Pan Yuesong, Wang Anxin, Liu Gaifen, Zhao Xingquan, Meng Xia, Zhao Kun, Liu Liping, Wang Chunxue, Johnston S Claiborne, Wang Yilong, Wang Yongjun
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Y.P., A.W., G.L., X.Z., X.M., L.L., C.W., Y.W., Y.W.).
China National Health Development Research Center, Beijing, China (K.Z.).
J Am Heart Assoc. 2014 Jun 5;3(3):e000912. doi: 10.1161/JAHA.114.000912.
Treatment with the combination of clopidogrel and aspirin taken soon after a transient ischemic attack (TIA) or minor stroke was shown to reduce the 90-day risk of stroke in a large trial in China, but the cost-effectiveness is unknown. This study sought to estimate the cost-effectiveness of the clopidogrel-aspirin regimen for acute TIA or minor stroke.
A Markov model was created to determine the cost-effectiveness of treatment of acute TIA or minor stroke patients with clopidogrel-aspirin compared with aspirin alone. Inputs for the model were obtained from clinical trial data, claims databases, and the published literature. The main outcome measure was cost per quality-adjusted life-years (QALYs) gained. One-way and multivariable probabilistic sensitivity analyses were performed to test the robustness of the findings. Compared with aspirin alone, clopidogrel-aspirin resulted in a lifetime gain of 0.037 QALYs at an additional cost of CNY 1250 (US$ 192), yielding an incremental cost-effectiveness ratio of CNY 33 800 (US$ 5200) per QALY gained. Probabilistic sensitivity analysis showed that clopidogrel-aspirin therapy was more cost-effective in 95.7% of the simulations at a willingness-to-pay threshold recommended by the World Health Organization of CNY 105 000 (US$ 16 200) per QALY.
Early 90-day clopidogrel-aspirin regimen for acute TIA or minor stroke is highly cost-effective in China. Although clopidogrel is generic, Plavix is brand in China. If Plavix were generic, treatment with clopidogrel-aspirin would have been cost saving.
在中国进行的一项大型试验表明，短暂性脑缺血发作（TIA）或轻度中风后立即联合使用氯吡格雷和阿司匹林进行治疗，可降低90天内的中风风险，但成本效益尚不清楚。本研究旨在评估氯吡格雷 - 阿司匹林方案用于急性TIA或轻度中风的成本效益。
建立了一个马尔可夫模型，以确定与单独使用阿司匹林相比，氯吡格雷 - 阿司匹林治疗急性TIA或轻度中风患者的成本效益。该模型的输入数据来自临床试验数据、索赔数据库和已发表的文献。主要结局指标是每获得一个质量调整生命年（QALY）的成本。进行了单因素和多因素概率敏感性分析，以检验研究结果的稳健性。与单独使用阿司匹林相比，氯吡格雷 - 阿司匹林可使终身QALY增加0.037个，额外成本为1250元人民币（192美元），每获得一个QALY的增量成本效益比为33800元人民币（5200美元）。概率敏感性分析表明，按照世界卫生组织建议的每QALY支付意愿阈值105000元人民币（16200美元），在95.7%的模拟中，氯吡格雷 - 阿司匹林治疗更具成本效益。
在中国，急性TIA或轻度中风的早期90天氯吡格雷 - 阿司匹林方案具有很高的成本效益。虽然氯吡格雷有仿制药，但在中国波立维是品牌药。如果波立维是仿制药，使用氯吡格雷 - 阿司匹林进行治疗将节省成本。
