Pharmacoeconomics Evaluation Of Invasive Versus Conservative Treatment In Patients With NSTEMI

Objective:1.From the perspective of the Chinese healthcare system,an pharmacoeconomics evaluation of invasive versus conservative treatment in patients with acute non-ST-segment elevation myocardial infarction was studied in the aims of optimizing the choice of treatment decisions based on the data from the clinical trials and published literatures.2.An appropriate markov model was established to make pharmacoeconomic evaluation model for invasive versus conservative treatment in patients with NSTEMI and determined all the parameters were suitable for the model to provide pharmacoeconomics evaluation and methodology reference for building model of invasive versus conservative treatment in patients with NSTEMI.Method:Clinical study combined with pharmacoeconomics evaluation,the Markov model and its application in terms of NSTEMI pharmacoeconomics evaluation were studied.1.The sample(n=243)from the the two level 3 grade general hospital was analysed by retrospectively and prospectively.Comparative analysis of the short-term clinical outcomes of hospitalization and follow-up 1 year between the two treatments.2.The costs were collected according to the Chinese pharmacoeconomics guide(2011 edition),and all the costs were obtained from the two comprehensive hospitals in this study.The transition probabilities of the states and utilities in the markov model were estimated from the clinical trials and published literatures.3.Using TreeAgePro 2011 software,combining two hospitals clinical cases and clinical trials data and referring to the published related Markov model structure,toestablish the Markov model which was suitable for invasive versus conservative treatment in patients with NSTEMI pharmacoeconomics evaluation.4.A pharmacoeconomics evaluation of the invasive versus conservative treatment for NSTEMI were studied by Roll Back Analysis,Markov Cohort Simulation,Monte Carlo Simulation,one-way and probabilistic sensitivity analysis for the markov model.Results:1.Compared with the conservative treatment group,the invasive treatment group had a lower incidence of the major adverse cardiovascular events,specially in the cases of heart failure and arrhythmia respectively(23.7% vs.52.9%,P<0.05)?(15.6vs.27.1,P<0.05).Follow-up visit 1 year,as a result of decreased incidence of the death in the invasive treatment group compared with the conservative treatment group(2.3%vs.8.6%,P<0.05),and the main causes of death was myocardial infarction in two groups.Besides,the incident of the non-fatal myocardial infarction and non-fatal stroke of the invasive group were 7.5% ? 2.9%,and the conservative group were14.3%?8.6%,two groups had significant difference.2.Markov Cohort Simulation at the 15 cycle predicted the invasive group had58% death?cost ? 150574.84 and gained 8.10 QALYs,while the conservative group had 64% death?cost ? 90313.73 and gained 7.37 QALYs,and the ICER was 82754.14(?/QALY).And Monte Carlo Simulation(simulation of 1000 samples)predicted the invasive group was cost ? 153474.0 and gained 8.09 QALYs,and in the conservative group was cost ? 90534.95 and gained 7.37 QALYs.There were no significant differences between Markov Cohort Simulation and Monte Carlo Simulation.3.One-way sensitivity analysis showed that the most influential three parameter were the transition probability(disease-free survival)in the invasive group,the transition probability(disease-free survival)in the conservative group and the utility of disease-free survival in two groups.And when WTP=139836.00(three times the per capita gross domestic product in China,2014),probabilistic sensitivity analysis predicted that the likelihood of cost-effectiveness achieved by the invasive group was84.8%,while the conservative group was 15.2%.4.The cost-effectiveness analysis of NSTEMI in short-term(follow-up 1 year)showed the ICER was 893138.17(?/QALY),while in the long-term(Markov model,15 years)predicted the ICER was 82754.14(?/QALY).Under the threshold standard(WTP=?139836.00),there were predicted the invasive group extremely had no cost-effectiveness in the short-term with the ICER greater than the threshold standard,while in the long-term had cost-effectiveness.Conclusion:1.Compared with the conservative treatment group,the invasive treatment group had a lower incidence of the major adverse cardiovascular events in hospitalization or follow-up visit 1 year.Therefore,the invasive treatment could reduce the risk of adverse cardiovascular events in patients with NSTEMI those who had surgical indication and were able to afford the costs.2.From the perspective of the Chinese health-care system and based on the data from clinical trials,Markov model could be applied to the pharmacoeconomics evaluation of invasive versus conservative treatment in patients with NSTEMI.3.According to the threshold standard(WTP=?139836.00,three times the per capita gross domestic product in China,2014)that were recommended by the Chinese pharmacoeconomics guide(2011 edition),the invasive group extremely had no cost-effectiveness in the short-term,while had cost-effectiveness.in the long-term.4.The probabilities of cost-effectiveness achieved completely by the invasive treatment in some eastern cities developed areas in China such as Tianjin,Beijing,Shanghai,etc.However,there was low cost-effectiveness probabilities in less developed area like Yunnan Province,Guizhou Province,Gansu Province,etc.5.The results could provide referential information for healthcare management department to make relevant policies and the patients with NSTEMI to choose satisfactory treatment,and also provide methodology reference for building Markov model of invasive versus conservative treatment in patients with NSTEMI to make pharmacoeconomics evaluation in the future.