Wisløff Torbjørn, Atar Dan
Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital & University of Oslo , Postboks 4950 Nydalen, Oslo 0424 , Norway.
Department of Cardiology, Oslo University Hospital, Ullevål, Norway.
Eur Heart J Qual Care Clin Outcomes. 2016 Jan 1;2(1):52-57. doi: 10.1093/ehjqcco/qcv023.
Clopidogrel has, for long time, been accepted as the standard treatment for patients who have undergone a percutaneous coronary intervention (PCI). The introduction of prasugrel-and more recently, ticagrelor-has introduced a decision-making problem for clinicians and governments worldwide: to use the cheaper clopidogrel or the more effective, and also more expensive prasugrel or ticagrelor. We aim to give helpful contributions to this debate by analysing the cost-effectiveness of clopidogrel, prasugrel, and ticagrelor compared with each other.
We modified a previously developed Markov model of cardiac disease progression. In the model, we followed up cohorts of patients who have recently had a PCI until 100 years or death. Possible events are revascularization, bleeding, acute myocardial infarction, and death. Our analysis shows that ticagrelor is cost-effective in 77% of simulations at an incremental cost-effectiveness ratio of €7700 compared with clopidogrel. Ticagrelor was also cost-effective against prasugrel at a cost-effectiveness ratio of €7800. Given a Norwegian cost-effectiveness threshold of €70 000, both comparisons appear to be clearly cost-effective in favour of ticagrelor.
Ticagrelor is cost-effective compared with both clopidogrel and prasugrel for patients who have undergone a PCI.
长期以来，氯吡格雷一直被视为接受经皮冠状动脉介入治疗（PCI）患者的标准治疗药物。普拉格雷的引入——以及最近替格瑞洛的出现——给全球的临床医生和政府带来了一个决策难题：是使用价格较低的氯吡格雷，还是使用效果更佳但价格也更高的普拉格雷或替格瑞洛。我们旨在通过分析氯吡格雷、普拉格雷和替格瑞洛相互之间的成本效益，为这场辩论提供有益的参考。
我们修改了先前开发的一个关于心脏病进展的马尔可夫模型。在该模型中，我们对近期接受PCI的患者队列进行随访，直至100岁或死亡。可能发生的事件包括血管再通、出血、急性心肌梗死和死亡。我们的分析表明，与氯吡格雷相比，替格瑞洛在77%的模拟分析中具有成本效益，增量成本效益比为7700欧元。替格瑞洛与普拉格雷相比也具有成本效益，成本效益比为7800欧元。鉴于挪威设定的成本效益阈值为70000欧元，这两种比较在支持替格瑞洛方面似乎都具有明显的成本效益。
对于接受PCI的患者，与氯吡格雷和普拉格雷相比，替格瑞洛具有成本效益。
