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目的:对于目前国内药物洗脱支架(DES)在临床普遍使用的现象进行社会经济学分析,为我国DES和金属裸支架(BMS)的科学合理使用提供依据.方法:运用成本效果分析方法分析比较了唐都医院心内科冠心病患者在经皮冠状动脉介入治疗(PCI)中植入DES相对于BMS的相关医疗成本开支的成本效果,以2006年国家统计局公布的我国居民人均年收入为标准,初步估测中国居民个人支付相关医疗费用的情况.结果:随着植入支架个数(1根或2根)和中国各地居民所享受的医保制度不同,植入DES较BMS增加的医疗费用相当于2006年中国城镇居民人均年可支配收入的0.80~1.32倍,2006年中国农民年纯收入的7.03~12.20倍.按照DES减少靶血管血运重建(TVR)率不同,植入1根或2根支架时,为避免一次TVR事件,中国城镇居民和农民需额外支付的医疗费用为人民币9720~59 500元和38 000~205 833元.结论:就中国医疗保障体系和国民的个人支付能力而言,BMS可能不应该过早地退出心血管介入领域.
OBJECTIVE: To provide a basis for the scientific and reasonable use of DES and bare metal stent (BMS) in our country for the socio-economic analysis of the current widespread use of drug-eluting stent (DES) in our country.Methods: The cost-effectiveness analysis was used to analyze and compare The cost effectiveness of medical costs related to DES implanted in percutaneous coronary intervention (PCI) in patients with coronary heart disease in the Department of Cardiology of Tangdu Hospital is based on the annual per capita income of Chinese residents released by the National Bureau of Statistics in 2006 , And initially estimated the personal medical expenses paid by Chinese residents.Results: With the different number of stents (1 or 2) and the medical insurance system enjoyed by residents in various places in China, the medical cost of DES was higher than that of BMS Equivalent to 0.80-1.32 times of annual disposable income of urban residents in China in 2006 and 7.03-12.20 times of annual net income of Chinese peasants in 2006. According to the different rates of target reduction of target vessel revascularization (TVR) by DES, one or 2 stents, in order to avoid a TVR incident, urban residents and peasants in China need to pay extra RMB 9720- 59 500 and RMB 38 000- 205 833 for medical expenses.Conclusion: With regard to China’s medical insurance system For individual citizens the ability to pay, BMS probably should not prematurely withdraw from cardiovascular intervention field.