依诺肝素治疗急性ST段抬高型心肌梗死的成本效益：ExTRACT-TIMI 25（依诺肝素与溶栓再灌注治疗急性心肌梗死-心肌梗死溶栓试验25）研究

Cost effectiveness of enoxaparin in acute ST-segment elevation myocardial infarction: the ExTRACT-TIMI 25 (Enoxaparin and Thrombolysis Reperfusion for Acute Myocardial Infarction Treatment-Thrombolysis In Myocardial Infarction 25) study.

作者信息

Marcoff Leo, Zhang Zugui, Zhang Wei, Ewen Edward, Jurkovitz Claudine, Leguet Prisca, Kolm Paul, Weintraub William S

机构信息

Christiana Care Center for Outcomes Research, Christiana Care Health System, Newark, Delaware 19718, USA.

出版信息

J Am Coll Cardiol. 2009 Sep 29;54(14):1271-9. doi: 10.1016/j.jacc.2009.05.060.

DOI:10.1016/j.jacc.2009.05.060

PMID:19778669

Abstract

OBJECTIVES

We used a U.S. model of health care costs to examine the cost effectiveness of enoxaparin compared with unfractionated heparin (UFH) as adjunctive therapy for fibrinolysis in patients with ST-segment elevation myocardial infarction (STEMI).

BACKGROUND

The ExTRACT-TIMI 25 (Enoxaparin and Thrombolysis Reperfusion for Acute Myocardial Infarction Treatment-Thrombolysis In Myocardial Infarction 25) study, a large, randomized, multinational trial, demonstrated a reduction in death or nonfatal myocardial infarction when enoxaparin was used instead of UFH as adjunctive therapy for fibrinolysis in patients with STEMI.

METHODS

We used patient-level clinical outcomes and resource use from the ExTRACT-TIMI 25 trial and estimates of life expectancy gains as a result of the prevention of the clinical events on the basis of the Framingham Heart Study.

RESULTS

Index hospitalization costs trended lower by $126 in the enoxaparin group (95% confidence interval [CI]: -$295 to $49). Thirty-day costs trended higher by $102 for enoxaparin (95% CI: $108 to $314). Patients receiving enoxaparin gained an average of 0.12 life-years relative to patients given UFH. Estimated total lifetime costs were $1,207 higher in the enoxaparin group (95% CI: $491 to $1,923). The incremental cost-effectiveness ratio of enoxaparin compared with UFH was $5,700 per life-year gained, with 99.9% of bootstrap-derived estimates <$50,000 per life-year gained. Using a probabilistic sensitivity analysis, there is a 90% probability that enoxaparin is cost effective for lifetime, provided that the willingness-to-pay value exceeds $50,000.

CONCLUSIONS

Based on a U.S. model of health care economics, the strategy of using enoxaparin instead of UFH as adjunctive therapy for fibrinolysis in patients with STEMI is cost effective according to commonly used benchmarks.

摘要

目的

我们采用美国医疗保健成本模型，研究依诺肝素与普通肝素（UFH）相比，作为ST段抬高型心肌梗死（STEMI）患者纤维蛋白溶解辅助治疗的成本效益。

背景

ExTRACT-TIMI 25（急性心肌梗死治疗中依诺肝素与溶栓再灌注-心肌梗死溶栓25）研究是一项大型、随机、多国试验，结果表明，在STEMI患者中，使用依诺肝素替代UFH作为纤维蛋白溶解辅助治疗可降低死亡或非致命性心肌梗死的发生率。

方法

我们使用了ExTRACT-TIMI 25试验中患者层面的临床结局和资源使用情况，并根据弗雷明汉心脏研究对预防临床事件后预期寿命的增加进行了估计。

结果

依诺肝素组的首次住院成本趋势降低了126美元（95%置信区间[CI]：-295美元至49美元）。依诺肝素的30天成本趋势增加了102美元（95%CI：108美元至314美元）。与接受UFH的患者相比，接受依诺肝素治疗的患者平均多获得了0.12个生命年。依诺肝素组的估计终身总成本高出1207美元（95%CI：491美元至1923美元）。依诺肝素与UFH相比的增量成本效益比为每获得一个生命年5700美元，99.9%的自抽样估计<每获得一个生命年50000美元。使用概率敏感性分析，若支付意愿值超过50000美元，依诺肝素在终身治疗中具有成本效益的概率为90%。