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PCI术后双联抗血小板后单用氯吡格雷或阿司匹林维持治疗的药物经济学评价
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| 篇名： | PCI术后双联抗血小板后单用氯吡格雷或阿司匹林维持治疗的药物经济学评价 |
| TITLE： | Pharmacoeconomic evaluation of dual antiplatelet therapy followed by maintenance therapy with clopidogrel or aspirin after PCI |
| 摘要： | 目的 从我国卫生体系角度出发，评价经皮冠状动脉介入治疗（PCI）术后患者在双联抗血小板治疗（DAPT）后接受氯吡格雷或阿司匹林单药维持治疗的经济性。方法采用Markov模型，研究时限设为25年，循环周期为1年，对氯吡格雷组和阿司匹林组患者分别进行队列模拟，预测和比较PCI术后患者DAPT后接受氯吡格雷或阿司匹林单药维持治疗方案带来的长期经济与健康结果，并进行成本-效用分析。以1倍2024年我国人均国内生产总值（GDP）作为意愿支付（WTP）阈值[95749元/质量调整生命年（QALY）]，计算增量成本-效果比（ICER）。采用单因素敏感性分析和概率敏感性分析验证基础分析结果的稳健性。结果PCI术后患者DAPT后采用氯吡格雷单药维持治疗能减少死亡事件的发生，而采用阿司匹林单药维持治疗发生卒中和心肌梗死事件的概率更低。氯吡格雷组方案相较于阿司匹林组方案的ICER为34644.87元/QALY，小于本研究的WTP阈值。单因素敏感性分析结果表明，影响基础分析结果较为显著的不确定因素为阿司匹林组无事件转移至死亡概率、氯吡格雷组无事件成本及阿司匹林组无事件成本。概率敏感性分析结果表明，当WTP阈值为95749元/QALY时，氯吡格雷组和阿司匹林组方案具有经济性的概率分别为83%和17%，且氯吡格雷组方案具有经济性的概率随WTP阈值增加而上升。结论相较于阿司匹林单药维持治疗方案，在1倍我国2024年人均GDP的WTP阈值下，PCI术后患者DAPT后接受氯吡格雷单药维持治疗的经济性更佳。 |
| ABSTRACT： | OBJECTIVE From the perspective of China’s health system， to evaluate the cost-effectiveness of maintenance therapy with clopidogrel or aspirin monotherapy in percutaneous coronary intervention （PCI） patients after dual antiplatelet therapy （DAPT）. METHODS A Markov model was adopted with a research period of 25 years and a cycle period of 1 year. Cohort simulations were conducted respectively for the clopidogrel group and aspirin group to predict and compare the long-term economic and health outcomes of PCI patients receiving either clopidogrel or aspirin monotherapy maintenance regimens after DAPT， and cost-effectiveness analysis was conducted. The willingness-to-pay （WTP） threshold was set at the level of 1 times China’s per capita gross domestic product （GDP） in 2024[95 749 yuan per quality-adjusted life year （QALY）]， and the incremental cost- effectiveness ratio （ICER） was calculated. The robustness of the basic analysis results was verified by using single-factor sensitivity analysis and probabilistic sensitivity analysis. RESULTS After PCI， patients received DAPT， clopidogrel monotherapy maintenance treatment reduced the occurrence of death events， and aspirin monotherapy maintenance treatment had a lower probability of stroke and myocardial infarction events. The ICER of the clopidogrel group regimen compared with the aspirin group regimen was 34 644.87 yuan/QALY， which was less than the WTP threshold set in this study. The results of univariate sensitivity analysis indicated that notable uncertainties affecting the basic analysis results were the probability of event-free progression to death in the aspirin group， the event-free cost in the clopidogrel group， and the event-free cost in the aspirin group. The results of probabilistic sensitivity analysis indicated that when the WTP threshold was 95 749 yuan /QALY， the economic probabilities of the clopidogrel group and the aspirin group were 83% and 17%， respectively. The economic probability of the clopidogrel group regimens showed an upward trend with the increase of the WTP threshold. CONCLUSIONS Compared to aspirin monotherapy for maintenance therapy， under the WTP threshold of 1 times China’s per capita GDP in 2024， receiving clopidogrel monotherapy for maintenance therapy after DAPT in PCI patients is more cost-effective. |
| 期刊： | 2025年第36卷第23期 |
| 作者： | 骆兵；蒋月云；陈艺莉 |
| AUTHORS： | LUO Bing，JIANG Yueyun，CHEN Yili |
| 关键字： | 氯吡格雷；阿司匹林；经皮冠状动脉介入治疗；抗血小板治疗；Markov模型；成本-效用分析；药物经济学评价 |
| KEYWORDS： | clopidogrel； aspirin； percutaneous coronary intervention； antiplatelet therapy； Markov model； cost-utility |
| 阅读数： | 1 次 |
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