中国卒中杂志 ›› 2016, Vol. 11 ›› Issue (06): 462-467.

• 论著 • 上一篇    下一篇

急性缺血性卒中3 h内rt-PA溶栓的成本效用分析

潘岳松,王伊龙,廖晓凌,刘改芬,姜勇,王春娟,张润华,王拥军   

  • 收稿日期:2015-12-17 出版日期:2016-06-20 发布日期:2016-06-20
  • 通讯作者: 王拥军yongjunwang1962@gmail.com
  • 基金资助:

    国家科技支撑计划项目(2013BAI09B03;2006BAI01A11;2011BAI08B01;2011BAI08B02)
    脑血管病创新药物临床评价技术平台建立(2012ZX09303-005-001)
    北京脑重大疾病研究院项目(BIBD-PXM2013_014226_07_000084)
    首都卫生发展科研专项项目(首发2011-2004-05)
    北京市科技计划重大项目(D131100002313003)

Cost-Utility Analysis of rt-PA Thrombolysis within 3 Hours of Acute Ischemic Stroke

1 100050 北京首都医科大学附属北京天坛医院神经内科
2 国家神经系统疾病临床医学研究中心
3 北京脑重大疾病研究院脑卒中研究所
4 脑血管病转化医学北京市重点实验室
5 首都医科大学公卫学院流行病学与卫生统计学系   

  • Received:2015-12-17 Online:2016-06-20 Published:2016-06-20

摘要:

目的 评价在当前中国医疗环境下,急性缺血性卒中3 h内重组人组织型纤溶酶原激活剂 (recombinant tissue-type plasminogen activator,rt-PA)溶栓治疗的成本效用情况。 方法 建立决策树与Markov模型相结合的模型,采用现有数据库分析和文献查阅等方法收集急性 缺血性卒中3 h内rt-PA溶栓治疗的效果、成本、健康效用及转移概率等模型参数。通过模型模拟,计 算溶栓后短期(1年或2年)和长期(30年)增量成本效果比(incremental cost-effectiveness ratio,ICER) 情况。 结果 溶栓治疗后1年ICER值为93 796元/健康调整寿命年(quality-adjusted life-years,QALY), ICER<3个人均国内生产总值(gross domestic product,GDP)(105 000元)/QALY。rt-PA治疗后30年ICER 值为5953元/QALY,ICER<1个人均GDP(35 100元)/QALY,rt-PA治疗增加的成本完全值得。 结论 在我国当前国情背景下,急性缺血性卒中患者3 h内rt-PA溶栓后短期和长期均具有经济性。

文章导读: 在我国当前国情背景下,急性缺血性卒中患者3 h内rt-PA溶栓后短期和长期均具有经济性。

关键词: 成本效用分析; 成本效果; 溶栓; 卒中; 健康调整寿命年

Abstract:

Objective To determine the cost-utility of recombinant tissue-type plasminogen activator (rt-PA) treatment within 3 hours after onset of acute ischemic stroke in China. Methods A combination of decision tree and Markov model was developed to determine the costutility of rt-PA treatment versus non-rt-PA treatment within 3 hours after stroke onset. Outcomes, costs, utility and transfer proportion of the model were derived from the database and the literatures. Incremental cost-effectiveness ratio (ICER) was estimated in both short term (2 years) and long term (30 years). Results Compared to non-rtPA treatment, rt-PA treatment within 3 hours had ICER of CNY 93,796 per quality-adjusted life-year (QALY) gained in 1 year which was lower than a willingness-to-pay threshold of CNY 105,000 (3 GDP of China) per QALY. Thrombolysis also had an ICER of CNY 5,953 per QALY gained in 30 years which was lower than a willingness-to-pay threshold of CNY 35,100 (1 GDP of China) per QALY. Conclusion Intravenous rt-PA treatment within 3 hours is highly cost-effective for acute ischemic strokes in China.

Key words: Cost-utility analysis; Cost-effective; Thrombolysis; Stroke; Quality-adjusted life-year