Fiolet Aernoud T L, Keusters Willem, Blokzijl Johan, Nidorf S Mark, Eikelboom John W, Budgeon Charley A, Tijssen Jan G P, Römer Tjeerd, Westendorp Iris, Cornel Jan Hein, Thompson Peter L, Frederix Geert W J, Mosterd Arend, de Wit G Ardine
Department of Cardiology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
Dutch Network for Cardiovascular Research (WCN), Moreelsepark 1, 3511 EP Utrecht, The Netherlands.
Eur Heart J Qual Care Clin Outcomes. 2025 Jan 16;11(1):89-96. doi: 10.1093/ehjqcco/qcae021.
Recent trials have shown that low-dose colchicine (0.5 mg once daily) reduces major cardiovascular events in patients with acute and chronic coronary syndromes. We aimed to estimate the cost-effectiveness of low-dose colchicine therapy in patients with chronic coronary disease when added to standard background therapy.
This Markov cohort cost-effectiveness model used estimates of therapy effectiveness, transition probabilities, costs, and quality of life obtained from the Low-Dose Colchicine 2 trial, as well as meta-analyses and public sources. In this trial, low-dose colchicine was added to standard of care and compared with placebo. The main outcomes were cardiovascular events, including myocardial infarction, stroke, and coronary revascularization, quality-adjusted life year (QALY), the cost per QALY gained (incremental cost-effectiveness ratio), and net monetary benefit. In the model, low-dose colchicine therapy yielded 0.04 additional QALYs compared with standard of care at an incremental cost of €455 from a societal perspective and €729 from a healthcare perspective, resulting in a cost per QALY gained of €12 176/QALY from a societal perspective and €19 499/QALY from a healthcare perspective. Net monetary benefit was €1414 from a societal perspective and €1140 from a healthcare perspective. Low-dose colchicine has a 96 and 94% chance of being cost-effective, from a societal and a healthcare perspective, respectively, when using a willingness to pay of €50 000/QALY. Net monetary benefit would decrease below zero when annual low-dose colchicine costs would exceed an annual cost of €221 per patient.
Adding low-dose colchicine to standard of care in patients with chronic coronary disease is cost-effective according to commonly accepted thresholds in Europe and Australia and compares favourably in cost-effectiveness to other drugs used in chronic coronary disease.
近期试验表明，低剂量秋水仙碱（每日一次0.5毫克）可降低急性和慢性冠状动脉综合征患者的主要心血管事件。我们旨在评估在慢性冠状动脉疾病患者中，低剂量秋水仙碱疗法加用标准背景治疗时的成本效益。
该马尔可夫队列成本效益模型使用了从低剂量秋水仙碱2试验中获得的治疗效果、转移概率、成本和生活质量估计值，以及荟萃分析和公共来源的数据。在该试验中，低剂量秋水仙碱加用至标准治疗，并与安慰剂进行比较。主要结局包括心血管事件，如心肌梗死、中风和冠状动脉血运重建、质量调整生命年（QALY）、每获得一个QALY的成本（增量成本效益比）以及净货币效益。在模型中，从社会角度看，与标准治疗相比，低剂量秋水仙碱疗法可额外产生0.04个QALY，增量成本为455欧元；从医疗保健角度看，增量成本为729欧元。从社会角度看，每获得一个QALY的成本为12176欧元/QALY，从医疗保健角度看为19499欧元/QALY。从社会角度看，净货币效益为1414欧元，从医疗保健角度看为1140欧元。当支付意愿为50000欧元/QALY时，从社会和医疗保健角度看，低剂量秋水仙碱具有成本效益的概率分别为96%和94%。当年度低剂量秋水仙碱成本超过每位患者每年221欧元的成本时，净货币效益将降至零以下。
根据欧洲和澳大利亚普遍接受的阈值，在慢性冠状动脉疾病患者的标准治疗中加用低剂量秋水仙碱具有成本效益，并且在成本效益方面优于用于慢性冠状动脉疾病的其他药物。
