Verhoef Talitha I, Morris Stephen, Mathur Anthony, Singer Mervyn
Department of Applied Health Research, University College London, London, UK.
Department of Cardiology, London Chest Hospital, Barts Health NHS Trust, London, UK Barts Health NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, Barts Health NHS Trust, London, UK.
BMJ Open. 2015 Nov 13;5(11):e008164. doi: 10.1136/bmjopen-2015-008164.
To investigate the cost-effectiveness of a hypothetical cardioprotective agent used to reduce infarct size in patients undergoing percutaneous coronary intervention (PCI) after anterior ST-elevation myocardial infarction.
A cost-utility analysis using a Markov model.
The National Health Service in the UK.
Patients undergoing PCI after anterior ST-elevation myocardial infarction.
A cardioprotective agent given at the time of reperfusion compared to no cardioprotection. We assumed the cardioprotective agent (given at the time of reperfusion) would reduce the risk and severity of heart failure (HF) after PCI and the risk of mortality after PCI (with a relative risk ranging from 0.6 to 1). The costs of the cardioprotective agent were assumed to be in the range £1000-4000.
The incremental costs per quality-adjusted life-year (QALY) gained, using 95% CIs from 1000 simulations.
Incremental costs ranged from £933 to £3820 and incremental QALYs from 0.04 to 0.38. The incremental cost-effectiveness ratio (ICER) ranged from £3311 to £63 480 per QALY gained. The results were highly dependent on the costs of a cardioprotective agent, patient age, and the relative risk of HF after PCI. The ICER was below the willingness-to-pay threshold of £20 000 per QALY gained in 71% of the simulations.
A cardioprotective agent that can reduce the risk of HF and mortality after PCI has a high chance of being cost-effective. This chance depends on the price of the agent, the age of the patient and the relative risk of HF after PCI.
研究一种用于降低前壁ST段抬高型心肌梗死后接受经皮冠状动脉介入治疗（PCI）患者梗死面积的假设性心脏保护剂的成本效益。
使用马尔可夫模型进行成本效用分析。
英国国家医疗服务体系。
前壁ST段抬高型心肌梗死后接受PCI的患者。
与不进行心脏保护相比，在再灌注时给予心脏保护剂。我们假设心脏保护剂（在再灌注时给予）会降低PCI后心力衰竭（HF）的风险和严重程度以及PCI后的死亡风险（相对风险范围为0.6至1）。假设心脏保护剂的成本在1000 - 4000英镑之间。
每获得一个质量调整生命年（QALY）的增量成本，使用来自1000次模拟的95%置信区间。
增量成本范围为933英镑至3820英镑，增量QALY范围为0.04至0.38。每获得一个QALY的增量成本效益比（ICER）范围为3311英镑至63480英镑。结果高度依赖于心脏保护剂的成本、患者年龄以及PCI后HF的相对风险。在71%的模拟中，ICER低于每获得一个QALY支付意愿阈值20000英镑。
一种能够降低PCI后HF风险和死亡率的心脏保护剂具有较高的成本效益可能性。这种可能性取决于该药物的价格、患者年龄以及PCI后HF 的相对风险。
