急性缺血性卒中3 h内rt-PA溶栓的成本效用分析

目的 评价在当前中国医疗环境下，急性缺血性卒中3 h内重组人组织型纤溶酶原激活剂
（recombinant tissue-type plasminogen activator，rt-PA）溶栓治疗的成本效用情况。
方法 建立决策树与Markov模型相结合的模型，采用现有数据库分析和文献查阅等方法收集急性
缺血性卒中3 h内rt-PA溶栓治疗的效果、成本、健康效用及转移概率等模型参数。通过模型模拟，计
算溶栓后短期（1年或2年）和长期（30年）增量成本效果比（incremental cost-effectiveness ratio，ICER）
情况。
结果 溶栓治疗后1年ICER值为93 796元/健康调整寿命年（quality-adjusted life-years，QALY），
ICER<3个人均国内生产总值（gross domestic product，GDP）（105 000元）/QALY。rt-PA治疗后30年ICER
值为5953元/QALY，ICER<1个人均GDP（35 100元）/QALY，rt-PA治疗增加的成本完全值得。
结论 在我国当前国情背景下，急性缺血性卒中患者3 h内rt-PA溶栓后短期和长期均具有经济性。

Cost-Utility Analysis of rt-PA Thrombolysis within 3 Hours of Acute Ischemic Stroke

Objective To determine the cost-utility of recombinant tissue-type plasminogen activator (rt-PA) treatment within 3 hours after onset of acute ischemic stroke in China.
Methods A combination of decision tree and Markov model was developed to determine the cost-utility of rt-PA treatment versus non-rt-PA treatment within 3 hours after stroke onset. Outcomes, costs, utility and transfer proportion of the model were derived from the database and the literatures. Incremental cost-effectiveness ratio (ICER) was estimated in both short term (2 years) and long term (30 years).
Results Compared to non-rtPA treatment, rt-PA treatment within 3 hours had ICER of CNY 93,796 per quality-adjusted life-year (QALY) gained in 1 year which was lower than a willingness-to-pay threshold of CNY 105,000 (3 GDP of China) per QALY. Thrombolysis also had an ICER of CNY 5,953 per QALY gained in 30 years which was lower than a willingness-to-pay threshold of CNY 35,100 (1 GDP of China) per QALY.
Conclusion Intravenous rt-PA treatment within 3 hours is highly cost-effective for acute ischemic strokes in China.