Brevetti Gregorio, Annecchini Roberta, Bucur Roxanna
Department of Medicine, University Federico II, Naples, Italy.
Pharmacoeconomics. 2002;20(3):169-81. doi: 10.2165/00019053-200220030-00003.
The purpose of this article is to review the literature on the pharmacoeconomics of treatment for intermittent claudication and to discuss the importance of quality-of-life assessment for evaluating treatment strategies. Systemic risk reduction is the primary objective in the treatment of patients with intermittent claudication, as these patients have a high future risk of cardiovascular morbidity and mortality. Modification of cardiovascular risk factors accompanied by antiplatelet therapy is likely to improve overall survival, reduce myocardial infarction and stroke, and will, perhaps, also reduce the risk of ulcers and amputation at acceptable cost-effectiveness ratios. The second goal in the treatment of patients with intermittent claudication is to improve their walking capacity and community-based functional status. Supervised exercise training is the most effective noninvasive intervention to improve walking capacity, but may have elevated indirect costs. Among patients with disabling claudication who are candidates for invasive therapeutic procedures, angioplasty is cost effective in those with femoropopliteal stenosis or occlusion and in those with critical limb ischaemia and a stenosis. For all these therapeutic strategies there is a need to relate the costs to a relevant and comprehensive measure of effectiveness. Quality-of-life evaluation by using questionnaires exploring the specific problems encountered by patients with intermittent claudication in their daily life appear to be the most appropriate tool to evaluate the net result of a treatment. Cost-utility studies by combining pecuniary and quality-of-life evaluations provide information that is extremely useful to patients with intermittent claudication, regulatory authorities, the pharmaceutical industry and healthcare providers.
本文旨在综述有关间歇性跛行治疗的药物经济学文献，并探讨生活质量评估在评价治疗策略中的重要性。降低全身风险是间歇性跛行患者治疗的主要目标，因为这些患者未来发生心血管疾病和死亡的风险很高。通过抗血小板治疗来改变心血管危险因素可能会提高总体生存率，减少心肌梗死和中风的发生，并且或许还能以可接受的成本效益比降低溃疡和截肢的风险。治疗间歇性跛行患者的第二个目标是提高他们的行走能力和基于社区的功能状态。有监督的运动训练是提高行走能力最有效的非侵入性干预措施，但可能会增加间接成本。在适合进行侵入性治疗的重度跛行患者中，血管成形术对于股腘动脉狭窄或闭塞的患者以及严重肢体缺血并伴有狭窄的患者具有成本效益。对于所有这些治疗策略，都需要将成本与相关且全面的疗效指标联系起来。通过使用问卷来评估间歇性跛行患者在日常生活中遇到的具体问题，从而进行生活质量评估，这似乎是评估治疗最终结果的最合适工具。将金钱和生活质量评估相结合的成本效用研究为间歇性跛行患者、监管机构、制药行业和医疗服务提供者提供了极其有用的信息。
