Pharmacoeconomic evaluation of clopidogrel versus aspirin for secondary prevention of ischemic stroke

LANG Yitian; ZHU Chunli; TAO Wenqi; LIAO Yahui; ZHANG Chi; LIU Xiaoyan; WU Bin

doi:10.6039/j.issn.1001-0408.2023.07.13

您当前的位置：

首页 >

文章列表页 >

Pharmacoeconomic evaluation of clopidogrel versus aspirin for secondary prevention of ischemic stroke

更新时间：2024-02-19

- Pharmacoeconomic evaluation of clopidogrel versus aspirin for secondary prevention of ischemic stroke
- ZHONGGUO YAOFANG Vol. 34, Issue 7, Pages: 837-843(2023)
- 作者机构：
  
  1.上海交通大学医学院附属第九人民医院黄浦分院药剂科，上海　200011
  2.上海交通大学医学院附属仁济医院药剂科，上海　200127
  3.上海交通大学医学院附属仁济医院临床研究中心，上海　200127
- 作者简介：
- 基金信息：
- DOI：10.6039/j.issn.1001-0408.2023.07.13
  CLC： R956;R973
- Published：15 April 2023，
  
  Received：16 August 2022，
  
  Revised：20 March 2023，
扫描看全文
郎驿天,朱春黎,陶文绮等.氯吡格雷对比阿司匹林用于缺血性脑卒中二级预防的药物经济学评价 ^Δ[J].中国药房,2023,34(07):837-843.

LANG Yitian,ZHU Chunli,TAO Wenqi,et al.Pharmacoeconomic evaluation of clopidogrel versus aspirin for secondary prevention of ischemic stroke[J].ZHONGGUO YAOFANG,2023,34(07):837-843.
郎驿天,朱春黎,陶文绮等.氯吡格雷对比阿司匹林用于缺血性脑卒中二级预防的药物经济学评价 ^Δ[J].中国药房,2023,34(07):837-843. DOI： 10.6039/j.issn.1001-0408.2023.07.13.

LANG Yitian,ZHU Chunli,TAO Wenqi,et al.Pharmacoeconomic evaluation of clopidogrel versus aspirin for secondary prevention of ischemic stroke[J].ZHONGGUO YAOFANG,2023,34(07):837-843. DOI： 10.6039/j.issn.1001-0408.2023.07.13.

摘要

目的

评价抗血小板药物氯吡格雷、阿司匹林单药方案用于缺血性脑卒中二级预防的经济性，为临床用药和相关决策提供经济学证据和参考。

方法

基于CAPRIE试验构建Markov模型，通过查阅相关文献确定风险事件发生概率、健康效用值以及风险事件管理成本等。模型循环周期为6个月，模拟时限为10年，年贴现率为5%。以总成本、质量调整生命年（QALY）和增量-成本效果比（ICER）作为主要计算结果，应用TreeAge Pro软件对上述2种方案进行成本-效用分析，并采用单因素敏感性分析、概率敏感性分析和情境分析来验证基础分析结果的稳健性。

结果

氯吡格雷方案与CAPRIE试验中325 mg/d剂量阿司匹林方案相比用于脑卒中二级预防在模拟10、20、30年时的ICER值分别为4 284.06、4 201.20、3 986.78元/QALY，均小于以1倍2021年我国人均国内生产总值（GDP）作为的意愿支付（WTP）阈值。而氯吡格雷方案与我国临床常用剂量（100 mg/d）的阿司匹林方案相比用于脑卒中二级预防在模拟10、20、30年时的ICER值分别为58 238.27、42 164.72、36 164.77元/QALY，也均小于WTP阈值。当对比325 mg/d剂量的阿司匹林方案时，单因素敏感性分析结果显示，氯吡格雷周期成本、阿司匹林周期成本、2组治疗方案的脑卒中首次复发概率等为模型敏感因素；概率敏感性分析结果显示，当WTP为1倍2021年我国人均GDP时，氯吡格雷方案具有经济性的概率约为66.5%。情境分析结果显示，无论是10、20、30年3种模拟时限，还是选用不同剂量（50、100、150、200、250 mg/d）阿司匹林方案，均不会使基础分析结果翻转。

结论

相较于阿司匹林单药方案，氯吡格雷单药方案用于缺血性脑卒中二级预防更具有经济性。

Abstract

OBJECTIVE

To evaluate the cost-effectiveness of clopidogrel versus aspirin monotherapy regimens for secondary prevention of ischemic stroke and to provide economic evidence and reference for clinical medication and decision-making.

METHODS

Based on the CAPRIE trial， a Markov model was constructed； the probabilities of risk events， health utility values， and costs of risk event management were obtained from relevant literature. The cycle length was 6 months， and the time horizon was 10 years. A discount rate of 5% per year was applied. The primary outcomes were total costs， quality-adjusted life-years （QALYs）， and incremental cost-effectiveness ratio （ICER）. Cost-utility analysis was performed for above 2 regimens by using TreeAge Pro software. The one-way sensitivity analysis， probabilistic sensitivity analysis and scenario analysis were conducted to validate the robustness of the analyses.

RESULTS

Compared with the aspirin regimen （325 mg/d of CAPRIE trial dose）， the ICER values of clopidogrel regimen for secondary stroke prevention for 10 years， 20 years and 30 years were 4 284.06， 4 201.20 and 3 986.78 yuan/QALY， respectively， which were all less than the willing-to-pay （WTP） threshold of one time China’s per capita gross domestic product （GDP） in 2021. Compared with the aspirin regimen （clinically recommended dose in China， 100 mg/d）， the ICER values of clopidogrel regimen for stroke secondary prevention for 10 years， 20 years and 30 years were 58 238.27， 42 164.72 and 36 164.77 yuan/QALY， respectively， which were all less than WTP threshold. When comparing with aspirin regimen of 325 mg/d， results of one-way sensitivity analysis showed that the cost of clopidogrel and aspirin， probability of the first recurrence of ischemic stroke were sensitive factors of model. Results of probabilistic sensitivity analysis showed that when WTP was set at one time GDP per capita in China in 2021， clopidogrel had a probability of being cost-effective of about 66.5%. Results of scenario analysis showed that neither changing the time horizon to 10， 20 or 30 years nor using different doses of aspirin （50， 100， 150， 200 or 250 mg/d） would not alter any conclusions.

CONCLUSIONS

Compared with aspirin monotherapy， clopidogrel monotherapy is more cost-effective for secondary prevention of ischemic stroke.

关键词

氯吡格雷阿司匹林抗血小板药物缺血性脑卒中二级预防药物经济学评价成本-效用分析

Keywords

aspirinantiplatelet agentsischemic strokesecondary preventionpharmacoeconomic evaluationcost-utility analysis

references

杨帆，李兴义，满劲进，等. 卒中后认知障碍早期预测因素的研究进展[J]. 神经损伤与功能重建，2022，17（4）：218-221.

Zhou M，Wang H，Zhu J，et al. Cause-specific mortality for 240 causes in China during 1990-2013：a systematic subnational analysis for the Global Burden of Disease Study 2013[J]. Lancet，2016，387（10015）：251-272.

WANG W Z，JIANG B，SUN H X，et al. Prevalence，incidence，and mortality of stroke in China：results from a nationwide population-based survey of 480 687 adults[J]. Circulation，2017，135（8）：759-771.

CHEN Y P，WRIGHT N，GUO Y，et al. Mortality and recurrent vascular events after first incident stroke：a 9-year community-based study of 0.5 million Chinese adults[J]. Lancet Glob Health，2020，8（4）：e580-e590.

王拥军. 缺血性卒中的二级预防[J]. 中华神经科杂志，2021，54（2）：139-148.

仵佳宁，张潇，江文. 伴有脑微出血的缺血性卒中或短暂性脑缺血发作患者的卒中二级预防研究进展[J]. 中国脑血管病杂志，2022，19（3）：211-216.

KLEINDORFER D O，TOWFIGHI A，CHATURVEDI S，et al. 2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack：a guideline from the American Heart Association/American Stroke Association[J]. Stroke，2021，52（7）：e364-e467.

SANDERCOCK P A，COUNSELL C，TSENG M C，et al. Oral antiplatelet therapy for acute ischaemic stroke[J]. Cochrane Database Syst Rev，2014（3）：CD000029.

ANUTA V，SARBU I，MIRCIOIU I，et al. Development of a new HPLC method for simultaneous determination of clopidogrel and its major metabolite using a chemometric approach[J]. Curr Health Sci J，2015，41（1）：11-21.

LI T，LIU M B，BEN H，et al. Clopidogrel versus aspirin in patients with recent ischemic stroke and established peripheral artery disease：an economic evaluation in a Chinese setting[J]. Clin Drug Investig，2015，35（6）：365-374.

CAPRIE Steering Committee. A randomised，blinded，trial of clopidogrel versus aspirin in patients at risk of ischaemic events （CAPRIE）[J]. Lancet，1996，348（9038）：1329-1339.

WU B，KUN L，LIU X Y，et al. Cost-effectiveness of different strategies for stroke prevention in patients with atrial fibrillation in a health resource-limited setting[J]. Cardiovasc Drugs Ther，2014，28（1）：87-98.

SHAH S V，GAGE B F. Cost-effectiveness of dabigatran for stroke prophylaxis in atrial fibrillation[J]. Circulation，2011，123（22）：2562-2570.

SORENSEN S V，KANSAL A R，CONNOLLY S，et al. Cost-effectiveness of dabigatran etexilate for the prevention of stroke and systemic embolism in atrial fibrillation：a Canadian payer perspective[J]. Thromb Haemost，2011，105（5）：908-919.

STEVANOVIĆ J，DE JONG L A，KAPPELHOFF B S，et al. Dabigatran for the treatment and secondary prevention of venous thromboembolism； a cost-effectiveness analysis for the Netherlands[J]. PLoS One，2016，11（10）：e0163550.

刘国恩. 中国药物经济学评价指南2020[M]. 北京：中国市场出版社，2020：25-28.

WU B，TOBE R G，LIU Y C，et al. Health economic analysis of antiplatelet therapy for acute coronary syndromes in the context of five Eastern Asian countries[J]. Clin Drug Investig，2018，38（7）：621-630.

张焕，徐诺，徐敢，等. 药品可及性视角下415种过评仿制药与基药、医保、集采目录的联动情况分析[J]. 中国药房，2022，33（6）：661-665，705.

JONES W S，MULDER H，WRUCK L M，et al. Comparative effectiveness of aspirin dosing in cardiovascular di- sease[J]. N Engl J Med，2021，384（21）：1981-1990.

Views

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Cost-utility analysis of dorzagliatin combined with metformin in the treatment of type 2 diabetes mellitus patients with poor glycemic control with metformin

Cost-utility analysis of trastuzumab deruxtecan versus trastuzumab emtansine in the second-line treatment for HER2-positive metastatic breast cancer

Cost-utility analysis of tislelizumab monotherapy for second-line treatment of advanced or metastatic esophageal squamous cell carcinoma

Introduction of measurement methods of health utility for cancer patients

Cost-utility analysis of denosumab and teriparatide in the treatment of postmenopausal osteoporosis in Chinese women

Related Author

LIU Guoqiang

NIU Mengna

GUO Shan

GAO Shengnan

FENG Bing

GAO Ning

HOU Yanhong

WU Fang

Related Institution

Dept. of Clinical Pharmacy， Hebei Medical University Third Hospital

Hebei Society for Integrated Drug and Health Technology Assessment

School of International Pharmaceutical Business， China Pharmaceutical University

Clinical Pharmaceutics Room， the First Affiliated Hospital of Xi’an Medical University

Dept. of Oncology， the First Affiliated Hospital of Xi’an Medical University

Address：8/F,129 Daping Main Street,Yuzhong District,Chongqing 400042,P.R.China
Technical support is provided by Beijing Founder Electronics co., LTD 渝ICP备15012710号公网安备50010302001817
It is recommended to read the content of this site in Chrome&IE9+. Please switch to extreme mode in browser 360.
Cookies We use cookies to help provide and enhance our service and tailor content. By continuing, you agree to the use of cookies.

⁰