Walker A, McMurray J, Stewart S, Berger W, McMahon A D, Dargie H, Fox K, Hillis S, Henderson N J K, Ford I
Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland.
Heart. 2006 May;92(5):619-24. doi: 10.1136/hrt.2003.026385.
To estimate the net cost of adding nicorandil to usual treatment for patients with angina and to compare this with indicators of health benefit.
Cost effectiveness analysis.
Based on results of the IONA (impact of nicorandil on angina) trial.
Patients with angina fulfilling the entry criteria for the IONA trial.
In one arm of the trial nicorandil was added to existing antianginal treatment and compared with existing treatment alone.
Costs were for use of hospital resources (for cardiovascular, cerebrovascular, and gastrointestinal reasons), nicorandil, and care after hospital discharge. Benefits were assessed in three ways: (1) IONA trial primary outcome (coronary heart disease (CHD) death, non-fatal myocardial infarction, or hospital admission for cardiac chest pain); (2) acute coronary syndrome (CHD death, non-fatal myocardial infarction, or unstable angina); and (3) event-free survivors at the end of the trial.
The net cost for each additional IONA trial end point averted was -5 pounds sterling (-7 euros). The net cost for each case of acute coronary syndrome averted was -8 pounds sterling (-12 euros). The net cost for each event-free survivor was -5 pounds sterling (-7 euros). These figures are based on gastrointestinal events that were judged definitely or probably related to nicorandil. When all gastrointestinal events were included these three ratios rose to 567 pounds sterling (835 euros), 886 pounds sterling (1305 euros), and 516 pounds sterling (760 euros), respectively.
A substantial amount of the additional cost of nicorandil is offset by reduced use of hospital services. The limited comparisons possible with other CHD interventions suggest that nicorandil compares favourably.
评估在心绞痛患者常规治疗基础上加用尼可地尔的净成本，并将其与健康获益指标进行比较。
成本效益分析。
基于IONA（尼可地尔对心绞痛的影响）试验结果。
符合IONA试验纳入标准的心绞痛患者。
试验的一组在现有抗心绞痛治疗基础上加用尼可地尔，并与单纯现有治疗进行比较。
成本包括医院资源使用（因心血管、脑血管和胃肠道原因）、尼可地尔以及出院后护理的费用。获益通过三种方式评估：（1）IONA试验主要结局（冠心病（CHD）死亡、非致命性心肌梗死或因心前区疼痛住院）；（2）急性冠状动脉综合征（CHD死亡、非致命性心肌梗死或不稳定型心绞痛）；（3）试验结束时无事件存活者。
每避免一个IONA试验终点的净成本为-5英镑（-7欧元）。每避免一例急性冠状动脉综合征的净成本为-8英镑（-12欧元）。每例无事件存活者的净成本为-5英镑（-7欧元）。这些数字基于判定为肯定或可能与尼可地尔相关的胃肠道事件。当纳入所有胃肠道事件时，这三个比率分别升至567英镑（835欧元）、886英镑（1305欧元）和516英镑（760欧元）。
尼可地尔额外成本的很大一部分被医院服务使用减少所抵消。与其他冠心病干预措施进行的有限比较表明，尼可地尔具有优势。
