高危險群門診病患Statin類藥物治療型態與費用效益評估

Treatment Patterns and Cost-Effective Evaluation of Statins in High Risk Outpatients

邱春吉(Chun-Chi Chiu) ； 陳世明(Shyh-Ming Chen) ； 李炳鈺(Ping-Yi Lee) ； 戴慶玲(Ching-Ling Ta) ； 江吉文(Chi-Wen Chiang)

《台灣醫學》 16卷1期 (2012/01) Pp. 1-12

https://doi.org/10.6320/FJM.2012.16(1).01

摘要

Coronary heart disease (CHD) is the leading cause of death in Taiwan. The low-density lipoprotein cholesterol (LDL-C) is the major lipoprotein to cause atherosclerosis. Many clinical trials indicated that lowering LDL-C with a statin can reduce the morbidity and mortality of CHD. Although there are well-established benefits of statin therapy from evidence-based medical researches, however current management of dyslipidemia in high risk patients is suboptimal. There remains room to improve the quality of care for these patients. We evaluate the treatment patterns and cost effective of statins in high risk outpatients in a medical center. In this retrospective, longitudinal and observational study, we extracted high risk patients who received newly treatment with statins from administrative claims database in a medical center. The patients eligible for participation were assigned to 10 treatment groups. The following data were obtained by using health information system (HIS) and the electronic medical record system including demographics, diagnoses, lipid levels, liver function tests, and use of statins. The date of the first dispensed prescription of statins was considered as the index date, patients were measured with one pre-index and at least one post-index lipid profile had been followed until their statin therapy was changed or until the end of the study period. A total of 319 patients met the inclusion criteria. The mean age was very similar among groups (63 to 67 years). Comparison of the pre-index and post-index changes of all lipid profiles across statins and dose ranges showed that only low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC) significantly changed (p＜0.05). The annual costs for each 1% LDL reduction were New Taiwan Dollar (NTD) 132 and 231 of rosuvastatin 5 mg and 10 mg, respectively. These costs were lower than those of simvastatin, fluvastatin, and atorvastatin. The annual costs for each patient to achieve the NCEP ATP III LDL goals (＜100 mg/dL) were lowest in rosuvastatin groups (NTD 8130-14695). Our study suggests that in statin-therapy for hyperlipidemia, even low dose statin can reveal clinical efficacy and the longer the duration of follow up the better. Our results also implied that rosuvastatin 5 mg may be the most cost-effective therapy and low dose statin may be suitable for patients whose baseline lipid profile is not very high in the study population. Our study may contribute to the development of strategy for promoting health and reducing costs of health care.

關鍵字

低密度脂蛋白膽固醇 ； statin ； 費用效益

並列摘要

Coronary heart disease (CHD) is the leading cause of death in Taiwan. The low-density lipoprotein cholesterol (LDL-C) is the major lipoprotein to cause atherosclerosis. Many clinical trials indicated that lowering LDL-C with a statin can reduce the morbidity and mortality of CHD. Although there are well-established benefits of statin therapy from evidence-based medical researches, however current management of dyslipidemia in high risk patients is suboptimal. There remains room to improve the quality of care for these patients. We evaluate the treatment patterns and cost effective of statins in high risk outpatients in a medical center. In this retrospective, longitudinal and observational study, we extracted high risk patients who received newly treatment with statins from administrative claims database in a medical center. The patients eligible for participation were assigned to 10 treatment groups. The following data were obtained by using health information system (HIS) and the electronic medical record system including demographics, diagnoses, lipid levels, liver function tests, and use of statins. The date of the first dispensed prescription of statins was considered as the index date, patients were measured with one pre-index and at least one post-index lipid profile had been followed until their statin therapy was changed or until the end of the study period. A total of 319 patients met the inclusion criteria. The mean age was very similar among groups (63 to 67 years). Comparison of the pre-index and post-index changes of all lipid profiles across statins and dose ranges showed that only low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC) significantly changed (p＜0.05). The annual costs for each 1% LDL reduction were New Taiwan Dollar (NTD) 132 and 231 of rosuvastatin 5 mg and 10 mg, respectively. These costs were lower than those of simvastatin, fluvastatin, and atorvastatin. The annual costs for each patient to achieve the NCEP ATP III LDL goals (＜100 mg/dL) were lowest in rosuvastatin groups (NTD 8130-14695). Our study suggests that in statin-therapy for hyperlipidemia, even low dose statin can reveal clinical efficacy and the longer the duration of follow up the better. Our results also implied that rosuvastatin 5 mg may be the most cost-effective therapy and low dose statin may be suitable for patients whose baseline lipid profile is not very high in the study population. Our study may contribute to the development of strategy for promoting health and reducing costs of health care.

並列關鍵字

low density lipoprotein cholesterol ； statin ； cost effective