比伐芦定与肝素用于急性冠脉综合征行经皮冠状动脉介入治疗的药物经济学研究

目的 对比研究比伐芦定及普通肝素用于急性冠脉综合征(ACS)行经皮冠状动脉介入(PCI)治疗的成本效果,为中国ACS患者PCI围手术期抗凝治疗药物的合理选用提供理论依据.方法 基于中国单中心临床研究数据,建立一年期决策树及Markov长期外推药物经济学模型,模拟计算使用比伐芦定或普通肝素治疗患者的调整质量生命年(QLAYs)及治疗成本,对比伐芦定用于中国ACS患者行PCI抗凝治疗的成本效益进行分析和研究.结果 比伐芦定和普通肝素组的治疗总成本分别为47089.56元和48766.33元,使用比伐芦定患者可获得的质量调整生命年(QALYs)为9.02,采用普通肝素治疗方案的患者QALYs为8.74.增量成本效果分析显示,采用比伐芦定可提高患者的健康效益(△E>0),同时还能降低治疗成本(△C<0),增量成本效果比(ICER)为-6010.02元/QALYs,提示采用比伐芦定是必然会接受的优势治疗方案.一维敏感度分析显示本研究结果稳定可靠.结论 在中国目前整体经济形势下,与使用普通肝素相比,比伐芦定用于PCI抗凝具有成本效果优势,可替代传统抗凝方案用于ACS患者PCI围手术期抗凝治疗.

Cost-effectiveness of Bivalirudin versus heparin in the treatment of acute coronary syndrome with percutaneous coronary intervention

Objective To compare the cost-effectiveness of bivalirudin versus heparin in the treatment of acute coronary syndrome with percutaneous coronary intervention(PCI) in China. Methods Based on the clinical research from a single center in China,we created a decision tree and a Markov decision model to study the cost-effectiveness of Bivalirudin versus heparin.We quantified the cost and QLAYs resulted from Bivalirudin compared with those from heparin therapy. Results Heparin therapy group resulted in a quality-adjusted life expectancy of 8.74 years at a cost of 48 766.33 yuan.In comparison,treatment with Bivalirudin led to 9.02 QLAYs years at a cost of 47 089.56 yuan.It concluded that,Bivalirudin provided a gain of quality-adjusted life-years (QALYs) with less cost,resulting in an incremental cost-effectiveness ratio of -6 010.02 yuan per QALY,which offered a high probability of dominance.The univariate sensitivity analyses were carried out to firm the robustness of this cost-effectiveness analysis. Conclusions Under the current economic condition in China,Bivalirudin appeared to have cost-effectiveness relative to heparin.It is recommended to using Bivalirudin instead of heparin in ACS patients undergoing PCI treatment.