急性心不全におけるカルペリチド治療の臨床的有用性と医療経済性

Efficacy and Economic Benefits of Carperitide Therapy in Patients with Acute Heart Failure

要旨　カルペリチドの急性心不全治療の臨床的有用性と医療経済性を，同剤導入以前の治療と比較評価した．1999年以前に治療を受けた患者(非ハンプ群)データ90例を対照に，2003年のカルペリチド治療患者(ハンプ群)データ90例を調査した．ハンプ群と非ハンプ群の患者は，平均年齢72.7歳と71.2歳，NYHAクラスIII，IVが78%と70%であった．非ハンプ群では強心剤が70%，血管拡張剤が34%に使用された．平均入院日数は18.7日と32.7日，トイレ歩行までの日数は7.0日と12.6日であった．有害事象は18人と29人で報告され，不整脈が主であった．診断群分類包括評価で算定した1患者入院費総額はハンプ群で507千円，非ハンプ群で738千円であった．カルペリチド治療は従来治療より入院期間短縮，入院費総額減少など臨床的，医療経済的に有用である．

　We assessed the efficacy and economic benefit of carperitide therapy(CA) in patients with acute heart failure to compare it with that of other therapies(OT) conducted before the introduction of CA. Data on the patients were selected sequentially in order of admission to our hospital because of acute heart failure including acute decompensation of chronic heart failure from the patient group who received CA during 2003; and in reverse order of admission before November 1999 for the OT group with a selection of patients to balance the baseline characteristics between the two cohorts.

　A total of 180 patients,90 for CA and 90 for OT,were subjected to the study; 54% and 59% male,72.7 and 71.2 years old, 78% and 70% NYHA class III to IV, respectively. In 70% of the OT group, patients were treated with inotropes and 34% were with vasodilators. Mean length of stay in hospital of CA and OT patients was 18.7 and 32.7 days,respectively. 78% of CA patients and 55% of OT patients were admitted to CCU during the hospitalization. Days before being able to walk to the restroom were 7.0 in CA patients and 12.6 in OT patients. Adverse events were reported in 18 patients (20.0%) under CA and 29 patients(32.2%) under OT during the therapy. Major events reported were cardiovascular events in the two cohorts including arrhythmia,(exacerbation of)the cardiac failure.Death during hospitalization was reported in 10(11%)of CA patients and 15(17%)of OT patients. Medical treatment fees for the patients were estimated based on the Diagnosis Procedure Combination system.They were 506,754 yen/hospitalization for CA therapy group and 737,973 yen/hospitalization for the OT group.Treatment fee per day was 27,541 yen for the CA group and 23,502 yen for the OT group. Pharmaceutical costs throughout the hospitalization period were 110,205 yen and 199,948 yen for patients who received CA and OT,respectively.Fees for clinical tests per hospitalization were 42,217 yen for the CA group and 65,628 yen for the OT group.

　CA is more efficient than other therapies given before the introduction of CA, including inotropes, in clinical effects including shortening of the length of hospital stay and economic benefits including reduction in therapeutic fees.