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A High-Throughput Luciferase Assay to Evaluate Proteolysis of the Single-Turnover Protease PCSK9
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ヘテロジゴト性家族性高コレステロール血症または動脈硬化性心血管疾患の患者におけるPCSK9阻害剤療法の費用対効果

Dhruv S Kazi1, Andrew E Moran2, Pamela G Coxson3

  • 1Department of Medicine, Center for Vulnerable Populations, University of California, San Francisco2Department of Medicine, University of California, San Francisco3Department of Epidemiology and Biostatistics, University of California, San Francisco4Center.

JAMA
|August 18, 2016
PubMed
まとめ
この要約は機械生成です。

家族性高コレステロール血症 (FH) と動脈硬化性心血管疾患 (ASCVD) に対するPCSK9阻害剤は,現在の価格では費用対効果が低い. 費用対効果の基準を満たし,米国の医療費の総額を増加させないようにするには,薬のコストを大幅に削減する必要があります.

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科学分野:

  • 心血管医学
  • 健康 経済
  • 薬学経済学

背景:

  • プロプロテインコンバーターゼサブチリシン/ケキシン9型 (PCSK9) 阻害剤は,動脈硬化性心血管疾患 (ASCVD) の予防に役立つ可能性がある.
  • PCSK9阻害剤の費用対効果と医療費への影響は不明である.

研究 の 目的:

  • PCSK9阻害剤の費用対効果を推定する.
  • 米国保健費に対するPCSK9阻害剤の潜在的影響を評価する.

主な方法:

  • シミュレーションモデル (心血管疾患政策モデル) で,ヘテロジゴス家族性高コレステロール血症 (FH) またはASCVDの成人の費用対効果を評価した.
  • モデルには2015年のPCSK9阻害剤のコスト (年間14,350ドル),健康システムの視点,および生涯の見通しが含まれています.
  • 不確実性に対処するために,確率的な感受性分析が行われました.

主要な成果:

  • FHでは,スタチンにPCSK9阻害剤を追加すると,エゼチミブと比較して,品質調整された寿命年 (QALY) につき50万3000ドルの費用がかかります.
  • ASCVDでは,スタチンにPCSK9阻害剤を加えると,エゼチミブと比較して1QALYにつき414,000ドルかかります.
  • 2015年の価格でPCSK9阻害剤の使用は,心臓血管疾患の治療費を29億ドル削減したにもかかわらず,5年間で590億ドル増加すると予測された.

結論:

  • 2015年の価格でPCSK9阻害剤の使用は,FHまたはASCVDの費用対効果の値を満たせず,米国の医療費を大幅に増加させます.
  • QALYの値が100,000ドルに達するには 年間薬費が4,536ドル以下に減る必要があります
  • 適格な人群にスタチンを投与すると 120億ドルの節約が予想されました