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1.
Chin Med J (Engl) ; 132(9): 1045-1052, 2019 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-30896567

RESUMO

BACKGROUND: Depression and anxiety have been correlated with elevated risks for quality-of-life (QOL), adverse outcomes, and medical expenditure in patients with acute coronary syndrome (ACS). However, the relevant data are lacking for Chinese ACS populations, especially regarding different effects of major depression, anxiety, and comorbidity. The objective of this study was to evaluate the dynamic changes of depression and/or anxiety over 12 months and examine the effects of depression, anxiety, and comorbidity on QOL, adverse outcomes, and medical expenditure in Chinese patients with ACS. METHODS: For this prospective longitudinal study, a total of 647 patients with ACS were recruited from North China between January 2013 and June 2015. Among them, 531 patients (82.1%) completed 12-month follow-ups. Logistic regression model was utilized for analyzing the association of baseline major depression, anxiety, and comorbidity with 12-month all-cause mortality, cardiovascular events, QOL, and health expenditure. RESULTS: During a follow-up period of 12 months, 7.3% experienced non-fatal myocardial infarction (MI) and 35.8% cardiac re-hospitalization. Baseline comorbidity, rather than major depression/anxiety, strongly predicted poor 12-month QOL as measured by short-form health survey-12 (odds ratio [OR]: 1.77, 95% confidence interval [CI]: 1.22-2.52, P = 0.003). Regarding 12-month non-fatal MI and cardiac re-hospitalization, baseline anxiety (OR: 2.83, 95% CI: 1.33-5.89, P < 0.01; OR: 4.47, 95% CI: 1.50-13.00, P < 0.01), major depression (OR: 2.58, 95% CI: 1.02-6.15, P < 0.05; OR: 5.22, 95% CI: 1.42-17.57, P < 0.03), and comorbidity (OR: 6.33, 95% CI: 2.96-13.79, P < 0.0001, OR: 14.08, 95% CI: 4.99-41.66, P < 0.0001) were all independent predictors, and comorbidity had the highest predictive value. Number of re-hospitalization stay, admission frequency within 12 months and medical expenditure within 2 months were the highest in patients with ACS with comorbidity. CONCLUSIONS: Major depression and anxiety may predict 12-month non-fatal MI and cardiac re-hospitalization. However, comorbidity has the highest predictive value with greater medical expenditure and worse QOL in Chinese patients with ACS. And depression with comorbid anxiety may be a new target of mood status in patients with ACS.


Assuntos
Ansiedade/fisiopatologia , Depressão/fisiopatologia , Infarto do Miocárdio/fisiopatologia , Síndrome Coronariana Aguda/economia , Síndrome Coronariana Aguda/fisiopatologia , Idoso , Feminino , Humanos , Modelos Logísticos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/economia , Estudos Prospectivos , Qualidade de Vida
2.
Circ Cardiovasc Qual Outcomes ; 12(1): e004945, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30606052

RESUMO

BACKGROUND: Balancing ischemic and bleeding risk is an evolving framework. METHODS AND RESULTS: Our objectives were to simulate changes in risks for adverse events and event-driven costs with use of ticagrelor or prasugrel versus clopidogrel according to varying levels of ischemic and bleeding risk. Using the validated PARIS risk functions, we estimated 1-year ischemic (myocardial infarction or stent thrombosis) and bleeding (Bleeding Academic Research Consortium types 3 or 5) event rates among PARIS study participants who underwent percutaneous coronary intervention with drug-eluting stent implantation for an acute coronary syndrome and were discharged with aspirin and clopidogrel (n=1497). Simulated changes in adverse events with ticagrelor or prasugrel were calculated by applying treatment effects from randomized trials for a 1-year time horizon. Event costs were estimated using National Inpatient Sample data. Net costs were calculated between antiplatelet therapy groups according to level of ischemic and bleeding risk. After weighting events for quality-of-life impact, we calculated event rates and costs for risk-tailored treatment versus clopidogrel under multiple drug pricing assumptions. One-year rates (per 1000 person-years) for ischemic events were 12.6, 24.1, and 66.1, respectively, among those at low (n=630), intermediate (n=536), and high (n=331) ischemic risk. Analogous bleeding rates were 11.0, 23.9, and 66.2, respectively, among low (n=728), intermediate (n=634), and high (n=135) bleeding risk patients. Mean per event costs were $22 174 (ischemic) and $12 203 (bleeding). When risks for ischemia matched or exceeded bleeding, simulated utility-weighted event rates favored ticagrelor/prasugrel, whereas clopidogrel reduced utility-weighted events when bleeding exceeded ischemic risk. One-year costs were sensitive to drug pricing assumptions, and risk-tailored treatment with either agent progressed from cost incurring to cost saving with increasing generic market share. CONCLUSIONS: Tailoring antiplatelet therapy intensity to patient risk may improve health utility and could produce cost savings in the first year after percutaneous coronary intervention. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT00998127.


Assuntos
Síndrome Coronariana Aguda/terapia , Clopidogrel/administração & dosagem , Trombose Coronária/prevenção & controle , Isquemia Miocárdica/prevenção & controle , Intervenção Coronária Percutânea , Inibidores da Agregação de Plaquetas/administração & dosagem , Cloridrato de Prasugrel/administração & dosagem , Ticagrelor/administração & dosagem , Síndrome Coronariana Aguda/economia , Síndrome Coronariana Aguda/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisão Clínica , Clopidogrel/efeitos adversos , Clopidogrel/economia , Trombose Coronária/economia , Trombose Coronária/epidemiologia , Redução de Custos , Análise Custo-Benefício , Custos de Medicamentos , Stents Farmacológicos , Europa (Continente)/epidemiologia , Feminino , Hemorragia/induzido quimicamente , Hemorragia/economia , Hemorragia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/economia , Isquemia Miocárdica/epidemiologia , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/economia , Intervenção Coronária Percutânea/instrumentação , Inibidores da Agregação de Plaquetas/efeitos adversos , Inibidores da Agregação de Plaquetas/economia , Cloridrato de Prasugrel/efeitos adversos , Cloridrato de Prasugrel/economia , Sistema de Registros , Medição de Risco , Fatores de Risco , Ticagrelor/efeitos adversos , Ticagrelor/economia , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia
3.
Arq Bras Cardiol ; 112(1): 40-47, 2019 01.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30570071

RESUMO

BACKGROUND: In multivessel disease patients with moderate stenosis, fractional flow reserve (FFR) allows the analysis of the lesions and guides treatment, and could contribute to the cost-effectiveness (CE) of non-pharmacological stents (NPS). OBJECTIVES: To evaluate CE and clinical impact of FFR-guided versus angiography-guided angioplasty (ANGIO) in multivessel patients using NPS. METHODS: Multivessel disease patients were prospectively randomized to FFR or ANGIO groups during a 5 year-period and followed for < 12 months. Outcomes measures were major adverse cardiac events (MACE), restenosis and CE. RESULTS: We studied 69 patients, 47 (68.1%) men, aged 62.0 ± 9.0 years, 34 (49.2%) in FFR group and 53 (50.7%) in ANGIO group, with stable angina or acute coronary syndrome. In FFR, there were 26 patients with biarterial disease (76.5%) and 8 (23.5%) with triarterial disease, and in ANGIO, 24 (68.6%) with biarterial and 11 (31.4%) with triarterial disease. Twelve MACEs were observed - 3 deaths: 2 (5.8%) in FFR and 1 (2.8%) in ANGIO, 9 (13.0%) angina: 4(11.7%) in FFR and 5(14.2%) in ANGIO, 6 restenosis: 2(5.8%) in FFR and 4 (11.4%) in ANGIO. Angiography detected 87(53.0%) lesions in FFR, 39(23.7%) with PCI and 48(29.3%) with medical treatment; and 77 (47.0%) lesions in ANGIO, all treated with angioplasty. Thirty-nine (33.3%) stents were registered in FFR (0.45 ± 0.50 stents/lesion) and 78 (1.05 ± 0.22 stents/lesion) in ANGIO (p = 0.0001), 51.4% greater in ANGIO than FFR. CE analysis revealed a cost of BRL 5,045.97 BRL 5,430.60 in ANGIO and FFR, respectively. The difference of effectiveness was of 1.82%. CONCLUSION: FFR reduced the number of lesions treated and stents, and the need for target-lesion revascularization, with a CE comparable with that of angiography.


Assuntos
Síndrome Coronariana Aguda/terapia , Angina Estável/terapia , Angioplastia Coronária com Balão/métodos , Angiografia Coronária/métodos , Reserva Fracionada de Fluxo Miocárdico/fisiologia , Síndrome Coronariana Aguda/economia , Síndrome Coronariana Aguda/patologia , Idoso , Angina Estável/economia , Angina Estável/mortalidade , Angioplastia Coronária com Balão/economia , Angiografia Coronária/economia , Reestenose Coronária/mortalidade , Reestenose Coronária/terapia , Análise Custo-Benefício , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estatísticas não Paramétricas , Stents , Fatores de Tempo , Resultado do Tratamento
4.
Clin Ther ; 40(12): 2125-2137, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30470579

RESUMO

PURPOSE: Monotherapy with either aspirin or clopidogrel is recommended for long-term use after discontinuation of dual-antiplatelet therapy (DAPT) for acute coronary syndrome (ACS) management after percutaneous coronary intervention (PCI). The present study is to evaluate the cost-effectiveness of clopidogrel versus aspirin after 12-month DAPT for patients with ACS who underwent PCI in China. METHODS: A 2-part model was developed to estimate the cost-effectiveness of clopidogrel compared with aspirin. The short-term part was a decision tree that included health states such as myocardial infarction (MI), stroke, MI and stroke, cardiovascular death, and death from other causes with a treatment horizon of 1 year (base case), 2 years or 3 years after 12-month DAPT. Major bleeding was included. The long-term (lifetime) part was a Markov model that included different health states such as MI, after MI, stroke, after stroke, and death. Drug acquisition cost and other direct medical costs were based on pricing records, literature, and expert panels. Clinical outcomes and utilities were based on literature. The model output included incremental cost-effectiveness ratio of quality-adjusted life-years (QALYs) and total costs per patient. Both 1-way sensitivity analysis and probabilistic sensitivity analysis (PSA) were conducted. FINDINGS: In the base-case scenario, the total costs of the treatment with clopidogrel and aspirin were ¥12,590 ($1849/€1590) and ¥10,642 ($1563/€1344), respectively; the total QALYs of the 2 patient populations were 9.7341 and 9.6894, respectively. The incremental cost-effectiveness ratio of ¥43,593 ($6402/€5515) per QALY gained was lower than 3 times of gross domestic product (GDP) per capita in China (¥161,940, $23,786/€20,449). Both 1-way sensitivity analysis and PSA confirmed the robustness of the results. PSA results indicated that clopidogrel was cost effective versus aspirin in 80.5% of the simulations, considering >3 times the GDP per capita as the threshold. Results in other scenarios (clopidogrel or aspirin for 2 or 3 years after 12-month DAPT) also indicated that clopidogrel was more cost effective than aspirin for patients with ACS after 12-month DAPT. IMPLICATIONS: Compared with aspirin monotherapy, clopidogrel monotherapy for 1 year after 12-month DAPT was cost effective for patients with ACS who underwent PCI in China. Furthermore, when the duration of clopidogrel the monotherapy extended up to 3 years, clopidogrel was still cost effective compared with aspirin. The study was limited by lack of high-quality efficacy data among the Chinese population.


Assuntos
Síndrome Coronariana Aguda/tratamento farmacológico , Aspirina/uso terapêutico , Clopidogrel/uso terapêutico , Inibidores da Agregação de Plaquetas/uso terapêutico , Síndrome Coronariana Aguda/economia , Idoso , Idoso de 80 Anos ou mais , Aspirina/economia , China , Clopidogrel/economia , Análise Custo-Benefício , Árvores de Decisões , Feminino , Humanos , Reembolso de Seguro de Saúde , Masculino , Cadeias de Markov , Intervenção Coronária Percutânea , Inibidores da Agregação de Plaquetas/economia , Anos de Vida Ajustados por Qualidade de Vida
5.
Can J Cardiol ; 34(10): 1365-1368, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30269834

RESUMO

Acute coronary syndromes (ACS) and heart failure (HF) are the leading diagnoses in patients admitted to critical care units (CCUs). Little is known about the differences between CCU resource use and outcomes across hospital types. The Canadian Institute for Health Information was used to identify patients hospitalized with primary diagnoses of ACS or HF. CCUs were categorized as teaching, large community, medium community, and small community hospitals. Outcomes included CCU rates of admission, use of critical care therapy/procedures, and in-hospital mortality. Among 204,900 patients hospitalized with ACS or HF, 73,338 (35.8%, hospital range 0% to 81.4%) were admitted to CCUs, and it varied across hospital types: 41.0% in teaching, 30.0% in large, 45.4% in medium, and 30.9% in small community hospitals (P < 0.001). The percentage of patients admitted to CCUs who received critical care therapies in teaching, large, medium, and small hospitals were as follows: 73.6%, 50.9%, 24.6%, and 8.8% (P < 0.0001). Compared with the in-hospital mortality rate for patients admitted to CCUs in teaching hospitals (8.2%), outcomes were worse for CCU patients in large (11.0%, adjusted odds ratio [aOR] 1.50; 95% CI, 1.19-1.90), medium (10.5%, aOR 1.56; 95% CI, 1.27-1.92), and small community hospitals (9.2%, aOR 1.59; 95% CI, 1.20-2.10). Patients admitted with ACS or HF to teaching hospital CCUs had a higher observed use of critical care therapies and lower mortality compared with community hospitals. These differences highlight the need to examine differences in CCU admission thresholds, resource utilization, and outcomes across hospitals types.


Assuntos
Síndrome Coronariana Aguda/epidemiologia , Unidades de Cuidados Coronarianos/estatística & dados numéricos , Insuficiência Cardíaca/epidemiologia , Hospitais Comunitários , Hospitais de Ensino , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Vigilância da População , Síndrome Coronariana Aguda/economia , Síndrome Coronariana Aguda/terapia , Idoso , Canadá/epidemiologia , Feminino , Insuficiência Cardíaca/economia , Insuficiência Cardíaca/terapia , Mortalidade Hospitalar/tendências , Humanos , Masculino , Morbidade/tendências , Razão de Chances , Admissão do Paciente/tendências
7.
BMC Cardiovasc Disord ; 18(1): 139, 2018 07 04.
Artigo em Inglês | MEDLINE | ID: mdl-29973147

RESUMO

BACKGROUND: The EPICOR Asia (long-tErm follow-uP of antithrombotic management patterns In acute CORonary syndrome patients in Asia) study (NCT01361386) was an observational study of patients hospitalized for acute coronary syndromes (ACS) enrolled in 218 hospitals in eight countries/regions in Asia. This study examined costs, length of stay and the predictors of high costs during an ACS hospitalization. METHODS AND RESULTS: Data for patients hospitalized for an ACS (n = 12,922) were collected on demographics, medical history, event characteristics, socioeconomic and insurance status at discharge. Patients were followed up at 6 weeks' post-hospitalization for an ACS event to assess associated treatment costs from a health sector perspective. Primary outcome was the incurring of costs in the highest quintile by country and index event diagnosis, and identification of associated predictors. Cost data were available for 10,819 patients. Mean length of stay was 10.1 days. The highest-cost countries were China, Singapore, and South Korea. Significant predictors of high-cost care were age, male sex, income, country, prior disease history, hospitalization in 3 months before index event, no dependency before index event, having an invasive procedure, hospital type and length of stay. CONCLUSIONS: Substantial variability exists in healthcare costs for hospitalized ACS patients across Asia. Of concern is the observation that the highest costs were reported in China, given the rapidly increasing numbers of procedures in recent years. TRIAL REGISTRATION: NCT01361386 .


Assuntos
Síndrome Coronariana Aguda/economia , Síndrome Coronariana Aguda/terapia , Disparidades em Assistência à Saúde/economia , Custos Hospitalares , Hospitalização/economia , /economia , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/epidemiologia , Idoso , Ásia/epidemiologia , Feminino , Humanos , Tempo de Internação/economia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
8.
Circ Cardiovasc Qual Outcomes ; 11(6): e004528, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29895612

RESUMO

BACKGROUND: Inability to resume employment after acute myocardial infarction (MI) has important implications for patients. We sought to assess the prevalence of and outcomes associated with adverse change in employment after MI in a national US cohort. METHODS AND RESULTS: The TRANSLATE-ACS study (Treatment with Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events after Acute Coronary Syndrome) assessed employment status at baseline and 1 year among 9319 patients with MI (mean age, 60.8 years; SD, 11.3; 27.3% women) enrolled at 233 US hospitals. We defined adverse change in employment as patients working at baseline but working less or not working at 1-year post-MI. In multivariable models, we assessed factors associated with adverse change in employment and its association with patient-reported depression, health status, persistence to evidence-based medications prescribed at discharge, and financial hardship affording medications. Half of the patients (51%; n=4730) were employed at the time of MI. By 1 year, 10% (n=492) of these reported an adverse change in employment, with 3% (n=143) working less and 7% (n=349) no longer working (only 27 of 349 reported retirement). Factors significantly associated with adverse change in employment included a number of unplanned readmissions, postdischarge bleeding complications, hypertension, and smoking. At 1 year, patients with an adverse change in employment were more likely to report depression (Patient Health Questionnaire 2 score >3: 27.4% versus 16.7%), lower health status (mean EuroQoL visual analogue scale: 73 [SD, 17.8] versus 78 [SD, 14.8]), and moderate-extreme financial hardship with medication costs (41.0% versus 28.4%; all P<0.001). There was no difference in persistence to evidence-based medications prescribed at discharge. CONCLUSIONS: Patients who experienced an adverse change in employment after MI reported lower quality of life, increased depression, and more difficulty affording medications. These results underscore the need for interventions to address this patient-centered outcome and its health impact. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01088503.


Assuntos
Síndrome Coronariana Aguda/terapia , Emprego , Infarto do Miocárdio/terapia , Intervenção Coronária Percutânea , Inibidores da Agregação de Plaquetas/uso terapêutico , Antagonistas do Receptor Purinérgico P2Y/uso terapêutico , Absenteísmo , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/economia , Síndrome Coronariana Aguda/epidemiologia , Idoso , Efeitos Psicossociais da Doença , Depressão/epidemiologia , Custos de Medicamentos , Feminino , Gastos em Saúde , Nível de Saúde , Humanos , Estudos Longitudinais , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/economia , Infarto do Miocárdio/epidemiologia , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/economia , Inibidores da Agregação de Plaquetas/efeitos adversos , Inibidores da Agregação de Plaquetas/economia , Antagonistas do Receptor Purinérgico P2Y/efeitos adversos , Antagonistas do Receptor Purinérgico P2Y/economia , Qualidade de Vida , Sistema de Registros , Aposentadoria , Retorno ao Trabalho , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Desemprego , Estados Unidos/epidemiologia
9.
Am Heart J ; 202: 84-88, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29906667

RESUMO

BACKGROUND: There is substantial variability among hospitals in critical care unit (CCU) utilization for patients admitted with non-ST-Segment Elevation Acute Coronary Syndromes (NSTE ACS). We estimated the potential cost saving if all hospitals adopted low CCU utilization practices for patients with NSTE ACS. METHODS: National hospital claims data were used to identify all patients with a primary diagnosis of NSTE ACS initially admitted to an acute care hospital between 2007 and 2013. Hospital CCU utilization was classified as low (<30%), medium (30-70%), or high (>70%). RESULTS: Among the 270,564 NSTE ACS hospitalizations (71.6% non-ST-segment elevation myocardial infarction; 28.4% unstable angina) admitted to 261 hospitals, 41.9% (inter-hospital range 0.3%-95.1%) were admitted to a CCU. The proportion of patients admitted to a CCU in low, medium and high utilization hospitals was 16.3%, 49.5%, and high 81.1%, respectively. No differences in adjusted inpatient mortality were observed by hospital CCU utilization. The overall inpatient costs of caring for NSTE ACS were $1.1 billion. CCU care accounted for 45.2% of all hospitalization costs including 22.6%, 49.9%, and 69.0% (P < .001) of costs in low, medium and high utilization centers. The national potential direct cost savings of medium and high CCU utilization centers adopting low NSTE ACS CCU utilization practices was $113.4 million over the study period. CONCLUSIONS: In a population-based contemporary cohort, CCU utilization for patients with NSTE ACS varied widely and in-hospital mortality was similar between low, medium and high utilization centers. CCU care accounted for 45% of hospitalization costs; thus, implementing policies and admission practices to align hospital resources with patient care needs have the potential to reduce overall health care costs.


Assuntos
Síndrome Coronariana Aguda/terapia , Unidades de Cuidados Coronarianos/economia , Custos Hospitalares/estatística & dados numéricos , Sobremedicalização/economia , Infarto do Miocárdio sem Supradesnível do Segmento ST/terapia , Síndrome Coronariana Aguda/economia , Adulto , Canadá , Unidades de Cuidados Coronarianos/estatística & dados numéricos , Custos Diretos de Serviços/estatística & dados numéricos , Humanos , Infarto do Miocárdio sem Supradesnível do Segmento ST/economia , Admissão do Paciente/estatística & dados numéricos , Estudos Retrospectivos
10.
PLoS One ; 13(6): e0198272, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29927947

RESUMO

RATIONALE: To address the inaccessibility of interventional cardiac services in North Queensland a new cardiac catheterisation laboratory (CCL) was established in Mackay Base Hospital (MBH) in February 2014. OBJECTIVE: To determine whether the provision of in-house angiography and/or percutaneous coronary intervention (PCI) 1) minimises treatment delays 2) further reduces the risk of mortality, recurrent myocardial infarction (MI) and recurrent ischaemia 3) improves patient satisfaction and 4) minimises cost expenditure compared with inter-hospital transfer for patients with acute coronary syndrome (ACS). METHODS: We compared ACS patients who were transferred to tertiary centres from July 2012 to June 2013 with those who received in-house angiography and/or PCI from February 2015 to January 2016. The primary outcome was the composite of all-cause mortality, recurrent myocardial infarction (MI) or recurrent ischaemia at six months. Pre-specified secondary outcomes were the composite of all-cause mortality, recurrent MI or recurrent ischaemia at one month, a summated patient satisfaction score and the proportional cost savings generated between 2015 and 2016. RESULTS: We included consecutive samples of 203 patients from July 2012 to June 2013 and 229 patients from February 2015 to January 2016. There was a reduction in the median time to treatment of 3.2 days and a reduction in the median length of stay of four days amongst all ACS patients receiving in-house angiography and/or PCI. The primary outcome occurred in 14 (6.9%) patients in the 2012 to 2013 group, as compared with 18 (7.9%) patients in the 2015 to 2016 group (OR = 0.71, 95% CI 0.24-2.1, P = 0.54). The secondary outcome at one month occurred in four (2.0%) patients in the 2012 to 2013 group, as compared with three (1.3%) patients in the 2015 to 2016 group (OR = 1.2, 95% CI 0.11-13.1, P = 0.87). There was a statistically significant improvement in the summated patient satisfaction score amongst patients who received in-house angiography and/or PCI (U = 1918, P <0.05 two tailed). A calculation of estimated cost savings showed a reduction in proportional cost of $14 481 (51%) per ACS patient receiving in house angiography and/or PCI between 2015 and 2016. CONCLUSION: This study suggests that the provision of regional in-house angiography and/or PCI for the treatment of ACS minimises delays to invasive treatment by 3.2 days, minimises the median length of stay by four days, significantly improves patient satisfaction and reduces proportional treatment costs by $14 481 (51%) per patient. Currently, however, it appears that that in-house treatment does not further reduce the risk of mortality, recurrent MI and recurrent ischaemia at one and six months.


Assuntos
Síndrome Coronariana Aguda/diagnóstico por imagem , Síndrome Coronariana Aguda/cirurgia , Intervenção Coronária Percutânea/métodos , Síndrome Coronariana Aguda/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia Coronária , Análise Custo-Benefício , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Transferência de Pacientes , Intervenção Coronária Percutânea/economia , Estudos Retrospectivos , Análise de Sobrevida , Centros de Atenção Terciária , Tempo para o Tratamento , Resultado do Tratamento
11.
Clin Drug Investig ; 38(7): 621-630, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29713921

RESUMO

BACKGROUND AND OBJECTIVE: The economic outcomes of dual antiplatelet therapy in East Asian patients are still unclear. We aimed to evaluate the economic outcomes of ticagrelor versus clopidogrel for patients with acute coronary syndrome (ACS) in China, Japan, Korea, Taiwan and Hong Kong. METHODS: A two-phase model consisting of a 1-year decision tree and a lifetime Markov model was used to estimate the economic outcomes. The data from the East Asian subgroup of Platelet Inhibition and Patient Outcomes (PLATO) and PHILO studies were used for the calculation of the events rate for ticagrelor and clopidogrel in the first 12 months, whereas the costs were obtained from East Asian sources and utility from the published literature. Sensitivity analyses were conducted to test model robustness. RESULTS: Ticagrelor showed the marginal lifetime quality-adjusted life-year (QALY) of 0.0050, 0.0091, 0.0107, 0.0050, and 0.0050 in China, Japan, Korea, Taiwan, and Hong Kong compared with clopidogrel, with marginal healthcare costs of (all values in US dollars) $562, $595, $975, $611, and $672, respectively. The marginal cost per QALY gained with ticagrelor was $112,051, $65,692, $91,207, $121,838, and $133,953 from a public healthcare system perspective of China, Japan, Korea, Taiwan, and Hong Kong, respectively. The sensitivity analysis showed consistent results. CONCLUSION: Treatment of ACS for 12 months with ticagrelor is not a cost-effective option for the prevention of thrombotic events in East Asia.


Assuntos
Síndrome Coronariana Aguda/economia , Síndrome Coronariana Aguda/epidemiologia , Análise Custo-Benefício/métodos , Árvores de Decisões , Inibidores da Agregação de Plaquetas/economia , Síndrome Coronariana Aguda/tratamento farmacológico , Adenosina/análogos & derivados , Adenosina/economia , Adenosina/uso terapêutico , Idoso , Ásia/epidemiologia , China/epidemiologia , Ensaios Clínicos como Assunto/economia , Clopidogrel , Feminino , Custos de Cuidados de Saúde/tendências , Hong Kong/epidemiologia , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/uso terapêutico , Anos de Vida Ajustados por Qualidade de Vida , República da Coreia/epidemiologia , Taiwan/epidemiologia , Ticagrelor , Ticlopidina/análogos & derivados , Ticlopidina/economia , Ticlopidina/uso terapêutico
12.
Clin Cardiol ; 41(4): 450-457, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29697866

RESUMO

BACKGROUND: Patients undergoing percutaneous mechanical circulatory support (pMCS)-assisted percutaneous coronary intervention (PCI) represent a high-risk group vulnerable to complications and readmissions. HYPOTHESIS: Thirty-day readmissions after pMCS-assisted PCI are common among patients with comorbidities and account for a significant amount of healthcare spending. METHODS: Patients undergoing PCI and pMCS (Impella, TandemHeart, or intra-aortic balloon pump) for any indication between January 1, 2012, and November 30, 2014, were selected from the Nationwide Readmissions Database. Patients were identified using appropriate ICD-9-CM codes. Clinical risk factors and complications were analyzed for association with 30-day readmission. RESULTS: Our analysis included 29 247 patients, of which 4535 (15.5%) were readmitted within 30 days. On multivariate analysis, age ≥ 65 years, female sex, hypertension, diabetes, chronic lung disease, heart failure, prior implantable cardioverter-defibrillator, liver disease, end-stage renal disease, and length of stay ≥5 days during index hospitalization were independent predictors of 30-day readmission. Cardiac etiologies accounted for ~60% of readmissions, of which systolic or diastolic heart failure (22%), stable coronary artery disease (11.1%), acute coronary syndromes (8.9%), and nonspecific chest pain (4.0%) were the most common causes. In noncardiac causes, sepsis/septic shock (4.6%), hypotension/syncope (3.2%), gastrointestinal bleed (3.1%), and acute kidney injury (2.6%) were among the most common causes of 30-day readmissions. Mean length of stay and cost of readmissions was 4 days and $16 191, respectively. CONCLUSIONS: Thirty-day readmissions after pMCS-assisted PCI are common and are predominantly associated with increased burden of comorbidities. Reducing readmissions for common cardiac etiologies could save substantial healthcare costs.


Assuntos
Síndrome Coronariana Aguda/terapia , Coração Auxiliar , Balão Intra-Aórtico/instrumentação , Readmissão do Paciente , Intervenção Coronária Percutânea/instrumentação , Choque Cardiogênico/terapia , Síndrome Coronariana Aguda/economia , Síndrome Coronariana Aguda/mortalidade , Síndrome Coronariana Aguda/fisiopatologia , Idoso , Distribuição de Qui-Quadrado , Comorbidade , Bases de Dados Factuais , Feminino , Coração Auxiliar/economia , Custos Hospitalares , Humanos , Balão Intra-Aórtico/efeitos adversos , Balão Intra-Aórtico/economia , Balão Intra-Aórtico/mortalidade , Tempo de Internação , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Readmissão do Paciente/economia , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/economia , Intervenção Coronária Percutânea/mortalidade , Fatores de Risco , Choque Cardiogênico/economia , Choque Cardiogênico/mortalidade , Choque Cardiogênico/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Estados Unidos
13.
Circ Cardiovasc Qual Outcomes ; 11(3): e004194, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29535091

RESUMO

BACKGROUND: Clopidogrel is one of the most commonly prescribed medications because of its ability to improve clinical outcomes for a broad range of cardiovascular conditions. After patent protection expired for Plavix in 2012, many healthcare systems adopted generic clopidogrel as a strategy to reduce healthcare costs. METHODS AND RESULTS: We conducted a population-based observational study to determine whether generic clopidogrel was noninferior to Plavix. Patients who were hospitalized with an acute coronary syndrome (ACS) from 2009 to 2014 in Ontario, Canada, >65 years, survived ≥7 days after discharge, were eligible for inclusion. The primary outcome was a composite of death and recurrent ACS at 1 year. The noninferiority margin was prespecified at a relative hazard difference of 10%. Inverse propensity of treatment weighting of the propensity score was used to account for differences in baseline characteristics between the treatment groups. The effect of clopidogrel on the hazard of clinical outcomes was estimated using a Cox proportional hazards model within the propensity-weighted cohort using Plavix as a reference. Our study included 24 530 patients with ACS, 12 643 were prescribed Plavix and 11 887 were prescribed generic clopidogrel at hospital discharge. The mean age was 77 years, 57% were men, and 21% had an ST-segment-elevation myocardial infarction. At 1 year, 17.6% of patients prescribed Plavix and 17.9% of patients prescribed clopidogrel experienced the primary outcome (hazard ratio, 1.02; 95% confidence interval, 0.96-1.08; P=0.005 for noninferiority). No significant differences between rates of death, all-cause readmission, ACS, stroke or transient ischemic attack, or bleeding were observed. CONCLUSIONS: Generic clopidogrel was noninferior to Plavix with respect to the composite end point of death and recurrent hospitalization for ACS at 1 year among adults >65 years after an ACS hospitalization. Our findings support generic clopidogrel in ACS, which could lead to substantial healthcare cost savings.


Assuntos
Síndrome Coronariana Aguda/tratamento farmacológico , Clopidogrel/uso terapêutico , Medicamentos Genéricos/uso terapêutico , Admissão do Paciente , Inibidores da Agregação de Plaquetas/uso terapêutico , Antagonistas do Receptor Purinérgico P2Y/uso terapêutico , Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/economia , Síndrome Coronariana Aguda/mortalidade , Idoso , Idoso de 80 Anos ou mais , Clopidogrel/efeitos adversos , Clopidogrel/economia , Redução de Custos , Análise Custo-Benefício , Bases de Dados Factuais , Custos de Medicamentos , Substituição de Medicamentos/economia , Medicamentos Genéricos/efeitos adversos , Medicamentos Genéricos/economia , Feminino , Hemorragia/induzido quimicamente , Humanos , Masculino , Ontário , Admissão do Paciente/economia , Readmissão do Paciente , Inibidores da Agregação de Plaquetas/efeitos adversos , Inibidores da Agregação de Plaquetas/economia , Antagonistas do Receptor Purinérgico P2Y/economia , Recidiva , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
14.
J Manag Care Spec Pharm ; 24(2): 142-152, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29384027

RESUMO

BACKGROUND: Poor health outcomes after percutaneous coronary intervention (PCI) in elderly patients is an area of concern among policymakers and administrators. In an effort to determine the best strategy to improve outcomes among elderly patients who underwent PCI, several studies have evaluated the cost-effectiveness of genotype-guided antiplatelet therapy compared with universal use of any one of the antiplatelet drugs indicated for patients with acute coronary syndrome (ACS) who underwent PCI. The results have either been in favor of genotype-guided antiplatelet therapy or universal use of ticagrelor. However, no study has yet evaluated the cost-effectiveness of pharmacist-provided face-to-face medication therapy management (MTM) combined with point-of-care genotype-guided antiplatelet therapy (POCP) when compared with universal use of ticagrelor or clopidogrel for the elderly after PCI. OBJECTIVE: To evaluate the cost-effectiveness of a pharmacist integration of MTM with POCP (MTM-POCP) when compared with universal use of ticagrelor or clopidogrel combined with MTM (MTM-ticagrelor or MTM-clopidogrel). METHODS: We conducted a cost-effectiveness analysis from the perspective of the U.S. health care system. A hybrid model, consisting of a 1-year decision tree and a 20-year Markov model, was used to simulate a cohort of elderly patients (aged at least 65 years) with ACS who underwent PCI. Treatment strategies available to patients were POCP, POCP-MTM, MTM-clopidogrel, or MTM-ticagrelor. Data used to populate the model were obtained from the PLATO trial and other published studies. Outcome measures were costs, quality-adjusted life-years (QALYs) and incremental cost per QALY gained. A deterministic and probabilistic sensitivity analysis was conducted to account for the joint uncertainty around the key parameters of the model. Finally, a benchmark willingness to pay of $50,000-200,000 was considered. RESULTS: The use of PCOP (with dual antiplatelet therapy) resulted in 5.29 QALYs, at a cost of $50,207. MTM-clopidogrel resulted in 5.34 QALYs, at a cost of $50,011. The use of POCP-MTM resulted in 5.36 QALYs, at a cost of $50,270. Finally, MTM-ticagrelor resulted in 5.42 QALYs, at a cost of $53,346. MTM-ticagrelor was found to be cost-effective compared with MTM-clopidogrel or MTM-POCP, irrespective of the willingness to pay. The deterministic and probabilistic sensitivity analyses confirmed the robustness of the base-case analysis. CONCLUSIONS: The combination of MTM-ticagrelor was cost-effective when compared with MTM-POCP or MTM-clopidogrel. The transitional probabilities, however, were mostly based on published studies. Analysis based on a prospective randomized clinical study, comparing all the treatment strategies included in this study, is warranted to confirm our findings. DISCLOSURES: No outside funding supported this study. The authors have no conflicts of interest to declare. Study concept and design were contributed by Okere and Diaby. Ezendu took the lead in data collection, along with Okere. Data interpretation was performed by all the authors. The manuscript was written by Okere, Diaby, and Berthe and revised by Okere and Diaby.


Assuntos
Síndrome Coronariana Aguda/terapia , Serviços Comunitários de Farmácia/economia , Custos de Medicamentos , Testes Genéticos/economia , Conduta do Tratamento Medicamentoso/economia , Intervenção Coronária Percutânea/economia , Inibidores da Agregação de Plaquetas/administração & dosagem , Inibidores da Agregação de Plaquetas/economia , Testes Imediatos/economia , Medicina de Precisão/economia , Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/economia , Síndrome Coronariana Aguda/genética , Adenosina/administração & dosagem , Adenosina/análogos & derivados , Adenosina/economia , Fatores Etários , Idoso , Clopidogrel , Serviços Comunitários de Farmácia/organização & administração , Simulação por Computador , Análise Custo-Benefício , Árvores de Decisões , Prestação Integrada de Cuidados de Saúde/economia , Feminino , Humanos , Masculino , Cadeias de Markov , Conduta do Tratamento Medicamentoso/organização & administração , Modelos Econômicos , Intervenção Coronária Percutânea/efeitos adversos , Inibidores da Agregação de Plaquetas/efeitos adversos , Testes Imediatos/organização & administração , Valor Preditivo dos Testes , Avaliação de Programas e Projetos de Saúde , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Ticagrelor , Ticlopidina/administração & dosagem , Ticlopidina/análogos & derivados , Ticlopidina/economia , Fatores de Tempo , Resultado do Tratamento , Estados Unidos
15.
Heart Lung Circ ; 27(12): 1398-1405, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29066011

RESUMO

BACKGROUND: Socioeconomic status (SES) is a social determinant of both health and receipt of health care services, but its impact is under-studied in acute coronary syndrome (ACS). The aim of this study was to examine the influence of SES on in-hospital care, and clinical events for patients presenting with an ACS to public hospitals in Australia. METHODS: Data from 9064 ACS patient records were collected from 41 public hospitals nationwide from 2009 as part of the Cooperative National Registry of Acute Coronary Syndrome Care (CONCORDANCE) registry. For this analysis, we divided the cohort into four socioeconomic groups (based on postcode of usual residence) and compared the in-hospital care provided and clinical outcomes before and after adjustment for both patient clinical characteristics and hospital clustering. RESULTS: Patients were divided into four SES groups (from the most to the least disadvantaged: 2042 (23%) vs. 2104 (23%) vs. 1994 (22%) vs. 2968 (32%)). Following adjustments for patient characteristics, there were no differences in the odds of receiving coronary angiogram, revascularisation, prescription of recommended medication, or referral to cardiac rehabilitation across the SES groups (p=0.06, 0.69, 0.89 and 0.79, respectively). After adjustment for clinical characteristics, no associations were observed for in-hospital and cumulative death (p=0.62 and p=0.71, respectively). However, the most disadvantaged group were 37% more likely to have a major adverse cardiovascular event (MACE) than the least disadvantaged group (OR (95% CI): 1.37 (1.1, 1.71), p=0.02) driven by incidence of in-hospital heart failure. CONCLUSIONS: Although there may be gaps in the delivery of care, this delivery of care does not differ by patient's SES. It is an encouraging affirmation that all patients in Australian public hospitals receive equal in-hospital care, and the likelihood of death is comparable between the SES groups.


Assuntos
Síndrome Coronariana Aguda/epidemiologia , Assistência à Saúde/economia , Hospitais Públicos/economia , Sistema de Registros , Síndrome Coronariana Aguda/economia , Idoso , Austrália/epidemiologia , Angiografia Coronária , Feminino , Mortalidade Hospitalar/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Fatores de Risco , Fatores Socioeconômicos
18.
Turk Kardiyol Dern Ars ; 45(7): 623-629, 2017 Oct.
Artigo em Turco | MEDLINE | ID: mdl-28990943

RESUMO

OBJECTIVE: This study was a comparison of the statin therapy protocol issued by the European Society of Cardiology (ESC) and the Ministry of Health's Health Implementation Directive (SUT) in Turkey, performed in order to assess the adequacy of hyperlipidemia treatment indications for primary prevention. METHODS: A total of 582 patients with first acute coronary syndrome were included in the study. Patients with noncritical stenosis observed on coronary angiography or a history of atherosclerotic disease were excluded. The risk calculation was determined using age, sex, smoking status, presence of diabetes mellitus, total cholesterol, and lipoprotein levels. Statin treatment indications were evaluated according to the ESC guidelines (2016) and the SUT (2016). RESULTS: Statin treatment was indicated for 96% of diabetic patients, and according to the ESC, it was appropriate for 13.5% of nondiabetic patients, while the SUT recommendation included 13.3% of nondiabetic patients (p<0.05). For patients younger than 60 years of age, the SUT had more guidelines than the ESC; however, for patients aged 70 to 90, the ESC had more guidelines than the SUT. For patients over 90, the indications were the same. For patients with low-density lipoprotein-cholesterol (LDL-C) >190 mg/dL there was greater discrepancy between the SUT and ESC guidelines. According to the SUT, all patients >190 mg/dL are to receive treatment. The ESC had more guidelines than the SUT for cases of LDLC <160b mg/dL. CONCLUSION: The scope of the SUT guidelines is generally not narrower than the ESC indications. However, the indications for patients >60 years of age and those with LDL-C >160 mg/ dL should be reassessed, as they are more limited than those of the ESC. A new treatment algorithm should be defined.


Assuntos
Síndrome Coronariana Aguda/economia , Complicações do Diabetes/prevenção & controle , Hiperlipidemias/tratamento farmacológico , Reembolso de Seguro de Saúde , Síndrome Coronariana Aguda/etiologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , LDL-Colesterol/sangue , Complicações do Diabetes/complicações , Complicações do Diabetes/tratamento farmacológico , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hiperlipidemias/complicações , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Prevenção Primária/economia , Estudos Retrospectivos , Turquia
19.
Rev. esp. cardiol. (Ed. impr.) ; 70(10): 825-831, oct. 2017. tab
Artigo em Espanhol | IBECS | ID: ibc-167863

RESUMO

Introducción y objetivos: Analizar los resultados económicos y en salud de un programa dirigido a reducir las hemorragias mediante la optimización del uso de fármacos antitrombóticos en pacientes con síndrome coronario agudo. Métodos: Estudio analítico, observacional, de cohortes, retrospectivo con evaluación preintervención (PRE) y posintervención (POST). En la primera cohorte se analizaron las situaciones corregibles relacionadas con un aumento de hemorragias (PRE). Posteriormente, se implantó un paquete de intervenciones y, en tercer lugar, se analizó el impacto del paquete en la reducción de hemorragias en una segunda cohorte (POST). La eficiencia se analizó considerando los ahorros derivados de la prevención de hemorragias y los costes de la implantación de las intervenciones. El análisis de los resultados en salud se calculó por el porcentaje de hemorragias intrahospitalarias y la tasa de reingresos a los 30 días. Resultados: Se incluyó a 677 pacientes (377 en PRE y 300 en POST). La intervención se asoció a una reducción en la probabilidad de desarrollar hemorragias de un 29,2% (31,6% en POST frente a 22,3% en PRE; OR = 0,62; IC95%, 0,44-0,88). La tasa de reingresos se redujo del 7,7% en PRE al 5% en POST (p = 0,20). El coste anual evitado se estimó en 95.113,6 euros, mientras que respecto al retorno de la inversión se calculó que, por cada euro invertido, se obtuvieron 10,1 euros de ahorro en el primer año y 36,3 euros en los siguientes. Conclusiones: Un programa multidisciplinario para reducir el riesgo de hemorragias en pacientes con síndrome coronario agudo es eficaz y económicamente atractivo (AU)


Introduction and objectives: To evaluate the clinical and economic impact of a multidisciplinary program to reduce bleeding events in patients with acute coronary syndrome through optimization of antithrombotic therapy. Methods: We designed a preintervention (PRE) and postintervention (POST) quasi-experimental study using a retrospective analysis of 2 cohorts. The first cohort was analyzed to detect correctable measures contributing to bleeding (PRE). Afterward, a quality improvement intervention with a bundle of recommendations was implemented. Finally, a second cohort of patients was evaluated to investigate the impact of the measures on bleeding reduction (POST). The impact on health outcomes was evaluated through comparison of the percentage of in-hospital bleeding events and 30-day readmissions between the 2 cohorts. The economic analysis took into account the costs associated with the implementation of the program and the cost-savings associated with the prevention of bleeding events and 30-day readmissions. Results: A total of 677 patients were included (377 in PRE and 300 in POST). The total bleeding rate was reduced after the implementation of the bundled intervention by 29.2% (31.6% in POST vs 22.3% in PRE; OR, 0.62; 95%CI, 0.44-0.88) while 30-day readmission rates were 7.7% in PRE and 5% in POST (P = .20). The estimated avoided cost was euros95 113.6 per year, meaning that euros10.1 would be obtained in return for each euro invested during the first year and euros36.3 during the following years. Conclusions: This multidisciplinary program has proven to be effective in reducing bleeding events and is economically attractive (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Síndrome Coronariana Aguda/tratamento farmacológico , Hemorragia/prevenção & controle , Intervenção Médica Precoce/tendências , Síndrome Coronariana Aguda/economia , Avaliação de Custo-Efetividade , Estudos Retrospectivos , Análise Estatística , Intervalos de Confiança , Estudos de Coortes , Avaliação de Processos e Resultados (Cuidados de Saúde)/métodos , Análise Custo-Benefício/métodos
20.
Int J Cardiol ; 248: 20-27, 2017 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-28823409

RESUMO

BACKGROUND: Clinical and cost-effectiveness of prasugrel vs. clopidogrel in acute coronary syndrome (ACS) was only evaluated using TRITON-TIMI 38 event rates. A comparative analysis of both drugs in contemporary European ACS patients is lacking. METHODS: To address this issue, cardiac and bleeding events of 2 "sister" multicenter stent trials, BASKET-PROVE (BP) I with clopidogrel and BPII with prasugrel (for 12months each) were used in a hybrid analysis. Medication costs were 2015 sales prices, event costs modelled for Denmark (DNK), Germany (GER) and Switzerland (SUI) and quality adjusted life years (QALY) by EQ-5D-3L questionnaire. RESULTS: In BPI and II, 1012 and 985 ACS-patients received drug eluting stents, respectively, followed-up for 2years. Compared to clopidogrel, prasugrel-treated patients had no more major cardiac events (5.2% vs. 6.4%, p=0.422) nor cardiac deaths (1.6% vs. 1.0%, p=0.255), but more major bleedings (4.0% vs. 1.7%, p<0.001) and altogether no difference in QALYs (-0.027 (95%CI: -0.064/0.011)). Prasugrel caused higher total expenditures per patient: 1116.3 (DNK), 1063.5 (GER) and 880.8 (SUI) EURO, respectively. Accordingly, incremental cost-effectiveness was negative for prasugrel vs. clopidogrel with ratios of -45,907 (DNK), -39,909 (GER) and -33,435 (SUI) EURO/QALY gained, making clopidogrel an economically dominant strategy, even after accounting for the non-randomized comparison. CONCLUSION: Findings of this contemporary European ACS-cohort showed markedly lower cardiac event rates than TRITON-TIMI 38 and no significant difference in 2-year QALYs between prasugrel and clopidogrel-treated patients. At current drug prices, clopidogrel use resulted in an economically dominant treatment strategy in Western European patients.


Assuntos
Síndrome Coronariana Aguda/tratamento farmacológico , Análise Custo-Benefício , Stents Farmacológicos , Inibidores da Agregação de Plaquetas/uso terapêutico , Cloridrato de Prasugrel/uso terapêutico , Ticlopidina/análogos & derivados , Síndrome Coronariana Aguda/economia , Síndrome Coronariana Aguda/epidemiologia , Idoso , Clopidogrel , Estudos de Coortes , Análise Custo-Benefício/métodos , Stents Farmacológicos/economia , Europa (Continente)/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/economia , Cloridrato de Prasugrel/economia , Estudos Retrospectivos , Ticlopidina/economia , Ticlopidina/uso terapêutico
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