Szucs T D, Guggenberger G, Berger K, März W, Schäfer J R
Center of Pharmacoeconomics, School of Pharmacy, Milan, Italy.
Herz. 1998 Aug;23(5):319-29. doi: 10.1007/BF03044365.
Those people who are to decide about health care systems are increasingly forced to identify unnecessary costs and achieve savings in health care. Especially for diseases with high prevalence like illnesses of the heart and the circulatory system preventive measures are very important. This economic analysis tries to clarify whether the secondary-preventive application of the HMG-CoA reductase-inhibitor pravastatin is, apart from the clinical benefit, economically justified in patients suffering from coronary heart disease with average cholesterol levels. In the case of this study, the underlying type of economic evaluation was an incremental cost-effectiveness analysis. The outcome was defined as costs per life-year saved. This retrospective study is based on the results of the CARE (Cholesterol And Recurrent Events) study which has been published elsewhere [21]. When calculating costs we took into account the perspective of 3rd party payers (public health insurance) in Germany. The calculation of cost-effectiveness was carried out for the whole study population in CARE as well as for all patients aged 60 or more years in the CARE study. This was done because the different groups vary by the numbers of avoided myocardial infarctions, strokes and loss of life years. Netcosts for pravastatin therapy, i.e. drug costs for pravastatin minus costs for avoided events, were about 9.54 Mio DM (referring to 1,000 patients treated for a period of 5 years). Net-costs for patients aged 60 or more years were 8.18 Mio DM. The effectiveness was defined as the number of life years saved and amounted to 216 years of life saved (YOLS) in the overall study group. For patients aged 60 or more years we found that 358 years were saved. The costs per life years saved (i.e. the net-costs of pravastatin therapy divided through the number of life years saved) turned out to be 44,000 DM per person in the study group. For patients over 60 the costs were 23,000 DM. Lipid-lowering with pravastatin in the secondary prevention of coronary heart disease in Germany is cost-effective. In those patients aged 60 or more yeas the use of pravastatin is even more cost-effective than in all patients included in the CARE study.
那些负责决策医疗保健系统的人越来越被迫去识别不必要的成本并实现医疗保健费用的节省。尤其是对于像心脏和循环系统疾病这类高患病率的疾病，预防措施非常重要。本经济分析试图阐明，对于胆固醇水平处于平均水平的冠心病患者，除了临床益处之外，HMG-CoA还原酶抑制剂普伐他汀的二级预防应用在经济上是否合理。在本研究中，基础的经济评估类型是增量成本效益分析。结果定义为每挽救一个生命年的成本。这项回顾性研究基于已在其他地方发表的CARE（胆固醇与再发事件）研究的结果[21]。在计算成本时，我们考虑了德国第三方支付者（公共医疗保险）的视角。对CARE研究中的整个研究人群以及所有60岁及以上的患者进行了成本效益计算。这样做是因为不同组在避免心肌梗死、中风和生命年损失的数量上存在差异。普伐他汀治疗的净成本，即普伐他汀的药物成本减去避免事件的成本，约为954万德国马克（针对1000名接受5年治疗的患者）。60岁及以上患者的净成本为818万德国马克。有效性定义为挽救的生命年数，在整个研究组中为216个挽救生命年（YOLS）。对于60岁及以上的患者，我们发现挽救了358个生命年。每挽救一个生命年的成本（即普伐他汀治疗的净成本除以挽救的生命年数）在研究组中为每人44,000德国马克。对于60岁以上的患者，成本为23,000德国马克。在德国，普伐他汀用于冠心病二级预防的降脂治疗具有成本效益。在60岁及以上的患者中，使用普伐他汀甚至比CARE研究中纳入的所有患者更具成本效益。
