Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
J Card Fail. 2013 Sep;19(9):611-20. doi: 10.1016/j.cardfail.2013.07.003.
The Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure (ASCEND-HF) randomly assigned 7,141 participants to nesiritide or placebo. Dyspnea improvement was more often reported in the nesiritide group, but there were no differences in 30-day all-cause mortality or heart failure readmission rates. We compared medical resource use, costs, and health utilities between the treatment groups.
There were no significant differences in inpatient days, procedures, and emergency department visits reported for the first 30 days or for readmissions to day 180. EQ-5D health utilities and visual analog scale ratings were similar at 24 hours, discharge, and 30 days. Billing data and regression models were used to generate inpatient costs. Mean length of stay from randomization to discharge was 8.5 days in the nesiritide group and 8.6 days in the placebo group (P = .33). Cumulative mean costs at 30 days were $16,922 (SD $16,191) for nesiritide and $16,063 (SD $15,572) for placebo (P = .03). At 180 days, cumulative costs were $25,590 (SD $30,344) for nesiritide and $25,339 (SD $29,613) for placebo (P = .58).
The addition of nesiritide contributed to higher short-term costs and did not significantly influence medical resource use or health utilities compared with standard care alone.
失代偿性心力衰竭的急性临床疗效研究（ASCEND-HF）将 7141 名参与者随机分为奈西立肽组或安慰剂组。奈西立肽组呼吸困难改善的报告更为常见，但 30 天全因死亡率或心力衰竭再入院率无差异。我们比较了两组的医疗资源使用、成本和健康效用。
前 30 天或 180 天再入院期间，报告的住院天数、程序和急诊就诊无显著差异。24 小时、出院和 30 天时，EQ-5D 健康效用和视觉模拟评分相似。使用计费数据和回归模型生成住院费用。奈西立肽组从随机分组到出院的平均住院时间为 8.5 天，安慰剂组为 8.6 天（P=0.33）。30 天的累积平均费用奈西立肽组为 16922 美元（SD=16191 美元），安慰剂组为 16063 美元（SD=15572 美元）（P=0.03）。180 天时，奈西立肽组的累积费用为 25590 美元（SD=30344 美元），安慰剂组为 25339 美元（SD=29613 美元）（P=0.58）。
与单独标准治疗相比，奈西立肽的加入导致短期成本增加，但对医疗资源使用或健康效用没有显著影响。
