Szucs T D, Goedde M, Berger K, Kiowski W
Forschungsgruppe Medizinische Okonomie, München.
Schweiz Med Wochenschr. 1997 Jul 22;127(29-30):1234-41.
Morbidity and mortality data in Switzerland underline the socioeconomic importance of heart failure. In the SOLVD study (Study on Left Ventricular Dysfunction), cardiovascular morbidity and mortality were reduced with the ACE inhibitor enalapril in patients with heart failure. The economic implications of this treatment were analyzed in a retrospective economic analysis from the perspective of Swiss third party payers.
Source of the economic analysis was the SOLVD study data. This prospective study was placebo-controlled, double-blind and had a mean follow-up of 3.45 years (41.4 months), involving 2569 patients with heart failure, mainly in NYHA classes II and III. Costing data for treatment with enalapril, the per diem charges for hospitalization and the average length of hospital stay were retrieved from published national sources. The costs of in- and output were calculated and compared for the two treatment groups in a cost-efficacy analysis.
Additional treatment with enalapril resulted in an additional cost of 2.5 million Swiss francs. These incremental costs were, however, offset by reduced hospital costs (CHF 6.45 million savings) in the enalapril group. For the complete treatment cohort of the SOLVD study, the net savings were approximately 4.26 million Swiss francs.
From the clinical point of view, treatment with ACE inhibitors leads to a reduction in the progression of heart failure and reduced cardiovascular morbidity and mortality. With respect to health economics, it can be demonstrated that treatment with enalapril does not only offer clinical benefits, but that these also translate into impressive economic savings of CHF 3315 per patient.
瑞士的发病率和死亡率数据突显了心力衰竭在社会经济方面的重要性。在SOLVD研究（左心室功能障碍研究）中，心力衰竭患者使用血管紧张素转换酶（ACE）抑制剂依那普利可降低心血管发病率和死亡率。从瑞士第三方支付方的角度，通过一项回顾性经济分析对该治疗的经济影响进行了评估。
经济分析的数据来源是SOLVD研究数据。这项前瞻性研究采用安慰剂对照、双盲设计，平均随访时间为3.45年（41.4个月），纳入了2569例心力衰竭患者，主要为纽约心脏协会（NYHA）心功能II级和III级患者。依那普利治疗的成本数据、每日住院费用以及平均住院天数均取自已发表的国内资料。在成本-效益分析中，计算并比较了两个治疗组的投入和产出成本。
依那普利的额外治疗导致额外成本250万瑞士法郎。然而，依那普利组住院成本的降低（节省645万瑞士法郎）抵消了这些增量成本。对于SOLVD研究的整个治疗队列，净节省约为426万瑞士法郎。
从临床角度来看，ACE抑制剂治疗可降低心力衰竭的进展，减少心血管发病率和死亡率。从卫生经济学角度而言，可以证明依那普利治疗不仅具有临床益处，而且还能转化为每位患者高达3315瑞士法郎的可观经济节省。
