Cost Effectiveness of Antiplatelet and Antithrombotic Therapy in the Setting of Acute Coronary Syndrome: Current Perspective and Literature Review.
Cost Effectiveness of Antiplatelet and Antithrombotic Therapy in the Setting of Acute Coronary Syndrome: Current Perspective and Literature Review.
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DOI：
10.1007/s40256-015-0131-6
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发表时间：
2015-12
期刊：
影响因子：
--
通讯作者：
Weintraub WS
中科院分区：
文献类型：
--
作者：
Fanari Z;Weiss S;Weintraub WS
急性冠状动脉综合征与高发病率和死亡率相关。多年来抗血小板和抗凝治疗的进步改善了心脏结果，但也增加了医疗保健成本。已经进行了多项成本效益研究，以评估现有抗血小板药物和抗凝治疗在 ST 段抬高型心肌梗死 (STEMI) 和非 ST 段抬高急性冠状动脉综合征 (NSTE-ACS) 中的使用情况。早期，GPI 的使用被证明在 ACS 治疗中具有经济吸引力，然而 P2Y12 受体拮抗剂的引入限制了它们在复杂干预措施中作为救援药物的使用。普通氯吡格雷可能仍然是一种经济上有吸引力的 P2Y12 受体拮抗剂选择，尤其是在低风险 ACS 中，而替格瑞洛和普拉格雷都是经济上有吸引力的替代选择，尤其是在高风险 ACS 和有支架血栓形成风险的患者中。虽然依诺肝素在 NSTE-ACS 中是经济上占主导地位的肝素替代品，但其在当代 STEMI 中的作用尚不清楚。在 PCI 期间，比伐卢定单药治疗被证明是 ACS 中肝素和 GPI 联合治疗的经济上占主导地位的替代方案。然而，新的研究可能表明，使用肝素单一疗法可能提供一种有吸引力的替代方案。抗血小板和抗血栓治疗不同组合的比较和成本效益将是未来预期临床和经济评估的重点。
Acute Coronary Syndromes are associated with high rates of morbidity and mortality. The advances of antiplatelet and anticoagulation therapy over several years time have result in in improved in cardiac outcomes, but with increased health care costs. Multiple cost effectiveness studies have been performed to evaluate the use of available antiplatelet agents and anticoagulation in the setting of both ST Elevation myocardial infarction (STEMI) and Non–ST Elevation Acute Coronary Syndrome (NSTE-ACS). Early on the use of GPI prove to be economically attractive in the management of ACS, however the introduction of P2Y12 receptor antagonist limited their use to a bail out agents in complex interventions. Generic clopidogrel is probably still an economically attractive P2Y12 receptor antagonist choice especially in low risk ACS, while both ticagrelor and prasugrel present an economically attractive alternative option especially in high risk ACS and patients at risk for stent thrombosis. While enoxaparin presents an economically dominant alternative to heparin in NSTE-ACS, its role in STEMI in the contemporary era is unclear. During PCI, bivalirudin monotherapy was shown to be an economically dominant alternative to the combination of heparin and GPI in ACS. However, new studies may suggest that using heparin monotherapy may offer an attractive alternative. The comparative and cost effectiveness of different combinations of antiplatelet and antithrombotic therapy will be the focus of future expected clinical and economic assessments.