Cost–utility analysis of using high-intensity statin among post-hospitalized acute coronary syndrome patients

Pramitha Esha Nirmala Dewi, Montarat Thavorncharoensap, Bangunawati Rahajeng
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Abstract

Post-hospitalized acute coronary syndrome (ACS) patients in Indonesia National Insurance does not pay for the use of high-intensity statin (HIS) for secondary prevention after ACS hospitalization. Moreover, a cost–utility analysis needs to be conducted to evaluate the cost-effectiveness of prescribing HIS and low-to-moderate-intensity statin (LMIS) per quality-adjusted life year (QALY). This study aimed to estimate the cost–utility of long-term HIS treatment in post-hospitalized ACS patients in Indonesia compared to current practice. This study compared the economic outcomes of long-term HIS and LMIS in Indonesian post-hospitalized ACS patients. A lifetime Markov model predicted ACS-related events, costs, and QALY from a payer perspective. A systematic review estimated treatment-specific event probabilities, post-event survival, health-related quality of life, and Indonesia medical-care expenses from published sources. This study conducted probabilistic sensitivity analysis (PSA) using 1000 independent Monte Carlo simulations and a series of one-way deterministic sensitivity analyses utilizing a tornado diagram. The economic evaluation model proved that intensive HIS treatment can increase per-patient QALYs and care expenditures compared to LMIS. The use of HIS among post-hospitalized ACS patients had ICER 31.843.492 IDR per QALY gained, below the Indonesia willingness-to-pay (WTP) for terminal disease and life-saving treatment. From the Indonesia payer perspective, using HIS for post-hospitalized ACS patients in Indonesia is cost-effective at 31.843.492 IDR per QALY gained.
住院后急性冠状动脉综合征患者使用高强度他汀类药物的成本效用分析
在印度尼西亚,急性冠状动脉综合征(ACS)患者住院后使用高强度他汀类药物(HIS)进行二级预防的费用不属于国家保险支付范围。此外,还需要进行成本效用分析,以评估处方高强度他汀和中低强度他汀(LMIS)每质量调整生命年(QALY)的成本效益。本研究旨在估算印度尼西亚住院后 ACS 患者接受长期 HIS 治疗的成本效用,并与现行做法进行比较。本研究比较了印尼住院后 ACS 患者长期 HIS 和 LMIS 的经济效益。一个终身马尔可夫模型从支付方的角度预测了 ACS 相关事件、成本和 QALY。一项系统性综述从已发表的资料中估算了治疗特异性事件概率、事件后存活率、健康相关生活质量和印尼医疗费用。本研究利用 1000 次独立蒙特卡罗模拟进行了概率敏感性分析(PSA),并利用龙卷风图进行了一系列单向确定性敏感性分析。经济评估模型证明,与 LMIS 相比,强化 HIS 治疗可增加每位患者的 QALYs 和护理支出。在住院后的 ACS 患者中使用 HIS,每 QALY 收益的 ICER 为 31.843.492 印度卢比,低于印尼对绝症和救生治疗的支付意愿(WTP)。从印尼支付方的角度来看,印尼住院后 ACS 患者使用 HIS 的成本效益为每 QALY 收益 31.843.492 IDR。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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