Hallinen T, Martikainen J A, Soini E J O, Suominen L, Aronkytö T
Center for Pharmaceutical Policy and Economics, Department of Social Pharmacy, University of Kuopio, Finland.
Curr Med Res Opin. 2006 Apr;22(4):683-92. doi: 10.1185/030079906X100014.
The main objective was to estimate the mean direct costs of warfarin treatment for atrial fibrillation (AF) patients. Secondly, the costs of initiating warfarin treatment during a 60-day period and the impact of International Normalized Ratio (INR) and co-morbidities on costs were estimated. DESIGN AND DATA: The study was performed as a retrospective cohort study over a 12-month period in a Finnish communal health care setting. All AF patients aged 65 years or older (n = 250) with warfarin treatment were identified from the database of the health service district of an urban area. Patient specific information related to comorbidities, INR-control, complications and health care resource use were collected. Cost information was obtained from the Finnish national health care unit cost list.
The effect of treatment balance and other background variables on treatment costs were evaluated using ordinary least squares regression (OLS), log-transformed OLS and generalized linear model (GLM). The mean costs were calculated on the basis of the different models and bias corrected and accelerated (BCa) bootstrap confidence intervals (CIs) were calculated for the mean costs.
The best fitting cost model was log-transformed OLS. The costs of warfarin treatment on the basis of the log-transformed model were 589.82 Euros (BCa 95% CI: 586.68-591.99) per patient compared to 616.00 Euros (BCa 95% CI: 579.98-652.96) obtained with the OLS-model. For the treatment initiation period, the mean costs were 263 Euros (BCa 95% CI: 218.90-314.71). Depending on the way that INR-control was defined, the mean costs were 95.27 Euros or 166.92 Euros higher for patients who were not in the defined INR-balance.
The INR-control has a significant impact on the warfarin treatment costs. The choice of model influences the estimated mean costs. In addition, different models identify statistically significant effects between different background variables and costs.
主要目的是估算心房颤动（AF）患者华法林治疗的平均直接成本。其次，估算60天内启动华法林治疗的成本以及国际标准化比值（INR）和合并症对成本的影响。
该研究作为一项回顾性队列研究，在芬兰社区医疗环境中进行了12个月。从一个城市地区卫生服务区的数据库中识别出所有接受华法林治疗的65岁及以上AF患者（n = 250）。收集了与合并症、INR控制、并发症和医疗资源使用相关的患者特定信息。成本信息来自芬兰国家医疗保健单位成本清单。
使用普通最小二乘法回归（OLS）、对数变换OLS和广义线性模型（GLM）评估治疗平衡和其他背景变量对治疗成本的影响。根据不同模型计算平均成本，并为平均成本计算偏差校正和加速（BCa）自助置信区间（CI）。
最佳拟合成本模型是对数变换OLS。基于对数变换模型的华法林治疗成本为每位患者589.82欧元（BCa 95% CI：586.68 - 591.99），而OLS模型得出的成本为616.00欧元（BCa 95% CI：579.98 - 652.96）。对于治疗启动期，平均成本为263欧元（BCa 95% CI：218.90 - 314.71）。根据INR控制的定义方式，未处于定义的INR平衡状态的患者平均成本高出95.27欧元或166.92欧元。
INR控制对华法林治疗成本有显著影响。模型的选择会影响估计的平均成本。此外，不同模型识别出不同背景变量与成本之间的统计学显著影响。
