CYP2C19基因导向的抗血小板药物治疗方案在急性冠状动脉综合征患者中的经济学评价

Economic evaluation of CYP2C19 genetic test guiding antiplatelet therapy in patients with acute coronary syndrome

目的:从药物经济学角度评价拟行介入手术的急性冠脉综合征患者依据CYP2C19基因指导抗血小板药物应用的可行性。方法:采用回顾性分析,选取皖南医学院弋矶山医院2018年4月至2020年4月收治的513例采用氯吡格雷联合阿司匹林或替格瑞洛联合阿司匹林进行抗血小板治疗的急性冠脉综合征住院患者,根据是否进行CYP2C19基因检测及个体化用药指导,非随机分为个体化治疗组和采用氯吡格雷标准剂量的常规治疗组。成本仅包括直接医疗成本,效果指标采用患者1年内发生主要心血管不良事件次数,进行增量成本效果分析和敏感性分析。结果:个体化治疗组(n=312)的人均总治疗费用为49319元,常规治疗组(n=201)为51820元;1年内再入院率个体化治疗组为12.18%,常规治疗组为21.89%,具有统计学差异(P<0.05)。增量成本效果比为257.5元/%,相比常规治疗组,个体化治疗组每使100个患者中减少1例因发生主要心血管不良事件再入院,可少花费25750元,表明个体化治疗策略具有明显的成本-效果优势。敏感性分析表明,提高用药效果对增量成本效果比的改变并不十分显著,提示医疗费用才是影响基因检测经济性的关键因素。结论:通过CYP2C19基因检测指导的抗血小板治疗方案对急性冠脉综合征患者经皮冠状动脉介入术后预防主要心血管不良事件具有良好效果,并具有明显成本-效果收益,更具有药物经济学优势。

OBJECTIVE To evaluate the feasibility of using antiplatelet drugs according to CYP2 C19 gene in patients with acute coronary syndrome undergoing interventional surgery from the perspective of pharmacoeconomics.METHODS A total of 513 hospitalized patients with acute coronary syndromes who received antiplatelet therapy with clopidogrel combined with aspirin or ticagrelor combined with aspirin in our hospital from April 2018 to April 2020 were selected by retrospective analysis.They were non-randomly divided in to the conventional treatment group in which the standard dose of clopidogrel was used for genetic testing according to whether CYP2 C19 gene detection was performed or not.The costs only included direct medical cost,and the effect measure used the number of adverse cardiovascular events within 1 year for incremental cost-effectiveness analysis and sensitivity analysis.RESULTS The per capita total treatment cost of the individualized treatment group(n=312)was 49319 yuan,and the conventional treatment group(n=201)was 51820 yuan.The readmission rate within 1 year was 12.18%in the individualized treatment group,21.89%in the conventional treatment group,and the difference was significant(P<0.05).The incremental cost-effectiveness ratio was 257.5 yuan/%,and compared with the conventional treatment group,the cost of major cardiovascular adverse events in patients in the individualized treatment group decreased by 25750 per case.The sensitivity analysis showed that the change of incremental cost-effectiveness ratio was not very significant,suggesting that medical cost is the key factor affecting the economy of gene testing.CONCLUSION The antiplatelet therapy guided by CYP2 C19 gene detection has good effect on the prevention of major adverse cardiovascular events after percutaneous coronary intervention in patients with acute coronary syndrome,and has obvious cost effect benefit and pharmacoeconomics advantage.