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Dela Rosa JGL, Catral CDM, Reyes NA, Opiso DMS, Ong EP, Ornos EDB, Santos JR, Quebral EPB, Callanta MLJ, Oliva RV, Tantengco OAG. Current status of hypertension care and management in the Philippines. Diabetes Metab Syndr 2024; 18:103008. [PMID: 38640838 DOI: 10.1016/j.dsx.2024.103008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 04/03/2024] [Accepted: 04/08/2024] [Indexed: 04/21/2024]
Abstract
AIMS In this paper, we discuss the existing data on the burden of hypertension in the Philippines and present the status of management, prevention, and control of hypertension in the country. METHODS A literature review was conducted to synthesize the status of hypertension care in the Philippines. RESULTS Hypertension continues to contribute to the country's leading causes of death. Similar to the global trend, almost half of hypertensive Filipinos are still not aware of their condition, and only 27 % have it under control. The prevalence of hypertension has steadily increased from 22 % in 1993 to 25.15 % in 2013. The 2020 Philippine Society for Hypertension clinical practice guideline defines hypertension as an office BP of 140/90 mm Hg or above following the proper standard BP measurement. During the past decade, monotherapy has been the mode of treatment in more than 80 % of Filipino patients. This could also explain why the BP control rates have been low. The most prevalent complications of hypertension in the Philippines were stroke (11.6 %), ischemic heart disease (7.7 %), chronic kidney disease (6.30 %), and hypertensive retinopathy (2.30 %). Hypertension causes economic tolls on patients, from the cost of drugs to hospitalization and complications. Hospitalization from hypertensive complications can easily wipe out the savings of middle-class families and is catastrophic for lower-income Filipinos. CONCLUSION In this review, we summarize the existing data on the burden of hypertension among Filipinos and the risk factors associated with the disease. We present the current screening tools, diagnostics, treatment, and prevention strategies for hypertension in the Philippines. Lastly, we propose solutions to meet the global targets of hypertension management and help relieve the growing burden of this disease.
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Affiliation(s)
| | | | | | - Danna Mae S Opiso
- College of Medicine, University of the Philippines, Ermita, Manila, Philippines
| | - Erika P Ong
- College of Medicine, University of the Philippines, Ermita, Manila, Philippines
| | - Eric David B Ornos
- Department of Medical Microbiology, College of Public Health, University of the Philippines, Ermita, Manila, Philippines
| | - Jerico R Santos
- Department of Medical Microbiology, College of Public Health, University of the Philippines, Ermita, Manila, Philippines
| | - Elgin Paul B Quebral
- Department of Medical Microbiology, College of Public Health, University of the Philippines, Ermita, Manila, Philippines
| | - Maria Llaine J Callanta
- Department of Biochemistry and Molecular Biology, College of Medicine, University of the Philippines, Ermita, Manila, Philippines
| | - Raymond V Oliva
- Department of Pharmacology and Toxicology, College of Medicine, University of the Philippines, Ermita, Manila, Philippines; Department of Medicine, University of the Philippines - Philippine General Hospital, Taft Avenue, Manila, Philippines
| | - Ourlad Alzeus G Tantengco
- Department of Physiology, College of Medicine, University of the Philippines, Ermita, Manila, Philippines; Department of Biology, College of Science, De La Salle University, Manila, Philippines.
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Teimourizad A, Jafari A, Esmaeilzadeh F. Budget impact analyses for treatment of heart failure. A systematic review. Heart Fail Rev 2024:10.1007/s10741-024-10397-8. [PMID: 38492179 DOI: 10.1007/s10741-024-10397-8] [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] [Accepted: 03/07/2024] [Indexed: 03/18/2024]
Abstract
Heart failure (HF) is increasing globally and turning out to be a serious worldwide public health problem with significant morbidity and mortality. This study aims to systemically review the budget impact analysis of heart failure treatments on health care expenditure worldwide. Scientific databases such as PubMed, Web of Science, Scopus, and Google Scholar were searched for budget impact analysis and heart failure treatments, over January 2001 to August 2023. The quality assessment of the selected studies was evaluated through ISPOR practice guideline. Nineteen studies were included in this systematic review. Based on ISPOR recommendations, most studies were performed on a 1-year time horizon and used a government (public health) or health system perspective. Data for selected studies was mainly collected from randomized clinical trials, published literature, pharmaceutical companies, and registry data. Only direct costs were reported in the studies. Sensitivity analyses were stated in almost all studies. However, studies conducted in high-income countries reported sensitivity analyses more elaborately than those performed in low- and middle-income countries. In many published articles related to the budget impact analyses of heart failure treatment, addition of new treatments to the health system's formularies can lead to a reduction in cardiovascular hospitalization rates, re-hospitalization rates, cardiac-associated mortality rates, and an improvement in heart failure class, which can decrease the costs of hospitalizations, specified care visits, primary care visits, and other related treatments.
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Affiliation(s)
| | - Abdosaleh Jafari
- Health Human Resources Research Centre, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Firooz Esmaeilzadeh
- Department of Public Health, School of Public Health, Maragheh University of Medical Sciences, Maragheh, Iran
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Ong SC, Low JZ. Financial burden of heart failure in Malaysia: A perspective from the public healthcare system. PLoS One 2023; 18:e0288035. [PMID: 37406003 DOI: 10.1371/journal.pone.0288035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/18/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Estimating and evaluating the economic burden of HF and its impact on the public healthcare system is necessary for devising improved treatment plans in the future. The present study aimed to determine the economic impact of HF on the public healthcare system. METHOD The annual cost of HF per patient was estimated using unweighted average and inverse probability weighting (IPW). Unweight average estimated the annual cost by considering all observed cases regardless of the availability of all the cost data, while IPW calculated the cost by weighting against inverse probability. The economic burden of HF was estimated for different HF phenotypes and age categories at the population level from the public healthcare system perspective. RESULTS The mean (standard deviation) annual costs per patient calculated using unweighted average and IPW were USD 5,123 (USD 3,262) and USD 5,217 (USD 3,317), respectively. The cost of HF estimated using two different approaches did not differ significantly (p = 0.865). The estimated cost burden of HF in Malaysia was USD 481.9 million (range: USD 31.7 million- 1,213.2 million) per year, which accounts for 1.05% (range: 0.07%-2.66%) of total health expenditure in 2021. The cost of managing patients with heart failure with reduced ejection fraction (HFrEF) accounted for 61.1% of the total financial burden of HF in Malaysia. The annual cost burden increased from USD 2.8 million for patients aged 20-29 to USD 142.1 million for those aged 60-69. The cost of managing HF in patients aged 50-79 years contributed 74.1% of the total financial burden of HF in Malaysia. CONCLUSION A large portion of the financial burden of HF in Malaysia is driven by inpatient costs and HFrEF patients. Long-term survival of HF patients leads to an increase in the prevalence of HF, inevitably increasing the financial burden of HF.
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Affiliation(s)
- Siew Chin Ong
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor, Penang, Malaysia
| | - Joo Zheng Low
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor, Penang, Malaysia
- Hospital Sultan Ismail Petra, Ministry of Health Malaysia, Kuala Krai, Kelantan, Malaysia
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Leong RN, Caesar Delos Trinos JP, Gerodias F, Mojica VJ, Alconera CJ, Tamayo RL, Alacapa J, Almirol BJ, Paredes KP, Lim S, Tumanan-Mendoza B. Budget Impact Analysis of Utilization of Sacubitril/Valsartan for the Treatment of Heart Failure With Reduced Ejection Fraction in the Philippines. Value Health Reg Issues 2023; 36:105-116. [PMID: 37104912 DOI: 10.1016/j.vhri.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/20/2022] [Accepted: 02/22/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVES This study aimed to estimate the financial and economic impact of sacubitril/valsartan compared with enalapril for the treatment and prevention of hospitalization/rehospitalization because of heart failure with reduced ejection fraction (HFrEF). METHODS The budget impact analysis was guided by the Philippine Reference Case and ISPOR's Principles of Good Practice for Budget Impact Analysis. A government-funded healthcare payer perspective and a societal perspective were considered. Data collection was guided by the pathways of disease progression and care. Collection of costing data followed a bottom-up approach. The model was based on a Markov model used in a study in Thailand. RESULTS Over the next 5 years, there will be 17 625 less hospitalizations (∼5.1% less than enalapril arm) and 7968 less cardiovascular-related deaths (∼7.0% less than enalapril arm). In 5 years, the total cost of treating patients with HFrEF with sacubitril/valsartan at current market coverage and annual growth conditions is ₱15.430 billion, which is ₱11.077 billion higher than fully treating with enalapril only. The total required additional investment with treatment of sacubitril/valsartan compared with the full enalapril arm are ₱407 million (at 30-day coverage), ₱800 million (at 60-day coverage), and ₱1.181 billion (at 90-day coverage). If hospitalizations costs alone are considered, only the 30-day coverage is cost-saving. If a societal perspective is considered, all options are cost-saving where at least ₱4.003 billion is saved by the economy. CONCLUSION The initial investment required to treat patients with HFrEF with sacubitril/valsartan is high; nevertheless, the year-on-year cost deficit shrinks in favor of investing in sacubitril/valsartan treatment.
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Affiliation(s)
| | | | | | - Vio Jianu Mojica
- metaHealth Insights and Innovations, Malabon, Philippines; University of the Philippines Manila, Manila, Philippines
| | | | | | - Jason Alacapa
- metaHealth Insights and Innovations, Malabon, Philippines
| | | | | | - Sheila Lim
- Novartis Healthcare Philippines, Inc, Makati City, Philippines
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Jimeno C, Sy RA, De La Pena P, Cipriano C, Tan R, Panelo A, Ng JYS. Direct medical costs of type 2 diabetes mellitus in the Philippines: findings from two hospital databases and physician surveys. BMJ Open 2021; 11:e049737. [PMID: 34635519 PMCID: PMC8506878 DOI: 10.1136/bmjopen-2021-049737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To estimate the annual direct medical cost of type 2 diabetes mellitus (T2DM) in hospitals and outpatient care clinics from a healthcare payer perspective in the Philippines. DESIGN AND PARTICIPANTS (1) A review of electronic hospital records of people with T2DM in two tertiary hospitals-Ospital ng Makati (OsMak) and National Kidney and Transplant Institute (NKTI) and (2) a cross-sectional survey with 50 physicians providing outpatient care for people with T2DM. SETTING Primary, secondary and tertiary healthcare facilities in Metro Manila. OUTCOME MEASURES Cost of managing T2DM and its related complications in US dollars (USD) in 2016. RESULTS A total of 1023 and 1378 people were identified in OsMak and NKTI, with a complication rate of 66% and 74%, respectively. In both institutions, the average annual cost per person was higher if individuals were diagnosed with any complication (NKTI: US$3226 vs US$2242 and OsMak: US$621 vs US$127). Poor diabetes control was estimated to incur higher per person cost than good control in both public outpatient care (poor control, range: US$727 to US$2463 vs good control, range: US$614 to US$1520) and private outpatient care (poor control, range: US$848 to US$2507 vs good control, range: US$807 to US$1603). CONCLUSION The results highlight the high direct medical cost resulting from poor diabetes control and the opportunity for cost reduction by improving control and preventing its complications.
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Affiliation(s)
- Cecilia Jimeno
- Department of Pharmacology and Toxicology, and Section of Endocrinology, Diabetes and Metabolism, University of the Philippines Manila College of Medicine, Manila, Metro Manila, Philippines
| | - Rosa Allyn Sy
- Section of Endocrinology, Diabetes, Metabolism and Nutrition, Ospital ng Makati, Makati, Metro Manila, Philippines
- Research Development and Innovation, Ospital ng Makati, Makati City, Philippines
| | - Pepito De La Pena
- Division of Internal Medicine, National Kidney and Transplant Institute, Quezon City, National Capital Region, Philippines
| | - Chritopher Cipriano
- Research Development and Innovation, Ospital ng Makati, Makati City, Philippines
| | - Rima Tan
- Institute for Studies on Diabetes Foundation Inc, Marikina City, Metro Manila, Philippines
| | - Araceli Panelo
- Department of Medicine, University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines
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Mendoza VL, Tumanan-Mendoza BA, Punzalan FER. Cost-utility analysis of add-on dapagliflozin in heart failure with reduced ejection fraction in the Philippines. ESC Heart Fail 2021; 8:5132-5141. [PMID: 34494399 PMCID: PMC8712807 DOI: 10.1002/ehf2.13583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/13/2021] [Accepted: 08/10/2021] [Indexed: 01/01/2023] Open
Abstract
Aim We aim to determine the cost‐effectiveness of dapagliflozin in addition to standard therapy versus standard therapy alone among patients with heart failure with reduced ejection fraction (HFrEF) using the public healthcare provider's perspective in the Philippines. Methods and results A thousand Filipino patients with HFrEF (with or without type 2 diabetes mellitus) were included in a simulation cohort using a lifetime Markov model. The model, which was developed based on the results of the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure trial, was composed of three health states. These were ‘alive without an event’ (chronic heart failure state), ‘alive but was hospitalized for heart failure’ (worsening heart failure), and ‘dead’ (death from any cause). Data regarding costs and utilities were obtained from previous studies and local data. These were used to estimate the incremental cost per quality‐adjusted life‐year (ICER). A 3% annual discount rate was used for both costs and effects. One‐way (deterministic) and probabilistic sensitivity analyses as well as scenario analyses were performed. The ICER for the addition of dapagliflozin to standard therapy among HFrEF patients was PHP177 868 (US$3434) and PHP160 983 (US$3108), respectively, if the present price (PHP44.00) and possible negotiated unit cost of dapagliflozin 10 mg tablet (PHP40.00) were used. These were deemed cost‐effective because they were both below the threshold ICER which was equivalent to the gross domestic product per capita of the Philippines in 2019, PHP180 500 (US$3485). Using the unit costs of dapagliflozin previously mentioned, the ICERs among HFrEF patients with diabetes were PHP132 582 (US$2560) and PHP120 249 (US$2321), respectively. Doing PSA involving Monte Carlo simulation of 10 000 iterations and plotting the resulting ICERs against the threshold ICER in the cost‐effectiveness acceptability curves, these ICERs for HFrEF among diabetics were determined to be 72% and 76% cost‐effective. Conclusion Dapagliflozin added to standard therapy for HFrEF patients is likely to be cost‐effective using the perspective of the Philippine public healthcare provider.
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Affiliation(s)
- Victor L Mendoza
- Department of Physiology and Section of Cardiology, Department of Internal Medicine, De La Salle Medical and Health Sciences Institute, Dasmariñas, Cavite, Philippines
| | - Bernadette A Tumanan-Mendoza
- Section of Cardiology, Department of Internal Medicine, Manila Doctors Hospital, United Nations Avenue, Manila, 1000, Philippines.,Department of Clinical Epidemiology, University of the Philippines College of Medicine, Manila, Philippines
| | - Felix Eduardo R Punzalan
- Section of Cardiology, Department of Internal Medicine, Manila Doctors Hospital, United Nations Avenue, Manila, 1000, Philippines.,Division of Cardiovascular Medicine, University of the Philippines College of Medicine, Philippine General Hospital, Manila, Philippines
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