McDonough K P, Weaver R H, Viall G D
Harvard Community Health Plan of New England, Providence, RI 02903.
Ann Pharmacother. 1992 Mar;26(3):399-404. doi: 10.1177/106002809202600316.
The cost-effectiveness of a voluntary program that switched enalapril to lisinopril therapy in patients with benign essential hypertension in a staff-model health maintenance organization (HMO) was evaluated.
The one-year nonrandomized, controlled trial was performed from November 1989 through October 1990.
One hundred twenty-seven patients were entered into the study: 75 who converted from enalapril to lisinopril and 52 who remained on enalapril throughout the study period. Patients were excluded from analysis because of diagnosis (not benign essential hypertension) or insufficient data collection.
Patients taking enalapril were asked by staff pharmacists if they were willing to consider switching from enalapril to lisinopril. To encourage patients, the HMO agreed to waive the drug rider copayment for three months. If patients were willing, their physicians were contacted and they established the lisinopril dosage.
Total direct cost and savings resulting from converting patients from enalapril to lisinopril were measured and compared with costs of therapy for patients who remained on enalapril.
The control and study groups were evenly matched according to demographics and concomitant drug therapy. Drug acquisition costs, costs associated with waiving drug rider copayment, pharmacy administrative costs, costs of managing adverse events, costs of visits to physicians, and laboratory test costs were assessed. Depending on the cost of capital assumed, net savings ranged from $85 to $110 per patient converted from enalapril to lisinopril. Monthly net savings that ranged from $2.04 to $2.61 per patient were required to result in overall net savings within the first two years.
In a regular practice setting, a net savings is realized in less than 12 months when patients are converted from enalapril to lisinopril for treatment of benign essential hypertension. The voluntary therapeutic interchange program provided a good means for achieving cost controls for pharmacy expenses.
评估在一个员工模式的健康维护组织（HMO）中，将依那普利转换为赖诺普利治疗良性原发性高血压患者的自愿项目的成本效益。
1989年11月至1990年10月进行了为期一年的非随机对照试验。
127名患者进入研究：75名从依那普利转换为赖诺普利，52名在整个研究期间继续使用依那普利。因诊断（非良性原发性高血压）或数据收集不足而被排除在分析之外的患者。
药房工作人员询问服用依那普利的患者是否愿意考虑从依那普利转换为赖诺普利。为鼓励患者，HMO同意免除三个月的药品附加费共付额。如果患者愿意，联系他们的医生并确定赖诺普利的剂量。
测量将患者从依那普利转换为赖诺普利所产生的总直接成本和节省情况，并与继续使用依那普利治疗的患者的治疗成本进行比较。
根据人口统计学和伴随药物治疗，对照组和研究组匹配良好。评估了药品采购成本、免除药品附加费共付额的相关成本、药房管理成本、不良事件管理成本、就诊成本和实验室检查成本。根据假设的资本成本，从依那普利转换为赖诺普利的每位患者的净节省范围为85美元至110美元。每位患者每月净节省2.04美元至2.61美元才能在前两年内实现总体净节省。
在常规实践环境中，将依那普利转换为赖诺普利治疗良性原发性高血压患者时，不到12个月即可实现净节省。自愿治疗药物互换项目为实现药房费用成本控制提供了一个很好的手段。
