Hilleman D E, Mohiuddin S M, Lucas B D, Stading J A, Stoysich A M, Ryschon K
Creighton University Cardiac Center, Creighton University, Omaha, Nebraska.
Clin Ther. 1994 Jan-Feb;16(1):88-102; discussion 87.
In addition to efficacy and safety, the cost of therapy has become an increasingly important factor to consider when selecting drugs to treat patients with mild-to-moderate hypertension. However, acquisition prices alone do not determine the total cost of therapy. To better assess total costs, we conducted a systematic, retrospective, cost-minimization analysis of drugs used to treat 673 patients with newly diagnosed, mild-to-moderate (> 95 to < 110 mmHg) diastolic hypertension between the years 1985 and 1992. Patients included in the study had started antihypertensive monotherapy, and a minimum of one dose titration was required before adding another antihypertensive agent to the regimen. A patient had to have a diastolic blood pressure of < or = 90 mmHg while undergoing therapy to be included in the analysis. Drug classes included diuretics, beta-adrenergic blockers, centrally acting alpha 2-agonists, alpha 1-adrenergic blockers, calcium channel blockers, and angiotensin-converting enzyme (ACE) inhibitors. Costs, adjusted to 1992 price levels, were analyzed for 32 individual agents for each of the following five cost variables: initial drug acquisition, supplemental drug acquisition, laboratory monitoring, clinic visits, and treatment of side effects. Mean total costs per patient for all five variables by drug class were $895 for beta-blockers, $1043 for diuretics, $1165 for centrally acting alpha 2-agonists, $1243 for ACE inhibitors, $1288 for alpha 1-blockers, and $1425 for calcium channel blockers. However, costs within each class varied considerably. Acquisition cost was often a poor predictor of the total cost of treatment. Therefore, acquisition cost must be considered in conjunction with a number of outcome variables to assess the true cost of antihypertensive therapy.
除疗效和安全性外，治疗成本已成为选择治疗轻至中度高血压患者的药物时需要考虑的一个越来越重要的因素。然而，仅采购价格并不能决定治疗的总成本。为了更好地评估总成本，我们对1985年至1992年间用于治疗673例新诊断的轻至中度（舒张压>95至<110 mmHg）舒张期高血压患者的药物进行了一项系统的、回顾性的成本最小化分析。纳入研究的患者开始接受抗高血压单药治疗，并且在将另一种抗高血压药物添加到治疗方案之前需要至少一次剂量滴定。患者在接受治疗时舒张压必须≤90 mmHg才能纳入分析。药物类别包括利尿剂、β-肾上腺素能阻滞剂、中枢作用的α2-激动剂、α1-肾上腺素能阻滞剂、钙通道阻滞剂和血管紧张素转换酶（ACE）抑制剂。针对以下五个成本变量，对32种个体药物的成本进行了分析，成本已调整至1992年的价格水平：初始药物采购、补充药物采购、实验室监测、门诊就诊和副作用治疗。按药物类别划分，所有五个变量的每位患者平均总成本分别为：β受体阻滞剂895美元、利尿剂1043美元、中枢作用的α2-激动剂1165美元、ACE抑制剂1243美元、α1-阻滞剂1288美元、钙通道阻滞剂1425美元。然而，每个类别中的成本差异很大。采购成本往往不能很好地预测治疗总成本。因此，必须结合多个结果变量来考虑采购成本，以评估抗高血压治疗的真实成本。
