抗高血压药物的成本效益和治疗指南。

Cost effectiveness of antihypertensive drugs and treatment guidelines.

机构信息

Primorje-Gorski Kotar County Community Health Centre, Rijeka, Croatia.

Faculty of Engineering, University of Rijeka, Rijeka, Croatia.

出版信息

Eur J Clin Pharmacol. 2021 Nov;77(11):1665-1672. doi: 10.1007/s00228-021-03163-4. Epub 2021 Jun 2.

DOI:10.1007/s00228-021-03163-4

PMID:34075437

Abstract

PURPOSE

Arterial hypertension (AH) is associated with a high economic burden for the individual patient and for society in general. The study evaluates antihypertensives and their cost-effectiveness, comparing diuretics (D), beta-blockers (B), angiotensin converting enzyme inhibitors/angiotensin-II receptor blockers (A) and calcium channel blockers (C) with no intervention (NI).

METHODS

The study included five health states in a Markov model. Cost values included average cost of the drugs used, treatment in hospital and treatment in general practice (collected from Croatian Health Insurance Fund). The study was conducted separately for 65-year old men and women, with an initial probability of cardiovascular death risk of 2% and heart failure risk of 1%. The results were presented in terms of increase in QALYs and associated financial savings or costs in euros (€).

RESULTS

Results for men (compared with NI): treatment with D resulted in a QALY increase of 0.76 and €886 in savings, treatment with C in an increase of 0.74 QALYs and €767 in savings, treatment with A in an increase of 0.69 QALYs and €834 in savings, treatment with B resulted in an increase of 0.40 QALYs, but with an additional cost of €41. Results for women (compared with NI): treatment with D resulted in an increase of 0.93 QALYs and €987 in savings, treatment with C in an increase of 0.89 QALYs and savings of €855, treatment with A in an increase of 0.86 QALYs and savings of €991, treatment with B in an increase of 0.48 QALYs, but with an additional cost of €148.

CONCLUSIONS

Treatment of AH with D, C and A is cost effective compared with the no-intervention scenario. Diuretics are the most cost-effective first-line treatment. The scenario with beta-blockers resulted in additional QALY when compared with no intervention, but also additional costs; therefore, based on our results, this therapy would not be recommended as first-line treatment.

摘要

目的

动脉高血压（AH）给患者个人和整个社会带来了沉重的经济负担。本研究评估了抗高血压药物及其成本效益，将利尿剂（D）、β受体阻滞剂（B）、血管紧张素转换酶抑制剂/血管紧张素 II 受体阻滞剂（A）和钙通道阻滞剂（C）与无干预（NI）进行比较。

方法

该研究在一个马尔可夫模型中包含了五个健康状态。成本值包括使用药物的平均成本、医院治疗和一般实践治疗（从克罗地亚健康保险基金收集）。该研究分别针对 65 岁男性和女性进行，心血管死亡风险的初始概率为 2%，心力衰竭风险为 1%。结果以 QALY 的增加和相关的节省或成本（以欧元表示）表示。

结果

对于男性（与 NI 相比）：使用 D 治疗可使 QALY 增加 0.76，节省 886 欧元，使用 C 治疗可使 QALY 增加 0.74，节省 767 欧元，使用 A 治疗可使 QALY 增加 0.69，节省 834 欧元，使用 B 治疗可使 QALY 增加 0.40，但增加 41 欧元的成本。对于女性（与 NI 相比）：使用 D 治疗可使 QALY 增加 0.93，节省 987 欧元，使用 C 治疗可使 QALY 增加 0.89，节省 855 欧元，使用 A 治疗可使 QALY 增加 0.86，节省 991 欧元，使用 B 治疗可使 QALY 增加 0.48，但增加 148 欧元的成本。