首页 期刊 论文 学科刊群 资讯 加盟 关于
EN
image
Article(id=1241522771038106386, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522764012647140, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202308506, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1692979200000, receivedDateStr=2023-08-26, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773931694993, onlineDateStr=2026-03-19, pubDate=1704816000000, pubDateStr=2024-01-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773931694993, onlineIssueDateStr=2026-03-19, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773931694993, creator=13701087609, updateTime=1773931694993, updator=13701087609, issue=Issue{id=1241522764012647140, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='1', pageStart='1', pageEnd='192', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773931693318, creator=13701087609, updateTime=1773931808852, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241523248643494379, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522764012647140, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241523248643494380, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522764012647140, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=180, endPage=185, ext={EN=ArticleExt(id=1241522771814052638, articleId=1241522771038106386, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Cost-effectiveness analysis of carotid endarterectomy versus medical therapy for asymptomatic stenosis, columnId=1228016569138213037, journalTitle=Modern Preventive Medicine, columnName=Clinical Medicine and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the cost-effectiveness of carotid endarterectomy carotid endarterectomy (CEA) and medical therapy for asymptomatic carotid stenosis in Chinese patients over 70 years old.

Methods

Based on the data of different outcomes of asymptomatic carotid stenosis patients who were followed up by CEA and drug therapy for 10 years, a Markov model was established to simulate the cost-effectiveness of the two treatments for 10 years. The outcome index was incremental cost-effectiveness ratio (ICER), which was the ratio of increased cost to increased quality-adjusted life years (QALY), and the thresholds of ICER and willingness to pay (WTP) were compared. In this paper, scenario analysis was carried out, and uncertainty test was carried out by single factor sensitivity analysis and probability sensitivity analysis.

Results

In the basic case analysis, the patients who received CEA could get 7.53 QALYs, the corresponding cost was 67 079.61 yuan and 31 982.38 yuan, and the ICER was 129 435.97 yuan / QALY, which was lower than the threshold of WTP. In scenario analysis, the ICER was 127 946.82 yuan / QALY and 240 283.17 yuan / QALY, respectively. The annual mortality of patients after CEA, the operation cost of CEA, and the perioperative mortality after CEA had great influence on the fluctuation of ICER.

Conclusion

According to the economic evaluation recommendation of WHO, the increased cost of CEA compared with drug therapy is acceptable for Chinese patients with asymptomatic carotid artery stenosis over 70 years old.

, correspAuthors=null, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, authorCompany=null, fund=null, authors=null, authorsList=Yao YAO, Yan-fang YANG), CN=ArticleExt(id=1241522775056249694, articleId=1241522771038106386, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=颈动脉内膜切除与药物治疗无症状颈动脉狭窄的成本-效果分析, columnId=1228016570119680182, journalTitle=现代预防医学, columnName=临床与预防, runingTitle=null, highlight=null, articleAbstract=
目的

分析颈动脉内膜切除术（carotid endarterectomy，CEA）与药物治疗中国70岁以上无症状颈动脉狭窄患者的成本-效果。

方法

本文通过一项无症状颈动脉狭窄人群经CEA与药物治疗随访10年后不同结局的研究数据，建立Markov模型模拟两种治疗方案10年的成本-效果，结局指标为增量成本-效果比（ICER），即增加的成本与增加的质量调整生命年（QALY）的比值，并将获得ICER与支付意愿（willingness-to-pay，WTP）阈值进行比较。本文进行了情景分析，单因素敏感性、概率敏感性分析进行了不确定检验。

结果

在基础病例分析中，接受CEA的患者可获得7.53QALYs，药物治疗为7.26，相应成本为67 079.61和31 982.38元，获得的ICER为129 435.97元/QALY，低于支付意愿阈值。在情景分析中，ICER分别为127 946.82和240 283.17元/QALY。接受CEA后患者的年死亡率，CEA的手术花费和CEA后围手术期的死亡率对ICER波动影响较大。

结论

依据WHO对经济学评价推荐意见，目前中国70岁以上无症状颈动脉狭窄患者，CEA与药物治疗相比增加的成本是可以接受的。

, correspAuthors=null, authorNote=null, correspAuthorsNote=
杨艳芳，E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=wiPb0TcpJuYMXypZxc//Kw==, magXml=8Mb7fPYc/tB48uUyvjotBA==, pdfUrl=null, pdf=HAhh/+QiASP2zGBGJpLd6w==, pdfFileSize=715374, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=aCNbIG4iyxN8+qcytWAdPw==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=f3ERJiK1ujjom5ynUBrhuA==, mapNumber=null, authorCompany=null, fund=null, authors=

姚瑶（1990—），女，硕士在读，研究方向：流行病学与卫生统计学

, authorsList=姚瑶, 杨艳芳)}, authors=[Author(id=1241677617238167879, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, orderNo=0, firstName=null, middleName=null, lastName=null, nameCn=null, orcid=null, stid=null, country=null, authorPic=null, dead=0, email=null, emailSecond=null, emailThird=null, correspondingAuthor=0, authorType=1, ext={EN=AuthorExt(id=1241677617418522966, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, authorId=1241677617238167879, language=EN, stringName=Yao YAO, firstName=Yao, middleName=null, lastName=YAO, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=1, 2, address=West China School of Public Health, Sichuan University/West China Fourth Hospital, Chengdu, Sichuan 610041, China, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null), CN=AuthorExt(id=1241677617527574879, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, authorId=1241677617238167879, language=CN, stringName=姚瑶, firstName=null, middleName=null, lastName=null, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=1, 2, address=1.四川大学华西公共卫生学院/华西第四医院，四川 成都 610041
2.四川省安岳县人民医院，四川 资阳 642350, bio={"content":"

姚瑶（1990—），女，硕士在读，研究方向：流行病学与卫生统计学

"}, bioImg=null, bioContent=

姚瑶（1990—），女，硕士在读，研究方向：流行病学与卫生统计学

, aboutCorrespAuthor=null)}, companyList=[AuthorCompany(id=1241677616927789353, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, xref=1., ext=[AuthorCompanyExt(id=1241677616931983660, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, companyId=1241677616927789353, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=West China School of Public Health, Sichuan University/West China Fourth Hospital, Chengdu, Sichuan 610041, China), AuthorCompanyExt(id=1241677616944566572, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, companyId=1241677616927789353, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.四川大学华西公共卫生学院/华西第四医院，四川 成都 610041)]), AuthorCompany(id=1241677617091367226, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, xref=2., ext=[AuthorCompanyExt(id=1241677617099755836, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, companyId=1241677617091367226, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.四川省安岳县人民医院，四川 资阳 642350)])]), Author(id=1241677617657598320, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, orderNo=1, firstName=null, middleName=null, lastName=null, nameCn=null, orcid=null, stid=null, country=null, authorPic=null, dead=0, email=yang2009@scu.edu.cn, emailSecond=null, emailThird=null, correspondingAuthor=0, authorType=1, ext={EN=AuthorExt(id=1241677617846342015, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, authorId=1241677617657598320, language=EN, stringName=Yan-fang YANG, firstName=Yan-fang, middleName=null, lastName=YANG, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=1, address=West China School of Public Health, Sichuan University/West China Fourth Hospital, Chengdu, Sichuan 610041, China, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null), CN=AuthorExt(id=1241677618039280011, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, authorId=1241677617657598320, language=CN, stringName=杨艳芳, firstName=null, middleName=null, lastName=null, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=1, address=1.四川大学华西公共卫生学院/华西第四医院，四川 成都 610041, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null)}, companyList=[AuthorCompany(id=1241677616927789353, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, xref=1., ext=[AuthorCompanyExt(id=1241677616931983660, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, companyId=1241677616927789353, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=West China School of Public Health, Sichuan University/West China Fourth Hospital, Chengdu, Sichuan 610041, China), AuthorCompanyExt(id=1241677616944566572, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, companyId=1241677616927789353, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.四川大学华西公共卫生学院/华西第四医院，四川 成都 610041)])])], keywords=[Keyword(id=1241677618332881309, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, language=EN, orderNo=1, keyword=Asymptomatic carotid stenosis), Keyword(id=1241677618450321834, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, language=EN, orderNo=2, keyword=Carotid endarterectomy), Keyword(id=1241677618546790834, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, language=EN, orderNo=3, keyword=Drug therapy), Keyword(id=1241677618643259838, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, language=EN, orderNo=4, keyword=Cost-effectiveness), Keyword(id=1241677618731340225, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, language=EN, orderNo=5, keyword=Economic evaluation), Keyword(id=1241677618844586440, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, language=CN, orderNo=1, keyword=无症状颈动脉狭窄), Keyword(id=1241677618995581391, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, language=CN, orderNo=2, keyword=颈动脉内膜切除术), Keyword(id=1241677619096244695, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, language=CN, orderNo=3, keyword=药物治疗), Keyword(id=1241677619192713698, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, language=CN, orderNo=4, keyword=成本-效果), Keyword(id=1241677619305959915, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, language=CN, orderNo=5, keyword=经济学评价)], refs=[Reference(id=1241677623277965954, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, doi=null, pmid=null, pmcid=null, year=2021, volume=20, issue=10, pageStart=795, pageEnd=820, url=null, language=null, rfNumber=[1], rfOrder=0, authorNames=Feigin VL, Stark BA, Johnson CO, journalName=The Lancet Neurology, refType=null, unstructuredReference=Feigin VL, Stark BA, Johnson CO, et al. Global, regional, and National burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019[J]. The Lancet Neurology, 2021, 20(10): 795-820., articleTitle=Global, regional, and National burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019, refAbstract=null), Reference(id=1241677623399600778, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, doi=null, pmid=null, pmcid=null, year=2019, volume=394, issue=10204, pageStart=1145, pageEnd=1158, url=null, language=null, rfNumber=[2], rfOrder=1, authorNames=Zhou MG, Wang HD, Zeng XY, journalName=Lancet, refType=null, unstructuredReference=Zhou MG, Wang HD, Zeng XY, et al. Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017[J]. Lancet,2019, 394(10204): 1145-1158., articleTitle=Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017, refAbstract=null), Reference(id=1241677623554790035, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, doi=null, pmid=null, pmcid=null, year=2021, volume=65, issue=null, pageStart=49, pageEnd=54, url=null, language=null, rfNumber=[3], rfOrder=2, authorNames=Heck D, Stenosis JAC, Stroke, journalName=Progress in Cardiovascular Diseases, refType=null, unstructuredReference=Heck D, Stenosis JAC, Stroke. And carotid artery revascularization[J]. Progress in Cardiovascular Diseases, 2021, 65: 49-54., articleTitle=And carotid artery revascularization, refAbstract=null), Reference(id=1241677623668036248, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, doi=null, pmid=null, pmcid=null, year=2018, volume=55, issue=1, pageStart=3, pageEnd=81, url=null, language=null, rfNumber=[4], rfOrder=3, authorNames=Naylor AR, Ricco JB, De BG, journalName=European Journal of Vascular and Endovascular Surgery:The Official Journal of the European Society for Vascular Surgery, refType=null, unstructuredReference=Naylor AR, Ricco JB, De BG, et al. Editor's Choice-Management of atherosclerotic carotid and vertebral artery disease:2017 clinical practice guidelines of the European society for vascular surgery(ESVS)[J]. European Journal of Vascular and Endovascular Surgery:The Official Journal of the European Society for Vascular Surgery,2018, 55(1): 3-81., articleTitle=Editor's Choice-Management of atherosclerotic carotid and vertebral artery disease:2017 clinical practice guidelines of the European society for vascular surgery(ESVS), refAbstract=null), Reference(id=1241677623873557149, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, doi=null, pmid=null, pmcid=null, year=2017, volume=9, issue=3, pageStart=169, pageEnd=175, url=null, language=null, rfNumber=[5], rfOrder=4, authorNames=陈忠, 杨耀国, journalName=中国血管外科杂志:电子版, refType=null, unstructuredReference=陈忠， 杨耀国.颈动脉狭窄诊治指南[J].中国血管外科杂志:电子版，2017，9（3）：169-175., articleTitle=颈动脉狭窄诊治指南, refAbstract=null), Reference(id=1241677625559667367, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, doi=null, pmid=null, pmcid=null, year=2017, volume=9, issue=3, pageStart=169, pageEnd=175, url=null, language=null, rfNumber=[5], rfOrder=5, authorNames=Chen Z, Yang YG, journalName=Chinese Journal of Vascular Surgery(Electronic Version), refType=null, unstructuredReference=Chen Z, Yang YG. Guidelines for diagnosis and treatment of carotid stenosis[J]. Chinese Journal of Vascular Surgery(Electronic Version), 2017, 9(3):169-175., articleTitle=Guidelines for diagnosis and treatment of carotid stenosis, refAbstract=null), Reference(id=1241677625723245231, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, doi=null, pmid=null, pmcid=null, year=2020, volume=2, issue=2, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[6], rfOrder=6, authorNames=Müller MD, Lyrer P, Brown MM, journalName=Cochrane Database of Systematic Reviews (Online), refType=null, unstructuredReference=Müller MD, Lyrer P, Brown MM, et al. Carotid artery stenting versus endarterectomy for treatment of carotid artery stenosis[J]. Cochrane Database of Systematic Reviews (Online), 2020, 2(2):CD000515., articleTitle=Carotid artery stenting versus endarterectomy for treatment of carotid artery stenosis, refAbstract=null), Reference(id=1241677625882628788, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, doi=null, pmid=null, pmcid=null, year=1991, volume=325, issue=7, pageStart=445, pageEnd=453, url=null, language=null, rfNumber=[7], rfOrder=7, authorNames=Barnett HJM, Taylor DW, Haynes RB, journalName=New England Journal of Medicine, refType=null, unstructuredReference=Barnett HJM, Taylor DW, Haynes RB, et al. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis[J]. New England Journal of Medicine, 1991, 325(7):445-453., articleTitle=Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis, refAbstract=null), Reference(id=1241677626025235130, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, doi=null, pmid=null, pmcid=null, year=1998, volume=339, issue=20, pageStart=1415, pageEnd=1425, url=null, language=null, rfNumber=[8], rfOrder=8, authorNames=Barnett HJ, Taylor DW, Eliasziw M, journalName=New England Journal of Medicine, refType=null, unstructuredReference=Barnett HJ, Taylor DW, Eliasziw M, et al. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators[J]. New England Journal of Medicine, 1998, 339(20):1415-1425., articleTitle=Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators, refAbstract=null), Reference(id=1241677626155258564, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, doi=null, pmid=null, pmcid=null, year=2021, volume=233, issue=5, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[9], rfOrder=9, authorNames=Domenick NS, Chaer RS, Smith K, journalName=Journal of the American College of Surgeons, refType=null, unstructuredReference=Domenick NS, Chaer RS, Smith K, et al. Carotid endarterectomy remains cost-effective for the management of carotid stenosis[J].Journal of the American College of Surgeons, 2021, 233(5): e234., articleTitle=Carotid endarterectomy remains cost-effective for the management of carotid stenosis, refAbstract=null), Reference(id=1241677626289476301, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, doi=null, pmid=null, pmcid=null, year=2014, volume=21, issue=2, pageStart=303, pageEnd=305, url=null, language=null, rfNumber=[10], rfOrder=10, authorNames=Paraskevas KI, Moore WS, Veith FJ, journalName=Journal of Endovascular Therapy, refType=null, unstructuredReference=Paraskevas KI, Moore WS, Veith FJ. Commentary: carotid artery stenting: still not as cost-effective as carotid endarterectomy, but the contest continues[J]. Journal of Endovascular Therapy, 2014, 21(2): 303-305., articleTitle=Commentary: carotid artery stenting: still not as cost-effective as carotid endarterectomy, but the contest continues, refAbstract=null), Reference(id=1241677626415305426, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, doi=null, pmid=null, pmcid=null, year=2010, volume=376, issue=9746, pageStart=1074, pageEnd=1084, url=null, language=null, rfNumber=[11], rfOrder=11, authorNames=Halliday A, Harrison M, Hayter E, journalName=The Lancet, refType=null, unstructuredReference=Halliday A, Harrison M, Hayter E, et al. 10-year stroke prevention after successful carotid endarterectomy for asymptomatic stenosis(ACST-1): a multicentre randomised trial[J]. The Lancet, 2010, 376(9746): 1074-1084., articleTitle=10-year stroke prevention after successful carotid endarterectomy for asymptomatic stenosis(ACST-1): a multicentre randomised trial, refAbstract=null), Reference(id=1241677626553717465, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, doi=null, pmid=null, pmcid=null, year=2020, volume=77, issue=9, pageStart=1110, pageEnd=1121, url=null, language=null, rfNumber=[12], rfOrder=12, authorNames=Keyhani S, Cheng EM, Hoggatt KJ, journalName=JAMA Neurology, refType=null, unstructuredReference=Keyhani S, Cheng EM, Hoggatt KJ, et al. Comparative effectiveness of carotid endarterectomy vs initial medical therapy in patients with asymptomatic carotid stenosis[J]. JAMA Neurology, 2020, 77(9):1110-1121., articleTitle=Comparative effectiveness of carotid endarterectomy vs initial medical therapy in patients with asymptomatic carotid stenosis, refAbstract=null), Reference(id=1241677626671157984, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, doi=null, pmid=null, pmcid=null, year=2016, volume=30, issue=null, pageStart=236, pageEnd=247, url=null, language=null, rfNumber=[13], rfOrder=13, authorNames=Luebke T, Brunkwall J, journalName=Annals of Vascular Surgery, refType=null, unstructuredReference=Luebke T, Brunkwall J. Impact of Real-World adherence with best medical treatment on Cost-Effectiveness of carotid endarterectomy for asymptomatic carotid artery stenosis[J]. Annals of Vascular Surgery, 2016, 30: 236-247., articleTitle=Impact of Real-World adherence with best medical treatment on Cost-Effectiveness of carotid endarterectomy for asymptomatic carotid artery stenosis, refAbstract=null), Reference(id=1241677626864095978, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, doi=null, pmid=null, pmcid=null, year=2017, volume=135, issue=8, pageStart=759, pageEnd=771, url=null, language=null, rfNumber=[14], rfOrder=14, authorNames=Wang WZ, Jiang B, Sun HX, journalName=Circulation, refType=null, unstructuredReference=Wang WZ, Jiang B, Sun HX, et al. Prevalence, incidence, and mortality of stroke in China: results from a nationwide Population-Based survey of 480 687 adults[J]. Circulation, 2017, 135(8): 759-771., articleTitle=Prevalence, incidence, and mortality of stroke in China: results from a nationwide Population-Based survey of 480 687 adults, refAbstract=null), Reference(id=1241677627073811188, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, doi=null, pmid=null, pmcid=null, year=2021, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[15], rfOrder=15, authorNames=国家卫生健康委员会, journalName=中国卫生健康统计年鉴-2021, refType=null, unstructuredReference=国家卫生健康委员会.中国卫生健康统计年鉴-2021[M].北京：中国协和医科大学出版社，2021., articleTitle=null, refAbstract=null), Reference(id=1241677627191251706, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, doi=null, pmid=null, pmcid=null, year=2021, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[15], rfOrder=16, authorNames=National Health Commission, journalName=China Health Statistics Yearbook 2021, refType=null, unstructuredReference=National Health Commission. China Health Statistics Yearbook 2021[M].Beijing: Peking Union Medical College Press, 2021., articleTitle=null, refAbstract=null), Reference(id=1241677627350635264, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, doi=null, pmid=null, pmcid=null, year=2019, volume=175, issue=4, pageStart=252, pageEnd=260, url=null, language=null, rfNumber=[16], rfOrder=17, authorNames=Kaboré N, Marnat G, Rouanet F, journalName=Revue Neurologique, refType=null, unstructuredReference=Kaboré N, Marnat G, Rouanet F, et al. Cost-effectiveness analysis of mechanical thrombectomy plus tissue-type plasminogen activator compared with tissue-type plasminogen activator alone for acute ischemic stroke in France[J]. Revue Neurologique, 2019, 175(4): 252-260., articleTitle=Cost-effectiveness analysis of mechanical thrombectomy plus tissue-type plasminogen activator compared with tissue-type plasminogen activator alone for acute ischemic stroke in France, refAbstract=null), Reference(id=1241677627497435908, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, doi=null, pmid=null, pmcid=null, year=2020, volume=107, issue=4, pageStart=313, pageEnd=318, url=null, language=null, rfNumber=[17], rfOrder=18, authorNames=Song JL, Murugiah K, Hu S, journalName=Heart, refType=null, unstructuredReference=Song JL, Murugiah K, Hu S, et al. Incidence, predictors, and prognostic impact of recurrent acute myocardial infarction in China[J].Heart, 2020, 107(4): 313-318., articleTitle=Incidence, predictors, and prognostic impact of recurrent acute myocardial infarction in China, refAbstract=null), Reference(id=1241677627619070732, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, doi=null, pmid=null, pmcid=null, year=2018, volume=18, issue=5, pageStart=405, pageEnd=413, url=null, language=null, rfNumber=[18], rfOrder=19, authorNames=Krittayaphong R, Permsuwan U, journalName=American Journal of Cardiovascular Drugs, refType=null, unstructuredReference=Krittayaphong R, Permsuwan U.Cost-Effectiveness analysis of Sacubitril-Valsartan compared with enalapril in patients with heart failure with reduced ejection fraction in Thailand[J]. American Journal of Cardiovascular Drugs, 2018, 18(5): 405-413., articleTitle=Cost-Effectiveness analysis of Sacubitril-Valsartan compared with enalapril in patients with heart failure with reduced ejection fraction in Thailand, refAbstract=null), Reference(id=1241677627744899858, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, doi=null, pmid=null, pmcid=null, year=2003, volume=21, issue=3, pageStart=191, pageEnd=200, url=null, language=null, rfNumber=[19], rfOrder=20, authorNames=Tengs TO, Lin TH, journalName=PharmacoEconomics, refType=null, unstructuredReference=Tengs TO, Lin TH. A Meta-Analysis of Quality-of-Life estimates for stroke[J]. PharmacoEconomics, 2003, 21(3): 191-200., articleTitle=A Meta-Analysis of Quality-of-Life estimates for stroke, refAbstract=null), Reference(id=1241677627853951768, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, doi=null, pmid=null, pmcid=null, year=2019, volume=8, issue=21, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[20], rfOrder=21, authorNames=Baradaran H, Gupta A, Anzai YSI, journalName=Journal of the American Heart Association, refType=null, unstructuredReference=Baradaran H, Gupta A, Anzai YSI, et al. Cost effectiveness of assessing ultrasound plaque characteristics to risk stratify asymptomatic patients with carotid stenosis[J]. Journal of the American Heart Association, 2019, 8(21): e012739., articleTitle=Cost effectiveness of assessing ultrasound plaque characteristics to risk stratify asymptomatic patients with carotid stenosis, refAbstract=null), Reference(id=1241677627967197980, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, doi=null, pmid=null, pmcid=null, year=2019, volume=54, issue=2, pageStart=137, pageEnd=143, url=null, language=null, rfNumber=[21], rfOrder=22, authorNames=刘利勤, 李青, 胡明, journalName=中国药学杂志, refType=null, unstructuredReference=刘利勤，李青，胡明，等.应用Markov模型对3种血管紧张素Ⅱ受体拮抗剂预防高血压患者卒中和心肌梗死的经济学评价[J].中国药学杂志，2019，54（2）：137-143., articleTitle=应用Markov模型对3种血管紧张素Ⅱ受体拮抗剂预防高血压患者卒中和心肌梗死的经济学评价, refAbstract=null), Reference(id=1241677628088832801, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, doi=null, pmid=null, pmcid=null, year=2019, volume=54, issue=2, pageStart=137, pageEnd=143, url=null, language=null, rfNumber=[21], rfOrder=23, authorNames=Liu LQ, Li Q, Hu M, journalName=Chinese Pharmaceutical Journal, refType=null, unstructuredReference=Liu LQ, Li Q, Hu M, et al. Economic evaluation of three angiotensin Ⅱreceptor antagonists in preventing stroke and myocardial infarction in patients with hypertension based on Markov model[J]. Chinese Pharmaceutical Journal, 2019, 54(2): 137-143., articleTitle=Economic evaluation of three angiotensin Ⅱreceptor antagonists in preventing stroke and myocardial infarction in patients with hypertension based on Markov model, refAbstract=null), Reference(id=1241677628189496099, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, doi=null, pmid=null, pmcid=null, year=2023, volume=15, issue=1, pageStart=46, pageEnd=51, url=null, language=null, rfNumber=[22], rfOrder=24, authorNames=Chen JG, Liang X, Tong X, journalName=Journal of NeuroInterventional Surgery, refType=null, unstructuredReference=Chen JG, Liang X, Tong X, et al. Economic evaluation of intravenous alteplase for stroke with the time of onset between 4.5 and 9 hours[J]. Journal of NeuroInterventional Surgery, 2023, 15(1): 46-51., articleTitle=Economic evaluation of intravenous alteplase for stroke with the time of onset between 4.5 and 9 hours, refAbstract=null), Reference(id=1241677628332102441, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, doi=null, pmid=null, pmcid=null, year=2022, volume=37, issue=6, pageStart=553, pageEnd=578, url=null, language=null, rfNumber=[23], rfOrder=25, authorNames=中国心血管健康与疾病报告编写组, journalName=中国循环杂志, refType=null, unstructuredReference=中国心血管健康与疾病报告编写组.中国心血管健康与疾病报告2021概要[J].中国循环杂志，2022，37（6）：553-578., articleTitle=中国心血管健康与疾病报告2021概要, refAbstract=null), Reference(id=1241677629850440492, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, doi=null, pmid=null, pmcid=null, year=2022, volume=37, issue=6, pageStart=553, pageEnd=578, url=null, language=null, rfNumber=[23], rfOrder=26, authorNames=Zhong Guo Xin Xie Guan Jian Kang Yu Ji Bing Bao Gao Bian Xie Zu, journalName=Chinese Circulation Journal, refType=null, unstructuredReference=Zhong Guo Xin Xie Guan Jian Kang Yu Ji Bing Bao Gao Bian Xie Zu.Report on cardiovascular health and diseases in China 2021: an updated summary[J]. Chinese Circulation Journal, 2022, 37(6): 553-578., articleTitle=Report on cardiovascular health and diseases in China 2021: an updated summary, refAbstract=null), Reference(id=1241677630009824047, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, doi=null, pmid=null, pmcid=null, year=2018, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[24], rfOrder=27, authorNames=侯帆迪, journalName=null, refType=null, unstructuredReference=侯帆迪.CEA和CAS治疗颈动脉狭窄的临床资料分析[D].石河子：石河子大学，2018., articleTitle=CEA和CAS治疗颈动脉狭窄的临床资料分析, refAbstract=null), Reference(id=1241677630181790515, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, doi=null, pmid=null, pmcid=null, year=2018, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[24], rfOrder=28, authorNames=Hou FD, journalName=null, refType=null, unstructuredReference=Hou FD. The Clinical Data Analysis of Carotid Artery Stenosis Treated with Carotid Endarterectomy and Carotid Artery Stenting[D]. Shihezi: Shihezi University, 2018., articleTitle=The Clinical Data Analysis of Carotid Artery Stenosis Treated with Carotid Endarterectomy and Carotid Artery Stenting, refAbstract=null), Reference(id=1241677630299231033, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[25], rfOrder=29, authorNames=国家统计局, journalName=null, refType=null, unstructuredReference=国家统计局. 居民消费价格指数(上年=100)（2016-）[EB/OL].[2023-12-20]. https://data.stats.gov.cn/tablequery.htm?code=AD09&from., articleTitle=居民消费价格指数(上年=100)（2016-）, refAbstract=null), Reference(id=1241677630500557634, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[25], rfOrder=30, authorNames=The National Bureau of Statistics, journalName=null, refType=null, unstructuredReference=The National Bureau of Statistics. Consumer price index (previous year =100) (2016-) [EB/OL]. [2023-12-20]. https://data.stats.gov.cn/tablequery.htm?code=AD09&from., articleTitle=Consumer price index (previous year =100) (2016-), refAbstract=null), Reference(id=1241677630609609543, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, doi=null, pmid=null, pmcid=null, year=2020, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[26], rfOrder=31, authorNames=刘国恩, journalName=中国药物经济学评价指南, refType=null, unstructuredReference=刘国恩.中国药物经济学评价指南[M].北京：中国市场出版社，2020., articleTitle=null, refAbstract=null), Reference(id=1241677630731244364, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, doi=null, pmid=null, pmcid=null, year=2020, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=[26], rfOrder=32, authorNames=Liu GE, journalName=Guidelines for pharmacoeconomic evaluation in China, refType=null, unstructuredReference=Liu GE. Guidelines for pharmacoeconomic evaluation in China[M]. Beijing:China Market Press, 2020., articleTitle=null, refAbstract=null), Reference(id=1241677630865462095, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, doi=null, pmid=null, pmcid=null, year=2013, volume=100, issue=2, pageStart=231, pageEnd=239, url=null, language=null, rfNumber=[27], rfOrder=33, authorNames=Thapar A, Garcia Mochon L, Epstein D, journalName=British Journal of Surgery, refType=null, unstructuredReference=Thapar A, Garcia Mochon L, Epstein D, et al. Modelling the cost-effectiveness of carotid endarterectomy for asymptomatic stenosis[J].British Journal of Surgery, 2013, 100(2): 231-239., articleTitle=Modelling the cost-effectiveness of carotid endarterectomy for asymptomatic stenosis, refAbstract=null), Reference(id=1241677630987096918, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, doi=null, pmid=null, pmcid=null, year=2021, volume=398, issue=10305, pageStart=1065, pageEnd=1073, url=null, language=null, rfNumber=[28], rfOrder=34, authorNames=Halliday A, Bulbulia R, Bonati LH, journalName=Lancet, refType=null, unstructuredReference=Halliday A, Bulbulia R, Bonati LH, et al. Second asymptomatic carotid surgery trial (ACST-2): a randomised comparison of carotid artery stenting versus carotid endarterectomy[J]. Lancet, 2021,398(10305): 1065-1073., articleTitle=Second asymptomatic carotid surgery trial (ACST-2): a randomised comparison of carotid artery stenting versus carotid endarterectomy, refAbstract=null), Reference(id=1241677631192617816, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, doi=null, pmid=null, pmcid=null, year=2020, volume=51, issue=10, pageStart=2960, pageEnd=2971, url=null, language=null, rfNumber=[29], rfOrder=35, authorNames=Turan TN, Voeks JH, Chimowitz MI, journalName=Stroke, refType=null, unstructuredReference=Turan TN, Voeks JH, Chimowitz MI, et al.Rationale, design, and implementation of intensive risk factor treatment in the CREST2 trial[J]. Stroke, 2020, 51(10): 2960-2971., articleTitle=Rationale, design, and implementation of intensive risk factor treatment in the CREST2 trial, refAbstract=null), Reference(id=1241677631301669723, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, doi=null, pmid=null, pmcid=null, year=2021, volume=20, issue=3, pageStart=193, pageEnd=202, url=null, language=null, rfNumber=[30], rfOrder=36, authorNames=Howard DPJ, Gaziano L, Rothwell PM, journalName=Lancet Neurolog, refType=null, unstructuredReference=Howard DPJ, Gaziano L, Rothwell PM, et al. Risk of stroke in relation to degree of asymptomatic carotid stenosis: a population-based cohort study, systematic review, and meta-analysis[J]. Lancet Neurolog, 2021, 20(3): 193-202., articleTitle=Risk of stroke in relation to degree of asymptomatic carotid stenosis: a population-based cohort study, systematic review, and meta-analysis, refAbstract=null), Reference(id=1241677631406527325, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, doi=null, pmid=null, pmcid=null, year=2022, volume=76, issue=1, pageStart=202, pageEnd=208, url=null, language=null, rfNumber=[31], rfOrder=37, authorNames=Thomas JP, Kumins NH, Schneider PA, journalName=Journal of Vascular Surgery, refType=null, unstructuredReference=Thomas JP, Kumins NH, Schneider PA, et al. Balloon dilation strategy does not affect outcomes for transcarotid artery revascularization in prospective trials[J]. Journal of Vascular Surgery, 2022, 76(1): 202-208., articleTitle=Balloon dilation strategy does not affect outcomes for transcarotid artery revascularization in prospective trials, refAbstract=null), Reference(id=1241677631532356449, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, doi=null, pmid=null, pmcid=null, year=2015, volume=274, issue=2, pageStart=455, pageEnd=463, url=null, language=null, rfNumber=[32], rfOrder=38, authorNames=Pandya A, Gupta A, Kamel H, journalName=Radiology, refType=null, unstructuredReference=Pandya A, Gupta A, Kamel H, et al. Carotid artery stenosis: cost-effectiveness of assessment of cerebrovascular reserve to guide treatment of asymptomatic patients[J]. Radiology, 2015, 274(2): 455-463., articleTitle=Carotid artery stenosis: cost-effectiveness of assessment of cerebrovascular reserve to guide treatment of asymptomatic patients, refAbstract=null), Reference(id=1241677631670768483, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, doi=null, pmid=null, pmcid=null, year=2019, volume=70, issue=1, pageStart=123, pageEnd=129, url=null, language=null, rfNumber=[33], rfOrder=39, authorNames=Kashyap VS, King AH, Foteh MI, journalName=Journal of Vascular Surgery, refType=null, unstructuredReference=Kashyap VS, King AH, Foteh MI, et al. A multi-institutional analysis of transcarotid artery revascularization compared to carotid endarterectomy[J]. Journal of Vascular Surgery, 2019, 70(1): 123-129., articleTitle=A multi-institutional analysis of transcarotid artery revascularization compared to carotid endarterectomy, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1241677616927789353, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, xref=1., ext=[AuthorCompanyExt(id=1241677616931983660, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, companyId=1241677616927789353, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=West China School of Public Health, Sichuan University/West China Fourth Hospital, Chengdu, Sichuan 610041, China), AuthorCompanyExt(id=1241677616944566572, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, companyId=1241677616927789353, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.四川大学华西公共卫生学院/华西第四医院，四川 成都 610041)]), AuthorCompany(id=1241677617091367226, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, xref=2., ext=[AuthorCompanyExt(id=1241677617099755836, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, companyId=1241677617091367226, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.四川省安岳县人民医院，四川 资阳 642350)])], figs=[ArticleFig(id=1241677621063373312, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, language=EN, label=Figure 1, caption=Markov model transition diagram, figureFileSmall=WqbxHG+CnVaYY43Sy24RgA==, figureFileBig=f1K2eRotidrbUBOWFVw8DA==, tableContent=null), ArticleFig(id=1241677621310837261, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, language=CN, label=图1, caption=Markov模型状态转移图, figureFileSmall=WqbxHG+CnVaYY43Sy24RgA==, figureFileBig=f1K2eRotidrbUBOWFVw8DA==, tableContent=null), ArticleFig(id=1241677621457637909, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, language=EN, label=Figure 2, caption=One-way sensitivity analysis, figureFileSmall=XViky2IzyWO4XtCWC+5N5w==, figureFileBig=y9c/IkJWd7iZFoQY7riVpw==, tableContent=null), ArticleFig(id=1241677621575078434, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, language=CN, label=图2, caption=单因素敏感性分析, figureFileSmall=XViky2IzyWO4XtCWC+5N5w==, figureFileBig=y9c/IkJWd7iZFoQY7riVpw==, tableContent=null), ArticleFig(id=1241677621667353129, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, language=EN, label=Figure 3, caption=Cost-effectiveness acceptability curve, figureFileSmall=AiFAqR70ppSWwjogcVMppw==, figureFileBig=DxITUvc84G1stLw8QbP3GQ==, tableContent=null), ArticleFig(id=1241677621780599346, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, language=CN, label=图3, caption=成本-效果可接受曲线, figureFileSmall=AiFAqR70ppSWwjogcVMppw==, figureFileBig=DxITUvc84G1stLw8QbP3GQ==, tableContent=null), ArticleFig(id=1241677621906428475, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, language=EN, label=Figure 4, caption=Incremental cost-effectiveness scatter plot, figureFileSmall=9C+zZVtjgSyWhn//Qryvxg==, figureFileBig=/MvMCWL+2tOPvH52xW6vQQ==, tableContent=null), ArticleFig(id=1241677622044840509, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, language=CN, label=图4, caption=增量成本-效果散点图, figureFileSmall=9C+zZVtjgSyWhn//Qryvxg==, figureFileBig=/MvMCWL+2tOPvH52xW6vQQ==, tableContent=null), ArticleFig(id=1241677622170669637, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, language=EN, label=Table 1, caption=

Markov model parameters

, figureFileSmall=null, figureFileBig=null, tableContent=
基础病例取值取值范围分布文献来源
初始概率
CEA组稳定状态0.9650.956～0.974β11
CEA组非致残状态0.0120.006～0.017β11
CEA组致残状态0.0060.002～0.010β11
CEA组心肌梗死0.0060.002～0.010β11
CEA组死亡0.0110.006～0.016β11
药物治疗组稳定状态0.9890.984～0.994β11
药物治疗组非致残状态0.0050.002～0.009β11
药物治疗组致残状态0.0030～0.006β11
药物治疗组心肌梗死0.0010～0.002β11
药物治疗组死亡0.0020～0.004β11
转移概率
CEA组0～5年非致残卒中概率0.0040.002～0.005β11
CEA组0～5年致残卒中概率0.0050.003～0.007β11
CEA组5～10年非致残卒中概率0.0060.004～0.008β11
CEA组5～10年致残卒中概率0.0080.006～0.010β11
药物治疗组0～5年非致残卒中概率0.0090.006～0.011β11
药物治疗组0～5年致残卒中概率0.0120.009～0.015β11
药物治疗组5～10年非致残卒中概率0.0070.005～0.009β11
药物治疗组5～10年致残卒中概率0.0090.007～0.012β11
非致残卒中到致残卒中概率
第一年0.0440.042～0.046β16
一年后0——16
卒中死亡率0.1120.109～0.116β14
心肌梗死死亡率0.284——17
贴现率0.050～0.08β26
非卒中相关死亡率—
70～75岁0.015—15
≥75岁0.026——15
效用值
稳定状态10.86～1β19、20
非致残卒中0.760.71～0.87β19、20
致残卒中0.390.31～0.52β19、20
心肌梗死（第一年）0.7——21
心肌梗死（一年后）0.8——21
成本
CEA手术花费35 185.14528 988.18～41 382.11γ24
CEA组每年药费3 5332 649.75～4 416.25γ估算
药物治疗组每年药费3 5332 649.75～4 416.25γ估算
非致残卒中花费12 483.5877 210.72～15 718.45γ22
致残卒中花费16 505.4419 070.89～21 644.42γ22
卒中死亡花费14 145.4766 646.53～18 696.76γ22
心肌梗死花费31 783.99723 838.00～39 730.00γ23
非致残卒中每年花费8 875.6732 657.39～11 321.49γ22
致残卒中每年花费13 504.6373 396.35～16 982.75γ22
心肌梗死每年花费（第一年）53 336.49840 002.37～66 670.62γ21
心肌梗死每年花费（一年后）11 664.6988 748.52～14 580.87γ21
超声费用220165～275γ医疗机构数据
CEA手术后一年内随访次数4——医疗机构数据
CEA手术后一年后随访次数1——医疗机构数据
模型1
CEA组非卒中死亡率0.058——11
药物治疗组非卒中死亡率0.052——11
模型2转移概率
CEA组非致残卒中概率0.005——12
CEA组致残卒中概率0.007——12
药物治疗组非致残卒中概率0.007——12
药物治疗组致残卒中概率0.01——12
), ArticleFig(id=1241677622300693073, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, language=CN, label=表1, caption=

Markov模型参数

, figureFileSmall=null, figureFileBig=null, tableContent=
基础病例取值取值范围分布文献来源
初始概率
CEA组稳定状态0.9650.956～0.974β11
CEA组非致残状态0.0120.006～0.017β11
CEA组致残状态0.0060.002～0.010β11
CEA组心肌梗死0.0060.002～0.010β11
CEA组死亡0.0110.006～0.016β11
药物治疗组稳定状态0.9890.984～0.994β11
药物治疗组非致残状态0.0050.002～0.009β11
药物治疗组致残状态0.0030～0.006β11
药物治疗组心肌梗死0.0010～0.002β11
药物治疗组死亡0.0020～0.004β11
转移概率
CEA组0～5年非致残卒中概率0.0040.002～0.005β11
CEA组0～5年致残卒中概率0.0050.003～0.007β11
CEA组5～10年非致残卒中概率0.0060.004～0.008β11
CEA组5～10年致残卒中概率0.0080.006～0.010β11
药物治疗组0～5年非致残卒中概率0.0090.006～0.011β11
药物治疗组0～5年致残卒中概率0.0120.009～0.015β11
药物治疗组5～10年非致残卒中概率0.0070.005～0.009β11
药物治疗组5～10年致残卒中概率0.0090.007～0.012β11
非致残卒中到致残卒中概率
第一年0.0440.042～0.046β16
一年后0——16
卒中死亡率0.1120.109～0.116β14
心肌梗死死亡率0.284——17
贴现率0.050～0.08β26
非卒中相关死亡率—
70～75岁0.015—15
≥75岁0.026——15
效用值
稳定状态10.86～1β19、20
非致残卒中0.760.71～0.87β19、20
致残卒中0.390.31～0.52β19、20
心肌梗死（第一年）0.7——21
心肌梗死（一年后）0.8——21
成本
CEA手术花费35 185.14528 988.18～41 382.11γ24
CEA组每年药费3 5332 649.75～4 416.25γ估算
药物治疗组每年药费3 5332 649.75～4 416.25γ估算
非致残卒中花费12 483.5877 210.72～15 718.45γ22
致残卒中花费16 505.4419 070.89～21 644.42γ22
卒中死亡花费14 145.4766 646.53～18 696.76γ22
心肌梗死花费31 783.99723 838.00～39 730.00γ23
非致残卒中每年花费8 875.6732 657.39～11 321.49γ22
致残卒中每年花费13 504.6373 396.35～16 982.75γ22
心肌梗死每年花费（第一年）53 336.49840 002.37～66 670.62γ21
心肌梗死每年花费（一年后）11 664.6988 748.52～14 580.87γ21
超声费用220165～275γ医疗机构数据
CEA手术后一年内随访次数4——医疗机构数据
CEA手术后一年后随访次数1——医疗机构数据
模型1
CEA组非卒中死亡率0.058——11
药物治疗组非卒中死亡率0.052——11
模型2转移概率
CEA组非致残卒中概率0.005——12
CEA组致残卒中概率0.007——12
药物治疗组非致残卒中概率0.007——12
药物治疗组致残卒中概率0.01——12
), ArticleFig(id=1241677622522991192, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, language=EN, label=Table 2, caption=

Comparison of the effect of the two groups after 10 years simulated by Markov model （%）

, figureFileSmall=null, figureFileBig=null, tableContent=
治疗方案稳定状态非致残卒中致残卒中心肌梗死死亡
CEA组81.02.73.6012.7
药物治疗组70.93.75.0020.4
), ArticleFig(id=1241677622678180449, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, language=CN, label=表2, caption=

Markov模型模拟十年后两组治疗方案的效果比较（%）

, figureFileSmall=null, figureFileBig=null, tableContent=
治疗方案稳定状态非致残卒中致残卒中心肌梗死死亡
CEA组81.02.73.6012.7
药物治疗组70.93.75.0020.4
), ArticleFig(id=1241677622787232360, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, language=EN, label=Table 3, caption=

Cost-effectiveness analysis based on different models

, figureFileSmall=null, figureFileBig=null, tableContent=
模型类型治疗方案成本增量成本效果增量效果ICER
基础病例药物治疗31 982.3835 097.237.2580.271129 435.97
CEA67 079.617.529
模型1药物治疗31 521.7435 087.707.2370.274127 946.82
CEA66 609.447.511
模型2药物治疗31 363.9535 891.077.3350.149240 283.17
CEA67 255.027.485
), ArticleFig(id=1241677622992753266, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522771038106386, language=CN, label=表3, caption=

基于不同模型的成本-效果分析

, figureFileSmall=null, figureFileBig=null, tableContent=
模型类型治疗方案成本增量成本效果增量效果ICER
基础病例药物治疗31 982.3835 097.237.2580.271129 435.97
CEA67 079.617.529
模型1药物治疗31 521.7435 087.707.2370.274127 946.82
CEA66 609.447.511
模型2药物治疗31 363.9535 891.077.3350.149240 283.17
CEA67 255.027.485
)], attaches=null, journal=Journal(id=1227664546253402114, delFlag=0, nameCn=现代预防医学, nameEn=Modern Preventive Medicine, nameHistory1=null, nameHistory2=null, issn=1003-8507, eissn=null, cn=51-1365/R, coden=null, periodic=3, language=CN, oaType=null, ccby=null, superviseOffice=null, ownerOffice=null, pubOffice=null, editorOffice=null, officeType=null, aims=null, clcCode=null, officeProv=null, officeCity=null, officeAddr=null, officeZip=null, officeEmail=null, officePhone=null, editDirector=null, officeDirector=null, officeDirectorPhone=null, officeStaffNum=null, officeEmpNum=null, coverPicUrl=IeiuPXEZi6AA+k0VfvoiOQ==, journalPrice=null, startedYear=null, abbrevIsoEn=Modern Preventive Medicine, journalRemark=null, publicationField=null, createdTime=1770627636734, updatedTime=1770628902248, createdBy=18614031015, updatedBy=13701087609, firstLetterCn=M, firstLetterEn=M, subjectCode=Life Sciences, subjectName=null, subjectCodeEn=Life Sciences, subjectNameEn=null, picCn=IeiuPXEZi6AA+k0VfvoiOQ==, picEn=/9iTl8/ndms4tBz1fL28Pg==, jcr=null, cjcr=null, exts=[JournalExt(id=1227669854342280188, language=CN, name=现代预防医学, nameHistory1=null, nameHistory2=null, managedBy=, sponsoredBy=, publishedBy=, editorOffice=, officeProv=null, officeCity=null, officeAddr=, officeZip=, editDirector=, officeDirector=null, officePhone=null, coverPicUrl=null, journalRemark=, submitArticleUrl=null, websiteUrl=, createdTime=1770628902278, updatedTime=1770628902278, createdBy=13701087609, updatedBy=13701087609, submissionGuidelinesUrl=, submissionAuthorUrl=http://xdyfyxzz.paperopen.com/#/regist, submissionEditorUrl=http://xdyfyxzz.paperopen.com/#/Login, submissionReviewUrl=http://xdyfyxzz.paperopen.com/#/Login, submissionCeEditorUrl=, submissionAeEditorUrl=, option={"copyright":""}), JournalExt(id=1227669854396806141, language=EN, name=Modern Preventive Medicine, nameHistory1=null, nameHistory2=null, managedBy=, sponsoredBy=, publishedBy=, editorOffice=, officeProv=null, officeCity=null, officeAddr=, officeZip=, editDirector=, officeDirector=null, officePhone=null, coverPicUrl=null, journalRemark=, submitArticleUrl=null, websiteUrl=, createdTime=1770628902291, updatedTime=1770628902291, createdBy=13701087609, updatedBy=13701087609, submissionGuidelinesUrl=, submissionAuthorUrl=http://xdyfyxzz.paperopen.com/#/regist, submissionEditorUrl=http://xdyfyxzz.paperopen.com/#/Login, submissionReviewUrl=http://xdyfyxzz.paperopen.com/#/Login, submissionCeEditorUrl=, submissionAeEditorUrl=, option={"copyright":""})], databaseList=null, tenantJournalId=1227665162245664772, websiteList=[Website(id=1227687234141352800, webName=null, webTitle=null, webDomain=null, webCopyrigh=null, webIpcNo=null, seoTitle=null, seoKeywords=null, seoDescription=null, tenantJournalId=null, journalId=1227665162245664772, journalNameCn=null, journalNameEn=null, grayFlag=null, tenantId=1146029695717560320, platformId=null, journalGroupId=null, journalGroupNameCn=null, journalGroupNameEn=null, type=1, domain=https://castjournals.cast.org.cn/joweb/xdyfyx/CN, language=CN, createTime=1770633045945, createBy=18614031015, updateTime=1770633090526, updateBy=18614031015, name=现代预防医学-中文, tplId=1146099689490845704, title=现代预防医学, delFlag=0, indexPage=/home, props=[WebsiteProps(id=1227687735088051072, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1227687234141352800, code=articleTextType, value=kx, createTime=1770633165380, updateTime=1770633165380, creator=18614031015, updator=18614031015), WebsiteProps(id=1227687735071273853, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1227687234141352800, code=banner, value=null, createTime=1770633165376, updateTime=1770633165376, creator=18614031015, updator=18614031015), WebsiteProps(id=1227687735113216899, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1227687234141352800, code=grayFlag, value=0, createTime=1770633165386, updateTime=1770633165386, creator=18614031015, updator=18614031015), WebsiteProps(id=1227687735062885244, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1227687234141352800, code=logo, value=https://castjournals.cast.org.cn/joweb/xdyfyx/CN/file/pic?fileId=/XB5plC0xuykmQnycvtyrw==, createTime=1770633165374, updateTime=1770633165374, creator=18614031015, updator=18614031015), WebsiteProps(id=1227687735125799813, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1227687234141352800, code=minRunFlag, value=0, createTime=1770633165389, updateTime=1770633165389, creator=18614031015, updator=18614031015), WebsiteProps(id=1227687735083856767, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1227687234141352800, code=picServerUrl, value=https://castjournals.cast.org.cn/joweb/xdyfyx/CN/file/pic, createTime=1770633165379, updateTime=1770633165379, creator=18614031015, updator=18614031015), WebsiteProps(id=1227687735121605508, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1227687234141352800, code=silenceFlag, value=0, createTime=1770633165388, updateTime=1770633165388, creator=18614031015, updator=18614031015), WebsiteProps(id=1227687735079662462, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1227687234141352800, code=staticResourcePath, value=https://castjournals.cast.org.cn/joweb/cast_kjdb_cn_619/, createTime=1770633165378, updateTime=1770633165378, creator=18614031015, updator=18614031015), WebsiteProps(id=1227687735096439681, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1227687234141352800, code=themeColor, value=null, createTime=1770633165382, updateTime=1770633165382, creator=18614031015, updator=18614031015), WebsiteProps(id=1227687735104828290, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1227687234141352800, code=themeStyle, value=null, createTime=1770633165384, updateTime=1770633165384, creator=18614031015, updator=18614031015)]), Website(id=1227687234338485094, webName=null, webTitle=null, webDomain=null, webCopyrigh=null, webIpcNo=null, seoTitle=null, seoKeywords=null, seoDescription=null, tenantJournalId=null, journalId=1227665162245664772, journalNameCn=null, journalNameEn=null, grayFlag=null, tenantId=1146029695717560320, platformId=null, journalGroupId=null, journalGroupNameCn=null, journalGroupNameEn=null, type=1, domain=https://castjournals.cast.org.cn/joweb/xdyfyx/EN, language=EN, createTime=1770633045992, createBy=18614031015, updateTime=1770633115374, updateBy=18614031015, name=现代预防医学-英文, tplId=1146101810881728533, title=Modern Preventive Medicine, delFlag=0, indexPage=/home, props=[WebsiteProps(id=1227687709129507332, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1227687234338485094, code=articleTextType, value=kx, createTime=1770633159191, updateTime=1770633159191, creator=18614031015, updator=18614031015), WebsiteProps(id=1227687709108535809, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1227687234338485094, code=banner, value=null, createTime=1770633159186, updateTime=1770633159186, creator=18614031015, updator=18614031015), WebsiteProps(id=1227687709167256071, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1227687234338485094, code=grayFlag, value=0, createTime=1770633159200, updateTime=1770633159200, creator=18614031015, updator=18614031015), WebsiteProps(id=1227687709095952896, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1227687234338485094, code=logo, value=https://castjournals.cast.org.cn/joweb/xdyfyx/EN/file/pic?fileId=/XB5plC0xuykmQnycvtyrw==, createTime=1770633159183, updateTime=1770633159183, creator=18614031015, updator=18614031015), WebsiteProps(id=1227687709179838985, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1227687234338485094, code=minRunFlag, value=0, createTime=1770633159203, updateTime=1770633159203, creator=18614031015, updator=18614031015), WebsiteProps(id=1227687709121118723, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1227687234338485094, code=picServerUrl, value=https://castjournals.cast.org.cn/joweb/xdyfyx/EN/file/pic, createTime=1770633159189, updateTime=1770633159189, creator=18614031015, updator=18614031015), WebsiteProps(id=1227687709171450376, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1227687234338485094, code=silenceFlag, value=0, createTime=1770633159201, updateTime=1770633159201, creator=18614031015, updator=18614031015), WebsiteProps(id=1227687709112730114, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1227687234338485094, code=staticResourcePath, value=https://castjournals.cast.org.cn/joweb/cast_kjdb_en_623/, createTime=1770633159187, updateTime=1770633159187, creator=18614031015, updator=18614031015), WebsiteProps(id=1227687709133701637, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1227687234338485094, code=themeColor, value=null, createTime=1770633159192, updateTime=1770633159192, creator=18614031015, updator=18614031015), WebsiteProps(id=1227687709154673158, tenantId=1146029695717560320, journalId=null, journalGroupId=null, siteId=1227687234338485094, code=themeStyle, value=null, createTime=1770633159197, updateTime=1770633159197, creator=18614031015, updator=18614031015)])], journalTitle=现代预防医学, weixinUrl=null, journalUrl=http://xdyfyxzz.paperopen.com/, iacademicId=null, status=1, seqNo=null, journalTitleEn=Modern Preventive Medicine, journalPhotoCn=IeiuPXEZi6AA+k0VfvoiOQ==, journalPhotoEn=/9iTl8/ndms4tBz1fL28Pg==, journalFirstLetter=M, journalRecommend=null, journalNew=null, journalCollection=null, jcrJf=null, cjcrJf=null, jcrJfStr=null, cjcrJfStr=null, submissionFirstDecision=null, sciSubjectClassification=null, casSubjectClassification=null, citeScore=null, totalCitationFrequency=null, icpCode=null, psCode=null, advertisingLicenseCode=null, copyrightInformation=null, country=null, option=, provinceCode=null, provinceName=null, collectFlag=false), detailUrlCn=https://castjournals.cast.org.cn/joweb/xdyfyx/CN/10.20043/j.cnki.MPM.202308506, detailUrlEn=https://castjournals.cast.org.cn/joweb/xdyfyx/EN/10.20043/j.cnki.MPM.202308506, pdfUrlCn=https://castjournals.cast.org.cn/joweb/xdyfyx/CN/PDF/10.20043/j.cnki.MPM.202308506, pdfUrlEn=https://castjournals.cast.org.cn/joweb/xdyfyx/EN/PDF/10.20043/j.cnki.MPM.202308506, aliStartDate=null, aliEndDate=null, collectionFlag=false, citedCount=null, citedUrl=null, reference=null)
收藏切换
颈动脉内膜切除与药物治疗无症状颈动脉狭窄的成本-效果分析
收藏切换
PDF下载
姚瑶 1, 2 , 杨艳芳 1
现代预防医学 | 临床与预防 2024,51(1): 180-185
收起
收藏切换
现代预防医学 | 临床与预防 2024, 51(1): 180-185
颈动脉内膜切除与药物治疗无症状颈动脉狭窄的成本-效果分析
全屏
姚瑶1, 2, 杨艳芳1
作者信息
  • 1.四川大学华西公共卫生学院/华西第四医院，四川 成都 610041
  • 2.四川省安岳县人民医院，四川 资阳 642350

    • 姚瑶（1990—），女，硕士在读，研究方向：流行病学与卫生统计学

通讯作者:

杨艳芳，E-mail:
Cost-effectiveness analysis of carotid endarterectomy versus medical therapy for asymptomatic stenosis
Yao YAO1, 2, Yan-fang YANG1
Affiliations
  • West China School of Public Health, Sichuan University/West China Fourth Hospital, Chengdu, Sichuan 610041, China
出版时间: 2024-01-10 doi: 10.20043/j.cnki.MPM.202308506
文章导航
收藏切换
摘要
收起
目的

分析颈动脉内膜切除术（carotid endarterectomy，CEA）与药物治疗中国70岁以上无症状颈动脉狭窄患者的成本-效果。

方法

本文通过一项无症状颈动脉狭窄人群经CEA与药物治疗随访10年后不同结局的研究数据，建立Markov模型模拟两种治疗方案10年的成本-效果，结局指标为增量成本-效果比（ICER），即增加的成本与增加的质量调整生命年（QALY）的比值，并将获得ICER与支付意愿（willingness-to-pay，WTP）阈值进行比较。本文进行了情景分析，单因素敏感性、概率敏感性分析进行了不确定检验。

结果

在基础病例分析中，接受CEA的患者可获得7.53QALYs，药物治疗为7.26，相应成本为67 079.61和31 982.38元，获得的ICER为129 435.97元/QALY，低于支付意愿阈值。在情景分析中，ICER分别为127 946.82和240 283.17元/QALY。接受CEA后患者的年死亡率，CEA的手术花费和CEA后围手术期的死亡率对ICER波动影响较大。

结论

依据WHO对经济学评价推荐意见，目前中国70岁以上无症状颈动脉狭窄患者，CEA与药物治疗相比增加的成本是可以接受的。

无症状颈动脉狭窄  /  颈动脉内膜切除术  /  药物治疗  /  成本-效果  /  经济学评价
Objective

To analyze the cost-effectiveness of carotid endarterectomy carotid endarterectomy (CEA) and medical therapy for asymptomatic carotid stenosis in Chinese patients over 70 years old.

Methods

Based on the data of different outcomes of asymptomatic carotid stenosis patients who were followed up by CEA and drug therapy for 10 years, a Markov model was established to simulate the cost-effectiveness of the two treatments for 10 years. The outcome index was incremental cost-effectiveness ratio (ICER), which was the ratio of increased cost to increased quality-adjusted life years (QALY), and the thresholds of ICER and willingness to pay (WTP) were compared. In this paper, scenario analysis was carried out, and uncertainty test was carried out by single factor sensitivity analysis and probability sensitivity analysis.

Results

In the basic case analysis, the patients who received CEA could get 7.53 QALYs, the corresponding cost was 67 079.61 yuan and 31 982.38 yuan, and the ICER was 129 435.97 yuan / QALY, which was lower than the threshold of WTP. In scenario analysis, the ICER was 127 946.82 yuan / QALY and 240 283.17 yuan / QALY, respectively. The annual mortality of patients after CEA, the operation cost of CEA, and the perioperative mortality after CEA had great influence on the fluctuation of ICER.

Conclusion

According to the economic evaluation recommendation of WHO, the increased cost of CEA compared with drug therapy is acceptable for Chinese patients with asymptomatic carotid artery stenosis over 70 years old.

Asymptomatic carotid stenosis  /  Carotid endarterectomy  /  Drug therapy  /  Cost-effectiveness  /  Economic evaluation
姚瑶, 杨艳芳. 颈动脉内膜切除与药物治疗无症状颈动脉狭窄的成本-效果分析. 现代预防医学, 2024 , 51 (1) : 180 -185 . DOI: 10.20043/j.cnki.MPM.202308506
Yao YAO, Yan-fang YANG. Cost-effectiveness analysis of carotid endarterectomy versus medical therapy for asymptomatic stenosis[J]. Modern Preventive Medicine, 2024 , 51 (1) : 180 -185 . DOI: 10.20043/j.cnki.MPM.202308506
正文
收起
根据全球疾病、损伤和风险因素负担研究（GBD），卒中是死亡和致残的主要原因，2019年，全球范围内卒中发病病例超过12 200万例，卒中死亡655万例[1]。在中国，卒中已上升为成年人的主要死亡原因[2]，颈动脉狭窄是发生卒中的重要原因之一[3]。目前颈动脉内膜切除术（carotid endarterectomy，CEA）、颈动脉支架植入术（carotid artery stenting，CAS）和药物治疗是治疗颈动脉狭窄和降低卒中风险的三种公认的有效方法[4-5]。
对于症状性颈动脉狭窄，鉴于一些强有力的临床试验，CEA被推荐为金标准[6-8]。在不同的研究中已证明CEA可降低任何形式卒中的绝对风险[7-8]。几项经济学评价显示CEA在这些患者中具有成本-效果[9-10]。对于无症状颈动脉狭窄，随机对照试验表明CEA可以降低卒中的发生率。在一项随访期延长至10年的研究（ACST-1试验）中，排除围手术期事件和非卒中死亡后，CEA组和药物组的卒中风险分别为10.8%和16.9%，但这也意味着如果考虑围手术期事件后年获益小于0.61%[11]。另一项最新研究发现，在目前最佳药物治疗下，CEA组5年的卒中风险仍比药物治疗低[12]，表明CEA可能带来些许获益。在德国进行的一项真实世界研究表明，在无症状颈动脉狭窄人群中，早期的颈动脉切除术可能比药物治疗更具成本效果[13]。因此，本研究拟分析颈动脉切除术在中国治疗无症颈动脉狭窄的实际成本-效果。
1　资料与方法
收起
1.1　研究人群
本研究的起始年龄为70岁，与ACST-1试验中接受降脂治疗患者的平均年龄相似[11]。纳入分析的患者需要符合以下标准：（1）狭窄程度至少为动脉直径的60%；（2）无卒中、短暂性脑缺血或其他相关症状；（3）他们可以随机接受CEA治疗或初始药物治疗。
1.2　模型概述
构建循环周期为十年的Markov模型，比较CEA与药物治疗无症状颈动脉狭窄患者的成本-效果。考虑到无症状颈动脉狭窄和CEA后状态稳定,故Markov循环周期设定为一年,研究终止条件为十年，所有统计分析均使用TreeagePro 2019处理。模型中使用了五种健康状态，两组患者以五种状态中的一种进入模型。由于在ACST-1试验中药物治疗的患者即使未接受即刻CEA治疗，但后期随访中患者仍可随机接受手术治疗，仍具有结局事件发生。考虑到围手术期并发症，CEA组围手术期并发症发生率显然高于药物治疗组，故两组进入模型的初始概率不同。Markov模型状态转移图，见图1。
1.3　确定Markov模型参数，见表1。
1.3.1　概率
1.3.1.1　基础病例概率
　
初始概率，卒中相关转移概率均来自ACST-1研究[11]。卒中相关死亡数据来自于在中国进行的一项调查[14]，非卒中相关死亡数据来源于《中国卫生健康统计年鉴2021》[15]，非致残卒中到致残卒中的转移概率，第一年为4.4%，一年后为0[16]，心肌梗死死亡率为28.4%[17]。
1.3.1.2　模型1概率
初始概率，卒中相关转移概率以及非卒中相关死亡率均来自ACST-1研究中。在ACST-1中，CEA组的非卒中死亡人数为554，观察总人年数为9 582，故模型1中CEA组的非卒中死亡率为0.058。同理，药物治疗组非卒中相关死亡率为0.052，其余概率与基础病例中来源一致。
1.3.1.3　模型2概率
　
此模型中采用的数据来自一项Keyhani[12]的最新的研究，在该项研究中，CEA组与药物治疗组5年卒中风险分别为5.5%与7.6%，在模型2中假设致残性卒中与非致残性卒中的比例与ACST-1研究中相似，分别为57.84%和42.16%。用公式分别计算CEA和药物治疗从稳定状态到致残卒中、非致残卒中的转移概率P，其余概率同基础病例。其中p为Keyhani研究中CEA与药物治疗两种方案卒中发生风险，T为该研究随访时间，t为本研究所需要的从一种状态到达另一状态的转移概率时间,此处为一年。计算公式[18]为P=1-exp[ln(1-p)/(T/t)]。
1.3.2　效用
从已发表的meta分析和原始研究中检索到稳定状态、非致残性卒中和致残性卒中的效用值[19-20]，心肌梗死后第一年的效用与一年以后的效用是不同的[21]。
1.3.3　成本
主要来源于中国真实世界研究或机构公布的数据[22-24]，并考虑到居民消费价格指数（CPI）[25]将所有成本都折算成2021年的成本。根据中国药物经济学评价指南，所有成本和效用均以0.05的贴现率贴现[26]。
2　结果
收起
本研究的主要终点是CEA相对于药物治疗的增量成本-效果比(ICER)，即每个质量调整生命年(QALY)的增量成本。本文将2021年我国人均GDP的3倍，即242 928.00元作为支付意愿(WTP)阈值。依据世界卫生组织对于经济学评价的推荐意见：如果获得的增量成本-效果比<人均GDP，则CEA增加的成本是完全能接受的，如果人均GDP<增量-成本效果比<3倍人均GDP，那么增加的成本是可以接受的，如果增量成本-效果比>3倍人均GDP，则建议增加的成本是不能接受的。本文还进行了敏感性分析以来证实模型的稳健性，最后基于不同的参数进行了情景分析。
2.1　基础病例与情景分析成本-效果结果
在基础病例分析中，两种治疗方案在Markov模型模拟十年后，CEA组队列中卒中和死亡的发生比例均低于药物治疗组，见表2。在考虑治疗成本的情况下，无论是基础病例分析还是情景分析均建议CEA增加的成本是可以接受的。见表3。
2.2　单因素敏感性分析
对于概率和效用，假设其服从Beta分布，利用95%置信区间的范围用于进行单因素敏感性分析。对于成本，其范围是从已发表的文章中提取，对于文献中没有提供成本范围的采用上下浮动25%来进行分析，单因素敏感性分析结果见图2，术后患者的年死亡率对增量成本效果比的影响最大，其次是手术花费和围手术期的死亡率。
2.3　概率敏感性分析
通过对模型进行100 00次Monte Carlo Simulation来执行分析，其中成本服从γ分布，可以得到成本-效果可接受曲线及增量成本-效果散点图，见图3、4。当支付意愿阈值设置为3倍人均GDP时，即242 928.00，CEA组增加的成本是可以接受的。
3　讨论
收起
本研究结果表明，在十年的Markov模拟期内，CEA与药物治疗的ICER为129 435.97元/QALY，建议CEA增加的成本是可以接受的。此外，本研究还通过最新发表的类临床随机试验研究验证了模型的稳定性。
最近还有几项研究集中于CEA与药物治疗在无症状颈动脉狭窄的经济评价，在Thapar[27]的研究中，他们使用了ACST-1研究的数据，发现早期CEA对于年龄小于75岁且支付意愿高于20 000英镑/QALY的患者是具有成本效果的。但他们也指出，如果每年卒中率低于1%，早期CEA将不具有成本效果。最近，还有一些临床随机对照试验在试图探讨治疗无症状颈动脉狭窄的其他策略，ACST-2(第二次无症状颈动脉手术试验)研究比较了CEA与颈动脉支架(CAS)治疗无症状颈动脉狭窄，发现CEA和CAS均具有相当的低卒中风险[28]。Brott等的研究也发现CAS效果可能并不亚于CEA。已发表的ACST-1研究是一项比较CEA与药物治疗的大型临床随机试验，但其中一些患者在未使用降脂药物的情况下开始纳入研究，这可能会削弱药物治疗的真正疗效。目前正在进行的CREST-2试验旨在研究血运重建与药物治疗的疗效，可能会提供一些新的观点[29]。然而，这些研究并没有解决颈动脉介入手术何时介入合适的问题。
Howard[30]的研究发现CEA相对于药物治疗的受益在很大程度上取决于狭窄的程度，对于中度狭窄的患者，药物治疗的五年卒中风险较低，但对于重度狭窄的患者完全可以从CEA手术中受益，该研究可能提供了一个新的视角。在此项研究中，CEA患者的年死亡率、手术费用、围手术期死亡对ICER有明显影响，表明手术费用和围术期并发症可能影响CEA的实际疗效，减少手术花费、降低围术期并发症可能是一种持续提高成本-效果的途径。此外，无症状颈动脉狭窄治疗的改善不仅在于药物治疗，还在于支架和经颈动脉血运重建术的进展[31-33]。
本研究有几个局限性。首先，研究中的数据不是原始数据，而是从已发表文章转换而来的数据，这可能会引入偏倚。其次，虽然使用了不同来源的数据，并证明CEA在当前中国环境下增加的成本是可以接受的，但如果数据来自中国人群，则会更好。最后，由于缺乏高危患者的数据，这限制了分析CEA在此类人群中的成本-效果，基于此类人群的真实世界研究可能会提供更多的医疗决策信息。
文献
收起
参考文献 引证文献
排序方式：
[1]
Feigin VL, Stark BA, Johnson CO, et al. Global, regional, and National burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019[J]. The Lancet Neurology, 2021, 20(10): 795-820.
[2]
Zhou MG, Wang HD, Zeng XY, et al. Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017[J]. Lancet,2019, 394(10204): 1145-1158.
[3]
Heck D, Stenosis JAC, Stroke. And carotid artery revascularization[J]. Progress in Cardiovascular Diseases, 2021, 65: 49-54.
[4]
Naylor AR, Ricco JB, De BG, et al. Editor's Choice-Management of atherosclerotic carotid and vertebral artery disease:2017 clinical practice guidelines of the European society for vascular surgery(ESVS)[J]. European Journal of Vascular and Endovascular Surgery:The Official Journal of the European Society for Vascular Surgery,2018, 55(1): 3-81.
[5]
陈忠， 杨耀国.颈动脉狭窄诊治指南[J].中国血管外科杂志:电子版，2017，9（3）：169-175.
Chen Z, Yang YG. Guidelines for diagnosis and treatment of carotid stenosis[J]. Chinese Journal of Vascular Surgery(Electronic Version), 2017, 9(3):169-175.
[6]
Müller MD, Lyrer P, Brown MM, et al. Carotid artery stenting versus endarterectomy for treatment of carotid artery stenosis[J]. Cochrane Database of Systematic Reviews (Online), 2020, 2(2):CD000515.
[7]
Barnett HJM, Taylor DW, Haynes RB, et al. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis[J]. New England Journal of Medicine, 1991, 325(7):445-453.
[8]
Barnett HJ, Taylor DW, Eliasziw M, et al. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators[J]. New England Journal of Medicine, 1998, 339(20):1415-1425.
[9]
Domenick NS, Chaer RS, Smith K, et al. Carotid endarterectomy remains cost-effective for the management of carotid stenosis[J].Journal of the American College of Surgeons, 2021, 233(5): e234.
[10]
Paraskevas KI, Moore WS, Veith FJ. Commentary: carotid artery stenting: still not as cost-effective as carotid endarterectomy, but the contest continues[J]. Journal of Endovascular Therapy, 2014, 21(2): 303-305.
[11]
Halliday A, Harrison M, Hayter E, et al. 10-year stroke prevention after successful carotid endarterectomy for asymptomatic stenosis(ACST-1): a multicentre randomised trial[J]. The Lancet, 2010, 376(9746): 1074-1084.
[12]
Keyhani S, Cheng EM, Hoggatt KJ, et al. Comparative effectiveness of carotid endarterectomy vs initial medical therapy in patients with asymptomatic carotid stenosis[J]. JAMA Neurology, 2020, 77(9):1110-1121.
[13]
Luebke T, Brunkwall J. Impact of Real-World adherence with best medical treatment on Cost-Effectiveness of carotid endarterectomy for asymptomatic carotid artery stenosis[J]. Annals of Vascular Surgery, 2016, 30: 236-247.
[14]
Wang WZ, Jiang B, Sun HX, et al. Prevalence, incidence, and mortality of stroke in China: results from a nationwide Population-Based survey of 480 687 adults[J]. Circulation, 2017, 135(8): 759-771.
[15]
国家卫生健康委员会.中国卫生健康统计年鉴-2021[M].北京：中国协和医科大学出版社，2021.
National Health Commission. China Health Statistics Yearbook 2021[M].Beijing: Peking Union Medical College Press, 2021.
[16]
Kaboré N, Marnat G, Rouanet F, et al. Cost-effectiveness analysis of mechanical thrombectomy plus tissue-type plasminogen activator compared with tissue-type plasminogen activator alone for acute ischemic stroke in France[J]. Revue Neurologique, 2019, 175(4): 252-260.
[17]
Song JL, Murugiah K, Hu S, et al. Incidence, predictors, and prognostic impact of recurrent acute myocardial infarction in China[J].Heart, 2020, 107(4): 313-318.
[18]
Krittayaphong R, Permsuwan U.Cost-Effectiveness analysis of Sacubitril-Valsartan compared with enalapril in patients with heart failure with reduced ejection fraction in Thailand[J]. American Journal of Cardiovascular Drugs, 2018, 18(5): 405-413.
[19]
Tengs TO, Lin TH. A Meta-Analysis of Quality-of-Life estimates for stroke[J]. PharmacoEconomics, 2003, 21(3): 191-200.
[20]
Baradaran H, Gupta A, Anzai YSI, et al. Cost effectiveness of assessing ultrasound plaque characteristics to risk stratify asymptomatic patients with carotid stenosis[J]. Journal of the American Heart Association, 2019, 8(21): e012739.
[21]
刘利勤，李青，胡明，等.应用Markov模型对3种血管紧张素Ⅱ受体拮抗剂预防高血压患者卒中和心肌梗死的经济学评价[J].中国药学杂志，2019，54（2）：137-143.
Liu LQ, Li Q, Hu M, et al. Economic evaluation of three angiotensin Ⅱreceptor antagonists in preventing stroke and myocardial infarction in patients with hypertension based on Markov model[J]. Chinese Pharmaceutical Journal, 2019, 54(2): 137-143.
[22]
Chen JG, Liang X, Tong X, et al. Economic evaluation of intravenous alteplase for stroke with the time of onset between 4.5 and 9 hours[J]. Journal of NeuroInterventional Surgery, 2023, 15(1): 46-51.
[23]
中国心血管健康与疾病报告编写组.中国心血管健康与疾病报告2021概要[J].中国循环杂志，2022，37（6）：553-578.
Zhong Guo Xin Xie Guan Jian Kang Yu Ji Bing Bao Gao Bian Xie Zu.Report on cardiovascular health and diseases in China 2021: an updated summary[J]. Chinese Circulation Journal, 2022, 37(6): 553-578.
[24]
侯帆迪.CEA和CAS治疗颈动脉狭窄的临床资料分析[D].石河子：石河子大学，2018.
Hou FD. The Clinical Data Analysis of Carotid Artery Stenosis Treated with Carotid Endarterectomy and Carotid Artery Stenting[D]. Shihezi: Shihezi University, 2018.
[25]
国家统计局. 居民消费价格指数(上年=100)（2016-）[EB/OL].[2023-12-20]. https://data.stats.gov.cn/tablequery.htm?code=AD09&from.
The National Bureau of Statistics. Consumer price index (previous year =100) (2016-) [EB/OL]. [2023-12-20]. https://data.stats.gov.cn/tablequery.htm?code=AD09&from.
[26]
刘国恩.中国药物经济学评价指南[M].北京：中国市场出版社，2020.
Liu GE. Guidelines for pharmacoeconomic evaluation in China[M]. Beijing:China Market Press, 2020.
[27]
Thapar A, Garcia Mochon L, Epstein D, et al. Modelling the cost-effectiveness of carotid endarterectomy for asymptomatic stenosis[J].British Journal of Surgery, 2013, 100(2): 231-239.
[28]
Halliday A, Bulbulia R, Bonati LH, et al. Second asymptomatic carotid surgery trial (ACST-2): a randomised comparison of carotid artery stenting versus carotid endarterectomy[J]. Lancet, 2021,398(10305): 1065-1073.
[29]
Turan TN, Voeks JH, Chimowitz MI, et al.Rationale, design, and implementation of intensive risk factor treatment in the CREST2 trial[J]. Stroke, 2020, 51(10): 2960-2971.
[30]
Howard DPJ, Gaziano L, Rothwell PM, et al. Risk of stroke in relation to degree of asymptomatic carotid stenosis: a population-based cohort study, systematic review, and meta-analysis[J]. Lancet Neurolog, 2021, 20(3): 193-202.
[31]
Thomas JP, Kumins NH, Schneider PA, et al. Balloon dilation strategy does not affect outcomes for transcarotid artery revascularization in prospective trials[J]. Journal of Vascular Surgery, 2022, 76(1): 202-208.
[32]
Pandya A, Gupta A, Kamel H, et al. Carotid artery stenosis: cost-effectiveness of assessment of cerebrovascular reserve to guide treatment of asymptomatic patients[J]. Radiology, 2015, 274(2): 455-463.
[33]
Kashyap VS, King AH, Foteh MI, et al. A multi-institutional analysis of transcarotid artery revascularization compared to carotid endarterectomy[J]. Journal of Vascular Surgery, 2019, 70(1): 123-129.
2024年第51卷第1期
PDF下载
43
19
引用本文
BibTeX
文章信息
doi: 10.20043/j.cnki.MPM.202308506
  • 接收时间：2023-08-26
  • 首发时间：2026-03-19
  • 出版时间：2024-01-10
补充材料
相关文章
文章信息
作者
出版历史
  • 收稿日期：2023-08-26
基金
作者信息
    1.四川大学华西公共卫生学院/华西第四医院，四川 成都 610041
    2.四川省安岳县人民医院，四川 资阳 642350

通讯作者:

杨艳芳，E-mail:
参考文献
分享链接
https://castjournals.cast.org.cn/joweb/xdyfyx/CN/10.20043/j.cnki.MPM.202308506
分享至
全文二维码

扫描看全文

引用本文
BibTeX
本文的引用情况
2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
关闭全屏
相关链接
论文
最新文章
热读文章
热点专题
内参
蓝皮书
产业发展报告
传播力报告
期刊分级目录
资讯
学术新闻
行业新闻
学术会议
行业会议
关于
关于我们
联系我们
北京市海淀区学院南路86号
100081
010-62199257
qkjq@cast.org.cn

中国科学技术协会版权所有 京ICP 备10216604号-4 海淀分局备案 1101084647
科技导报社主办 中国科协信息中心技术支持