以血小板活性为指导的个体化抗血小板治疗方案的药物经济学评价综述

Review on pharmacoeconomic evaluation of personalized antiplatelet therapy guided by platelet reactivity

目的对以血小板活性为指导的个体化抗血小板治疗方案的药物经济学评价研究进行总结探讨。方法利用Embase和Medline数据库,遴选自2000年以来发表的相关文献。结果共4项研究纳入分析,均使用决策分析模型比较急性冠状动脉综合征(ACS)患者传统抗血小板治疗(全部患者使用氯吡格雷、普拉格雷或替格瑞洛)与个体化抗血小板治疗方案的成本-效果(效用)。个体化方案以高血小板活性(high on-treatment platelet reactivity,HTPR)为指标,HTPR患者使用普拉格雷或替格瑞洛,非HTPR患者使用氯吡格雷。相比传统方案,个体化抗血小板方案为优势(dominant)或最具成本-效果方案。基线研究结果受药物成本、心血管源性死亡率及HTPR患者比例等因素影响。结论相比传统抗血小板治疗,ACS患者以血小板活性为指导的个体化抗血小板治疗具有更好的成本-效果(效用)。

Objective This study aims to review pharmacoeconomic evaluation on personalized antiplatelet therapy guided by on-treatment platelet reactivity.Methods Published literature since 2000 was searched on Embase and Medline databases.Results Four studies that satisfied selection criteria were reviewed.All of four studies designed decision analytic modelling to compare the cost-effectiveness of traditional antiplatelet treatment（universal clopidogrel,prasugrel,or ticagrelor） versus personalized antiplatelet approaches in patients with acute coronary syndrome（ACS）.For personalized treatment,ACS patients were categorized into two groups：patients with high on-treatment platelet reactivity（HTPR） received prasugrel or ticagrelor,whist non-HTPR patients received clopidogrel.Four studies consistently found personalized antiplatelet therapy was dominant or cost-effective compared to traditional strategies.One-way sensitivity analysis found the drug cost,hazard ratio of cardiovascular death of prasugrel or ticagrelor versus clopidogrel, and the prevalence of HTPR were the influential parameters of base-case results.Conclusion Personalized antiplatelet therapy guided by platelet reactivity was preferred over universal antiplatelet strategies for ACS patients.