主動脈瓣狹窄經導管主動脈瓣植入術與主動脈瓣置換手術之成本效果分析：系統性回顧與統合分析

研究目的：台灣於2012年執行經導管主動脈瓣植入術(TAVI)， TAVI是否優於主動脈瓣置換手術(SAVR) 目前尚無一致性結論。本研究旨在利用系統性回顧與統合分析探討TAVI與SAVR之成本、效果和成本效果分析，以期能得出一致性的結論。研究方法：本研究使用系統性回顧與統合分析。利用關鍵詞搜尋六個資料庫，再依據PRISMA四階段和檢核表納入11篇文獻，TAVI與SAVR之成本、效果差異使用CMAⅢ統合分析軟體進行分析：Q-value、I^2、漏斗圖、成敗估計值、總效果量和森林圖；兩者成本效果分析以敘述性統計比較呈現。研究結果：經統合分析結果，在成本TAVI較SAVR高。在效果TAVI比SAVR常放置心臟節律器和血管損傷；TAVI比SAVR加護病房天數短；心肌梗塞、中風和三十天內死亡兩者無差異。於ICER TAVI比SAVR介於非常有成本效果與具有成本效果。結論與應用：研究發現兩者皆具成本效果，TAVI比SAVR成本高，且縮短住院天數，減少病人住院的不適。台灣目前無兩者成本效果分析，期待有此方面的研究，以提供國人更好的就醫選擇。

關鍵字

主動脈瓣狹窄；經導管主動脈瓣植入術；主動脈瓣置換手術；成本效果分析

並列摘要

Objective There is no consistent conclusion regarding whether Transcatheter Aortic Valve Implantation (TAVI) is a better option than Surgical Aortic Valve Replacement (SAVR). Therefore, this study is to examine the differences in cost, effectiveness and cost-effectiveness between TAVI and SAVR. Material and methods This study was conducted using systemic review and meta-analysis. Different combinations of key words were used in searching six database. After being through PRISMA four stages and flow diagram, 11 articles were selected and further analyzed using CMA III meta-analysis software. Meta-analysis tools used included I^2, Q-value, p value, funnel plot, fail-safe number, summary effect size and forest plot. Results The differences of cost and effectiveness between TAVI and SAVR were analyzed using meta-analysis whereas incremental cost-effectiveness ratio (ICER) was presented using descriptive statistics. The result showed that the cost of TAVI is higher than that of SAVR. In terms of effectiveness, more patients in TAVI group needed pacemaker implantation and had vascular damage in comparison to SAVR group. There was no difference in other complications, including myocardial infarction, stroke and 30-day mortality. Additionally, patients in TAVI group had a shorter stay in intensive care unit. Furthermore, ICER of TAVI compared with SAVR was considered cost-effective or very cost-effective. Conclusions Both TAVI and SAVR were deemed cost-effective. TAVI was more expensive than SAVR; however, the hospital stay after TAVI was shorter than that of SAVR. Nevertheless, none of those studies were carried out in Taiwan hence equivalent studies on Taiwanese population is expected in order to provide our people better options.