作者：申娇洁，王滢鹏，万彬，李歆，占伊扬，丁海霞

单位：

1.211166江苏省南京市，南京医科大学药学院　2.210029江苏省南京市，南京医科大学第一附属医院 江苏省人民医院医疗保险处　3.210029江苏省南京市，南京医科大学第一附属医院 江苏省人民医院院长办公室

Units：

1.School of Pharmacy, Nanjing Medical University, Nanjing 211166, China2.Department of Health Insurance Management, the First Affiliated Hospital of Nanjing Medical University/Jiangsu ProvinceHospital, Nanjing 210029, China3.Hospital President's Office, the First Affiliated Hospital of Nanjing Medical University/Jiangsu Province Hospital, Nanjing210029, China

关键词：

颅内动脉瘤；Tubridge血流导向装置；支架辅助弹簧圈栓塞技术；成本效果分析

Keywords：

Intracranial aneurysm; Tubridge flow diverter; Stent-assisted coiling; Cost-effectiveness analysis

CLC：

R 743.9

DOI：

10.12114/j.issn.1008-5971.2023.00.247

Funds：

摘要：

目的　评估Tubridge血流导向装置（FD）对比支架辅助弹簧圈栓塞技术（SAC）治疗大型或巨大型颅内动脉瘤（LGIA）的成本效果。方法　本研究目标人群为拟行血管内介入治疗的LGIA患者，其中Tubridge FD组接受Tubridge FD治疗，SAC组接受SAC治疗。咨询临床医生，结合LGIA患者临床治疗情况和疾病转归，构建LGIA患者马尔可夫模型；并基于医保支付方视角，分析Tubridge FD和SAC治疗LGIA的成本效果。结果　将Tubridge FD组与SAC组的转移概率、成本、健康效用值及贴现率（取5%年贴现率）输入LGIA患者的马尔可夫模型，模拟24个周期，结果显示，与SAC组患者相比，Tubridge FD组患者多出0.359个质量调整生命年（QALY），成本降低了207 183.84元，增量成本效果比（ICER）为-577 113.76元/QALY，低于我国2022年1倍人均GDP（85 700元）。根据2022年7月江苏省开展的第七轮医用耗材集采数据，神经专用弹簧圈价格平均降幅54%，对SAC组的相关费用进行调整，结果显示，与SAC组患者相比，Tubridge FD组患者多出0.359个QALY，成本增加了9 782.51元，ICER为27 249.33元/QALY，低于我国2022年1倍人均GDP。单因素敏感性分析结果显示，对马尔可夫模型结果影响较大的参数为术后稳定（SP）状态时的健康效用值、SAC组首次治疗成本、SAC组复发再治疗成本及Tubridge FD组首次治疗成本。散点图分析结果显示，当使用2022年我国1倍人均GDP为支付意愿阈值时，大多数散点分布于支付意愿阈值线以下，提示多数情况下Tubridge FD具有经济性；成本-效果可接受曲线分析结果显示，在整个区间内，Tubridge FD组具有经济性的概率＞90%。结论　在当前价格水平下，与SAC相比，Tubridge FD治疗LGIA方面更具有成本效果优势。

Abstract：

Objective To evaluate the cost-effectiveness of Tubridge flow diverter (FD) versus stent-assisted coiling(SAC) in the treatment of large or giant intracranial aneurysms (LGIA) . Methods The target population of this study was LGIApatients undergoing endovascular intervention, in which Tubridge FD group received Tubridge FD treatment and SAC groupreceived SAC treatment. The Markov model of LGIA patients was constructed thorough clinician consultation, clinical treatmentand disease outcome of LGIA patients. Based on the perspective of medical insurance payers, the cost-effectiveness of TubridgeFD and SAC in the treatment of LGIA was analyzed. Results The transitional probability, cost, health utility value and discountrate (annual discount rate was 5%) of Tubridge FD group and SAC group were input into the Markov model of LGIA patients for24 cycles of simulation, and the results showed that compared with SAC group, patients in Tubridge FD group had 0.359 morequality-adjusted life years (QALY) , the cost was reduced by 207 183.84 yuan, and the incremental cost-effectiveness ratio (ICER)was -577 113.76 yuan/QALY, which was lower than China's per capita GDP in 2022 (85 700 yuan) . According to the data fromJiangsu Province's seventh round bulk-buying of medical consumables in July 2022, the average reduction of nerve-specificcoils was 54%, and the relevant costs of the SAC group were adjusted accordingly, the results showed that compared with the SAC group, the Tubridge FD group gained 0.359 more QALY, the cost increased by 9 782.51 yuan, and the ICER was 27 249.33yuan/QALY, which was also lower than China's per capita GDP in 2022. The results of one-way sensitivity analysis showed thatthe parameters that had a greater impact on Markov model result were the health utility value in the postoperative stable phase (SP)state, the cost of initial treatment in the SAC group, the cost of retreatment of recurrence in the SAC group, and the cost of initialtreatment in the Tubridge FD group. The scatter plot analysis results showed that when taking China's per capita GDP in 2022as the willingness-to-pay threshold, most scatter points were distributed below the willingness-to-pay threshold line, suggestingthat Tubridge FD had economic benefits in most cases; the results of cost-effectiveness acceptable curve analysis showed thatthe probability of Tubridge FD group having economic benefits was greater than 90% in the whole interval. Conclusion At thecurrent price level, compare to SAC, Tubridge FD has more cost-effective advantage in the treatment of LGIA.

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