Pneumology Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron Barcelona Hospital Campus, CIBER for Respiratory Diseases (CIBERES), Barcelona, Spain.
Market Access Department of Boehringer Ingelheim SA, Barcelona, Spain.
Int J Chron Obstruct Pulmon Dis. 2021 Nov 16;16:3131-3143. doi: 10.2147/COPD.S322793. eCollection 2021.
The objective of this study was to assess the non-adherence level of Spanish clinical practice to guideline recommendations for the treatment of chronic obstructive pulmonary disease (COPD) and to estimate the potential impact on pharmaceutical expenditure resulting from transitioning current treatment patterns according to guidelines.
A model was developed to compare current prescribing patterns with two alternative scenarios: the first aligned with the Global Initiative for Chronic Obstructive Lung Disease (GOLD 2020) recommendations, and the second with the Spanish Guidelines for COPD (GesEPOC 2017). Current treatment practice was obtained from publications that describe treatment patterns by pulmonology departments in Spain. The economic impact between patterns was calculated from the perspective of the Spanish National Health System (NHS), considering the annual pharmacological costs of COPD inhaled maintenance therapy. Two additional analyses were performed: one that included current prescribing patterns of patients managed by pulmonology and primary care centers in Spain (published aggregated data); and another that only considered the appropriate use of inhaled corticosteroids (ICS) treatment according to guidelines.
It was estimated that 54% and 38% of patients were not treated in line with GOLD and GesEPOC recommendations, respectively, mainly due to a broader use of ICS-based therapies. Adapting treatment to recommendations could provide a potential annual cost-saving of €17,792,022 (according to GOLD) and €5,881,785 (according to GesEPOC). In scenario analysis 1, a 26% of non-adherence to GesEPOC guideline was observed with a potential annual pharmacological cost-saving of €2,707,554. In scenario analysis 2, considering only inappropriate use of ICS treatment, an annual cost-saving of €17,863,750 (according to GOLD) and €9,904,409 (according to GesEPOC) was calculated.
More than a third of treatments for COPD patients in Spain are not prescribed in accordance with guideline recommendations. The adaptation of clinical practice to guideline recommendations could provide important cost-savings for the Spanish NHS.
本研究旨在评估西班牙临床实践在治疗慢性阻塞性肺疾病（COPD）方面对指南推荐的不依从水平，并根据指南估计根据当前治疗模式过渡可能对药物支出产生的潜在影响。
建立了一个模型，以比较当前的处方模式与两种替代方案：第一种方案与全球慢性阻塞性肺疾病倡议（GOLD 2020）的建议一致，第二种方案与西班牙 COPD 指南（GesEPOC 2017）一致。当前的治疗实践是从描述西班牙肺病科治疗模式的出版物中获得的。从西班牙国家卫生系统（NHS）的角度计算了不同模式之间的经济影响，考虑了 COPD 吸入维持治疗的年度药物成本。进行了两项额外的分析：一项包括西班牙肺病科和初级保健中心管理的患者当前处方模式（已发布的汇总数据）；另一项仅考虑根据指南适当使用吸入皮质类固醇（ICS）治疗。
据估计，分别有 54%和 38%的患者未按照 GOLD 和 GesEPOC 建议进行治疗，主要是由于更广泛地使用了基于 ICS 的治疗方法。根据 GOLD 和 GesEPOC 建议调整治疗方案可分别节省潜在的年度费用 1779.2022 万欧元和 588.1785 万欧元。在方案分析 1 中，观察到 GesEPOC 指南的不依从率为 26%，潜在的年度药物成本节省为 270.7554 万欧元。在方案分析 2 中，仅考虑不适当使用 ICS 治疗，根据 GOLD 和 GesEPOC 计算，每年可节省 1786.375 万欧元和 990.4409 万欧元。
西班牙超过三分之一的 COPD 患者的治疗方案不符合指南建议。临床实践向指南建议的转变可以为西班牙 NHS 节省大量成本。
