Bentkover Judith D, Stewart Edward J, Ignaszewski Andrew, Lepage Serge, Liu Peter, Cooper Jill
Innovative Health Solutions, 1330 Beacon Street, Suite 316, Brookline, MA 02446, USA.
Int J Cardiol. 2003 Mar;88(1):33-41. doi: 10.1016/s0167-5273(02)00378-9.
Heart failure affects 1-2% of the Canadian population. The 1-year mortality rates in New York Heart Association Class III/IV heart failure patients range from 11 to 44%. This study evaluates costs associated with current management of Class III/IV heart failure and potential savings if morbidity and mortality are reduced.
To construct an economic model to evaluate the components of treating Class III/IV heart failure patients in Canada and the resulting direct medical costs. The model also estimates the potential savings that could result from the introduction of a new technology such as cardiac resynchronization therapy that reduces morbidity and mortality.
The model evaluates costs of pharmacological therapy, medical care, laboratory and diagnostic tests, and complications, most commonly hospitalization. Estimates are based on a literature review, expert opinion, and standard cost sources using widely accepted health economic methods.
The model, under conservative assumptions, estimates that Class III/IV heart failure costs between CAD$1.4 billion and CAD$2.3 billion in Canada overall. Costs are substantial on the provincial level as well and are estimated to be approximately CAD$700 million, CAD$500 million, and CAD$300 million in Ontario, Québec, and British Columbia, respectively. New treatments could bring substantial savings depending on their effectiveness-measured as reduction in morbidity and mortality-and the number of patients who receive that treatment. Potential savings in Canada could reduce the total annual costs for this group of patients by approximately 10% or up to CAD$200 million annually.
The high level of morbidity and mortality in Class III/IV heart failure patients and costs associated with their care are an impetus for the development of new therapies such as cardiac resynchronization therapy, that could deliver long-term benefits including increased exercise tolerance, reduced hospitalizations, and improved quality of life. Successful therapies could provide substantial savings and present a favorable economic profile in the treatment of heart failure. In order to ensure that appropriate technologies are commercialized and marketed, prospective evaluation of new therapies should include critical assessment of direct medical costs in addition to evaluating morbidity, quality of life and survival.
心力衰竭影响着1%至2%的加拿大人口。纽约心脏协会III/IV级心力衰竭患者的1年死亡率在11%至44%之间。本研究评估了与III/IV级心力衰竭当前管理相关的成本，以及如果发病率和死亡率降低可能节省的费用。
构建一个经济模型，以评估加拿大治疗III/IV级心力衰竭患者的组成部分及其产生的直接医疗成本。该模型还估计了引入如心脏再同步治疗等可降低发病率和死亡率的新技术可能带来的潜在节省。
该模型评估药物治疗、医疗护理、实验室和诊断测试以及并发症（最常见的是住院）的成本。估计基于文献综述、专家意见以及使用广泛接受的健康经济方法的标准成本来源。
在保守假设下，该模型估计加拿大III/IV级心力衰竭的总成本在14亿加元至23亿加元之间。省级层面的成本也很高，安大略省、魁北克省和不列颠哥伦比亚省的估计成本分别约为7亿加元、5亿加元和3亿加元。新治疗方法可能带来大量节省，这取决于其有效性（以发病率和死亡率的降低来衡量）以及接受该治疗的患者数量。加拿大的潜在节省可能使该组患者的年度总成本降低约10%，即每年高达2亿加元。
III/IV级心力衰竭患者的高发病率和死亡率以及与其护理相关的成本，推动了诸如心脏再同步治疗等新疗法的开发，这些疗法可带来长期益处，包括提高运动耐量、减少住院次数和改善生活质量。成功的疗法可节省大量费用，并在心力衰竭治疗中呈现出有利的经济状况。为确保适当的技术得以商业化和推广，对新疗法的前瞻性评估除了评估发病率、生活质量和生存率外，还应包括对直接医疗成本的关键评估。
