Evolocumab 治疗心血管疾病的成本效益：系统综述

IF 1.6 Q3 MEDICINE, RESEARCH & EXPERIMENTAL

Current Therapeutic Research-clinical and Experimental Pub Date : 2024-01-01 DOI:10.1016/j.curtheres.2024.100758

Nashmil Ghadimi , Rajabali Daroudi , Hosein Shabaninejad , Mahshad Goharimehr , Davoud Khodamorzideh , Sara Kaveh

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引用次数: 0

摘要

背景随着心血管疾病（CVD）负担的不断增加以及对具有成本效益的干预措施的需求，评估 Evolocumab 的经济意义变得至关重要。方法我们在 Cochrane Library、EMBASE、PubMed、ProQuest 和 Web of Science 中进行了广泛的检索。我们还检查了所选文献综述的参考文献列表，以找到 2023 年 3 月之前发表的 Evolocumab 用于心血管疾病患者的合适成本效益分析 (CEA)。综合卫生经济评估报告标准声明（CHEERS）用于评估报告质量。与成本相关的研究结果经调整后反映了2023年以美元计价的购买力平价（PPP）值，以便进行跨研究比较。结果这项系统性综述包括16项研究，发表于2016年至2023年之间，大部分来自美国和中国。在摘要、背景和目标等部分，CHEERS检查表的合规性较高。然而，视角（71.4%）、时间跨度（57.1%）和患者参与（14.3%）等方面的报告率较低。所有研究都评估了 Evolocumab 与其他降脂治疗（LLTs）联用的成本效益。值得注意的是，所有研究都采用了马尔科夫队列状态转换模型进行基于模型的经济评估，其中大多数研究采用了终生视野。大多数研究（10 例）同时报告了每质量调整生命年 (QALY) 的增量成本效益比 (ICER) 和每挽救生命年 (LYS) 的 ICER。4 项研究专门报告了 ICER/QALY，2 项研究只关注 ICER/LYS。ICER/QALY 的范围很广（3,342.57 美元至 2,687,920.13 美元），其中一项研究为离群值。敏感性分析揭示了影响成本效益结果的因素，包括低密度脂蛋白胆固醇（LDL-C）水平、Evolocumab 成本和疾病类型，同时有几项研究报告了成本效益分析的公认阈值。未来的研究应调查经济影响的确定性和不确定性，并考虑不同国家的收入水平。低密度脂蛋白胆固醇水平、用药成本和心血管疾病类型是影响成本效益分析的重要因素。

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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Cost-effectiveness of Evolocumab in Cardiovascular Disease: A Systematic Review

Background

With the rising burden of cardiovascular disease (CVD) and the need for cost-effective interventions, evaluating the economic implications of Evolocumab becomes crucial.

Objectives

This study aimed to systematically review and evaluate the cost-effectiveness of Evolocumab in adults at risk of CVD.

Methods

We performed an extensive search in Cochrane Library, EMBASE, PubMed, ProQuest, and Web of Science. The reference lists of chosen literature reviews were also examined to find suitable cost-effectiveness analyses (CEAs) of Evolocumab in patients with CVD published until March 2023. The Consolidated Health Economic Evaluation Reporting Standards statement (CHEERS) was used to assess the reporting quality. Cost-related findings were adjusted to reflect 2023 purchase power parity (PPP) values in US dollars to enable cross-study comparisons.

Results

This systematic review comprised 16 studies, published between 2016 and 2023, mostly from the USA and China. Compliance with the CHEERS checklist was high in sections like abstracts, backgrounds, and objectives. However, areas like perspective (71.4%), time horizon (57.1%), and engagement with patients (14.3%) showed lower reporting rates. All studies evaluated the cost-effectiveness of Evolocumab in combination with other lipid-lowering treatments (LLTs). Notably, all studies employed model-based economic evaluations using a Markov cohort state-transition model, with a majority adopting a lifetime horizon. Most studies (10 cases) simultaneously reported both the Incremental Cost-Effectiveness Ratio (ICER) per Quality Adjusted Life Years (QALY) and the ICER per Life-Years Saved (LYS). Four studies exclusively reported ICER/QALY, and 2 studies solely focused on ICER/LYS. The ICER/ QALY exhibited a wide range (3,342.57 to 2,687,920.13 USD), with one study presenting as an outlier. Sensitivity analyses revealed factors influencing cost-effectiveness outcomes, including Low-Density Lipoprotein Cholesterol (LDL-C) levels, Evolocumab costs, and disease type, while several studies reported accepted thresholds for cost-effectiveness analysis.

Conclusions

Our systematic review concludes that Evolocumab could be a cost-effective treatment, particularly for high-risk patient groups, but this varies by disease category, risk level, and evaluation methods. Future studies should investigate the economic impact's certainty and uncertainty, and consider different countries' income levels. LDL-C levels, medication costs, and CVD types are important factors affecting cost-effectiveness analysis.

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来源期刊

Current Therapeutic Research-clinical and Experimental 医学-药学

CiteScore

3.50

自引率

0.00%

发文量

审稿时长

3 months

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