延长急性冠状动脉综合征患者双联抗栓治疗的成本效果分析  

Cost-effectiveness analysis of extended duration dual antithrombotic therapy in acute coronary syndrome

作　　者：林璐 陈宜锋 刘弋戈 LIN Lu;CHEN Yi-feng;LIU Yi-ge(Department of Pharmacy,Xiamen Cardiovascular Hospital,Xiamen University,Xiamen FUJIAN 361000,China)

机构地区：[1]厦门大学附属心血管病医院药学部,福建厦门361000

出　　处：《中国新药与临床杂志》2022年第3期181-185,共5页Chinese Journal of New Drugs and Clinical Remedies

摘　　要：目的比较急性冠状动脉综合征(ACS)高缺血风险患者中延长使用3种双联抗栓治疗方案的成本效果。方法从卫生经济学角度,建立决策树和马尔可夫模型,决策树模型时间为服用双联的33个月,马尔可夫模型周期为30年,模拟患者30年的健康产出以及成本,其中健康产出以质量调整生命年(QALYs)为产出指标。通过TreeAge Pro软件计算阿司匹林联用氯吡格雷、利伐沙班或替格瑞洛3个方案的成本和产出,以增量成本效果比(ICER)为评价指标,并进行敏感性分析。结果利伐沙班组的健康产出为13.01 QALYs,高于替格瑞洛组0.02 QALYs,高于氯吡格雷组0.15 QALYs。利伐沙班组的成本为26783.10元,分别高于替格瑞洛组132.22元,高于氯吡格雷445.81元。与氯吡格雷组相比,利伐沙班组ICER为3016.77元·QALY^(-1),替格瑞洛组ICER为2714.46元·QALY^(-1),均低于意愿支付阈值(212676元)。敏感性分析显示利伐沙班和替格瑞洛的年费用及利伐沙班心肌梗死发生率风险比值是主要影响因素,模型结果稳定。结论高缺血风险的ACS患者抗栓治疗1年后的3种双联抗栓方案中,利伐沙班联用阿司匹林方案最具成本效果优势。AIM To determine cost-effectiveness options of extended duration dual antithrombotic therapy in patients with high ischemic risk of acute coronary syndrome(ACS).METHODS From the perspective of health economics,the relevant decision tree and Markov model were established to simulate the 30-year health output and cost of patients.The relevant decision tree spanned 33 months after one year of anti-thrombosis,and the Markov model spanned 30 years.The health output was based on quality-adjusted life years(QALYs)as the output indicator.The cost and output of the three programs of aspirin combined with clopidogrel,rivaroxaban or ticagrelor were calculated by TreeAge Pro software,and the incremental cost-effectiveness ratio(ICER)was used as the evaluation index.One-way and probabilistic sensitivity analyses were performed.RESULTS The health output of the rivaroxaban group was 13.01 QALYs,which was 0.02 QALYs higher than the ticagrelor group,and 0.15 higher than the clopidogrel group.The total cost of the rivaroxaban group was 26783.10 yuan,which was 132.22 yuan higher than the ticagrelor group,and 445.81 yuan higher than the clopidogrel group.Compared with the clopidogrel group,the ICER of the rivaroxaban group was 3016.77 yuan·QALY^(-1),and the ICER of the ticagrelor group was 2714.46 yuan·QALY^(-1),both of which were lower than the willingness-to-pay threshold(212676 yuan).Sensitivity analysis showed that the annual cost of rivaroxaban and ticagrelor,and the hazard ratio value of the incidence of myocardial infarction in the rivaroxaban group were the main influencing factors,and the model results were stable.CONCLUSION Among the three schemes of dual antithrombotic for ACS patients with high ischemic risk after 1 year of antithrombotic therapy,the combination of rivaroxaban and aspirin has the most cost-effectiveness advantage.

关 键 词：急性冠状动脉综合征 血小板聚集抑制剂 抗凝药 纤维蛋白溶解药 费用效益分析 

分 类 号：R973.2[医药卫生—药品]