多血管疾病患者急性心肌梗死后心血管事件的复发及相关医疗费用:德国索赔数据分析》。

IF 4.4 3区 医学 Q1 ECONOMICS PharmacoEconomics Pub Date : 2024-11-04 DOI:10.1007/s40273-024-01440-5
Alexandra Starry, Nils Picker, Jonathan Galduf, Ulf Maywald, Axel Dittmar, Stefan G Spitzer
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引用次数: 0

摘要

目的:本研究旨在量化多血管疾病(MVD)的医疗成本,并确定急性心肌梗死(MI)后确诊为多血管疾病的高危患者中复发性主要不良心血管事件(MACE)的发生率和发病率:这项回顾性研究利用了 2010 年 1 月 1 日至 2020 年 12 月 31 日期间的德国索赔数据(AOK PLUS)。研究对象包括以下患者:(1) 2012 年 1 月 1 日至 2019 年 12 月 31 日(指数日期)期间被诊断为心肌梗死的住院患者;(2) 诊断为心肌梗死时年龄≥ 18 岁;(3) 患有糖尿病或符合以下两项标准:≥ 65 岁、既往心肌梗死、外周动脉疾病。MACE定义为:(1)心肌梗死;(2)中风;或(3)30天内经心血管诊断死亡。为衡量 MVD 造成的负担,在指数住院期间根据是否存在 MVD 对患者进行识别。根据倾向得分匹配(PSM)进行调整后,比较了医疗资源使用情况和成本:主要分析共纳入了 5158 名有 MVD 证据的患者。31.17%的患者在发生心肌梗死后的365天内发生了MACE。经 PSM 调整后,33.22% 的 MVD 患者经历了 MACE,而非 MVD 患者的这一比例为 36.48%。MVD患者的心肌梗死复发率更高(14.22% 对 9.81%)。此外,在发生心肌梗死后的第一年,MVD队列的公共医疗费用比非MVD队列高出约400万欧元(分别为47896012.32欧元对43718713.75欧元),这反映出MVD队列对公共医疗系统的使用率更高。更多的 MVD 患者接受了指南推荐的药物治疗(61.4% 对 46.0%):本研究发现,MVD患者的心肌梗死复发率较高。尽管与非MVD患者相比,MVD患者接受指南指导药物治疗的比例更高,但其心肌梗死复发率也更高。相反,非 MVD 患者的死亡率较高。
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Recurrence of Cardiovascular Events After an Acute Myocardial Infarction in Patients with Multivessel Disease and Associated Healthcare Costs: A German Claims Data Analysis.

Aim: This study sought to quantify the healthcare costs of multivessel disease (MVD) and determine the prevalence and incidence of recurrent major adverse cardiovascular events (MACE) in high-risk patients diagnosed with MVD following an acute myocardial infarction (MI).

Methods: This retrospective study utilized German claims data (AOK PLUS), between 01/01/2010 and 31/12/2020. Patients were included if they (1) had an inpatient diagnosis of an MI between 01/01/2012 and 31/12/2019 (index date), (2) were ≥ 18 years of age at date of MI diagnosis, and (3) had diabetes or met two of the following criteria: ≥ 65 years old, prior MI, peripheral arterial disease. MACE was defined as (1) MI, (2) stroke, or (3) death with a cardiovascular diagnosis within 30 days prior. To measure the burden of MVD, patients were identified during the index hospitalization by presence of MVD. Healthcare resource use and costs were compared after adjustment based on propensity score matching (PSM).

Results: A total of 5158 patients with evidence for MVD were included in the main analysis. 31.17% experienced a MACE within 365 days following the incident MI. After PSM adjustment, 33.22% of the MVD cohort experienced a MACE versus 36.48% of non-MVD patients. MVD patients had a higher rate of recurrent MI (14.22% vs. 9.81%). Additionally, public healthcare costs were about €4 million higher in the total MVD cohort than in the non-MVD cohort in the first year after an MI (€47,896,012.32 vs. €43,718,713.75, respectively), reflecting the MVD cohort's higher use of the public healthcare system. More MVD patients were prescribed guideline-recommended medication (61.4% vs. 46.0%).

Conclusion: This study found that presence of MVD contributed to higher rates of recurrent MI. Patients with MVD experienced higher rates of recurrent MI despite a higher proportion of patients receiving guideline-directed medication therapy compared to non-MVD patients. Conversely, there was a higher mortality rate observed in the non-MVD cohort.

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来源期刊
PharmacoEconomics
PharmacoEconomics 医学-药学
CiteScore
8.10
自引率
9.10%
发文量
85
审稿时长
6-12 weeks
期刊介绍: PharmacoEconomics is the benchmark journal for peer-reviewed, authoritative and practical articles on the application of pharmacoeconomics and quality-of-life assessment to optimum drug therapy and health outcomes. An invaluable source of applied pharmacoeconomic original research and educational material for the healthcare decision maker. PharmacoEconomics is dedicated to the clear communication of complex pharmacoeconomic issues related to patient care and drug utilization. PharmacoEconomics offers a range of additional features designed to increase the visibility, readership and educational value of the journal’s content. Each article is accompanied by a Key Points summary, giving a time-efficient overview of the content to a wide readership. Articles may be accompanied by plain language summaries to assist readers who have some knowledge of, but not in-depth expertise in, the area to understand the scientific content and overall implications of the article.
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