摘要
目的:评估急性冠状动脉综合征(acute coronary syndrome,ACS)患者接受经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后使用血小板活性检测系统——VerifyNow P2Y12指导氯吡格雷或替格瑞洛应用的成本-效用。方法:患者年龄≥55岁,部分接受氯吡格雷或替格瑞洛联合阿司匹林治疗1年,部分在双联抗血小板治疗(dual antiplatelet therapy,DAPT)前接受VerifyNow P2Y12检测,并根据活性检测结果再选择氯吡格雷或替格瑞洛联合阿司匹林治疗1年。由此建立决策树及Markov模型并进行成本-效用分析,评价开展血小板活性检测的成本-效用。结果:与直接使用氯吡格雷相比,指导下的DAPT每年可以在每1000名患者中减少5次心梗和4次死亡。指导下的个体化治疗,每名患者的总成本预测值比所有患者都使用替格瑞洛时低32%。单因素敏感性分析与概率敏感性分析的结果与基础分析的结果一致。结论:制订DAPT方案前,使用VerifyNow P2Y12评估血小板活性以实施个体化用药是一种具备成本-效用的策略,与直接使用替格瑞洛相比可减轻经济负担。
OBJECTIVE To evaluate the cost-effectiveness of using verifynow P2 Y12 to guide the application of clopidogrel or ticagrelor in patients with acute coronary syndrome(ACS)after percutaneous coronary intervention(PCI).METHODS The patient age≥55 years.It was assumed that all patients received either generic clopidogrel or ticagrelor for 1 year,and underwent VerifyNow P2 Y12 assay testing before DAPT maintenance.Based on this,a decision tree and Markov model were established and cost-utility analysis was performed to evaluate the cost-utility of platelet function testing.RESULTS Guided DAPT will prevent five more MIs and four more deaths per 1000 patients than a standard prescription of generic clopidogrel.The total predictive value of costs per patient is 32%lower if a guided strategy is used than if ticagrelor is given to all patients.The results of single factor sensitivity analysis and probabilistic sensitivity analysis were consistent with that of basic analysis.CONCLUSION Using VerifyNow P2 Y12 to assess platelet activity for personalized medicine prior to treatment planning in DAPT is a cost-effective strategy that reduces the financial burden compared to direct use of ticagrelor.
作者
张亮
侯文洁
李璧辰
王洁
ZHANG Liang;HOU Wen-jie;LI Bi-chen;WANG Jie(Department of Pharmacy,Nanjing Chest Hospital,Jiangsu Nanjing 210029,China;Department of Pharmacy,Affiliated Nanjing Brain Hospital,Nanjing Medical University,Jiangsu Nanjing 210029,China)
出处
《中国医院药学杂志》
CAS
北大核心
2022年第16期1703-1708,共6页
Chinese Journal of Hospital Pharmacy
基金
江苏省药学会—奥赛康医院药学基金(编号:A201909)
南京市医学科技发展一般项目(编号:YKK16207)
南京药学会-常州四药医院药学科研基金(编号:2019YX008)。
