高血压脑出血外科治疗的成本-效果比较研究

目的:对出血性脑卒中的传统骨瓣开颅、颅骨钻孔碎吸和微创手术进行成本／效果比较研究。方法:在国内92家医疗单位多中心单盲研究基础上,根据汇总的2 464例出血性脑卒中病历和经济学调查资料,采用同等效果的最小平均成本比较法,以及临床流行病指标NNT进行临床卫生经济学的综合评价。结果:每救活1例脑出血患者和每获得1例能自理生存患者的平均费用比较,钻孔碎吸组最低,微创手术组次之,传统手术组最高。临床综合效果的总成本(NMTcost)比较提示:每避免1例不能自理生存的总治疗成本碎吸组为152 838．00元,微创组为120 208．41元。结论:应用NNT进行卫生经济的综合评价比较,微创手术最具有经济性,其次是钻孔碎吸术,而传统手术最差。但从可及性和公平性来看,钻孔碎吸术更适宜国情。

Cost-effectiveness Analysis on Surgical Treatment for Intracerebral Hemorrhage

Objective:To conduct cost-effectiveness analysis on three surgical procedures.Methods:Based on the information collected from 2 464 cases of Intracerebral Hemorrhage in 92 hospitals,we have conducted a multi - center clinical trial. By applying cost-effectiveness analysis,the per capita inpatient cost of each surgical procedure was compared.In order to carry out a comprehensive health economic evaluation,NNT was also introduced as a clinical epidemiological indicator to calculate the total cost involved in avoiding one non - self care patient. Results: The average cost for saving one patient with Intracerebral Hemorrhage and the average cost for one self-care patient were as follows:the cost of traditional craniotomy was the highest, the cost of minimally invasive surgery was in the middle and the cost of simple sphenotresia was the lowest.The total cost of avoiding one non - self care was 152 838.00 Yuan in simple sphenotresia group and 120 208.41 Yuan in minimally invasive surgery group.Conclusion:The results of the comprehensive health economic evaluation show that minimally invasive surgery was the most cost-effective,simple sphenotresia was less cost-effective and traditional craniotomy was the least cost-effective.However,from the perspectives of accessibility and equity,simple sphenotresia was more suitable to the national conditions of China.