Marissal J P, Selke B, Lebrun T
Department of Health Economics, Catholic University of Lille, France.
Pharmacoeconomics. 2000 Aug;18(2):185-200. doi: 10.2165/00019053-200018020-00008.
To analyse the economic benefits, in comparison with placebo, of the secondary prevention of ischaemic stroke and myocardial infarction (MI) with lysine acetylsalicylate (Kardégic) in patients with a history of ischaemic stroke, MI or stable and unstable angina pectoris.
This was a modelling study from the perspectives of direct medical costs, the social security system and society in France.
Efficacy data for the secondary prevention of ischaemic events were derived from the Antiplatelet Trialists' Collaboration meta-analysis on antithrombotics. The rates and costs of ischaemic disease and of serious gastrointestinal adverse affects arising from long term aspirin treatment, as well as the costs of treatment with lysine acetylsalicylate, were taken from published sources, using French data where possible.
From the social security perspective, the estimated cost-effectiveness ratios show that the prevention of MI in patients with a history of unstable angina (with a 1-year follow-up) is a cost-saving strategy, with net benefits ranging from $US5703 (1996 prices) per avoided MI for lysine acetylsalicylate 300 mg/day to $US5761 per avoided MI for lysine acetylsalicylate 75 mg/day. The prevention of MI and stroke is also a cost-saving strategy in patients with prior MI [net benefits in a 2-year follow-up (5% discount rate) ranging from $US15 to $US494 per avoided MI and from $US37 to $US1170 per avoided stroke]. This was also true in patients with prior ischaemic stroke (net benefits in a 3-year follow-up ranging from $US610 to $US2082 per avoided MI and from $US176 to $US599 per avoided stroke). Finally, a 4-year follow-up in patients with a history of stable angina pectoris shows that prophylactic treatment with lysine acetylsalicylate is associated with net costs per avoided MI, ranging from $US4375 to $US3608 per avoided event. Sensitivity analysis confirmed that prophylaxis with lysine acetylsalicylate in patients at high risk of cardiovascular and cerebrovascular events results in savings in social security expenditure.
Our results underline the high economic benefit of using lysine acetylsalicylate to prevent secondary ischaemic stroke and MI in patients at high risk of cardiovascular and/or cerebrovascular events, leading to savings for the social security system and society.
比较赖氨酸阿司匹林（卡地嗪）与安慰剂对有缺血性中风、心肌梗死（MI）病史或稳定型及不稳定型心绞痛患者进行缺血性中风和心肌梗死二级预防的经济效益。
这是一项从法国直接医疗成本、社会保障系统和社会角度进行的建模研究。
缺血性事件二级预防的疗效数据来自抗血小板试验协作组关于抗血栓药物的荟萃分析。缺血性疾病的发生率和成本、长期阿司匹林治疗引起的严重胃肠道不良反应以及赖氨酸阿司匹林治疗的成本，尽可能采用法国数据，取自已发表的资料。
从社会保障角度看，估计的成本效益比表明，对有不稳定型心绞痛病史的患者预防心肌梗死（随访1年）是一种节省成本的策略，每避免发生一次心肌梗死，每天服用300毫克赖氨酸阿司匹林的净效益为5703美元（1996年价格），每天服用75毫克赖氨酸阿司匹林的净效益为5761美元。对有心肌梗死病史的患者预防心肌梗死和中风也是一种节省成本的策略[在2年随访（5%贴现率）中，每避免发生一次心肌梗死的净效益为15美元至494美元，每避免发生一次中风的净效益为37美元至1170美元]。对有缺血性中风病史的患者也是如此（在3年随访中，每避免发生一次心肌梗死的净效益为610美元至2082美元，每避免发生一次中风的净效益为176美元至599美元）。最后，对有稳定型心绞痛病史的患者进行4年随访表明，赖氨酸阿司匹林预防性治疗每避免发生一次心肌梗死的净成本为4375美元至3608美元。敏感性分析证实，对心血管和脑血管事件高危患者使用赖氨酸阿司匹林进行预防可节省社会保障支出。
我们的结果强调了使用赖氨酸阿司匹林预防心血管和/或脑血管事件高危患者继发性缺血性中风和心肌梗死具有很高的经济效益，可为社会保障系统和社会节省开支。
