Iatrogenic Cost Factors Incorporating Mild and Moderate Adverse Events in the Economic Comparison of Aceclofenac and Other NSAIDs
作者:Francesc Peris、Eduard Mart??nez、Xavier Badia、Max Brosa
DOI:10.2165/00019053-200119070-00006
日期:——
Objective: To perform a modelled economic analysis of the efficacy and tolerability of aceclofenac in comparison with those of other nonsteroidal antiinflammatory drugs (NSAIDs) used in the treatment of common arthritic disorders including osteoarthritis, rheumatoid arthritis and ankylosing spondylitis. Design: A decision analytical model was constructed to represent the clinical and economic consequences of NSAID treatment. Probabilities of noncompliance, lack of efficacy and incidence of adverse events were obtained from comparative randomised double-blind clinical trials. Local unit treatment costs were used and an expert panel was convened to estimate resource use. Both classical foldback analysis and bootstrap methods were used to compute point estimates and 95% confidence limits of costs for NSAID treatment. Patients and interventions: Data were obtained from 12 randomised double-blind clinical trials included in an earlier meta-analysis. Main outcome measures: Total costs to the healthcare provider, including NSAID treatment costs (drug acquisition costs and physician visits for prescription) and iatrogenic costs (substitution treatment costs for patients not achieving clinical efficacy and costs of medical visits, treatment, diagnostic tests and hospital stays associated with adverse events) and the iatrogenic cost factor (ICF) were used as the primary outcome measures. Results: Means and 95% confidence intervals revealed no statistically significant differences in total costs between aceclofenac and other NSAIDs, with the exception of piroxicam, despite substantial differences in drug acquisition costs. The ICF for aceclofenac was lower than that for all other comparators, and differences in ICF between aceclofenac 200 mg/day and diclofenac 150 mg/day, indomethacin 100 mg/day, naproxen 1000 mg/day, tenoxicam 20 mg/day or ketoprofen 150 mg/day were statistically significant. Conclusion: These results show that the comparative overall costs of NSAIDs bears little relation to drug acquisition cost, and that the ICF is one of the most important determinants of overall costs.
目标:对乙酰氯芬酸与其他用于治疗包括骨关节炎、类风湿关节炎和强直性脊柱炎在内的常见关节病的非甾体抗炎药(NSAID)在功效和耐受性方面的经济性进行模型化分析。设计:构建了一个决策分析模型,以代表NSAID治疗的临床和经济后果。不依从性、缺乏疗效和不良事件发生率的数据来自比较随机双盲临床试验。使用当地单位治疗成本,并召集专家小组估计资源使用。同时使用经典的综合分析和自举方法来计算NSAID治疗成本的点估计值和95%置信区间。患者和干预措施:数据来自早期荟萃分析中包含的12项随机双盲临床试验。主要结局指标:包括NSAID治疗成本(药品获取成本和处方医生就诊费用)和医源性成本(未达到临床疗效患者的替代治疗成本以及与不良事件相关的医疗访问、治疗、诊断测试和住院费用)以及医源性成本因子(ICF)作为主要结局指标。结果:平均值和95%置信区间显示,除吡罗昔康外,乙酰氯芬酸与其他NSAID在总成本上无统计学显著差异,尽管药品获取成本存在显著差异。乙酰氯芬酸的ICF低于所有其他比较药物,乙酰氯芬酸200 mg/天与双氯芬酸150 mg/天、吲哚美辛100 mg/天、萘普生1000 mg/天、替诺昔康20 mg/天或酮洛芬150 mg/天之间的ICF差异具有统计学意义。结论:这些结果表明,NSAID的比较总体成本与药品获取成本关系不大,而ICF是总体成本最重要的决定因素之一。