急性缺血性腦中風使用血栓溶解劑與動脈內取栓術之成本效果分析之探討-系統性文獻回顧暨統合分析

研究目的：1995年後，靜脈注射血栓溶解劑治療（IV r-tPA）已成為急性缺血性腦中風的標準治療。為了有效治療急性缺血性腦中風，2015年全球開始執行動脈內取栓術治療(IAT)。IAT是否優於IV r-tPA，目前尚無一致性結論，本研究旨在利用系統性文獻回顧暨統合分析探討IAT與IV r-tPA之成本、效果與成本效果分析，以期能得出一致性結論。研究方法：本研究使用系統性文獻回顧暨統合分析，利用關鍵字搜尋8個電子資料庫，再依據PRISMA四階段與檢核表納入18篇文獻，IAT與IV r-tPA之成本、效果差異使用CMA 3統合分析軟體進行分析：Q-value、I2、漏斗圖、總效果量和森林圖；二者成本效果分析則以敘述性統計比較呈現。研究結果：經統合分析結果，在成本上IAT較IV r-tPA高；在效果上IAT的效果上，中風90天後整體性功能評估(mRS)較IV r-Tpa好；在死亡率比較IAT較IV r-Tpa發生率高；在顱內出血率比較中IAT較IV r-Tpa高。於ICER比較IAT較IV r-Tpa介於非常具有成本效果。結論與應用：研究發現二者皆具有成本效果，IAT較IV r-tPA成本高，且90天後整體性身體功能(mRS)較佳，降低病人身體失能狀況。台灣目前無二者成本效果分析，期待有此方面的研究，以提供國人更好的就醫選擇。

關鍵字

急性缺血性腦中風；血栓溶解劑治療(IV r-tPA) ；動脈內血管取栓術(IAT) ；成本效果分析

並列摘要

There is no consistent conclusion regarding whether Intra-arterial embolectomy (IAT) is better than Intravenous thrombolytic therapy (IV r-tPA). Therefore, this study is to examine the differences in cost, effectiveness and cost-effectiveness between IAT and IB r-tPA. Materials and methods This study was conducted using systemic review and meta-analysis.Different combinations of key words were used in searching eight databases. After being through PRISMA for stages and flow diagram, 18 articles were selected and further analyzed using CMAIII meta-analysis software. Meta-analysis tools used included I2, Q-value, p value, funnel plot, fail-safe number, summary effect size and forest plot. Results The difference of cost and effectiveness between IAT and IV r-tPA were analyzed using meta-analysis whereas incremental cost-effectiveness(ICER)was presented using descriptive statistics. The results sowed that the cost of IAT is higher than that of IV r-tPA. In terms of effectiveness, more patients in IAT group after 90 day primary efficacy end point modified Rankin Scale score (mRS) in comparison to IV r-tPA group. There was no difference in other complications, including mortality rate, Intracranial hemorrhage rate. Furthermore, ICER of IAT compared with IV r-tPA was considered very cost-effective. Conclusions Both IAT and IV r-tPA were deemed cost-effective.IAT was more expensive than IAT. Nevertheless, none of those studies were carried out in Taiwan hence equivalent studies on Taiwanese is expectel in order to provide our people better options.