摘要
目的基于中国人群的真实临床数据,从中国医疗卫生体系的角度出发,对比WEB装置与支架辅助弹簧圈栓塞术(SAC)治疗颅内未破裂宽颈动脉瘤的长期健康结果与经济产出。方法采用患者层面的模拟研究方法,纳入平均年龄为61岁、直径为4~10 mm颅内未破裂宽颈动脉瘤,模拟评估WEB治疗方案与SAC治疗方案在初始治疗效果、随访结果、再治疗需求及康复相关成本和出血性/缺血性事件处理等方面的表现。通过计算增量成本效果比(ICER),评估每增加1个质量调整生命年(QALY)的成本,并运用确定型与概率型敏感性分析探讨模型参数对结果的影响。结果模型基础分析结果显示,与SAC治疗方案相比,WEB治疗方案在患者整个生命周期的治疗成本上节约了12476.52元,并额外增加了0.97个QALY,表现为主导治疗方案(ICER值为负数)。确定型抽样分析结果显示,材料成本及其使用数量、初始治疗时完全闭塞率是影响ICER的关键因素。结论WEB装置在治疗颅内未破裂宽颈动脉瘤方面,展现出相比SAC治疗的经济学优势,WEB装置是一种经济有效的治疗选择,建议在决策过程中考虑患者偏好、治疗方案、耗材价格变动及技术学习曲线等因素对结果的潜在影响。
Objective Based on real-world clinical data from the Chinese population and from the perspective of the Chinese healthcare system,this study compares the long-term health outcomes and economic outputs of the Woven Endo-Bridge(WEB)device versus stent-assisted coiling(SAC)for the treatment of intracranial unruptured wide-neck aneurysms.Methods A patient-level simulation study was conducted,enrolling patients with intracranial unruptured wide-neck aneurysms(mean age 61 years,diameter 4~10 mm).The simulation assessed the performance of the WEB treatment strategy versus the SAC strategy in terms of initial treatment efficacy,follow-up outcomes,retreatment needs,and associated costs for rehabilitation and management of hemorrhagic/ischemic events.The incremental cost-effectiveness ratio(ICER)was calculated to evaluate the cost per additional quality-adjusted life year(QALY)gained.Deterministic and probabilistic sensitivity analyses were performed to explore the impact of model parameters on the results.Results The base-case analysis showed that,compared with the SAC strategy,the WEB strategy saved CNY 12476.52 in lifetime treatment costs and provided an additional 0.97 QALYs,making it a dominant treatment strategy(negative ICER).Deterministic sensitivity analysis indicated that material costs,their quantities,and the complete occlusion rate at initial treatment were key factors influencing the ICER.Conclusion The WEB device demonstrates economic advantages over SAC in the treatment of intracranial unruptured wide-neck aneurysms.The WEB device is a cost-effective treatment option.It is recommended that decision-making consider potential influences from patient preferences,treatment protocols,changes in material prices,and the technical learning curve.
作者
何川
王春露
于保荣
史怀璋
HE Chuan;WANG Chunlu;YU Baorong;SHI Huaizhang(Department of Neurosurgery,Xuanwu Hospital Capital Medical University,Beijing 100053,China;Center for Health Insurance&Health Services Research,University of International Business and Economics,Beijing 100029;Department of Neurosurgery,The First Affiliated Hospital of Harbin Medical University,Harbin 150001,China)
出处
《中国临床神经外科杂志》
2025年第10期590-595,共6页
Chinese Journal of Clinical Neurosurgery
