依替巴肽与替罗非班在急性非ST段抬高型心肌梗死患者介入治疗中的药物经济学研究

Cost-effectiveness of eptifibatide versus tirofiban in the treatment of non-ST-segment elevation myocardial infarction with percutaneous coronary intervention

目的:本研究旨在对比依替巴肽与替罗非班在急性非ST段抬高型心肌梗死(NSTEMI)患者介入治疗中的成本-效果分析,为中国NSTEMI患者经皮冠状动脉介入治疗(PCI)抗栓药物的选用提供依据及参考。方法:基于Markov数学模型,以国内医疗成本为成本数据,以国内外临床研究结果为疗效指标,利用Treeage软件模拟计算使用依替巴肽或替罗非班在NSTEMI患者介入治疗过程中质量调整生命年(QALYs)及治疗成本,对比依替巴肽或替罗非班用于国内NSTEMI患者行PCI术的成本效果。结果:依替巴肽和替罗非班的总治疗成本分别为76 047.19元和75 094.83元,使用依替巴肽患者可获得的QALYs为10.58,替罗非班可获得的QALYs为9.69。增量成本效果比(ICER)分析显示,ICER为1 070.07元/QALYs,小于人均GDP,提示NSTEMI患者介入治疗中使用依替巴肽较替罗非班是更具优势的方案。敏感性分析显示本研究结果稳定可靠。结论:在我国目前经济形势下,使用依替巴肽更具成本效果优势,可替代NSTEMI患者介入治疗过程中替罗非班这一抗栓选择。

OBJECTIVE To compare the cost-effectiveness of eptifibatide versus tirofiban in the treatment of non-ST-segment elevation myocardial infarction(NSTEMI)with percutaneous coronary intervention(PCI)to provide rationales for selecting drugs for PCI antithrombotic therapy in Chinese NSTEMI patients.METHODS Based upon domestic and foreign clinical studies, Treeage software was to create a markov model for calculating the quality adjusted life years(QALYs)and treatment costs for PCI in NSTEMI patients using eptifibatide and compared with those on tirofiban therapy.RESULTS The total treatment cost of eptifibatide and tirofiban was RMB 76 047.19 yuan and RMB 75 094.83 yuan respectively.QALYs available to patients using eptifibatide was 10.58 and QALYs available to tirofiban 9.69.The incremental cost effect(ICER)analysis showed that ICER was 1 070.07 yuan/QALYs and it was less than per capita GDP.It hinted that eptifibatide was superior to tirofiban in PCI for NSTEMI patients.The sensitivity analysis shows that the results were both stable and reliable.CONCLUSION Under the current economic condition in China, eptifibatide is more cost-effective and it can replace the antithrombotic option of tirofiban during PCI of NSTEMI patients.