Lyseng-Williamson Katherine A, Plosker Greg L
Adis International Limited, Mairangi Bay, Auckland, New Zealand.
Pharmacoeconomics. 2006;24(7):709-26. doi: 10.2165/00019053-200624070-00009.
Clopidogrel (Plavix) is a selective inhibitor of adenosine diphosphate-induced platelet aggregation. In patients with acute coronary syndromes (ACS) [unstable angina or non-ST-segment elevation myocardial infarction], clopidogrel plus aspirin (acetylsalicylic acid) for up to 1 year significantly reduced the risk of cardiovascular events relative to placebo plus aspirin in the well designed clinical trial CURE (Clopidogrel in Unstable angina to prevent Recurrent Events) and its substudy in patients undergoing percutaneous coronary intervention (PCI) [PCI-CURE]. In pharmacoeconomic evaluations based on data from these trials conducted in a number of countries that used a variety of models, methods and/or type of costs, clopidogrel plus aspirin was consistently predicted to be cost effective relative to aspirin alone in the management of patients with ACS, including those undergoing PCI. Clopidogrel plus aspirin in patients with ACS reduced the incremental cost per cardiovascular event prevented and/or life-year gained (LYG) relative to aspirin alone in analyses using within-trial data (including longer-term analyses incorporating life-expectancy estimates) from the CURE or PCI-CURE studies. In Markov models of cost effectiveness with a lifetime horizon from a healthcare payer perspective based on the CURE trial, relative to aspirin alone, clopidogrel plus aspirin for 1 year was predicted to have incremental costs per LYG of 8132Euro in Spain (2003 values) and 1365Euro in Sweden (2000 values). In similar Swedish analyses from a healthcare payer perspective, clopidogrel plus aspirin for 1 year was predicted to have incremental costs per LYG of 10,993Euro (2004 values) relative to aspirin alone based on data from the PCI-CURE substudy. Broadly similar results have also been reported in modelled analyses from other countries. Cost-utility analyses based on the CURE trial suggest that, relative to lifelong aspirin alone, clopidogrel plus aspirin for 1 year followed by aspirin alone is associated with incremental costs per QALY gained that are below the traditional threshold of cost utility in Spain, the UK and the US. In patients with ACS, including those undergoing PCI, the addition of clopidogrel to standard therapy with aspirin is clinically effective in preventing cardiovascular events. Available pharmacoeconomic data from several countries, despite some inherent limitations, support the use of clopidogrel plus aspirin for up to 1 year as a cost-effective treatment relative to aspirin alone in this patient population.
氯吡格雷（波立维）是一种二磷酸腺苷诱导的血小板聚集的选择性抑制剂。在急性冠状动脉综合征（ACS）[不稳定型心绞痛或非ST段抬高型心肌梗死]患者中，在精心设计的临床试验CURE（不稳定型心绞痛中氯吡格雷预防再发事件）及其针对接受经皮冠状动脉介入治疗（PCI）患者的子研究[PCI-CURE]中，氯吡格雷联合阿司匹林（乙酰水杨酸）使用长达1年相对于安慰剂联合阿司匹林显著降低了心血管事件风险。在基于这些试验数据在多个国家开展的药物经济学评估中，使用了各种模型、方法和/或成本类型，在ACS患者管理中，包括接受PCI的患者，氯吡格雷联合阿司匹林一直被预测相对于单用阿司匹林具有成本效益。在使用CURE或PCI-CURE研究的试验内数据（包括纳入预期寿命估计的长期分析）进行的分析中，ACS患者使用氯吡格雷联合阿司匹林相对于单用阿司匹林降低了预防每例心血管事件和/或获得每生命年（LYG）的增量成本。在基于CURE试验从医疗保健支付方角度进行的终身成本效益马尔可夫模型中，相对于单用阿司匹林，在西班牙（2003年数值），氯吡格雷联合阿司匹林使用1年每LYG的增量成本预计为8132欧元，在瑞典（2000年数值）为1365欧元。从医疗保健支付方角度进行的类似瑞典分析中，基于PCI-CURE子研究数据，相对于单用阿司匹林，氯吡格雷联合阿司匹林使用1年每LYG的增量成本预计为10993欧元（2004年数值）。其他国家的模型分析也报告了大致相似的结果。基于CURE试验的成本效用分析表明，相对于终身单用阿司匹林，氯吡格雷联合阿司匹林使用1年然后单用阿司匹林，在西班牙、英国和美国，每获得一个质量调整生命年（QALY）的增量成本低于传统的成本效用阈值。在ACS患者中，包括接受PCI的患者，在阿司匹林标准治疗基础上加用氯吡格雷在预防心血管事件方面具有临床疗效。来自几个国家的现有药物经济学数据，尽管存在一些固有局限性，但支持在该患者群体中使用氯吡格雷联合阿司匹林长达1年作为相对于单用阿司匹林具有成本效益的治疗方法。
