Adena Michael A, Hamann Gary, Sindone Andrew P
Datalytics Pty Ltd, Kingston, ACT, Australia.
Servier Laboratories (Aust) Pty Ltd, Melbourne, Vic, Australia.
Heart Lung Circ. 2019 Mar;28(3):414-422. doi: 10.1016/j.hlc.2018.01.011. Epub 2018 Feb 8.
In the Systolic Heart failure treatment with the I inhibitor Trial (SHIFT) randomised placebo-controlled trial, ivabradine was shown to reduce hospital admissions for worsening heart failure (HF) and deaths due to HF in patients with symptomatic systolic HF and an elevated resting heart rate (HR). This analysis evaluates the cost effectiveness of adding ivabradine to optimal standard HF treatment in patients with a HR≥77 bpm.
A Markov model was developed to assess the impact of ivabradine on mean survival and quality of life over a patient's lifetime (10 years). The hospitalisation and death rates were calculated using patient-level data from SHIFT. The reduction in quality of life due to HF hospitalisations was estimated directly from EQ-5D data collected in SHIFT. Australian costs were applied to the resource use from SHIFT.
The modelled mean increase in survival with ivabradine was 0.115 years. The mean increase in quality-adjusted survival was 0.108 years. The average cost of ivabradine was A$2,957 and the cost savings associated with a reduction in HF hospitalisations was A$1,344. The cost per quality adjusted life year gained (QALYG) was A$14,905. The conservative approach to the modelled evaluation, as well as results of the sensitivity analysis, demonstrates that ivabradine is likely to be cost-effective in this indication.
The conservative approach to the modelled evaluation, as well as results of the sensitivity analysis, demonstrates that ivabradine is a cost-effective treatment in the Australian setting for HF patients with a HR≥77 bpm on optimal standard therapy with a cost per QALYG similar or lower than that for other publicly funded treatments.
在收缩期心力衰竭伴伊伐布雷定治疗试验（SHIFT）这项随机安慰剂对照试验中，对于有症状的收缩期心力衰竭且静息心率（HR）升高的患者，伊伐布雷定可降低因心力衰竭加重导致的住院率及心力衰竭所致死亡率。本分析评估了在HR≥77次/分的患者中，在最佳标准心力衰竭治疗基础上加用伊伐布雷定的成本效益。
建立马尔可夫模型，以评估伊伐布雷定对患者一生（10年）的平均生存期和生活质量的影响。使用SHIFT的患者层面数据计算住院率和死亡率。因心力衰竭住院导致的生活质量下降直接根据SHIFT收集的EQ-5D数据进行估算。将澳大利亚的成本应用于SHIFT中的资源使用情况。
模型显示，使用伊伐布雷定后生存期平均增加0.115年。质量调整生存期平均增加0.108年。伊伐布雷定的平均成本为2957澳元，因心力衰竭住院减少带来的成本节省为1344澳元。每获得一个质量调整生命年（QALYG）的成本为14905澳元。模型评估的保守方法以及敏感性分析结果表明，伊伐布雷定在该适应症中可能具有成本效益。
模型评估的保守方法以及敏感性分析结果表明，在澳大利亚，对于HR≥77次/分且接受最佳标准治疗的心力衰竭患者，伊伐布雷定是一种具有成本效益的治疗方法，每QALYG的成本与其他公共资助治疗方法相似或更低。
