Cordero Alberto, Dalmau González-Gallarza Regina, Masana Lluis, Fuster Valentín, Castellano Jose Mª, Ruiz Olivar José Emilio, Zsolt Ilonka, Sicras-Mainar Antoni, González Juanatey Jose Ramón
Cardiology Service, San Juan University Hospital, Alicante, Spain.
Cardiovascular Diseases Network Research Center (CIBERCV), Madrid, Spain.
Clinicoecon Outcomes Res. 2023 Jul 19;15:559-571. doi: 10.2147/CEOR.S396290. eCollection 2023.
The aim of this study was to estimate health-care resources utilization, costs and cost-effectiveness associated with the treatment with CNIC-Polypill as secondary prevention of atherosclerotic cardiovascular disease (ASCVD) compared to other treatments, in clinical practice in Spain.
An observational, retrospective study was performed using medical records (economic results [healthcare perspective], NEPTUNO-study; BIG-PAC-database) of patients who initiated secondary prevention between 2015 and 2018. Patients were followed up to 2 years (maximum). Four cohorts were balanced with a propensity-score-matching (PSM): 1) CNIC-Polypill (aspirin+atorvastatin+ramipril), 2) Monocomponents (same separate drugs), 3) Equipotent (equipotent drugs) and 4) Other therapies ([OT], other cardiovascular drugs). Incidence of cardiovascular events, health-care resources utilization and healthcare and non-healthcare costs (2020 Euros) were compared. Incremental cost-effectiveness ratios per cardiovascular event avoided were estimated.
After PSM, 1614 patients were recruited in each study cohort. The accumulated incidence of cardiovascular events during the 24-month follow-up was lower in the CNIC-Polypill cohort vs the other cohorts (19.8% vs Monocomponents: 23.3%, Equipotent: 25.5% and OT: 26.8%; p<0.01). During the follow-up period, the CNIC-Polypill cohort also reduced the health-care resources utilization per patient compared to the other cohorts, particularly primary care visits (16.6 vs Monocomponents: 18.7, Equipotent: 18.9 and OT: 21.0; p<0.001) and hospitalization days (2.3 vs Monocomponents: 3.4, Equipotent: 3.7 and OT: 4.0; p<0.001). The treatment cost in the CNIC-Polypill cohort was lower than that in the other cohorts (€4668 vs Monocomponents: €5587; Equipotent: €5682 and OT: €6016; p<0.001) (Difference: -€919, -€1014 and -€1348, respectively). Due to the reduction of cardiovascular events and costs, the CNIC-Polypill is a dominant alternative compared to the other treatments.
CNIC-Polypill reduces recurrent major cardiovascular events and costs, being a cost-saving strategy as secondary prevention of ASCVD.
本研究旨在评估在西班牙的临床实践中，与其他治疗方法相比，使用CNIC复方药丸作为动脉粥样硬化性心血管疾病（ASCVD）二级预防治疗的医疗资源利用情况、成本及成本效益。
采用2015年至2018年开始二级预防的患者的医疗记录（经济结果[医疗保健视角]，NEPTUNO研究；BIG-PAC数据库）进行一项观察性回顾性研究。对患者进行最长2年的随访。通过倾向得分匹配（PSM）平衡了四个队列：1）CNIC复方药丸（阿司匹林+阿托伐他汀+雷米普利），2）单一组分（相同的单一药物），3）等效药物组（等效药物）和4）其他疗法（[OT]，其他心血管药物）。比较了心血管事件的发生率、医疗资源利用情况以及医疗和非医疗成本（2020欧元）。估算了避免每例心血管事件的增量成本效益比。
PSM后，每个研究队列招募了1614名患者。在24个月的随访期间，CNIC复方药丸队列中心血管事件的累积发生率低于其他队列（19.8%，而单一组分组为23.3%，等效药物组为25.5%，其他疗法组为26.8%；p<0.01）。在随访期间，与其他队列相比，CNIC复方药丸队列还降低了每位患者的医疗资源利用，尤其是初级保健就诊次数（16.6次，而单一组分组为18.7次，等效药物组为18.9次，其他疗法组为21.0次；p<0.001）和住院天数（2.3天，而单一组分组为3.4天，等效药物组为3.7天，其他疗法组为4.0天；p<0.001）。CNIC复方药丸队列的治疗成本低于其他队列（4668欧元，而单一组分组为5587欧元；等效药物组为5682欧元，其他疗法组为6016欧元；p<0.001）（差异分别为-919欧元、-1014欧元和-1348欧元）。由于心血管事件和成本的降低，与其他治疗方法相比，CNIC复方药丸是一种占优选择。
CNIC复方药丸可降低复发性重大心血管事件和成本，作为ASCVD的二级预防是一种节省成本的策略。
