Perreault S, Hamilton V H, Lavoie F, Grover S
Centre for the Analysis of Cost-Effective Care, Montreal General Hospital, Quebec, Canada.
Cardiovasc Drugs Ther. 1997 Jan;10(6):787-94. doi: 10.1007/BF00053037.
The objective of this study was to compare the lifetime cost-effectiveness of HMG-CoA reductase inhibitors and fibrates for the treatment of hyperlipidemia. Estimates of lipid modification achieved due to drug therapy were based on published head-to-head comparisons of specific HMG-CoA reductase inhibitors and fibrates in randomized, double-blind studies. We used a validated coronary heart disease (CHD) prevention computer model to estimate the costs and benefits of lifelong lipid modification. The patients were middle-aged men and women who were free of CHD, with either primary type IIa or IIb hyperlipidemia. The intervention used were specific HMG-CoA reductase inhibitors and fibrates at several dosages, which reduced total cholesterol 11-34% and increased high-density lipoprotein cholesterol 1-29%. The main outcome measure was the cost per year of life saved after discounting benefits and costs by 5% annually. The lifetime cost effectiveness of HMG-CoA reductase inhibitors (fluvastatin, lovastatin, pravastatin, simvastatin) and fibrates (bezafibrate, fenofibrate, gemfibrozil) for the treatment of primary hyperlipidemia varied according to patient population, the effectiveness of each drug in modifying lipid levels, and the price of each drug. The estimates of cost per year of life saved for HMG-CoA reductase inhibitors range from $19,886 to $73,632, and $16,955 to $59,488 for fibrates according to gender and type of primary hyperlipidemia. Fluvastatin 20 mg/day was significantly more cost effective than gemfibrozil 1200 mg/day for male patients with type IIa hyperlipidemia. Simvastatin 17.3 mg/day or 20 mg/day yielded similar cost-effectiveness ratios compared with fibrates among type II hyperlipidemic patients. However, micronized fenofibrate was more cost effective than simvastatin 20 mg/day among type IIb patients. The cost effectiveness of lipid therapy varies widely and can be maximized by selecting specific drugs for specific lipid abnormalities.
本研究的目的是比较HMG-CoA还原酶抑制剂和贝特类药物治疗高脂血症的终生成本效益。药物治疗导致的血脂改变估计值基于已发表的特定HMG-CoA还原酶抑制剂和贝特类药物在随机双盲研究中的直接比较。我们使用经过验证的冠心病（CHD）预防计算机模型来估计终生血脂改变的成本和效益。患者为无冠心病的中年男性和女性，患有原发性IIa型或IIb型高脂血症。所采用的干预措施是几种剂量的特定HMG-CoA还原酶抑制剂和贝特类药物，它们可使总胆固醇降低11%-34%，高密度脂蛋白胆固醇升高1%-29%。主要结局指标是在每年对效益和成本进行5%的贴现后，每挽救一年生命的成本。HMG-CoA还原酶抑制剂（氟伐他汀、洛伐他汀、普伐他汀、辛伐他汀）和贝特类药物（苯扎贝特、非诺贝特、吉非贝齐）治疗原发性高脂血症的终生成本效益因患者群体、每种药物改变血脂水平的有效性以及每种药物的价格而异。根据性别和原发性高脂血症类型，HMG-CoA还原酶抑制剂每挽救一年生命的成本估计值在19,886美元至73,632美元之间，贝特类药物为16,955美元至59,488美元。对于患有IIa型高脂血症的男性患者，每天20毫克氟伐他汀比每天1200毫克吉非贝齐的成本效益显著更高。在II型高脂血症患者中，每天17.3毫克或20毫克辛伐他汀产生的成本效益比与贝特类药物相似。然而，在IIb型患者中，微粒化非诺贝特比每天20毫克辛伐他汀更具成本效益。脂质治疗的成本效益差异很大，通过为特定的脂质异常选择特定的药物可使其最大化。
