Using Triple Antiplatelet Therapy in Patients with Non-ST Elevation Acute Coronary Syndrome Managed Invasively: A Cost-Effectiveness Analysis

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• 作者：Jaime Latour-Pé ; rez ; MD ; PhD^a ; ^{jlatour@wanadoo.es} ; Eva de Miguel Balsa ; MD^a ; Lourdes Betegó ; n ; BSc^b ; Xavier Badia ; MD ; PhD^b
• 关键词：acute coronary syndrome ; clopidogrel ; cost-effectiveness ; glycoprotein IIb/IIIa inhibitors
• 刊名：Value in Health
• 出版年：2008
• 出版时间：September-October 2008
• 年：2008
• 卷：11
• 期：5
• 页码：853-861
• 全文大小：228 K

文摘

Objectives

To assess the incremental cost-effectiveness ratio (ICER) of glycoprotein IIb/IIIa (GPIIb/IIIa) inhibitors in patients with non-ST elevation acute coronary syndrome (NSTE-ACS) pretreated with aspirin and clopidogrel undergoing an early invasive treatment strategy.

Methods

Cost-effectiveness analysis and cost-utility analysis were performed from a health-care system perspective, based on a Markov model with a time horizon of the patient life span. The risk of death and ischemic events was assessed using the Thrombolysis in Myocardial Infarction (TIMI) risk score. We compared three strategies: 1) routine upstream use of a GPIIb/IIIa inhibitor to all patients before angiography, 2) deferred selective use of abciximab in the catheterization laboratory just before angioplasty, and 3) double antiplatelet therapy without GPIIb/IIIa inhibitors. Both univariate sensitivity analysis and second-order probabilistic microsimulation were performed.

Results

In the base case (65 years old, TIMI score 3), strategy A was the most effective, with an ICER of ?5,150 per quality-adjusted life-year gained. Strategy B was dominated by a combination of strategies A and C. The ICER was very sensitive to the age and baseline risk of the patient. According to the widely accepted cost-effectiveness thresholds, strategy A would be cost-effective only in patients with an intermediate to high TIMI score, especially within the younger age groups. The probability that strategy A was cost-effective under the base case was 91.2 % .

Conclusions

The use of GPIIb/IIIa inhibitors upstream in high-risk NSTE-ACS patients (TIMI score ?) pretreated with aspirin and clopidogrel is cost-effective, particularly in the younger age groups.