Mahoney Elizabeth M, Wang Kaijun, Cohen David J, Hirsch Alan T, Alberts Mark J, Eagle Kim, Mosse Frederique, Jackson Joseph D, Steg P Gabriel, Bhatt Deepak L
Saint Luke's Mid America Heart Institute, Kansas City, MO 64111, USA.
Circ Cardiovasc Qual Outcomes. 2008 Sep;1(1):38-45. doi: 10.1161/CIRCOUTCOMES.108.775247.
Atherothrombosis is the underlying cause of cardiovascular, cerebrovascular, and peripheral arterial disease and is the leading cause of death in the industrialized world. The objectives of the present study are (1) to examine the annual costs associated with vascular events and interventions that require hospitalization, as well as long-term medication use for the management of associated risk factors, in a US population of outpatients with multiple atherothrombotic risk factors or a history of symptomatic disease and (2) to compare costs across patient subgroups defined according to specific arterial bed(s) affected and the number of affected arterial beds.
The international REduction of Atherothrombosis for Continued Health (REACH) Registry enrolled outpatients > or =45 years of age who had established coronary artery, cerebrovascular, or peripheral artery disease or > or =3 atherothrombotic risk factors. Data on risk factors, associated medications, and vascular hospitalizations and interventions were collected. Of the total 68 236-patient REACH cohort, 25 763 were enrolled from US sites. Complete 1-year data were available for 23 974 (93%) of the US patients. Annualized medication costs ranged from $2401 to $3481. Mean annual hospitalization costs per patient were $1344, $2864, $4824, and $8155 for patients with 0 (n=6145), 1 (n=14 353), 2 (n=3106), and 3 (n=370) affected arterial beds at baseline (P<0.0001 for trend). Among patients with 1 affected arterial bed, mean hospitalization costs were $2999, $2010, and $3911 for patients with coronary artery disease (n=11 063), cerebrovascular disease (n=2613), and peripheral arterial disease (n=677), respectively. Annualized medication costs ranged from $2401 to $3481.
These results reveal the high economic burden of atherothrombosis-related clinical events and procedures and the especially high economic burden associated with polyvascular disease.
动脉粥样硬化血栓形成是心血管、脑血管和外周动脉疾病的根本原因，也是工业化国家的主要死因。本研究的目的是：（1）在美国患有多种动脉粥样硬化血栓形成危险因素或有症状性疾病病史的门诊患者人群中，研究与需要住院治疗的血管事件和干预措施以及用于管理相关危险因素的长期药物治疗相关的年度费用；（2）比较根据受影响的特定动脉床和受影响动脉床的数量定义的患者亚组之间的费用。
国际持续健康动脉粥样硬化血栓形成减少（REACH）注册研究纳入了年龄≥45岁、患有已确诊的冠状动脉、脑血管或外周动脉疾病或≥3个动脉粥样硬化血栓形成危险因素的门诊患者。收集了有关危险因素、相关药物以及血管住院治疗和干预措施的数据。在REACH队列的68236名患者中，有25763名来自美国的研究点。美国患者中有23974名（93%）获得了完整的1年数据。年度药物费用从2401美元到3481美元不等。基线时，受影响动脉床数量为0（n = 6145）、1（n = 14353）、2（n = 3106）和3（n = 370）的患者，每位患者的平均年度住院费用分别为1344美元、2864美元、4824美元和8155美元（趋势P<0.0001）。在受影响动脉床数量为1的患者中，患有冠状动脉疾病（n = 11063）、脑血管疾病（n = 2613）和外周动脉疾病（n = 677）的患者，平均住院费用分别为2999美元、2010美元和3911美元。年度药物费用从2401美元到3481美元不等。
这些结果揭示了动脉粥样硬化血栓形成相关临床事件和治疗的高经济负担，以及与多血管疾病相关的特别高的经济负担。
