Kourlaba Georgia, Gourzoulidis George, Andrikopoulos George, Tsioufis Konstantinos, Beletsi Alexandra, Maniadakis Nikos
The Stavros Niarchos Foundation-Collaborative Center for Clinical Epidemiology and Outcomes Research (CLEO), National and Kapodistrian University of Athens, School of Medicine, Thivon & Papadiamantopoulou, Athens, 115 27, Greece.
Department of Health Services Organization & Management, National School of Public Health, Athens, Greece.
BMC Health Serv Res. 2016 Sep 27;16(1):520. doi: 10.1186/s12913-016-1779-6.
To evaluate the cost-effectiveness of trimetazidine (TMZ) as add-on therapy to standard-of-care (SoC) compared to SoC alone in patients with chronic stable angina who did not respond adequately to first line therapy with b-blockers, nitrates or calcium channel antagonists in Greece.
A Markov model with 3-month cycles and 1-year time horizon was developed to assess the comparators. The analysis was conducted from a third-party payer perspective. The clinical inputs and utility values were extracted from the published literature. Resource consumption data were obtained from local experts, using a questionnaire developed for the purpose of the study and were combined with unit cost data (in €2016) obtained from official sources. Cost effectiveness was assessed by calculating the incremental cost effectiveness ratio (ICER). Probabilistic sensitivity analysis (PSA) was performed to account for uncertainty and variation in the input parameters of the model.
The analysis showed that the cost of TMZ plus SoC was €1755.57 versus €1751.76 of SoC alone. In terms of health outcomes, TMZ plus SoC was associated with 0.6650 QALYs versus 0.6562 QALYs for SoC alone. The incremental analysis resulted in an ICER of €430.67 per QALY gained. PSA revealed that the probability of TMZ plus SoC being cost-effective over SoC was 89 %, at a threshold of €34,000 per QALY gained.
The results indicate that TMZ as add -on treatment may be a highly cost-effective option for the symptomatic treatment of patients with chronic stable angina in Greece relative to SoC alone.
在希腊，对于那些使用β受体阻滞剂、硝酸盐或钙通道拮抗剂进行一线治疗效果不佳的慢性稳定型心绞痛患者，评估曲美他嗪（TMZ）作为标准治疗（SoC）附加疗法相对于单纯标准治疗的成本效益。
开发了一个以3个月为周期、1年为时间范围的马尔可夫模型来评估比较方案。分析是从第三方支付者的角度进行的。临床数据和效用值从已发表的文献中提取。资源消耗数据通过为该研究专门设计的问卷从当地专家处获得，并与从官方来源获取的单位成本数据（2016年欧元）相结合。通过计算增量成本效益比（ICER）来评估成本效益。进行概率敏感性分析（PSA）以考虑模型输入参数的不确定性和变化。
分析表明，TMZ加SoC的成本为1755.57欧元，而单纯SoC的成本为1751.76欧元。在健康结果方面，TMZ加SoC的质量调整生命年（QALY）为0.6650，而单纯SoC为0.6562。增量分析得出每获得一个QALY的ICER为430.67欧元。PSA显示，在每获得一个QALY的阈值为34000欧元时，TMZ加SoC相对于SoC具有成本效益的概率为89%。
结果表明，在希腊，相对于单纯标准治疗，TMZ作为附加治疗对于慢性稳定型心绞痛患者的症状治疗可能是一种极具成本效益的选择。
