Idaho State University, College of Pharmacy, Meridian, ID, United States of America.
University of Connecticut, Schools of Pharmacy and Medicine, Storrs and Farmington, CT, United States of America.
Int J Cardiol. 2018 Dec 15;273:34-38. doi: 10.1016/j.ijcard.2018.09.060. Epub 2018 Sep 21.
Type 2 diabetes (T2D) is associated with a high burden of angina. Ranolazine has been shown to reduce angina frequency versus placebo in patients with T2D and stable angina. We sought to estimate the cost-effectiveness of ranolazine when added to standard-of-care (SoC) versus SoC alone in patients with T2D and stable, but symptomatic coronary disease despite treatment with 1-2 antianginals.
A Markov model was developed and evaluated using cohort simulation. The model utilized a US societal perspective, 1-month cycle length and 1-year time horizon and was developed to estimate the cost-effectiveness of ranolazine versus SoC. Patients entered the model in 1 of 4 angina frequency health states based on baseline Seattle Angina Questionnaire Angina Frequency scores (100 = no; 61-99 = monthly; 31-60 = weekly; 0-30 = daily) and could transition between health states (first cycle only) or to death (any cycle) based on probabilities derived from the Type 2 Diabetes Evaluation of Ranolazine in Subjects with Chronic Stable Angina trial.
Our model estimated patients treated with ranolazine lived a mean of 0.728 quality adjusted life years (QALYs) at a cost of $16,654. Those not receiving ranolazine lived a mean of 0.702 QALYs and incurred costs of $15,476. The incremental cost-effectiveness ratio for the addition of ranolazine to SoC was $45,308/QALY. Short Form-36 data suggest improvements in patients' bodily pain drove the gain in QALYs associated with ranolazine (2.73 versus 3.96, p = 0.01).
Our model suggests the addition of ranolazine to SoC is likely cost-effective from a US societal perspective for the treatment of patients with T2D and stable, symptomatic coronary disease despite treatment with 1-2 antianginals.
2 型糖尿病（T2D）与心绞痛负担沉重有关。与安慰剂相比，雷诺嗪已被证明可减少 T2D 合并稳定型心绞痛患者的心绞痛发作频率。我们旨在评估雷诺嗪添加至标准治疗（SoC）与仅 SoC 相比在 T2D 合并稳定但有症状的冠状动脉疾病患者中的成本效益，这些患者尽管接受了 1-2 种抗心绞痛药物治疗但仍有症状。
开发了一个 Markov 模型，并通过队列模拟进行了评估。该模型采用美国社会视角，1 个月周期长度和 1 年时间范围，旨在估计雷诺嗪与 SoC 相比的成本效益。患者根据基线西雅图心绞痛问卷心绞痛发作频率评分（100=无；61-99=每月；31-60=每周；0-30=每日）进入模型中的 1 个心绞痛发作频率健康状态，并且可以根据从 2 型糖尿病慢性稳定型心绞痛患者中评估雷诺嗪的试验中得出的概率在健康状态之间转移（仅第一个周期）或死亡（任何周期）。
我们的模型估计，接受雷诺嗪治疗的患者的平均生活质量调整生命年（QALY）为 0.728，成本为 16654 美元。未接受雷诺嗪治疗的患者平均生活质量调整生命年为 0.702，成本为 15476 美元。将雷诺嗪添加到 SoC 的增量成本效益比为 45308 美元/QALY。SF-36 数据表明，患者的身体疼痛得到改善，这是与雷诺嗪相关的 QALY 获益的驱动因素（2.73 比 3.96，p=0.01）。
我们的模型表明，从美国社会的角度来看，雷诺嗪添加至 SoC 可能对 T2D 合并稳定、有症状的冠状动脉疾病患者的治疗具有成本效益，尽管这些患者接受了 1-2 种抗心绞痛药物治疗。
