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目的:评价在中国的不稳定型心绞痛和非ST段抬高心梗患者中应用氯吡格雷预防再发血栓形成事件的成本效果。方法:应用CURE临床试验得到的疗效和资源使用情况,结合2003年我国急性冠脉综合症相关费用,用Markov模型计算每增加一个生命年的费用,评价氯吡格雷预防血栓栓塞事件的成本效果。我国急性冠脉综合症(ACS)治疗成本的数据来自卫生统计年报、Delphi专家咨询、医院住院病例分析以及公开发表的文献。结果:氯吡格雷治疗的非ST段抬高ACS首次住院费用为25,191元,与阿司匹林(ASA)对照组相比平均减少了550元。氯吡格雷治疗ST段抬高ACS的远期成本效果是比较理想的。治疗非ST段抬高ACS患者1年,人均增加医药费用6298元,平均期望寿命延长0.1504年(55天),每增加一个生命年的费用为41,875元,低于我国日前肾透析病人的年平均治疗费用10万元。
OBJECTIVE: To evaluate the cost-effectiveness of clopidogrel in preventing recurrent thrombotic events in patients with unstable angina and non-ST-segment heart disease in China. Methods: Using CURE clinical trial efficacy and resource utilization, combined with the related costs of acute coronary syndrome in China in 2003, Markov model was used to calculate the cost per additional life span to evaluate the cost-effectiveness of clopidogrel in preventing thromboembolism. Data on the costs of treating acute coronary syndrome (ACS) in China come from the annual report on health statistics, Delphi expert consultation, hospital inpatient analysis and published literature. Results: The first hospitalization cost of non-ST-elevation ACS treated with clopidogrel was 25,191 yuan, an average reduction of 550 yuan compared with the aspirin (ASA) control group. Clopidogrel in the treatment of ST-segment elevation ACS long-term cost effect is ideal. Treatment of non-ST-segment elevation ACS patients for 1 year, the average per capita increase in medical costs 6,298 yuan, the average life expectancy extended 0. 1504 (55 days), the cost of a life of 41,875 yuan for each additional year, lower than the average annual renal dialysis patients in China Treatment costs 100,000 yuan.