ICON Health Economics, Oxford, UK.
Servier Laboratories Ltd, Suresnes, France.
Heart. 2014 Jul;100(13):1031-6. doi: 10.1136/heartjnl-2013-304598. Epub 2014 Mar 14.
Ivabradine, a specific heart rate lowering therapy, has been shown in a randomised placebo-controlled study, Systolic HF Treatment with the If Inhibitor Ivabradine Trial (SHIfT), to significantly reduce the composite end point of cardiovascular death and hospitalisation for worsening heart failure (HF) in patients with systolic HF who are in sinus rhythm and with a heart rate ≥70 bpm, when added to optimised medical therapy (HR: 0.82, 95% CI 0.75 to 0.90, p<0.0001). We assessed the cost effectiveness of ivabradine, from a UK National Health Service perspective, based on the results of SHIfT.
A Markov model estimated the cost effectiveness of ivabradine compared with standard care for two cohorts of patients with HF (heart rate ≥75 bpm in line with the EU labelled indication; and heart rate ≥70 bpm in line with the SHIfT study population). Modelled outcomes included death, hospitalisation, quality of life and New York Heart Association class. Total costs and quality adjusted life years (QALYs) for ivabradine and standard care were estimated over a lifetime horizon.
The incremental cost per additional QALY for ivabradine plus standard care versus standard care has been estimated as £8498 for heart rate ≥75 bpm and £13 764 for heart rate ≥70 bpm. Ivabradine is expected to have a 95% chance of being cost-effective in the EU licensed population using the current National Institute for Health and Care Excellence cost effectiveness threshold of £20 000 per QALY. These results were robust in sensitivity analyses.
This economic evaluation suggests that the use of ivabradine is likely to be cost-effective in eligible patients with HF from a UK National Health Service perspective.
伊伐布雷定是一种特定的心率降低治疗药物，在一项随机安慰剂对照研究（收缩性心力衰竭治疗中使用 If 抑制剂伊伐布雷定试验，简称 SHIfT）中，已证实其可显著降低窦性心律且心率≥70bpm 的收缩性心力衰竭患者的心血管死亡和因心力衰竭恶化而住院的复合终点，当添加到优化的药物治疗中时（HR：0.82，95%CI 0.75 至 0.90，p<0.0001）。我们根据 SHIfT 的结果，从英国国家医疗服务体系的角度评估了伊伐布雷定的成本效益。
一项 Markov 模型评估了伊伐布雷定与标准治疗相比，对两组心力衰竭患者（符合欧盟标签适应证的心率≥75bpm 患者；符合 SHIfT 研究人群的心率≥70bpm 患者）的成本效益。模型评估的结果包括死亡、住院、生活质量和纽约心脏协会（NYHA）心功能分级。伊伐布雷定和标准治疗的总费用和质量调整生命年（QALY）在终生范围内进行了估计。
对于心率≥75bpm 的患者，伊伐布雷定联合标准治疗比标准治疗每增加一个 QALY 的增量成本为 8498 英镑；对于心率≥70bpm 的患者，这一数字为 13764 英镑。伊伐布雷定在欧盟许可人群中，使用当前英国国家卫生与临床优化研究所（NICE）每 QALY 20000 英镑的成本效益阈值，有 95%的可能性具有成本效益。这些结果在敏感性分析中是稳健的。
从英国国家医疗服务体系的角度来看，这项经济评估表明，对于符合条件的心力衰竭患者，伊伐布雷定的使用可能具有成本效益。
