Tumanan-Mendoza Bernadette A, Mendoza Victor L
Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Philippines.
De La Salle Health Sciences Institute, Dasmariñas, Cavite, Philippines.
Value Health Reg Issues. 2013 May;2(1):13-20. doi: 10.1016/j.vhri.2013.01.003. Epub 2013 Mar 13.
To determine the cost-effectiveness of lipid-lowering therapy in the secondary prevention of cardiovascular events in the Philippines.
A cost-utility analysis was performed by using Markov modeling in the secondary prevention setting. The models incorporated efficacy of lipid-lowering therapy demonstrated in randomized controlled trials and mortality rates obtained from local life tables. Average and incremental cost-effectiveness ratios were obtained for simvastatin, atorvastatin, pravastatin, and gemfibrozil. The costs of the following were included: medications, laboratory examinations, consultation and related expenses, and production losses. The costs were expressed in current or nominal prices as of the first quarter of 2010 (Philippine peso). Utility was expressed in quality-adjusted life-years gained. Sensitivity analyses were performed by using variations in the cost centers, discount rates, starting age, and differences in utility weights for stroke.
In the analysis using the lower-priced generic counterparts, therapy using 40 mg simvastatin daily was the most cost-effective option compared with the other therapies, while pravastatin 40 mg daily was the most cost-effective alternative if the higher-priced innovator drugs were used. In all sensitivity analyses, gemfibrozil was strongly dominated by the statins.
In secondary prevention, simvastatin or pravastatin were the most cost-effective options compared with atorvastatin and gemfibrozil in the Philippines. Gemfibrozil was strongly dominated by the statins.
确定菲律宾心血管事件二级预防中降脂治疗的成本效益。
在二级预防环境中使用马尔可夫模型进行成本效用分析。模型纳入了随机对照试验中降脂治疗的疗效以及从当地生命表中获得的死亡率。得出了辛伐他汀、阿托伐他汀、普伐他汀和吉非贝齐的平均和增量成本效益比。纳入了以下各项的成本：药物、实验室检查、咨询及相关费用以及生产损失。成本以截至2010年第一季度的现行或名义价格（菲律宾比索）表示。效用以获得的质量调整生命年表示。通过改变成本中心、贴现率、起始年龄以及中风效用权重的差异进行敏感性分析。
在使用价格较低的通用仿制药的分析中，与其他疗法相比，每日使用40毫克辛伐他汀的治疗是最具成本效益的选择，而如果使用价格较高的创新药物，每日40毫克普伐他汀是最具成本效益的替代方案。在所有敏感性分析中，吉非贝齐被他汀类药物强烈主导。
在菲律宾的二级预防中，与阿托伐他汀和吉非贝齐相比，辛伐他汀或普伐他汀是最具成本效益的选择。吉非贝齐被他汀类药物强烈主导。
