Koroner arter hastalığının tedavisinde çıplak metal stent ile ilaç salınımlı stentin maliyet etkililik analizi

Bu çalışma, Koroner Arter Hastalığının (KAH) tedavisinde kullanılan ilaç salınımlı stent ile çıplak metal stent takılan hastaların klinik takiplerinin yapılarak, hangi tedavi türünün klinik olarak daha etkili olduğunu, maliyet bakımından iki tedavi türünün kıyaslanmasını ve stent geri ödemesiyle ilgili alternatif önerileri ele almaktadır. 2009 Nisan-2013 Şubat döneminde stent takılan hastalar için tüm muayene, tetkik, tedavi, ilaç, stent türüne ait veriler Sosyal Güvenlik Kurumu (SGK) veri ambarından temin edilmiş olup, ilaç salınımlı stent takılan hastalarla ilaçsız stent takılan hastaların durumları; stent takıldıktan ne kadar süre sonra sonra kalp krizi (MI) geçirdikleri, ne kadar süre sonra antikoagülan ilaçları kullanmaya başladıkları, birden fazla stent takılma oranı ve maliyetler açısından veri madenciliği yöntemleri kullanılarak kıyaslanmıştır. Ayıca, uluslararası yayından yararlanılarak elde edilen kaliteye ayarlanmış yaşam yılları (QALY) değerleri kullanılarak oluşturulan karar ağacı ile her iki tedavi yöntemi maliyet etkililik yönünden karşılaştırılmıştır. Çalışma sonucunda, ilaç salınımlı stent ile çıplak metal stent tedavisinin maliyet yönünden ve klinik olarak karşılaştırması yapılarak mevcut geri ödeme sistemine alternatif olabileceği düşünülen yeni öneriler getirilmiştir. Ayrıca, yapılan karar ağacı maliyet etkililik analizi neticesinde ilaç salınımlı stentlerin ilaçsız stentlere göre maliyet etkili olmadığı sonucu bulunmuştur.

Cost effectiveness analysis of drug eluting stents and bare metalstents in the treatment of coronary artery disease

This study addresses compared cost effectiveness of drug-eluting stents and bare metal stents which are used in coronary artery disease and discusses which treatment is superior to one another and evaluates alternative suggestions about reimbursement of these stent types through clinical follow up of stent-placed patients. For the period of April 2009-September 2013, the data related to entire clinical examinations, inspections, treatments, drugs and stent types have been obtained from Turkish Social Security Institution (SSI) data warehouse. Status of patients with drug-eluting stents and bare metal stents have been compared in terms of time of first date of heart attack (MI), starting use of anticoagulant drugs after stent plantation, more-than-one- stent implementation rate and stenting expenditures by use of data mining practices. Moreover, benefiting from quality-adjusted life years (QALY) values derived from international publications a decision tree is created and that two treatment methods are compared in terms of cost effectiveness. At the end of the study, by comparing drug-eluting stents and bare metal stent treatments in terms of cost and clinical outputs, proposals which might be an alternative to the current reimbursement system are brought forward. In addition, as a result of the decision tree cost effectiveness analysis, it is concluded that drug-eluting stents are not superior to bare metal stents.

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Akdağ, Recep Türkiyede Sağlıkta Dönüşüm Programı Değerlendirme Raporu (2003-2010), Sağlık Bakanlığı, Ankara, 2011.
Bagust, Adrian; Greyson A. D., Palmer N. D., Perry R. A. ve T. Walley Cost Efectiveness of Drug-Eluting Coronary Artery Stenting in a UK Setting: Cost- Utility Study, Heart Journal, Cilt:92, Sayı:1, 2006.
Baim, Donald S., Grossmans Cardiac Catheterization, Angiography and Intervention, Lippincott Williams &Wilkins, Boston, 2006.
Bowen, James; Hopkins Robert, He Yaohua, Bcoom Gord Blackhouse, Lazzam Charles, Tu Jack, Cohen Eric, Tarride Jean-Eric ve Ron Goeree Systematic Review and Cost- Effectiveness Analysis of Drug Eluting Stents Compared to Bare Metal Stents for Percutaneous Coronary Interventions in Ontario, Interim Report Prepared for the Ontario Ministry of Healty & Long-Term Care, Report No: HTA002-0512, 2005.
Brophy, James M. ve Lonny J. Erickson Cost Effectiveness of Drug-Eluting Coronary Stents in Quebec, Canada, International Journal of Technology Assessment in Health Care, Cilt: 21, Sayı:3, Temmuz 2005.
Drummond, Michael F.; Sculper Mark J., Torrance George W., OBrien Bernie J. ve Greg L. Stoddart (2006) Methods for the Economic Evaluation of Health Care Programmes, Oxford University Press Inc., New York, 2006, s. 124.
Eısenberg, J. Mark Drug-Eluting Stents: The Price is not Right, American Heart Association, 2006.
Ekman, Mattias; Sjögren, Iwar ve Stefan James, Cost Effectiveness of the Taxus Paclitaxel-Eluting Stent in the Swedish Health Care System, Scandinavian Cardiovascular Journal, Cilt. 40, Sayı.1, Şubat 2006, s. 17-24.
EUnet HTA (2008), Core HTA on Drug Eluting Stents, Work Package 4, Avrupa Komisyonu, Aralık 2008, s. 67-73, Finlandiya.
Food and Drug Administration (FDA) Many New Heart Devices, Such as Valvesand Stents, are Approved for use by the US Food and Drug Administration Without Good Studies Showing That They Offer Any Benefits Beyonde Existing Treatments, According to a New Study, Monday Morning, Cilt: 20, Sayı: 43, Kasım 2012.
Gisela Kobelt, Health Economics: An Introduction to Economic Evaluation, Office of Health Economics, Londra, Mart 2002, s. 9-23.
Groeneveld Peter; Matta Peter, Matta Anne, Greenhut P. Alexis ve Feifei Yang The Costs of Drug-Eluting Coronary Stents Among Medicare Beneficiaries, American Heart Journal, Cilt: 155, Sayı: 6, s.1097.
HAS, Assessment of Drug-Eluting Stents, Medical Device and Health Strategies Assessment Department, Fransa, 2009.
Mittmann Nicole Economic Evaluation of Drug Eluting Stents-Technology Report No 53, Canadian Coordinating Office for Health Technology Assessment, Ottawa, 2005, s. 3.
National Institute for Health and Care Excellence (NICE) (2009), Drug Eluting Stents for the Treatment of Coronary Artery Disease, NICE Technology Appraisal Guidance 152, 2009, s.5.
Nice, Drug Eluting Stents for the Treatment of Coronary Artery Disease, Nice Technology Appraisal Guidance 152, 2008.
Neyt, Mattias; Brabandt Hans Van, Devriese Stephan, Mahieu Joris (UA), De Ridder Annemieke (UA), De Graeve Diana (UA) ve Chris De Laet Drug Eluting Stents in Belgium: Health Technology Assessment, the Belgian Health Care Knowledge Centre, 2007.
Neyt, Mattias; De Laet Chris, De Ridder Annemieke and Hans Van Brabandt Cost Efectiveness of Drug-Eluting Stents In Belgian Practice: Healthcare Payer Perspective, Pharmacoeconomics, Cilt: 27, Sayı: 4, 313-327, Nisan 2009.
Normand, Charles ve Axel Weber, Social Health Insurance: A Guide Book For Planning, World Health Organization, 1994.
Amin, Amit P. ve diğerleri, Use of Drug- Eluting Stents as a Function of Predicted Benefit, JAMA International Medicine, Cilt:172, Sayı: 15, Ağustos 2012, s. 1143.
Serruys, Patrick W., Anthony H. Gershlick, Handbook of Drug-Eluting Stents, Taylor and Francis Group, Global, 2005.
Smith, Sidney C.; Feldman Ted E., Hirsfeld John W., Jacobs Alice K., Kern Morton J., King Spencer B., Morrison Dauglas A., ONeill William W., Schaff Hartzell V. ve Patrick L. Whirlow Guideline Update for Percutaneous Coronary Intervention- Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, American Heart Association Journals, Cilt:113, Sayı:1, 2006.
Sosyal Güvenlik Kurumu Veri Ambarı MEDULA Sistemi (2013), 2009-2013 Dönemi Stent, MI, Antikoagülan İlaç ve Komorbidite Verileri, 2013, Ankara.
Türk Kardiyoloji Derneği Arşivi, Kadın Kalbinde Kırmızı Alarm Sonuç Raporları, Türk Kardiyoloji Derneği Arşivi, Cilt.38, 2010, s.9-10.
Vasaıwala Samip ve diğerleri, Comparison of Bare-Metal Stents and Drug-Eluting Stents in Coronary Ostial Lesions (from the National Heart, Lung, and Blood Institute Dynamic Registry). Amerika Kardiyoloji Dergisi, Cilt: 110, Sayı: 8, 15.10.2012.
Yeh, Robert W.; Normand Sharon-Lise T., Wolf Robert E., Jones Philip G., Ho Kalon KL, Cutlip Donald E., Mauri Laura, Kugelmass Aaron D., Amin Amit P. ve John A. Spertus Predicting the Restenosis Benefit of Drug-Eluting Versus Bare Metal Stents in Percutaneous Coronary Intervention, American Heart Association, 2011 [http://en.wikipedia. org/wiki/Canadian_Agency_for_Drugs_ and_Technologies_in_Health]