Cost-Effectiveness of Aspirin Adherence for Secondary Prevention of Cardiovascular Events.
Cost-Effectiveness of Aspirin Adherence for Secondary Prevention of Cardiovascular Events.
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DOI：
10.1007/s41669-018-0075-2
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发表时间：
2018-12
期刊：
影响因子：
--
通讯作者：
Lieberthal RD
中科院分区：
文献类型：
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作者：
Djatche LM;Varga S;Lieberthal RD
心血管（CV）事件二级预防中阿司匹林治疗依从性不佳是一个重要的公共卫生问题。既往研究表明，未依从治疗的患者发生CV事件的风险更高。本研究旨在评估既往发生过主要CV事件的患者中阿司匹林非依从性的临床和经济结局。我们开发了一个马尔可夫模型，从美国管理式医疗支付者的角度，在5年的时间范围内估计阿司匹林依从性的成本效益。从已发表的文献中收集阿司匹林依从性、CV事件和不良事件的成本、效用和发生率，以填充模型。结果是质量调整生命年（QER），成本（美元）和增量成本效益比（ICER）。我们将该模型分别应用于没有II型糖尿病的人群作为合并症（非糖尿病模型）和患有II型糖尿病的人群（II型糖尿病模型）。进行了单向敏感性分析，以评估模型的不确定性。基础病例显示，在非糖尿病模型和II型糖尿病模型中，依从性患者的生存时间分别比非依从性患者长0.25和0.36 Qs。在非糖尿病人群中，坚持服用阿司匹林的ICER为25美元/QALY，而在II型糖尿病人群中，5年内每例患者可节省297美元。单因素敏感性分析显示，模型对非依从性患者的非致死性事件发生率最敏感。这项研究表明，阿司匹林依从性可能会改善既往发生过主要CV事件的患者的QCI。此外，它可以降低II型糖尿病患者的费用。虽然需要更多的研究来验证这些结果，但付款人可能希望增加促进依从性的策略，以改善人口健康。不适用因
Suboptimal adherence to aspirin therapy for secondary prevention of cardiovascular (CV) events is an important public health problem. Prior studies have demonstrated non-adherent patients are at higher risk of experiencing CV events. This study aimed to estimate the clinical and economic outcomes of aspirin non-adherence in patients with a prior primary CV event. We developed a Markov model to estimate the cost-effectiveness of aspirin adherence from a generic US managed care payer perspective over a 5-year time horizon. Costs, utilities and rates of aspirin adherence, CV events and adverse events were gathered from published literature to populate the model. Outcomes were quality-adjusted life years (QALYs), costs (US$) and incremental cost-effectiveness ratios (ICERs). We applied the model separately to a population without type II diabetes as a comorbidity (non-diabetic model) and a population with type II diabetes (type II diabetes model). A one-way sensitivity analysis was performed to assess the model uncertainty. The base case showed adherent patients lived 0.25 and 0.36 QALYs longer than non-adherent patients in the non-diabetic model and type II diabetes model, respectively. Adherence to aspirin had an ICER of US$25/QALY in the non-diabetic population, while it saved US$297 per patient over a 5-year period in the type II diabetes population. One-way sensitivity analysis showed the models were most sensitive to rates of non-fatal events in non-adherent patients. This study suggests aspirin adherence may improve QALYs for patients with a prior primary CV event. Further, it may decrease costs in patients with type II diabetes. While additional research is needed to validate these results, payers may wish to increase strategies to promote adherence in order to improve population health. Not applicable.