Short- and long-term cost-effectiveness analysis of adding clopidogrel to standard therapy in acute coronary syndrome patients in Spain
Short- and long-term cost-effectiveness analysis of adding clopidogrel to standard therapy in acute coronary syndrome patients in Spain
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DOI：
10.1016/s0300-8932(05)74068-9
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发表时间：
2005-12-01
影响因子：
5.9
通讯作者：
Rubio, M
中科院分区：
文献类型：
--
作者：
Badia, X;Bueno, H;Rubio, M
引言和目标。CURE研究表明，在乙酰水杨酸标准治疗中加入氯吡格雷可降低急性冠状动脉综合征但无st段抬高患者心血管事件（即卒中、心肌梗死和心血管性死亡）的风险。本研究的目的是进行短期和长期的成本效益分析，在治疗的第一年，在标准治疗的基础上给予氯吡格雷。患者和方法。为了进行短期分析，临床数据和卫生资源利用信息取自CURE研究。对于长期分析，采用了国际上使用的马尔可夫模型，涉及六个健康状态。临床资料来源于临床试验和流行病学研究。关于资源使用的信息来自两个西班牙急性冠脉综合征患者登记处、文献综述和专家小组咨询。结果以避免每个事件或获得每个生命年的增量成本表示。结果。在短期分析中，在标准治疗中加入氯吡格雷避免每个事件的增量成本为17190欧元。在长期分析中，每生命年获得的增量成本为8132欧元，低于西班牙的成本效益阈值30000欧元/生命年。在治疗的第一年，在标准治疗中加入氯吡格雷在短期和长期都具有成本效益。
Introduction and objectives. The CURE study showed that adding clopidogrel to standard therapy with acetylsalicylic acid reduces the risk of cardiovascular events (i.e., stroke, myocardial infarction, and cardiovascular death) in patients with acute coronary syndrome but without ST-segment elevation. The objective of this study was to carry out short- and long-term cost-effectiveness analyses of administering clopidogrel in addition to standard therapy during the first year of treatment.Patients and method. For the short-term analysis, clinical data and information on health resource utilization were taken from the CURE study. For the long-term analysis, an adaptation of an internationally used Markov model involving six health states was employed. Clinical data were obtained from clinical trials and epidemiological studies. Information on resource use was obtained from two Spanish registries of patients with acute coronary syndrome, a literature review, and consultations with an expert panel. Results are expressed in terms of incremental cost per event avoided or per life-year gained.Results. In the short-term analysis, the incremental cost per event avoided of adding clopidogrel to standard therapy was 17190Euro. In the long-term analysis, the incremental cost per life-year gained was 8132 Euro, which is below the Spanish cost-effectiveness threshold of 30000 Euro per life-year gained.Conclusions. Adding clopidogrel to standard therapy during the first year of treatment is cost-effective in both the short and long term.