涂层可降解药物支架短期双抗治疗及相关疾病的直接经济负担

The direct economical burden of biodegradable drug stent short-term DAPT and relevant disease

[目的]基于涂层可降解药物支架缩短双重抗血小板治疗(DAPT)治疗时间,以涂层可降解药物洗脱支架(SYNERGY)为例分析减少使用的药物成本,以及降低出血事件节约的社会经济成本。[方法]以EVOLVE Short DAPT临床试验结果为基础,结合文献估算相关疾病直接经济负担。[结果]以中国大陆地区2018年冠心病PCI数据推算,2018年急性心肌梗塞的直接经济负担约为264.51亿元。针对高出血风险冠心病患者,接受SYNERGY支架治疗后给予3个月DAPT治疗是安全和有效的。以2019年冠状动脉支架置入术(PCI)预计数为基础推算,相比于12个月的DAPT治疗方案,当有30%PCI手术患者采用SYNERGY支架并接受3个月的DAPT治疗时,每年药物使用减少成本为2.47亿元,60%的患者使用时会减少成本4.94亿元,90%使用时将会减少7.41亿元。另外,每年的脑出血和急性上消化道出血的直接经济负担分别为2.11亿元和1.48亿元。[结论]SYNERGY支架缩短DAPT治疗时间,降低出血事件发生率,能够节约药物使用成本,并减少因出血事件产生的直接经济负担,具有一定的成本经济性,建议在临床使用及市场准入等决策中予以关注。

Objectives:As the biodegradable drug stent to shorten the treatment time of DAPT,taking STNERGY stent as an example,the study analyzes the cost of reducing use of drugs as well as the social and economic cost of reducing bleeding events.Methods:Based on the results of EVOLVE Short DAPT clinical trial,combined with literatures,to estimate the direct economic burden of related diseases.Results:The Economic Burden of AMI is RMB 26.45 billion in 2018.DAPT treatment is safe and effective for coronary heart disease patients with high bleeding risk.Compared with 12-month DAPT treatment,when 30%of PCI patients use SYNERGY stent and receive DAPT for only 3 months,the annual cost reduction of drug use is 247 million;when 60%of PCI patients use SYNERGY stent,the cost saving will be 494 million;when 90%of PCI patients use SYNERGY stent,741 million of the cost will be saved.In addition,the direct economic burdens caused by cerebral hemorrhage and acute upper gastrointestinal hemorrhage are 211 million and 148 million respectively every year.Conclusions SYNERGY stent can shorten the time of DAPT treatment,reduce the incidence of bleeding events,save the cost of drug use,and reduce the direct economic burden caused by bleeding events,which has certain cost-effectiveness.It is suggested to pay attention to it in the decision-making of clinical use and market access.