Latour-Pérez Jaime, de Miguel Balsa Eva, Betegón Lourdes, Badia Xavier
Intensive Care Unit, Hospital General Universitario de Elche, Elche, Spain.
Value Health. 2008 Sep-Oct;11(5):853-61. doi: 10.1111/j.1524-4733.2008.00338.x. Epub 2008 May 16.
To assess the incremental cost-effectiveness ratio (ICER) of glycoprotein IIb/IIIa (GPIIb/IIIa) inhibitors in patients with non-ST elevation acute coronary syndrome (NSTE-ACS) pretreated with aspirin and clopidogrel undergoing an early invasive treatment strategy.
Cost-effectiveness analysis and cost-utility analysis were performed from a health-care system perspective, based on a Markov model with a time horizon of the patient life span. The risk of death and ischemic events was assessed using the Thrombolysis in Myocardial Infarction (TIMI) risk score. We compared three strategies: 1) routine upstream use of a GPIIb/IIIa inhibitor to all patients before angiography, 2) deferred selective use of abciximab in the catheterization laboratory just before angioplasty, and 3) double antiplatelet therapy without GPIIb/IIIa inhibitors. Both univariate sensitivity analysis and second-order probabilistic microsimulation were performed.
In the base case (65 years old, TIMI score 3), strategy A was the most effective, with an ICER of 15,150 euros per quality-adjusted life-year gained. Strategy B was dominated by a combination of strategies A and C. The ICER was very sensitive to the age and baseline risk of the patient. According to the widely accepted cost-effectiveness thresholds, strategy A would be cost-effective only in patients with an intermediate to high TIMI score, especially within the younger age groups. The probability that strategy A was cost-effective under the base case was 91.2%.
The use of GPIIb/IIIa inhibitors upstream in high-risk NSTE-ACS patients (TIMI score > or = 3) pretreated with aspirin and clopidogrel is cost-effective, particularly in the younger age groups.
评估在接受早期侵入性治疗策略的、已用阿司匹林和氯吡格雷预处理的非ST段抬高急性冠状动脉综合征（NSTE-ACS）患者中，糖蛋白IIb/IIIa（GPIIb/IIIa）抑制剂的增量成本-效果比（ICER）。
从卫生保健系统的角度进行成本-效果分析和成本-效用分析，基于一个时间跨度为患者寿命的马尔可夫模型。使用心肌梗死溶栓（TIMI）风险评分评估死亡和缺血事件风险。我们比较了三种策略：1）在血管造影前对所有患者常规上游使用GPIIb/IIIa抑制剂；2）在血管成形术前于导管室延迟选择性使用阿昔单抗；3）不使用GPIIb/IIIa抑制剂的双重抗血小板治疗。进行了单变量敏感性分析和二阶概率微观模拟。
在基础病例（65岁，TIMI评分3）中，策略A最有效，每获得一个质量调整生命年的ICER为15,150欧元。策略B被策略A和C的组合所主导。ICER对患者年龄和基线风险非常敏感。根据广泛接受成本-效果阈值，策略A仅在TIMI评分中等至高的患者中具有成本效益，尤其是在较年轻的年龄组中。在基础病例下策略A具有成本效益的概率为91.2%。
在已用阿司匹林和氯吡格雷预处理的高危NSTE-ACS患者（TIMI评分≥3）中上游使用GPIIb/IIIa抑制剂具有成本效益，特别是在较年轻的年龄组中。
