Christie Angela H, Culbert Pearl, Guest Julian F
Catalyst Health Economics Consultants, Northwood, Middlesex, United Kingdom.
Pharmacoeconomics. 2002;20(1):49-60. doi: 10.2165/00019053-200220010-00005.
To estimate the economic impact of using low dose polyethyene glycol 3350 (PEG 3350) plus electrolytes (PEG+E) compared with lactulose in the treatment of idiopathic constipation in ambulant patients. DESIGN AND PERSPECTIVE: This was a decision analytic modelling study performed from the perspective of the UK's National Health Service (NHS).
The clinical outcomes from a previously reported single-blind, randomised, multicentre trial were used as the clinical basis for the analysis. These data were combined with resource utilisation estimates derived from a panel of six general practitioners (GPs) and four nurses enabling a decision model to be constructed depicting the management of idiopathic constipation with either PEG+E or lactulose over 3 months. The model was used to estimate the expected 3-monthly NHS cost of using either laxative to manage idiopathic constipation.
The expected 3-monthly NHS cost of using PEG+E or lactulose to manage idiopathic constipation was estimated to be 85 pound sterling and 96 pound sterling per patient, respectively (1999/2000 values). However, significantly more patients were successfully treated with PEG+E than lactulose (53% versus 24%; p < 0.001) at 3 months. GP visits were the primary cost driver for both PEG+E- and lactulose-treated patients, accounting for 56% (2.9 visits) and 73% (4.4 visits), respectively, of the expected NHS cost per patient at 3 months. Among PEG+E-treated patients, the acquisition cost of PEG+E was the secondary cost driver, accounting for 30% of the expected NHS cost per patient at 3 months, whereas the acquisition cost of lactulose accounted for only 11% of the expected NHS cost per lactulose-treated patient. District nurse domiciliary visits accounted for 4% and thyroid function tests for 2%. The costs of switched laxatives, concomitant laxatives, and gastroenterologist and colorectal surgeon visits collectively accounted for up to 9% of the total.
The true cost of managing idiopathic constipation is impacted on by a broad range of resources and not only laxative acquisition costs. This study indicated that managing idiopathic constipation with PEG+E instead of lactulose reduces the expected 3-monthly NHS cost by 11 pound sterling per patient. Moreover, using PEG+E instead of lactulose is expected to double the percentage of patients successfully treated at 3 months. Hence, PEG+E is a dominant treatment compared with lactulose. This suggests that the decision to use either PEG+E or lactulose to treat idiopathic constipation should be based on efficacy, safety, patient preferences and total management costs, and not drug acquisition costs.
评估在门诊患者中使用低剂量聚乙二醇3350（PEG 3350）加电解质（PEG+E）与乳果糖治疗特发性便秘的经济影响。
这是一项从英国国家医疗服务体系（NHS）视角进行的决策分析模型研究。
将先前报道的一项单盲、随机、多中心试验的临床结果用作分析的临床依据。这些数据与由6名全科医生（GP）和4名护士组成的小组得出的资源利用估计值相结合，构建了一个决策模型，描述在3个月内使用PEG+E或乳果糖治疗特发性便秘的管理情况。该模型用于估计使用任一种泻药治疗特发性便秘的NHS预期3个月成本。
使用PEG+E或乳果糖治疗特发性便秘的NHS预期3个月成本估计分别为每位患者85英镑和96英镑（1999/2000年数值）。然而，在3个月时，使用PEG+E成功治疗的患者显著多于使用乳果糖的患者（53%对24%；p<0.001）。全科医生诊疗是PEG+E治疗组和乳果糖治疗组患者的主要成本驱动因素，分别占3个月时每位患者预期NHS成本的56%（2.9次诊疗）和73%（4.4次诊疗）。在PEG+E治疗组患者中，PEG+E的购置成本是次要成本驱动因素，占3个月时每位患者预期NHS成本的30%，而乳果糖的购置成本仅占乳果糖治疗组每位患者预期NHS成本的11%。地区护士上门访视占4%，甲状腺功能检查占2%。更换泻药、联合使用泻药以及胃肠病学家和结直肠外科医生诊疗的成本总计占总成本的9%。
特发性便秘管理的实际成本受到广泛资源的影响，而不仅仅是泻药购置成本。本研究表明，用PEG+E而非乳果糖治疗特发性便秘可使每位患者的NHS预期3个月成本降低11英镑。此外，使用PEG+E而非乳果糖有望使3个月时成功治疗患者的比例翻倍。因此，与乳果糖相比，PEG+E是一种占优治疗方法。这表明，决定使用PEG+E还是乳果糖治疗特发性便秘应基于疗效、安全性、患者偏好和总体管理成本，而非药物购置成本。
