Cost-effectiveness of optimal use of acute myocardial infarction treatments and impact on coronary heart disease mortality in China.
Cost-effectiveness of optimal use of acute myocardial infarction treatments and impact on coronary heart disease mortality in China.
复制标题
最佳使用急性心肌梗塞治疗的成本效益以及对中国冠心病死亡率的影响。
DOI：
10.1161/circoutcomes.113.000674
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发表时间：
2014-01
期刊：
影响因子：
--
通讯作者：
Zhao D
中科院分区：
文献类型：
--
作者：
Wang M;Moran AE;Liu J;Coxson PG;Heidenreich PA;Gu D;He J;Goldman L;Zhao D
在中国，优化使用医院为基础的急性心肌梗死治疗的成本-效果及其对冠心病死亡率的潜在影响尚不为人所知。以医院为基础的急性心肌梗死治疗的最佳使用的有效性和成本由一个马尔可夫式的计算机模拟模型结果是模拟急性心肌梗死、冠心病死亡率、质量调整的生命年和总的医疗费用的变化。使用增量成本效益比来评估预计的成本效益。在所有符合条件的急性心肌梗死或非ST段抬高心肌梗死患者中，最佳使用4种口服药物(阿司匹林、β阻滞剂、他汀类药物和血管紧张素转换酶抑制剂)是一种高成本效益策略(增量成本-效果比约为3,100美元或更少)。在符合条件的ST段抬高心肌梗死患者中，再灌注治疗的最佳使用是中等成本效益的(增量成本-效果比≤为10700美元)。对于所有符合条件的急性心肌梗死患者或仅在三级医院接受直接经皮冠状动脉介入治疗的高危非ST段抬高心肌梗死患者，氯吡格雷的最佳使用成本效益较低。所有选定的以医院为基础的急性心肌梗死治疗策略一起使用将具有成本效益，并将中国的总冠心病死亡率降低≈9.6%。对于中国来说，最合理地使用最标准的以医院为基础的急性心肌梗死治疗策略，特别是联合治疗策略，将是具有成本效益的。然而，由于有如此多的急性心肌梗死死亡发生在中国的医院外，预计总体上对预防冠心病死亡的影响并不大。
The cost-effectiveness of the optimal use of hospital-based acute myocardial infarction (AMI) treatments and their potential impact on coronary heart disease (CHD) mortality in China is not well known. The effectiveness and costs of optimal use of hospital-based AMI treatments were estimated by the CHD Policy Model-China, a Markov-style computer simulation model. Changes in simulated AMI, CHD mortality, quality-adjusted life years, and total healthcare costs were the outcomes. The incremental cost-effectiveness ratio was used to assess projected cost-effectiveness. Optimal use of 4 oral drugs (aspirin, β-blockers, statins, and angiotensin-converting enzyme inhibitors) in all eligible patients with AMI or unfractionated heparin in non–ST-segment–elevation myocardial infarction was a highly cost-effective strategy (incremental cost-effectiveness ratios approximately US $3100 or less). Optimal use of reperfusion therapies in eligible patients with ST-segment–elevation myocardial infarction was moderately cost effective (incremental cost-effectiveness ratio ≤$10 700). Optimal use of clopidogrel for all eligible patients with AMI or primary percutaneous coronary intervention among high-risk patients with non–ST-segment– elevation myocardial infarction in tertiary hospitals alone was less cost effective. Use of all the selected hospital-based AMI treatment strategies together would be cost-effective and reduce the total CHD mortality rate in China by ≈9.6%. Optimal use of most standard hospital-based AMI treatment strategies, especially combined strategies, would be cost effective in China. However, because so many AMI deaths occur outside of the hospital in China, the overall impact on preventing CHD deaths was projected to be modest.