Value-Based Prices Could Establish Common Ground on Heart Failure Drug Pricing and Coverage.
Value-Based Prices Could Establish Common Ground on Heart Failure Drug Pricing and Coverage.
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基于价值的价格可以为心力衰竭药物的定价和承保范围建立共同点。
DOI：
10.1016/j.jacc.2022.04.032
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发表时间：
2022
影响因子：
24
通讯作者：
O'Kelly,AnnaC
中科院分区：
文献类型：
--
作者：
Wasfy,JasonH;O'Kelly,AnnaC
在过去的几年里，四联疗法，包括b受体阻滞剂，盐皮质激素受体拮抗剂（MRA），钠葡萄糖协同转运蛋白-2抑制剂（SGLT 2抑制剂）和血管紧张素受体-脑啡肽酶抑制剂（ARNI），为估计300万美国人1生活在射血分数降低的心力衰竭（HFrEF）患者提供了新的希望。模型表明，相对于省略SGLT 2抑制剂和ARNI并替代血管紧张素转换酶抑制剂（ACEIs）或血管紧张素受体阻滞剂（ARB）的所有非专利治疗方案，四重治疗可以将HFrEF患者的死亡率降低约50%。2排除SGLT 2抑制剂和ARNI会产生很大的不同。一项比较ARNI与ACEI的开创性试验由于ARNI的发病率和死亡率降低而提前停止。3研究还显示，在HFrEF患者中使用SGLT 2抑制剂可降低发病率和死亡率。4，5在支持ARNI使用的证据背景下，一些指南现在建议将ARNI作为HFrEF的一线治疗。6-8在2022年美国心脏协会（AHA）/美国心脏病学会（ACC）心力衰竭指南中，SGLT 2抑制剂现在被推荐用于1类适应症，
Over the past few years, quadruple therapy, which includes b-blockers, mineralocorticoid receptor antagonists (MRAs), sodiumglucose cotransporter-2 inhibitors (SGLT2 inhibitors), and angiotensin receptor-neprilysin inhibitors (ARNIs), has offered new hope for the estimated 3 million Americans 1 living with heart failure with reduced ejection fraction (HFrEF). Models suggest that quadruple therapy could reduce mortality in patients with HFrEF by approximately 50% relative to all-generic regimens that omit SGLT2 inhibitors and ARNIs and substitute angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs). 2Leaving out SGLT2 inhibitors and ARNIs makes a big difference. A seminal trial that compared ARNIs with ACEIs was stopped early because of reduced morbidity and mortality with ARNIs. 3 Studies have also shown reduced morbidity and mortality with SGLT2 inhibitor use in patients with HFrEF. 4, 5 In the context of evidence supporting ARNI use, several guidelines now recommend ARNIs as first-line therapy in HFrEF. 6-8 In the 2022 American Heart Association (AHA)/American College of Cardiology (ACC) Heart Failure guidelines, SGLT2 inhibitors are now recommended with a Class 1 indication in