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1.
Public Health ; 190: 23-29, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33338899

RESUMO

OBJECTIVES: We aimed to determine whether there are any differences in all-cause and cause-specific mortality with cardiovascular disease (CVD) risk between health screening attenders and non-attenders among young adults. STUDY DESIGN: We performed a retrospective cohort study using claim data from the Korean National Health Insurance Service database. METHODS: Individuals aged 20-39 years who had received health screening at least once between 2002 and 2005 were classified as attenders, and the others were classified as non-attenders. After propensity score matching according to attendance of health screening, 2,060,409 attenders and 2,060,409 non-attenders were included. We estimated adjusted hazard ratios (HRs) and 95% confidence interval (CI) for all-cause mortality, cause-specific mortality, and hospitalization of CVD from 2006 to 2015. RESULTS: Survival from all-cause mortality was greater among attenders than among non-attenders (log rank P < 0.001). Similarly, death from CVD (log rank P = 0.007) and CVD events (log rank P < 0.001) were less likely among attenders. The risk for all-cause mortality in attenders was significantly lower than that in non-attenders (HR = 0.83, 95% CI = 0.81 to 0.84). The risk for CVD mortality (HR = 0.80, 95% CI = 0.73 to 0.87) and hospitalization of CVD (HR = 0.92, 95% CI = 0.91 to 0.94) were lower in attenders. In stratified analyses, the risk for all-cause and cause-specific mortalities was lower among attenders regardless of insurance type. CONCLUSIONS: Among young adults, the risk for all-cause mortality, CVD mortality, and hospitalization of CVD were lower for those who underwent health screenings. Future studies that evaluate the cost-effectiveness of health screening with additional consideration of psychosocial aspects are needed.


Assuntos
Doenças Cardiovasculares/diagnóstico , Programas de Rastreamento/estatística & dados numéricos , Programas Nacionais de Saúde/economia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto , Idoso , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/mortalidade , Causas de Morte/tendências , Estudos de Coortes , Feminino , Hospitalização , Humanos , Incidência , Masculino , Programas de Rastreamento/economia , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , República da Coreia/epidemiologia , Estudos Retrospectivos
2.
PLoS Med ; 17(12): e1003478, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33326459

RESUMO

BACKGROUND: People with reduced kidney function have increased cardiovascular disease (CVD) risk. We present a policy model that simulates individuals' long-term health outcomes and costs to inform strategies to reduce risks of kidney and CVDs in this population. METHODS AND FINDINGS: We used a United Kingdom primary healthcare database, the Clinical Practice Research Datalink (CPRD), linked with secondary healthcare and mortality data, to derive an open 2005-2013 cohort of adults (≥18 years of age) with reduced kidney function (≥2 measures of estimated glomerular filtration rate [eGFR] <90 mL/min/1.73 m2 ≥90 days apart). Data on individuals' sociodemographic and clinical characteristics at entry and outcomes (first occurrences of stroke, myocardial infarction (MI), and hospitalisation for heart failure; annual kidney disease stages; and cardiovascular and nonvascular deaths) during follow-up were extracted. The cohort was used to estimate risk equations for outcomes and develop a chronic kidney disease-cardiovascular disease (CKD-CVD) health outcomes model, a Markov state transition model simulating individuals' long-term outcomes, healthcare costs, and quality of life based on their characteristics at entry. Model-simulated cumulative risks of outcomes were compared with respective observed risks using a split-sample approach. To illustrate model value, we assess the benefits of partial (i.e., at 2013 levels) and optimal (i.e., fully compliant with clinical guidelines in 2019) use of cardioprotective medications. The cohort included 1.1 million individuals with reduced kidney function (median follow-up 4.9 years, 45% men, 19% with CVD, and 74% with only mildly decreased eGFR of 60-89 mL/min/1.73 m2 at entry). Age, kidney function status, and CVD events were the key determinants of subsequent morbidity and mortality. The model-simulated cumulative disease risks corresponded well to observed risks in participant categories by eGFR level. Without the use of cardioprotective medications, for 60- to 69-year-old individuals with mildly decreased eGFR (60-89 mL/min/1.73 m2), the model projected a further 22.1 (95% confidence interval [CI] 21.8-22.3) years of life if without previous CVD and 18.6 (18.2-18.9) years if with CVD. Cardioprotective medication use at 2013 levels (29%-44% of indicated individuals without CVD; 64%-76% of those with CVD) was projected to increase their life expectancy by 0.19 (0.14-0.23) and 0.90 (0.50-1.21) years, respectively. At optimal cardioprotective medication use, the projected health gains in these individuals increased by further 0.33 (0.25-0.40) and 0.37 (0.20-0.50) years, respectively. Limitations include risk factor measurements from the UK routine primary care database and limited albuminuria measurements. CONCLUSIONS: The CKD-CVD policy model is a novel resource for projecting long-term health outcomes and assessing treatment strategies in people with reduced kidney function. The model indicates clear survival benefits with cardioprotective treatments in this population and scope for further benefits if use of these treatments is optimised.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Taxa de Filtração Glomerular , Rim/fisiopatologia , Modelos Teóricos , Serviços Preventivos de Saúde , Insuficiência Renal Crônica/terapia , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/mortalidade , Bases de Dados Factuais , Inglaterra/epidemiologia , Feminino , Custos de Cuidados de Saúde , Nível de Saúde , Humanos , Masculino , Cadeias de Markov , Pessoa de Meia-Idade , Serviços Preventivos de Saúde/economia , Prognóstico , Qualidade de Vida , Insuficiência Renal Crônica/economia , Insuficiência Renal Crônica/mortalidade , Insuficiência Renal Crônica/fisiopatologia , Medição de Risco , Fatores de Risco , Fatores de Tempo
3.
Methodist Debakey Cardiovasc J ; 16(3): 225-231, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33133359

RESUMO

Over the past two decades, Medicare and other payers have been looking at ways to base payment for cardiovascular care on the quality and outcomes of care delivered. Public reporting of hospital performance on a series of quality measures began in 2004 with basic processes of care such as aspirin use and influenza vaccination, and it expanded in later years to include outcomes such as mortality and readmission rates. Following the passage of the Affordable Care Act in March 2010, Medicare and other payers moved forward with pay-for-performance programs, more commonly referred to as value-based purchasing (VBP) programs. These programs are largely based on an underlying fee-for-service payment infrastructure and give hospitals and clinicians bonuses or penalties based on their performance. Another new payment mechanism, called alternative payment models (APMs), aims to move towards episode-based or global payments to improve quality and efficiency. The two most relevant APMs for cardiovascular care include Accountable Care Organizations and bundled payments. Both VBP programs and APMs have challenges related to program efficacy, accuracy, and equity. In fact, despite over a decade of progress in measuring and incentivizing high-quality care delivery within cardiology, major limitations remain. Many of the programs have had little benefit in terms of clinical outcomes yet have led to marked administrative burden for participants. However, there are several encouraging prospects to aid the successful implementation of value-based high-quality cardiovascular care, such as more sophisticated data science to improve risk adjustment and flexible electronic health records to decrease administrative burden. Furthermore, payment models designed specifically for cardiovascular care could incentivize innovative care delivery models that could improve quality and outcomes for patients. This review provides an overview of current efforts, largely at the federal level, to pay for high-quality cardiovascular care and discusses the challenges and prospects related to doing so.


Assuntos
Cardiologia/economia , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/terapia , Custos de Cuidados de Saúde , Avaliação de Processos e Resultados em Cuidados de Saúde/economia , Reembolso de Incentivo/economia , Cardiologia/normas , Doenças Cardiovasculares/diagnóstico , Custos de Cuidados de Saúde/normas , Humanos , Avaliação de Processos e Resultados em Cuidados de Saúde/normas , Pacotes de Assistência ao Paciente/economia , Melhoria de Qualidade/economia , Indicadores de Qualidade em Assistência à Saúde/economia , Reembolso de Incentivo/normas , Resultado do Tratamento , Seguro de Saúde Baseado em Valor/economia , Aquisição Baseada em Valor/economia
4.
Methodist Debakey Cardiovasc J ; 16(3): 232-240, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33133360

RESUMO

In an effort to curb excessive health care spending and incentivize high-quality care, many payers have implemented value-based payment reforms designed to pay for the quality rather than the quantity of health care services. Medicare, the largest payer in the United States, has implemented numerous value-based payment policies over the past decade, many of which affect cardiovascular care. In this review, we discuss some of these major nationwide value-based payment reforms as they relate to cardiovascular care and what we may expect in the future from cardiovascular value-based policies.


Assuntos
Cardiologia/economia , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/terapia , Custos de Cuidados de Saúde , Reforma dos Serviços de Saúde/economia , Medicare/economia , Avaliação de Processos e Resultados em Cuidados de Saúde/economia , Seguro de Saúde Baseado em Valor/economia , Aquisição Baseada em Valor/economia , Organizações de Assistência Responsáveis/economia , Cardiologia/legislação & jurisprudência , Doenças Cardiovasculares/diagnóstico , Custos de Cuidados de Saúde/legislação & jurisprudência , Reforma dos Serviços de Saúde/legislação & jurisprudência , Política de Saúde , Humanos , Medicare/legislação & jurisprudência , Pacotes de Assistência ao Paciente/economia , Formulação de Políticas , Resultado do Tratamento , Estados Unidos , Aquisição Baseada em Valor/legislação & jurisprudência
5.
Artigo em Inglês | MEDLINE | ID: mdl-32751102

RESUMO

Although the adverse effects of ambient particulate matter (PM) on cardiovascular disease (CVD) have been previously documented, information about their economic consequence was insufficient. This study aimed to evaluate the attributable risk and economic cost of cardiovascular hospitalizations due to ambient PM. Data of CVD hospitalizations and PM concentrations from 1 January 2015 to 31 December 2017 were collected in Wuhan, China. A generalized additive model was applied to quantify the PM-attributable CVD hospitalizations, and total attributable hospitalization costs were calculated via multiplying the total attributable cases by the case-average hospitalization costs. A total of 45,714 CVD hospitalizations were included in this study. The results showed that a 10 µg/m3 increase in PM2.5 and PM10 concentrations at lag7 day, respectively, contributed to a 1.01% (95% confidence interval: 0.67-1.34) and 0.48% (0.26-0.70) increase in CVD hospitalizations. During the study period, 1487 and 983 CVD hospitalizations were attributable to PM2.5 and PM10, equaling an economic cost of 29.27 and 19.34 million RMB (1 RMB = 0.1424 USD), respectively, and significant differences in PM-attributable hospitalizations and economic burden were found between gender and age groups. Our study added evidence in heavily polluted megacities regarding the increased health risk and economic cost of CVD hospitalizations associated with ambient particulate pollution.


Assuntos
Poluição do Ar/estatística & dados numéricos , Doenças Cardiovasculares/epidemiologia , Hospitalização/economia , Material Particulado/análise , Poluentes Atmosféricos/efeitos adversos , Poluentes Atmosféricos/análise , Poluição do Ar/efeitos adversos , Poluição do Ar/análise , Doenças Cardiovasculares/economia , China/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Material Particulado/efeitos adversos
6.
Health Qual Life Outcomes ; 18(1): 251, 2020 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-32718355

RESUMO

OBJECTIVE: Identify the most recent utility value estimates for cardiovascular disease (CVD) via systematic literature review (SLR) and explore trends in utility elicitation methods in the last 6 years. METHODS: This SLR was updated on January 25, 2018, and identified studies reporting utilities for myocardial infarction (MI), stroke, angina, peripheral artery disease (PAD), and any-cause revascularization by searching Embase, PubMed, Health Technology Assessment Database, and grey literature. RESULTS: A total of 375 studies reported CVD utilities (pre-2013 vs post-2013: MI, 38 vs 32; stroke, 86 vs 113; stable angina, 8 vs 9; undefined/unstable angina, 23 vs 8; PAD, 29 vs 13; revascularization, 54 vs 40). Median average utilities for MI, stroke, and revascularization increased over time (pre-2013 vs post-2013: MI, 0.71 vs 0.79; stroke, 0.63 vs 0.64; revascularization, 0.76 vs 0.81); angina and PAD showed a decrease in median values over time (stable angina, 0.83 vs 0.72; undefined/unstable angina, 0.70 vs 0.69; PAD, 0.76 vs 0.71). The proportion of utility estimates from trials increased across health states (pre-2013 vs post-2013: 22.5% vs 37.2%), as did the proportion of trials using the EuroQol Five Dimensions Questionnaire (EQ-5D; pre-2013 vs post-2013: 73.8% vs 91.4%). Use of methods such as the standard gamble, time trade-off, and Health Utilities Index has declined. CONCLUSIONS: Health state utilities for cardiovascular health states have changed in the last 6 years, likely due to changes in the types of studies conducted, the patient populations evaluated, and possibly changing utility elicitation methods. The EQ-5D has been used more frequently.


Assuntos
Doenças Cardiovasculares/economia , Indicadores Básicos de Saúde , Qualidade de Vida , Doenças Cardiovasculares/psicologia , Análise Custo-Benefício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Anos de Vida Ajustados por Qualidade de Vida , Inquéritos e Questionários/normas
10.
Lancet HIV ; 7(4): e279-e293, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32243826

RESUMO

HIV-related cardiovascular disease research is predominantly from Europe and North America. Of the estimated 37·9 million people living with HIV worldwide, 25·6 million live in sub-Saharan Africa. Although mechanisms for HIV-related cardiovascular disease might be the same in all people with HIV, the distribution of cardiovascular disease risk factors varies by geographical location. Sub-Saharan Africa has a younger population, higher prevalence of elevated blood pressure, lower smoking rates, and lower prevalence of elevated cholesterol than western Europe and North America. These variations mean that the profile of cardiovascular disease differs between low-income and high-income countries. Research in, implementation of, and advocacy for risk reduction of cardiovascular disease in the global context of HIV should account for differences in the distribution of traditional cardiovascular disease risk factors (eg, hypertension, smoking), consider non-traditional cardiovascular disease risk factors (eg, access to antiretroviral therapy with more benign cardiovascular disease side effect profiles, indoor air pollution), and encourage the inclusion of relevant risk reduction approaches for cardiovascular disease in HIV-care guidelines. Future research priorities include implementation science to scale up and expand integrated HIV and cardiovascular disease care models, which have shown promise in sub-Saharan Africa; HIV and cardiovascular disease epidemiology and mechanisms in women; and tobacco cessation for people living with HIV.


Assuntos
Doenças Cardiovasculares/epidemiologia , Infecções por HIV/complicações , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/etiologia , Humanos , Pobreza , Prevalência
11.
Artigo em Inglês | MEDLINE | ID: mdl-32120888

RESUMO

The purpose of this study was to evaluate the association of insurance status with all-cause and cause-specific mortality. A total of 390,881 participants, aged 18-64 years and interviewed from 1997 to 2013 were eligible for a mortality follow-up in December 31, 2015. Cox proportional hazards models were used to calculate the hazards ratios (HR) and 95% confidence intervals (CI) to determine the association between insurance status and all-cause and cause-specific mortality. The sample group cumulatively aged 4.22 million years before their follow-ups, with a mean follow-up of 10.4 years, and a total of 22,852 all-cause deaths. In fully adjusted models, private insurance was significantly associated with a 17% decreased risk of mortality (HR = 0.83; 95% CI = 0.80-0.87), but public insurance was associated with a 21% increased risk of mortality (HR = 1.21; 95% CI = 1.15-1.27). Compared to noninsurance, private coverage was associated with about 21% lower CVD mortality risk (HR = 0.79, 95% CI = 0.70-0.89). In addition, public insurance was associated with increased mortality risk of kidney disease, diabetes and CLRD, compared with noninsurance, respectively. This study supports the current evidence for the relationship between private insurance and decreased mortality risk. In addition, our results show that public insurance is associated with an increased risk of mortality.


Assuntos
Doenças Cardiovasculares , Seguro Saúde , Neoplasias , Adolescente , Adulto , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/mortalidade , Causas de Morte , Pré-Escolar , Feminino , Humanos , Seguro Saúde/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Neoplasias/economia , Neoplasias/mortalidade , Setor Privado , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Adulto Jovem
12.
Value Health ; 23(3): 397-405, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32197736

RESUMO

OBJECTIVE: The aims of this study were to examine current reporting standards of health state utilities (HSU) using a review of published cost-effectiveness analyses in cardiovascular disease and to explore the impact of variation in model inputs used in these on estimated quality-adjusted life-years (QALYs) and cost-effectiveness. METHODS: Key health/economics bibliographic databases were searched to identify relevant articles published after 2014. Any narrative or values relating to the HSU used in the model were extracted and reviewed. The HSUs were systematically applied to an existing model to explore the influence of different values on QALYs and the incremental cost-effectiveness ratio. RESULTS: Twenty-four peer-reviewed articles were identified. Only 2 studies referred to a literature review for the HSUs. Most (18 of 24) referenced previously published economic studies (as opposed to the original source) for at least 1 of the HSUs. Only 4 studies referenced the original sources and reported all of the HSUs accurately, and several did not provide all the HSUs. Little information was provided on the methods used to calculate QALYs, for example, the duration of time for acute HSUs, what the baseline HSU was, the method that was used to assign HSUs for subsequent different events, or how constant HSUs for clinical events were combined with age-adjusted baseline values. The huge differences in HSUs used in the studies produced substantial variations in the QALYs and incremental cost-effectiveness ratios generated from the cost-effectiveness model. CONCLUSION: Current standards are poor, and there is a need for greater transparency in reporting the HSUs used in cost-effectiveness models.


Assuntos
Doenças Cardiovasculares/economia , Doenças Cardiovasculares/terapia , Custos de Cuidados de Saúde , Indicadores Básicos de Saúde , Nível de Saúde , Modelos Econômicos , Anos de Vida Ajustados por Qualidade de Vida , Projetos de Pesquisa/normas , Idoso , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/mortalidade , Análise Custo-Benefício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Fatores de Tempo , Resultado do Tratamento
14.
PLoS One ; 15(1): e0228019, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31990957

RESUMO

OBJECTIVES: To estimate the adult health burden and costs in California during 2013 associated with adults' prior Adverse Childhood Experiences (ACEs). METHODS: We analyzed five ACEs-linked conditions (asthma, arthritis, COPD, depression, and cardiovascular disease) and three health risk factors (lifetime smoking, heavy drinking, and obesity). We estimated ACEs-associated fractions of disease risk for people aged 18+ for these conditions by ACEs exposure using inputs from a companion study of California Behavioral Risk Factor Surveillance System data for 2008-2009, 2011, and 2013. We combined these estimates with published estimates of personal healthcare spending and Disability-Adjusted-Life-Years (DALYs) in the United States by condition during 2013. DALYs captured both the years of healthy life lost to disability and the years of life lost to deaths during 2013. We applied a published estimate of cost per DALY. RESULTS: Among adults in California, 61% reported ACEs. Those ACEs were associated with $10.5 billion in excess personal healthcare spending during 2013, and 434,000 DALYs valued at approximately $102 billion dollars. During 2013, the estimated health burden per exposed adult included $589 in personal healthcare expenses and 0.0224 DALYs valued at $5,769. CONCLUSIONS: Estimates of the costs of childhood adversity are far greater than previously understood and provide a fiscal rationale for prevention efforts.


Assuntos
Experiências Adversas da Infância/economia , Artrite/epidemiologia , Asma/epidemiologia , Doenças Cardiovasculares/epidemiologia , Depressão/epidemiologia , Custos de Cuidados de Saúde/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Adolescente , Adulto , Experiências Adversas da Infância/estatística & dados numéricos , Consumo de Bebidas Alcoólicas/economia , Consumo de Bebidas Alcoólicas/epidemiologia , Artrite/economia , Asma/economia , California/epidemiologia , Doenças Cardiovasculares/economia , Criança , Depressão/economia , Pessoas com Deficiência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/economia , Obesidade/epidemiologia , Vigilância em Saúde Pública/métodos , Anos de Vida Ajustados por Qualidade de Vida , Fatores de Risco , Fumar/economia , Fumar/epidemiologia
15.
Ann Thorac Surg ; 109(4): 1069-1078, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31904370

RESUMO

BACKGROUND: Cardiac surgery results in complications for some patients that lead to a longer hospital stay and higher costs. This study identified the presurgery characteristics of patients that were associated with the cost of their hospital stay and estimated how much of that cost could be attributed to a bleeding event, defined as requiring 3 units or more of packed red blood cells or returning to the operating room for bleeding. We also identified the presurgery characteristics that were associated with the bleeding event. METHODS: This prospective cohort of patients (n = 1459) underwent cardiac surgery at 3 tertiary referral hospitals in Australia during 2014 and 2015. Clinical data included the variables held by the Australian and New Zealand Society of Cardiac and Thoracic Surgeons registry. Cost data were collected as part of a state-level hospital data collection. RESULTS: Many of the baseline patient characteristics were associated with the total cost of cardiac surgery. After adjusting for these characteristics, the cost of cardiac surgery was 1.76 (confidence interval, 1.64-1.90) times higher for patients who had a bleeding event (P < .001), thus resulting in a median increase in costs (in Australian dollars) of $33,338 (confidence interval, $21,943-$38,415). Several baseline characteristics were strongly associated with a bleeding event. CONCLUSIONS: The impact of a bleeding event on the cost of cardiac surgery is substantial. This study identified a set of risk factors for bleeding that could be used to identify patients for discussion at the heart team level, where measures to minimize the risk of transfusion may be initiated.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/economia , Doenças Cardiovasculares/cirurgia , Custos de Cuidados de Saúde , Tempo de Internação/economia , Hemorragia Pós-Operatória/economia , Idoso , Austrália , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/economia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/terapia
17.
Diabetes Care ; 43(2): 374-381, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31806653

RESUMO

OBJECTIVE: To compare medical resource use, costs, and health utilities for 14,752 patients with type 2 diabetes who were randomized to once-weekly exenatide (EQW) or placebo in addition to usual diabetes care in the Exenatide Study of Cardiovascular Event Lowering (EXSCEL). RESEARCH DESIGN AND METHODS: Medical resource use data and responses to the EuroQol 5-Dimension (EQ-5D) instrument were collected at baseline and throughout the trial. Medical resources and medications were assigned values by using U.S. Medicare payments and wholesale acquisition costs, respectively. Secondary analyses used English costs. RESULTS: Patients were followed for an average of 3.3 years, during which time those randomized to EQW experienced 0.41 fewer inpatient days (7.05 vs. 7.46 days; relative rate ratio 0.91; P = 0.05). Rates of outpatient medical visits were similar, as were total inpatient and outpatient costs. Mean costs for nonstudy diabetes medications over the study period were ∼$1,600 lower with EQW than with placebo (P = 0.01). Total within-study costs, excluding study medication, were lower in the EQW arm than in the placebo arm ($28,907 vs. $30,914; P ≤ 0.01). When including the estimated cost of EQW, total mean costs were significantly higher in the EQW group than in the placebo group ($42,697 vs. $30,914; P < 0.01). With English costs applied, mean total costs, including exenatide costs, were £1,670 higher in the EQW group than the placebo group (£10,874 vs. £9,204; P < 0.01). There were no significant differences in EQ-5D health utilities between arms over time. CONCLUSIONS: Medical costs were lower in the EQW arm than the placebo arm, but total costs were significantly higher once the cost of branded exenatide was incorporated.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus Tipo 2/tratamento farmacológico , Exenatida/uso terapêutico , Custos de Cuidados de Saúde , Recursos em Saúde , Qualidade de Vida , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/epidemiologia , Causas de Morte , Diabetes Mellitus Tipo 2/economia , Diabetes Mellitus Tipo 2/epidemiologia , Angiopatias Diabéticas/economia , Angiopatias Diabéticas/epidemiologia , Angiopatias Diabéticas/prevenção & controle , Exenatida/economia , Feminino , Seguimentos , Custos de Cuidados de Saúde/estatística & dados numéricos , Recursos em Saúde/economia , Recursos em Saúde/estatística & dados numéricos , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Hipoglicemiantes/economia , Hipoglicemiantes/uso terapêutico , Incidência , Análise de Intenção de Tratamento , Masculino , Medicare/economia , Medicare/estatística & dados numéricos , Pessoa de Meia-Idade , Reino Unido/epidemiologia , Estados Unidos/epidemiologia
18.
Cardiology ; 145(1): 21-26, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31801130

RESUMO

BACKGROUND: Digital health is rapidly entering clinical practice in cardiology. Estonia is one of the leading nations in implementing digital nationwide solutions. Recently, the European Society of Cardiology organized the 1st Summit on Digital Health in Tallinn, which provided the opportunity to discuss various aspects concerning the digitalization of cardiology. SUMMARY: The current review focuses on the advancements of Estonian digital health and digital cardiology as well as possible barriers and solutions for implementing digital innovations in cardiology. Key Messages: The authors have included aspects from the recent summit, personal communications, and literature reviews to express the current state and future possibilities of digital health in -cardiology from the Estonian perspective.


Assuntos
Cardiologia , Doenças Cardiovasculares/economia , Telemedicina/tendências , Doenças Cardiovasculares/terapia , Congressos como Assunto , Estônia , Humanos
19.
Am J Public Health ; 110(1): 119-126, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31725311

RESUMO

Objectives. To estimate the population-level effectiveness and cost-effectiveness of a subsidized community-supported agriculture (CSA) intervention in the United States.Methods. In 2019, we developed a microsimulation model from nationally representative demographic, biomedical, and dietary data (National Health and Nutrition Examination Survey, 2013-2016) and a community-based randomized trial (conducted in Massachusetts from 2017 to 2018). We modeled 2 interventions: unconditional cash transfer ($300/year) and subsidized CSA ($300/year subsidy).Results. The total discounted disability-adjusted life years (DALYs) accumulated over the life course to cardiovascular disease and diabetes complications would be reduced from 24 797 per 10 000 people (95% confidence interval [CI] = 24 584, 25 001) at baseline to 23 463 per 10 000 (95% CI = 23 241, 23 666) under the cash intervention and 22 304 per 10 000 (95% CI = 22 084, 22 510) under the CSA intervention. From a societal perspective and over a life-course time horizon, the interventions had negative incremental cost-effectiveness ratios, implying cost savings to society of -$191 100 per DALY averted (95% CI = -$191 767, -$188 919) for the cash intervention and -$93 182 per DALY averted (95% CI = -$93 707, -$92 503) for the CSA intervention.Conclusions. Both the cash transfer and subsidized CSA may be important public health interventions for low-income persons in the United States.


Assuntos
Agricultura/organização & administração , Participação da Comunidade/métodos , Abastecimento de Alimentos/métodos , Nível de Saúde , Pobreza , Assistência Pública/estatística & dados numéricos , Adulto , Idoso , Agricultura/economia , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/prevenção & controle , Participação da Comunidade/economia , Análise Custo-Benefício , Complicações do Diabetes/economia , Complicações do Diabetes/prevenção & controle , Dieta , Feminino , Abastecimento de Alimentos/economia , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Econômicos , Inquéritos Nutricionais , Assistência Pública/economia , Meio Social , Fatores Socioeconômicos
20.
Diabetes Care ; 43(3): 563-571, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31882408

RESUMO

OBJECTIVE: Previous randomized trials found that treating periodontitis improved glycemic control in patients with type 2 diabetes (T2D), thus lowering the risks of developing T2D-related microvascular diseases and cardiovascular disease (CVD). Some payers in the U.S. have started covering nonsurgical periodontal treatment for those with chronic conditions, such as diabetes. We sought to identify the cost-effectiveness of expanding periodontal treatment coverage among patients with T2D. RESEARCH DESIGN AND METHODS: A cost-effectiveness analysis was conducted to estimate lifetime costs and health gains using a stochastic microsimulation model of oral health conditions, T2D, T2D-related microvascular diseases, and CVD of the U.S. POPULATION: Model parameters were obtained from the nationally representative National Health and Nutrition Examination Survey (NHANES) (2009-2014) and randomized trials of periodontal treatment among patients with T2D. RESULTS: Expanding periodontal treatment coverage among patients with T2D and periodontitis would be expected to avert tooth loss by 34.1% (95% CI -39.9, -26.5) and microvascular diseases by 20.5% (95% CI -31.2, -9.1), 17.7% (95% CI -32.7, -4.7), and 18.4% (95% CI -34.5, -3.5) for nephropathy, neuropathy, and retinopathy, respectively. Providing periodontal treatment to the target population would be cost saving from a health care perspective at a total net savings of $5,904 (95% CI -6,039, -5,769) with an estimated gain of 0.6 quality-adjusted life years per capita (95% CI 0.5, 0.6). CONCLUSIONS: Providing nonsurgical periodontal treatment to patients with T2D and periodontitis would be expected to significantly reduce tooth loss and T2D-related microvascular diseases via improved glycemic control. Encouraging patients with T2D and poor oral health conditions to receive periodontal treatment would improve health outcomes and still be cost saving or cost-effective.


Assuntos
Diabetes Mellitus Tipo 2/terapia , Angiopatias Diabéticas/prevenção & controle , Modelos Econômicos , Periodontite/terapia , Doenças Vasculares/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Simulação por Computador , Análise Custo-Benefício , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/economia , Diabetes Mellitus Tipo 2/epidemiologia , Angiopatias Diabéticas/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais/estatística & dados numéricos , Periodontite/complicações , Periodontite/economia , Periodontite/epidemiologia , Medicina Preventiva/economia , Medicina Preventiva/métodos , Medicina Preventiva/estatística & dados numéricos , Anos de Vida Ajustados por Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto/economia , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Estados Unidos/epidemiologia , Doenças Vasculares/economia , Doenças Vasculares/epidemiologia
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