根据不同策略的他汀类药物用于心血管预防的成本分析。

Institute of Health Economics and Management, University of Lausanne, Lausanne, Switzerland.

Am J Cardiovasc Drugs. 2011;11(1):33-44. doi: 10.2165/11586760-000000000-00000.

BACKGROUND

Several studies have shown that treatment with HMG-CoA reductase inhibitors (statins) can reduce coronary heart disease (CHD) rates. However, the cost effectiveness of statin treatment in the primary prevention of CHD has not been fully established.

OBJECTIVE

To estimate the costs of CHD prevention using statins in Switzerland according to different guidelines, over a 10-year period.

METHODS

The overall 10-year costs, costs of one CHD death averted, and of 1 year without CHD were computed for the European Society of Cardiology (ESC), the International Atherosclerosis Society (IAS), and the US Adult Treatment Panel III (ATP-III) guidelines. Sensitivity analysis was performed by varying number of CHD events prevented and costs of treatment.

RESULTS

Using an inflation rate of medical costs of 3%, a single yearly consultation, a single total cholesterol measurement per year, and a generic statin, the overall 10-year costs of the ESC, IAS, and ATP-III strategies were 2.2, 3.4, and 4.1 billion Swiss francs (SwF [SwF1 = $US0.97]). In this scenario, the average cost for 1 year of life gained was SwF352, SwF421, and SwF485 thousand, respectively, and it was always higher in women than in men. In men, the average cost for 1 year of life without CHD was SwF30.7, SwF42.5, and SwF51.9 thousand for the ESC, IAS, and ATP-III strategies, respectively, and decreased with age. Statin drug costs represented between 45% and 68% of the overall preventive cost. Changing the cost of statins, inflation rates, or number of fatal and non-fatal cases of CHD averted showed ESC guidelines to be the most cost effective.

CONCLUSION

The cost of CHD prevention using statins depends on the guidelines used. The ESC guidelines appear to yield the lowest costs per year of life gained free of CHD.

背景

多项研究表明，使用羟甲基戊二酰辅酶 A 还原酶抑制剂（他汀类药物）治疗可以降低冠心病（CHD）的发生率。然而，他汀类药物在 CHD 一级预防中的成本效益尚未得到充分证实。

目的

根据不同的指南，估算瑞士使用他汀类药物预防 CHD 的成本，时间跨度为 10 年。

方法

根据欧洲心脏病学会（ESC）、国际动脉粥样硬化学会（IAS）和美国成人治疗专家组 III（ATP-III）指南，计算了 10 年内预防 CHD 死亡、避免 1 例 CHD 死亡以及避免 1 年 CHD 的总成本。通过改变预防 CHD 事件的数量和治疗成本，进行了敏感性分析。

结果

假设医疗成本通胀率为 3%，每年一次就诊，每年一次总胆固醇测量，使用一种通用的他汀类药物，ESC、IAS 和 ATP-III 策略的总成本分别为 22 亿瑞士法郎（SF[SF1=0.97 美元]）、34 亿瑞士法郎和 41 亿瑞士法郎。在此情况下，获得 1 年生命的平均成本分别为 SF35.2 万、SF42.1 万和 SF48.5 万，女性高于男性。在男性中，ESC、IAS 和 ATP-III 策略分别为 SF30.7 万、SF42.5 万和 SF51.9 万，且随年龄增长而降低。他汀类药物的药物成本占总预防成本的 45%至 68%之间。改变他汀类药物的成本、通胀率或预防的致命和非致命 CHD 病例数量，ESC 指南显示成本效益最高。