Sigvant B, Henriksson M, Lundin F, Wahlberg E
Institute of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Eur J Cardiovasc Prev Rehabil. 2011 Apr;18(2):254-61. doi: 10.1177/1741826710389368. Epub 2011 Jan 28.
Peripheral arterial disease (PAD) is associated with an increased risk of early death in cardiovascular (CV) disease. The majority of PAD subjects are asymptomatic with a prevalence of 11 per cent among the elderly. Long-term drug prevention aiming to minimize disease progression and CV events in these subjects is probably beneficial, but expensive. The purpose of this analysis was to evaluate the cost-effectiveness of pharmacological risk reduction in subclinical PAD. Long-term costs and quality-adjusted life years (QALYs) were estimated by employing a decision-analytic model for ACE-inhibitor, statin, aspirin and non-aspirin anti-platelet therapy. Rates of CV events without treatment were derived from epidemiological studies and event rate reduction were retrieved from clinical trials. Costs and health-related quality of life estimates were obtained from published sources. All four drugs reduced CV events. Using ACE-inhibition resulted in a heart rate (HR) of 0.67 (95% CI: 0.55-0.79), statins 0.74 (0.70-0.79), and clopidogrel 0.72 (0.43-1.00). Aspirin had a HR of 0.87 and the 95% CI passed included one (0.72-1.03). ACE-inhibition was associated with the largest reduction in events leading to the highest gain in QALYs (7.95). Furthermore, ACE-inhibitors were associated with the lowest mean cost €40.556. In conclusion, while all drugs reduced CV events, ACE-inhibition was the most cost-effective. These results suggest that we should consider efforts to identify patients with asymptomatic PAD and, when identified, offer ACE-inhibition.
外周动脉疾病（PAD）与心血管（CV）疾病早期死亡风险增加相关。大多数PAD患者无症状，在老年人中的患病率为11%。旨在使这些患者疾病进展和CV事件最小化的长期药物预防可能有益，但成本高昂。本分析的目的是评估亚临床PAD药物风险降低的成本效益。通过采用决策分析模型对ACE抑制剂、他汀类药物、阿司匹林和非阿司匹林抗血小板治疗进行评估，估计长期成本和质量调整生命年（QALY）。未治疗时的CV事件发生率来自流行病学研究，事件发生率降低数据来自临床试验。成本和与健康相关的生活质量估计值来自已发表的资料。所有四种药物均降低了CV事件。使用ACE抑制剂导致的心率（HR）为0.67（95%CI：0.55 - 0.79），他汀类药物为0.74（0.70 - 0.79），氯吡格雷为0.72（0.43 - 1.00）。阿司匹林的HR为0.87，95%CI包含1（0.72 - 1.03）。ACE抑制剂与事件减少最多相关，导致QALY增益最高（7.95）。此外，ACE抑制剂的平均成本最低，为40556欧元。总之，虽然所有药物都降低了CV事件，但ACE抑制剂最具成本效益。这些结果表明，我们应努力识别无症状PAD患者，一旦识别出来，应给予ACE抑制剂治疗。
