Levy Emile, Gabriel Sylvie, Dinet Jérôme
Université Paris IX, Dauphine, Paris, France.
Pharmacoeconomics. 2003;21(9):651-9. doi: 10.2165/00019053-200321090-00003.
The clinical manifestations of atherothrombotic disease include ischaemic heart disease (including myocardial infarction [MI]) and cerebrovascular disease (including ischaemic stroke [IS]). Although costs generated by the clinical manifestations of atherothrombotic disease represent an important economic burden for any healthcare system, very few economic comparative data are available.
To: (i) assess management costs of the different practice patterns for acute and chronic phases for MI, IS and peripheral arterial disease (PAD) in eight European countries; and (ii) to simulate the cost of managing a patient with an atherothrombotic disease for 2 years in Europe.
Healthcare system.
Firstly, the medical costs of managing MI and IS were analysed during the acute phase and subsequent 6-month periods over a total of 2 years. In each case, a decision tree was designed to indicate resource use. Assumptions concerning patient management and resource use were based on currently available local and international literature, official national statistics and local expert opinions (Delphi panel). Costs were assessed using diagnosis-related groups (Austria, Italy, Portugal and Sweden), or hospital databases and national tariffs (Belgium, France, Spain and Switzerland). Secondly, these costs were correlated to data from a large randomised clinical trial to estimate the overall cost per patient with atherothrombotic disease over a 2-year period.
For MI, there was a 2-fold difference in costs between the eight countries (euro9512-18 293), with 47-76% of costs devoted to acute management, 14-48% to follow-up management during the first year, and 4-17% to follow-up during the second year. For IS, there was a 10-fold difference (euro5607-56 370), with 18-75% devoted to follow-up for the years 1995-1997.
There are differences in the overall costs and cost breakdown in the clinical management patterns of MI and IS in Europe. These differences seem to arise as a result of local treatment pattern specificities as well as the availability of specific and well-adapted structures for patients' rehabilitation. Further studies are necessary to fully explain these differences. The assessment of the total medical costs of managing an atherothrombotic patient over a 2-year period (MI, IS, established PAD) has to take into account the risk of ischaemic events in different vascular areas (MI, IS or major leg ischaemia).
动脉粥样硬化血栓形成性疾病的临床表现包括缺血性心脏病（包括心肌梗死[MI]）和脑血管疾病（包括缺血性中风[IS]）。尽管动脉粥样硬化血栓形成性疾病的临床表现所产生的费用对任何医疗保健系统来说都是一项重要的经济负担，但可用的经济比较数据却非常少。
（i）评估欧洲八个国家心肌梗死、缺血性中风和外周动脉疾病（PAD）急性和慢性阶段不同治疗模式的管理成本；（ii）模拟在欧洲对一名动脉粥样硬化血栓形成性疾病患者进行2年管理的成本。
医疗保健系统。
首先，分析了心肌梗死和缺血性中风在急性期及随后2年中每6个月期间的医疗成本。在每种情况下，设计了一个决策树以表明资源使用情况。关于患者管理和资源使用的假设基于当前可用的本地和国际文献、官方国家统计数据以及本地专家意见（德尔菲小组）。使用诊断相关组（奥地利、意大利、葡萄牙和瑞典）或医院数据库及国家收费标准（比利时、法国、西班牙和瑞士）评估成本。其次，将这些成本与一项大型随机临床试验的数据相关联，以估计2年期间每名动脉粥样硬化血栓形成性疾病患者的总体成本。
对于心肌梗死，八个国家之间的成本存在2倍差异（9512欧元至18293欧元），其中47%至76%的成本用于急性管理，14%至48%用于第一年的后续管理，4%至17%用于第二年的后续管理。对于缺血性中风，差异为10倍（5607欧元至56370欧元），1995年至1997年期间18%至75%的成本用于后续管理。
欧洲心肌梗死和缺血性中风临床管理模式的总体成本和成本细目存在差异。这些差异似乎是由于当地治疗模式的特殊性以及患者康复的特定且适配良好的结构的可用性所致。需要进一步研究以充分解释这些差异。对一名动脉粥样硬化血栓形成性疾病患者（心肌梗死、缺血性中风、已确诊的外周动脉疾病）进行2年管理的总医疗成本评估必须考虑不同血管区域（心肌梗死、缺血性中风或严重下肢缺血）缺血事件的风险。
