Cost-effectiveness Analysis And Health Economics Research Of AngioJet And CDT For Lower Extremity Deep Vein Thrombosis

Objective:Lower extremity deep vein thrombosis(LEDVT)is a disease caused by the formation of an embolus in the venous system and obstruction of venous blood circulation.Although doctors’ awareness and strategy of prevention have been improved,the incidence rate has not declined.Even under standard anticoagulant therapy,more than 70% of the patients still have post thrombotic syndrome(PTS).Therefore,the rapid recovery of venous access and reducing the incidence of PTS have become the focus of clinical attention in recent years.Due to the complexity of the cause of LEDVT,the treatment methods are different.Catheter directed thrombolysis(CDT)is the most commonly used treatment at present.Its thrombolytic efficiency is higher than that of systemic thrombolysis,with less bleeding complication,but the catheter time is longer.AngioJet has high thrombolytic efficiency,and will not cause serious damage to the vein wall and valve.Compared with CDT,the cost of AngioJet is higher,and its indications are still controversial.There is a lack of relevant research in health economics,which can’t measure the benefits of different treatments to patients.The objective of the research is to compare the benefits of the 2 methods through the comprehensive evaluation of LEDVT patients receiving surgical treatment,and to predict the long-term cost of the two methods by building Markov model,and to give clinicians suggestions on the choice of treatment methods,so that patients can get the maximum benefits in terms of curative effect,life and economy.Methods:1.Participants:79 cases of LEDVT diagnosed in vascular surgery of Northern Jiangsu People’s Hospital from December 2018 to August 2020 were collected.The patients were divided into AngioJet group(n = 47)and CDT group(n = 32).The general information,treatment effect and treatment cost of patients were counted.2.Research methods:1)Perioperative cost-effectiveness analysis: The therapeutic effects of LEDVT were classified according to “diagnostic and curative effect standard of deep venous thrombosis of lower extremity".The medical cost of patients is determined through the hospital financial system and the cost-effectiveness analysis was performed based on the data.2)Long term effect prediction: Markov model was used to simulate the disease outcome of LEDVT patients,and the long-term cost-effectiveness ratio of the two treatment methods was predicted by the conversion rate,effect value and corresponding cost of each Markov state.3)Sensitivity analysis: The perioperative cost-effectiveness analysis was sensitized by the discount rate.The stability of markov model was verified through single factor sensitivity analysis and probabilistic sensitivity analysis.3.Statistical analysisSPSS 25.0 software was used for statistical analysis of the data,and the Markov model was constructed and analyzed by Tree Age 2011.Result:1.There was no significant difference in baseline data and stent(balloon)usage between the two groups,indicating strong comparability.Preoperative quantitative score was 19.23±3.19 in the AngioJet group and 20.88±3.17 in the CDT group.After treatment,the patients were discharged from the hospital with 2.85±2.24 points in the AngioJet group and 5.25±2.14 points in the CDT group.The symptoms in both groups were significantly improved,and the AngioJet group was more obvious(P<0.001).By reference to Nimodipine method to calculate symptoms integral,AngioJet group levelⅢ therapy was higher than that of CDT,levels Ⅱ and Ⅰ treatment were lower than that of CDT group.2.Due to the use of consumables,the average cost was ￥77498.11 ± 19365.25 in AngioJet group and ￥66092.58 ± 9336.93 in CDT group.Through the comparison of cost and benefit,it was found that it cost ￥2579.831 for AngioJet group to achieve 1%grade III treatment rate,and ￥5287.406 for CDT group.The cost of CDT group was lower than that of AngioJet group when the treatment effect reached grade II and grade I.The sensitivity analysis of 5% discount rate shows that AngioJet can get better therapeutic effect with lower cost.3.After 20 cycles of Markov model,the probability of the AngioJet group in the post-thrombosis state was 0.353,and the probability of the CDT group was 0.2570.The probability of the AngioJet group in the ideal state was higher.The PTS probability of CDT group was 0.4308,which was higher than that of AngioJet group.The cumulative C/E of AngioJet is 6872.4263 ￥/QALYs,while that of CDT is 10762.1391 ￥/QALYs.The sensitivity analysis results showed that the markov model had strong stability,and the long-term benefit of AngioJet was higher than that of CDT,which was a treatment with more benefits for patients Conclusion:1.Both AngioJet and CDT can effectively treat LEDVT with safety.Compared with CD,the treatment effect of AngioJet is better.Although the cost of AngioJet is higher than that of CDT due to the use of consumables,the treatment effect of AngioJet can still be achieved at a lower cost.2.The long-term cost-effectiveness prediction based on Markov model shows that the long-term benefit of AngioJet is more advantageous than that of CDT group,and the conclusion is the same as that of clinical studies.This indicates that AngioJet is a highly effective treatment for LEDVT patients.If the economy permits,AngioJet can be used.