Lovelace Clinic Foundation, Albuquerque, New Mexico 87106-4264, USA.
Pharmacoeconomics. 2010;28(9):733-49. doi: 10.2165/11535600-000000000-00000.
Some treatments for chronic obstructive pulmonary disease (COPD) can reduce exacerbations, and thus could have a favourable impact on overall healthcare costs.
To evaluate a new method for assessing the potential cost savings of COPD controller medications based on the incidence of exacerbations and their related resource utilization in the general population.
Patients with COPD (n = 1074) enrolled in a regional managed care system in the US were identified using administrative data and divided by their medication use into three groups (salbutamol, ipratropium and salmeterol). Exacerbations were captured using International Classification of Diseases, Ninth Edition (ICD-9) and current procedural terminology (CPT) codes, then logistic regression models were created that described the risk of exacerbations for each comparator group and exacerbation type over a 6-month period. A Monte Carlo simulation was then applied 1000 times to provide the range of potential exacerbation reductions and cost consequences in response to a range of hypothetical examples of COPD controller medications.
Exacerbation events for each group could be modelled such that the events predicted by the Monte Carlo estimates were very close to the actual prevalences. The estimated cost per exacerbation avoided depended on the incidence of exacerbation in the various subpopulations, the assumed relative risk reduction, the projected daily cost for new therapy, and the costs of exacerbation treatment.
COPD exacerbation events can be accurately modelled from the healthcare utilization data of a defined cohort with sufficient accuracy for cost-effectiveness analysis. Treatments that reduce the risk or severity of exacerbations are likely to be cost effective among those patients who have frequent exacerbations and hospitalizations.
一些治疗慢性阻塞性肺疾病（COPD）的方法可以减少恶化，从而对整体医疗保健成本产生有利影响。
根据一般人群中恶化的发生率及其相关资源利用情况，评估一种评估 COPD 控制药物潜在成本节约的新方法。
使用管理数据在美国的一个区域管理式医疗保健系统中确定患有 COPD（n=1074）的患者，并根据其药物使用情况将患者分为三组（沙丁胺醇、异丙托溴铵和沙美特罗）。使用国际疾病分类第 9 版（ICD-9）和当前程序术语（CPT）代码捕获恶化情况，然后创建逻辑回归模型，描述每个比较组和恶化类型在 6 个月内恶化的风险。然后，通过蒙特卡罗模拟应用 1000 次，提供针对一系列假设的 COPD 控制药物的潜在恶化减少和成本后果的范围。
可以对每个组的恶化事件进行建模，使得蒙特卡罗估计预测的事件非常接近实际流行率。避免每次恶化的估计成本取决于不同亚人群中恶化的发生率、假设的相对风险降低、新疗法的预计日成本以及恶化治疗的成本。
从具有足够准确性进行成本效益分析的特定队列的医疗保健利用数据中，可以准确地对 COPD 恶化事件进行建模。对于那些经常发生恶化和住院的患者，降低恶化风险或严重程度的治疗方法可能具有成本效益。
