冠状动脉搭桥手术后添加终身低剂量秋水仙碱作为二级预防的临床益处和成本效益。

Clinical benefit and cost effectiveness of adding life-time low-dose colchicine as secondary prevention following coronary artery bypass grafting surgery.

作者信息

Ponnana Sai Rahul, Mahalwar Gauranga, Holtrop Joris, Hageman Steven H J, Zhang Tong, Sirasapalli Santosh Kumar, Moorthy Skanda, Chen Zhuo, Dazard Jean-Eudes, Al-Kindi Sadeer, Elgudin Yakov, Sattar Naveed, Rajagopalan Sanjay, Deo Salil V

机构信息

Harrington Heart and Vascular Institute, University Hospitals, Cleveland, USA.

Department of Internal Medicine, Cleveland Clinic, Cleveland, USA.

出版信息

Am Heart J Plus. 2025 Jul 16;57:100580. doi: 10.1016/j.ahjo.2025.100580. eCollection 2025 Sep.

DOI:10.1016/j.ahjo.2025.100580

PMID:40727715

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12303075/

Abstract

BACKGROUND

Low-dose Colchicine therapy has demonstrated clinical benefit as secondary preventive therapy in patients with chronic coronary artery disease. While prior studies have reported its cost-effectiveness in this patient group, this has not yet been studied in post-coronary artery bypass grafting (CABG) patients. Therefore, we evaluated the 5-year potential clinical benefit and lifetime cost-effectiveness of adding low-dose Colchicine to routine secondary preventive therapy among U.S. Veterans post-CABG.

METHODS

A discrete time-homogeneous, annual cycle, state-transition Markov Chain model was developed using MACE (myocardial infarction, stroke, coronary reintervention, and all-cause mortality) information from 27,443 U.S. Veterans who underwent CABG. Cost and utility estimates were sourced from peer-reviewed literature. Current secondary preventive therapy was compared with secondary preventive therapy + Colchicine over a 35-year period. Clinical benefit was extrapolated from a nationwide perspective. Cost-effectiveness was modeled by calculating incremental cost-effectiveness ratios (ICERs) across a wide range of willingness-to-pay (WTP) thresholds. Deterministic, probabilistic, and alternative real-world scenarios were modeled to evaluate real-world use.

RESULTS

In 150,000 isolated CABG patients who received surgery in 2019 across the U.S., Colchicine therapy could potentially reduce 8266 myocardial infarctions, 16,674 strokes, and 9472 coronary reinterventions over 5 years. Lifetime Colchicine therapy yielded a QALY gain of 0.74 and an ICER of $26,684 per QALY. Monte Carlo simulation supported these findings (median ICER: $19,598; IQR: $17,995-$20,921). Colchicine remained cost-effective at WTP thresholds >$20,000 per QALY, even with 5-year or mixed adherence.

CONCLUSION

Adjunct life-long Colchicine therapy may reduce cardiovascular events at an acceptable additional cost post-CABG.

摘要

背景

低剂量秋水仙碱疗法已被证明作为慢性冠状动脉疾病患者的二级预防疗法具有临床益处。虽然先前的研究报告了其在该患者群体中的成本效益，但尚未在冠状动脉旁路移植术（CABG）患者中进行研究。因此，我们评估了在美国退伍军人冠状动脉旁路移植术后，在常规二级预防治疗中添加低剂量秋水仙碱的5年潜在临床益处和终生成本效益。

方法

使用来自27443名接受冠状动脉旁路移植术的美国退伍军人的主要不良心血管事件（心肌梗死、中风、冠状动脉再次干预和全因死亡率）信息，建立了一个离散时间齐次、年度周期、状态转移马尔可夫链模型。成本和效用估计来自同行评审的文献。在35年的时间里，将当前的二级预防治疗与二级预防治疗加秋水仙碱进行了比较。从全国范围推断临床益处。通过计算广泛的支付意愿（WTP）阈值下的增量成本效益比（ICER）来模拟成本效益。对确定性、概率性和替代现实世界情景进行建模，以评估现实世界中的使用情况。

结果

在2019年美国接受手术的150000例孤立性冠状动脉旁路移植术患者中，秋水仙碱疗法在5年内可能减少8266例心肌梗死、16674例中风和9472例冠状动脉再次干预。终生秋水仙碱疗法产生了0.74的质量调整生命年增益，每质量调整生命年的增量成本效益比为26684美元。蒙特卡罗模拟支持了这些发现（中位增量成本效益比：19598美元；四分位间距：17995 - 20921美元）。即使有5年或混合依从性，在每质量调整生命年支付意愿阈值>20000美元时，秋水仙碱仍然具有成本效益。