心不全の黒人に対するイソソorbide dinitrateとhydralazineの固定用量併用療法の費用対効果
Derek C Angus1, Walter T Linde-Zwirble, S William Tam
1Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA. angusdc@upmc.edu
Circulation
|December 14, 2005
まとめ
固定用量イソソorbide dinitrate/hydralazine (ISDN/HYD) は,A-HeFT試験における心不全の入院と医療費を削減しました. この治療法は,アフリカ系アメリカ人における心不全の管理に有利な費用対効果のプロファイルを示しています.
科学分野:
- 心血管医学 心血管医学
- 健康経済学 医療経済学
- 薬学経済学 薬学経済学
背景:
- アフリカ系アメリカ人の心不全試験 (A-HeFT) は,固定用量イソソorbide dinitrate/hydralazine (ISDN/HYD) で改善された臨床結果を示しました.
- この特定の集団におけるISDN/HYD療法の資源利用と費用対効果は評価が必要です.
研究 の 目的:
- A-HeFT試験集団におけるISDN/HYD療法の資源利用,医療費,費用対効果を評価する.
- ISDN/HYD療法が臨床上の利点と並行して好ましい経済的プロフィールを提供しているかどうかを判断する.
主な方法:
- A-HeFT試験のリソース使用データは,米国の連邦費用源を使用して分析されました.
- 試験内のコストと費用対効果は,米国の社会的生涯基準ケースを含む,延長された時間枠でモデル化されました.
- 心不全に関連する医療費と医療費の総額は,ISDN/HYDとプラセボグループ間で,間接的な費用を除いて比較されました.
主要な成果:
- ISDN/HYDグループは,心不全に関連した入院が著しく減少した (0.33対0.47/被験者,P=0.002) と入院期間が短くなった (6.7対7.9日,P=0.006).
- 試験薬の費用を除くと,ISDN/HYD療法は,被験者一人当たりの心不全関連コスト (5,997ドル対9,144ドル,P=0.04) と医療費総額 (15,384ドル対19,728ドル,P=0.03) の平均が低いことと関連していました.
- ISDN/HYD療法は,試験期間中に優位性 (コストの削減と成果の改善) を示し,費用対効果は,2年間の16,600ドルから,生涯にわたって41,800ドルまでと予測されています.
結論:
- ISDN/HYD療法は,臨床結果を改善するだけでなく,A-HeFT集団における資源利用と医療費を大幅に削減します.
- コスト削減の主な要因は,入院件数の大幅な減少でした.
- ISDN/HYD療法の長期利用は,この患者グループにとって有利な費用対効果プロファイルを持つと予測されています.
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