关键词: 血管支架, 卫生经济学, 医疗管理质量, 药物洗脱支架, 金属支架, 成本效果分析, 可视化分析, 文献计量学

Abstract: BACKGROUND: Clinical use of vascular stents involves high medical costs, but it may also bring long-term benefits in reducing cardiovascular events and improving the quality of life in patients. Economics evaluation can help decision makers better understand the balance between the cost and benefit of treatment.
OBJECTIVE: To analyze the related articles of health economics and discuss the hot spots in the study of the effect and problems of vascular stents in medical quality management.
METHODS: The articles concerning health economics evaluation of vascular stents were retrieved from the core set of the Web of Science. The VOSviewer_1.6.19 software was used to make a visualization analysis of the annual publication volume, institutions, countries, keywords, etc. Finally, the research hot spots on the effects and problems of vascular stents were analyzed from the perspective of health economics and medical quality management.
RESULTS AND CONCLUSION: (1) 120 articles in English were finally included. In the past 10 years, the highest number of articles published in this field was in 2019, with 10 articles. The institution with the largest number of articles published was Harvard University in the United States with 20 articles, and the country with the largest number of articles published was the United States with 58 articles. (2) Keyword cluster analysis demonstrated that the cost-effectiveness analysis of bare metal stents and drug-eluting stents in coronary disease, the cost-effectiveness analysis of angioplasty stent intervention, and the effect of coronary stents in percutaneous coronary intervention are the research hot spots in the field of health economics evaluation of vascular stent research. (3) In the context of medical quality management, the paper further summarized the research hot spots on the therapeutic effect of vascular stents as follows: long-term effect of vascular stents, safety, drug release mechanism research, personalized therapy, restenosis problems, and stent insertion technology. (4) The results of highly cited literature analysis exhibited that drug-eluting stents release drugs to reduce the risk of vascular restenosis, and the restenosis rate is lower than that of bare metal stents, but the cost is usually higher. Biodegradable stents combine the advantages of bare metal stents and drug-eluting stents, that is, avoiding long-term stent existence and reducing the risk of restenosis, but their cost may be higher, and there may be some complications in the short term, and they are not widely used at present. (5) In addition to the direct stent cost, factors that need to be considered when comparing the cost-effectiveness of vascular stents include the risk and cost of stent re-intervention, the risk and cost of complications, the duration and cost of drug therapy, and the quality of life of patients. Therefore, while the initial cost of drug-eluting and biodegradable stents may be higher than bare metal stents, they may lead to better clinical outcomes in the long term, resulting in a more favorable cost effect. (6) Future research directions should focus on making personalized vascular stent treatment decisions, observing the long-term effect of stent treatment, the impact of the stent on patients’ quality of life, formulating health policies, rational allocation of medical resources, and the establishment of long-term follow-up mechanisms.

Key words: vascular stent, health economics, medical quality management, drug-eluting stent, metal support, cost-effectiveness analysis, visualization analysis, bibliometrics