Aronson Solomon, Dasta Joseph F, Levy Jerrold H, Lumb Philip D, Fontes Manuel, Wang Yamei, Crothers Tracy A, Sulham Katherine A, Navetta Marco S
Professor, Department of Anesthesiology, Duke University, Durham, NC.
Hosp Pract (1995). 2014 Aug;42(3):26-32. doi: 10.3810/hp.2014.08.1115.
To examine the impact of intravenous antihypertensive selection on hospital health resource utilization using data from the Evaluation of CLevidipine In the Perioperative Treatment of Hypertension Assessing Safety Events (ECLIPSE) trials.
Analysis of ECLIPSE trial data comparing clevidipine to nitroglycerin, sodium nitroprusside, and nicardipine and unit costs based on the Premier Hospital database to assess surgery duration, time to extubation, and length of stay (LOS) with the associated cost.
A total of 1414 patients from the ECLIPSE trials and the Premier hospital database were included for analysis. The duration of surgery and postoperative LOS were similar across groups. The time from chest closure to extubation was shorter in patients receiving clevidipine group compared with the pooled comparator group (median 7.0 vs 7.6 hours, P = 0.04). There was shorter intensive care unit (ICU) LOS in the clevidipine group versus the nitroglycerin group (median 27.2 vs 33.0 hours, P = 0.03). A trend toward reduced ICU LOS was also seen in the clevidipine compared with the pooled comparator group (median 32.3 vs 43.5 hours, P = 0.06). The costs for ICU LOS and time to extubation were lower with clevidipine than with the comparators, with median cost savings of $887 and $34, respectively, compared with the pooled comparator group, for a median cost savings of $921 per patient.
Health resource utilization across therapeutic alternatives can be derived from an analysis of standard costs from hospital financial data to matched utilization metrics as part of a randomized controlled trial. In cardiac surgical patients, intravenous antihypertensive selection was associated with a shorter time to extubation in the ICU and a shorter ICU stay compared with pooled comparators, which in turn may decrease total costs.
利用围手术期高血压治疗中左西孟旦安全性事件评估（ECLIPSE）试验的数据，研究静脉降压药物的选择对医院卫生资源利用的影响。
分析ECLIPSE试验数据，将左西孟旦与硝酸甘油、硝普钠和尼卡地平进行比较，并根据Premier医院数据库中的单位成本，评估手术持续时间、拔管时间和住院时间（LOS）以及相关成本。
共纳入1414例来自ECLIPSE试验和Premier医院数据库的患者进行分析。各治疗组间手术持续时间和术后住院时间相似。与联合对照组相比，接受左西孟旦治疗的患者从关胸到拔管的时间更短（中位数7.0小时对7.6小时，P = 0.04）。与硝酸甘油组相比，左西孟旦组的重症监护病房（ICU）住院时间更短（中位数27.2小时对33.0小时，P = 0.03）。与联合对照组相比，左西孟旦组的ICU住院时间也有缩短趋势（中位数32.3小时对43.5小时，P = 0.06）。左西孟旦组的ICU住院时间和拔管时间成本低于对照组，与联合对照组相比，中位数成本分别节省887美元和34美元，每位患者中位数成本节省共计921美元。
作为随机对照试验的一部分，通过分析医院财务数据中的标准成本与匹配的利用指标，可以得出不同治疗方案的卫生资源利用情况。在心脏手术患者中，与联合对照组相比，静脉降压药物的选择与ICU中更短的拔管时间和更短的ICU住院时间相关，这反过来可能会降低总成本。
