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Pouwels XG, van Mil D, Kieneker LM, Boersma C, van Etten RW, Evers-Roeten B, Heerspink HJ, Hemmelder MH, Langelaan ML, Thelen MH, Gansevoort RT, Koffijberg H. Cost-effectiveness of home-based screening of the general population for albuminuria to prevent progression of cardiovascular and kidney disease. EClinicalMedicine 2024; 68:102414. [PMID: 38299045 PMCID: PMC10827681 DOI: 10.1016/j.eclinm.2023.102414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 02/02/2024] Open
Abstract
Background Chronic kidney disease (CKD) is often detected late, leading to substantial health loss and high treatment costs. Screening the general population for albuminuria identifies individuals at high risk of kidney events and cardiovascular disease (CVD) who may benefit from early start of preventive interventions. Previous studies on the cost-effectiveness of albuminuria population screening were inconclusive, but were based on survey or cohort data rather than an implementation study, modelled screening as performed by general practitioners rather than home-based screening, and often included only benefits with respect to kidney events. We evaluated the cost-effectiveness of home-based general population screening for increased albuminuria based on real-world data obtained from a prospective implementation study taking into account prevention of CKD as well as CVD events. Methods We developed an individual-level simulation model to compare home-based screening using a urine collection device with usual care (no home-based screening) in individuals of the general population aged 45-80, based on the THOMAS study (Towards HOMe-based Albuminuria Screening). Cost-effectiveness was assessed from the Dutch healthcare perspective with a lifetime horizon. The costs of the screening process and benefits of preventing CKD progression (dialysis and kidney transplantation) and CVD events (non-fatal myocardial infarction, non-fatal stroke, fatal CVD event) were reflected. Albuminuria detection led to treatment of identified risk factors. The model subsequently simulated CKD progression, the occurrence of CVD events, and death. The risks of experiencing CVD events were calculated using the SCORE2 CKD risk prediction model and individual-level data from the THOMAS study. Relative treatment effectiveness, quality of life scores, resource use, and cost inputs were obtained from literature. Model outcomes were the number of CKD and CVD-related events, total costs, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER) per QALY gained by screening versus usual care. All results were obtained through probabilistic analysis. Findings The absolute difference between screening versus usual care in lifetime probability of dialysis, kidney transplantation, non-fatal myocardial infarction, non-fatal stroke, and fatal CVD events were 0.2%, 0.05%, 0.6%, 0.6%, and 0.2%, respectively. This led to relative decreases compared to usual care in lifetime incidence of these events of 10.7%, 11.1%, 5.1%, 4.1%, and 1.6%, respectively. The incremental costs and QALYs of screening were €1607 and 0.17 QALY, respectively, which led to a corresponding ICER of €9225/QALY. The probability of screening being cost-effective for the Dutch willingness-to-pay threshold for preventive population screening of €20,000/QALY was 95.0%. Implementing the screening in the subgroup of 45-64 years old reduced the ICER (€7946/QALY), whereas implementing screening in the subgroup of 65-80 years old increased the ICER (€10,310/QALY). A scenario analysis assuming treatment optimization in all individuals with newly diagnosed risk factors or known risk factors not within target range reduced the ICER to €7083/QALY, resulting from the incremental costs and QALY gain of €2145 and 0.30, respectively. Interpretation Home-based screening for increased albuminuria to prevent CVD and CKD events is likely cost-effective. More health benefits can be obtained by screening younger individuals and better optimization of care in individuals identified with newly diagnosed or known risk factors outside target range. Funding Dutch Kidney Foundation, Top Sector Life Sciences & Health of the Dutch Ministry of Economic Affairs.
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Affiliation(s)
- Xavier G.L.V. Pouwels
- Health Technology and Services Research Department, Technical Medical Centre, Faculty of Behavioral, Management, and Social Sciences, University of Twente, Enschede, the Netherlands
| | - Dominique van Mil
- Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
- Department of Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Lyanne M. Kieneker
- Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Cornelis Boersma
- Unit of Global Health, Department of Health Science, University Medical Centre Groningen, Groningen, the Netherlands
- Faculty of Management Sciences, Open University, Heerlen, the Netherlands
| | | | | | - Hiddo J.L. Heerspink
- Department of Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
- The George Institute for Global Health, Sydney, NSW, Australia
| | - Marc H. Hemmelder
- Division of Nephrology, Department of Internal Medicine, Maastricht Universal Medical Center and Cardiovascular Research Institute University Maastricht, Maastricht, the Netherlands
| | | | | | - Ron T. Gansevoort
- Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Hendrik Koffijberg
- Health Technology and Services Research Department, Technical Medical Centre, Faculty of Behavioral, Management, and Social Sciences, University of Twente, Enschede, the Netherlands
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Chan CC, Tung Y, Lee K, Chan Y, Chu P. Clinical outcomes of generic versus brand-name clopidogrel for secondary prevention in patients with acute myocardial infarction: A nationwide cohort study. Clin Transl Sci 2023; 16:1594-1605. [PMID: 37448335 PMCID: PMC10499421 DOI: 10.1111/cts.13590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/19/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
Skepticism exists among healthcare workers and patients regarding the efficacy and safety of generic medication, despite its potential to lower healthcare costs. This study aimed to compare the outcomes of a generic clopidogrel and its brand-name counterpart for secondary prevention in patients with acute myocardial infarction (AMI). Using the Taiwan National Health Insurance Research Database, we identified 49,325 patients who were hospitalized for AMI between January 1, 2008 and December 31, 2013 and prescribed either generic or brand-name clopidogrel. Among them, 2419 (4.9%) were prescribed the generic clopidogrel. After propensity score matching, both the generic and brand-name groups consisted of 2382 patients. The primary efficacy outcome was a composite of myocardial infarction, coronary revascularization, ischemic stroke, and all-cause death. The primary safety outcome was major bleeding requiring hospitalization. At a mean follow-up of 2.5 years, the generic and brand-name clopidogrel groups had comparable risks of primary efficacy outcome (41.9% vs. 42%; hazard ratio [HR] 0.96; 95% confidence interval [CI] 0.88-1.04), and the risks of the individual components were also similar. There were no significant differences between the two groups in major bleeding (7.9% vs. 7.9%; HR 0.99; 95% CI 0.81-1.21). Subgroup analyses also revealed no statistically significant interactions between the treatment effect and various subgroups. In this retrospective database analysis, the generic clopidogrel was comparable to its brand-name counterpart regarding cardiovascular and bleeding outcomes for the treatment of patients with AMI.
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Affiliation(s)
- Cze Ci Chan
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial HospitalChang Gung University College of MedicineTaoyuanTaiwan
| | - Ying‐Chang Tung
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial HospitalChang Gung University College of MedicineTaoyuanTaiwan
- Institute of Stem Cell and Translational Cancer Research, Chang Gung Memorial HospitalChang Gung University College of MedicineTaoyuanTaiwan
| | - Kuang‐Tso Lee
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial HospitalChang Gung University College of MedicineTaoyuanTaiwan
| | - Yi‐Hsin Chan
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial HospitalChang Gung University College of MedicineTaoyuanTaiwan
| | - Pao‐Hsien Chu
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial HospitalChang Gung University College of MedicineTaoyuanTaiwan
- Institute of Stem Cell and Translational Cancer Research, Chang Gung Memorial HospitalChang Gung University College of MedicineTaoyuanTaiwan
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3
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Zeevat F, Wilschut JC, Boersma C, Postma MJ. Reducing Hospital Capacity Needs for Seasonal Respiratory Infections: The Case of Switching to High-Dose Influenza Vaccine for Dutch Older Adults. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:461-464. [PMID: 36509369 DOI: 10.1016/j.jval.2022.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 10/11/2022] [Accepted: 11/28/2022] [Indexed: 05/06/2023]
Abstract
OBJECTIVES Influenza is responsible for considerable health and economic burden every year. Especially older adults are vulnerable for influenza infection and its complications due to immunosenescence and often-underlying medical conditions. Recently, the innovative quadrivalent high-dose influenza vaccine (QIV-HD) has become available in Europe. Through its enhanced immunogenicity, QIV-HD offers improved protection for older adults against respiratory as well as cardiovascular complications. We estimated the potential impact-specifically in terms of hospital admissions and related costs-of a hypothetical past switch from QIV-Standard dose (SD) to QIV-HD in The Netherlands. METHODS Estimates of hospitalizations for the older adults vaccinated with QIV-SD were derived from the seasons 2010/2011-2017/2018. Subsequently, the number of respiratory infections and cardiovascular complications of influenza were estimated for the year 2019/2020 for both QIV-SD and QIV-HD. To calculate the overall corresponding savings, costs for hospital complications, derived from literature, were used. RESULTS When QIV-HD would have been used instead of QIV-SD during the season 2019/2020, an additional 220 hospitalizations would have been averted among older adults of 60 years and older in the Netherlands. This corresponds to savings of €1 219 779 (uncertainty interval: 1 089 813-1 348 549), of which 69% is attributable to cardiovascular-related hospitalizations. CONCLUSIONS We demonstrate that a relevant improvement in influenza vaccination among older adults in The Netherlands can be achieved by switching from the current QIV-SD to QIV-HD. Not only comes a switch from QIV-SD to QIV-HD with a significant reduction in pressure on hospital capacity but also with notable cost savings.
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Affiliation(s)
- Florian Zeevat
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, The Netherlands.
| | - Jan C Wilschut
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Cornelis Boersma
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, The Netherlands; Faculty of Management Sciences, Open University, Heerlen, The Netherlands; Health-Ecore, Zeist, The Netherlands
| | - Maarten J Postma
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, The Netherlands; Department of Economics, Econometrics & Finance, Faculty of Economics & Business, University of Groningen, Groningen, The Netherlands
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van Schoonhoven AV, Schöttler MH, Serné EH, Schrömbges PPG, Postma MJ, Boersma C. The health and budget impact of sodium-glucose co-transporter-2 inhibitors (SGLT2is) in the Netherlands. J Med Econ 2023; 26:547-553. [PMID: 36987694 DOI: 10.1080/13696998.2023.2194802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
OBJECTIVES Type-2 Diabetes Mellitus (T2DM) increases both the patient risk of cardiovascular disease (CVD) and renal outcomes, such as chronic kidney disease (CKD). Recent clinical trials of the glucose-lowering drug-class of sodium-glucose co-transporter-2 inhibitors (SGLT2is) have shown benefits in preventing CVD events and progression of CKD, leading to an update of the Dutch T2DM treatment guideline for patients at risk. The aim of this study is to assess the health and economic impact of the guideline-recommended utilisation of SGLT2is in the Netherlands. METHODS The patient population at risk was determined by multiplying Dutch T2DM prevalence rates with the total numbers of inhabitants of the Netherlands in 2020. Subsequently, two analyses, comparing a treatment setting before and after implementation of the new guideline for SGLT2is, were conducted. Clinical and adverse event rates in both settings as well as direct healthcare costs were sourced from the literature. Total costs were calculated by multiplying disease prevalence, event rates and costs associated to outcomes. One-time disutilities per event were included to estimate the health impact. The potential health and economic impact of implementing the updated guideline was calculated. RESULTS Using a 5-year time horizon, the guideline-suggested utilisation of SGLT2is resulted in a health impact equal to 4,835 quality adjusted life years gained (0.0031 per patient per year) and €461 million cost-savings. The costs of treatment with SGLT2is were €813 million. Hence the net budget impact was €352 million for the total Dutch T2DM population, which translated to €0,57 per patient per day. CONCLUSION SGLT2is offer an option to reduce the number of CVD and CKD related events and associated healthcare costs and health losses in the Netherlands. Further research is needed to include the benefits of improved T2DM management options from a broader societal perspective.
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Affiliation(s)
- Alexander V van Schoonhoven
- Department of Global Health, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
- Asc Academics, Groningen, the Netherlands
| | - Marcel H Schöttler
- Department of Global Health, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
- Health-Ecore B.V., Zeist, the Netherlands
| | - Erik H Serné
- Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Maarten J Postma
- Department of Global Health, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
- Health-Ecore B.V., Zeist, the Netherlands
| | - Cornelis Boersma
- Department of Global Health, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
- Health-Ecore B.V., Zeist, the Netherlands
- Department of Management Sciences, Open Universiteit, Heerlen, the Netherlands
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van den Broek WWA, van Paassen JG, Gimbel ME, Deneer VHM, ten Berg JM, Vreman RA. Cost-effectiveness of clopidogrel vs. ticagrelor in patients of 70 years or older with non-ST-elevation acute coronary syndrome. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2022; 9:76-84. [PMID: 35723240 PMCID: PMC9753095 DOI: 10.1093/ehjcvp/pvac037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/13/2022] [Accepted: 06/15/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The POPular AGE trial showed that clopidogrel significantly reduced bleeding risk compared with ticagrelor without any signs of an increase in thrombotic events. The aim of this analysis was to estimate the long-term cost-effectiveness of clopidogrel compared with ticagrelor in these patients aged 70 years or older with non-ST-elevation acute coronary syndrome (NSTE-ACS). METHODS AND RESULTS A 1-year decision tree based on the POPular AGE trial in combination with a lifelong Markov model was developed to compare clopidogrel with ticagrelor in terms of clinical outcomes, costs, and quality-adjusted life years (QALYs) in elderly patients (above 70 year) with NSTE-ACS. Cost-effectiveness was assessed from a Dutch healthcare system perspective. Events rates and utility data observed in the POPular AGE trial were combined with lifetime projections to evaluate costs and effects for a fictional cohort of 1000 patients. Treatment with clopidogrel instead of ticagrelor led to a cost saving of €1484 575 (€1485 per patient) and a decrease of 10.96 QALYs (0.011 QALY per patient) in the fictional cohort. In an alternative base case with equal distribution over health states in the first year, treatment with clopidogrel led to an increase in QALYs. In all scenario analyses, treatment with clopidogrel was cost-saving. CONCLUSION Clopidogrel is a cost-saving alternative to ticagrelor in elderly patients after NSTE-ACS, though regarding overall cost-effectiveness clopidogrel was not superior to ticagrelor, as it resulted in a small negative effect on QALYs. However, based on the results of the alternative base case and clinical outcomes of the POPular AGE trial, clopidogrel could be a reasonable alternative to ticagrelor for elderly NSTE-ACS patients with a higher bleeding risk.
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Affiliation(s)
- Wout W A van den Broek
- Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands
| | - Jacqueline G van Paassen
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Heidelberglaan 8, 3584 CS, Utrecht, The Netherlands
| | - Marieke E Gimbel
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands
| | - Vera H M Deneer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Heidelberglaan 8, 3584 CS, Utrecht, The Netherlands,Department of Clinical Pharmacy, Division Laboratories, Pharmacy and Biomedical Genetics, University Medical Centre Utrecht, Heidelberglaan 8, 3584 CS, Utrecht, The Netherlands
| | - Jurriën M ten Berg
- Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands,Cardiovascular Research Institute Maastricht (CARIM), Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands
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Comparison of medical resource use and total admission cost in patients with acute myocardial infarction between on-hours visit versus off-hours visit. Cardiovasc Interv Ther 2022; 37:651-659. [DOI: 10.1007/s12928-022-00838-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/15/2022] [Indexed: 11/02/2022]
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7
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Bui MH, Khuong QL, Dao PT, Le CPD, Nguyen TA, Tran BG, Duong DH, Duong TD, Tran TH, Pham HH, Dao XT, Le QC. Myocardial Infarction Complications After Surgery in Vietnam: Estimates of Incremental Cost, Readmission Risk, and Length of Hospital Stay. Front Public Health 2021; 9:799529. [PMID: 34957040 PMCID: PMC8702745 DOI: 10.3389/fpubh.2021.799529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 11/18/2021] [Indexed: 11/16/2022] Open
Abstract
Myocardial infarction is a considerable burden on public health. However, there is a lack of information about its economic impact on both the individual and national levels. This study aims to estimate the incremental cost, readmission risk, and length of hospital stay due to myocardial infarction as a post-operative complication. We used data from a standardized national system managed by the Vietnam Social Insurance database. The original sample size was 1,241,893 surgical patients who had undergone one of seven types of surgery. A propensity score matching method was applied to create a matched sample for cost analysis. A generalized linear model was used to estimate direct treatment costs, the length of stay, and the effect of the complication on the readmission of surgical patients. Myocardial infarction occurs most frequently after vascular surgery. Patients with a myocardial infarction complication were more likely to experience readmission within 30 and 90 days, with an OR of 3.45 (95%CI: 2.92–4.08) and 4.39 (95%CI: 3.78–5.10), respectively. The increments of total costs at 30 and 90 days due to post-operative myocardial infarction were 4,490.9 USD (95%CI: 3882.3–5099.5) and 4,724.6 USD (95%CI: 4111.5–5337.8) per case, while the increases in length of stay were 4.9 (95%CI: 3.6–6.2) and 5.7 (95%CI: 4.2–7.2) per case, respectively. Perioperative myocardial infarction contributes significantly to medical costs for the individual and the national economy. Patients with perioperative myocardial infarction are more likely to be readmitted and face a longer treatment duration.
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Affiliation(s)
- My Hanh Bui
- Department of Tuberculosis and Lung Diseases, Hanoi Medical University, Hanoi, Vietnam.,Department of Functional Exploration, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Quynh Long Khuong
- Center for Population Health Science, Hanoi University of Public Health, Hanoi, Vietnam
| | - Phuoc Thang Dao
- Department of Monitoring and Evaluation, Interactive and Research Development, Ho Chi Minh City, Vietnam
| | - Cao Phuong Duy Le
- Department of Interventional Cardiology, Nguyen Tri Phuong Hospital, Ho Chi Minh City, Vietnam
| | - The Anh Nguyen
- Department of Intensive Care, Huu Nghi Hospital, Hanoi, Vietnam
| | - Binh Giang Tran
- Department of Gastroenterology Surgery, Viet Duc Hospital, Hanoi, Vietnam
| | - Duc Hung Duong
- Department of Cardiovascular Surgery, Bach Mai Hospital, Hanoi, Vietnam
| | | | | | - Hoang Ha Pham
- Department of Gastroenterology Surgery, Viet Duc Hospital, Hanoi, Vietnam
| | - Xuan Thanh Dao
- Department of Orthopedic, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Quang Cuong Le
- Department of Neurology, Hanoi Medical University, Hanoi, Vietnam
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Sülz S, Wagenaar H, van de Klundert J. Have Dutch Hospitals Saved Lives and Reduced Costs? A longitudinal patient-level analysis over the years 2013-2017. HEALTH ECONOMICS 2021; 30:2399-2408. [PMID: 34251075 PMCID: PMC8518627 DOI: 10.1002/hec.4391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 06/25/2021] [Accepted: 06/29/2021] [Indexed: 06/13/2023]
Abstract
The purpose of this paper is to shed light on the ongoing Dutch health system reforms and identify whether hospital costs and hospital outcomes have changed over time. We present an empirical analysis that is based on granular micro-costing data and focuses on conditions for which mortality is indicative of outcome quality, that is, acute myocardial infarction (AMI), chronic heart failure (CHF), and pneumonia (PNE). We deploy a dataset of more than 80,000 inpatient episodes over 5 years (2013-2017) to estimate regression models that control for variation between patients and hospitals. We have three main findings. First, our results do not indicate significant outcome improvements over the years; that is, there is no time trend for mortality. Second, there is heterogeneity in cost developments: for patients who survive their inpatient stay, our data indicate that costs increase significantly by 0.9% per year for AMI patients, while costs decrease significantly by 1.7% per year for CHF patients and by 1.9% per year for PNE patients. For patients who pass away during their inpatient stay, our data do not indicate significant time trends. Third and finally, our results suggest the existence of substantial cost variation between hospitals.
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Affiliation(s)
- Sandra Sülz
- Erasmus School of Health Policy & ManagementRotterdamThe Netherlands
| | | | - Joris van de Klundert
- Erasmus School of Health Policy & ManagementRotterdamThe Netherlands
- Prince Mohammad bin Salman College of Business & EntrepreneurshipKing Abdullah Economic CitySaudi Arabia
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Comparison of the cost in percutaneous coronary intervention between ST-segment elevation myocardial infarction vs. non-ST-segment elevation myocardial infarction. Cardiovasc Interv Ther 2021; 37:293-303. [PMID: 33884579 DOI: 10.1007/s12928-021-00778-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/16/2021] [Indexed: 12/19/2022]
Abstract
Percutaneous coronary intervention (PCI) is a standard strategy for non-ST-segment elevation myocardial infarction (NSTEMI) as well as for ST-segment elevation myocardial infarction (STEMI). The device cost for PCI may be more expensive in NSTEMI, because the culprit lesion morphology may be more complex in NSTEMI. This study aimed to compare the total device cost of PCI between STEMI and NSTEMI. We included 504 patients with acute myocardial infraction (AMI) who underwent PCI, and divided those into a STEMI group (n = 286) and a NSTEMI group (n = 218). We compared the total device cost, the number of used devices, and procedure cost between the 2 groups. The total device cost was significantly higher in the NSTEMI group [¥371,300 (¥320,700-503,350)] than in the STEMI group [¥341,200 (¥314,200-410,475)] (p = 0.001), whereas the procedure cost was significantly higher in the STEMI group [¥343,800 (¥243,800-343,800)] than in the NSTEMI group [¥220,000 (¥216,800-243,800)] (p < 0.001). Drug eluting stent (85.3% vs. 76.1%, p = 0.029) and aspiration catheter (16.8% vs. 2.3%, p < 0.001) were more frequently used in the STEMI group, whereas rotablator (0.7% vs. 8.3%, p < 0.001) were more frequently used in the NSTEMI group. The multivariate logistic regression analysis revealed that NSTEMI was significantly associated with the high device cost (odds ratio 1.899, 95% confidence interval 1.166-3.093, p = 0.01). In conclusion, the total device cost for PCI was significantly higher in the culprit lesions of NSTEMI than in those of STEMI, whereas the procedure cost was significantly higher in the culprit lesions of STEMI than in those of NSTEMI.
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Liao CT, Hsieh TH, Shih CY, Liu PY, Wang JD. Cost-effectiveness of percutaneous coronary intervention versus medical therapy in patients with acute myocardial infarction: real-world and lifetime-horizon data from Taiwan. Sci Rep 2021; 11:5608. [PMID: 33692425 PMCID: PMC7947011 DOI: 10.1038/s41598-021-84853-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 02/15/2021] [Indexed: 12/04/2022] Open
Abstract
Although some studies have assessed the cost-effectiveness of percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI), there has been a lack of nationwide real-world studies estimating life expectancy (LE), loss-of-LE, life-years saved, and lifetime medical costs. We evaluated the cost-effectiveness of PCI versus non-PCI therapy by integrating a survival function and mean-cost function over a lifelong horizon to obtain the estimations for AMI patients without major comorbidities. We constructed a longitudinal AMI cohort based on the claim database of Taiwan's National Health Insurance during 1999–2015. Taiwan's National Mortality Registry Database was linked to derive a survival function to estimate LE, loss-of-LE, life-years saved, and lifetime medical costs in both therapies. This study enrolled a total of 38,441 AMI patients; AMI patients receiving PCI showed a fewer loss-of-LE (3.6 versus 5.2 years), and more lifetime medical costs (US$ 49,112 versus US$ 43,532). The incremental cost-effectiveness ratio (ICER) was US$ 3488 per life-year saved. After stratification by age, the AMI patients aged 50–59 years receiving PCI was shown to be cost-saving. From the perspective of Taiwan's National Health Insurance, PCI is cost-effective in AMI patients without major comorbidities. Notably, for patients aged 50–59 years, PCI is cost-saving.
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Affiliation(s)
- Chia-Te Liao
- Division of Cardiology, Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan.,Department of Public Health, College of Medicine, National Cheng Kung University, No. 1, University Road, Tainan, 701, Taiwan.,Department of Electrical Engineer, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Tung-Han Hsieh
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Chia-Yin Shih
- Department of Public Health, College of Medicine, National Cheng Kung University, No. 1, University Road, Tainan, 701, Taiwan
| | - Ping-Yen Liu
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Jung-Der Wang
- Department of Public Health, College of Medicine, National Cheng Kung University, No. 1, University Road, Tainan, 701, Taiwan. .,Department of Internal Medicine and Occupational and Environmental Medicine, National Cheng Kung University Hospital Tainan, No. 1, University Road, Tainan, 701, Taiwan.
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Spoorendonk JA, Briere JB, Bowrin K, Millier A, Coppens M, Tempelaar S, Verheggen B. Clinical implications and cost-effectiveness analysis of rivaroxaban in patients with coronary artery disease or peripheral arterial disease in the Netherlands. J Med Econ 2021; 24:1231-1239. [PMID: 34749569 DOI: 10.1080/13696998.2021.1997024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Patients with stable coronary artery disease (CAD) or peripheral artery disease (PAD) are at substantial risk of atherothrombotic events. The COMPASS trial showed that patients with stable CAD or PAD experienced significant benefits after treatment with rivaroxaban in combination with acetylsalicylic acid (ASA) compared with ASA alone. This paper aims to provide insight into the clinical and economic consequences of treatment with rivaroxaban from a Dutch societal perspective. METHODS The clinical and economic implications of rivaroxaban in terms of the number of events prevented, costs, the incremental cost per life-years gained (LYG), and incremental cost per quality-adjusted life-years (QALYs) were determined based on a cost-effectiveness model for patients with stable CAD or PAD and in high-risk subgroups (i.e. patients with CAD and PAD, CAD and prior myocardial infarction and renal impairment, CAD and heart failure) using results from the Cardiovascular OutcoMes for People Using Anticoagulation Strategies (COMPASS) trial. RESULTS Patients treated with rivaroxaban have an expected increased discounted life expectancy of 0.67 years. In high-risk groups discounted incremental life expectancy ranged from 1.33 to 1.90 years. The incremental cost-effectiveness ratio for the full COMPASS population was €9,760/LYG and €12,033/QALY, whereas, for high-risk subgroups of patients with underlying conditions, incremental cost-effectiveness ratios ranged from €2,966/LYG to €5,052/LYG and from €3,940/QALY to €6,815/QALY. Results from the sensitivity analyses revealed that the model results were robust to variations in single or multiple input parameters at once. CONCLUSIONS The cost-effectiveness analysis showed that rivaroxaban in combination with ASA is a cost-effective treatment option in stable CAD or PAD patients. Rivaroxaban in combination with ASA is even more cost-effective in high-risk subgroups.
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Affiliation(s)
| | | | - K Bowrin
- Bayer Plc, Reading, Berkshire, United Kingdom
| | | | - M Coppens
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Academic Medical Center, Amsterdam, The Netherlands
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12
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Berkelmans GFN, Greving JP, van der Graaf Y, Visseren FLJ, Dorresteijn JAN. Would treatment decisions about secondary prevention of CVD based on estimated lifetime benefit rather than 10-year risk reduction be cost-effective? Diagn Progn Res 2020; 4:4. [PMID: 32318625 PMCID: PMC7161238 DOI: 10.1186/s41512-020-00072-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 03/13/2020] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To test the hypothesis that treatment decisions (treatment with a PCSK9-mAb versus no treatment) are both more effective and more cost-effective when based on estimated lifetime benefit than when based on estimated risk reduction over 10 years. METHODS A microsimulation model was constructed for 10,000 patients with stable cardiovascular disease (CVD). Costs and quality-adjusted life years (QALYs) due to recurrent cardiovascular events and (non)vascular death were estimated for lifetime benefit-based compared to 10-year risk-based treatment, with PCSK9 inhibition as an illustration example. Lifetime benefit in months gained and 10-year absolute risk reduction were estimated using the SMART-REACH model, including an individualized treatment effect of PCSK9 inhibitors based on baseline low-density lipoprotein cholesterol. For the different numbers of patients treated (i.e. the 5%, 10%, and 20% of patients with the highest estimated benefit of both strategies), cost-effectiveness was assessed using the incremental cost-effectiveness ratio (ICER), indicating additional costs per QALY gain. RESULTS Lifetime benefit-based treatment of 5%, 10%, and 20% of patients with the highest estimated benefit resulted in an ICER of €36,440/QALY, €39,650/QALY, or €41,426/QALY. Ten-year risk-based treatment decisions of 5%, 10%, and 20% of patients with the highest estimated risk reduction resulted in an ICER of €48,187/QALY, €53,368/QALY, or €52,390/QALY. CONCLUSION Treatment decisions (treatment with a PCSK9-mAb versus no treatment) are both more effective and more cost-effective when based on estimated lifetime benefit than when based on estimated risk reduction over 10 years.
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Affiliation(s)
- Gijs F. N. Berkelmans
- grid.7692.a0000000090126352Department of Vascular Medicine, University Medical Center Utrecht, PO Box 85500, 3508 Utrecht, GA The Netherlands
| | - Jacoba P. Greving
- grid.7692.a0000000090126352Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Yolanda van der Graaf
- grid.7692.a0000000090126352Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank L. J. Visseren
- grid.7692.a0000000090126352Department of Vascular Medicine, University Medical Center Utrecht, PO Box 85500, 3508 Utrecht, GA The Netherlands
| | - Jannick A. N. Dorresteijn
- grid.7692.a0000000090126352Department of Vascular Medicine, University Medical Center Utrecht, PO Box 85500, 3508 Utrecht, GA The Netherlands
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13
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van Schoonhoven AV, Gout-Zwart JJ, de Vries MJS, van Asselt ADI, Dvortsin E, Vemer P, van Boven JFM, Postma MJ. Costs of clinical events in type 2 diabetes mellitus patients in the Netherlands: A systematic review. PLoS One 2019; 14:e0221856. [PMID: 31490989 PMCID: PMC6730996 DOI: 10.1371/journal.pone.0221856] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 08/18/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is an established risk factor for cardiovascular and nephropathic events. In the Netherlands, prevalence of T2DM is expected to be as high as 8% by 2025. This will result in significant clinical and economic impact, highlighting the need for well-informed reimbursement decisions for new treatments. However, availability and consistent use of costing methodologies is limited. OBJECTIVE We aimed to systematically review recent costing data for T2DM-related cardiovascular and nephropathic events in the Netherlands. METHODS A systematic literature review in PubMed and Embase was conducted to identify available Dutch cost data for T2DM-related events, published in the last decade. Information extracted included costs, source, study population, and costing perspective. Finally, papers were evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS). RESULTS Out of initially 570 papers, 36 agreed with the inclusion criteria. From these studies, 150 cost estimates for T2DM-related clinical events were identified. In total, 29 cost estimates were reported for myocardial infarction (range: €196-€27,038), 61 for stroke (€495-€54,678), fifteen for heart failure (€325-€16,561), 24 for renal failure (€2,438-€91,503), and seventeen for revascularisation (€3,000-€37,071). Only four estimates for transient ischaemic attack were available, ranging from €587 to €2,470. Adherence to CHEERS was generally high. CONCLUSIONS The most expensive clinical events were related to renal failure, while TIA was the least expensive event. Generally, there was substantial variation in reported cost estimates for T2DM-related events. Costing of clinical events should be improved and preferably standardised, as accurate and consistent results in economic models are desired.
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Affiliation(s)
- Alexander V. van Schoonhoven
- Unit of PharmacoTherapy, Epidemiology & Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, the Netherlands
| | - Judith J. Gout-Zwart
- Asc Academics, Groningen, the Netherlands
- Department of Nephrology, University of Groningen, University Medical Centre Groningen (UMCG), Groningen, the Netherlands
| | - Marijke J. S. de Vries
- Unit of PharmacoTherapy, Epidemiology & Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, the Netherlands
| | - Antoinette D. I. van Asselt
- Department of Epidemiology, University Medical Centre Groningen, Groningen, the Netherlands
- Department of Health Sciences, University of Groningen, University Medical Centre Groningen (UMCG), Groningen, the Netherlands
| | | | - Pepijn Vemer
- Unit of PharmacoTherapy, Epidemiology & Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, the Netherlands
- Department of Epidemiology, University Medical Centre Groningen, Groningen, the Netherlands
| | - Job F. M. van Boven
- Department of General Practice & Elderly Care, University of Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
- Department of Clinical Pharmacy & Pharmacology, University of Groningen, University Medical Centre Groningen (UMCG), Groningen, the Netherlands
| | - Maarten J. Postma
- Unit of PharmacoTherapy, Epidemiology & Economics (PTE2), Department of Pharmacy, University of Groningen, Groningen, the Netherlands
- Department of Health Sciences, University of Groningen, University Medical Centre Groningen (UMCG), Groningen, the Netherlands
- Department of Economics, Econometrics & Finance, University of Groningen, Faculty of Economics & Business, Groningen, The Netherlands
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Jenniskens K, Lagerweij GR, Naaktgeboren CA, Hooft L, Moons KGM, Poldervaart JM, Koffijberg H, Reitsma JB. Decision analytic modeling was useful to assess the impact of a prediction model on health outcomes before a randomized trial. J Clin Epidemiol 2019; 115:106-115. [PMID: 31330250 DOI: 10.1016/j.jclinepi.2019.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 06/11/2019] [Accepted: 07/16/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To demonstrate how decision analytic models (DAMs) can be used to quantify impact of using a (diagnostic or prognostic) prediction model in clinical practice and provide general guidance on how to perform such assessments. STUDY DESIGN AND SETTING A DAM was developed to assess the impact of using the HEART score for predicting major adverse cardiac events (MACE). Impact on patient health outcomes and health care costs was assessed in scenarios by varying compliance with and informed deviation (ID) (using additional clinical knowledge) from HEART score management recommendations. Probabilistic sensitivity analysis was used to assess estimated impact robustness. RESULTS Impact of using the HEART score on health outcomes and health care costs was influenced by an interplay of compliance with and ID from HEART score management recommendations. Compliance of 50% (with 0% ID) resulted in increased missed MACE and costs compared with usual care. Any compliance combined with at least 50% ID reduced both costs and missed MACE. Other scenarios yielded a reduction in missed MACE at higher costs. CONCLUSION Decision analytic modeling is a useful approach to assess impact of using a prediction model in practice on health outcomes and health care costs. This approach is recommended before conducting an impact trial to improve its design and conduct.
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Affiliation(s)
- Kevin Jenniskens
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands.
| | - Ghizelda R Lagerweij
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Christiana A Naaktgeboren
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Lotty Hooft
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands; Cochrane Netherlands, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Karel G M Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands; Cochrane Netherlands, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Judith M Poldervaart
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Hendrik Koffijberg
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Johannes B Reitsma
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands; Cochrane Netherlands, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
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Ryder S, Fox K, Rane P, Armstrong N, Wei CY, Deshpande S, Stirk L, Qian Y, Kleijnen J. A Systematic Review of Direct Cardiovascular Event Costs: An International Perspective. PHARMACOECONOMICS 2019; 37:895-919. [PMID: 30949988 DOI: 10.1007/s40273-019-00795-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION There is a lack of comprehensive cost information for cardiovascular events since 2013. OBJECTIVE A systematic review on the contemporary cost of cardiovascular events was therefore undertaken. METHODS Methods complied with those recommended by the Cochrane Collaboration and the Centre for Reviews and Dissemination. Studies were unrestricted by language, were from 2013 to 23 December 2017, and included cost-of-illness data in adults with the following cardiovascular conditions: myocardial infarction (MI), stroke, transient ischaemic attack (TIA), heart failure (HF), unstable angina (UA), coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI), or peripheral artery disease (PAD). Seven electronic databases were searched, namely Embase (Ovid), MEDLINE (Ovid), MEDLINE In-Process Citations and Daily Update (Ovid), NHS Economic Evaluation Database (NHS EED), Health Technology Assessment (HTA) database, Cochrane Central Register of Controlled Trials (CENTRAL), and PubMed. The included studies reported data from a variety of years (sometimes prior to 2013), so costs were inflated and converted to $US, year 2018 values, for standardization. RESULTS After de-duplication, 29,945 titles and abstracts and then 403 full papers were screened; 82 studies (88 papers) were extracted. Year 1 average cost ranges were as follows: MI ($11,970 in Sweden to $61,864 in the USA), stroke ($10,162 in Spain to $46,162 in the USA), TIA ($6049 in Sweden to $25,306 in the USA), HF ($4456 in China to $49,427 in the USA), UA ($11,237 in Sweden to $31,860 in the USA), PCI ($17,923 in Italy to $45,533 in the USA), CABG ($17,972 in the UK to $76,279 in the USA). One Swedish study reported PAD costs in a format convertible to $US, 2018 values, with a mean annual cost of $15,565. CONCLUSIONS There was considerable unexplained variation in contemporary costs for all major cardiovascular events. One emerging theme was that average costs in the USA were considerably higher than anywhere else.
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Affiliation(s)
- Steve Ryder
- Kleijnen Systematic Reviews Ltd, Unit 6, Escrick Business Park, Riccall Road, Escrick, York, YO19 6FD, UK.
| | - Kathleen Fox
- Strategic Healthcare Solutions LLC, 133 Cottonwood Creek Lane, Aiken, SC, 29803, USA
| | - Pratik Rane
- Amgen Inc, One Amgen Center Drive, Thousand Oaks, CA, 91320-1799, USA
| | - Nigel Armstrong
- Kleijnen Systematic Reviews Ltd, Unit 6, Escrick Business Park, Riccall Road, Escrick, York, YO19 6FD, UK
| | - Ching-Yun Wei
- Kleijnen Systematic Reviews Ltd, Unit 6, Escrick Business Park, Riccall Road, Escrick, York, YO19 6FD, UK
| | - Sohan Deshpande
- Kleijnen Systematic Reviews Ltd, Unit 6, Escrick Business Park, Riccall Road, Escrick, York, YO19 6FD, UK
| | - Lisa Stirk
- Kleijnen Systematic Reviews Ltd, Unit 6, Escrick Business Park, Riccall Road, Escrick, York, YO19 6FD, UK
| | - Yi Qian
- Amgen Inc, One Amgen Center Drive, Thousand Oaks, CA, 91320-1799, USA
| | - Jos Kleijnen
- School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
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Bennaghmouch N, de Veer AJWM, Mahmoodi BK, Jofre-Bonet M, Lip GYH, Bode K, Ten Berg JM. Economic evaluation of the use of non-vitamin K oral anticoagulants in patients with atrial fibrillation on antiplatelet therapy: a modelling analysis using the healthcare system in the Netherlands. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2019; 5:127-135. [PMID: 30016398 DOI: 10.1093/ehjqcco/qcy030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 05/20/2018] [Accepted: 07/10/2018] [Indexed: 01/02/2023]
Abstract
AIMS Non-vitamin K oral anticoagulants (NOACs) have consistently demonstrated superior efficacy in terms of stroke prevention and safety in terms of bleeding over vitamin K antagonist (VKA) in patients with non-valvular atrial fibrillation (AF). The potential use of NOACs in AF patients requiring antiplatelet therapy (APT) has only been assessed in small meta-analyses reporting consistent benefits of NOACs over VKAs. However, the prescription costs of NOACs are higher than those of VKAs. The aim of his study was to estimate the cost-effectiveness (CE) of NOACs compared to VKAs in patients with non-valvular AF also requiring APT with the Dutch healthcare system used as a surrogate of many European healthcare systems. METHODS AND RESULTS A decision tree was constructed to analyse the CE of NOACs compared to VKAs in patients with non-valvular AF with an indication for APT over a horizon of 1 year. Beside the base-case analysis, univariate probabilistic sensitivity and two sensitivity analyses were performed: first, we assessed the impact of VKA home monitoring; second, we varied the NOACs price assuming patent expiration. Use of NOACs instead of VKA is associated with a health gain of 0.0171 quality-adjusted life years (QALYs) and with an incremental cost of €357, resulting in an incremental cost-effectiveness ratio of €20 919, which is almost equal to the generally accepted CE threshold of €20 000 used in the Netherlands. The probability that NOACs are cost-effective at a conservative willingness-to-pay threshold of €20 000 per QALY was 50%. Introducing home monitoring increased VKAs costs so much that NOACs became the dominant option (less costly and more effective). Price drops associated to patent expiration of NOACs increased its CE. CONCLUSION This analysis suggests that the use of NOACs is a cost-effective alternative of VKAs in patients with AF needing APT. Our findings in the Netherlands healthcare system are probably consistent with other European populations.
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Affiliation(s)
- Naoual Bennaghmouch
- Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, CM Nieuwegein, the Netherlands
| | - Anne J W M de Veer
- Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, CM Nieuwegein, the Netherlands
| | - Bakhtawar K Mahmoodi
- Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, CM Nieuwegein, the Netherlands
| | - Mireia Jofre-Bonet
- Department of Economics, City University of London, Northampton Square, London, UK
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, City Hospital, Birmingham, UK
| | - Kerstin Bode
- Heart Center, University of Leipzig, Strümpellstraße 39, Leipzig, Germany
| | - Jurriën M Ten Berg
- Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, CM Nieuwegein, the Netherlands
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Yamamoto K, Sakakura K, Akashi N, Watanabe Y, Noguchi M, Seguchi M, Taniguchi Y, Ugata Y, Wada H, Momomura SI, Fujita H. Novel Acute Myocardial Infarction Risk Stratification (nARS) System Reduces the Length of Hospitalization for Acute Myocardial Infarction. Circ J 2019; 83:1039-1046. [PMID: 30890684 DOI: 10.1253/circj.cj-18-1221] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The novel Acute Myocardial Infarction (AMI) Risk Stratification (nARS) system was recently developed based on original criteria. The use of nARS may reduce the length of hospitalization. Methods and Results: We allocated 560 AMI patients into the pre-nARS group (before adopting nARS) or the nARS group. Patients in the nARS group were subdivided into the low (L), intermediate (I), and high (H) risk groups, whereas patients in the pre-nARS group were subdivided into the equivalent L (eL), equivalent I (eI), or equivalent H (eH) risk groups based on the nARS criteria. Length of coronary care unit (CCU) stay was significantly shorter in the nARS group (2.8±3.5 days) compared with the pre-nARS group (4.4±5.4 days; P<0.001). Length of hospital stay was also shorter in the nARS group (9.4±8.9 days) compared with the pre-nARS group (13.4±12.8 days; P<0.001). Length of CCU stay was significantly shorter in the L (1.1±1.0 days), I (2.8±3.5 days), and H (5.0±4.8 days) risk groups compared with corresponding eL (2.2±1.1 days), eI (4.4±5.4 days), and eH (7.1±7.8 days) risk groups. CONCLUSIONS Length of CCU and hospital stay were significantly shorter in the nARS group compared with the pre-nARS group. The use of nARS may save medical resources in the treatment of AMI in the regional health-care system.
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Affiliation(s)
- Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Naoyuki Akashi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Yusuke Watanabe
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Masamitsu Noguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Masaru Seguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Yusuke Ugata
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Shin-Ichi Momomura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
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Tran DT, Welsh RC, Ohinmaa A, Thanh NX, Kaul P. Resource Use and Burden of Hospitalization, Outpatient, Physician, and Drug Costs in Short- and Long-term Care After Acute Myocardial Infarction. Can J Cardiol 2018; 34:1298-1306. [PMID: 30170782 DOI: 10.1016/j.cjca.2018.05.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 05/25/2018] [Accepted: 05/28/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Little is known about the resource use and cost burden of acute myocardial infarction (AMI) beyond the index event. We examined resource use and care costs during the first and each subsequent year, among patients with incident AMI. METHODS Patients aged ≥18 years who were admitted with incident AMI at emergency departments or hospitals in Alberta, Canada, between April 2004 and March 2014 were included. Incident cases were defined as those without an AMI hospitalization in the previous 10 years. Inpatient, outpatient, practitioner claims, drug claims, and vital statistics were linked and follow-up data were available until March 2016. Resource use and care costs per patient for each year after the AMI were calculated. RESULTS The analysis included 41,210 patients with incident AMI (non-ST-segment elevation myocardial infarction [NSTEMI] = 50.8%, ST-segment elevation myocardial infarction = 36.8%, and undefined myocardial infarction [MI] = 12.5%). Resource use and care costs were highest during the first year. Compared with other MI groups, patients with ST-segment elevation myocardial infarction had more frequent outpatient visits (mean 1.64 vs 0.99 [NSTEMI] and 0.87 [undefined MI] visits) but spent fewer days in hospital (mean 7.72 vs 9.23 [NSTEMI] and 8.5 [undefined MI] days) during the first year. AMI costs were $19,842 during the first year and $845 per year for the next 5 years. Hospitalization costs accounted for the majority of costs during the first year (81.1%), whereas drug costs did for the next 5 years (62.1%). CONCLUSIONS The long-term annual cost burden of AMI is modest compared with care costs during the first year. Although hospitalization dominates first year costs, pharmaceuticals do so in the long term.
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Affiliation(s)
- Dat T Tran
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada; Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.
| | - Robert C Welsh
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, University of Alberta Hospital, Edmonton, Canada
| | - Arto Ohinmaa
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada; Institute of Health Economics, Edmonton, Alberta, Canada
| | - Nguyen X Thanh
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada; Institute of Health Economics, Edmonton, Alberta, Canada
| | - Padma Kaul
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Kim E, Kwon HY, Baek SH, Lee H, Yoo BS, Kang SM, Ahn Y, Yang BM. Medical costs in patients with heart failure after acute heart failure events: one-year follow-up study. J Med Econ 2018; 21:288-293. [PMID: 29125033 DOI: 10.1080/13696998.2017.1403922] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
AIMS This study investigated annual medical costs using real-world data focusing on acute heart failure. METHODS The data were retrospectively collected from six tertiary hospitals in South Korea. Overall, 330 patients who were hospitalized for acute heart failure between January 2011 and July 2012 were selected. Data were collected on their follow-up medical visits for 1 year, including medical costs incurred toward treatment. Those who died within the observational period or who had no records of follow-up visits were excluded. Annual per patient medical costs were estimated according to the type of medical services, and factors contributing to the costs using Gamma Generalized Linear Models (GLM) with log link were analyzed. RESULTS On average, total annual medical costs for each patient were USD 6,199 (±9,675), with hospitalization accounting for 95% of the total expenses. Hospitalization cost USD 5,904 (±9,666) per patient. Those who are re-admitted have 88.5% higher medical expenditure than those who have not been re-admitted in 1 year, and patients using intensive care units have 19.6% higher expenditure than those who do not. When the number of hospital days increased by 1 day, medical expenses increased by 6.7%. LIMITATIONS Outpatient drug costs were not included. There is a possibility that medical expenses for AHF may have been under-estimated. CONCLUSION It was found that hospitalization resulted in substantial costs for treatment of heart failure in South Korea, especially in patients with an acute heart failure event. Prevention strategies and appropriate management programs that would reduce both frequency of hospitalization and length of stay for patients with the underlying risk of heart failure are needed.
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Affiliation(s)
- Eugene Kim
- a Graduate School of Public Health , Seoul National University , Seoul , South Korea
| | - Hye-Young Kwon
- b Division of Biology & Public Health , Mokwon University , Daejeon , South Korea
| | - Sang Hong Baek
- c Department of Cardiovascular , The Catholic University of Korea Seoul, St. Mary's Hospital , Seoul , South Korea
| | - Haeyoung Lee
- d Department of Internal Medicine , Seoul National University Hospital , Division of Cardiology , Seoul , South Korea
| | - Byung-Su Yoo
- e Division of Cardiology, Department of Internal Medicine , Yonsei University , Wonju College of Medicine , Gangwon-Do , South Korea
| | - Seok-Min Kang
- f Division of Cardiology, Department of Internal Medicine , Yonsei University , Seoul , South Korea
| | - Youngkeun Ahn
- g Department of Cardiology , Cheonnam National University , Gwangju , South Korea
| | - Bong-Min Yang
- a Graduate School of Public Health , Seoul National University , Seoul , South Korea
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Stam-Slob MC, van der Graaf Y, de Boer A, Greving JP, Visseren FL. Cost-effectiveness of PCSK9 inhibition in addition to standard lipid-lowering therapy in patients at high risk for vascular disease. Int J Cardiol 2018; 253:148-154. [DOI: 10.1016/j.ijcard.2017.10.080] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 10/04/2017] [Accepted: 10/19/2017] [Indexed: 12/28/2022]
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van Hulst M, Stevanovic J, Jacobs MS, Tieleman RG, Kappelhoff B, Postma MJ. The cost-effectiveness and monetary benefits of dabigatran in the prevention of arterial thromboembolism for patients with non-valvular atrial fibrillation in the Netherlands. J Med Econ 2018; 21:38-46. [PMID: 28836865 DOI: 10.1080/13696998.2017.1372222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) causes a significant health and economic burden to the Dutch society. Dabigatran was proven to have at least similar efficacy and a similar or better safety profile when compared to vitamin K antagonists (VKAs) in preventing arterial thromboembolism in patients with AF. OBJECTIVE To evaluate the cost-effectiveness and monetary benefit of dabigatran vs VKAs in Dutch patients with non-valvular AF. Value-based pricing considerations and corresponding negotiations on dabigatran will be explicitly considered. METHODS The base case economic analysis was conducted from the societal perspective. Health effects and costs were analysed using a Markov model. The main model inputs were derived from the RE-LY trial and Dutch observational data. Univariate, probabilistic sensitivity, and various scenario analyses were performed. RESULTS Dabigatran was cost saving compared to VKAs. A total of 4,552 QALYs were gained, and €13,892,288 was saved in a cohort of 10,000 AF patients. The economic value of dabigatran was strongly related to the costs of VKA control that are averted. Notably, dabigatran was cost saving compared to VKAs if annual costs of VKA control exceeded €159 per person, or dabigatran costs were below €2.81 per day. CONCLUSION Dabigatran was cost saving compared to VKAs for the prevention of atrial thromboembolism in patients with non-valvular AF in the Netherlands. This result appeared robust in the sensitivity analysis. Furthermore, volume based reduction of the price in the Netherlands will further increase the monetary benefits of dabigatran.
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Affiliation(s)
- Marinus van Hulst
- a Department of Clinical Pharmacy and Toxicology , Martini Hospital , Groningen , The Netherlands
- b Department of PharmacoTherapy, Epidemiology & Economics, Department of Pharmacy , University of Groningen , Groningen , The Netherlands
| | - Jelena Stevanovic
- b Department of PharmacoTherapy, Epidemiology & Economics, Department of Pharmacy , University of Groningen , Groningen , The Netherlands
| | - Maartje S Jacobs
- a Department of Clinical Pharmacy and Toxicology , Martini Hospital , Groningen , The Netherlands
- b Department of PharmacoTherapy, Epidemiology & Economics, Department of Pharmacy , University of Groningen , Groningen , The Netherlands
| | - Robert G Tieleman
- c Department of Cardiology , Martini Hospital , Groningen , The Netherlands
- d Department of Cardiology , University Medical Center Groningen , Groningen , The Netherlands
| | | | - Maarten J Postma
- b Department of PharmacoTherapy, Epidemiology & Economics, Department of Pharmacy , University of Groningen , Groningen , The Netherlands
- f Institute of Science in Healthy Aging & healthcaRE (SHARE) , University Medical Center Groningen (UMCG), University of Groningen , Groningen , The Netherlands
- g Department of Epidemiology , University Medical Center Groningen , Groningen , The Netherlands
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Lee KY, Wan Ahmad WA, Low EV, Liau SY, Anchah L, Hamzah S, Liew HB, Mohd Ali RB, Ismail O, Ong TK, Said MA, Dahlui M. Comparison of the treatment practice and hospitalization cost of percutaneous coronary intervention between a teaching hospital and a general hospital in Malaysia: A cross sectional study. PLoS One 2017; 12:e0184410. [PMID: 28873473 PMCID: PMC5584952 DOI: 10.1371/journal.pone.0184410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 08/23/2017] [Indexed: 11/25/2022] Open
Abstract
Introduction The increasing disease burden of coronary artery disease (CAD) calls for sustainable cardiac service. Teaching hospitals and general hospitals in Malaysia are main providers of percutaneous coronary intervention (PCI), a common treatment for CAD. Few studies have analyzed the contemporary data on local cardiac facilities. Service expansion and budget allocation require cost evidence from various providers. We aim to compare the patient characteristics, procedural outcomes, and cost profile between a teaching hospital (TH) and a general hospital (GH). Methods This cross-sectional study was conducted from the healthcare providers’ perspective from January 1st to June 30th 2014. TH is a university teaching hospital in the capital city, while GH is a state-level general hospital. Both are government-funded cardiac referral centers. Clinical data was extracted from a national cardiac registry. Cost data was collected using mixed method of top-down and bottom-up approaches. Total hospitalization cost per PCI patient was summed up from the costs of ward admission and cardiac catheterization laboratory utilization. Clinical characteristics were compared with chi-square and independent t-test, while hospitalization length and cost were analyzed using Mann-Whitney test. Results The mean hospitalization cost was RM 12,117 (USD 3,366) at GH and RM 16,289 (USD 4,525) at TH. The higher cost at TH can be attributed to worse patients’ comorbidities and cardiac status. In contrast, GH recorded a lower mean length of stay as more patients had same-day discharge, resulting in 29% reduction in mean cost of admission compared to TH. For both hospitals, PCI consumables accounted for the biggest proportion of total cost. Conclusions The high PCI consumables cost highlighted the importance of cost-effective purchasing mechanism. Findings on the heterogeneity of the patients, treatment practice and hospitalization cost between TH and GH are vital for formulation of cost-saving strategies to ensure sustainable and equitable cardiac service in Malaysia.
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Affiliation(s)
- Kun Yun Lee
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- * E-mail:
| | - Wan Azman Wan Ahmad
- Division of Cardiology, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ee Vien Low
- Pharmaceutical Services Division, Ministry of Health, Selangor, Malaysia
| | - Siow Yen Liau
- Department of Pharmacy, Queen Elizabeth 2 Hospital, Sabah, Malaysia
- Clinical Research Centre, Queen Elizabeth 2 Hospital, Sabah, Malaysia
| | - Lawrence Anchah
- Department of Pharmacy, Sarawak General Hospital Heart Centre, Sarawak, Malaysia
| | - Syuhada Hamzah
- Administrative Office, Penang General Hospital, Penang, Malaysia
| | - Houng-Bang Liew
- Clinical Research Centre, Queen Elizabeth 2 Hospital, Sabah, Malaysia
- Division of Cardiology, Queen Elizabeth 2 Hospital, Sabah, Malaysia
| | - Rosli B. Mohd Ali
- Department of Cardiology, National Heart Institute, Kuala Lumpur, Malaysia
| | - Omar Ismail
- Division of Cardiology, Penang General Hospital, Penang, Malaysia
| | - Tiong Kiam Ong
- Department of Cardiology, Sarawak General Hospital Heart Centre, Sarawak, Malaysia
| | - Mas Ayu Said
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Maznah Dahlui
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Stam-Slob MC, van der Graaf Y, Greving JP, Dorresteijn JAN, Visseren FLJ. Cost-Effectiveness of Intensifying Lipid-Lowering Therapy With Statins Based on Individual Absolute Benefit in Coronary Artery Disease Patients. J Am Heart Assoc 2017; 6:e004648. [PMID: 28214794 PMCID: PMC5523762 DOI: 10.1161/jaha.116.004648] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 12/20/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND A validated prediction model estimates the absolute benefit of intensive versus standard lipid-lowering therapy (LLT) with statins on next major cardiovascular events for individual patients with coronary artery disease. We aimed to assess whether targeting intensive LLT therapy to coronary artery disease patients with the highest predicted absolute benefit is cost-effective compared to treating all with standard or all with intensive LLT. METHODS AND RESULTS A lifetime Markov model was constructed for coronary artery disease patients (n=10 000) with mean age 61 years. Number of major cardiovascular events, (non) vascular death, costs, and quality-adjusted life years (QALYs) were estimated for the following strategies: (1) standard LLT for all (reference strategy); (2) intensive LLT for those with 5-year absolute major cardiovascular events risk reduction (ARR) ≥3%, ≥2.3%, or ≥1.5% (corresponding to ≥20%, ≥15%, or ≥10% 5-year major cardiovascular events risk); and (3) intensive LLT for all. With intensive LLT for those with ≥3% 5-year ARR (13% of patients), 380 QALYs were gained for €2423/QALY. Using a threshold of ≥2.3% ARR (26% of patients), 630 QALYs were gained for €5653/QALY. Using a threshold of ≥1.5% ARR (56% of patients), 1020 QALYs were gained for €10 960/QALY. By treating all intensively, 1410 QALYs were gained (0.14 QALY per patient) for €17 223/QALY. With benefit-based treatment, 0.16 to 0.17 QALY was gained per treated patient. CONCLUSIONS Intensive LLT with statins for all coronary artery disease patients results in the highest overall QALY gain against acceptable costs. However, the number of QALYs gained with intensive LLT by statins in individual patients can be increased with selective benefit-based treatment. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00327691 and NCT00159835.
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Affiliation(s)
- Manon C Stam-Slob
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Yolanda van der Graaf
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jacoba P Greving
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jannick A N Dorresteijn
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
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Stevanović J, de Jong LA, Kappelhoff BS, Dvortsin EP, Voorhaar M, Postma MJ. Dabigatran for the Treatment and Secondary Prevention of Venous Thromboembolism; A Cost-Effectiveness Analysis for the Netherlands. PLoS One 2016; 11:e0163550. [PMID: 27776137 PMCID: PMC5077099 DOI: 10.1371/journal.pone.0163550] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 09/11/2016] [Indexed: 01/31/2023] Open
Abstract
Background Dabigatran was proven to have similar effect on the prevention of recurrence of venous thromboembolism (VTE) and a lower risk of bleeding compared to vitamin K antagonists (VKA). The aim of this study is to assess the cost-effectiveness (CE) of dabigatran for the treatment and secondary prevention in patients with VTE compared to VKAs in the Dutch setting. Methods Previously published Markov model was modified and updated to assess the CE of dabigatran and VKAs for the treatment and secondary prevention in patients with VTE from a societal perspective in the base-case analysis. The model was populated with efficacy and safety data from major dabigatran trials (i.e. RE-COVER, RECOVER II, RE-MEDY and RE-SONATE), Dutch specific costs, and utilities derived from dabigatran trials or other published literature. Univariate, probabilistic sensitivity and a number of scenario analyses evaluating various decision-analytic settings (e.g. the perspective of analysis, use of anticoagulants only for treatment or only for secondary prevention, or comparison to no treatment) were tested on the incremental cost-effectiveness ratio (ICER). Results In the base-case scenario, patients on dabigatran gained an additional 0.034 quality adjusted life year (QALY) while saving €1,598. Results of univariate sensitivity analysis were quite robust. The probability that dabigatran is cost-effective at a willingness-to-pay threshold of €20,000/QALY was 98.1%. From the perspective of healthcare provider, extended anticoagulation with dabigatran compared to VKAs was estimated at €2,158 per QALY gained. The ICER for anticoagulation versus no treatment in patients with equipoise risk of recurrent VTE was estimated at €33,379 per QALY gained. Other scenarios showed dabigatran was cost-saving. Conclusion From a societal perspective, dabigatran is likely to be a cost-effective or even cost-saving strategy for treatment and secondary prevention of VTE compared to VKAs in the Netherlands.
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Affiliation(s)
- J. Stevanović
- Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), University of Groningen, Groningen, the Netherlands
| | - L. A. de Jong
- Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), University of Groningen, Groningen, the Netherlands
- * E-mail:
| | | | - E. P. Dvortsin
- Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), University of Groningen, Groningen, the Netherlands
| | - M. Voorhaar
- Boehringer Ingelheim, Alkmaar, the Netherlands
| | - M. J. Postma
- Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), University of Groningen, Groningen, the Netherlands
- Institute for Science in Healthy Aging & healthcaRE (SHARE), University Medical Center Groningen (UMCG), University of Groningen, Groningen, the Netherlands
- Department of Epidemiology, UMCG, University of Groningen, Groningen, the Netherlands
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Burgers L, Vahl A, Severens J, Wiersema A, Cuypers P, Verhagen H, Redekop W. Cost-effectiveness of Elective Endovascular Aneurysm Repair Versus Open Surgical Repair of Abdominal Aortic Aneurysms. Eur J Vasc Endovasc Surg 2016; 52:29-40. [DOI: 10.1016/j.ejvs.2016.03.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 03/02/2016] [Indexed: 11/26/2022]
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Bruins MJ, Dötsch-Klerk M, Matthee J, Kearney M, van Elk K, Weber P, Eggersdorfer M. A Modelling Approach to Estimate the Impact of Sodium Reduction in Soups on Cardiovascular Health in the Netherlands. Nutrients 2015; 7:8010-9. [PMID: 26393647 PMCID: PMC4586570 DOI: 10.3390/nu7095375] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 08/28/2015] [Accepted: 09/06/2015] [Indexed: 12/30/2022] Open
Abstract
Hypertension is a major modifiable risk factor for cardiovascular disease and mortality, which could be lowered by reducing dietary sodium. The potential health impact of a product reformulation in the Netherlands was modelled, selecting packaged soups containing on average 25% less sodium as an example of an achievable product reformulation when implemented gradually. First, the blood pressure lowering resulting from sodium intake reduction was modelled. Second, the predicted blood pressure lowering was translated into potentially preventable incidence and mortality cases from stroke, acute myocardial infarction (AMI), angina pectoris, and heart failure (HF) implementing one year salt reduction. Finally, the potentially preventable subsequent lifetime Disability-Adjusted Life Years (DALYs) were calculated. The sodium reduction in soups might potentially reduce the incidence and mortality of stroke by approximately 0.5%, AMI and angina by 0.3%, and HF by 0.2%. The related burden of disease could be reduced by approximately 800 lifetime DALYs. This modelling approach can be used to provide insight into the potential public health impact of sodium reduction in specific food products. The data demonstrate that an achievable food product reformulation to reduce sodium can potentially benefit public health, albeit modest. When implemented across multiple product categories and countries, a significant health impact could be achieved.
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Affiliation(s)
- Maaike J Bruins
- DSM Biotechnology Center, Alexander Fleminglaan 1, Delft 2613AX, The Netherlands.
| | - Mariska Dötsch-Klerk
- Unilever R&D Vlaardingen, Olivier van Noortlaan 120, Vlaardingen 3133 AT, The Netherlands.
| | - Joep Matthee
- Unilever R&D Vlaardingen, Olivier van Noortlaan 120, Vlaardingen 3133 AT, The Netherlands.
| | - Mary Kearney
- Unilever R&D Vlaardingen, Olivier van Noortlaan 120, Vlaardingen 3133 AT, The Netherlands.
| | - Kathelijn van Elk
- Unilever R&D Vlaardingen, Olivier van Noortlaan 120, Vlaardingen 3133 AT, The Netherlands.
| | - Peter Weber
- DSM Nutritional Products, Wurmisweg 576, Kaiseraugst CH-4303, Switzerland.
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Everaert B, Felix C, Koolen J, den Heijer P, Henriques J, Wykrzykowska J, van der Schaaf R, de Smet B, Hofma S, Diletti R, Van Mieghem N, Regar E, Smits P, van Geuns RJM. Appropriate use of bioresorbable vascular scaffolds in percutaneous coronary interventions: a recommendation from experienced users : A position statement on the use of bioresorbable vascular scaffolds in the Netherlands. Neth Heart J 2015; 23:161-5. [PMID: 25626696 PMCID: PMC4352153 DOI: 10.1007/s12471-015-0651-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Percutaneous coronary interventions (PCI) have become a reliable revascularisation option to treat ischaemic coronary artery disease. Drug-eluting stents (DES) are widely used as first choice devices in many procedures due to their established good medium to long term outcomes. These permanent implants, however, do not have any residual function after vascular healing following the PCI. Beyond this initial healing period, metallic stents may induce new problems, resulting in an average rate of 2 % reinterventions per year. To eliminate this potential late limitation of permanent metallic DES, bioresorbable coronary stents or ‘vascular scaffolds’ (BVS) have been developed. In a parallel publication in this journal, an overview of the current clinical performance of these scaffolds is presented. As these scaffolds are currently CE marked and commercially available in many countries and as clinical evidence is still limited, recommendations for their general usage are needed to allow successful clinical introduction.
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Affiliation(s)
- Bert Everaert
- Thoraxcenter, Erasmus Medical Centre, 's-Gravendijkwal 230, 3015 GE, Rotterdam, The Netherlands,
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28
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Li Q, Lin Z, Masoudi FA, Li J, Li X, Hernández-Díaz S, Nuti SV, Li L, Wang Q, Spertus JA, Hu FB, Krumholz HM, Jiang L. National trends in hospital length of stay for acute myocardial infarction in China. BMC Cardiovasc Disord 2015; 15:9. [PMID: 25603877 PMCID: PMC4360951 DOI: 10.1186/1471-2261-15-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 01/12/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND China is experiencing increasing burden of acute myocardial infarction (AMI) in the face of limited medical resources. Hospital length of stay (LOS) is an important indicator of resource utilization. METHODS We used data from the Retrospective AMI Study within the China Patient-centered Evaluative Assessment of Cardiac Events, a nationally representative sample of patients hospitalized for AMI during 2001, 2006, and 2011. Hospital-level variation in risk-standardized LOS (RS-LOS) for AMI, accounting for differences in case mix and year, was examined with two-level generalized linear mixed models. A generalized estimating equation model was used to evaluate hospital characteristics associated with LOS. Absolute differences in RS-LOS and 95% confidence intervals were reported. RESULTS The weighted median and mean LOS were 13 and 14.6 days, respectively, in 2001 (n = 1,901), 11 and 12.6 days in 2006 (n = 3,553), and 11 and 11.9 days in 2011 (n = 7,252). There was substantial hospital level variation in RS-LOS across the 160 hospitals, ranging from 9.2 to 18.1 days. Hospitals in the Central regions had on average 1.6 days (p = 0.02) shorter RS-LOS than those in the Eastern regions. All other hospital characteristics relating to capacity for AMI treatment were not associated with LOS. CONCLUSIONS Despite a marked decline over the past decade, the mean LOS for AMI in China in 2011 remained long compared with international standards. Inter-hospital variation is substantial even after adjusting for case mix. Further improvement of AMI care in Chinese hospitals is critical to further shorten LOS and reduce unnecessary hospital variation.
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Affiliation(s)
- Qian Li
- />Department of Epidemiology, Harvard School of Public Health, Boston, MA USA
- />Epidemiology, Worldwide Safety & Regulatory, Pfizer Inc., New York, NY USA
| | - Zhenqiu Lin
- />Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, CT USA
| | - Frederick A Masoudi
- />Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | - Jing Li
- />National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037 China
| | - Xi Li
- />National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037 China
| | | | - Sudhakar V Nuti
- />Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, CT USA
| | - Lingling Li
- />Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA USA
| | - Qing Wang
- />National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037 China
| | - John A Spertus
- />Saint Luke’s Mid America Heart Institute, Kansas City, MO USA
| | - Frank B Hu
- />Department of Epidemiology, Harvard School of Public Health, Boston, MA USA
- />Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA USA
- />Department of Nutrition, Harvard School of Public Health, Boston, MA USA
| | - Harlan M Krumholz
- />Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, CT USA
| | - Lixin Jiang
- />National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, 100037 China
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The global impact of non-communicable diseases on healthcare spending and national income: a systematic review. Eur J Epidemiol 2015; 30:251-77. [DOI: 10.1007/s10654-014-9984-2] [Citation(s) in RCA: 151] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 12/23/2014] [Indexed: 12/11/2022]
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Henry TL, De Brouwer BFE, Van Keep MML, Blankestijn PJ, Bots ML, Koffijberg H. Cost-effectiveness of renal denervation therapy for the treatment of resistant hypertension in The Netherlands. J Med Econ 2015; 18:76-87. [PMID: 25367314 DOI: 10.3111/13696998.2014.978453] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Safety and efficacy data for catheter-based renal denervation (RDN) in the treatment of resistant hypertension have been used to estimate the cost-effectiveness of this approach. However, there are no Dutch-specific analyses. This study examined the cost-effectiveness of RDN from the perspective of the healthcare payer in The Netherlands. METHODS A previously constructed Markov state-transition model was adapted and updated with costs and utilities relevant to the Dutch setting. The cost-effectiveness of RDN was compared with standard of care (SoC) for patients with resistant hypertension. The efficacy of RDN treatment was modeled as a reduction in the risk of cardiovascular events associated with a lower systolic blood pressure (SBP). RESULTS Treatment with RDN compared to SoC gave an incremental quality-adjusted life year (QALY) gain of 0.89 at an additional cost of €1315 over a patient's lifetime, resulting in a base case incremental cost-effectiveness ratio (ICER) of €1474. Deterministic and probabilistic sensitivity analyses (PSA) showed that treatment with RDN therapy was cost-effective at conventional willingness-to-pay thresholds (€10,000-80,000/QALY). CONCLUSION RDN is a cost-effective intervention for patients with resistant hypertension in The Netherlands.
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IJkema BBLM, Bonnier JJRM, Schoors D, Schalij MJ, Swenne CA. Role of the ECG in initial acute coronary syndrome triage: primary PCI regardless presence of ST elevation or of non-ST elevation. Neth Heart J 2014; 22:484-90. [PMID: 25200324 PMCID: PMC4391175 DOI: 10.1007/s12471-014-0598-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The major initial triaging decision in acute coronary syndrome (ACS) is whether or not percutaneous coronary intervention (PCI) is the primary treatment. Current guidelines recommend primary PCI in ST-elevation ACS (STEACS) and initial antithrombotic therapy in non-ST-elevation ACS (NSTEACS). This review probes the question whether this decision can indeed be based on the ECG. Genesis of STE/NSTE ECGs depends on the coronary anatomy, collateral circulation and site of the culprit lesion. Other causes than ischaemia may also result in ST-segment changes. It has been demonstrated that the area at risk cannot reliably be estimated by the magnitude of the ST change, that complete as well as incomplete occlusions can cause STE as well as NSTE ECGs, and that STE and NSTE patterns cannot differentiate between transmural and non-transmural ischaemia. Furthermore, unstable angina can occur with STE and NSTE ECGs. We conclude that the ECG can be used to assist in detecting ischaemia, but that electrocardiographic STE and NSTE patterns are not uniquely related to distinctly different pathophysiological mechanisms. Hence, in ACS, primary PCI might be considered regardless of the nature of the ST deviation, and it should be done with the shortest possible delay, because ‘time is muscle’.
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Affiliation(s)
- B B L M IJkema
- Department of Cardiology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, the Netherlands
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Stevanović J, Pompen M, Le HH, Rozenbaum MH, Tieleman RG, Postma MJ. Economic evaluation of apixaban for the prevention of stroke in non-valvular atrial fibrillation in the Netherlands. PLoS One 2014; 9:e103974. [PMID: 25093723 PMCID: PMC4122386 DOI: 10.1371/journal.pone.0103974] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 07/04/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Stroke prevention is the main goal of treating patients with atrial fibrillation (AF). Vitamin-K antagonists (VKAs) present an effective treatment in stroke prevention, however, the risk of bleeding and the requirement for regular coagulation monitoring are limiting their use. Apixaban is a novel oral anticoagulant associated with significantly lower hazard rates for stroke, major bleedings and treatment discontinuations, compared to VKAs. OBJECTIVE To estimate the cost-effectiveness of apixaban compared to VKAs in non-valvular AF patients in the Netherlands. METHODS Previously published lifetime Markov model using efficacy data from the ARISTOTLE and the AVERROES trial was modified to reflect the use of oral anticoagulants in the Netherlands. Dutch specific costs, baseline population stroke risk and coagulation monitoring levels were incorporated. Univariate, probabilistic sensitivity and scenario analyses on the impact of different coagulation monitoring levels were performed on the incremental cost-effectiveness ratio (ICER). RESULTS Treatment with apixaban compared to VKAs resulted in an ICER of €10,576 per quality adjusted life year (QALY). Those findings correspond with lower number of strokes and bleedings associated with the use of apixaban compared to VKAs. Univariate sensitivity analyses revealed model sensitivity to the absolute stroke risk with apixaban and treatment discontinuations risks with apixaban and VKAs. The probability that apixaban is cost-effective at a willingness-to-pay threshold of €20,000/QALY was 68%. Results of the scenario analyses on the impact of different coagulation monitoring levels were quite robust. CONCLUSIONS In patients with non-valvular AF, apixaban is likely to be a cost-effective alternative to VKAs in the Netherlands.
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Affiliation(s)
| | | | - Hoa H. Le
- University of Groningen, Groningen, the Netherlands
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Sözmen K, Pekel Ö, Yılmaz TS, Şahan C, Ceylan A, Güler E, Korkmaz E, Ünal B. Determinants of inpatient costs of angina pectoris, myocardial infarction, and heart failure in a university hospital setting in Turkey. Anatol J Cardiol 2014; 15:325-33. [PMID: 25413230 PMCID: PMC5336844 DOI: 10.5152/akd.2014.5320] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: This study aimed to determine the correlates of in-hospital costs for angina pectoris (AP), myocardial infarction (MI), and heart failure (HF) in a university hospital setting. Methods: This is a retrospective cost-of-illness study using data from the records of patients who were admitted with AP, MI, or HF to Dokuz Eylül University Hospital during 2008. Direct medical costs were calculated from the Social Security Institute perspective using a bottom-up approach. Socio-demographic and clinical information was abstracted from patient files. Costs were presented in Turkish lira (TL). A generalized linear model was used in the multivariate analysis. Results: We included 337 in-patients in total in the study. AP was present in 26.4% (n=89), MI was present in 55.8% (n=188), and HF was present in 17.8% (n=60) of patients. MI was the most costly disease (2760 TL), followed by HF (2350 TL) and AP (1881 TL). The largest proportion of the total cost was formed by medical interventions (27.5%), followed by surgery (22.2%). Presence of DM, smoking, diagnosis of MI, HF, need for intensive care, and resulting in death were strong predictors of treatment costs. Conclusion: Both preadmission characteristics of patients (diabetes mellitus, smoking, use of anti-aggregant before admission) and in-patient characteristics (diagnosis, coronary artery bypass grafting, intensive care need, death) predicted the hospital cost of cardiovascular diseases (CVDs) independently. Our results may be used as input for health-economic models and economic evaluations to support the decision-making of reimbursement and the cost-effectiveness of public health interventions in healthcare.
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Affiliation(s)
- Kaan Sözmen
- Provincial Public Health Directorate, Ministry of Health of Turkey; İzmir-Turkey.
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de Vries FM, Denig P, Visser ST, Hak E, Postma MJ. Cost-effectiveness of statins for primary prevention in patients newly diagnosed with type 2 diabetes in the Netherlands. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2014; 17:223-230. [PMID: 24636380 DOI: 10.1016/j.jval.2013.12.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 11/14/2013] [Accepted: 12/20/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND Statins are lipid-lowering drugs that reduce the risk of cardiovascular events in patients with diabetes. OBJECTIVES The objective of this study was to determine whether statin treatment for primary prevention in newly diagnosed type 2 diabetes is cost-effective, taking nonadherence, baseline risk, and age into account. METHODS A cost-effectiveness analysis was performed by using a Markov model with a time horizon of 10 years. The baseline 10-year cardiovascular risk was estimated in a Dutch population of primary prevention patients with newly diagnosed diabetes from the Groningen Initiative to Analyse Type 2 Diabetes Treatment (GIANTT) database, using the United Kingdom Prospective Diabetes Study risk engine. Statin adherence was measured as pill days covered in the IADB.nl pharmacy research database. Cost-effectiveness was measured in costs per quality-adjusted life-year (QALY) from the health care payers' perspective. RESULTS For an average patient aged 60 years, the base case, statin treatment was highly cost-effective at €2245 per QALY. Favorable cost-effectiveness was robust in sensitivity analysis. Differences in age and 10-year cardiovascular risk showed large differences in cost-effectiveness from almost €100,000 per QALY to almost being cost saving. Treating all patients younger than 45 years at diabetes diagnosis was not cost-effective (weighted cost-effectiveness of almost €60,000 per QALY). CONCLUSIONS Despite the nonadherence levels observed in actual practice, statin treatment is cost-effective for primary prevention in patients newly diagnosed with type 2 diabetes. Because of large differences in cost-effectiveness according to different risk and age groups, the efficiency of the treatment could be increased by targeting patients with relatively higher cardiovascular risk and higher ages.
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Affiliation(s)
- Folgerdiena M de Vries
- Department of Pharmacy, Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), University of Groningen, Groningen, The Netherlands.
| | - Petra Denig
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sipke T Visser
- Department of Pharmacy, Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), University of Groningen, Groningen, The Netherlands
| | - Eelko Hak
- Department of Pharmacy, Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), University of Groningen, Groningen, The Netherlands
| | - Maarten J Postma
- Department of Pharmacy, Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), University of Groningen, Groningen, The Netherlands
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Simoons ML. Costs and benefits of treatment of myocardial infarction. Neth Heart J 2013; 21:228-9. [PMID: 23572331 PMCID: PMC3636338 DOI: 10.1007/s12471-013-0410-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- M L Simoons
- Cardiology, Thoraxcentrum, Erasmus MC, Rotterdam, the Netherlands,
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