Chen Stephanie, Tourkodimitris Stavros, Lukic Tatjana
Forest Research Institute , Jersey City, NJ , USA.
J Med Econ. 2014 Oct;17(10):685-90. doi: 10.3111/13696998.2014.940421. Epub 2014 Jul 17.
To estimate the real-world economic impact of switching hypertensive patients from metoprolol, a commonly prescribed, generic, non-vasodilatory β1-blocker, to nebivolol, a branded-protected vasodilatory β1-blocker.
Retrospective analysis with a pre-post study design was conducted using the MarketScan database (2007-2011). Hypertensive patients continuously treated with metoprolol for ≥6 months (pre-period) and then switched to nebivolol for ≥6 months (post-period) were identified. The index date for switching was defined as the first nebivolol dispensing date. Data were collected for the two 6-month periods pre- and post-switching. Monthly healthcare resource utilization and healthcare costs pre- and post-switching were calculated and compared using Wilcoxon test and paired t-test. Medical costs at different years were inflated to the 2011 dollar.
In total, 2259 patients (mean age: 60 years; male: 52%; cardiovascular [CV] disease: 37%) met the selection criteria. Switching to nebivolol was associated with statistically significant reductions in the number of all-cause hospitalization (-33%; p < 0.01), CV-related hospitalizations (-60%; p < 0.01), and outpatient visits (-7%; p < 0.01). Monthly inpatient costs were reduced by $111 (p < 0.01), while monthly drug costs increased by $52 (p < 0.01). No statistically significant differences were found in overall costs and costs of outpatient or ER visits. Sensitivity analyses, conducted using various lengths of medication exposure, controlling for spill-over effect or excluding patients with compelling indications for metoprolol, all found some level of reduction in resource utilization and no significant difference in overall healthcare costs.
This real-world study suggests that switching from metoprolol to nebivolol is associated with an increase in medication costs and significant reductions in hospitalizations and outpatient visits upon switching, resulting in an overall neutral effect on healthcare costs. These results may be interpreted with caution due to lack of a comparator group and confounding control caused by design and limitations inherent in insurance claims data.
评估将高血压患者从常用的非血管扩张型β1受体阻滞剂美托洛尔转换为有品牌保护的血管扩张型β1受体阻滞剂奈必洛尔对实际经济的影响。
采用前后对照研究设计，利用MarketScan数据库（2007 - 2011年）进行回顾性分析。确定连续使用美托洛尔≥6个月（前期）然后转换为奈必洛尔≥6个月（后期）的高血压患者。转换的索引日期定义为首次使用奈必洛尔配药日期。收集转换前后两个6个月期间的数据。使用Wilcoxon检验和配对t检验计算并比较转换前后每月的医疗资源利用情况和医疗费用。将不同年份的医疗费用折算为2011年的美元价值。
共有2259名患者（平均年龄：60岁；男性：52%；心血管疾病：37%）符合入选标准。转换为奈必洛尔与全因住院次数（-33%；p < 0.01）、心血管相关住院次数（-60%；p < 0.01）和门诊就诊次数（-7%；p < 0.01）的显著减少相关。每月住院费用减少了111美元（p < 0.01），而每月药品费用增加了52美元（p < 0.01）。在总费用以及门诊或急诊就诊费用方面未发现统计学上的显著差异。使用不同用药暴露时长进行敏感性分析、控制溢出效应或排除有美托洛尔强制适应症的患者，均发现资源利用有一定程度的降低，且总体医疗费用无显著差异。
这项实际研究表明，从美托洛尔转换为奈必洛尔会导致药品费用增加，转换后住院和门诊就诊次数显著减少，对医疗费用产生总体中性影响。由于缺乏对照组以及保险理赔数据固有的设计和局限性导致的混杂控制问题，这些结果的解释需谨慎。
