JAMA Netw Open：他汀类药物治疗高危高甘油三酯血症患者的成本-效果分析

2022-02-22 从医路漫漫 MedSci原创

二十碳联苯乙基干预试验(Reduce-IT)减少心血管事件证明了二十碳五烯酸乙酯(IPE)对高甘油三酯血症、已知心血管疾病或糖尿病以及至少1个其他危险因素接受他汀类药物治疗的高危患者的疗效。

重要性：二十碳联苯乙基干预试验(Reduce-IT)减少心血管事件证明了二十碳五烯酸乙酯(IPE)对高甘油三酯血症、已知心血管疾病或糖尿病以及至少1个其他危险因素接受他汀类药物治疗的高危患者的疗效。

目的：评估使用他汀类药物治疗高危高甘油三酯血症患者的IPE与标准治疗相比的成本-效果。

设计、设置和参与者：使用Reduce-IT的患者水平研究数据进行试验中的成本-效果分析，使用微观模拟模型和已发表文献的数据进行寿命分析。这项研究包括8179名高甘油三酯血症患者，尽管他们在2011年11月21日至2018年5月31日期间接受了稳定的他汀类药物治疗。分析是从美国卫生保健部门的角度进行的。统计分析时间为2018年3月1日至2021年10月31日。

干预：患者被随机分配到IPE组、4g/d组或安慰剂组，并进行了中位时间4.9年的随访(IQR，3.5-5.3年)。在使用SSR健康净成本(SSR成本)回扣后，IPE的成本为4.16美元/天，加上批发采购成本(WAC)后为9.28美元/天。

主要成果和措施：主要结果是增量质量调整寿命年(QALY)、总直接医疗成本(2019年美元)和成本效益。

结果：共有4089名患者(2927名男性(71.6%)，中位年龄64.0岁[智商(IQR)57.0-69.0岁])被随机分配接受IPE，4090名患者(2895名男性[70.8%]，中位年龄64.0岁[智商(IQR)57.0-69.0岁])被随机分配接受标准治疗。IPE治疗的QALY在试验中(3.34比3.27；平均差异，0.07[95%CI，0.01-0.12])和终生预测(10.59比10.35；平均差异，0.24[95%CI，0.15-0.33])都比标准护理产生更多的QALY。在试验期间，使用SSR成本(18786美元)或WAC(24544美元)的IPE的总医疗成本高于标准医疗(17273美元；与SSR成本的平均差额1513美元[95%CI，155-2870美元]；与WAC的平均差额7271美元[95%CI，5911-8630美元])。使用SSR成本获得的每QALY成本为22311美元，使用WAC获得的每QALY成本为107218美元。在一生中，使用SSR费用(195276美元)与标准护理(197064美元；平均差异，-1788[95%CI，-9735至6159])相比，IPE被预测为节省成本，但与标准护理(平均差异5766[95%CI，1094-10438])相比，使用WAC(202830美元)的IPE成本更高。与标准护理相比，使用SSR成本时，IPE的终生成本更低和更有效的概率为58.4%，使用SSR成本时，每个QALY成本低于5万美元的概率为89.4%，使用WAC成本时，每个QALY成本低于50000美元的概率为72.5%，而使用SSR成本时，IPE的终生成本低于50000美元的概率为58.4%，使用WAC成本的终身成本低于50000美元的概率为89.4%。

图1.使用全国住院患者事件样本费用的试验期内的成本效益平面

图2.使用全国住院患者事件样本成本计算的生命周期内的成本效益平面

图3.不同WTP阈值下的二十烷基日成本

图4.增量成本效益比(ICER)的龙卷风图

结论：这项研究表明，无论是在试验中还是在整个生命周期内，在共同的支付意愿阈值下，IPE在减少IT参与者中提供了比标准治疗更好的心血管结果。

原文出处： Weintraub WS, Bhatt DL, Zhang Z, et al.Cost-effectiveness of Icosapent Ethyl for High-risk Patients With Hypertriglyceridemia Despite Statin Treatment.JAMA Netw Open 2022 02 01;5(2)

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2022-10-06 ms6390871039024434

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2022-09-07 canlab

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2022-10-07 flyingeagle85

#高甘油三酯#

38 0
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2022-09-12 yinhl1978

#效果分析#

37 0
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2022-04-24 feather89

#PE#

31 0
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2022-03-10 maotouying

学习了，很不错

36 0
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2022-02-23 bioon4

#高甘油三酯血症#

44 0
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2022-02-22 ms2000001545439177

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