Cost effectiveness of perindopril in reducing cardiovascular events in patients with stable coronary artery disease using data from the EUROPA study
Cost effectiveness of perindopril in reducing cardiovascular events in patients with stable coronary artery disease using data from the EUROPA study
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DOI：
10.1136/hrt.2005.086728
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发表时间：
2007-09-01
期刊：
影响因子：
5.7
通讯作者：
Fox, Kim
中科院分区：
文献类型：
--
作者：
Briggs, Andrew;Mihaylova, Borislava;Fox, Kim
背景资料：最近报道了在稳定型冠状动脉疾病中使用培哚普利减少心脏事件的EUROPA试验。目的：评价培哚普利治疗英国稳定型冠心病的成本效果。方法：临床和资源使用数据来自EUROPA试验。费用包括药物和住院治疗。健康相关的生活质量值取自已发表的资料。成本效益分析是作为主要事件（非致命性心肌梗死、心脏骤停或心血管死亡）风险的函数提出的，以确定治疗提供最大性价比的人群。结果如下：在EUROPA的异质人群中，培哚普利每质量调整生命年（QALY）的中位增量成本估计为9700磅（四分位距6400磅-14200磅）。总体而言，88%的EUROPA人群的每QALY估计成本低于20磅000，97%低于30磅000。对于成本效益阈值为30磅000/QALY的收益，培哚普利成本效益分布第25、50（中位数）和75百分位数的患者的治疗成本效益概率分别为0.999、0.99和0.93。成本效益与标准治疗下原发事件的高风险密切相关。结论：培哚普利的使用是否具有成本效益取决于医疗保健系统的成本效益阈值。对于EUROPA中纳入的绝大多数患者，获得的每QALY增量成本低于英国国家健康与临床优化研究所使用的明显阈值。
Background: The EUropean trial on Reduction Of cardiac events with Perindopril in stable coronary Artery disease ( EUROPA) trial has recently reported. Objective: To assess the cost effectiveness of perindopril in stable coronary heart disease in the UK. Methods: Clinical and resource use data were taken from the EUROPA trial. Costs included drugs and hospitalisations. Health- related quality of life values were taken from published sources. A cost- effectiveness analysis is presented as a function of the risk of a primary event ( non- fatal myocardial infarction, cardiac arrest or cardiovascular death) in order to identify people for whom treatment offers greatest value for money. Results: The median incremental cost of perindopril for each quality- adjusted life year ( QALY) gained across the heterogeneous population of EUROPA was estimated as 9700 pound ( interquartile range pound 6400 -) pound 14 200). Overall, 88% of the EUROPA population had an estimated cost per QALY below 20 pound 000 and 97% below 30 pound 000. For a threshold value of cost effectiveness of 30 pound 000 per QALY gained, treatment of people representing the 25th, 50th ( median) and 75th centiles of the cost effectiveness distribution for perindopril has a probability of 0.999, 0.99 and 0.93 of being cost effective, respectively. Cost effectiveness was strongly related to higher risk of a primary event under standard care. Conclusions: Whether the use of perindopril can be considered cost effective depends on the threshold value of cost effectiveness of healthcare systems. For the large majority of patients included in EUROPA, the incremental cost per QALY gained was lower than the apparent threshold used by the National Institute for Health and Clinical Excellence in the UK.