Hempel A G, Wagner M L, Maaty M A, Sage J I
College of Pharmacy, Rutgers, State University of New Jersey, Piscataway 08854, USA.
Ann Pharmacother. 1998 Sep;32(9):878-83. doi: 10.1345/aph.16353.
To compare the costs of pharmacotherapy in patients with Parkinson's disease before and after converting from standard Sinemet to extended-release Sinemet CR.
Investigators retrospectively reviewed records of patients converting from Sinemet to Sinemet CR for efficacy and total drug costs. Cost-effectiveness was evaluated retrospectively from data collected in prospective Sinemet CR efficacy trials.
Parkinson's disease clinic at a tertiary care university teaching hospital.
100 patients with motor fluctuations who had undergone an initial 6-month course of Sinemet therapy, followed by a 6-month course of Sinemet CR.
Total cost was measured as the cost of Sinemet formulations plus the costs of other antiparkinson medications. Differences in pre- and postconversion costs were compared by using the paired, two-tailed Student's t-test. A substudy of 39 patients on the cost-effectiveness of conversion measured the ratio of daily medication costs to the daily hours "on" without chorea.
While total daily medication costs after conversion increased by 21%, patients experienced either a comparable or an improved degree of disease control with Sinemet CR. Patients who were also taking selegiline were able to decrease selegiline expense by 20%. The costs of other adjunctive medications did not differ significantly after conversion. The cost-effectiveness analysis revealed an increase in postconversion on time by 2.2 hours (p = 0.0001), accompanied by a $2.85 decrease in total cost per hour on without chorea (p = 0.11).
Although Sinemet CR is more costly, it may be more cost-effective in patients with motor fluctuations. Some patients may be able to reduce adjunctive medications.
比较帕金森病患者从标准息宁转换为息宁控释片前后药物治疗的费用。
研究者回顾性分析了从息宁转换为息宁控释片患者的疗效及总药物费用记录。成本效益是根据前瞻性息宁控释片疗效试验收集的数据进行回顾性评估的。
一所三级大学教学医院的帕金森病诊所。
100例有运动波动的患者，他们最初接受了6个月的息宁治疗，随后接受了6个月的息宁控释片治疗。
总成本以息宁制剂成本加上其他抗帕金森药物的成本来衡量。采用配对双尾学生t检验比较转换前后成本的差异。对39例患者进行的关于转换成本效益的子研究测量了每日药物成本与无舞蹈症“开”期每日小时数的比值。
虽然转换后每日总药物成本增加了21%，但患者使用息宁控释片时疾病控制程度相当或有所改善。同时服用司来吉兰的患者能够将司来吉兰费用降低20%。转换后其他辅助药物的成本没有显著差异。成本效益分析显示，转换后“开”期时间增加了2.2小时（p = 0.0001），无舞蹈症时每小时总成本降低了2.85美元（p = 0.11）。
虽然息宁控释片成本更高，但对于有运动波动的患者可能更具成本效益。一些患者可能能够减少辅助药物的使用。
