RESUMEN
Coronary heart disease (CHD) is a major cause of death and important driver of health care costs. Recent German health care reforms have promoted integrated care contracts allowing statutory health insurance providers more room to organize health care provision. One provider offers KardioPro, an integrated primary care-based CHD prevention program. As insurance providers should be aware of the financial consequences when developing optional programs, this study aims to analyze the costs associated with KardioPro participation. 13,264 KardioPro participants were compared with a propensity score-matched control group. Post-enrollment health care costs were calculated based on routine data over a follow-up period of up to 4 years. For those people who incurred costs, KardioPro participation was significantly associated with increased physician costs (by 33%), reduced hospital costs (by 19%), and reduced pharmaceutical costs (by 16%). Overall costs were increased by 4%, but this was not significant. Total excess costs per observation year were 131 per person (95% confidence interval: [-36.5; 296]). Overall, KardioPro likely affected treatment as the program increased costs of physician services and reduced costs of hospital services. Further effects of substituting potential inpatient care with increased outpatient care might become fully apparent only over a longer time horizon.
Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Prestación Integrada de Atención de Salud/economía , Costos de la Atención en Salud/estadística & datos numéricos , Anciano , Enfermedades Cardiovasculares/economía , Análisis Costo-Beneficio , Femenino , Alemania , Costos de Hospital/estadística & datos numéricos , Humanos , Seguro de Salud , Masculino , Persona de Mediana Edad , Atención Primaria de Salud/economía , Atención Primaria de Salud/estadística & datos numéricos , Puntaje de PropensiónRESUMEN
OBJECTIVE: The aim of this study was to assess the cost effectiveness of the novel fixed-dose anticoagulant rivaroxaban compared with the current standard of care, warfarin, for the prevention of stroke in patients with atrial fibrillation (AF). METHODS: A Markov model was constructed to model the costs and health outcomes of both treatments, potential adverse events, and resulting health states over 35 years. Analyses were based on a hypothetical cohort of 65-year-old patients with non-valvular AF at moderate to high risk of stroke. The main outcome measure was cost per quality-adjusted life-year (QALY) gained over the lifetime, and was assessed from the German Statutory Health Insurance (SHI) perspective. Costs and utility data were drawn from public data and the literature, while event probabilities were derived from both the literature and rivaroxaban's pivotal ROCKET AF trial. RESULTS: Stroke prophylaxis with rivaroxaban offers health improvements over warfarin treatment at additional cost. From the SHI perspective, at baseline the incremental cost-effectiveness ratio of rivaroxaban was
Asunto(s)
Anticoagulantes/uso terapéutico , Fibrilación Atrial/tratamiento farmacológico , Rivaroxabán/uso terapéutico , Accidente Cerebrovascular/prevención & control , Anciano , Anticoagulantes/administración & dosificación , Anticoagulantes/economía , Fibrilación Atrial/complicaciones , Fibrilación Atrial/economía , Análisis Costo-Beneficio , Inhibidores del Factor Xa/administración & dosificación , Inhibidores del Factor Xa/economía , Inhibidores del Factor Xa/uso terapéutico , Alemania , Hemorragia/economía , Hemorragia/epidemiología , Humanos , Cadenas de Markov , Años de Vida Ajustados por Calidad de Vida , Factores de Riesgo , Rivaroxabán/administración & dosificación , Rivaroxabán/economía , Accidente Cerebrovascular/economía , Accidente Cerebrovascular/etiología , Warfarina/administración & dosificación , Warfarina/economía , Warfarina/uso terapéuticoRESUMEN
BACKGROUND: Patients undergoing major orthopaedic surgery (MOS), such as total hip (THR) or total knee replacement (TKR), are at high risk of developing venous thromboembolism (VTE). For thromboembolism prophylaxis, the oral anticoagulant rivaroxaban has recently been included in the German diagnosis related group (DRG) system. However, the cost-effectiveness of rivaroxaban is still unclear from both the German statutory health insurance (SHI) and the German hospital perspective. OBJECTIVES: To assess the cost-effectiveness of rivaroxaban from the German statutory health insurance (SHI) perspective and to analyse financial incentives from the German hospital perspective. METHODS: Based on data from the RECORD trials and German cost data, a decision tree was built. The model was run for two settings (THR and TKR) and two perspectives (SHI and hospital) per setting. RESULTS: Prophylaxis with rivaroxaban reduces VTE events (0.02 events per person treated after TKR; 0.007 after THR) compared with enoxaparin. From the SHI perspective, prophylaxis with rivaroxaban after TKR is cost saving (27.3 saving per patient treated). However, the cost-effectiveness after THR (17.8 cost per person) remains unclear because of stochastic uncertainty. From the hospital perspective, for given DRGs, the hospital profit will decrease through the use of rivaroxaban by 20.6 (TKR) and 31.8 (THR) per case respectively. CONCLUSIONS: Based on our findings, including rivaroxaban for reimbursement in the German DRG system seems reasonable. Yet, adequate incentives for German hospitals to use rivaroxaban are still lacking.