Zhao Sean Z, Burke Thomas A, Whelton Andrew, von Allmen Heather, Henderson Scott C
Pharmacia Corporation, Peapack, New Jersey, USA.
Am J Manag Care. 2002 Oct;8(15 Suppl):S414-27.
To determine the costs of heart failure in hypertensive patients receiving celecoxib, rofecoxib, and nonspecific nonsteroidal anti-inflammatory drugs (NSAIDs) in clinical practice.
Stable hypertensive patients without a history of heart failure and newly treated with celecoxib, rofecoxib, ibuprofen, naproxen, or diclofenac between January 1, 1999, and September 30, 2000, were identified from the LifeLink Integrated Claims Solutions employer database. The incidence rate of inpatient and outpatient heart failure claims was determined based on patients' time of exposure to study drugs after adjusting for confounding factors. The heart failure costs of managing inpatient and outpatient events were estimated as the total healthcare costs for patients with heart failure claims minus the total healthcare costs among matched control groups without heart failure claims. Healthcare costs were computed for the 0 to 30 days and 31 to 90 days following the initial outpatient or inpatient claim. Finally, the excess incidence rate of patients with inpatient and outpatient heart failure claims, relative to celecoxib, were multiplied by the heart failure cost of an inpatient and outpatient event to determine the incremental costs of heart failure associated with each of the study drugs relative to celecoxib.
Among 50 940 patients, 707 patients had outpatient heart failure claims and 229 patients had inpatient heart failure claims. In this study, rofecoxib-treated patients were 26% more likely to have an outpatient claim (rate ratio [RR] = 1.26; 95% confidence interval [CI], 1.06-1.48; P= .007) and 52% more likely to have an inpatient claim (RR = 1.52; 95% Cl, 1.15-2.02; P = .003) for heart failure than celecoxib-treated patients. The adjusted RR of heart failure claims was similar between celecoxib and NSAIDs. The average cost of outpatient heart failure was $1054 within 30 days and $221 for the period 31 to 90 days after the initial claim (total 90-day cost of $1275). The cost for a patient with inpatient heart failure was $5966 during the hospitalization. The 90-day posthospitalization heart failure cost was $245 (total 90-day cost of $6,211 for hospitalization and follow-up). The total heart failure-related incremental cost per patient per day of use was $0.15 for rofecoxib and $0.04 for nonspecific NSAIDs relative to celecoxib.
The additional heart failure costs associated with the use of rofecoxib significantly add to its cost in patients with stable hypertension, relative to celecoxib and nonspecific NSAIDs. The higher heart failure costs of rofecoxib were attributable to the higher incidence of patients with inpatient and outpatient heart failure claims relative to celecoxib and nonspecific NSAID populations being compared.
确定在临床实践中接受塞来昔布、罗非昔布和非特异性非甾体抗炎药（NSAIDs）治疗的高血压患者发生心力衰竭的成本。
从LifeLink综合理赔解决方案雇主数据库中识别出1999年1月1日至2000年9月30日期间开始接受塞来昔布、罗非昔布、布洛芬、萘普生或双氯芬酸治疗且无心力衰竭病史的稳定高血压患者。在调整混杂因素后，根据患者接触研究药物的时间确定住院和门诊心力衰竭理赔的发生率。将管理住院和门诊事件的心力衰竭成本估计为有心力衰竭理赔患者的总医疗成本减去无心力衰竭理赔的匹配对照组的总医疗成本。计算首次门诊或住院理赔后0至30天以及31至90天的医疗成本。最后，将住院和门诊心力衰竭理赔患者相对于塞来昔布的超额发生率乘以住院和门诊事件的心力衰竭成本，以确定每种研究药物相对于塞来昔布的心力衰竭增量成本。
在50940例患者中，707例有门诊心力衰竭理赔，229例有住院心力衰竭理赔。在本研究中，与接受塞来昔布治疗的患者相比，接受罗非昔布治疗的患者发生门诊心力衰竭理赔的可能性高26%（率比[RR]=1.26；95%置信区间[CI]，1.06 - 1.48；P = 0.007），发生住院心力衰竭理赔的可能性高52%（RR = 1.52；95%CI，1.15 - 2.02；P = 0.003）。塞来昔布和非特异性NSAIDs之间心力衰竭理赔的调整后RR相似。首次理赔后30天内门诊心力衰竭的平均成本为1054美元，31至90天期间为221美元（90天总成本为1275美元）。住院心力衰竭患者的住院成本为5966美元。出院后90天的心力衰竭成本为245美元（住院和随访90天总成本为6211美元）。相对于塞来昔布，罗非昔布每位患者每天使用的心力衰竭相关增量成本为0.15美元，非特异性NSAIDs为0.04美元。
与塞来昔布和非特异性NSAIDs相比，使用罗非昔布导致的额外心力衰竭成本显著增加了其在稳定高血压患者中的成本。罗非昔布较高的心力衰竭成本归因于与塞来昔布和所比较的非特异性NSAIDs人群相比，住院和门诊心力衰竭理赔患者的发生率更高。
