Boczar Kevin E, Beanlands Rob, Wells George, Coyle Doug
Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
CJC Open. 2022 Jan 17;4(5):441-448. doi: 10.1016/j.cjco.2022.01.003. eCollection 2022 May.
Cardiovascular (CV) disease is a condition with high levels of morbidity and mortality. Canakinumab is a novel monoclonal antibody therapy that has been shown to reduce CV events but is associated with side effects and high cost. The main objective for this analysis is to determine whether canakinumab use is cost-effective for the prevention of recurrent CV events.
A decision model was developed to estimate the direct costs and outcomes among patients who have suffered a myocardial infarction and are treated with canakinumab. A lifetime study horizon was used to analyze the base-case costs and utilities from the perspective of the Canadian publicly funded healthcare system. Markov modeling was used in combination with Monte Carlo simulation to derive expected values for costs and quality-adjusted life years (QALYs), permitting the calculation of incremental cost-effectiveness ratios.
Canakinumab was associated with higher average lifetime costs per patient ($457,982 vs $82,565) and higher average QALYs per patient (14.90 vs 14.20), compared with standard of care. Thus, the incremental cost per QALY gained for canakinumab treatment vs standard-of-care therapy was $535,365. The probability that canakinumab treatment is cost-effective was 0%. Results were consistent over a range of scenario analyses.
Treatment of patients post-myocardial infarction with canakinumab is not cost-effective, compared with standard-of-care therapy at the current price. Based on currently accepted willingness-to-pay thresholds in Canada, a reduction in price of 91% is required to yield a cost per patient that would be considered appropriate.
心血管疾病是一种发病率和死亡率都很高的疾病。卡那单抗是一种新型单克隆抗体疗法，已被证明可减少心血管事件，但会产生副作用且成本高昂。本分析的主要目的是确定使用卡那单抗预防复发性心血管事件是否具有成本效益。
建立了一个决策模型，以估计心肌梗死患者接受卡那单抗治疗的直接成本和结果。采用终身研究视角，从加拿大公共资助医疗系统的角度分析基础病例成本和效用。马尔可夫模型与蒙特卡罗模拟相结合，得出成本和质量调整生命年（QALY）的期望值，从而计算增量成本效益比。
与标准治疗相比，卡那单抗使每位患者的平均终身成本更高（457,982美元对82,565美元），每位患者的平均QALY也更高（14.90对14.20）。因此，卡那单抗治疗相对于标准治疗每获得一个QALY的增量成本为535,365美元。卡那单抗治疗具有成本效益的概率为0%。在一系列情景分析中结果一致。
与当前价格的标准治疗相比，用卡那单抗治疗心肌梗死后患者不具有成本效益。根据加拿大目前公认的支付意愿阈值，需要将价格降低91%，才能使每位患者的成本被认为是合适的。
