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氯吡格雷对比阿司匹林用于缺血性脑卒中二级预防的药物经济学评价
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| 篇名： | 氯吡格雷对比阿司匹林用于缺血性脑卒中二级预防的药物经济学评价 |
| TITLE： | Pharmacoeconomic evaluation of clopidogrel versus aspirin for secondary prevention of ischemic stroke |
| 摘要： | 目的 评价抗血小板药物氯吡格雷、阿司匹林单药方案用于缺血性脑卒中二级预防的经济性，为临床用药和相关决策提供经济学证据和参考。方法基于CAPRIE试验构建Markov模型，通过查阅相关文献确定风险事件发生概率、健康效用值以及风险事件管理成本等。模型循环周期为6个月，模拟时限为10年，年贴现率为5%。以总成本、质量调整生命年（QALY）和增量-成本效果比（ICER）作为主要计算结果，应用TreeAgePro软件对上述2种方案进行成本-效用分析，并采用单因素敏感性分析、概率敏感性分析和情境分析来验证基础分析结果的稳健性。结果氯吡格雷方案与CAPRIE试验中325mg/d剂量阿司匹林方案相比用于脑卒中二级预防在模拟10、20、30年时的ICER值分别为4284.06、4201.20、3986.78元/QALY，均小于以1倍2021年我国人均国内生产总值（GDP）作为的意愿支付（WTP）阈值。而氯吡格雷方案与我国临床常用剂量（100mg/d）的阿司匹林方案相比用于脑卒中二级预防在模拟10、20、30年时的ICER值分别为58238.27、42164.72、36164.77元/QALY，也均小于WTP阈值。当对比325mg/d剂量的阿司匹林方案时，单因素敏感性分析结果显示，氯吡格雷周期成本、阿司匹林周期成本、2组治疗方案的脑卒中首次复发概率等为模型敏感因素；概率敏感性分析结果显示，当WTP为1倍2021年我国人均GDP时，氯吡格雷方案具有经济性的概率约为66.5%。情境分析结果显示，无论是10、20、30年3种模拟时限，还是选用不同剂量（50、100、150、200、250mg/d）阿司匹林方案，均不会使基础分析结果翻转。结论相较于阿司匹林单药方案，氯吡格雷单药方案用于缺血性脑卒中二级预防更具有经济性。 |
| ABSTRACT： | OBJECTIVE To evaluate the cost-effectiveness of clopidogrel versus aspirin monotherapy regimens for secondary prevention of ischemic stroke and to provide economic evidence and reference for clinical medication and decision-making. METHODS Based on the CAPRIE trial， a Markov model was constructed； the probabilities of risk events， health utility values， and costs of risk event management were obtained from relevant literature. The cycle length was 6 months， and the time horizon was 10 years. A discount rate of 5% per year was applied. The primary outcomes were total costs， quality-adjusted life-years （QALYs）， and incremental cost-effectiveness ratio （ICER）. Cost-utility analysis was performed for above 2 regimens by using TreeAge Pro software. The one-way sensitivity analysis， probabilistic sensitivity analysis and scenario analysis were conducted to validate the robustness of the analyses. RESULTS Compared with the aspirin regimen （325 mg/d of CAPRIE trial dose）， the ICER values of clopidogrel regimen for secondary stroke prevention for 10 years， 20 years and 30 years were 4 284.06， 4 201.20 and 3 986.78 yuan/QALY， respectively， which were E-mail：liuxiaoyanrj@sjtu.edu.cn all less than the willing-to-pay （WTP） threshold of one time 。 China’s per capita gross domestic product （GDP） in 2021. E-mail：scilwsjtu-wb@yahoo.com Compared with the aspirin regimen （clinically recommended dose in China， 100 mg/d）， the ICER values of clopidogrel regimen for stroke secondary prevention for 10 years， 20 years and 30 years were 58 238.27， 42 164.72 and 36 164.77 yuan/QALY， respectively， which were all less than WTP threshold. When comparing with aspirin regimen of 325 mg/d， results of one-way sensitivity analysis showed that the cost of clopidogrel and aspirin， probability of the first recurrence of ischemic stroke were sensitive factors of model. Results of probabilistic sensitivity analysis showed that when WTP was set at one time GDP per capita in China in 2021， clopidogrel had a probability of being cost- effective of about 66.5%. Results of scenario analysis showed that neither changing the time horizon to 10， 20 or 30 years nor using different doses of aspirin （50， 100， 150， 200 or 250 mg/d） would not alter any conclusions. CONCLUSIONS Compared with aspirin monotherapy， clopidogrel monotherapy is more cost-effective for secondary prevention of ischemic stroke. |
| 期刊： | 2023年第34卷第07期 |
| 作者： | 郎驿天；朱春黎；陶文绮；廖雅慧；张弛；刘晓琰；吴斌 |
| AUTHORS： | LANG Yitian，ZHU Chunli，TAO Wenqi，LIAO Yahui，ZHANG Chi，LIU Xiaoyan，WU Bin |
| 关键字： | 氯吡格雷；阿司匹林；抗血小板药物；缺血性脑卒中；二级预防；药物经济学评价；成本-效用分析 |
| KEYWORDS： | clopidogrel； aspirin； antiplatelet agents； ischemic stroke； secondary prevention； pharmacoeconomic evaluation； |
| 阅读数： | 174 次 |
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