关键词: 气管狭窄, 支架, 成本及成本分析, 费用效益分析, 对比研究

Abstract:

Objective: To compare the cost-effectiveness of tracheal stents made of different materials in the treatment of central airway stenosis. Methods: A retrospective analysis was conducted. A total of 77 patients who underwent tracheal stent implantation for central airway stenosis at The Affiliated Hospital of Qingdao University (including Shinan, Laoshan, West Coast and Pingdu campuses) from March 2022 to March 2025 were enrolled as study subjects. Based on the stent material, the subjects were divided into the temporary stent group (uncovered metal stents, 44 cases) and the long-term stent group (covered metal stents and silicone stents, 33 cases). The cost indicator was the total inpatient and outpatient expenses incurred from tracheal stent implantation and related bronchoscopic follow-ups within 1 year after surgery. The effectiveness indicator was the degree of improvement in dyspnea symptoms. The average cost-effectiveness ratio (CER) was calculated. Multiple linear regression model was used to adjust for baseline differences between groups. One-way sensitivity analysis and probabilistic sensitivity analysis were performed to evaluate the robustness of the results. Results: The mean total costs of the temporary stent group and the long-term stent group were 41009.17 yuan and 69114.86 yuan, respectively. The mean degrees of dyspnea improvement were 1.84 grades and 2.36 grades, respectively, with corresponding CER of 22276.59 and 29240.90. Cost composition analysis showed that the consumables cost, drug cost and general medical service fee in the long-term stent group (median (interquartile range): 17803.36 (15548.68, 22274.72) yuan, 7030.51 (3457.31, 16860.39) yuan, 5323.00 (1823.33, 9825.30) yuan, respectively) were significantly higher than those in the temporary stent group (median (interquartile range): 5158.43 (3349.65, 7402.15) yuan, 3712.29 (1378.60, 7163.31) yuan, 2735.50 (796.75, 4904.61) yuan, respectively), with statistically significant differences (consumables cost: Z=-6.361, P<0.001; drug cost: Z=-2.645, P=0.008; general medical service fee: Z=-2.275, P=0.023). The numbers of repeated interventional treatments due to complications in the temporary stent group and the long-term stent group were 262 and 191, respectively. Among them, outpatient treatments accounted for 64.5% (169/262) and 65.4% (125/191), and inpatient treatments accounted for 35.5% (93/262) and 34.6% (66/191), respectively, with no statistically significant difference (χ²=0.043, P=0.836). Multiple regression analysis showed that stent type (mean total medical cost within 1 year: β (95%CI)=23412.43 (2142.10-44682.76) yuan, P=0.031; mean dyspnea improvement: β (95%CI)=0.88 (0.58-1.17) grades, P<0.001) was an independent influencing factor for both cost and effectiveness. Sensitivity analysis verified the robustness of the results. Conclusion: Temporary stents have better short-term cost-effectiveness than long-term stents in the treatment of central airway stenosis.

Key words: Tracheal stenosis, Stents, Costs and cost analysis, Cost-benefit analysis, Comparative study