Pharmacoeconomic evaluation of COPD
Pharmacoeconomic evaluation of COPD
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DOI：
10.1378/chest.118.5.1278
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发表时间：
2000-11-01
期刊：
影响因子：
9.6
通讯作者：
Friedman, M
中科院分区：
文献类型：
--
作者：
Hilleman, DE;Dewan, N;Friedman, M
研究目的：报告413例慢性阻塞性肺病患者的临床结果和医疗保健费用。设计：本研究为回顾性药物经济学分析。单位：大学教学医院及附属诊所。患者：FEV1 <预测的65%且FEV1/FVC比率< 70%的COPD患者符合纳入本分析的条件。干预措施：通过图表回顾确定卫生保健资源利用和成本，并根据COPD的严重程度采用美国胸科学会I、II和III期进行分层。药物经济学分析是一种疾病成本评估，包括最初处方肺部药物的获取成本、随访期间增加的肺部药物的获取成本、氧气治疗、实验室和诊断测试成本、诊所就诊成本、急诊科和医院成本。结果：总治疗费用与疾病严重程度高度相关，I期COPD成本最低（每位患者每年1,681美元），III期COPD成本最高（每位患者每年10,812美元），II期COPD成本介于I期和III期之间（每位患者每年5,037美元）。除附加药物获取成本外，所有成本变量在III期COPD中最高，在I期COPD中最低，在II期COPD中处于中等水平。住院治疗是所有三个阶段COPD严重程度中最重要的成本变量。当按疾病严重程度和初始支气管扩张剂药物选择分层时，I期COPD患者单独使用异丙托品和II期和III期COPD患者联合使用异丙托品加β受体激动剂（伴或不伴类固醇治疗）的总成本最低。异丙托品和异丙托品加受体激动剂治疗组总费用较低的原因包括附加药物费用较低，诊断和实验室检查较少，门诊就诊、急诊就诊和住院的使用率较低。结论：我们的研究表明，CORD的疾病严重程度与总治疗费用之间存在很强的相关性。此外，支气管扩张剂治疗的类型影响慢性阻塞性肺病的胎儿成本。在I期COPD中，单独异丙托品的总成本最低，而在II期和III期COPD中，异丙托品加β受体激动剂的组合总成本最低。这些数据支持这样一种观点，即遵守已公布的治疗指南将降低慢性阻塞性肺病的医疗保健费用。
Study objectives: The clinical outcomes and health-care costs of a cohort of 413 patients with COPD are reported.Design: This study was a retrospective pharmacoeconomic analysis.Setting: University teaching hospital and affiliated clinics.Patients: COPD patients with an FEV1 < 65% of predicted and an FEV1/FVC ratio < 70% were eligible to be included in this analysis.Interventions: Health-care resource utilization and costs were identified through chart review and were stratified according to the severity of COPD using the American Thoracic Society stages I, II, and III. The pharmacoeconomic analysis was a cost-of-illness evaluation that included the acquisition costs of initially prescribed pulmonary drugs, acquisition cost of pulmonary drugs added during the follow-up period, oxygen therapy, laboratory and diagnostic test costs, clinic visit costs, and emergency department and hospital costs.Results: Total treatment cost was highly correlated with disease severity, with stage I COPD having the lo,vest cost ($1,681 per patient per year), stage III COPD having the highest cost ($10,812 per patient per year), and stage II COPD having a cost intermediate to stage I and stage III ($5,037 per patient per year). With the exception of add-on drug acquisition cost, all cost variables were the highest in stage III COPD, the lowest in stage I COPD, and intermediate in stage II COPD. Hospitalization was the most important cost variable for all three stages of COPD severity. When stratified by both disease severity and initial bronchodilator drug selection, ipratropium alone in stage I COPD patients and the combination of ipratropium plus a beta -agonist (with or without steroid therapy) in stage II and stage III COPD patients had the lowest total costs. Reasons for the lower total cost of the ipratropium and ipratropium plus beta -agonist treatment groups included lower add-on drug costs, fewer diagnostic and laboratory tests, and a lower utilization rate for clinic visits, emergency department visits, and hospitalizations.Conclusions: Our study demonstrates a strong correlation between disease severity and total treatment cost in CORD. In addition, the type of bronchodilator therapy impacts fetal cost in COPD. In stage I COPD, ipratropium alone had the lowest total cost, while in stage II and stage III COPD, a combination of ipratropium plus a beta -agonist had the lowest total cost. These data support tbe concept that adherence to published treatment guidelines will result in lower health-care costs due to COPD.