下肢动脉定期全程修复防治糖尿病合并下肢动脉硬化闭塞症的成本效用预测分析

辛文琳; 孙晓伟; 虞泽星; 李丽; 范恩芳; 朱晓霞; 刘春峰; 倪春明; 汤敬东

doi:10.16766/j.cnki.issn.1674-4152.002899

下肢动脉定期全程修复防治糖尿病合并下肢动脉硬化闭塞症的成本效用预测分析

doi: 10.16766/j.cnki.issn.1674-4152.002899

1.
上海市浦东医院全科医学科，上海 200120
2.
上海市浦东新区祝桥街道社区卫生服务中心，上海 201323
3.
上海市浦东新区花木街道社区卫生服务中心，上海 201204
4.
上海市浦东新区北蔡街道社区卫生服务中心，上海 201204
5.
上海市浦东新区泥城街道社区卫生服务中心，上海 201306
6.
上海市浦东新区书院街道社区卫生服务中心，上海 201304
7.
上海市浦东新区万祥街道社区卫生服务中心，上海 201313
8.
上海市浦东新区芦潮港街道社区卫生服务中心，上海 201309
9.
上海市浦东医院血管外科

基金项目:

上海市卫生健康委员会科研项目 202150004

详细信息

通讯作者:
汤敬东，E-mail：drtangjingdong@126.com

中图分类号: R587.1R543.6
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- 文章访问数: 285
- HTML全文浏览量: 105
- PDF下载量: 7
- 被引次数: 0
出版历程
- 收稿日期: 2022-03-23
- 网络出版日期: 2023-04-19

Predictive analysis of cost utility of lower extremity artery repair in prevention of diabetes and lower extremity arteriosclerosis obliterans

1.
Department of General Medicine, Shanghai Pudong Hospital, Shanghai 200120, China

摘要

摘要: 目的分析下肢动脉定期全程修复防治糖尿病合并下肢动脉硬化闭塞症(ASO)的成本效用，论证下肢动脉全程修复治疗方案在社区糖尿病患者管理中的应用价值。方法于2020年12月—2021年2月通过文献研究和上海市浦东医院血管外科专家咨询，进行糖尿病合并下肢动脉病变的状态分类、转移概率、成本、质量调整生命年等相关数据采集，建立糖尿病合并ASO马尔科夫模型，生成常规治疗和下肢动脉定期全程修复治疗下的队列数据，并结合治疗成本、质量调整生命年产出进行成本效用比较。结果模拟样本为1 000例，常规治疗下，有18.5%(185例)的患者会在末期发生溃疡，截肢率为50.3%(503例)，死亡率为36.7%(367例)；下肢动脉定期全程修复治疗下，末期溃疡发生率在10%以下，截肢率为1.0%~4.9%，死亡率为0.7%~3.3%。定期进行下肢动脉全程修复治疗时，每位糖尿病患者在20年间的平均治疗成本比常规治疗高出397 476.8~706 237.5元，增量成本效用比为129 087.4~213 034.5元/质量调整生命年。结论下肢动脉定期全程修复的增量成本效用比的最低值低于1倍的上海市2019年人均国内生产总值，最高值低于3倍的上海市2019年人均国内生产总值，值得纳入上海市糖尿病合并下肢动脉硬化闭塞症患者糖尿病足防治先进适宜技术范围。
- 下肢动脉硬化闭塞症 /
- 糖尿病 /
- 全程修复治疗 /
- 马尔科夫模型 /
- 成本 /
- 效用
Abstract: Objective To analyse the cost-effectiveness of regular full-course repair of lower extremity arteries in the prevention and treatment of diabetes complicated with lower extremity arteriosclerosis obliterans (ASO), to demonstrate the application value of the full-course repair of lower extremity arteries in the management of diabetes patients in the community. Methods Literature research and consultation with Shanghai Pudong Hospital ' s vascular surgery experts were conducted from December 2020 to February 2021. Status classification, transition probability, cost, quality-adjusted life year and other related data of diabetes complicated with lower extremity arterial disease were collected to establish diabetes combined with the Markov model of lower extremity ASO, generate cohort data under conventional treatment and regular full-course repair of lower extremity arteries and compare the cost-effectiveness of treatment costs and quality-adjusted life-year output. Results The simulated sample was 1 000 cases under conventional treatment, and 18.5% (185 cases) of patients developed ulcers in the terminal stage, with an amputation rate of 50.3% (503 cases) and a mortality rate of 36.7% (367 cases). Under regular full-course repair of lower limb arteries, the rate of terminal ulcers was less than 10%, the rate of amputation was 1.0%-4.9% and the mortality rate was between 0.7%-3.3%. When the lower extremity arterial repair treatment was performed regularly, the average treatment cost of each diabetic patient in 20 years was 397 476.8-706 237.5 yuan higher than that of conventional treatment, and the incremental cost-utility ratio was 129 087.4-213 034.5 yuan/quality-adjusted life year. Conclusion The lowest value of the incremental cost-utility ratio of regular full-course repair of lower extremity arteries is less than the GDP per capita of Shanghai in 2019, and the highest value is less than three times the GDP per capita of Shanghai in 2019, which is worthy of being included in the advanced and appropriate technology for prevention and treatment of diabetes foot in diabetes patients with lower limb ASO in Shanghai.
- Arteriosclerosis obliterans /
- Diabetes /
- Full repair treatment /
- Markov model /
- Cost /
- Utility

HTML全文

图 1 马尔科夫模型状态转移图

Figure 1. State transition diagram of Markov model

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图 2 下肢动脉定期全程修复治疗与常规治疗下的无溃疡人数变化比较

Figure 2. Changes in the number of ulcer-free patients treated with regular whole-course repair of lower extremity arteries compared with conventional treatment

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图 3 常规治疗方案下糖尿病合并下肢动脉硬化闭塞症20年疾病状态分布预测结果

Figure 3. Predicted results of disease status distribution of diabetes mellitus with lower extremity arteriosclerosis obliterans over 20 years under conventional treatment regimens

下载: 全尺寸图片幻灯片

图 4 定期治疗方法下糖尿病合并下肢动脉硬化闭塞症20年疾病状态分布预测结果

Figure 4. Predicted results of disease status distribution of diabetes mellitus with lower extremity arteriosclerosis obliterans over 20 years under regular treatment methods

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表 1 糖尿病合并下肢动脉硬化闭塞症各状态间转移概率

Table 1. Transition probabilities between states of diabetes mellitus with lower extremity arteriosclerosis obliterans

状态转移	具体内涵	常规治疗	下肢动脉定期全程修复治疗
无溃疡→新溃疡	无溃疡症状的患者出现溃疡的概率	0.081^[17]	-^a
新溃疡→溃疡未愈	已经出现溃疡的患者溃疡依然未愈合的概率	0.25	0.25
新溃疡→溃疡愈合	已经出现溃疡的患者溃疡愈合的概率	0.75^[15]	0.75^[15]
溃疡未愈→截肢	已经出现溃疡的患者恶化到需要截肢的概率	0.38^[15]	0.38^[15]
溃疡愈合→截肢	溃疡已经愈合的患者仍需要接受截肢手术处理的概率	0.035^[15]	0.035^[15]
溃疡愈合→新溃疡	溃疡已经愈合的患者再次出现溃疡的概率	0.316^[17]	0.316^[17]
截肢→再截肢	截肢后再次截肢的概率	0.125^[17]	0.125^[17]
截肢→死亡	截肢后死亡的概率	0.22^[17]	0.22^[17]
再截肢→死亡	再次截肢后死亡的概率	0.22^[17]	0.22^[17]
注：0.001≤a≤0.005。转移周期为1年。

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表 2 糖尿病足治疗成本

Table 2. Treatment costs of diabetic foot

干预方案	直接治疗成本
糖尿病基础治疗	2015年为900元/月×12个月(800~1 000元/月)^[18]；按2019年贴现为1 094元/月×12个月
溃疡治疗(开放手术治疗)	53 272.89元^a
截肢手术及相关治疗	首次，20 000元^b；二次，50 585元^{[17, 19]}
减容治疗(如准分子激光消蚀术)	40 000元^c
注：^a为2019年上海市各医院血管外科下肢动脉硬化闭塞症开放手术治疗平均费用；^b为上海市2019年血管外科下肢动脉硬化闭塞症收治病例截肢费用；^c为上海市浦东医院准分子激光消蚀术定价。

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