应用Markov-Monte Carlo模型评价ACS患者应用抗血小板药物致出血不良事件的经济负担(1)
中圖分类号 R956 文献标志码 A 文章编号 1001-0408(2019)22-3117-05
DOI 10.6039/j.issn.1001-0408.2019.22.19
摘 要 目的：为急性冠脉综合征(ACS)患者抗血小板治疗提供决策依据。方法：收集PLATO和TREAT研究中的相关数据建立Markov模型，计算ACS患者应用替格瑞洛或氯吡格雷的总出血风险、主要出血风险、次要出血风险及致命出血风险等，依据既往文献收集、计算各状态间的转移概率、各状态的成本及效用值，运用TreeAge Pro 2011软件计算不同方案的医疗费用、质量调整生命年(QALYs)以及增量-成本效果比(ICER)，并对模型进行单因素敏感性分析及概率敏感性分析。结果：替格瑞洛组平均总成本是66 449.38元，获得7.34 QALYs;氯吡格雷组平均总成本是53 846.03元，获得6.68 QALYs。替格瑞洛组与氯吡格雷组相比的ICER为19 095.98元/QALYs，即每多获得1个QALYs，替格瑞洛组患者需多花19 095.98元，低于意愿支付阈值(64 644元)。敏感性分析结果与上述结果一致。结论：相较于氯吡格雷，替格瑞洛对ACS患者尤其是发生出血不良事件的ACS患者具有更小的经济负担。
关键词 Markov模型;Monte Carlo模拟;抗血小板药物;氯吡格雷;替格瑞洛;出血事件;经济负担
Economic Burden Evaluation of Adverse Events Caused by Antiplatelet Drugs in ACS Patients Using Markov-Monte Carlo Model
CHENG Yan1，TANG Shaoliang2，LI Xin3，ZOU Ying4(1. Dept. of Pharmacy， Nanjing Hospital of TCM Affiliated to Nanjing University of TCM， Nanjing 210012， China; 2. College of Health Economics and Management， Nanjing University of TCM， Nanjing 210023， China; 3. School of Pharmacy， Nanjing Medical University， Nanjing 211166， China; 4. Dept. of Pharmacy， the First Affiliated Hospital of Nanjing Medical University， Nanjing 210029， China)
ABSTRACT OBJECTIVE： To provide decision basis for antiplatelet therapy in ACS patients. METHODS： Markov model was established by collecting the related data in PLATO and TREAR study. Total bleeding risk， major bleeding risk， secondary bleeding risk and fatal bleeding risk in ACS patients who using ticagrelor or clopidogrel were calculated. Transfer probability， the cost and utility value between each state were collected and calculated according to previous literatures. The medical expenses of different methods were calculated by using TreeAge Pro 2011 software to obtain quality-adjusted life years (QALYs) and increment-cost- effectiveness ratio (ICER). Furthermore， single-factor sensitivity analysis and probability sensitivity analysis were carried out. RESULTS： The average total cost of ticagrelor group was 66 449.38 yuan， obtaining 7.34 QALYs; the average total cost of clopidogrel group was 53 846.03 yuan， obtaining 6.68 QALYs. Compared with the clopidogrel group， the ICER of the ticagrelor group was 19 095.98 yuan/QALYs， that is， for each additional QALYs obtained， the cost of ticagrelor group was 19 095.98 yuan， less than willingness to pay threshold (64 644 yuan). Sensitivity analysis was consistent with above analysis. CONCLUSIONS： Compared with clopidogrel， ticagrelor has less economic burden in ACS patients， especially in the patients with adverse bleeding events., 百拇医药(成彦 汤少梁 李歆 邹颖)
DOI 10.6039/j.issn.1001-0408.2019.22.19
摘 要 目的：为急性冠脉综合征(ACS)患者抗血小板治疗提供决策依据。方法：收集PLATO和TREAT研究中的相关数据建立Markov模型，计算ACS患者应用替格瑞洛或氯吡格雷的总出血风险、主要出血风险、次要出血风险及致命出血风险等，依据既往文献收集、计算各状态间的转移概率、各状态的成本及效用值，运用TreeAge Pro 2011软件计算不同方案的医疗费用、质量调整生命年(QALYs)以及增量-成本效果比(ICER)，并对模型进行单因素敏感性分析及概率敏感性分析。结果：替格瑞洛组平均总成本是66 449.38元，获得7.34 QALYs;氯吡格雷组平均总成本是53 846.03元，获得6.68 QALYs。替格瑞洛组与氯吡格雷组相比的ICER为19 095.98元/QALYs，即每多获得1个QALYs，替格瑞洛组患者需多花19 095.98元，低于意愿支付阈值(64 644元)。敏感性分析结果与上述结果一致。结论：相较于氯吡格雷，替格瑞洛对ACS患者尤其是发生出血不良事件的ACS患者具有更小的经济负担。
关键词 Markov模型;Monte Carlo模拟;抗血小板药物;氯吡格雷;替格瑞洛;出血事件;经济负担
Economic Burden Evaluation of Adverse Events Caused by Antiplatelet Drugs in ACS Patients Using Markov-Monte Carlo Model
CHENG Yan1，TANG Shaoliang2，LI Xin3，ZOU Ying4(1. Dept. of Pharmacy， Nanjing Hospital of TCM Affiliated to Nanjing University of TCM， Nanjing 210012， China; 2. College of Health Economics and Management， Nanjing University of TCM， Nanjing 210023， China; 3. School of Pharmacy， Nanjing Medical University， Nanjing 211166， China; 4. Dept. of Pharmacy， the First Affiliated Hospital of Nanjing Medical University， Nanjing 210029， China)
ABSTRACT OBJECTIVE： To provide decision basis for antiplatelet therapy in ACS patients. METHODS： Markov model was established by collecting the related data in PLATO and TREAR study. Total bleeding risk， major bleeding risk， secondary bleeding risk and fatal bleeding risk in ACS patients who using ticagrelor or clopidogrel were calculated. Transfer probability， the cost and utility value between each state were collected and calculated according to previous literatures. The medical expenses of different methods were calculated by using TreeAge Pro 2011 software to obtain quality-adjusted life years (QALYs) and increment-cost- effectiveness ratio (ICER). Furthermore， single-factor sensitivity analysis and probability sensitivity analysis were carried out. RESULTS： The average total cost of ticagrelor group was 66 449.38 yuan， obtaining 7.34 QALYs; the average total cost of clopidogrel group was 53 846.03 yuan， obtaining 6.68 QALYs. Compared with the clopidogrel group， the ICER of the ticagrelor group was 19 095.98 yuan/QALYs， that is， for each additional QALYs obtained， the cost of ticagrelor group was 19 095.98 yuan， less than willingness to pay threshold (64 644 yuan). Sensitivity analysis was consistent with above analysis. CONCLUSIONS： Compared with clopidogrel， ticagrelor has less economic burden in ACS patients， especially in the patients with adverse bleeding events., 百拇医药(成彦 汤少梁 李歆 邹颖)