Tavakoli Manouchehr, Pumford Neil, Woodward Mark, Doney Alex, Chalmers John, MacMahon Stephen, Macwalter Ronald
School of Management, University of St Andrews, St Andrews, KY16 9SS, UK.
Eur J Health Econ. 2009 Feb;10(1):111-9. doi: 10.1007/s10198-008-0108-3. Epub 2008 Apr 30.
Cerebrovascular disease (or stroke) is one of the main causes of long-term disability and the second leading cause of death worldwide. The economic impact of stroke is clearly seen, as it is the largest single cause of bed occupancy in hospitals in England and accounts for 6% of hospital costs. This analysis is the first to quantify the economic consequences of a blood pressure lowering regimen based on the PROGRESS study (perindopril-based regimen), for reducing future cardiovascular events.
A Markov decision analytical model was used to estimate the cost per quality adjusted life year (QALY) of blood pressure lowering in the treatment of patients presenting with a cerebrovascular event. The health states are based upon Barthel indices for which resource utilisation and health benefits have previously been estimated.
The participants for the economic analysis were obtained from the PROGRESS study database. 6,105 clinical study participants were recruited through both primary and secondary care centres.
The mean age was 64 years; 70% were male in the original study.
In the PROGRESS study, blood pressure lowering by a perindopril-based regimen was compared to standard care.
Cost per quality adjusted life year for the duration of the study (4 years) and for a time span of 20 years.
Using only direct hospital medical costs, the cost per QALY for a perindopril based regimen is pound 6,927 for the base study period and pound 10,133 for a 20-year time period. These results are sensitive to the cost of perindopril, the cost of the stroke unit, length of stay, and to a lesser extent, the cost of indapamide.
This analysis demonstrates a cost-effective treatment for patients suffering a cerebrovascular event with a blood pressure lowering regimen. The findings of this study are in line with current decisions and guidance by the national institute for health and clinical excellence (NICE) in England.
脑血管疾病（或中风）是导致长期残疾的主要原因之一，也是全球第二大死因。中风的经济影响显而易见，因为它是英国医院床位占用的最大单一原因，占医院成本的6%。本分析首次基于PROGRESS研究（培哚普利治疗方案）对降压方案减少未来心血管事件的经济后果进行了量化。
采用马尔可夫决策分析模型来估计脑血管事件患者降压治疗的每质量调整生命年（QALY）成本。健康状态基于巴氏指数，此前已对其资源利用和健康效益进行了估计。
经济分析的参与者来自PROGRESS研究数据库。通过初级和二级护理中心招募了6105名临床研究参与者。
平均年龄为64岁；在原研究中，70%为男性。
在PROGRESS研究中，将基于培哚普利的降压方案与标准治疗进行了比较。
研究期间（4年）和20年时间跨度内的每质量调整生命年成本。
仅使用直接医院医疗成本，基于培哚普利方案的每QALY成本在基础研究期为6927英镑，在20年时间期为10133英镑。这些结果对培哚普利成本、中风单元成本、住院时间敏感，在较小程度上对吲达帕胺成本也敏感。
本分析表明，对于患有脑血管事件的患者，降压方案是一种具有成本效益的治疗方法。本研究结果与英国国家卫生与临床优化研究所（NICE）目前的决策和指南一致。
