University of Alberta and Mazankowski Alberta Heart Institute, Edmonton, Canada.
Can J Cardiol. 2009 Dec;25(12):e399-405. doi: 10.1016/s0828-282x(09)70532-x.
To evaluate the cost-effectiveness of enoxaparin versus unfractionated heparin in conjunction with fibrinolysis in ST elevation myocardial infarction patients within Canada.
Based on the Enoxaparin and Thrombolysis Reperfusion for Acute Myocardial Infarction Treatment - Thrombolysis in Myocardial Infarction (ExTRACT-TIMI) 25 trial, a model was created to analyze the cost-effectiveness of enoxaparin compared with unfractionated heparin in conjunction with fibrinolysis among ST elevation myocardial infarction patients within Canada. Clinical outcomes were derived from published results of the main trial. Resource use costs were first assessed based on United States Diagnosis-Related Group values for hospitalizations and Current Procedural Terminology codes for outpatient visits and tests. Both were then converted using Canadian local costs. Survival and life expectancy were estimated from Framingham survival data. The incremental cost-effectiveness ratio was expressed as cost per life year gained.
Through 30 days after random assignment, the primary composite end point favoured the enoxaparin group over the unfractionated heparin group (death or recurrent myocardial infarction rate 9.9% versus 12.0%, P<0.001), and was associated with a modest increased cost of $169.50 ($8,757.00 versus $8,587.50, respectively). Life years gained as a result of treatment with enoxaparin was increased by 0.11 years (P<0.05). Enoxaparin was found to be cost-effective, as indicated by an incremental cost-effectiveness ratio of $4,930 with a 99% probability of costing less than $20,000.
Although associated with modest increased direct medication costs, enoxaparin following fibrinolysis improved the clinical efficacy in STEMI patients and increased the life years gained.
评估在加拿大 ST 段抬高型心肌梗死患者中，依诺肝素与未分级肝素联合溶栓治疗的成本效果。
基于依诺肝素与溶栓治疗急性心肌梗死治疗-心肌梗死溶栓试验 25（ExTRACT-TIMI 25）试验，建立模型分析依诺肝素与未分级肝素联合溶栓治疗在加拿大 ST 段抬高型心肌梗死患者中的成本效果。临床结局源自主要试验的发表结果。资源使用成本首先根据美国诊断相关组的住院费用和门诊就诊和检查的当前操作术语代码进行评估。然后使用加拿大当地成本进行转换。生存和预期寿命根据弗雷明汉生存数据进行估计。增量成本效果比表示每获得 1 个生命年的成本。
在随机分组后 30 天，主要复合终点有利于依诺肝素组，依诺肝素组的死亡率或复发性心肌梗死发生率为 9.9%，未分级肝素组为 12.0%（P<0.001），并且成本略有增加 169.50 美元（分别为 8757.00 美元和 8587.50 美元）。依诺肝素治疗增加的预期寿命为 0.11 年（P<0.05）。依诺肝素具有成本效果，增量成本效果比为 4930 美元，99%的可能性成本低于 20000 美元。
尽管与适度增加的直接药物成本相关，但依诺肝素溶栓后改善了 STEMI 患者的临床疗效并增加了预期寿命。
