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Burn E, Roel E, Pistillo A, Fernández-Bertolín S, Aragón M, Raventós B, Reyes C, Verhamme K, Rijnbeek P, Li X, Strauss VY, Prieto-Alhambra D, Duarte-Salles T. Thrombosis and thrombocytopenia after vaccination against and infection with SARS-CoV-2 in Catalonia, Spain. Nat Commun 2022; 13:7169. [PMID: 36418321 PMCID: PMC9684434 DOI: 10.1038/s41467-022-34669-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/01/2022] [Indexed: 11/24/2022] Open
Abstract
Population-based studies can provide important evidence on the safety of COVID-19 vaccines. Here we compare rates of thrombosis and thrombocytopenia following vaccination against SARS-CoV-2 with the background (expected) rates in the general population. In addition, we compare the rates of the same adverse events among persons infected with SARS-CoV-2 with background rates. Primary care and linked hospital data from Catalonia, Spain informed the study, with participants vaccinated with BNT162b2 or ChAdOx1 (27/12/2020-23/06/2021), COVID-19 cases (01/09/2020-23/06/2021) or present in the database as of 01/01/2017. We included 2,021,366 BNT162b2 (1,327,031 with 2 doses), 592,408 ChAdOx1, 174,556 COVID-19 cases, and 4,573,494 background participants. Standardised incidence ratios for venous thromboembolism were 1.18 (95% CI 1.06-1.32) and 0.92 (0.81-1.05) after first- and second dose BNT162b2, and 0.92 (0.71-1.18) after first dose ChAdOx1. The standardised incidence ratio for venous thromboembolism in COVID-19 was 10.19 (9.43-11.02). Standardised incidence ratios for arterial thromboembolism were 1.02 (0.95-1.09) and 1.04 (0.97-1.12) after first- and second dose BNT162b2, 1.06 (0.91-1.23) after first-dose ChAdOx1 and 4.13 (3.83-4.45) for COVID-19. Standardised incidence ratios for thrombocytopenia were 1.49 (1.43-1.54) and 1.40 (1.35-1.45) after first- and second dose BNT162b2, 1.28 (1.19-1.38) after first-dose ChAdOx1 and 4.59 (4.41- 4.77) for COVID-19. While rates of thrombosis with thrombocytopenia were generally similar to background rates, the standardised incidence ratio for pulmonary embolism with thrombocytopenia after first-dose BNT162b2 was 1.70 (1.11-2.61). These findings suggest that the safety profiles of BNT162b2 and ChAdOx1 are similar, with rates of adverse events seen after vaccination typically similar to background rates. Meanwhile, rates of adverse events are much increased for COVID-19 cases further underlining the importance of vaccination.
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Affiliation(s)
- Edward Burn
- grid.452479.9Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain ,grid.4991.50000 0004 1936 8948Centre for Statistics in Medicine (CSM), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Elena Roel
- grid.452479.9Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain ,grid.7080.f0000 0001 2296 0625Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain
| | - Andrea Pistillo
- grid.452479.9Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Sergio Fernández-Bertolín
- grid.452479.9Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Maria Aragón
- grid.452479.9Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Berta Raventós
- grid.452479.9Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain ,grid.7080.f0000 0001 2296 0625Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain
| | - Carlen Reyes
- grid.452479.9Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Katia Verhamme
- grid.5645.2000000040459992XDepartment of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Peter Rijnbeek
- grid.5645.2000000040459992XDepartment of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Xintong Li
- grid.4991.50000 0004 1936 8948Centre for Statistics in Medicine (CSM), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Victoria Y. Strauss
- grid.4991.50000 0004 1936 8948Centre for Statistics in Medicine (CSM), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Daniel Prieto-Alhambra
- grid.4991.50000 0004 1936 8948Centre for Statistics in Medicine (CSM), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK ,grid.5645.2000000040459992XDepartment of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Talita Duarte-Salles
- grid.452479.9Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
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Real-world cost-effectiveness analysis of NOACs versus VKA for stroke prevention in Spain. PLoS One 2022; 17:e0266658. [PMID: 35443000 PMCID: PMC9020681 DOI: 10.1371/journal.pone.0266658] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 03/24/2022] [Indexed: 01/21/2023] Open
Abstract
Aims A Markov model was adapted to assess the real-world cost-effectiveness of rivaroxaban, dabigatran and apixaban. Each of these non-vitamin K antagonist oral anticoagulants was compared with vitamin K antagonist for stroke prevention in patients with non-valvular atrial fibrillation in Spain. Methods All inputs were derived from real-world studies: baseline patient characteristics, clinical event rates, as well as persistence rates for the vitamin K antagonist treatment option. A meta-analysis of real-world studies provided treatment effect and persistence data for rivaroxaban, dabigatran and apixaban, each compared with vitamin K antagonist therapy. The model considered 3-month cycles over a lifetime horizon. The model outcomes included different costs, quality-adjusted life years and life-years gained. Sensitivity analyses were performed to test the robustness of the model. Results When compared with vitamin K antagonist, rivaroxaban incurred incremental costs of €77 and resulted in incremental quality-adjusted life years of 0.08. The incremental cost per quality-adjusted life year was €952. For the same comparison, the incremental cost per quality-adjusted life year for dabigatran was €4,612. Finally, compared with vitamin K antagonist, the incremental cost per quality-adjusted life year for apixaban was €32,015. The sensitivity analyses confirmed the robustness of the base case results. The probabilities to be cost-effective versus vitamin K antagonist were 94%, 86% and 35%, respectively, for rivaroxaban, dabigatran and apixaban, considering a willingness-to-pay threshold of €22,000 per quality-adjusted life year gained, based on a cost-effectiveness study of the Spanish National Health System. Conclusion These results suggest that rivaroxaban and dabigatran are cost-effective versus vitamin K antagonist for stroke prevention in non-valvular atrial fibrillation, from the Spanish National Health System perspective.
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Barrios V, Cinza-Sanjurjo S, Gavín O, Egocheaga I, Burgos-Pol R, Soto J, Polanco C, Suárez J, Casado MÁ. Carga y coste del mal control de la anticoagulación con antagonistas de la vitamina K en pacientes con fibrilación auricular no valvular en España. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Barrios V, Cinza-Sanjurjo S, Gavín O, Egocheaga I, Burgos-Pol R, Soto J, Polanco C, Suárez J, Casado MÁ. Cost and burden of poor anticoagulation control with vitamin K antagonists in patients with nonvalvular atrial fibrillation in Spain. ACTA ACUST UNITED AC 2020; 74:773-780. [PMID: 32980294 DOI: 10.1016/j.rec.2020.06.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 06/05/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND OBJECTIVES The aim of this analysis was to evaluate the burden and cost of complications due to poor anticoagulation control in patients with nonvalvular atrial fibrillation (NVAF) treated with vitamin K antagonists (VKA) in Spain. METHODS An analytical model was used to estimate annual differences in ischemic stroke, major bleeding, deaths, costs, and potential years of life lost between patients with poor anticoagulation control (time in therapeutic range <65%) and adequate control (time in therapeutic range ≥ 65%) with a 1-year time horizon. Information on the target population (patients ≥ 65 years), event rates, and costs were obtained from national sources. Direct costs in euros (2018) were included from the perspective of the national health system (NHS) and direct and indirect costs from the societal perspective. A sensitivity analysis was performed with post-hoc data from the SPORTIF III/V trials. RESULTS We analyzed a hypothetical cohort of 594 855 patients, 48.3% with poor anticoagulation control, with an increase of 2321 ischemic strokes, 2236 major bleeding events and 14 463 deaths, and an annual incremental cost between €29 578 306 from the NHS perspective and €75 737 451 from the societal perspective. The annual impact of mortality was 170 502 potential years of life lost. The results of the sensitivity analysis showed that the annual cost would reach €97 787 873 from the societal perspective. CONCLUSIONS Poor anticoagulation control with AVK has a strong impact on loss of health and on increased spending for the NHS.
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Affiliation(s)
- Vivencio Barrios
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain.
| | - Sergio Cinza-Sanjurjo
- Centro de Salud Porto do Son, Área Sanitaria de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Olga Gavín
- Servicio de Hematología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | - Ramón Burgos-Pol
- Pharmacoeconomics & Outcomes Research Iberia (PORIB), Madrid, Spain
| | - Javier Soto
- Farmacoeconomía e Investigación de Resultados, Pfizer S.L.U., Madrid, Spain
| | - Carlos Polanco
- Health Economics and Outcomes Research, Bristol-Myers Squibb, Madrid, Spain
| | - Jorge Suárez
- Health Economics and Outcomes Research, Bristol-Myers Squibb, Madrid, Spain
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Hempenius M, Luijken K, de Boer A, Klungel O, Groenwold R, Gardarsdottir H. Quality of reporting of drug exposure in pharmacoepidemiological studies. Pharmacoepidemiol Drug Saf 2020; 29:1141-1150. [PMID: 32394589 PMCID: PMC7539966 DOI: 10.1002/pds.5020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 03/26/2020] [Accepted: 04/06/2020] [Indexed: 12/31/2022]
Abstract
Purpose Exposure definitions vary across pharmacoepidemiological studies. Therefore, transparent reporting of exposure definitions is important for interpretation of published study results. We aimed to assess the quality of reporting of exposure to identify where improvement may be needed. Method We systematically reviewed observational pharmacoepidemiological studies that used routinely collected health data, published in 2017 in six pharmacoepidemiological journals. Reporting of exposure was scored using 11 items of the ISPE‐ISPOR guideline on reporting of pharmacoepidemiological studies. Results Of the 91 studies included, all studies reported the type of exposure (100%), while most reported the exposure risk window (85%) and the exposure assessment window (98%). Operationalization of the exposure window was described infrequently: 16% (14/90) of the studies explicitly reported the presence or absence of an induction period if applicable, 11% (5/47), and 35% (17/49) reported how stockpiling and gaps between exposure episodes were handled, respectively, and 35% (17/49) explicitly mentioned the exposure extension. Switching/add‐on was reported in 62% (50/81). How switching between drugs was dealt with and specific drug codes were reported in 52 (57%) and 24 (26%) studies, respectively. Conclusion Publications of pharmacoepidemiological studies frequently reported the type of exposure, the exposure risk window, and the exposure assessment window. However, more details on exposure assessment are needed, especially when it concerns the operationalization of the exposure risk window (eg, the presence or absence of an induction period or exposure extension, handling of stockpiling and gaps, and specific codes), to allow for correct interpretation, reproducibility, and assessment of validity.
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Affiliation(s)
- Mirjam Hempenius
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Kim Luijken
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Anthonius de Boer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - Olaf Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Rolf Groenwold
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands.,Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Helga Gardarsdottir
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands.,Department of Clinical Pharmacy, Division Laboratories, Pharmacy and Biomedical Genetics, University Medical Center Utrecht, Utrecht, the Netherlands.,Faculty of Pharmaceutical Sciences, University of Iceland, Reykjavik, Iceland
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Giner-Soriano M, Casajuana M, Roso-Llorach A, Vedia C, Morros R. [Effectiveness, safety and costs of stroke prevention in non-valvular auricular fibrillation. Study of cohorts matched by Propensity score]. Aten Primaria 2020; 52:176-184. [PMID: 31551166 PMCID: PMC7063152 DOI: 10.1016/j.aprim.2019.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/28/2019] [Accepted: 06/05/2019] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To analyze the use, effectiveness, safety and costs of stroke prevention in non-valvular atrial fibrillation (AF) in patients initiating treatment with dabigatran or vitamin K antagonists (VKA). SETTING Primary Care (PC) at the Catalan Health Institute (ICS) in Catalonia, during 2011-2013. PARTICIPANTS Patients attended in ICS PC centres with a registered diagnosis of AF who initiate dabigatran or VKA. INTERVENTIONS Not applicable MAIN MEASUREMENTS: Number of prescriptions and reimbursements of dabigatran and VKA, incidence of stroke and haemorrhages, incidence of mortatlity, number of sickness leave, and costs associated to all the previous variables. RESULTS 14,930 patients were included; 94.6% initiated VKA and 5.4%, dabigatran. Dabigatran patients were younger and with less comorbidity. There were no statistically significant differences between VKA and dabigatran in the risk of stroke, haemorrhages or death. The costs associated to AF management were higher for PC visits in the VKA group, and higher for laboratory and pharmacy in the dabigatran group, although overall costs were not statistically different. CONCLUSIONS Most patients initiated VKA. We found no differences between VKA and dabigatran in the risk of stroke, haemorrhages or mortality.
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Affiliation(s)
- Maria Giner-Soriano
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, España; Institut Català de la Salut, Departament de Salut, Generalitat de Catalunya, Barcelona, España.
| | - Marc Casajuana
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, España
| | - Albert Roso-Llorach
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, España
| | - Cristina Vedia
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, España; Unitat de Farmàcia, Servei d'Atenció Primària Barcelonès Nord i Maresme, Institut Català de la Salut, Badalona, Barcelona, España
| | - Rosa Morros
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, España; Institut Català de la Salut, Departament de Salut, Generalitat de Catalunya, Barcelona, España
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7
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Ibáñez L, Sabaté M, Vidal X, Ballarin E, Rottenkolber M, Schmiedl S, Heeke A, Huerta C, Martin Merino E, Montero D, Leon-Muñoz LM, Gasse C, Moore N, Droz C, Lassalle R, Aakjaer M, Andersen M, De Bruin ML, Groenwold R, van den Ham HA, Souverein P, Klungel O, Gardarsdottir H. Incidence of direct oral anticoagulant use in patients with nonvalvular atrial fibrillation and characteristics of users in 6 European countries (2008-2015): A cross-national drug utilization study. Br J Clin Pharmacol 2019; 85:2524-2539. [PMID: 31318059 PMCID: PMC6848911 DOI: 10.1111/bcp.14071] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 06/20/2019] [Accepted: 07/05/2019] [Indexed: 11/30/2022] Open
Abstract
Aims To estimate the incidence of direct oral anticoagulant drug (DOAC) use in patients with nonvalvular atrial fibrillation and to describe user and treatment characteristics in 8 European healthcare databases representing 6 European countries. Methods Longitudinal drug utilization study from January 2008 to December 2015. A common protocol approach was applied. Annual period incidences and direct standardisation by age and sex were performed. Dose adjustment related to change in age and by renal function as well as concomitant use of potentially interacting drugs were assessed. Results A total of 186 405 new DOAC users (age ≥18 years) were identified. Standardized incidences varied from 1.93–2.60 and 0.11–8.71 users/10 000 (2011–2015) for dabigatran and rivaroxaban, respectively, and from 0.01–8.12 users/10 000 (2012–2015) for apixaban. In 2015, the DOAC incidence ranged from 9 to 28/10 000 inhabitants in SIDIAP (Spain) and DNR (Denmark) respectively. There were differences in population coverage among the databases. Only 1 database includes the total reference population (DNR) while others are considered a population representative sample (CPRD, BIFAP, SIDIAP, EGB, Mondriaan). They also varied in the type of drug data source (administrative, clinical). Dose adjustment ranged from 4.6% in BIFAP (Spain) to 15.6% in EGB (France). Concomitant use of interacting drugs varied between 16.4% (SIDIAP) and 70.5% (EGB). Cardiovascular comorbidities ranged from 25.4% in Mondriaan (The Netherlands) to 82.9% in AOK Nordwest (Germany). Conclusion Overall, apixaban and rivaroxaban increased its use during the study period while dabigatran decreased. There was variability in patient characteristics such as comorbidities, potentially interacting drugs and dose adjustment. (EMA/2015/27/PH).
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Affiliation(s)
- Luisa Ibáñez
- Fundació Institut Català de Farmacologia (FICF), Hospital Vall d'Hebron, Barcelona, Spain.,Department of Clinical Pharmacology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Department of Pharmacology, Toxicology and Therapeutics, Universitat Autònoma de Barcelona, Spain
| | - Mònica Sabaté
- Fundació Institut Català de Farmacologia (FICF), Hospital Vall d'Hebron, Barcelona, Spain.,Department of Clinical Pharmacology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Department of Pharmacology, Toxicology and Therapeutics, Universitat Autònoma de Barcelona, Spain
| | - Xavier Vidal
- Fundació Institut Català de Farmacologia (FICF), Hospital Vall d'Hebron, Barcelona, Spain.,Department of Clinical Pharmacology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Department of Pharmacology, Toxicology and Therapeutics, Universitat Autònoma de Barcelona, Spain
| | - Elena Ballarin
- Fundació Institut Català de Farmacologia (FICF), Hospital Vall d'Hebron, Barcelona, Spain.,Department of Clinical Pharmacology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Marietta Rottenkolber
- Diabetes Research Group, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
| | - Sven Schmiedl
- Department of Clinical Pharmacology, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany.,Philipp Klee-Institute for Clinical Pharmacology, Helios University Hospital Wuppertal, Wuppertal, Germany
| | | | - Consuelo Huerta
- Pharmacoepidemiology and Pharmacovigilance Division, Spanish Agency of Medicines and Medical Devices (AEMPS), Madrid, Spain
| | - Elisa Martin Merino
- Pharmacoepidemiology and Pharmacovigilance Division, Spanish Agency of Medicines and Medical Devices (AEMPS), Madrid, Spain
| | - Dolores Montero
- Pharmacoepidemiology and Pharmacovigilance Division, Spanish Agency of Medicines and Medical Devices (AEMPS), Madrid, Spain
| | - Luz María Leon-Muñoz
- Pharmacoepidemiology and Pharmacovigilance Division, Spanish Agency of Medicines and Medical Devices (AEMPS), Madrid, Spain
| | | | - Nicholas Moore
- Bordeaux PharmacoEpi, INSERM CIC1401, Université de Bordeaux, CHU de Bordeaux, Bordeaux, France
| | - Cécile Droz
- Bordeaux PharmacoEpi, INSERM CIC1401, Université de Bordeaux, CHU de Bordeaux, Bordeaux, France
| | - Régis Lassalle
- Bordeaux PharmacoEpi, INSERM CIC1401, Université de Bordeaux, CHU de Bordeaux, Bordeaux, France
| | - Mia Aakjaer
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Morten Andersen
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marie Louise De Bruin
- Copenhagen Centre for Regulatory Science (CORS), Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rolf Groenwold
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hendrika A van den Ham
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Universiteit Utrecht, David de Wiedgebouw, Utrecht, The Netherlands
| | - Patrick Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Universiteit Utrecht, David de Wiedgebouw, Utrecht, The Netherlands
| | - Olaf Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Universiteit Utrecht, David de Wiedgebouw, Utrecht, The Netherlands.,Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Helga Gardarsdottir
- Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht, The Netherlands.,Faculty of Pharmaceutical Sciences, University of Iceland, Reykjavik, Iceland
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Casajuana M, Giner-Soriano M, Roso-Llorach A, Vedia C, Violan C, Morros R. Annual costs attributed to atrial fibrillation management: cross-sectional study of primary healthcare electronic records. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2018; 19:1129-1136. [PMID: 29464418 DOI: 10.1007/s10198-018-0961-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 02/14/2018] [Indexed: 06/08/2023]
Abstract
Atrial fibrillation (AF) is the most common chronic arrhythmia, with increasing healthcare and economic burden and a prevalence which increases with progressive ageing. This study aims to describe overall annual costs per patient for management of non-valvular AF in a primary healthcare (PHC) setting and compare these costs between the groups of patients treated with vitamin K antagonists, antiplatelets or non-treated through a population-based study conducted with electronic health records. We analysed annual costs per person of 19,787 patients in 2012; PHC visits, hospital admissions, AF-related events requiring hospital admission, referrals to secondary specialists, sick leave, diagnostic tests and laboratory tests at PHC level, including INR determinations performed in PHC, and drug therapy. Higher costs of AF management were associated with increasing age, male sex, stroke and bleeding risks, comorbidities and occurrence of events associated to AF. The sensitivity analyses conducted showed that PHC visits and hospitalizations represented the most important part of overall costs for all patients.
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Affiliation(s)
- Marc Casajuana
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Gran Via de les Corts Catalanes 587, àtic, 08007, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Maria Giner-Soriano
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Gran Via de les Corts Catalanes 587, àtic, 08007, Barcelona, Spain.
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.
- Institut Català de la Salut, Departament de Salut, Generalitat de Catalunya, Barcelona, Spain.
| | - Albert Roso-Llorach
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Gran Via de les Corts Catalanes 587, àtic, 08007, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Cristina Vedia
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Unitat de Farmàcia, Servei d'Atenció Primària Barcelonès Nord i Maresme, Institut Català de la Salut, Badalona, Spain
| | - Concepció Violan
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Gran Via de les Corts Catalanes 587, àtic, 08007, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Rosa Morros
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Gran Via de les Corts Catalanes 587, àtic, 08007, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Institut Català de la Salut, Departament de Salut, Generalitat de Catalunya, Barcelona, Spain
- UICEC IDIAP Jordi Gol, Plataforma SCReN, Barcelona, Spain
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9
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Giner-Soriano M, Sotorra Figuerola G, Cortés J, Pera Pujadas H, Garcia-Sangenis A, Morros R. Impact of Medication Adherence on Mortality and Cardiovascular Morbidity: Protocol for a Population-Based Cohort Study. JMIR Res Protoc 2018. [PMID: 29523501 PMCID: PMC5866299 DOI: 10.2196/resprot.8121] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is a group of disorders of the heart and blood vessels, such as coronary heart disease (CHD), cerebrovascular disease, and peripheral artery disease. CVD is the leading threat to global health, whether measured by mortality, morbidity, or economic cost. Long-term administration of aspirin, statins, beta-blockers, and angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers improves survival in patients with stablished coronary heart disease. Nevertheless, adherence to prescribed medication is poor for long-term drug treatment. OBJECTIVE We aim to assess the relationship between adherences to the four pharmacological groups recommended for secondary prevention and the clinical outcomes of cardiovascular morbidity and mortality in patients with established CHD according to the level of adherence to these drugs in a population of incident cases of acute coronary syndrome (ACS). METHODS Population-based cohort study of patients with a first episode of ACS during 2006-2015 in the Information System for Research in Primary Care (SIDIAP) database. We will estimate adherence to these drugs. The primary endpoint is a composite of all-cause mortality, ACS, and ischaemic stroke. Bivariate analyses will be performed estimating odds ratios for categorical variables and mean differences for continuous variables. Hazard ratios for adherences will be calculated for outcome events using Cox proportional hazard regression models, and proportionality of hazards assumption will be tested. RESULTS We expect to estimate adherence to all four study treatments, the incidence of MACE, and to analyze if this incidence is associated with the level of drug adherence. CONCLUSIONS We expect to find that adherent patients have a lower risk of the primary endpoints compared with nonadherent patients. TRIAL REGISTRATION This study protocol was classified as EPA-OD by the AEMPS (IJG-EST-2017-01-2017-01, 07/04/2017) and registered in the EU PAS register (EUPAS19017, 09/05/2017).
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Affiliation(s)
- Maria Giner-Soriano
- Medicines Research Unit, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain.,Departament de Farmacologia, Terapèutica i Toxicologia, Universitat Autònoma de Barcelona, Bellaterra, Spain.,Institut Català de la Salut, Barcelona, Spain
| | - Gerard Sotorra Figuerola
- Medicines Research Unit, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Jordi Cortés
- Medicines Research Unit, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Departament d'Estadística i Investigació Operativa, Universitat Politècnica de Catalunya, Barcelona, Spain.,Spanish Clinical Research Network, Unidad de Investigación Clínica y Ensayos Clínicos, Institut Universitari d'Investigació en Atenció Primària, Barcelona, Spain
| | - Helena Pera Pujadas
- Medicines Research Unit, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Spanish Clinical Research Network, Unidad de Investigación Clínica y Ensayos Clínicos, Institut Universitari d'Investigació en Atenció Primària, Barcelona, Spain
| | - Ana Garcia-Sangenis
- Medicines Research Unit, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Rosa Morros
- Medicines Research Unit, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain.,Departament de Farmacologia, Terapèutica i Toxicologia, Universitat Autònoma de Barcelona, Bellaterra, Spain.,Institut Català de la Salut, Barcelona, Spain.,Spanish Clinical Research Network, Unidad de Investigación Clínica y Ensayos Clínicos, Institut Universitari d'Investigació en Atenció Primària, Barcelona, Spain
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10
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Burgun A, Bernal-Delgado E, Kuchinke W, van Staa T, Cunningham J, Lettieri E, Mazzali C, Oksen D, Estupiñan F, Barone A, Chène G. Health Data for Public Health: Towards New Ways of Combining Data Sources to Support Research Efforts in Europe. Yearb Med Inform 2017; 26:235-240. [PMID: 29063571 PMCID: PMC6239221 DOI: 10.15265/iy-2017-034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Indexed: 12/21/2022] Open
Abstract
Objectives: To present the European landscape regarding the re-use of health administrative data for research. Methods: We present some collaborative projects and solutions that have been developed by Nordic countries, Italy, Spain, France, Germany, and the UK, to facilitate access to their health data for research purposes. Results: Research in public health is transitioning from siloed systems to more accessible and re-usable data resources. Following the example of the Nordic countries, several European countries aim at facilitating the re-use of their health administrative databases for research purposes. However, the ecosystem is still a complex patchwork, with different rules, policies, and processes for data provision. Conclusion: The challenges are such that with the abundance of health administrative data, only a European, overarching public health research infrastructure, is able to efficiently facilitate access to this data and accelerate research based on these highly valuable resources.
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Affiliation(s)
- A. Burgun
- Inserm, UMR 1138, Centre de Recherche des Cordeliers, AP-HP, Paris Descartes University, Paris, France
| | - E. Bernal-Delgado
- Institute for Health Sciences in Aragon (IACS), BridgeHealth Consortium, Zaragoza, Spain
| | - W. Kuchinke
- University of Dusseldorf, Dusseldorf, Germany
| | - T. van Staa
- Health eResearch Centre, Farr Institute, University of Manchester, Manchester, United Kingdom
| | - J. Cunningham
- Health eResearch Centre, Farr Institute, University of Manchester, Manchester, United Kingdom
| | | | | | - D. Oksen
- Public Health Institute, Inserm, AVIESAN, Paris, France
| | - F. Estupiñan
- Institute for Health Sciences in Aragon (IACS), BridgeHealth Consortium, Zaragoza, Spain
| | - A. Barone
- Lombardia Informatica, Milano, Italy
| | - G. Chène
- Inserm, UMR 1219, CIC1401-EC, Univ. Bordeaux, ISPED, CHU Bordeaux, Bordeaux, France
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11
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Dabigatran and vitamin K antagonists’ use in naïve patients with non-valvular atrial fibrillation: a cross-sectional study of primary care-based electronic health records. Eur J Clin Pharmacol 2017; 73:1323-1330. [DOI: 10.1007/s00228-017-2305-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 07/13/2017] [Indexed: 10/19/2022]
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