阿司匹林用于心血管疾病预防的药物经济学评价文献研究

Literature Study on Pharmacoeconomic Evaluation of Aspirin for Cardiovascular Disease Prevention

目的:综述阿司匹林用于心血管疾病预防的药物经济学研究的评价方法及结果,为该药的经济学评价和临床用药决策提供参考。方法:以“心血管疾病”“成本-效果”“成本-效用”“成本-效益”“成本效果”“成本效用”“成本效益”“经济性分析”“药物经济学”为中文检索词,以“cost-effectiveness”“cost-utility”“cost-benefit”“economic analysis”“pharmacoeconomics”为英文检索词,在中国知网、万方数据、维普网、PubMed、WebofScience、Cochrane图书馆等数据库中检索2000年1月1日-2021年1月17日公开发表的阿司匹林预防心血管疾病的药物经济学评价文献,按照纳入与排除标准筛选文献后,提取相关信息,使用卫生经济学评价报告标准共识量表对纳入文献进行质量评价,从文献基本信息、文献质量、模型结构及要素、健康状态及效用值、成本项目和来源、健康产出、经济学评价、敏感性分析等对阿司匹林预防心血管疾病的药物经济学评价方法和结果进行描述性统计分析。结果与结论:共纳入9篇文献,文献总符合率均在80.00%以上。阿司匹林预防心血管疾病的药物经济学评价研究主要采用马尔可夫模型,模型结构较为成熟;成本主要考虑直接成本,数据主要来源于医保数据库等;效用根据健康状态效用值进行计算,效用值多来源于已有文献研究;敏感性分析采用确定性敏感性分析和概率敏感性分析,主要影响因素为成本;多数情况下阿司匹林用于心血管疾病预防具有经济性,且阿司匹林用于心血管疾病一级预防更具有经济性。建议国内学者可参考我国药物经济学指南,更规范地开展相关药物经济学评价研究。

OBJECTIVE:To review the method and results of pharmacoeconomic evaluation of aspirin for cardiovascular disease prevention,and to provide reference for economic evaluation of aspirin and clinical medication decision.METHODS:Using“cardiovascular disease”“cost-effectiveness”“cost-utility”“cost-benefit”“cost effectiveness”“cost utility”as the Chinese search terms,using“cost-effectiveness”“cost-utility”“cost-benefit”“economic analysis”“pharmacoeconomics”as English search terms,relevant literatures about pharmacoeconomic evaluation of aspirin for cardiovascular disease prevention published during January 1,2000 to January 17,2021 were retrieved from CNKI,Wanfang database,VIP,PubMed,Web of Science,the Cochrane Library.After screening literatures according to inclusion and exclusion criteria,extracting relevant data,the quality of included literatures was evaluated with CHEERS scale.The method and results of pharmacoeconomic evaluation of aspirin in the prevention of cardiovascular diseases were analyzed statistically in terms of basic information,literature quality,model structure and elements,health status and utility value,cost items and sources,health output,economic evaluation and sensitivity analysis.RESULTS&CONCLUSIONS:Nine literatures were included,and the total coincidence rates of the literatures were all above 80.00%.The pharmacoeconomic evaluation of aspirin in the prevention of cardiovascular disease mainly adopted Markov model,and the model structure was relatively mature.The cost mainly considered the direct cost,and the data mainly came from the medical insurance database;utility was calculated according to the utility value of health state,which mostly came from the existing literatures.The sensitivity analysis adopted deterministic sensitivity analysis and probabilistic sensitivity analysis,and the main influential factor was cost.It was economical to use aspirin for cardiovascular disease prevention in most cases,and aspirin was more economical for primary prevention of cardiovascular disease.It is suggested that domestic scholars can refer to China’s pharmacoeconomic guidelines to carry out relvant pharmacoeconomic evaluation research more standardized.