Hilleman D E, Dewan N, Malesker M, Friedman M
Department of Pharmacy Practice, Creighton University School of Pharmacy and Allied Health Professions, Omaha, NE 68178, USA.
Chest. 2000 Nov;118(5):1278-85. doi: 10.1378/chest.118.5.1278.
The clinical outcomes and health-care costs of a cohort of 413 patients with COPD are reported.
This study was a retrospective pharmacoeconomic analysis.
University teaching hospital and affiliated clinics.
COPD patients with an FEV(1) < 65% of predicted and an FEV(1)/FVC ratio < 70% were eligible to be included in this analysis.
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.
Total treatment cost was highly correlated with disease severity, with stage I COPD having the lowest 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 ss-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 ss-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.
Our study demonstrates a strong correlation between disease severity and total treatment cost in COPD. In addition, the type of bronchodilator therapy impacts total 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 ss-agonist had the lowest total cost. These data support the concept that adherence to published treatment guidelines will result in lower health-care costs due to COPD.
报告413例慢性阻塞性肺疾病（COPD）患者的临床结局和医疗费用。
本研究为回顾性药物经济学分析。
大学教学医院及附属诊所。
符合以下条件的COPD患者可纳入本分析：第1秒用力呼气容积（FEV₁）<预计值的65%且FEV₁/用力肺活量（FVC）比值<70%。
通过病历审查确定医疗资源利用情况和费用，并根据美国胸科学会的Ⅰ、Ⅱ、Ⅲ期标准按COPD严重程度进行分层。药物经济学分析为疾病成本评估，包括初始开具的肺部药物购置成本、随访期间添加的肺部药物购置成本、氧疗、实验室及诊断检查费用、门诊就诊费用以及急诊科和住院费用。
总治疗成本与疾病严重程度高度相关，Ⅰ期COPD成本最低（每年每位患者1681美元），Ⅲ期COPD成本最高（每年每位患者10812美元），Ⅱ期COPD成本介于Ⅰ期和Ⅲ期之间（每年每位患者5037美元）。除添加药物购置成本外，所有成本变量在Ⅲ期COPD中最高，在Ⅰ期COPD中最低，在Ⅱ期COPD中处于中间水平。住院是COPD严重程度所有三个阶段最重要的成本变量。按疾病严重程度和初始支气管扩张剂药物选择进行分层时，Ⅰ期COPD患者单用异丙托溴铵以及Ⅱ期和Ⅲ期COPD患者使用异丙托溴铵加短效β受体激动剂（无论是否使用类固醇治疗）的总成本最低。异丙托溴铵组和异丙托溴铵加短效β受体激动剂治疗组总成本较低的原因包括添加药物成本较低、诊断和实验室检查较少以及门诊就诊、急诊科就诊和住院利用率较低。
我们的研究表明COPD疾病严重程度与总治疗成本之间存在很强的相关性。此外，支气管扩张剂治疗类型会影响COPD的总成本。在Ⅰ期COPD中，单用异丙托溴铵总成本最低，而在Ⅱ期和Ⅲ期COPD中，异丙托溴铵加短效β受体激动剂联合使用总成本最低。这些数据支持以下观点：遵循已发表的治疗指南将降低COPD导致的医疗费用。
