Segal R, Russell W L, Ben-Joseph R, Mansheim B
University of Florida, College of Pharmacy, Gainsville, USA.
Clin Ther. 1996 Mar-Apr;18(2):319-33; discussion 302. doi: 10.1016/s0149-2918(96)80013-0.
The purpose of this study was to determine the cost of managing ambulatory patients with symptoms of acid peptic disorders in a managed-care organization under actual clinical conditions. Study data were collected in a large independent practice association model health maintenance organization in Gainesville, Florida, from prescription records maintained in a computerized database and from patient medical records. Patients had to be started on a histamine2-receptor antagonist (H2RA) or the proton pump inhibitor omeprazole between 1992 and 1994. A total of 113 patients qualified for inclusion in the study; 57 received H2RAs, 27 received omeprazole, and 29 received combination therapy. The costs of procedures, physician visits, and drug therapy were considered in the economic evaluation. Costs were evaluated using two methods: the capitation total cost (CTC) and the fee-for-service total cost (FSTC). The mean CTC and FSTC for managing a patient with acid peptic symptoms for 6 months were $382 +/- 356 (range, $14 to $1820) and $456 +/- 368 (range, $52 to $1925), respectively. Drug costs represented 52% of the total FSTC and 62% of the total CTC. Drug costs were followed by the costs for encounters with primary care physicians, endoscopy, referral to specialists, and upper gastrointestinal (UGI) tract procedures. Documented outcomes were available for 85 patients. Compared with patients receiving H2RAs (n = 41), patients receiving omeprazole (n = 18) had significantly lower FSTCs ($317 +/- 219 compared with $423 +/- 307, respectively); diagnostic testing costs (for endoscopy, $0 compared with $44 +/- 119, respectively; for UGI procedures, $22 +/- 42 compared with $55 +/- 54, respectively); physician encounter costs ($66 +/- 40 compared with $86 +/- 38, respectively); and referral to specialist costs ($0 compared with $18 +/- 60, respectively). Patients receiving omeprazole also had more positive clinical outcomes than patients receiving H2RAs (78% compared with 49%, respectively), resulting in a more favorable cost of producing a successful outcome compared with patients receiving an H2RA. The cost of success was $407 for patients treated with omeprazole compared with $869 for patients treated with H2RAs. The findings of this analysis conducted under actual clinical conditions support findings of randomized clinical trials showing the cost-effectiveness of proton pump inhibitors.
本研究的目的是在实际临床条件下，确定在一家管理式医疗组织中管理有消化性溃疡症状的门诊患者的成本。研究数据收集于佛罗里达州盖恩斯维尔的一个大型独立执业协会模式的健康维护组织，数据来自计算机化数据库中保存的处方记录以及患者病历。患者必须在1992年至1994年期间开始使用组胺2受体拮抗剂（H2RA）或质子泵抑制剂奥美拉唑。共有113名患者符合纳入研究的条件；57名接受H2RA治疗，27名接受奥美拉唑治疗，29名接受联合治疗。经济评估中考虑了诊疗程序、医生诊疗以及药物治疗的成本。成本评估采用两种方法：按人头计算的总成本（CTC）和按服务收费的总成本（FSTC）。管理一名有消化性溃疡症状的患者6个月的平均CTC和FSTC分别为382美元±356美元（范围为14美元至1820美元）和456美元±368美元（范围为52美元至1925美元）。药物成本占FSTC总额的52%，占CTC总额的62%。其次是与初级保健医生诊疗、内镜检查、转诊至专科医生以及上消化道（UGI）诊疗程序的成本。85名患者有记录在案的治疗结果。与接受H2RA治疗的患者（n = 41）相比，接受奥美拉唑治疗的患者（n = 18）的FSTC显著更低（分别为317美元±219美元和423美元±307美元）；诊断检查成本（内镜检查分别为0美元和44美元±119美元；UGI诊疗程序分别为22美元±42美元和55美元±54美元）；医生诊疗成本（分别为66美元±40美元和86美元±38美元）；以及转诊至专科医生的成本（分别为0美元和18美元±60美元）。接受奥美拉唑治疗的患者的临床结果也比接受H2RA治疗的患者更积极（分别为78%和49%），与接受H2RA治疗的患者相比，成功治疗结果的成本效益更高。接受奥美拉唑治疗的患者成功治疗的成本为407美元，而接受H2RA治疗的患者为869美元。在实际临床条件下进行的这项分析结果支持了随机临床试验显示质子泵抑制剂成本效益的结果。
