PDF(Pubmed)
Abstract：
BACKGROUND: Single-pill combination (SPC) of three antihypertensive drugs has been shown to improve adherence to therapy compared with free combinations, but little is known about its long-term costs and health consequences. This study aimed to evaluate the lifetime cost-effectiveness profile of a three-drug SPC of an angiotensin-converting enzyme inhibitor, a calcium-channel blocker, and a diuretic vs the corresponding two-pill administration (a two-drug SPC plus a third drug separately) from the Italian payer perspective.
METHODS: A cost-effectiveness analysis was conducted using multi-state semi-Markov modeling and microsimulation. Using the healthcare utilization database of the Lombardy Region (Italy), 30,172 and 65,817 patients aged ≥ 40 years who initiated SPC and two-pill combination, respectively, between 2015 and 2018 were identified. The observation period extended from the date of the first drug dispensation until death, emigration, or December 31, 2019. Disease and cost models were parametrized using the study cohort, and a lifetime microsimulation was applied to project costs and life expectancy for the compared strategies, assigning each of them to each cohort member. Costs and life-years gained were discounted by 3%. Probabilistic sensitivity analysis with 1,000 samples was performed to address parameter uncertainty.
RESULTS: Compared with the two-pill combination, the SPC increased life expectancy by 0.86 years (95% confidence interval [CI] 0.61-1.14), with a mean cost differential of -€12 (95% CI -9,719-8,131), making it the dominant strategy (ICER = -14, 95% CI -€15,871-€7,113). The cost reduction associated with the SPC was primarily driven by savings in hospitalization costs, amounting to €1,850 (95% CI 17-7,813) and €2,027 (95% CI 19-8,603) for patients treated with the SPC and two-pill combination, respectively. Conversely, drug costs were higher for the SPC (€3,848, 95% CI 574-10,640 vs. €3,710, 95% CI 263-11,955). The cost-effectiveness profile did not significantly change according to age, sex, and clinical status.
CONCLUSIONS: The SPC was projected to be cost-effective compared with the two-pill combination at almost all reasonable willingness-to-pay thresholds. As it is currently prescribed to only a few patients, the widespread use of this strategy could result in benefits for both patients and the healthcare system.
METHODS: A cost-effectiveness analysis was conducted using multi-state semi-Markov modeling and microsimulation. Using the healthcare utilization database of the Lombardy Region (Italy), 30,172 and 65,817 patients aged ≥ 40 years who initiated SPC and two-pill combination, respectively, between 2015 and 2018 were identified. The observation period extended from the date of the first drug dispensation until death, emigration, or December 31, 2019. Disease and cost models were parametrized using the study cohort, and a lifetime microsimulation was applied to project costs and life expectancy for the compared strategies, assigning each of them to each cohort member. Costs and life-years gained were discounted by 3%. Probabilistic sensitivity analysis with 1,000 samples was performed to address parameter uncertainty.
RESULTS: Compared with the two-pill combination, the SPC increased life expectancy by 0.86 years (95% confidence interval [CI] 0.61-1.14), with a mean cost differential of -€12 (95% CI -9,719-8,131), making it the dominant strategy (ICER = -14, 95% CI -€15,871-€7,113). The cost reduction associated with the SPC was primarily driven by savings in hospitalization costs, amounting to €1,850 (95% CI 17-7,813) and €2,027 (95% CI 19-8,603) for patients treated with the SPC and two-pill combination, respectively. Conversely, drug costs were higher for the SPC (€3,848, 95% CI 574-10,640 vs. €3,710, 95% CI 263-11,955). The cost-effectiveness profile did not significantly change according to age, sex, and clinical status.
CONCLUSIONS: The SPC was projected to be cost-effective compared with the two-pill combination at almost all reasonable willingness-to-pay thresholds. As it is currently prescribed to only a few patients, the widespread use of this strategy could result in benefits for both patients and the healthcare system.
摘要：
背景：与免费组合相比，三种抗高血压药物的单药组合（SPC）已被证明可以改善对治疗的依从性，但对其长期成本和健康后果知之甚少。这项研究旨在评估血管紧张素转换酶抑制剂的三种药物SPC的终生成本效益概况，钙通道阻滞剂,从意大利付款人的角度来看，利尿剂与相应的两丸给药（两药SPC加第三种药物）。
方法：使用多状态半马尔可夫建模和微观模拟进行了成本效益分析。使用伦巴第大区（意大利）的医疗保健利用数据库，30,172和65,817名年龄≥40岁的患者开始SPC和两药联合治疗，分别,在2015年至2018年之间被确定。观察期从第一次配药之日起延长至死亡，移民,或2019年12月31日。使用研究队列对疾病和成本模型进行参数化，并对比较策略的项目成本和预期寿命进行了终身微观模拟，将它们中的每一个分配给每个队列成员。获得的成本和生命年折价3%。对1,000个样本进行了概率敏感性分析，以解决参数不确定性。
结果：与两药组合相比，SPC将预期寿命增加了0.86年(95%置信区间[CI]0.61-1.14)，平均成本差异为-12欧元(95%CI-9,719-8,131)，使其成为主导战略（ICER=-14，95%CI-15,871-7,113欧元）。与SPC相关的成本降低主要是由于住院费用的节省，SPC和双药联合治疗的患者总计1,850欧元（95%CI17-7,813）和2,027欧元（95%CI19-8,603），分别。相反，SPC的药物费用更高（3,848欧元，95%CI574-10,640与3,710欧元，95%CI263-11,955）。成本效益状况没有因年龄而显著变化，性别,和临床状态。
结论：在几乎所有合理的支付意愿阈值下，与双药组合相比，SPC预计具有成本效益。由于目前只有少数患者处方，这一策略的广泛使用可能会给患者和医疗系统带来益处.
方法：使用多状态半马尔可夫建模和微观模拟进行了成本效益分析。使用伦巴第大区（意大利）的医疗保健利用数据库，30,172和65,817名年龄≥40岁的患者开始SPC和两药联合治疗，分别,在2015年至2018年之间被确定。观察期从第一次配药之日起延长至死亡，移民,或2019年12月31日。使用研究队列对疾病和成本模型进行参数化，并对比较策略的项目成本和预期寿命进行了终身微观模拟，将它们中的每一个分配给每个队列成员。获得的成本和生命年折价3%。对1,000个样本进行了概率敏感性分析，以解决参数不确定性。
结果：与两药组合相比，SPC将预期寿命增加了0.86年(95%置信区间[CI]0.61-1.14)，平均成本差异为-12欧元(95%CI-9,719-8,131)，使其成为主导战略（ICER=-14，95%CI-15,871-7,113欧元）。与SPC相关的成本降低主要是由于住院费用的节省，SPC和双药联合治疗的患者总计1,850欧元（95%CI17-7,813）和2,027欧元（95%CI19-8,603），分别。相反，SPC的药物费用更高（3,848欧元，95%CI574-10,640与3,710欧元，95%CI263-11,955）。成本效益状况没有因年龄而显著变化，性别,和临床状态。
结论：在几乎所有合理的支付意愿阈值下，与双药组合相比，SPC预计具有成本效益。由于目前只有少数患者处方，这一策略的广泛使用可能会给患者和医疗系统带来益处.
