RÉSUMÉ
OBJECTIVE: To investigate the cost effectiveness of ticagrelor versus clopidogrel in patients with acute coronary syndromes (ACS) in the Platelet Inhibition and Patient Outcomes (PLATO) study who were scheduled for non-invasive management. METHODS: A previously developed cost effectiveness model was used to estimate long-term costs and outcomes for patients scheduled for non-invasive management. Healthcare costs, event rates and health-related quality of life under treatment with either ticagrelor or clopidogrel over 12â months were estimated from the PLATO study. Long-term costs and health outcomes were estimated based on data from PLATO and published literature sources. To investigate the importance of different healthcare cost structures and life expectancy for the results, the analysis was carried out from the perspectives of the Swedish, UK, German and Brazilian public healthcare systems. RESULTS: Ticagrelor was associated with lifetime quality-adjusted life-year (QALY) gains of 0.17 in Sweden, 0.16 in the UK, 0.17 in Germany and 0.13 in Brazil compared with generic clopidogrel, with increased healthcare costs of 467, 551, 739 and 574, respectively. The cost per QALY gained with ticagrelor was 2747, 3395, 4419 and 4471 from a Swedish, UK, German and Brazilian public healthcare system perspective, respectively. Probabilistic sensitivity analyses indicated that the cost per QALY gained with ticagrelor was below conventional threshold values of cost effectiveness with a high probability. CONCLUSIONS: Treatment of patients with ACS scheduled for 12â months' non-invasive management with ticagrelor is associated with a cost per QALY gained below conventional threshold values of cost effectiveness compared with generic clopidogrel. TRIAL REGISTRATION NUMBER: NCT000391872.
Sujet(s)
Syndrome coronarien aigu/traitement médicamenteux , Adénosine/analogues et dérivés , Ticlopidine/analogues et dérivés , Syndrome coronarien aigu/diagnostic , Syndrome coronarien aigu/économie , Syndrome coronarien aigu/psychologie , Adénosine/économie , Adénosine/usage thérapeutique , Brésil , Clopidogrel , Analyse coût-bénéfice , Prise en charge de la maladie , Électrocardiographie , Femelle , Allemagne , Coûts des soins de santé/statistiques et données numériques , Humains , Mâle , Chaines de Markov , 29918 , Antiagrégants plaquettaires/économie , Antiagrégants plaquettaires/usage thérapeutique , Qualité de vie , Années de vie ajustées sur la qualité , Prévention secondaire/économie , Prévention secondaire/méthodes , Suède , Ticagrélor , Ticlopidine/économie , Ticlopidine/usage thérapeutique , Royaume-UniRÉSUMÉ
During the last decade, the usefulness of functional endoscopic sinus surgery (FESS) has been clearly demonstrated in adult patients. Several recent studies have described the use of FESS in children. Most of the patients in these earlier studies have been school age or older. This paper will examine the follow-up of 44 children treated using FESS. The children's ages ranged from 14 months to 13 years with a mean age of 54.5 months. Thirty-three of the children were less than 6 years of age with a mean age of 35.3 months. Follow-up after surgery varied from 1 to 21 months with a mean of 7.4 months. There were no major surgical or anesthetic complications noted during the initial procedure or at the follow-up debridement. Overall the children did well, with 86% showing improvement. It appears that FESS can be helpful for even young children with chronic sinusitis.