目的：分析经导管主动脉瓣置换术（TAVR）对比外科主动脉瓣置换术（SAVR）治疗重度主动脉瓣狭窄（AS）的住院费用,为临床治疗决策与相关部门政策制定提供依据。方法：收集上海市某大型综合医院2015年-2019年应用TAVR术和SAVR治疗AS的病例资料,对使用TAVR和SAVR两组患者根据人口学以及病情的基线特征进行匹配,对比分析两组患者住院期间发生的住院总费用、费用结构和人均住院天数。结果：共收集285例（TAVR 92例,SAVR 193例）患者资料,PSM匹配后共获得TAVR和SAVR各30例。AS患者首次进行TAVR术或SAVR术的平均住院总费用分别为284476元和153772元,其中材料费用占比分别为90.2%和57.2%,住院总费用和材料费用两组之间都具有显著统计学差异。住院天数方面,TAVR术、SAVR术分别是9.3天和15.0天,具有统计学差异。结论：TAVR术对比SAVR术治疗主动脉瓣狭窄可以显著降低住院天数,然而TAVR术的住院总费用显著高于SAVR术,患者经济负担较重,临床应用与推广TAVR术时应当给予关注。
Abstract
Objective: To assess the in-hospital costs of transcatheter aortic valve replacement (TAVR) vs. surgical aortic valve replacement (SAVR) in the treatment of severe aortic stenosis. Methods: Patients treated with TAVR and SAVR in Shanghai Zhongshan Hospital from 2015 to 2019 were retrospectively collected, according to demography and baseline characteristics of the disease, propensity score matching (PSM) was used to control for baseline bias factors. The total hospitalization expenses, cost structure and per capita hospitalization days of the two groups were compared and analyzed. Results: A total of 285 cases (92 cases of TAVR and 193 cases of SAVR) were collected. After PSM, 30 cases of TAVR and 30 cases of SAVR were obtained. The results showed that the average total hospitalization cost of AS patients undergoing TAVR or SAVR for the first time was 284,476 yuan and 153,772 yuan, respectively, of which consumables cost accounted for 90.2% and 57.2%, respectively. The total hospitalization cost and consumables cost showed statistical differences between the two groups. In terms of hospitalization days, TAVR and SAVR were 9.3 and 15.0 days, respectively, with statistical differences. Conclusion: Compared with SAVR, TAVR can significantly reduce the length of hospital stay in the treatment of severe aortic stenosis. However, the total in-hospital costs of TAVR is significantly higher than SAVR, which leads to a heavy economic burden. Thus, we should pay attention to the clinical application and promotion of TAVR.
关键词
经导管主动脉瓣置换术 /
外科主动脉瓣置换术 /
住院费用
Key words
Transcatheter aortic valve replacement /
Surgical aortic valve replacement /
in-hospital costs
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