在COMPASS试验中,Rivaroxaban加阿司匹林与单独阿司匹林相比的成本效益:美国的观点
Andre Lamy1,2,3,4,5, John Eikelboom6,7, Wesley Tong6,8
1Population Health Research Institute, McMaster University, Hamilton, ON, Canada. alamy1@mac.com.
概括
里瓦罗克萨班加阿司匹林在患有冠状动脉或外周动脉疾病的患者中预防心血管事件具有成本效益. 这种组合治疗在美国医疗保健系统中具有很高的价值.
科学领域:
- 心血管医学 心血管医学
- 卫生经济学 卫生经济学
- 药物经济学 药物经济学
背景情况:
- 里瓦罗克萨班2.5毫克每天两次加上阿司匹林100毫克每天在预防稳定冠状动脉疾病 (CAD) 或外周动脉疾病 (PAD) 患者的主要心血管不良事件方面表现出比单独阿司匹林更高的疗效.
- 对医疗保健决策者来说,评估这种组合治疗方案的成本效益至关重要.
研究的目的:
- 在美国医疗保健系统中,评估Rivaroxaban 2.5 mg两次每天加上阿司匹林100 mg的成本效益,与单独的阿司匹林相比,对于稳定的CAD或PAD患者.
主要方法:
- 通过使用具有1年周期长度的两种状态马尔科夫模型进行了终身成本效益分析.
- 美国直接医疗保健系统成本应用于住院事件,程序和研究药物.
- 计算了经质量调整的寿命年 (QALY) 和增量成本效益比率 (ICER). 对药物价格和戒药率进行了敏感性分析.
主要成果:
- 由于药物采购,利瓦洛克萨班加阿司匹林组的总成本较高 (7426美元与4173美元),但事件和程序的成本降低.
- 在一生中,组合疗法导致额外费用为27255美元,并获得1.17个QALY,产生23,295美元/QALY的ICER.
- 仅在周围动脉疾病 (PAD) 和多血管疾病亚组中观察到较低的ICER.
结论:
- 里瓦罗克萨班2.5毫克两次加上阿司匹林是美国对稳定CAD或PAD患者的成本有效策略.
- 这种组合疗法在研究人口中预防心血管结果方面具有很高的价值.
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