Palmer Stephen, Sculpher Mark, Philips Zoe, Robinson Mike, Ginnelly Laura, Bakhai Ameet, Abrams Keith, Cooper Nicola, Packham Chris, Alfakih Khaled, Hall Alistair, Gray David
Centre for Health Economics, University of York, Heslington, UK.
Int J Cardiol. 2005 Apr 20;100(2):229-40. doi: 10.1016/j.ijcard.2004.08.042.
The glycoprotein IIb/IIIa antagonists (GPAs) represent a new class of drugs to prevent platelet aggregation in the acute treatment of non-ST-elevation acute coronary syndromes (NSTE-ACS). Systematic reviews have identified serious limitations in published cost-effectiveness analyses, including a lack of UK-specific studies and an absence of studies comparing different protocols for the use of GPAs.
A model was developed to assess the cost effectiveness of a variety of protocols employing GPAs for patients presenting with NSTE-ACS in the UK. The perspective of the UK National Health Service was adopted, with outcomes in terms of quality-adjusted life-years (QALYs). Four treatment strategies were evaluated: GPAs as part of initial medical management (Strategy 1); GPAs in patients with planned percutaneous coronary interventions (PCIs; Strategy 2); GPAs as an adjunct to the PCI procedure (Strategy 3); and no GPAs (Strategy 4). Baseline event rates and costs were taken from a UK observational study of ACS patients and relative risk reductions from GPAs were taken from a meta analysis of trials. Long-term costs and QALYs were estimated using data from a UK longitudinal study.
The most cost-effective use of GPAs is likely to be Strategy 1, with an incremental cost per QALY gained of between pound4605 to pound10,343. Focusing this use of GPAs only on the subgroup of patients at high risk appears to represent the most cost-effective use of NHS resources.
Medical management of patients with NSTE-ACS using GPAs is the most cost-effective use of resources, particularly if targeted to higher risk subgroups.
糖蛋白IIb/IIIa拮抗剂（GPAs）是一类新型药物，用于在非ST段抬高型急性冠状动脉综合征（NSTE-ACS）的急性治疗中预防血小板聚集。系统评价发现已发表的成本效益分析存在严重局限性，包括缺乏针对英国的研究以及缺乏比较不同GPA使用方案的研究。
建立了一个模型，以评估在英国使用GPA治疗NSTE-ACS患者的各种方案的成本效益。采用英国国家医疗服务体系的视角，以质量调整生命年（QALYs）为结果指标。评估了四种治疗策略：GPA作为初始药物治疗的一部分（策略1）；计划进行经皮冠状动脉介入治疗（PCI）的患者使用GPA（策略2）；GPA作为PCI手术的辅助手段（策略3）；不使用GPA（策略4）。基线事件发生率和成本取自英国一项关于ACS患者的观察性研究，GPA的相对风险降低率取自试验的荟萃分析。长期成本和QALYs使用英国一项纵向研究的数据进行估计。
GPA最具成本效益的使用方式可能是策略1，每获得一个QALY的增量成本在4605英镑至10343英镑之间。仅将GPA的这种使用方式集中于高危患者亚组似乎代表了英国国家医疗服务体系资源的最具成本效益的使用方式。
使用GPA对NSTE-ACS患者进行药物治疗是资源最具成本效益的使用方式，特别是如果针对较高风险亚组。
