Medical Decision and Economic Group, Department of Pharmacy, Ren Ji Hospital, South Campus, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, 6823 Saint Charles Ave, New Orleans, LA 70118, USA.
Eur Heart J Cardiovasc Pharmacother. 2021 Nov 3;7(6):529-538. doi: 10.1093/ehjcvp/pvaa082.
Ticagrelor plus aspirin could reduce the risks of major adverse cardiac events in diabetic patients with stable coronary artery disease (SCD), and yet it also increases bleeding risk. This study would compare the cost and effectiveness of aspirin and ticagrelor plus aspirin therapies in diabetic patients with SCD from a US healthcare sector perspective.
A state-transition Markov model was developed to project probabilities of myocardial infarction, ischaemic stroke, bleeding, and death with and without ticagrelor among all diabetic patients with SCD as the overall population, and those with a history of previous percutaneous coronary intervention (PCI) as a sub-population. Model inputs were extracted from published sources. Lifetime costs and quality-adjusted life-years (QALYs) were measured. The clinical benefits and bleeding risk of ticagrelor added to aspirin were translated into additional 0.08 QALYs at incremental costs of $19 580 in the overall population, yielding an incremental cost-utility ratio (ICUR) of $260 032/QALY. In the sub-population with an additional 0.43 QALYs at an incremental cost of $20 189, the ICUR was $46 426/QALY. Two-way sensitivity showed the clinical benefits of ticagrelor plus aspirin was counterbalanced by its risk of major bleeding. One-way sensitivity and probabilistic sensitivity analysis demonstrated that the results were generally robust except the all-cause death reduction.
The results indicated that ticagrelor plus aspirin is likely to be a cost-effective option in the diabetic patients with a history of PCI. Diabetes management can be improved by carefully prescribing ticagrelor to individuals with low risk of bleeding and high risk of ischaemic events.
替格瑞洛联合阿司匹林可降低稳定型冠状动脉疾病（SCD）合并糖尿病患者发生主要不良心脏事件的风险，但同时也会增加出血风险。本研究将从美国医疗保健的角度，比较 SCD 合并糖尿病患者使用阿司匹林和替格瑞洛联合阿司匹林治疗的成本和效果。
采用状态转移马尔可夫模型，预测所有 SCD 合并糖尿病患者（总体人群）以及有既往经皮冠状动脉介入治疗（PCI）史的患者（亚人群）应用替格瑞洛和阿司匹林的心肌梗死、缺血性卒中和出血发生率和死亡率。模型输入来自已发表的研究。采用终生成本和质量调整生命年（QALY）进行测量。替格瑞洛联合阿司匹林的临床获益和出血风险用增加的 0.08 QALY 和增量成本 19580 美元表示，总体人群的增量成本效用比（ICUR）为 260032 美元/QALY。在既往有 PCI 史的亚人群中，ICUR 为 46426 美元/QALY，可增加 0.43 QALY，增量成本为 20189 美元。双向敏感性分析显示，替格瑞洛联合阿司匹林的临床获益被其大出血风险所抵消。单因素敏感性分析和概率敏感性分析表明，除全因死亡率降低外，结果基本稳健。
结果表明，替格瑞洛联合阿司匹林对有 PCI 史的糖尿病患者可能是一种具有成本效益的选择。通过仔细地对低出血风险、高缺血事件风险的个体处方替格瑞洛，可以改善糖尿病管理。
