Tsevat J, Duke D, Goldman L, Pfeffer M A, Lamas G A, Soukup J R, Kuntz K M, Lee T H
Section for Clinical Epidemiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
J Am Coll Cardiol. 1995 Oct;26(4):914-9. doi: 10.1016/0735-1097(95)00284-1.
This study sought to assess the cost-effectiveness of captopril therapy for survivors of myocardial infarction.
The recent randomized, controlled Survival and Ventricular Enlargement (SAVE) trial showed that captopril therapy improves survival in survivors of myocardial infarction with an ejection fraction < or = 40%. The present ancillary study was designed to determine how the costs required to achieve this increase in survival compared with those of other medical interventions.
We developed a decision-analytic model to assess the cost-effectiveness of captopril therapy in 50- to 80-year old survivors of myocardial infarction with an ejection fraction < or = 40%. Data on costs, utilities (health-related quality of life weights) and 4-year survival were obtained directly from the SAVE trial, and long-term survival was estimated using a Markov model. In one set of analyses, we assumed that the survival benefit associated with captopril therapy would persist beyond 4 years (persistent-benefit analyses), whereas in another set we assumed that captopril therapy incurred costs but no survival benefit beyond 4 years (limited-benefit analyses).
In the limited-benefit analyses, the incremental cost-effectiveness of captopril therapy ranged from $3,600/quality-adjusted life-year for 80-year old patients to $60,800/quality-adjusted life-year for 50-year old patients. In the persistent-benefit analyses, incremental cost-effectiveness ratios ranged from $3,700 to $10,400/quality-adjusted life-year, depending on age. The outcome was generally not sensitive to changes in estimates of variables when they were varied individually over wide ranges. In a "worst-case" analysis, incremental cost-effectiveness ratios for captopril therapy remained favorable ($8,700 to $29,200/quality-adjusted life-year) for 60- to 80-year old patients but were higher ($217,600/quality-adjusted life-year) for 50-year old patients.
We conclude that the cost-effectiveness of captopril therapy for 50- to 80-year old survivors of myocardial infarction with a low ejection fraction compares favorably with other interventions for survivors of myocardial infarction.
本研究旨在评估卡托普利治疗心肌梗死幸存者的成本效益。
近期的随机对照生存与心室扩大（SAVE）试验表明，卡托普利治疗可提高射血分数≤40%的心肌梗死幸存者的生存率。本辅助研究旨在确定与其他医学干预措施相比，实现这种生存率提高所需的成本情况。
我们建立了一个决策分析模型，以评估卡托普利治疗对年龄在50至80岁、射血分数≤40%的心肌梗死幸存者的成本效益。成本、效用（与健康相关的生活质量权重）和4年生存率的数据直接取自SAVE试验，并使用马尔可夫模型估计长期生存率。在一组分析中，我们假设与卡托普利治疗相关的生存获益将持续超过4年（持续获益分析），而在另一组分析中，我们假设卡托普利治疗会产生成本，但4年后无生存获益（有限获益分析）。
在有限获益分析中，卡托普利治疗的增量成本效益从80岁患者的每质量调整生命年3600美元到50岁患者的每质量调整生命年60800美元不等。在持续获益分析中，增量成本效益比根据年龄在每质量调整生命年3700美元至10400美元之间。当各个变量在很宽的范围内单独变化时，结果通常对变量估计值的变化不敏感。在“最坏情况”分析中，卡托普利治疗的增量成本效益比对于60至80岁患者仍然有利（每质量调整生命年8700美元至29200美元），但对于50岁患者则更高（每质量调整生命年217600美元）。
我们得出结论，对于射血分数低的50至80岁心肌梗死幸存者，卡托普利治疗的成本效益与心肌梗死幸存者的其他干预措施相比具有优势。
