Alberto Cordero, Regina Dalmau González-Gallarza, Lluis Masana, Valentín Fuster, Jose Mª Castellano, José Emilio Ruiz Olivar, Ilonka Zsolt, Antoni Sicras-Mainar, Jose Ramón González Juanatey
{"title":"西班牙二级预防中与心血管多片剂治疗相关的经济负担:NEPTUNO研究的成本-效果结果","authors":"Alberto Cordero, Regina Dalmau González-Gallarza, Lluis Masana, Valentín Fuster, Jose Mª Castellano, José Emilio Ruiz Olivar, Ilonka Zsolt, Antoni Sicras-Mainar, Jose Ramón González Juanatey","doi":"10.2147/CEOR.S396290","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to estimate health-care resources utilization, costs and cost-effectiveness associated with the treatment with CNIC-Polypill as secondary prevention of atherosclerotic cardiovascular disease (ASCVD) compared to other treatments, in clinical practice in Spain.</p><p><strong>Patients and methods: </strong>An observational, retrospective study was performed using medical records (economic results [healthcare perspective], NEPTUNO-study; BIG-PAC-database) of patients who initiated secondary prevention between 2015 and 2018. Patients were followed up to 2 years (maximum). Four cohorts were balanced with a propensity-score-matching (PSM): 1) CNIC-Polypill (aspirin+atorvastatin+ramipril), 2) Monocomponents (same separate drugs), 3) Equipotent (equipotent drugs) and 4) Other therapies ([OT], other cardiovascular drugs). Incidence of cardiovascular events, health-care resources utilization and healthcare and non-healthcare costs (2020 Euros) were compared. Incremental cost-effectiveness ratios per cardiovascular event avoided were estimated.</p><p><strong>Results: </strong>After PSM, 1614 patients were recruited in each study cohort. The accumulated incidence of cardiovascular events during the 24-month follow-up was lower in the CNIC-Polypill cohort vs the other cohorts (19.8% vs Monocomponents: 23.3%, Equipotent: 25.5% and OT: 26.8%; p<0.01). During the follow-up period, the CNIC-Polypill cohort also reduced the health-care resources utilization per patient compared to the other cohorts, particularly primary care visits (16.6 vs Monocomponents: 18.7, Equipotent: 18.9 and OT: 21.0; p<0.001) and hospitalization days (2.3 vs Monocomponents: 3.4, Equipotent: 3.7 and OT: 4.0; p<0.001). The treatment cost in the CNIC-Polypill cohort was lower than that in the other cohorts (€4668 vs Monocomponents: €5587; Equipotent: €5682 and OT: €6016; p<0.001) (Difference: -€919, -€1014 and -€1348, respectively). Due to the reduction of cardiovascular events and costs, the CNIC-Polypill is a dominant alternative compared to the other treatments.</p><p><strong>Conclusion: </strong>CNIC-Polypill reduces recurrent major cardiovascular events and costs, being a cost-saving strategy as secondary prevention of ASCVD.</p>","PeriodicalId":47313,"journal":{"name":"ClinicoEconomics and Outcomes Research","volume":null,"pages":null},"PeriodicalIF":2.1000,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/78/05/ceor-15-559.PMC10363366.pdf","citationCount":"1","resultStr":"{\"title\":\"Economic Burden Associated with the Treatment with a Cardiovascular Polypill in Secondary Prevention in Spain: Cost-Effectiveness Results of the NEPTUNO Study.\",\"authors\":\"Alberto Cordero, Regina Dalmau González-Gallarza, Lluis Masana, Valentín Fuster, Jose Mª Castellano, José Emilio Ruiz Olivar, Ilonka Zsolt, Antoni Sicras-Mainar, Jose Ramón González Juanatey\",\"doi\":\"10.2147/CEOR.S396290\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>The aim of this study was to estimate health-care resources utilization, costs and cost-effectiveness associated with the treatment with CNIC-Polypill as secondary prevention of atherosclerotic cardiovascular disease (ASCVD) compared to other treatments, in clinical practice in Spain.</p><p><strong>Patients and methods: </strong>An observational, retrospective study was performed using medical records (economic results [healthcare perspective], NEPTUNO-study; BIG-PAC-database) of patients who initiated secondary prevention between 2015 and 2018. 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引用次数: 1
摘要
目的:本研究的目的是评估在西班牙临床实践中，与其他治疗方法相比，CNIC-Polypill作为动脉粥样硬化性心血管疾病(ASCVD)二级预防的医疗资源利用率、成本和成本效益。患者和方法:一项观察性、回顾性研究使用了医疗记录(经济结果[医疗保健角度]，neptuno研究;big - pac数据库)在2015年至2018年期间启动二级预防的患者。随访时间最长为2年。采用倾向-评分匹配(PSM)对四个队列进行平衡:1)CNIC-Polypill(阿司匹林+阿托伐他汀+雷米普利)，2)单组分(相同的单独药物)，3)等效(等效药物)和4)其他治疗([OT]，其他心血管药物)。比较了心血管事件发生率、卫生保健资源利用以及卫生保健和非卫生保健费用(2020欧元)。估算每个避免的心血管事件的增量成本-效果比。结果:PSM后，每个研究队列中招募了1614名患者。在24个月的随访期间，CNIC-Polypill队列的心血管事件累积发生率低于其他队列(19.8% vs Monocomponents: 23.3%，等效组:25.5%，OT组:26.8%;结论:CNIC-Polypill减少了主要心血管事件的复发和成本，是ASCVD二级预防的一种节省成本的策略。
Economic Burden Associated with the Treatment with a Cardiovascular Polypill in Secondary Prevention in Spain: Cost-Effectiveness Results of the NEPTUNO Study.
Purpose: The aim of this study was to estimate health-care resources utilization, costs and cost-effectiveness associated with the treatment with CNIC-Polypill as secondary prevention of atherosclerotic cardiovascular disease (ASCVD) compared to other treatments, in clinical practice in Spain.
Patients and methods: An observational, retrospective study was performed using medical records (economic results [healthcare perspective], NEPTUNO-study; BIG-PAC-database) of patients who initiated secondary prevention between 2015 and 2018. Patients were followed up to 2 years (maximum). Four cohorts were balanced with a propensity-score-matching (PSM): 1) CNIC-Polypill (aspirin+atorvastatin+ramipril), 2) Monocomponents (same separate drugs), 3) Equipotent (equipotent drugs) and 4) Other therapies ([OT], other cardiovascular drugs). Incidence of cardiovascular events, health-care resources utilization and healthcare and non-healthcare costs (2020 Euros) were compared. Incremental cost-effectiveness ratios per cardiovascular event avoided were estimated.
Results: After PSM, 1614 patients were recruited in each study cohort. The accumulated incidence of cardiovascular events during the 24-month follow-up was lower in the CNIC-Polypill cohort vs the other cohorts (19.8% vs Monocomponents: 23.3%, Equipotent: 25.5% and OT: 26.8%; p<0.01). During the follow-up period, the CNIC-Polypill cohort also reduced the health-care resources utilization per patient compared to the other cohorts, particularly primary care visits (16.6 vs Monocomponents: 18.7, Equipotent: 18.9 and OT: 21.0; p<0.001) and hospitalization days (2.3 vs Monocomponents: 3.4, Equipotent: 3.7 and OT: 4.0; p<0.001). The treatment cost in the CNIC-Polypill cohort was lower than that in the other cohorts (€4668 vs Monocomponents: €5587; Equipotent: €5682 and OT: €6016; p<0.001) (Difference: -€919, -€1014 and -€1348, respectively). Due to the reduction of cardiovascular events and costs, the CNIC-Polypill is a dominant alternative compared to the other treatments.
Conclusion: CNIC-Polypill reduces recurrent major cardiovascular events and costs, being a cost-saving strategy as secondary prevention of ASCVD.
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