Health Economics and Outcomes Research Ltd, Cardiff, United Kingdom.
Huron Consulting Group, London, United Kingdom.
J Manag Care Spec Pharm. 2022 Apr;28(4):415-424. doi: 10.18553/jmcp.2022.21385. Epub 2022 Jan 12.
Currently, concerted efforts to identify, prevent, and treat type 2 diabetes mellitus (T2DM), heart failure (HF), and chronic kidney disease (CKD) comorbidities are lacking at the institutional level, with emphasis placed on individual specialties. An integrated approach to tackle T2DM, HF, and CKD within the context of cardiorenal disease has the potential to improve outcomes and reduce costs at the system level. To synthesize published evidence describing the burden of those diagnosed with T2DM, HF, and CKD in the United States as individual discrete chronic conditions, in order to evaluate the potential economic impact of novel therapies in this population. We developed a compartmental Markov model with an annual time cycle to model an evolving prevalent US patient population with T2DM, HF, or CKD over the period 2021-2030 (either in isolation or combined). The model was used to explore the potential impact of novel therapies such as sodium-glucose cotransporter 2 inhibitors on future disease burden, by extrapolating the results of relevant clinical trials to representative patient populations. The model estimates that total prevalence across all disease states will have increased by 28% in 2030. Cumulatively, the direct health care cost of cardiorenal disease between 2021 and 2030 is estimated at $4.8 trillion. However, treatment with dapagliflozin has the potential to reduce disease prevalence by 8.0% and estimated cumulative service delivery costs by 3.6% by 2030. Considering a holistic approach when managing patients with cardiorenal disease offers an opportunity to reduce the disease burden over the next 10 years in the US population. This work was funded by AstraZeneca, which provided support for data analysis. McEwan, Morgan, and Boyce are employees of Health Economics and Outcomes Research Ltd., Cardiff, UK, which received fees from AstraZeneca in relation to this study. Song and Huang are employees of AstraZeneca. Bergenheim is an employee of AstraZeneca and holds AstraZeneca stocks/stock options. Green has no conflicts of interest to declare.
目前，在机构层面上缺乏针对 2 型糖尿病（T2DM）、心力衰竭（HF）和慢性肾病（CKD）合并症的识别、预防和治疗的协同努力，重点放在各个专业上。在心脏肾脏疾病的背景下，采取综合方法来解决 T2DM、HF 和 CKD 问题，有可能改善系统层面的结果并降低成本。为了综合描述在美国被诊断为 T2DM、HF 和 CKD 的患者的负担，作为个体离散的慢性疾病，以评估新型疗法在这一人群中的潜在经济影响。我们开发了一个房室马尔可夫模型，具有每年的时间周期，以模拟 2021 年至 2030 年期间（单独或组合）不断演变的美国普遍患者群体中患有 T2DM、HF 或 CKD 的患者。该模型用于通过将相关临床试验的结果外推到代表性患者群体来探索新型疗法（如钠-葡萄糖共转运蛋白 2 抑制剂）对未来疾病负担的潜在影响。该模型估计，到 2030 年，所有疾病状态的总患病率将增加 28%。总体而言，2021 年至 2030 年期间心脏肾脏疾病的直接医疗保健成本估计为 4.8 万亿美元。然而，达格列净的治疗有可能降低 8.0%的疾病患病率，并降低到 2030 年 3.6%的累计服务交付成本。在管理心脏肾脏疾病患者时考虑整体方法，为未来 10 年内减少美国人群的疾病负担提供了机会。这项工作得到了阿斯利康的资助，该公司为数据分析提供了支持。麦克尤恩、摩根和博伊斯是英国卡迪夫健康经济与成果研究有限公司的员工，该公司因这项研究从阿斯利康获得了费用。宋和黄是阿斯利康的员工。伯根海姆是阿斯利康的员工，并持有阿斯利康的股票/股票期权。格林没有利益冲突需要申报。
