Economic Modeling Analysis of an Intensive GDMT Optimization Program in Hospitalized Heart Failure Patients.
Economic Modeling Analysis of an Intensive GDMT Optimization Program in Hospitalized Heart Failure Patients.
复制标题
住院心力衰竭患者强化 GDMT 优化计划的经济模型分析。
DOI：
10.1161/circheartfailure.123.011218
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Fonarow,GreggC
中科院分区：
文献类型：
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作者：
Dixit,NealM;Parikh,NeilU;Ziaeian,Boback;Fonarow,GreggC
研究背景STRONG-HF试验（安全性、耐受性和有效性的指南指导的药物治疗急性心力衰竭的上调）表明，与常规治疗相比，随机接受强化指南指导的药物治疗（GDMT）优化的心力衰竭（HF）住院患者6个月内的死亡率和发病率复合指标显著降低。一个密集的GDMT优化程序是否将具有成本效益的HF患者与射血分数降低是unknow. METHODS使用2状态马尔可夫模型，我们评估了一个密集的GDMT优化程序的效果与HF住院患者与射血分数降低。创建了两个人群模型来模拟这种干预，一个是基于STRONG-HF试验参与者的临床试验模型，另一个是基于HF恶化患者的Get With The Guidelines-HF登记研究的真实世界模型。然后，我们模拟了由心脏病专家、临床药剂师和注册护士组成的6个月强化三联治疗GDMT优化计划的效果。将来自STRONG-HF试验干预组的风险比应用于两个人群模型，以从美国医疗保健部门的角度模拟具有终身时间范围的强化GDMT优化计划的临床和财务结局。最佳的四重GDMT使用也被建模。一个密集的GDMT优化程序是非常具有成本效益的增量成本效益比<10000每质量调整的生命年在两个模型。最佳的四重GDMT实施导致最大的收益在生命年的增量成本效益比为60000和54000在临床试验和现实世界的模型，结论：一个强化GDMT优化方案，用于HF患者，降低了注射分数，有效和实质性的止痛效果，特别是使用最佳的四倍GDMT。临床医生，付款人和政策制定者应该优先考虑创建这样的程序。
BACKGROUNDThe STRONG-HF trial (Safety, Tolerability and Efficacy of Up-Titration of Guideline-Directed Medical Therapies for Acute Heart Failure) demonstrated substantial reductions in the composite of mortality and morbidity over 6 months among hospitalized patients with heart failure (HF) who were randomized to intensive guideline-directed medical therapy (GDMT) optimization compared with usual care. Whether an intensive GDMT optimization program would be cost-effective for patients with HF with reduced ejection fraction is unknown.METHODSUsing a 2-state Markov model, we evaluated the effect of an intensive GDMT optimization program on hospitalized patients with HF with reduced ejection fraction. Two population models were created to simulate this intervention, a clinical trial model, based on the participants in the STRONG-HF trial, and a real-world model, based on the Get With The Guidelines–HF registry of patients admitted with worsening HF. We then modeled the effect of a 6-month intensive triple therapy GDMT optimization program comprised of cardiologists, clinical pharmacists, and registered nurses. Hazard ratios from the intervention arm of the STRONG-HF trial were applied to both population models to simulate clinical and financial outcomes of an intensive GDMT optimization program from a US health care sector perspective with a lifetime time horizon. Optimal quadruple GDMT use was also modeled.RESULTSAn intensive GDMT optimization program was extremely cost-effective with incremental cost-effectiveness ratios< 10000perquality-adjustedlife-yearinbothmodels.OptimalquadrupleGDMTimplementationresultedinthemostgainsinlife-yearswithincrementalcost-effectivenessratiosof 60 000 and 54000intheclinicaltrialandreal-worldmodels,respectively.CONCLUSIONSAnintensiveGDMToptimizationprogramforpatientshospitalizedwithHFwithreducedejectionfractionwouldbecost-effectiveandresultinsubstantialgainsinclinicaloutcomes,especiallywiththeuseofoptimalquadrupleGDMT.Clinicians,payers,andpolicymakersshouldprioritizethecreationofsuchprograms.