在住院心力衰竭患者中进行密集GDMT优化计划的经济建模分析
Neal M Dixit1, Neil U Parikh2, Boback Ziaeian3,4
1Division of Cardiovascular Medicine, Department of Medicine, University of California, Davis, Sacramento (N.M.D.).
Circulation. Heart failure
|November 6, 2023
概括
强化指南导向医学治疗 (GDMT) 的优化显著改善了结果,并且在心力衰竭中具有降低射出分数患者的成本效益非常高. 这种方法,特别是四倍GDMT,提供了实质性的临床收益,应该优先考虑.
科学领域:
- 心脏病学 心脏病学
- 卫生经济学 卫生经济学
- 药理学 药理学 是一个学科.
背景情况:
- STRONG-HF试验显示,强化指南导向医学治疗 (GDMT) 的优化减少了住院心力衰竭 (HF) 患者的死亡率和发病率.
- 对降低射出分数 (HFrEF) 的高频进行密集GDMT优化的成本效益仍然未确立.
研究的目的:
- 评估住院HFrEF患者的密集GDMT优化计划的成本效益.
- 为了比较临床试验模型和现实世界的模型之间的结果.
主要方法:
- 一个2态马尔科夫模型被用来模拟一个密集的6个月的GDMT优化程序.
- 开发了两个模型:一个基于STRONG-HF试验,另一个基于Get With The Guidelines-HF注册表.
- 这些模型纳入了来自STRONG-HF试验的危险比率,并考虑了最佳的四倍GDMT.
主要成果:
- 密集的GDMT优化计划非常具有成本效益,在两种模型中,增量成本效益比率低于10,000美元/质量调整寿命年.
- 在临床试验和现实世界的模型中,最佳的四倍GDMT产生了最大的生命年增长,其增量成本效益比分分别为60,000美元和54,000美元.
结论:
- 对于住院的HFrEF患者来说,密集的GDMT优化计划具有成本效益,并改善了临床结果.
- 最佳四倍GDMT进一步增强了这些好处,支持临床医生,支付者和政策制定者的优先考虑.
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