Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, Connecticut; Department of Pharmacy Practice, University of Connecticut/Hartford Hospital Evidence-Based Practice Center, Storrs and Hartford, Connecticut.
Department of Cardiology, Hartford Hospital, Hartford, Connecticut.
Am J Cardiol. 2014 Apr 15;113(8):1306-11. doi: 10.1016/j.amjcard.2014.01.407. Epub 2014 Jan 31.
Ranolazine has been shown to decrease angina pectoris frequency and nitroglycerin consumption. We assessed the cost-effectiveness of ranolazine when added to standard-of-care (SoC) antianginals compared with SoC alone in patients with stable coronary disease experiencing ≥3 attacks/week. A Markov model utilizing a societal perspective, a 1-month cycle length, and a 1-year time horizon was developed to estimate costs (2013 US$) and quality-adjusted life years (QALYs) for patients receiving and not receiving ranolazine. Patients entered the model in 1 of the 4 angina frequency health states based upon Seattle Angina Questionnaire angina frequency (SAQAF) scores (100=no; 61 to 99=monthly; 31 to 60=weekly; and 0 to 30=daily angina) and were allowed to transition between states or to death based upon probabilities derived from the Efficacy of Ranolazine in Chronic Angina and other studies. Patients not responding to ranolazine in month 1 (not improving ≥1 SAQAF health state) were assumed to discontinue ranolazine and behave like SoC patients. Ranolazine patients lived a mean of 0.700 QALYs at a cost of $15,661. Those not receiving ranolazine lived 0.659 QALYs and at a cost of $14,321. The incremental cost-effectiveness ratio (ICER) for the addition of ranolazine was $32,682/QALY. The ICER was most sensitive to ranolazine cost but only exceeded $50,000/QALY when the cost of ranolazine increased >32% above base case. The ICER remained <$50,000/QALY when indirect costs were excluded, and mortality rates were assumed equivalent between SAQAF health states. Monte Carlo simulation found ranolazine cost-effective in 97% of 10,000 iterations at a $50,000/QALY willingness-to-pay threshold. In conclusion, ranolazine added to SoC is cost-effective in patients with weekly or daily angina.
雷诺嗪已被证明可减少心绞痛发作频率和硝化甘油的消耗。我们评估了雷诺嗪添加到标准治疗（SoC）抗心绞痛药物与单独使用 SoC 相比，在每周经历≥3 次心绞痛发作的稳定型冠心病患者中的成本效益。利用社会视角、1 个月周期和 1 年时间范围开发了一个 Markov 模型，以估算接受和不接受雷诺嗪的患者的成本（2013 年的美国美元）和质量调整生命年（QALY）。患者根据西雅图心绞痛问卷心绞痛频率（SAQAF）评分进入模型（100=无；61 至 99=每月；31 至 60=每周；0 至 30=每日心绞痛），并根据来自雷诺嗪在慢性心绞痛和其他研究中的疗效研究的概率在状态之间或死亡之间进行转换。在第 1 个月对雷诺嗪无反应（≥1 个 SAQAF 健康状态未改善）的患者假定停止使用雷诺嗪并表现得像 SoC 患者一样。雷诺嗪患者的平均寿命为 0.700 QALY，成本为 15661 美元。未接受雷诺嗪的患者的寿命为 0.659 QALY，成本为 14321 美元。添加雷诺嗪的增量成本效益比（ICER）为 32682 美元/QALY。ICER 对雷诺嗪的成本最为敏感，但仅当雷诺嗪的成本比基础病例增加超过 32%时，才超过 50000 美元/QALY。当排除间接成本且假设 SAQAF 健康状态之间的死亡率相等时，ICER 仍低于 50000 美元/QALY。蒙特卡罗模拟发现，在 50000 美元/QALY 的支付意愿阈值下，雷诺嗪在 10000 次迭代中的 97%是成本有效的。总之，在每周或每日心绞痛的患者中，添加到 SoC 的雷诺嗪具有成本效益。
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