Casciano Roman, Tarride Jean-Eric, Breton Marie Claude, Stern Lee, Langer Anatoly
The Analytica Group, New York, New York, USA.
Can J Clin Pharmacol. 2004 Spring;11(1):e179-90.
To determine a 16-week total healthcare cost and the cost-effectiveness of short-term, lipid-lowering therapy with atorvastatin 80 mg following acute coronary syndrome (ACS) in Canada.
The expected costs per patient on atorvastatin 80 mg per day and placebo were compared using clinical outcome data from the MIRACL study and cost data from the Ontario Case Costing Project and the Ontario Schedule of Benefits. The cost per event avoided was also assessed. The clinical outcomes measured included: death, cardiac arrest, non-fatal myocardial infarction (MI), fatal MI, angina pectoris, stroke, congestive heart failure, and surgical or percutaneous coronary revascularizations. All direct medical costs from the perspective of the Canadian health care system were taken into account.
The total expected cost per patient was 2,590 dollars in the placebo group and 2,639 dollars in the atorvastatin group. The incremental cost of atorvastatin treatment (49.26 dollars per patient) corresponded to a cost of 1,285 dollars per event avoided. The cost savings obtained through the reduction in events offset 86% of the cost of atorvastatin treatment. Budget impact analysis revealed that increased rates of atorvastatin usage following ACS were associated with large numbers of events avoided at a small additional cost when projected to the Canadian population.
In Canada, the clinical benefits of intensive short-term atorvastatin treatment administered within 96 hours after ACS were associated with a favorable cost-effectiveness ratio. The incremental cost of atorvastatin is mostly offset by savings due to the reduction in events in patients treated with atorvastatin.
确定加拿大急性冠脉综合征（ACS）后使用80毫克阿托伐他汀进行短期降脂治疗的16周总医疗费用及成本效益。
使用来自MIRACL研究的临床结局数据以及安大略病例成本核算项目和安大略福利清单的成本数据，比较每日服用80毫克阿托伐他汀的患者和服用安慰剂患者的预期成本。还评估了避免发生每个事件的成本。所测量的临床结局包括：死亡、心脏骤停、非致命性心肌梗死（MI）、致命性MI、心绞痛、中风、充血性心力衰竭以及外科或经皮冠状动脉血运重建。考虑了从加拿大医疗保健系统角度出发的所有直接医疗费用。
安慰剂组每位患者的总预期成本为2590美元，阿托伐他汀组为2639美元。阿托伐他汀治疗的增量成本（每位患者49.26美元）相当于避免发生每个事件的成本为1285美元。通过减少事件获得的成本节省抵消了阿托伐他汀治疗成本的86%。预算影响分析显示，将ACS后阿托伐他汀使用比例提高的情况推算至加拿大人口时，会以少量额外成本避免大量事件的发生。
在加拿大，ACS后96小时内进行强化短期阿托伐他汀治疗的临床益处与良好的成本效益比相关。阿托伐他汀的增量成本大部分被阿托伐他汀治疗患者因事件减少而节省的费用所抵消。
