Long-term cost-effectiveness of early and sustained clopidogrel therapy for up to 1 year in patients undergoing percutaneous coronary intervention after presenting with acute coronary syndromes without ST-segment elevation
Long-term cost-effectiveness of early and sustained clopidogrel therapy for up to 1 year in patients undergoing percutaneous coronary intervention after presenting with acute coronary syndromes without ST-segment elevation
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DOI：
10.1016/j.ahj.2005.02.044
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发表时间：
2006-01-01
影响因子：
4.8
通讯作者：
Weintraub, WS
中科院分区：
文献类型：
--
作者：
Mahoney, EM;Mehta, S;Weintraub, WS
背景 PCI-CURE 研究证明，在出现急性冠状动脉综合征但无 ST 段抬高后接受经皮冠状动脉介入治疗 (PCI) 的患者中，氯吡格雷和阿司匹林与单用阿司匹林相比，长达 1 年的优越性得到了证实。我们使用 PCI-CURE 的患者水平结果和资源使用情况，以及基于外部来源的预期寿命增益估计，评估了使用氯吡格雷长达 1 年的长期成本效益。方法 PCI-CURE 纳入了 2658 名在 CURE 试验中于 1998 年至 2000 年间接受 PCI 的患者，这些患者在 CURE 试验中被随机分配到氯吡格雷（n = 1313）或安慰剂（n = 1345）。大约三分之二（氯吡格雷 n = 82±1，安慰剂 n = 909）在初次住院期间（早期 PCI）接受了 PCI。根据诊断相关组将费用应用于住院费用。氯吡格雷的平均批发价为每天 3.22 美元。使用外部来源估计预防重大临床事件带来的预期寿命延长。结果 氯吡格雷的平均总成本较高（差异[基于成本计算方法]253-423 美元）。对于初次住院期间接受 PCI 的患者，氯吡格雷的差异从低 155 美元到高 90 美元不等。氯吡格雷的估计预期寿命延长为 0.0885 岁，而早期 PCI 亚组的预期寿命延长为 0.0962 岁。使用氯吡格雷获得的每年生命的增量成本总体为 2856 美元至 4775 美元，对于早期 PCI 亚组，从占主导地位（节省成本的预期寿命获益）到 935 美元。结论 对于出现急性冠脉综合征并接受 PCI 的患者，给予长达 1 年的氯吡格雷是一种极具成本效益的治疗策略。
Background The superiority of clopidogrel and aspirin versus aspirin alone for up to I year in patients who undergo percutaneous coronary intervention (PCI) after presenting with acute coronary syndromes without ST-segment elevation was demonstrated in the PCI-CURE study. We evaluated the long-term cost-effectiveness of clopidogrel use for up to 1 year using patient-level outcomes and resource use from PCI-CURE, and estimates of life expectancy gains based on external sources.Methods PCI-CURE involved 2658 patients who underwent PCI between 1998 and 2000 after being randomized in the CURE trial to clopidogrel (n = 1313) or placebo (n = 1345). Roughly two thirds (clopidogrel n = 82 1, placebo n = 909) underwent PCI during the initial hospitalization (early PCI). Costs were applied to hospitalizations according to diagnosis-related group. Clopidogrel was assigned the average wholesale price of $3.22 per day. Life expectancy gains resulting from the prevention of major clinical events were estimated using external sources.Results Average total costs were higher with clopidogrel (difference [based on costing method] $253-$423). For patients who underwent PCI during the initial hospitalization, the difference ranged from $155 lower to $90 higher with clopidogrel. The estimated life expectancy gain with clopidogrel was 0.0885 years, whereas it was 0.0962 years for the early PCI subgroup. Incremental cost per year of life gained with clopidogrel ranges from $2856 to $4775 overall and from dominant (life expectancy benefit with cost savings) to $935 for the early PCI subgroup.Conclusions Clopidogrel given for up to 1 year in patients undergoing PCI after presentation with acute coronary syndromes is a highly cost-effective treatment strategy.