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DES降低医保患者的再血管化发生率
DES Lowered Revascularization Rates in Medicare Patients
（阜外心血管病医院 高立建 翻译）
关键词：从2001年到2004年心血管相关费用降低
与金属裸支架时代接受PCI治疗相比，接受DES治疗的医保患者再血管化率较低，而且不增加STEMI或死亡。
David J. Malenka医生报道了一项包括67003例医保患者的观察性研究，该研究比较了金属裸支架（BMS）时代和药物洗脱支架（DES）时代的结果，David J. Malenka医生是来自于黎巴嫩Dartmouth-Hitchcock医疗中心的心脏病学专家。
DES时代与BMS时代接受支架治疗的患者相比，未调整的再血管化累积风险DES(n=28,086; HR=0.82; 95% CI, 0.79-0.85)较BMS(n=38,917)低。而死亡率或STEMI发生率两组相似(HR=0.96; 95% CI, 0.92-1.01)。
alenka说道：“在医保范围内的人群可提供的DES降低了再次血管重建率，同时并不增加STEMI或死亡风险。”Malenka推测无论其他任何与DES相关的风险增加，都能够被DES降低再狭窄率及治疗再狭窄的操作风险所抵消。
DES的费用-效益和结果
David J. Cohen医生，是哥伦比亚大学临床内科副教授，报道了DES的结果和费用-效益的相关分析。该研究包括了2001年前BMS时代 (n=14,362)和2004年后DES时代(n=16,374) 进行PCI或CABG的医保患者。根据这项研究结果，在后DES时代相对减少了20%的MI(10.6% 与8.5%; P=0.001)和7%的再血管化(17.1% 与16.0%; P =0.01)。两组死亡率没有差别。从2001年-2004年间，心血管费用平均降低了1680美元，而非心血管相关费用增加了2481美元。虽然每位再血管化患者的治疗费用从2001年的32780美元降低到2004年的31100美元（5%），但每10，000例医保受益人通过PCI或CABG进行再血管化率增加了11%。
Cohen说：“当真正考虑到这两个方面的因素和调查是什么影响着整个美国医保费用。与再血管化相关的人数和总的心血管费用和每例再血管化的费用，在当时医疗框架下的费用实际上增加了544万美元。”“这完全可以用我们完成再血管化操作所解释”。
（来源：www.tctmd.com）
DES Lowered Revascularization Rates in Medicare Patients
Key Points:
• Cardiovascular-related costs decreased from 2001 to 2004.
By TCT Daily Staff
Medicare patients receiving DES had lower rates of repeat revascularization and no observed increase in STEMI or death compared with patients receiving PCI in the bare-metal stent era.
Results of an observational study of 67,003 Medicare patients comparing outcomes from both the bare-metal stent and DES eras were reported by David J. Malenka, MD, a cardiologist at the Dartmouth-Hitchcock Medical Center in Lebanon, NH.
The unadjusted cumulative risk of repeat revascularization was lower for patients receiving stents in the DES era (n=28,086; HR=0.82; 95% CI, 0.79-0.85) compared with the bare-metal stent era (n=38,917). The unadjusted rate of death or STEMI was similar between the DES and bare-metal stent cohorts (HR=0.96; 95% CI, 0.92-1.01).
"Within the Medicare population the availability of DES has decreased the incidence of repeat revascularization without increasing the incidence of STEMI or death," Malenka said. "We can speculate ... that whatever the other increased risk associated with DES is, it is offset by a decrease in the risk of developing restenosis and the risk of any procedure used to treat that restenosis."
Cost-effectiveness and outcomes of DES
David J. Cohen, MD, associate professor of clinical medicine at Columbia University, presented results of a related analysis of outcomes and cost effectiveness of DES. The study included Medicare patients who underwent PCI and CABG in the pre-DES era in 2001 (n=14,362) and post-DES era in 2004 (n=16,374). According to the study results, there was a 20% relative reduction in MI (10.6% vs. 8.5%; P,.001) and a 7% relative reduction in any repeat revascularization (17.1% vs. 16.0%; P=.01) in the post-DES group. There was no significant difference in mortality between the groups.
There was an average decrease of $1,680 in cardiovascular costs between 2001 and 2004 coupled with an average increase in non-cardiovascular costs of $2,481. Although the cost per revascularized patient dropped from $32,780 in 2001 to $31,100 in 2004 (5%), the revascularization rate per 10,000 Medicare beneficiaries increased by 11% for patients undergoing PCI and CABG.
"When you actually take these two into account and look into what has been the net impact of Medicare spending over the entire U.S. population and despite the cost per revascularized patients, total cardiovascular expenditures associated with revascularizations and follow-up actually increased by about $544 million over that time frame," Cohen said. "It is explained entirely by the increase in revascularization procedures that we are performing."
Disclosures:
• Dr. Malenka reports no relevant conflicts of interest.
• Dr. Cohen reports no relevant conflicts of interest.
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