エプレレノンの費用対効果は,左心室機能不全と心不全によって合併された心筋梗塞の患者でプラセボと比較した
William S Weintraub1, Zefeng Zhang, Elizabeth M Mahoney
1Emory University, 1256 Briarcliff Rd, Suite 1N, Atlanta, GA 30306, USA. wweintr@emory.edu
Circulation
|February 23, 2005
まとめ
エプレレノンは,心筋梗塞後の心不全患者の死亡率を著しく減少させます. このアルドステロン阻害剤は,費用対効果の高い治療法であり,患者の改善のために得られた寿命年数を増加させます.
科学分野:
- 心臓病学 心臓病学
- 薬学経済学 薬学経済学
- クリニック・トライアル 臨床試験
背景:
- エプレレノンによるアルドステロン阻害は,心不全の心筋梗塞後の患者のEPHESUS試験で死亡率の低下を示した.
- EPHESUS研究では,この患者グループにおける生存率の改善におけるエプレレノンの有効性が確認されました.
研究 の 目的:
- エプレレノンの費用対効果をプラセボと比較して,急性心筋梗塞後の左心室内静脈機能不全および心不全の患者で評価する.
- 生存率と生活の質の改善におけるエプレレノンの経済的価値を評価する.
主な方法:
- エプレレノンとプラセボを比較した6632人の患者のランダム化試験で,平均フォローアップ期間は16ヶ月でした.
- コプライマリーエンドポイントには,全因死亡率と,心血管疾患による死亡率/入院率の複合値が含まれていました.
- 資源利用 (入院,診療,医薬品) が分析され,エプレレノンの価格は3.60ドル/日であった.
主要な成果:
- エプレレノンの使用は,使用した生存データソース (フレミングハム,サスカチュワン,ウースター) に基づいて,0.06から0.13の寿命年増加をもたらしました.
- 漸進的な費用対効果比は,10,402ドルから21,876ドルまで,生涯1年当たりで得られた.
- 試験期間中のエプレレノンの費用は,プラセボと比較して1391ドル高かった.
結論:
- エプレレノンは,急性心筋梗塞後の心不全患者の死亡率を低減するのに有効です.
- この治療法は,寿命を延ばすための標準的な基準に基づいて,費用対効果が高いと考えられています.
- エプレレノンは,この高リスク集団の長期的な結果を改善するための貴重な治療選択肢を提供します.
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