目的 了解急性冠脉综合征(ACS)患者血运重建术后双联抗血小板用药依从性对其临床结局及经济负担的影响,为提高ACS患者用药依从性,降低其疾病负担提供证据支撑.方法 基于2015-2019年天津市城镇职工基本医疗保险随机抽样数据库,通过疾病诊断与药品处方信息识别2016-2018年进行过血运重建术且使用过双联抗血小板药物的ACS患者4986例为研究对象.对研究对象进行随访,随访时间为1年,随访结局为随访期内首次发生的主要不良心血管事件(MACE)、急性心肌梗死、缺血性卒中、全因死亡、经皮冠状动脉介入术(PCI)、冠状动脉旁路移植术(CABG)以及任意出血和严重出血.根据ACS事件出院后1年内的双联抗血小板用药依从性,将患者分为依从组和非依从组.使用Stata 13.0进行t检验、x2检验、Kaplan-Meier生存分析、Log-rank检验、Cox回归分析、logistic回归、负二项回归和广义线性回归分析.结果 该研究4 986例患者的平均依从用药天数占比(PDC)为0.57±0.28.依从组1 314人(26.4％),非依从组3 672人(73.6％).多因素Cox回归分析结果显示,与非依从组相比,依从组患者的MACE发生风险降低34％(HR=0.66),PCI发生风险降低55％(HR=0.45),均有统计学意义(P＜0.05);两组患者的任意出血事件发生风险差异无统计学意义(P＞0.05).依从组患者的MACE发生率低于非依从组,生存曲线差异有统计学意义(P＜0.05).在医疗资源使用方面,依从用药会增加人均门诊就诊次数(调整后差值=8.4次,P＜0.01),但显著降低了住院患者的比例(调整后差值=-7.1％,P＜0.01)、人均住院次数(调整后差值=-0.1次,P＜0.01)和人均住院天数(调整后差值=-2.0d,P＜0.01).在直接医疗费用方面,依从用药会增加人均门诊费用2 952元(P＜0.01),但人均住院费用降低4 079元(P＜0.01).总体而言,依从组患者的人均总费用与非依从组患者的差异无统计学意义(P＞0.05).结论 天津市ACS患者血运重建术后的双联抗血小板用药依从性较差.依从使用双联抗血小板药物可降低ACS患者血运重建术后MACE和PCI事件发生风险,对其他单个心脑血管终点的影响较小,总体上并未增加ACS患者的总医疗费用.

目的 从中国卫生体系角度,评价地舒单抗较阿仑膦酸钠和唑来膦酸,用于治疗绝经后女性骨质疏松症(osteoporosis,OP)的经济性.方法 构建Markov模型,设定治疗周期为5年,通过已发表文献获得临床疗效、健康收益及成本数据,计算各干预措施下患者终身疾病转归、效用及成本.以增量成本-效果比(incremental cost-effectiveness ratio,ICER)为指标,在3倍人均GDP阈值下,评价各干预措施的经济性.采用情境分析、单因素敏感性分析和概率敏感性分析检验结果稳健性.结果 地舒单抗、阿仑膦酸钠和唑来膦酸组患者的总成本分别为19 268、18 324和22 386元;总质量调整生命年(quality-adjusted life year,QALY)为7.58、7.53和7.56.与阿仑膦酸钠相比,地舒单抗使患者增加了 0.05个QALY,ICER为18 279元/QALY,远低于1倍人均GDP,更具经济性.与唑来膦酸相比,地舒单抗使患者增加了 0.03个QALY且成本更低,具有绝对优势.敏感性分析证明了结果的稳健性.结论 在治疗绝经后女性OP方面,地舒单抗较阿仑膦酸钠更具经济性,较唑来膦酸具有绝对优势.

目的:掌握真实世界中初始使用胰高血糖素样肽-1受体激动剂(Glucagon-like Peptide-1 Receptor Agonists,GLP-1 RAs)的2型糖尿病患者的基本特征和用药模式.方法:基于2015-2019年间天津市10家三级医院的信息系统数据库,通过疾病诊断与药品处方信息识别2016-2018年间初始使用GLP-1类药物的2型糖尿病患者.分别统计入组患者的基线特征及随访期间的用药模式,包括用药依从性、持续性、平均日剂量以及联合用药情况等.结果:研究共识别到初始使用GLP-1类药物的患者1705人,由于利拉鲁肽使用者占95％以上,为保证样本人群的同质性,仅纳入利拉鲁肽用药患者1624人.患者入组时的平均年龄为52.5±12.8岁,男性占比56.8％.患者在入组后一年内使用GLP-1类药物的依从性(处方覆盖天数比例)为0.54,依从性好、依从性一般和依从性差的患者比例分别为35.4％、21.2％和43.5％;患者平均持续用药天数为201.9±170.0天,在入组后一年内停止用药的患者比例为49.3％;平均日剂量为0.70 mg·d-1;有46.7％的患者在GLP-1类药物基础上联合使用其他降糖药.结论:在中国2型糖尿病患者中,GLP-1类药物的用药依从性有待提高,应加强糖尿病患者特别是心脑血管疾病高危人群的用药教育和管理,以提高患者对药品使用的依从性.

Objectives This study aimed to estimate the impact of hyperkalemia on 1-year survival and all-cause healthcare resource utilization among patients with chronic kidney disease in China. Methods Adult new-onset chronic kidney disease patients were identified between 2012 and 2016, among which the hyperkalemia and non-hyperkalemia cohorts were further selected and matched. Survival and all-cause healthcare resource utilization during a 12 month period were compared using Kaplan-Meier curves with log-rank test, Cox proportional hazard model, and Kaplan-Meier sample average method. Results Among 1,003 pairs of patients (mean age 67.2 ± 14.3 years), the 1-year all-cause mortality was 5.39-times higher in the hyperkalemia cohort than the non-hyperkalemia cohort (hazard ratio = 5.39, P < 0.001). The mean costs and number of healthcare services among the hyperkalemia patients were significantly higher ( P < 0.05) in each follow-up month. An annual increase cost of ¥38,479 was observed in the hyperkalemia cohort, largely due to the sharp increase in inpatient costs during the first month after hyperkalemia events (¥22,204 vs. 1,032, P < 0.001). Medication costs were the most important cost component for both cohorts [¥26,786 (45%) vs. ¥12,378(60%)]. However, hyperkalemia patients spent more on non-medication treatment [¥13,410(23%) vs. ¥2,335(11%)] including nursing, monitoring, etc. Hyperkalemia patients had more annual inpatient admissions (1.9 vs. 0.7) and length of stays (28.6 vs. 8.7), while the number of outpatient visits (36.8 vs. 36.4) were similar. Conclusions In Chinese chronic kidney disease patients, hyperkalemia is associated with substantially increased clinical and economic burdens that are driven by the short period following the hyperkalemia events, which strengthens calls for sufficient supervision and management of serum potassium.

Aims: To investigate the association of severe hypoglycemia (SH) with all-cause mortality and complication risks among Chinese patients with type 2 diabetes mellitus (T2DM). Methods: Cohort study and nested case-control studies were conducted based on medical insurance database 2008-2015. The incidence of outcomes or the exposure of previous SH was compared among matched patients, respectively. The association between SH and outcomes was investigated and validated by different models. Results: Among cohort study participants (mean age of 59.0 +/- 11.2 years), SH was associated with higher risk of all-cause mortality (HR = 1.80, P < 0.001) and transient ischemic attacks (TIA, HR = 1.51, P < 0.001), while no association was observed between SH and complications including myocardial infarction (MI), angina, arrhythmia and stroke. Similarly, SH was associated with about doubled all-cause mortality (OR = 1.76, P < 0.001) and TIA (OR = 2.00, P < 0.001), but not associated with risk of MI or stroke in nested case-control studies. Conclusions: In Chinese patients with T2DM, SH is associated with increased risk of all cause mortality and TIA, but no significant differences were found regard to the other examined complication risks, which need to be further explored in future studies. (c) 2020 Elsevier B.V. All rights reserved.