植込型補助人工心臓がもたらす ... - jsao.org

1 1 2 . 3 . 1 2 3. Tomoyuki TAKURA, Shunei KYO, Yoshiki SAWA.. 1.. value . function cost .. performance value .. outcome . utility 1 .. well- being .. outcome cost .. performance value . socioeconomics .. 2.. 1 . 1) .. 2 .. 2 . 1 . utility . 565-0871 2-2 . E-mail.. 41 1 2012 93. Cost utility utility year Qalys (-). Therapy(+) Doubtful Dominant Cost Utility Cost Utility . base Survival time (quantitative profit), Quality of Utility U t ility life (qualitative (-) ( +). profit). Therapy(-). Inferior Effective pre treatment post . Cost Utility Cost Utility . time . 1 consideration Cost in press 2) . (+). ICUR Performances are compared between medical technology Value of medicine is discussed with acceptance of public health insurance 2 . utility 2 Incremental Cost Utility Ratio ICUR .. 1 1340: 16-7, 2009 3).. Qaly: quality adjusted life years . 1 2) . / willingness to pay 2 .. 1 1 Qaly 3 5 US$ .. 1 .. 4) Qaly . incremental cost utility ratio: ICUR . ICUR / 1 Qaly . 5),6) 600.

2 Benefit .. 2 . 2 .. 3) .. 3 2 . stated preference 1 . ICUR . WTP: . 94 41 1 2012 . 1 US$/Qaly . Range of Cost-Utility Therapy Notes Reference Performance: US$/Qaly . Usual clinical ventricular assist system 78,000 324,100 BTT/LTCS 7) 11). Implantable clinical ventricular assist 198,184 414,200 HeartMate , BTT/DT, 13),14). system second-generation significantly increases survival and QOL but high cost . Transplantation 29,000 57,000 12). BTT: bridge to transplantation, LTCS: long-term chronic support, DT: destination therapy, QOL: quality of life. Qaly DuraHear t EVAHEAR T .. Qaly ml prospective health rule .. Qaly . fair inning rule . rule of rescue 2011 2012 . 2 13),14) BTT . destination therapy: DT HeartMate .. Qaly QOL . 3.. 1 198,184 414,200. 2. US$/Qaly . ventricular assist . system: VAS DT. 1 .. 2 . 7) 11) bridge to . transplantation: BTT 78,000 324,100 US$/Qaly .. quality of life: QOL .. value . QOL . value of medicine . 29,000 57,000 US$/Qaly 12) 1 .. 3 3 1.

3 2. 41 1 2012 95. 3 index of To urge socioeconomics technological innovation Improvement of burden OS, QOL, etc.. Evaluat ion of discusses Reduction of social cost medical technology as Budget impact, etc.. economical t echnology value Growth of economic condition GDP, trade balance, etc.. 3 3 . 1340: 16-7, 2009 3).. 12 1 2,166 . Improvement of burden 5,402. 2,374 . 1 . Reduction of social cost 791 .. Growth of economic condition Qaly . 15) Qaly .. 3 . 881 /3.. 3 . 2 . 3,326 /3 . 2 VAS .. 3 .. 70 /3 .. 207 /3 . 3,027 . 7) 33) /3 1 1,375 .. / .. 3 .. 4.. 3 . 96 41 1 2012 .. years, per person years, per person . A B C . socioeconomics . thousand Yen/3.. Accumulation 21, 54, 23, 2, 30, Total .. thousand Yen/3. Accumulation . Labor productivity-National contribution . Growth of economic condition . C : impact .. i I, Ur, Br, Sr, S, A, N . Sr: Survival rate, S: Sex, A: Age, vs. Usual Clinical Ventricular vs. Conservative Treatment N: National contribution rate, Br: Comeback ratio to work.

4 Ur: Unemployment rate, i: time of post treatment 1) . Model . I : Annual income, Assist System 77: 836-46, 2007. Medicine . monthly . 2) in press . 3) . 2 . i 36. 1340: 16-7, i 1. 2009. years, per person . thousand Yen/3. 4) Guidelines Manual-Appraising Orphan Drugs, NICE, 2006. Accumulation 21, 58, 33, 11, 25, Available from: Medical cost Public sector , etc. 5) .. Reduction of social cost 18 7) 25) 7 26) 33) . B : imapct . 40 Suppl : S-107, 2011. 6) 1 QALY . The labor production is not converted into the tax and insurance fee. WTP: willingness to pay, QALY: quality adjusted life year. vs. Usual Clinical Ventricular vs. Conservative Treatment 16: 157-65, 2006. outpatient , Sr: Survival rate, S: Sex, A: Age, i: time of post C: Cost surgery, hospital, 7) Hutchinson J, Scott DA, Clegg AJ, et al: Cost-effectiveness i C, Sr, S, A . treatment monthly . of left ventricular-assist devices in end-stage heart failure. Model Expert Rev Cardiovasc Ther 6: 175-85, 2008. Assist System 8) Sharples LD, Dyer M, Cafferty F, et al: Cost-effectiveness of Medicine.

5 Ventricular assist device use in the United Kingdom: results from the evaluation of ventricular assist device programme i 36. in the UK (EVAD-UK). J Hear t Lung T ransplant 25: i 1. 1336-43, 2006. years, per person . thousand Yen/3. 9) Mahle WT, Ianucci G, Vincent RN, et al: Costs associated Accumulation Utility-Benefit Spirit of cooperation , etc. with ventricular assist device use in children. Ann Thorac 4, 8, 8, 4, Surg 86: 1592-7, 2008. 10) Sharples L, Buxton M, Caine N, et al: Evaluation of the Improvement of burden A : impact . ventricular assist device programme in the UK. Health Technol Assess 10: 1-119, iii-iv, 2006. vs. Usual Clinical Ventricular W: WTP-Qaly, Rr: Return ratio Socioeconomic gain of vs. Conservative Treatment to society, Sr: Survival rate, S: 11) Clegg AJ, Scott DA, Loveman E, et al: The clinical and cost- Treatment Medicine i W, Rr, Sr, S, A . Sex, A: Age, i: time of post effectiveness of left ventricular assist devices for end-stage treatment monthly.

6 Heart failure: a systematic review and economic evaluation. Model Health Technol Assess 9: 1-132, iii-iv, 2005. Assist System 12) . Medicine . 44: 60-8, 2009. 13) Rogers JG, Bostic RR, Tong KB, et al: Cost-effectiveness i 36. analysis of continuous-flow left ventricular assist devices as i 1. destination therapy. Circ Heart Fail 5: 10-6, 2012. 14) Moreno SG, Novielli N, Cooper NJ: Cost-effectiveness of Implantable Clinical Implantable Clinical the implantable HeartMate II left ventricular assist device Ventricular Assist Ventricular Assist Ventricular Assist System second- Therapy for patients awaiting heart transplantation. J Heart Lung Usual Clinical Conservative generation . Transplant, 2011 [Epub ahead of print]. 15) . System System 1338: 14-5, 2008. 41 1 2012 97. 16) failure: looking backward or for ward?. Circulation 108: 492-7, 2003. 218: 1355-60, 2006. 25) Slaughter MS, Rogers JG, Milano CA, et al: Advanced heart 17) failure treated with continuous-flow left ventricular assist 37: 815-22, 2007 device.

7 N Engl J Med 361: 2241-51, 2009. 18) 26) . 15: 246, 2008 2010. 19) 27) . 239: 193-8, 2011 2010. 20) 28) 23 12 . 62: 67-73, 2007 2011. 21) 29) . 36: 244-7, 2007 2012. 22) Hear t View 12: 1006-13, 30) 22 . 2008 2010. 23) 31) 2009. 44: 10-7, 2009 32) 2009. 24) Stevenson LW: Clinical use of inotropic therapy for heart 33) 2010. 98 41 1 2012.