Hummel S, Piercy J, Wright R, Davie A, Bagust A, McMurray J
York Health Economics Consortium, University of York, England.
Pharmacoeconomics. 1997 Aug;12(2 Pt 1):182-92. doi: 10.2165/00019053-199712020-00008.
Recent studies have shown that ACE inhibitors reduce morbidity and mortality after myocardial infarction (MI). While these trials have obvious clinical implications, the widespread introduction of a new treatment for a condition as common as MI also has clear cost implications. The results of the post-MI studies with ACE inhibitors suggest that restricted use of treatment-in high-risk patients-is likely to be most cost effective, whereas treatment of all MI survivors, many of whom are at low risk, will be least cost effective. An approach somewhere in between may maximise clinical benefit at an acceptable cost. Economic analysis may help in deciding how these drugs might be best used after MI. We have conducted a cost-effectiveness and cost-utility analysis of the Survival and Ventricular Enlargement (SAVE) study, which reported the benefit of ACE inhibitors in intermediate-risk patients. Assuming all MI survivors require measurement of left ventricular function before selection for treatment (the approach used in the SAVE study), the incremental cost per life-year gained (LYG), over 4 years, using prophylactic captopril is approximately 10000 pounds sterling (Pounds) [1994 to 1995 values]. The cost per quality-adjusted life-year (QALY) is similar. These incremental cost per LYG and cost per QALY ratios compare favourably with other commonly used symptomatic and prophylactic treatments, and argue for extending post-MI use of ACE inhibitors to intermediate-as well as high-risk patients.
近期研究表明，血管紧张素转换酶（ACE）抑制剂可降低心肌梗死（MI）后的发病率和死亡率。虽然这些试验具有明显的临床意义，但对于像MI这样常见疾病广泛采用一种新疗法也有着明确的成本影响。MI后使用ACE抑制剂的研究结果表明，限制治疗——应用于高危患者——可能最具成本效益，而对所有MI幸存者进行治疗（其中许多人风险较低）则最不具成本效益。介于两者之间的方法可能会以可接受的成本使临床获益最大化。经济分析可能有助于决定MI后如何最佳使用这些药物。我们对生存与心室扩大（SAVE）研究进行了成本效益和成本效用分析，该研究报告了ACE抑制剂对中度风险患者的益处。假设所有MI幸存者在选择治疗前都需要测量左心室功能（SAVE研究中采用的方法），使用预防性卡托普利在4年内每获得一个生命年（LYG）的增量成本约为10000英镑（按1994年至1995年的价值计算）。每质量调整生命年（QALY）的成本与之相似。这些每LYG的增量成本和每QALY成本比率与其他常用的对症和预防性治疗相比具有优势，支持将MI后ACE抑制剂的使用范围扩大至中度风险以及高危患者。
