冠状动脉粥样硬化性心脏病患者经皮冠状动脉介入术后不同双联抗血小板方案的经济性评价  

Economic Evaluation of Different Dual Antiplatelet Regimens in Patients with Coronary Heart Disease After Percutaneous Coronary Intervention

作　　者：王培培[1] 吴义来 WANG Peipei;WU Yilai(Yijishan Hospital of Wannan Medical College,Wuhu,Anhui,China 241001)

机构地区：[1]皖南医学院弋矶山医院,安徽芜湖241001

出　　处：《中国药业》2025年第7期117-121,共5页China Pharmaceuticals

基　　金：安徽省教育厅高等学校省级质量工程项目[2023sx090];校企融合发展-“恒瑞科研基金”横向课题项目[XQHR202426]。

摘　　要：目的基于CYP2C19基因多态性评价冠状动脉粥样硬化性心脏病(简称冠心病)患者经皮冠状动脉介入术(PCI)后不同双联抗血小板治疗方案的经济性。方法回顾性分析2022年1月至12月就诊某院且诊断为冠心病并行CYP2C19基因检测的84例患者的临床资料,根据CYP2C19基因检测结果分为快代谢基因组(37例)和功能缺失基因组(47例)。快代谢基因组患者予阿司匹林联合氯吡格雷治疗,功能缺失基因组患者予阿司匹林联合替格瑞洛治疗,比较两组患者的主要不良心血管事件(MACE)再入院率和成本-效果比,并进行敏感性分析和情境分析。结果功能缺失基因组患者出院后1年内MACE再入院率为2.13%,显著低于快代谢基因组的10.81%(P=0.025)。功能缺失基因组的成本-效果比为249.87±45.76,显著高于快代谢基因组的204.04±48.76(P<0.05)。敏感性分析结果提示经济性评价结果稳健。情境分析假定功能缺失基因组患者选用国产替格瑞洛,功能缺失基因组和快代谢基因组的成本-效果比无显著差异(P>0.05)。结论CYP2C19基因检测指导下的双联抗血小板方案阿司匹林联合氯吡格雷相比阿司匹林联合进口替格瑞洛更具经济性,但若换用国产替格瑞洛,则二者经济性相当。Objective To evaluate the economics of different dual antiplatelet therapy regimens in patients with coronary heart disease(CHD)after percutaneous coronary intervention(PCI)based on CYP2C19 gene polymorphism.Methods A retrospective analysis was conducted on the clinical data of 84 patients diagnosed with CHD and underwent CYP2C19 gene testing who visited the hospital from January to December 2022.According to the CYP2C19 gene testing results,they were divided into rapid metabolism genome group(37 cases)and loss-of-function genome group(47 cases).The patients in the rapid metabolism genome group received aspirin combined with clopidogrel,while the patients in the loss-of-function genome group received aspirin combined with ticagrelor.The readmission rate of major adverse cardiovascular events(MACE)and cost-effectiveness ratio between the two groups were compared,and sensitivity analysis and scenario analysis were conducted.Results The readmission rate of MACE within one year after discharge in the loss-of-function genome group was 2.13%,which was significantly lower than 10.81%in the rapid metabolism genome group(P=0.025).The cost-effectiveness ratio in the loss-of-function genome group was 249.87±45.76,which was significantly higher than 204.04±48.76 in the rapid metabolism genome group(P<0.05).The sensitivity analysis results indicated that the economic evaluation results were robust.Scenario analysis assumed that patients in the loss-of-function genome group received domestic ticagrelor,and there was no significant difference in cost-effectiveness between the two groups(P>0.05).Conclusion Under the guidance of CYP2C19 gene testing,the dual antiplatelet regimen of aspirin combined with clopidogrel is more economical compared to aspirin combined with imported ticagrelor.However,if domestically produced ticagrelor is used,the cost-effectiveness of the two regimens is comparable.

关 键 词：氯吡格雷 替格瑞洛 CYP2C19基因多态性 冠状动脉粥样硬化性心脏病 经皮冠状动脉介入术 急性冠状动脉综合征 经济性评价 

分 类 号：R95[医药卫生—药学] R973