan)in 2022,ICD therapy was more cost-effective in preventing SCD among primary prevention patients than traditional drug administration.Probability sensitivity analysis showed that ICD was 86.3%,more cost effective than drug administration in preventing SCD.Conclusion In the prevention of SCD in China,the economic value of ICD therapy is superior to drug administration,and it can be used as the preferred plan for the primary prevention of SCD.