Cost-effectiveness of new antiplatelet regimens used as secondary prevention of stroke or transient ischemic attack.
Cost-effectiveness of new antiplatelet regimens used as secondary prevention of stroke or transient ischemic attack.
复制标题
用作中风或短暂性脑缺血发作二级预防的新抗血小板治疗方案的成本效益。
DOI：
10.1001/archinte.160.18.2773
复制
发表时间：
2000
影响因子：
--
通讯作者：
H. Bounameaux
中科院分区：
文献类型：
--
作者：
F. Sarasin;J. Gaspoz;H. Bounameaux
背景
与单独使用阿司匹林相比，使用新的抗血小板方案，包括阿司匹林联合双嘧达莫和硫酸氢氯吡格雷，已被发现可以进一步降低经历过中风或短暂性脑缺血发作的患者发生中风和其他血管事件的风险。然而，它们相对于单独使用阿司匹林的成本-效果比尚未估计。
方法
我们开发了一个马尔可夫模型来衡量以下策略治疗65岁或以上高危患者的临床获益和经济后果：（1）阿司匹林，325 mg/d;（2）阿司匹林，50 mg/d，双嘧达莫，400 mg/d;（3）硫酸氢氯吡格雷，75 mg/d。输入数据通过文献综述获得。结果表示为每质量调整生命年（QALY）的美元。
结果
与单独使用阿司匹林相比，使用阿司匹林联合双嘧达莫更有效，成本更低，为65岁患者提供了0.3 QALY的增益。尽管进行了广泛的敏感性分析，但该方案仍具有成本效益。与单独使用阿司匹林相比，氯吡格雷更有效，成本更高，每增加一个QALY（患者年龄65岁），获得0.2个QALY，边际成本-效果比为26，580美元。敏感性分析表明，氯吡格雷的疗效和成本是决定其成本-效果比的关键因素，与阿司匹林相比，当其疗效降低一半或成本增加一倍时，成本超过50，000美元。
结论
为了预防高危患者的卒中，双嘧达莫联合阿司匹林比单独使用阿司匹林更有效，成本更低，与当前的医疗实践标准相比，氯吡格雷具有成本效益，除非在极端情况下。
BACKGROUND
Compared with aspirin alone, use of the new antiplatelet regimens, including aspirin combined with dipyridamole and clopidogrel bisulfate, has been found to further reduce the risk of stroke and other vascular events in patients who have experienced stroke or transient ischemic attack. However, their cost-effectiveness ratios relative to aspirin alone have not been estimated.
METHODS
We developed a Markov model to measure the clinical benefits and the economic consequences of the following strategies to treat high-risk patients aged 65 years or older: (1) aspirin, 325 mg/d; (2) aspirin, 50 mg/d, and dipyridamole, 400 mg/d; and (3) clopidogrel bisulfate, 75 mg/d. Input data were obtained by literature review. Outcomes were expressed as US dollars per quality-adjusted life-year (QALY).
RESULTS
The use of aspirin combined with dipyridamole was more effective and less costly compared with the use of aspirin alone, providing a gain of 0.3 QALY for a 65-year-old patient. This regimen remained cost-effective despite wide sensitivity analyses. Clopidogrel was more effective and more costly compared with aspirin alone, yielding a gain of 0.2 QALY with a marginal cost-effectiveness ratio of $26,580 per each additional QALY (patient aged 65 years). Sensitivity analyses demonstrated that the efficacy of clopidogrel and its cost were key factors in determining its cost-effectiveness ratio compared with aspirin, which exceeded $50,000 when its efficacy decreased by half or its cost doubled.
CONCLUSION
To prevent stroke in high-risk patients, dipyridamole combined with aspirin was more effective and less costly than aspirin alone, and clopidogrel was cost-effective compared with current standards of medical practice, except in extreme scenarios.
影响因子：
8.3
作者：
SACCO, RL;WOLF, PA;MCNAMARA, PM
通讯作者：
MCNAMARA, PM
米索前列醇预防非甾体抗炎药引起的胃肠道出血的成本效益。
DOI：
--
发表时间：
1990
期刊：
JAMA : the journal of the American Medical Association
影响因子：
--
作者：
Edelson,JT;Tosteson,AN;Sax,P
通讯作者：
Sax,P
影响因子：
158.5
作者：
Barnett, HJM;Taylor, W;Spence, JD
通讯作者：
Spence, JD