From January 1994 through May 1995, Prudential HealthCare-North Texas prospectively studied 299 member patients diagnosed with hypercholesterolemia for whom pharmacotherapy with one of four 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, also known as statins, was prescribed. The purpose of this study was to measure the relative cost-effectiveness (CE) of these drugs in a real-world setting. This study provides information to assist decision makers in managed-care organizations (MCO) in making formulary selections. The study used a prospective, randomized, balanced cohort design, examining patients who had been prescribed initial therapy with a statin drug as monotherapy. Costs (direct medical and indirect costs) and effectiveness (percent reduction in low-density lipoprotein cholesterol levels) were based on approximately the first 6 months of initial therapy. Both the MCO and patient perspectives were considered. In the base case, mean CE ratios were significantly lower for fluvastatin compared with lovastatin, pravastatin, and simvastatin from both the managed-care perspective and the patient perspective. Sensitivity analysis did not alter the CE conclusions, even under conditions of varying cost structures. Although differences were found in the effectiveness of lovastatin, pravastatin, and simvastatin measured in this study versus efficacy measured for these drugs in controlled clinical trials, sensitivity analysis suggests that these differences alone do not determine the superior CE of fluvastatin. Finally, this study supports the idea that well-designed formularies should consider drug CE (based on safety, effectiveness, and cost) and that integration of the pharmacy benefit management with other medical management is essential. These results provide evidence that fluvastatin may represent a more cost-effective formulary choice among statin products used for initial monotherapy of hypercholesterolemia.

译文

从1994年1月到1995年5月,Prudential HealthCare-North Texas对299名被诊断患有高胆固醇血症的成员患者进行了前瞻性研究,他们开了用四种3-羟基-3-甲基戊二酰辅酶A还原酶抑制剂(也称为他汀类药物)之一进行药物治疗的处方。这项研究的目的是在现实环境中测量这些药物的相对成本效益(CE)。这项研究提供信息,以帮助管理服务组织(MCO)的决策者选择配方。该研究采用前瞻性,随机,均衡的队列设计,检查了已开始接受他汀类药物作为单一疗法的初始治疗的患者。成本(直接医疗和间接成本)和有效性(低密度脂蛋白胆固醇水平降低的百分比)基于初始治疗的前6个月。同时考虑了MCO和患者的观点。在基本病例中,从管理治疗和患者角度看,氟伐他汀的平均CE比率均比洛伐他汀,普伐他汀和辛伐他汀低。即使在成本结构变化的情况下,敏感性分析也不会改变CE的结论。尽管在这项研究中发现洛伐他汀,普伐他汀和辛伐他汀的疗效与对照临床试验中这些药物的疗效存在差异,但敏感性分析表明,仅凭这些差异并不能确定氟伐他汀的优异CE。最后,本研究支持以下观点:精心设计的配方应考虑药物CE(基于安全性,有效性和成本),并且将药房收益管理与其他医疗管理相结合是必不可少的。这些结果表明,氟伐他汀可能代表一种用于高胆固醇血症初始单一疗法的他汀类产品中更具成本效益的配方选择。

+1
+2
100研值 100研值 ¥99课程
检索文献一次
下载文献一次

去下载>

成功解锁2个技能,为你点赞

《SCI写作十大必备语法》
解决你的SCI语法难题!

技能熟练度+1

视频课《玩转文献检索》
让你成为检索达人!

恭喜完成新手挑战

手机微信扫一扫,添加好友领取

免费领《Endnote文献管理工具+教程》

微信扫码, 免费领取

手机登录

获取验证码
登录