Nelles Sandra, Köberlein Juliane, Grimm Christine, Pittrow David, Kirch Wilhelm, Rychlik Reinhard
Institut für Empirische Gesundheitsökonomie, Burscheid, Germany.
Med Klin (Munich). 2009 May 15;104(5):363-71. doi: 10.1007/s00063-009-1075-x. Epub 2009 May 16.
1.3% of German adults suffer from clinically relevant restless legs syndrome (RLS). A cost-of-illness study was conducted to evaluate the costs for diagnosis and therapy of the idiopathic RLS.
A clinical pathway based on expert guidelines was developed. The costs for the 1st year of treatment in idiopathic RLS were calculated with the Markov Model. Relevant published clinical study data were used for the model as well as questioning of physicians.
Costs per patient with approved drug treatment are 989.80 Euro for sickness funds and 1,285.26 Euro from the societal perspective. Drug costs are the main cost components for sickness funds and the society with 69% and 61%, respectively. Less than half of the patients continue an L-dopa therapy longer than 1 year. About one quarter of all RLS patients need off-label therapy after the 1st year of treatment.
The costs for a guideline-oriented therapy for all patients with clinically relevant RLS in Germany are about 1,135 billion Euro, representing 0.5% of all health-related costs in Germany. Further controlled clinical trials are required to provide evidence for the efficacy of different treatment options including drugs without an approval for RLS and long-term use. Health services research is required for cost-utility analysis, to evaluate the costs of inadequate treatment, and to obtain additional information to improve the resource allocation in RLS treatment.
1.3%的德国成年人患有具有临床意义的不宁腿综合征(RLS)。开展了一项疾病成本研究,以评估特发性RLS的诊断和治疗成本。
制定了基于专家指南的临床路径。采用马尔可夫模型计算特发性RLS患者第一年的治疗成本。该模型使用了已发表的相关临床研究数据以及对医生的问询。
对于疾病基金而言,每名接受批准药物治疗的患者成本为989.80欧元,从社会角度来看为1285.26欧元。药物成本是疾病基金和社会的主要成本组成部分,分别占69%和61%。不到一半的患者持续进行左旋多巴治疗超过1年。在治疗的第一年之后,约四分之一的所有RLS患者需要标签外治疗。
在德国,为所有具有临床意义的RLS患者提供以指南为导向的治疗成本约为11350亿欧元,占德国所有与健康相关成本的0.5%。需要进一步的对照临床试验,为不同治疗方案(包括未经批准用于RLS的药物和长期使用)的疗效提供证据。需要开展卫生服务研究进行成本效益分析,评估治疗不足的成本,并获取更多信息以改善RLS治疗中的资源分配。