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目的探讨急性非ST段抬高型心肌梗死(NSTEMI)介入治疗与药物保守治疗的成本-效果。方法选取2013年1月至2014年12月广东省第二人民医院心内科和中山大学孙逸仙纪念心内科确诊的153例NSTEMI患者作为研究对象,其中行介入治疗102例,药物保守治疗51例,运用成本-效果分析法对两种治疗方案的临床效果和医疗成本进行药物经济学评价。结果介入治疗组患者住院期间再发心绞痛、心力衰竭、心律失常、脑卒中发生率均明显低于药物保守治疗组,差异均有统计学意义(均P<0.05);介入治疗组患者住院期间总成本明显高于药物保守治疗组,差异有统计学意义(P<0.05);随访1年,介入治疗组患者心源性病死的发生率明显低于药物保守治疗组,避免联合主要终点事件发生率,总成本均明显高于药物保守治疗组,差异均有统计学意义(均P<0.05);成本-效果分析显示,介入治疗组明显高于药物保守治疗组,差异有统计学意义(P<0.05)。结论介入治疗具有一定优势,能够降低住院期间不良心血管事件和随访1年主要终点事件发生率,但从药物经济学角度考虑,短期内药物保守治疗比介入治疗更具有经济性。
Objective To investigate the cost-effectiveness of interventional therapy and conservative treatment of non-ST-segment elevation myocardial infarction (NSTEMI). Methods From January 2013 to December 2014, 153 patients with NSTEMI diagnosed by Department of Cardiology, Second People’s Hospital of Guangdong Province and Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2013 to December 2014 were enrolled in this study. Among them, 102 cases received interventional therapy and 51 cases received conservative treatment. Cost-effectiveness analysis of the clinical efficacy of the two treatment options and medical costs of drug economics evaluation. Results The incidence of recurrent angina pectoris, heart failure, arrhythmia and stroke in the intervention group was significantly lower than that in the conservative treatment group (all P <0.05). During the hospitalization of the intervention group The cost was significantly higher than the conservative treatment group, the difference was statistically significant (P <0.05); follow-up of 1 year, interventional treatment group was significantly lower incidence of cardiogenic disease than the conservative treatment group, to avoid the incidence of combined primary end point , The total cost was significantly higher than the conservative treatment group, the difference was statistically significant (all P <0.05); cost-effectiveness analysis showed that the intervention group was significantly higher than the conservative treatment group, the difference was statistically significant (P < 0.05). Conclusion Interventional therapy has the advantage of reducing adverse cardiovascular events during hospitalization and the incidence of primary end-point events at 1-year follow-up. However, in terms of pharmacoeconomics, conservative treatment in the short term is more economical than interventional therapy.