CYP2C19基因检测指导抗血小板治疗的成本-效果分析  

Cost-effectiveness analysis of CYP2C19 genetic test in guiding antiplatelet therapy

作　　者：安小芳[1] 翟娅婧 安焕萍 王小莉[1] 李小颖[4] 曾宪涛 吕军[2] AN Xiao-fang;ZHAI Ya-jing;AN Huan-ping;WANG Xiao-li;LI Xiao-ying;ZENG Xian-tao;Lv Jun(Medical Insurance Office,The First Affiliated Hospital of Xi an Jiaotong University,Xi an 710061;Clinical Research Center,The First Affiliated Hospital of Xi an Jiaotong University,Xi an 710061;Department of Emergency,The First Affiliated Hospital of Xi an Jiaotong University,Xi an 710061;Hospital of Xi an Jiaotong University Health Science Center,Xi an 710061;Center for Evidence-based and Translational Medicine,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)

机构地区：[1]西安交通大学第一附属医院医保办,陕西西安710061 [2]西安交通大学第一附属医院临床研究中心,陕西西安710061 [3]西安交通大学第一附属医院急诊科,陕西西安710061 [4]西安交通大学医学部校医院,陕西西安710061 [5]武汉大学中南医院循证与转化医学中心,湖北武汉430071

出　　处：《西安交通大学学报（医学版）》2018年第6期853-859,共7页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：国家社会科学基金资助项目(No.16BGL183)~~

摘　　要：目的评价CYP2C19基因检测指导中国急性冠脉综合征患者抗血小板治疗的有效性与经济性。方法使用经济学评价专业分析软件TreeAge Pro 2012构建决策树及Markov模型,采用我国相关数据,比较基因检测指导抗血小板治疗与传统治疗的成本及效果。结果当意愿支付阈值为三倍我国国内生产总值时,基因检测方案和替格瑞洛方案比直接使用氯吡格雷更有优势,且替格瑞洛方案比基因检测方案更具有成本-效果。结论对于中国急性冠脉综合征患者而言,最具有成本效用的抗血小板方案是直接使用新一代抗血小板药物替格瑞洛,其次是药物基因组学检测指导的个体化治疗。Objective To evaluate the effectiveness and economics of CYP2C19 genetic test in guiding antiplatelet therapy for Chinese patients with acute coronary syndromes.Methods The decision tree and Markov model were established using TreeAge Pro 2012 software,which simulated the costs and effectiveness of CYP2C19-guided antiplatelet therapy versus the traditional use of clopidogrel or ticagrelor from the perspective of China third-party payer.Results Base-case results showed that genotype-guided ticagrelor and universal ticagrelor were dominant compared with universal clopidogrel(incremental cost-effectiveness ratio underwillingness-to-pay threshold of three times China s GDP).Universal ticagrelor was cost-effective when compared with universal clopidogrel.Conclusion The most cost-effective antiplatelet regimen for acute coronary syndromes patients in China is universal ticagrelor,followed by genotype-directed individualized therapy.

关 键 词：氯吡格雷 替格瑞洛 基因检测 CYP2C19 MARKOV模型 药物经济学 

分 类 号：R574.62[医药卫生—消化系统]