Cheng C W R, Chan J C N, Tomlinson B, Woo K S, You J H S
School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, NT, China.
Int J Clin Pharmacol Ther. 2006 Oct;44(10):484-8. doi: 10.5414/cpp44484.
Socio-economic status, comorbidities and adherence to statin therapy might affect the cost-effectiveness of statin therapy in hyperlipidemia.
To examine the effects size of demographic factors, clinical factors and adherence to statin therapy on the direct medical costs for Chinese patients at high risk of coronary heart disease (CHD).
This was a prospective, observational cohort study conducted in the outpatient departments of a public teaching hospital in Hong Kong. Patients at high risk of CHD who had been on statin monotherapy for < 12 months were recruited. Baseline demographic and clinical data were obtained. Statin adherence was monitored prospectively over 6 months using the Medication Event Monitoring System. Total direct medical costs per member per month (cPMPM), including cost for clinic visits, statin medication, laboratory tests on lipids and management of CHD events if any, were calculated from the perspective of a public healthcare organization.
83 patients completed the study. Median cPMPM in 80 patients (96% of 83 patients) without a new CHD event (USD 42) and for 3 (4%) patients who experienced CHD events (USD 444) were significantly different (p = 0.003). History of congestive heart failure (beta = 1,957, 95% CI = 1,006 - 2,909), male gender (beta = 584, 95% CI = 215 - 952), coronary atherosclerosis (beta = 1,436, 95% CI = 538 - 2,334) and diabetes mellitus (beta = 604, 95% CI = 136 - 1,07 1) were positive predictors for cPMPM.
In this pilot study male gender, diabetes mellitus, congestive heart failure and coronary atherosclerosis appear to be significantly associated with higher costs for Chinese patients at high risk of CHD.
社会经济地位、合并症以及他汀类药物治疗的依从性可能会影响高脂血症患者他汀类药物治疗的成本效益。
研究人口统计学因素、临床因素以及他汀类药物治疗依从性对中国冠心病（CHD）高危患者直接医疗费用的效应大小。
这是一项在香港一家公立教学医院门诊部进行的前瞻性观察队列研究。招募接受他汀类药物单药治疗<12个月的CHD高危患者。获取基线人口统计学和临床数据。使用药物事件监测系统对他汀类药物依从性进行为期6个月的前瞻性监测。从公共医疗保健机构的角度计算每位成员每月的总直接医疗费用（cPMPM），包括门诊就诊费用、他汀类药物费用、血脂实验室检查费用以及CHD事件（如有）的管理费用。
83例患者完成研究。80例（83例患者中的96%）无新发CHD事件患者的cPMPM中位数（42美元）与3例（4%）发生CHD事件患者的cPMPM中位数（444美元）有显著差异（p = 0.003）。充血性心力衰竭病史（β = 1,957，95%CI = 1,006 - 2,909）、男性（β = 584，95%CI = 215 - 952）、冠状动脉粥样硬化（β = 1,436，95%CI = 538 - 2,334）和糖尿病（β = 604，95%CI = 136 - 1,071）是cPMPM的阳性预测因素。
在这项初步研究中，男性、糖尿病、充血性心力衰竭和冠状动脉粥样硬化似乎与中国CHD高危患者的较高费用显著相关。
