Gumbs Pearl D, Verschuren W M Monique, Mantel-Teeuwisse Aukje K, de Wit Ardine G, Hofman Albert, Trienekens Paul H, Stricker Bruno H Ch, de Boer Antonius, Klungel Olaf H
Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceuticals Sciences (UIPS), Utrecht University, Utrecht, The Netherlands.
Drugs Aging. 2006;23(9):733-41. doi: 10.2165/00002512-200623090-00003.
In The Netherlands, costs of HMG-CoA reductase inhibitor (statin) use have recently increased sharply compared with costs of other drugs. However, several studies have established both undertreatment and non-guidelines-indicated treatment with statins, suggesting a suboptimal use of resources.
To estimate the drug costs associated with non-guidelines-indicated treatment and undertreatment with statins in an elderly population.
Data were obtained from the Rotterdam Study, a population-based prospective cohort study which began in 1990 with 7983 participants aged > or =55 years. Subjects with a history of cardiovascular disease (CVD) were excluded. Pharmacy records were used to assess patterns of medication use in daily medical practice.
Non-guidelines-indicated treatment and undertreatment with statins were established in relation to Dutch cholesterol management guidelines for all participants. We calculated the costs of statin therapy associated with non-guidelines-indicated treatment, and the costs of statins if all those undertreated were to receive statins. The results were projected on to the Dutch population to determine the economic implications of non-adherence to cholesterol management guidelines in the elderly.
Of the participants who started treatment with statins for the primary prevention of CVD during follow-up, 69% received non-guidelines-indicated treatment. More men (7.5%) were undertreated than women (1.6%) and more women (6.2%) received non-guidelines-indicated treatment than men (1.5%). Among the participants without CVD who were still alive at 1 January 2002, 14% were eligible for statin therapy but were untreated. After projection of the prevalence of non-guidelines-indicated treatment and undertreatment to the Dutch population, the absolute costs for non-guidelines-indicated treatment with statins in 2005 were estimated to be approximately 23 million euro(uncertainty limits [UL]: 19-28 million euro), while the cost to eliminate undertreatment was also 23 million euro (UL: 19-28 million euro).
Reallocation of resources used for statin therapy from those receiving non-guidelines-indicated treatment to those being undertreated could lead to a more efficient use of resources.
在荷兰，与其他药物的成本相比，使用HMG-CoA还原酶抑制剂（他汀类药物）的成本最近急剧增加。然而，多项研究已证实存在他汀类药物治疗不足和非指南推荐治疗的情况，这表明资源利用未达最优。
评估老年人群中与他汀类药物非指南推荐治疗和治疗不足相关的药物成本。
数据来自鹿特丹研究，这是一项基于人群的前瞻性队列研究，始于1990年，有7983名年龄≥55岁的参与者。有心血管疾病（CVD）病史的受试者被排除。药房记录用于评估日常医疗实践中的用药模式。
根据荷兰胆固醇管理指南，确定所有参与者中他汀类药物的非指南推荐治疗和治疗不足情况。我们计算了与非指南推荐治疗相关的他汀类药物治疗成本，以及如果所有治疗不足者都接受他汀类药物治疗的成本。将结果推算至荷兰人群，以确定老年人不遵守胆固醇管理指南的经济影响。
在随访期间开始使用他汀类药物进行心血管疾病一级预防治疗的参与者中，69%接受了非指南推荐治疗。治疗不足的男性（7.5%）多于女性（1.6%），接受非指南推荐治疗的女性（6.2%）多于男性（1.5%）。在2002年1月1日仍存活的无心血管疾病参与者中，14%符合他汀类药物治疗条件但未接受治疗。将非指南推荐治疗和治疗不足的患病率推算至荷兰人群后，2005年他汀类药物非指南推荐治疗的绝对成本估计约为2300万欧元（不确定区间[UL]：1900 - 2800万欧元），而消除治疗不足所需的成本也是2300万欧元（UL：1900 - 2800万欧元）。
将用于他汀类药物治疗的资源从接受非指南推荐治疗者重新分配给治疗不足者，可能会使资源利用更高效。
