目的:本研究的目的是评估西班牙临床实践对慢性阻塞性肺疾病(COPD)治疗指南建议的不遵守程度,并评估根据指南转变当前治疗模式对药物支出的潜在影响。
方法:开发了一个模型,用于将当前的处方模式与两种替代方案进行比较:第一种方案符合全球慢性阻塞性肺疾病倡议(GOLD2020)的建议,第二个是西班牙COPD指南(GesEPOC2017)。当前的治疗实践是从描述西班牙肺科治疗模式的出版物中获得的。模式之间的经济影响是从西班牙国家卫生系统(NHS)的角度计算的,考虑COPD吸入性维持治疗的年度药物费用。另外进行了两项分析:一项分析包括由西班牙肺科和初级保健中心管理的患者的当前处方模式(已发布的汇总数据);另一项分析仅根据指南考虑适当使用吸入性皮质类固醇(ICS)治疗。
结果:估计有54%和38%的患者未按照GOLD和GesEPOC的建议进行治疗,分别,主要是由于更广泛地使用基于ICS的疗法。根据建议调整治疗方法可以每年节省17,792,022欧元(根据GOLD)和5,881,785欧元(根据GesEPOC)。在情景分析1中,观察到26%的不遵守GesEPOC指南,潜在的年度药理学成本节省为2,707,554欧元。在情景分析2中,仅考虑不适当地使用ICS治疗,计算出每年节省的成本为17,863,750欧元(根据GOLD)和9,904,409欧元(根据GesEPOC)。
结论:在西班牙,超过三分之一的COPD患者的治疗没有按照指南建议进行。使临床实践适应指南建议可以为西班牙NHS节省重要的成本。
OBJECTIVE: The objective of this study was to assess the non-adherence level of Spanish clinical practice to
guideline recommendations for the treatment of chronic obstructive pulmonary disease (COPD) and to estimate the potential impact on pharmaceutical expenditure resulting from transitioning current treatment patterns according to
guidelines.
METHODS: A model was developed to compare current prescribing patterns with two alternative scenarios: the first aligned with the Global Initiative for Chronic Obstructive Lung Disease (GOLD 2020) recommendations, and the second with the Spanish
Guidelines for COPD (GesEPOC 2017). Current treatment practice was obtained from publications that describe treatment patterns by pulmonology departments in Spain. The economic impact between patterns was calculated from the perspective of the Spanish National Health System (NHS), considering the annual pharmacological costs of COPD inhaled maintenance therapy. Two additional analyses were performed: one that included current prescribing patterns of patients managed by pulmonology and primary care centers in Spain (published aggregated data); and another that only considered the appropriate use of inhaled corticosteroids (ICS) treatment according to
guidelines.
RESULTS: It was estimated that 54% and 38% of patients were not treated in line with GOLD and GesEPOC recommendations, respectively, mainly due to a broader use of ICS-based therapies. Adapting treatment to recommendations could provide a potential annual cost-saving of €17,792,022 (according to GOLD) and €5,881,785 (according to GesEPOC). In scenario analysis 1, a 26% of non-adherence to GesEPOC guideline was observed with a potential annual pharmacological cost-saving of €2,707,554. In scenario analysis 2, considering only inappropriate use of ICS treatment, an annual cost-saving of €17,863,750 (according to GOLD) and €9,904,409 (according to GesEPOC) was calculated.
CONCLUSIONS: More than a third of treatments for COPD patients in Spain are not prescribed in accordance with guideline recommendations. The adaptation of clinical practice to
guideline recommendations could provide important cost-savings for the Spanish NHS.