Orlewska Ewa, Budaj Andrzej, Tereszkowski-Kaminski Dariusz
Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland.
Pharmacoeconomics. 2003;21(10):737-48. doi: 10.2165/00019053-200321100-00005.
AIM AND PERSPECTIVE: To estimate the cost effectiveness of enoxaparin versus unfractionated heparin (UFH) in patients with acute coronary syndrome (ACS) from a Polish hospital perspective. This was intended to facilitate the decisionmaking process in selecting the most cost-effective treatment for ACS.
A decision model was used to quantify costs and effectiveness of alternative treatments. Published results from the Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-Wave Coronary Events (ESSENCE) study were used to estimate the probability for clinical endpoints (death, myocardial infarction or recurrent angina) at 30 days. Probabilities of patients undergoing revascularisation procedures were obtained from the Global Registry of Acute Coronary Events (GRACE) which included data from 961 patients at six centres in Poland. The analysis assessed only direct medical costs, determined from actual resource consumption on a patient-specific basis (6-month observational study) and estimated using Polish data on unit costs. One- and two-way sensitivity analyses and threshold analysis were performed.
At 30 days, 19.8% of patients receiving enoxaparin compared with 23.3% of those receiving UFH reached a composite endpoint consisting of death, myocardial infarction and recurrent angina (p = 0.02). The average costs (in zloty ; 1 US dollar = 4 zloty [2000 values]) were 1,085 per patient receiving enoxaparin compared with 1,097 per patient receiving UFH. Therefore, for every 29 patients treated, not only would enoxaparin therapy avoid one event of the composite endpoint, it would also save 348 zloty. The threshold analysis suggests that enoxaparin would lose dominance when the cost of enoxaparin increased by 10%, the cost of monitoring UFH therapy decreased by 12%, the probability of reaching the composite endpoint in the enoxaparin arm increased to 0.22 or decreased to 0.21 in the UFH arm.
According to our model enoxaparin was more effective at a lower cost than UFH, therefore this treatment was shown to be dominant for patients with ACS in Poland.
目的与展望：从波兰一家医院的角度评估依诺肝素与普通肝素（UFH）在急性冠脉综合征（ACS）患者中的成本效益。这旨在促进为ACS选择最具成本效益治疗方案的决策过程。
使用决策模型来量化替代治疗的成本和效果。皮下注射依诺肝素在非Q波冠脉事件中的疗效与安全性（ESSENCE）研究的已发表结果用于估计30天时临床终点（死亡、心肌梗死或复发性心绞痛）的概率。接受血运重建手术患者的概率来自全球急性冠脉事件注册研究（GRACE），该研究包含波兰六个中心961例患者的数据。分析仅评估直接医疗成本，其根据患者特定的实际资源消耗确定（为期6个月的观察性研究），并使用波兰单位成本数据进行估计。进行了单因素和双因素敏感性分析以及阈值分析。
30天时，接受依诺肝素治疗的患者中有19.8%达到由死亡、心肌梗死和复发性心绞痛组成的复合终点，而接受UFH治疗的患者中这一比例为23.3%（p = 0.02）。接受依诺肝素治疗的患者平均成本（以兹罗提计；1美元 = 4兹罗提[2000年数值]）为每位患者1085兹罗提，而接受UFH治疗的患者平均成本为每位患者1097兹罗提。因此，每治疗29例患者，依诺肝素治疗不仅可避免一次复合终点事件，还可节省348兹罗提。阈值分析表明，当依诺肝素成本增加10%、UFH治疗监测成本降低12%、依诺肝素组达到复合终点的概率增至0.22或UFH组降至0.21时，依诺肝素将失去优势。
根据我们的模型，依诺肝素在成本较低的情况下比UFH更有效，因此该治疗方案在波兰被证明对ACS患者具有优势。
