地高辛与β受体阻滞剂治疗永久性房颤的成本-效果：永久性房颤（Rate - af）随机试验的率控制治疗评估。

IF 5.1 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Heart Pub Date : 2025-01-16 DOI:10.1136/heartjnl-2024-324761

Zainab Abdali, Karina V Bunting, Samir Mehta, John Camm, Kazem Rahimi, Mary Stanbury, Sandra Haynes, Dipak Kotecha, Sue Jowett

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引用次数: 0

摘要

背景：房颤（AF）是卫生服务的一个主要和日益增加的负担。本研究旨在评估地高辛与β受体阻滞剂对永久性房颤和心力衰竭患者心率控制的成本-效果。永久性房颤（RAte - af）的比率控制治疗评估是一项随机、开放标签、盲法、终点试验，嵌入英国国家卫生服务（NHS），直接比较低剂量地高辛和β受体阻滞剂（ClinicalTrials.gov: NCT02391337）。从医疗保健角度进行了为期12个月的基于试验的成本效用分析。前瞻性地收集初级和二级卫生保健服务、药物和患者报告的生活质量的资源使用情况，以估计成本和质量调整生命年（QALYs）的差异。结果：RATE-AF随机纳入160例患者，平均年龄76岁（SD 8），女性46%，其中149例（地高辛73例，受体阻滞剂76例）数据完整，随访12个月。地高辛治疗的成本明显较低，每位患者每年平均节省530.41英镑（95% CI - 848.06 - 249.38英镑，p=0.001）。这主要是由于不良事件发生率大大降低，与受体阻滞剂治疗相比，初级和二级医疗保健使用率更低。两组QALYs差异无统计学意义(0.013；95% CI -0.033 ~ 0.052, p=0.56)。在每个qaly愿意支付20,000英镑的阈值下，地高辛与β受体阻滞剂相比具有成本效益的概率为94%，每年可能为NHS节省1.02亿英镑（95% CI为4800万英镑至1.64亿英镑，p=0.001）。结论：与β受体阻滞剂相比，地高辛是一种成本更低的选择，用于控制永久性房颤患者的心率，更大的成本效益研究有理由为国家和全球政策制定提供建议。试验注册号：NCT02391337， EudraCT 2015-005043-13。

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 digoxin versus beta blockers in permanent atrial fibrillation: the Rate Control Therapy Evaluation in Permanent Atrial Fibrillation (RATE-AF) randomised trial.

Background: Atrial fibrillation (AF) is a major and increasing burden on health services. This study aimed to evaluate the cost-effectiveness of digoxin versus beta-blockers for heart rate control in patients with permanent AF and symptoms of heart failure.

Methods: RAte control Therapy Evaluation in permanent Atrial Fibrillation (RATE-AF) was a randomised, open-label, blinded, endpoint trial embedded in the UK National Health Service (NHS) to directly compare low-dose digoxin with beta-blockers (ClinicalTrials.gov: NCT02391337). A trial-based cost-utility analysis was performed from a healthcare perspective over 12 months. Resource use in primary and secondary healthcare services, medications and patient-reported quality of life were prospectively collected to estimate differences in costs and quality-adjusted life years (QALYs).

Results: RATE-AF randomised 160 patients with mean age of 76 (SD 8) years and 46% women, of which 149 patients (n=73 digoxin, n=76 beta blockers) had complete data and survived to 12-month follow-up. Treatment with digoxin was significantly less costly, with a mean saving of £530.41 per patient per year (95% CI -£848.06 to -£249.38, p=0.001). This was principally due to substantially lower rates of adverse events, with less primary and secondary healthcare utilisation compared with beta-blocker therapy. There was no significant difference in QALYs (0.013; 95% CI -0.033 to 0.052, p=0.56). At the £20 000 per-QALY willingness to pay threshold, the probability of digoxin being cost-effective compared with beta-blockers was 94%, with potential annual savings to the NHS of £102 million/year (95% CI £48 million to £164 million saving, p=0.001).

Conclusions: Digoxin is a less costly option when compared with beta-blockers for control of heart rate in suitable patients with permanent AF, with larger cost-effectiveness studies warranted to advise on national and global policy-making.

Trial registration number: NCT02391337, EudraCT 2015-005043-13.

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来源期刊

Heart 医学-心血管系统

CiteScore

10.30

自引率

5.30%

发文量

320

审稿时长

3-6 weeks

期刊介绍： Heart is an international peer reviewed journal that keeps cardiologists up to date with important research advances in cardiovascular disease. New scientific developments are highlighted in editorials and put in context with concise review articles. There is one free Editor’s Choice article in each issue, with open access options available to authors for all articles. Education in Heart articles provide a comprehensive, continuously updated, cardiology curriculum.