急性冠脉综合征患者不同调脂方案的成本-效果分析

Cost-effectiveness Analysis of Different Lipid-lowering Regimens in Patients with Acute Coronary Syndrome

目的评价急性冠脉综合征(ACS)患者使用不同调脂方案的经济学。方法分析2018年9月至2019年3月符合条件的ACS患者,按医师开具的调脂方案分为瑞舒伐他汀强化组(20 mg/d,简称R组)、阿托伐他汀强化组(40 mg/d,简称A组)、瑞舒伐他汀联合依折麦布组(10 mg/d、10 mg/d,简称R-E组)以及阿托伐他汀联合依折麦布组(20 mg/d、10 mg/d,简称A-E组),并对患者进行随访。运用药物经济学中的成本-效果分析法对上述治疗方案进行评价。结果共观察80例患者(R组n=23,A组n=20,R-E组n=17,A-E组n=20),4组患者年龄、性别、治疗前LDL-C、随访时间比较,差异无统计学意义(P>0.05),均完成随访。以LDL-C达标率为评价标准时,R组的成本-效果比(CER)(C/E1=364.36)最小;以LDL-C下降幅度为评价标准时,R-E组的CER(C/E2=649.29)最小。但无论采用何种评价标准,A-E组与CER最小组比较均更具成本-效果优势(ICER1=844.32,ICER2=2 235.1),A组均处于绝对劣势(ICER1=-827.38,ICER2=-1 026.2)。结论对成本和效果进行综合考虑,A-E组最具有成本-效果优势,A组经济学最差。

Objective To compare the cost and efficacy of schemes of lipid lowering in patients with acute coronary syndrome(ACS).Methods Data of eligible ACS patients from September 1,2018 to March 31,2019 were collected.According to the schemes of lipid lowering,it is divided into 4 groups-group of doubling rosuvastatins?,group of doubling atorvastatin(A),group of ezetimibe plus rosuvastatins(R-E)and group of ezetimibe plus atorvastatin(A-E).The patients were followed up.Cost-effectiveness analysis(CEA)was utilized to evaluate the 4 groups.Results A total of 80 patients(R group n=23,A group n=20,R-E group n=17,A-E group n=20)were observed.There was no significant difference in age,sex,LDL-C before treatment and follow-up time between the 4 groups(P>0.05).The cost-effectiveness ratio(CER)(C/E1=364.36)of group R was the smallest when the LDL-C compliance rate was used as the evaluation criterion,while the CER(C/E2=649.29)of group R-E was the smallest when the LDL-C decline rate was used as the evaluation criterion.However,no matter what evaluation criteria are used,group A-E has more cost-effectiveness advantages than the minimum CER group(ICER1=844.32,ICER2=2 235.1),and group A is at absolute disadvantage(ICER1=827.38,ICER2=1 026.2).Conclusion Considering the cost and efficacy,the A-E group has the most cost-effective advantage,while the A group has the worst economic performance.