Taylor Matthew, Scuffham Paul A, Chaplin Stephen, Papo Natalie L
University of York, York Health Economics Consortium, York, UK.
Value Health. 2009 Jun;12(4):459-65. doi: 10.1111/j.1524-4733.2008.00494.x. Epub 2009 Jan 14.
The overall objective of this study was to estimate the costs and outcomes associated with treatment with valsartan for post-myocardial infarction (post-MI) patients with left ventricular systolic dysfunction, heart failure, or both, who are not suitable for treatment with angiotensin-converting enzyme (ACE) inhibitors, compared to placebo.
A Markov model, using data drawn from the Valsartan in Acute Myocardial Infarction (VALIANT) trial and other trials, was developed to predict the future health pathways, resource use, and costs for patients who have recently experienced an MI. Patients received either valsartan (mean dose 247 mg) or placebo. Cost data were drawn from national databases and published literature, although health outcome utility weights were derived from existing studies. Patient outcomes were modeled for 10 years, and incremental cost-effective ratios were calculated for valsartan compared with placebo.
Over a period of 10 years, a cohort of 1000 patients treated with valsartan experienced 147 fewer cardiovascular deaths, 37 fewer nonfatal MIs, and 95 fewer cases of heart failure than a cohort who received placebo. The incremental cost of valsartan, compared with placebo, was 2680 pound per patient, although the incremental effectiveness of valsartan was 0.5021 quality-adjusted life-years (QALYs) gained per patient. Therefore, the incremental cost per QALY for treatment with valsartan was 5338 pound. When analysis was undertaken using life-years rather than QALYs, the cost per life-year gained was 4672 pound.
For patients who are not suitable for treatment with ACE inhibitors, valsartan is a viable and cost-effective treatment for their management after an MI.
本研究的总体目标是评估与缬沙坦治疗相关的成本和结果，该治疗针对的是心肌梗死后（post-MI）出现左心室收缩功能障碍、心力衰竭或两者皆有的患者，这些患者不适合使用血管紧张素转换酶（ACE）抑制剂治疗，与安慰剂进行比较。
利用从缬沙坦急性心肌梗死试验（VALIANT）和其他试验中获取的数据，建立了一个马尔可夫模型，以预测近期发生心肌梗死患者的未来健康路径、资源使用和成本。患者接受缬沙坦（平均剂量247毫克）或安慰剂治疗。成本数据来自国家数据库和已发表的文献，尽管健康结果效用权重来自现有研究。对患者的结果进行了10年的建模，并计算了缬沙坦与安慰剂相比的增量成本效益比。
在10年期间，与接受安慰剂治疗的队列相比，接受缬沙坦治疗的1000名患者队列中心血管死亡少147例，非致命性心肌梗死少37例，心力衰竭病例少95例。与安慰剂相比，缬沙坦的增量成本为每位患者2680英镑，尽管缬沙坦的增量效果是每位患者获得0.5021个质量调整生命年（QALY）。因此，缬沙坦治疗的每QALY增量成本为5338英镑。当使用生命年而非QALY进行分析时，每获得一个生命年的成本为4672英镑。
对于不适合使用ACE抑制剂治疗的患者，缬沙坦是心肌梗死后管理的一种可行且具有成本效益的治疗方法。
