Université de Paris, AP-HP, Hôpital Bichat, FACT (French Alliance for Cardiovascular trials) and INSERM-U1148, Paris, France.
Department of Medicine, Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA 02115, USA.
Eur Heart J Cardiovasc Pharmacother. 2022 Dec 2;8(8):777-785. doi: 10.1093/ehjcvp/pvac032.
To conduct a health economic evaluation of ticagrelor in patients with type 2 diabetes and coronary artery disease (CAD) from a multinational payer perspective. Cost-effectiveness and cost-utility of ticagrelor were evaluated in the overall effect of Ticagrelor on Health Outcomes in Diabetes Mellitus Patients Intervention Study (THEMIS) trial population and in the predefined patient group with prior percutaneous coronary intervention.
A Markov model was developed to extrapolate patient outcomes over a lifetime horizon. The primary outcome was incremental cost-effectiveness ratios (ICERs), which were compared with conventional willingness-to-pay thresholds [€47 000/quality-adjusted life-year (QALY) in Sweden and €30 000/QALY in other countries].Treatment with ticagrelor resulted in QALY gains of up to 0.045 in the overall population and 0.099 in patients with percutaneous coronary intervention (PCI). Increased costs and benefits translated to ICERs ranged between €27 894 and €42 252/QALY across Sweden, Germany, Italy, and Spain in the overall population. In patients with prior PCI, estimated ICERs improved to €18 449, €20 632, €20 233, and €13 228/QALY in Sweden, Germany, Italy, and Spain, respectively, driven by higher event rates and treatment benefit.
Based on THEMIS results, ticagrelor plus aspirin compared with aspirin alone may be cost-effective in some European countries in patients with T2DM and CAD and no prior myocardial infarction (MI) or stroke. Additionally, ticagrelor is likely to be cost-effective across European countries in patients with a history of PCI.
从多国支付者的角度对替格瑞洛在 2 型糖尿病（T2DM）和冠状动脉疾病（CAD）患者中的经济学效果进行评估。在 Ticagrelor 对糖尿病患者心血管结局影响研究（THEMIS）试验人群和预先经皮冠状动脉介入治疗（PCI）的预设患者组中，评估了替格瑞洛的成本效果和成本效用。
建立了一个马尔可夫模型来推断患者终生的结局。主要结局指标为增量成本效果比（ICER），并与传统的支付意愿阈值[瑞典 47000 欧元/质量调整生命年（QALY），其他国家 30000 欧元/QALY]进行比较。替格瑞洛治疗在总体人群中可使 QALY 增加 0.045，在 PCI 患者中增加 0.099。在瑞典、德国、意大利和西班牙，总体人群中成本的增加和效益的提高导致 ICER 范围在替格瑞洛治疗组为 27894 欧元至 42252 欧元/QALY。在预先接受 PCI 的患者中，估计的 ICER 在瑞典、德国、意大利和西班牙分别改善至 18449 欧元、20632 欧元、20233 欧元和 13228 欧元/QALY，这主要是由于更高的事件发生率和治疗获益。
基于 THEMIS 研究结果，替格瑞洛加阿司匹林与单独应用阿司匹林相比，在无心肌梗死（MI）或卒中史的 T2DM 和 CAD 患者中，可能在一些欧洲国家具有成本效果。此外，替格瑞洛在有 PCI 病史的患者中，在整个欧洲国家中可能具有成本效果。
