国产比伐卢定在经皮冠状动脉介入术中的有效性及安全性的观察

目的评价比伐卢定用于经皮冠状动脉介入术（PCI）中抗凝治疗的有效性及安全性。方法选择64例择期行PCI的患者,术中分别采用肝素（n=32）或国产注射用比伐卢定（n=32）抗凝。分别在用药前、用药后5min、用药结束、用药结束1、3、24、48h检测各项临床指标。结果国产注射用比伐卢定组用药后活化凝血时间（ACT）值迅速升高,用药过程中保持稳定,用药结束后1h与用药前相比较,差异无统计学意义（P〈0．05）;肝素组用药后ACT值升高,然后逐渐下降,用药结束后3hACT值均高于用药前,差异有统计学意义（P〈0．05）。PCI术后6、24、48、72h比伐卢定组与肝素组心电图、心肌酶谱,凝血功能、血常规与术前相比较,差异无统计学意义（P〉0．05）。结论与常规肝素抗凝相比,国产注射用比伐卢定在PCI术中可以获得更稳定的抗凝效果及更好的安全性,其作为抗凝剂用于PCI术中具有良好的安全性和有效性。     

阿托伐他汀在经皮冠状动脉介入术中的应用及研究进展

经皮冠状动脉介入治疗(percutaneous coronary interven-tions,PCI)已成为冠状动脉疾病血运重建的重要手段,但是PCI本身可能会导致血管壁的损伤和炎症反应,进而引起心肌损伤,甚至心肌梗死(MI)。近年来阿托伐他汀在PCI手术期的应用越来越多,有许多循证医学证据表明,阿托伐他汀可以有效减少冠脉介入治疗中的心血管终点事件,改善预后。就阿托伐他汀在此方面的治疗的效果、机制及应用进展作一综述。     

经皮冠状动脉介入术后常见并发症的护理

目的 经皮冠状动脉介入术后常见并发症的护理措施.方法通过对临床113例经皮冠状动脉介入术后患者常见并发症的护理论证工作中积累的经皮冠状动脉介入术后并发症的护理经验.结果 采取积极有效地护理措施,并发症得到一定的控制.结论针对经皮冠状动脉介入术后常见并发症采取科学的护理,对于提高手术成功率和促进患者早日康复具有重要的临床意义.     

经皮冠状动脉介入术治疗老年急性心肌梗死效果

目的比较分析经皮冠状动脉介入术与溶栓治疗老年急性心肌梗死的临床效果。方法将寿光市人民医院2017年6月-2018年3月收治的186例老年急性心肌梗死患者随机分为观察组和对照组各93例。对照组采用溶栓治疗,即口服氯吡格雷以及静脉滴注尿激酶,观察组使用经皮冠状动脉介入术治疗。比较两组前后的心功能以及血清TnI、CK-MB、SOD和ET-1水平。结果观察组患者的有效率明显高于对照组;治疗后,观察组患者左心室射血分数、左心室舒张末期内径、左心室后壁厚度、TnI、CK-MB、ET-1、SOD水平优于对照组,差异均有统计学意义(P0.05)。结论经皮冠状动脉介入术对老年急性心肌梗死的治疗效果明显优于溶栓治疗,值得临床推广。     

经皮冠状动脉介入术前阿托伐他汀强化治疗的心肌保护作用研究

目的 观察阿托伐他汀强化治疗对经皮冠状动脉介入术(PCI)后可溶性P-选择素(sP-selectin)和高敏C反应蛋白(hs-CRP)水平的影响,探讨阿托伐他汀强化治疗在PCI术后心肌保护方面的作用.方法 选取PCI治疗的冠心病患者100例,按随机数字表法分为三组:标准治疗组(A组,阿托伐他汀20 mg) 30例、低剂量阿托伐他汀强化治疗组(B组,术前12、2h阿托伐他汀分别追加40、20 mg) 35例、高剂量阿托伐他汀强化治疗组(C组,术前12、2h阿托伐他汀分别追加80、40mg) 35例;采用酶联免疫吸附试验法检测血浆sP-selectin水平,乳胶增强免疫比浊法检测血清hs-CRP水平.结果 血浆sP-selectin水平A、B、C组术前分别为(2.32±0.40)、(2.51±0.33)、(2.47±0.28) μg/L,术后6h分别为(4.12±0.75)、(3.34±0.42)、(3.31±0.46) μg/L,术后12h分别为(5.64±1.07)、(4.08±0.74)、(3.84±0.48) μg/L,血浆sP-selectin水平在PCI术后各时间点均较术前显著升高,差异有统计学意义(P＜0.05);术后相同时间点B、C组血浆sP-selectin水平均显著低于A组,差异有统计学意义(P＜0.05).血清hs-CRP水平A、B、C组术前分别为(4.32±0.51)、(4.46±0.57)、(4.29±0.43) mg/L,术后6h分别为(8.91±1.34)、(7.44±1.06)、(7.28±0.95) mg/L,术后12h分别为(13.66±1.49)、(8.08±1.14)、(7.92±1.04) mg/L,血清hs-CRP水平在PCI术后各时间点均较术前显著升高,差异有统计学意义(P＜0.05);相同时间点B、C组血清hs-CRP水平均显著低于A组,差异有统计学意义(P＜0.05).Pearson相关性分析结果显示,sP-selectin与hs-CRP的表达水平呈正相关(r=0.753,P＜0.01).PCI术后围手术期A、B、C组心肌梗死再发生率分别为23.3％(7/30)、5.7％(2/35)、2.9％(1/35),B组与C组比较差异无统计学意义(P＞0.05),A组与B、C组比较差异有统计学意义(P＜0.05).结论 阿托伐他汀强化治疗可以抑制PCI术后炎性因子sP-selectin和hs-CRP的表达水平,阿托伐他汀强化治疗可以显著降低PCI术后心血管不良事件的发生率,对心肌具有一定的保护作用.     

经皮冠状动脉介入术后假性动脉瘤内科治疗

PCI(经皮冠状动脉介入治疗术)后假性动脉瘤是较常见并发症.德阳人民医院院于2001-2004年对5例患者进行局部加压包扎固定,结合多次局部抽血内科治疗.收到良好效果,5例患者均全部治愈.     

经皮冠状动脉介入术后心脏运动康复治疗的研究进展

冠心病(CHD)在美国和许多发达国家是排在首位的死亡原因,经皮冠状动脉介入治疗术(PCI)是目前治疗冠心病的重要手段,但PCI术并不能消除冠心病危险因素,心脏运动康复作为PCI术后治疗的重要辅助手段,可显著减缓动脉粥样硬化进展,减少心血管事件发生,提高患者运动耐量,改善患者生活质量,现已在发达国家蓬勃发展,并取得显著成...     

经皮冠状动脉介入诊疗术并发造影剂肾病的临床观察

目的：探讨经皮冠状动脉介入诊疗术对造影剂肾病（contrast-induced nephropathy,CIN）的影响。方法：回顾性分析2011年4月-2012年3月68例行冠状动脉造影术（CAG组）和63例行冠状动脉内支架植入术（PCI组）患者的临床资料,术前均接受水化治疗。分别检测术前1天和术后第3天的血清肌酐（Scr）、尿素氮（BUN）,分析经皮冠状动脉介入诊疗术对患者肾功能的影响。结果：有1例行CAG患者发生CIN（发病率为1.47%）,有2例行PCI者发生CIN（发病率为3.17%）。结论：经皮冠状动脉介入诊疗术可导致造影剂肾病,PCI危害大于CAG,其原因可能与造影剂用量有关。     

普通肝素或比伐芦定对经皮冠状动脉介入治疗不稳定性心绞痛患者的疗效研究

目的研究普通肝素或比伐芦定对经皮冠状动脉介入(PCI)治疗不稳定性心绞痛患者的疗效。方法分析2016年09月-2018年9月于北京阜外医院因不稳定性心绞痛行经皮冠状动脉介入治疗的96例患者,根据随机数表法将患者分为观察组和对照组,各48例,对照组术前予普通肝素100 IU/kg抗凝治疗,观察组术前予比伐芦定0.75 mg/kg静脉输注,然后以1.75 mg/(kg·h)持续静脉点滴至手术结束2 h。通过激活凝固时间(ACT)来评估两组药物的抗凝效果,并比较两组患者术后30 d主要不良心血管事件(MACE)和出血事件的发生率。结果术前、给药后5 min、给药后1 h及术后0 min,两组患者的ACT结果相比均无显著统计学差异(P0.05),而术后1h及术后2h观察组的ACT结果低于对照组,且两组间比较均具有显著统计学差异(P0.05)。从给药到手术结束,观察组的ACT达标率为58.3%。而对照为31.3%,两组间比较具有显著统计学差异(χ~2=5.693,P0.001)。术后30 d,观察组的出血时间发生率为12.5%,对照组为22.9%,两组间比较无统计学差异(χ~2=1.787,P=0.181);观察组的MACE发生率为18.8%,对照组为22.9%,两组间比较无统计学差异(χ~2=0.253,P=0.615)。结论对于因不稳定性心绞痛行经皮冠状动脉介入治疗的患者而言,比伐芦定相对普通肝素的抗凝效果更好,且并未增加出血事件及MACE发生率,值得临床进一步应用。     

Costs and Cost-Effectiveness of Malaria Control Interventions: A Systematic Literature Review

ObjectivesTo systematically review the literature on the unit cost and cost-effectiveness of malaria control.MethodsTen databases and gray literature sources were searched to identify evidence relevant to the period 2005 to 2018. Studies with primary financial or economic cost data from malaria endemic countries that took a provider, provider and household, or societal perspective were included.ResultsWe identified 103 costing studies. The majority of studies focused on individual rather than combined interventions, notably insecticide-treated bed nets and treatment, and commonly took a provider perspective. A third of all studies took place in 3 countries. The median provider economic cost of protecting 1 person per year ranged from $1.18 to $5.70 with vector control and from $0.53 to $5.97 with chemoprevention. The median provider economic cost per case diagnosed with rapid diagnostic tests was $6.06 and per case treated $9.31 or $89.93 depending on clinical severity. Other interventions did not share enough similarities to be summarized. Cost drivers were rarely reported. Cost-effectiveness of malaria control was reiterated, but care in methodological and reporting standards is required to enhance data transferability.ConclusionsImportant information that can support resource allocation was reviewed. Given the variability in methods and reporting, global efforts to follow existing standards are required for the evidence to be most useful outside their study context, supplemented by guidance on options for transferring existing data across settings.     

A Scoping Review of Item-Level Missing Data in Within-Trial Cost-Effectiveness Analysis

ObjectivesCost-effectiveness analysis (CEA) alongside randomized controlled trials often relies on self-reported multi-item questionnaires that are invariably prone to missing item-level data. The purpose of this study is to review how missing multi-item questionnaire data are handled in trial-based CEAs.MethodsWe searched the National Institute for Health Research journals to identify within-trial CEAs published between January 2016 and April 2021 using multi-item instruments to collect costs and quality of life (QOL) data. Information on missing data handling and methods, with a focus on the level and type of imputation, was extracted.ResultsA total of 87 trial-based CEAs were included in the review. Complete case analysis or available case analysis and multiple imputation (MI) were the most popular methods, selected by similar numbers of studies, to handle missing costs and QOL in base-case analysis. Nevertheless, complete case analysis or available case analysis dominated sensitivity analysis. Once imputation was chosen, missing costs were widely imputed at item-level via MI, whereas missing QOL was usually imputed at the more aggregated time point level during the follow-up via MI.ConclusionsMissing costs and QOL tend to be imputed at different levels of missingness in current CEAs alongside randomized controlled trials. Given the limited information provided by included studies, the impact of applying different imputation methods at different levels of aggregation on CEA decision making remains unclear.     

Accounting for Cured Patients in Cost-Effectiveness Analysis

Background

Economic evaluations often measure an intervention effect with mean overall survival (OS). Emerging types of cancer treatments offer the possibility of being “cured” in that patients can become long-term survivors whose risk of death is the same as that of a disease-free person. Describing cured and noncured patients with one shared mean value may provide a biased assessment of a therapy with a cured proportion.

Model Comparisons of the Effectiveness and Cost-Effectiveness of Vaccination: A Systematic Review of the Literature

Objectives

To describe all published articles that have conducted comparisons of model-based effectiveness and cost-effectiveness results in the field of vaccination. Specific objectives were to 1) describe the methodologies used and 2) identify the strengths and limitations of the studies.

Examining Equity Effects of Health Interventions in Cost-Effectiveness Analysis: A Systematic Review

ObjectiveThis systematic review aims to catalogue and describe published applications of equity-informative cost-effectiveness analysis (CEAs).MethodsFollowing PRISMA guidelines, we searched Medline for English-language, peer-reviewed CEAs published on or before August 2019. We included CEAs that evaluated 2 or more alternatives; explicitly mentioned equity as a consideration or decision-making principle; and applied an equity-informative CEA method to analyze or examine at least 1 equity criterion in an applied CEA. We extracted data on selected characteristics and analyzed reporting quality using the CHEERS checklist.ResultsFifty-four articles identified through a search and bibliography reviews met the inclusion criteria. All articles were published on or after 2010, with 80% published after 2015. Most studies evaluated primary prevention interventions in disease areas such as cancer, infectious diseases, and cardiovascular disease. Equity impact analysis alone was the most common equity-informative CEA (56%), followed by equity impact analysis with financial protection effects (30%). At least 11 different equity criteria have been used in equity-informative CEAs; socioeconomic status and race/ethnicity were used most frequently. Seventy-eight percent of studies reported finding “greater value” in an intervention after examining its distributional effects.ConclusionThe number of equity-informative CEAs is increasing, and the wide range of equity criteria, diseases, interventions, settings, and populations represented suggests that broad application of these methods is feasible but will require further refinement. Inclusion of equity into CEAs may shift the value of evaluated interventions and can provide crucial additional information for decision makers.     

A Cost-Effectiveness Analysis of Continuous Subcutaneous Insulin Injection versus Multiple Daily Injections in Type 1 Diabetes Patients: A Third-Party US Payer Perspective

Objective:  To estimate the long-term cost-effectiveness of using continuous subcutaneous insulin infusion (CSII) compared with multiple daily injections (MDI) of insulin in adult and child/young adult type 1 diabetes mellitus (T1DM) patients from a third-party payer perspective in the United States.
Method:  A previously validated health economic model was used to determine the incremental cost-effectiveness ratio (ICER) of CSII compared with MDI using published clinical and cost data. The primary input variable was change in HbA_1c, and was assumed to be an improvement of −0.9% to −1.2% for CSII compared with MDI for child/young adult and adults, respectively. A series of Markov constructs simulated the progression of diabetes-related complications.
Results:  CSII was associated with an improvement in quality-adjusted life-years (QALYs) gained of 1.061 versus MDI for adults and 0.799 versus MDI for children/young adults. ICERs were $16,992 and $27,195 per QALY gained for CSII versus MDI in adults and children/young adults, respectively. Improved glycemic control from CSII led to a lower incidence of diabetes complications, with the most significant reduction in proliferative diabetic retinopathy (PDR), end stage renal disease (ESRD), and peripheral vascular disease (PVD). The number needed to treat (NNT) for PDR was nine patients, suggesting that only nine patients need to be treated with CSII to avoid one case of PDR. The NNT for ESRD and PVD was 19 and 41, respectively.
Conclusions:  Setting the willingness to pay at $50,000/QALY, the analysis demonstrated that CSII is a cost-effective option for patients with T1DM in the United States.     

Cost-Effectiveness of RAS Genetic Testing Strategies in Patients With Metastatic Colorectal Cancer: A Systematic Review

BackgroundMonoclonal antibodies against epidermal growth factor receptor (EGFR) have proved beneficial for the treatment of metastatic colorectal cancer (mCRC), particularly when combined with predictive biomarkers of response. International guidelines recommend anti-EGFR therapy only for RAS (NRAS, KRAS) wild-type tumors because tumors with RAS mutations are unlikely to benefit.ObjectivesWe aimed to review the cost-effectiveness of RAS testing in mCRC patients before anti-EGFR therapy and to assess how well economic evaluations adhere to guidelines.MethodsA systematic review of full economic evaluations comparing RAS testing with no testing was performed for articles published in English between 2000 and 2018. Study quality was assessed using the Quality of Health Economic Studies scale, and the British Medical Journal and the Philips checklists.ResultsSix economic evaluations (2 cost-effectiveness analyses, 2 cost-utility analyses, and 2 combined cost-effectiveness and cost-utility analyses) were included. All studies were of good quality and adopted the perspective of the healthcare system/payer; accordingly, only direct medical costs were considered. Four studies presented testing strategies with a favorable incremental cost-effectiveness ratio under the National Institute for Clinical Excellence (£20 000-£30 000/QALY) and the US ($50 000-$100 000/QALY) thresholds.ConclusionsTesting mCRC patients for RAS status and administering EGFR inhibitors only to patients with RAS wild-type tumors is a more cost-effective strategy than treating all patients without testing. The treatment of mCRC is becoming more personalized, which is essential to avoid inappropriate therapy and unnecessarily high healthcare costs. Future economic assessments should take into account other parameters that reflect the real world (eg, NRAS mutation analysis, toxicity of biological agents, genetic test sensitivity and specificity).     

Cost-Effectiveness Analysis of Early versus Late Total Hip Replacement in Italy

ObjectiveTo assess the cost-effectiveness of early primary total hip replacement (THR) for functionally independent older adult patients with osteoarthritis (OA) versus 1) nonsurgical therapy followed by THR once the patient has progressed to a functionally dependent state (“delayed THR”) and 2) nonsurgical therapy alone (‘medical therapy’), from the Italian National Health Service perspective.MethodsIndividual patient data and evidence from published literature on disease progression, economic costs and THR outcomes in OA, including utilities, perioperative mortality rates, prosthesis survival, and costs of prostheses, THR, rehabilitation, follow-up, revision, and nonsurgical management, combined with population life tables, were synthesized in a Markov model of OA. The model represents the lifetime experience of a patient cohort following their treatment choice, discounting costs and benefits (quality-adjusted life-years) at 3% annually.ResultsAt age 65 years, the incremental cost per quality-adjusted life-year of THR over delayed THR was €987 in men and €466 in women; the figures for delayed THR versus medical therapy were €463 and €82, respectively. Among 80-year-olds, early THR is (extended) dominant. With gradual utility loss after primary THR, delaying surgery may be more appealing in women than in men in their 50s, because longer female life expectancy implies longer latter periods of low health-related quality of life (HRQOL) with early THR.ConclusionsTHR is cost-effective. Patients’ HRQOL benefits forgone with delayed THR are worth more than the costs it saves to the Italian National Health Service. This analysis might help to explain women's consistently lower HRQOL by the time of primary operation.     

Cost-Effectiveness of Neoadjuvant Chemotherapy versus Primary Surgery in Elderly Patients with Advanced Ovarian Cancer

BackgroundThe use of neoadjuvant chemotherapy (NAC) in the treatment of advanced ovarian cancer has increased in recent years. There is uncertainty about NAC’s effectiveness and no study of its cost-effectiveness compared with that of standard primary debulking surgery (PDS).ObjectivesTo seek answers to three important questions: 1) What is the lifetime cost of treating elderly patients with advanced ovarian cancer, based on the primary treatment received? 2) Are the extra costs expended by the NAC group worth any extra survival advantage? 3) Would NAC potentially benefit a particular subgroup and serve as a cost-effective first-line treatment approach?MethodsA cohort of elderly women (≥65 years) with stage III/IV ovarian cancer was identified from the Surveillance, Epidemiology and End Results-Medicare linked database from January 1, 2000, to December 31, 2009. Cost analysis was conducted from a payer perspective, and direct medical costs incurred by Medicare were integrated for each patient. Cumulative treatment costs were estimated with a phase-of-care approach, and effectiveness was measured as years of survival. Incremental cost-effectiveness ratio (ICER) and propensity-score–adjusted net monetary benefit regression was used to estimate the cost-effectiveness of NAC per life-year gained. Analyses were further stratified by risk group categorization on the basis of tumor stage, patient age, and comorbidity score.ResultsAverage lifetime cost for treatment with NAC was $17,417 more than with PDS. With only 0.1 incremental life-year gained, the ICER estimate was $174,173. Stratification, however, helped to delineate the treatment effect. Patients in the high-risk subgroup incurred $34,390 and 0.8 life-years more than did patients in the PDS subgroup, with a corresponding ICER of $42,987. In the non–high-risk subgroup, NAC use was dominated by PDS (more costly, less effective).ConclusionsAdministering NAC before surgery to patients in the high-risk subgroup was cost-effective at “normal” levels of willingness to pay, but not for the overall sample or for patients in the non–high-risk subgroup.