低剂量与高剂量血管紧张素转换酶抑制剂赖诺普利治疗慢性心力衰竭的成本效益分析：基于赖诺普利治疗与生存评估（ATLAS）研究。ATLAS研究小组

Low doses vs. high doses of the angiotensin converting-enzyme inhibitor lisinopril in chronic heart failure: a cost-effectiveness analysis based on the Assessment of Treatment with Lisinopril and Survival (ATLAS) study. The ATLAS Study Group.

作者信息

Sculpher M J, Poole L, Cleland J, Drummond M, Armstrong P W, Horowitz J D, Massie B M, Poole-Wilson P A, Ryden L

机构信息

Centre for Health Economics, University of York, Helsington, York, YO10 5DD, UK.

出版信息

Eur J Heart Fail. 2000 Dec;2(4):447-54. doi: 10.1016/s1388-9842(00)00122-7.

DOI:10.1016/s1388-9842(00)00122-7

PMID:11113723

Abstract

OBJECTIVE

A cost-effectiveness analysis of high and low doses of the angiotensin-converting enzyme (ACE) inhibitor lisinopril in the treatment of chronic heart failure.

METHODS

A cost-effectiveness analysis using data from a randomized controlled trial, ATLAS, where 3164 patients with chronic heart failure were allocated to a high-dose (daily target dose 32.5-35 mg) or low-dose strategy (daily target dose 2.5-5.0 mg) of lisinopril. Differential costs were based on resource use data collected in the trial costed using UK unit costs. Cost-effectiveness analysis related differential costs to differential life-years during a 4-year trial follow-up.

RESULTS

The mean total number of hospital in-patient days per patient was 18. 5 in the high dose group and 22.5 in the low dose group. Over the whole duration of the trial, the mean (S.D.) daily dose of lisinopril in the high-dose group was 22.5 mg (15.7 mg) compared to 3.2 mg (2.5 mg) in the low-dose group. The mean difference in cost per patient was pound sterling 397 lower in the high-dose group [95% CI (high-dose-low-dose) - pound sterling 1263 to pound sterling 436]. Mean life-years per patient were 0.085 years higher in the high-dose group [95% CI (high-dose-low-dose) -0.0074 to 0.1706). Based on mean costs and life-years, high-dose therapy dominates low-dose (less costly and more effective). Allowing for uncertainty in mean costs and life-years, the probability of high-dose therapy being less costly than low dose was 82%. If a decision maker is willing to pay at least pound sterling 3600 per life-year gained, the probability of high-dose being more cost-effective was 92%.

CONCLUSIONS

The ATLAS Study showed that the treatment of heart failure with high-doses of lisinopril has a high probability of being more cost-effective than low-dose therapy.

摘要

目的

对高剂量和低剂量血管紧张素转换酶（ACE）抑制剂赖诺普利治疗慢性心力衰竭进行成本效益分析。

方法

采用随机对照试验ATLAS的数据进行成本效益分析，该试验将3164例慢性心力衰竭患者分配至赖诺普利高剂量策略组（每日目标剂量32.5 - 35毫克）或低剂量策略组（每日目标剂量2.5 - 5.0毫克）。差异成本基于试验中收集的资源使用数据，使用英国单位成本进行成本核算。成本效益分析将差异成本与4年试验随访期间的差异生命年相关联。

结果

高剂量组患者的平均住院总天数为18.5天，低剂量组为22.5天。在整个试验期间，高剂量组赖诺普利的平均（标准差）日剂量为22.5毫克（15.7毫克），而低剂量组为3.2毫克（2.5毫克）。高剂量组每位患者的平均成本差异比低剂量组低397英镑[95%可信区间（高剂量 - 低剂量） - 1263英镑至436英镑]。高剂量组每位患者的平均生命年数高0.085年[95%可信区间（高剂量 - 低剂量） - 0.0074至0.1706]。基于平均成本和生命年，高剂量治疗优于低剂量（成本更低且更有效）。考虑到平均成本和生命年的不确定性，高剂量治疗成本低于低剂量的概率为82%。如果决策者愿意为每获得一个生命年至少支付3600英镑，高剂量更具成本效益的概率为92%。