RESUMEN
BACKGROUND: This study evaluated the cost-effectiveness of catheter ablation therapy versus amiodarone for treating ventricular tachycardia (VT) in patients with structural heart disease. The analysis used a societal perspective for a hypothetical cohort of VT patients with implantable cardioverter-defibrillators, who were experiencing frequent shocks. METHODS AND RESULTS: We calculated incremental cost-effectiveness of ablation relative to amiodarone over 5 years after treatment initiation. Event probabilities were from the Chilli randomized clinical trial (Chilli Cooled Ablation System, Cardiac Pathways Corporation, Sunnyvale, Calif), the literature, and a consensus panel. Costs were from 1998 national Medicare reimbursement schedules. Quality-of-life weights (utilities) were estimated using an established preference measurement technique. In a hypothetical cohort of 10 000 patients, 5-year costs were higher for patients undergoing ablation compared with amiodarone therapy ($21 795 versus $19 075). Ablation also produced a greater increase in quality of life (2.78 versus 2.65 quality-adjusted life-years [QALYs]). This yielded a cost-effectiveness ratio of $20 923 per QALY gained for ablation compared with amiodarone. Results were relatively insensitive to assumptions about ablation success and durability. In less severe patients with good ejection fractions who suffer their first VT episode, the incremental cost-effectiveness ratio was $6028 per QALY gained. These cost-effectiveness ratios are within the range generally thought to warrant technology adoption. CONCLUSIONS: This study demonstrates that, from a societal perspective, catheter ablation appears to be a cost-effective alternative to amiodarone for treating VT patients.
Asunto(s)
Ablación por Catéter/economía , Taquicardia Ventricular/cirugía , Análisis Costo-Beneficio , HumanosRESUMEN
OBJECTIVE: To identify costs among rheumatoid arthritis (RA) patients receiving alternative disease-modifying antirheumatic drug (DMARD) therapies. METHODS: Using managed care organization data, we identified members who (a) were prescribed any DMARD therapy for two consecutive months between July 1993 and February 1998, (b) were aged > or = 18 years, (c) had > or = 6 months of DMARD-free enrollment prior to the first DMARD, and (d) had a diagnosis of RA. RESULTS: The average age of the cohort (n = 571) was 51 years, and 70% were women. Mean duration of enrollment following initiation of DMARD therapy (observation period) was 19.5 months; 28.8% of patients switched DMARD regimens. The average monthly cost of care was $853, of which $294 (34%) was for RA-coded medical services. Monthly RA-coded costs varied by DMARD: hydroxychloroquine $227 (n = 252), methotrexate $340 (n = 185); sulfasalazine $233 (n = 49), and other mono/combination therapy $425 (n = 85) (P = 0.001). CONCLUSION: Costs of RA-coded care in patients receiving DMARDs are low and vary by DMARD.
Asunto(s)
Antirreumáticos/uso terapéutico , Artritis Reumatoide/tratamiento farmacológico , Artritis Reumatoide/economía , Recursos en Salud/economía , Recursos en Salud/estadística & datos numéricos , Antirreumáticos/economía , Costos Directos de Servicios/estadística & datos numéricos , Costos de los Medicamentos , Quimioterapia Combinada , Femenino , Costos de la Atención en Salud/estadística & datos numéricos , Investigación sobre Servicios de Salud , Humanos , Hidroxicloroquina/uso terapéutico , Masculino , Programas Controlados de Atención en Salud/economía , Programas Controlados de Atención en Salud/estadística & datos numéricos , Metotrexato/uso terapéutico , Persona de Mediana Edad , Medio Oeste de Estados Unidos , New England , Sulfasalazina/uso terapéutico , Factores de Tiempo , Resultado del TratamientoRESUMEN
Pharmacotherapeutic interventions and drug acquisition costs in HIV-positive and HIV-negative patients on a hospital medical service were studied. In November and December 1995, HIV-positive and HIV-negative patients were randomly selected and matched on the basis of admission date. Pharmacotherapeutic interventions were recorded by a pharmacist until the time of discharge. Drug acquisition costs were obtained through records of medications ordered. The two patient groups were compared with respect to length of stay (LOS), number and cost of medications, and number of interventions. HIV-positive patients had significantly more medication orders and required more interventions than HIV-negative patients. Mean LOS was not significantly different. HIV status and number of medications were significantly associated with requiring five or more interventions. Drug acquisition costs were significantly higher in the HIV-positive group. The mean pharmacist-attributed cost saving per patient was $134 for HIV-positive patients and $27 for HIV-negative patients. HIV-positive patients required more interventions and consumed more medication resources than HIV-negative patients. Pharmacist interventions produced drug acquisition cost savings for both groups, with more savings being realized for positive patients.
Asunto(s)
Fármacos Anti-VIH/economía , Infecciones por VIH/economía , Hospitales Universitarios/economía , Farmacéuticos/economía , Servicio de Farmacia en Hospital/economía , Adulto , Anciano , Fármacos Anti-VIH/uso terapéutico , Antiinfecciosos/economía , Antiinfecciosos/uso terapéutico , Control de Costos , Femenino , Infecciones por VIH/tratamiento farmacológico , Hospitales con más de 500 Camas , Humanos , Infecciones/tratamiento farmacológico , Infecciones/economía , Masculino , Maryland , Persona de Mediana EdadAsunto(s)
Aborto Terapéutico , Relaciones Interpersonales , Trastornos Mentales/etiología , Adaptación Psicológica , Adulto , Ansiedad/etiología , Consejo , Cultura , Depresión/etiología , Composición Familiar , Femenino , Homosexualidad , Humanos , Identificación Psicológica , Ilegitimidad , Masculino , Matrimonio , Embarazo , Teoría Psicoanalítica , Conducta Sexual , Persona Soltera , Estrés Psicológico , Factores de TiempoAsunto(s)
Aborto Terapéutico , Actitud , Persona Soltera , Ajuste Social , Aborto Legal , Adaptación Psicológica , Adolescente , Adulto , Síntomas Afectivos/etiología , California , Conflicto Psicológico , Toma de Decisiones , Fantasía , Femenino , Estudios de Seguimiento , Humanos , Proyectos Piloto , Embarazo , Embarazo no Deseado , Autoimagen , Cambio Social , Estrés PsicológicoRESUMEN
We compared medical resource use and costs among rheumatoid arthritis (RA) patients receiving alternative disease-modifying antirheumatic drugs (DMARDs). The cohort study used data from a managed care organization. Health plan members who were prescribed DMARD therapy for at least 2 consecutive months, were age 18 years or older, had at least 6 months of DMARD-free enrollment prior to the first DMARD, and had a diagnosis of RA before or during the first month of DMARD were eligible. Median duration of initial DMARD therapy was 10 months overall: 11 months for hydroxychloroquine (n = 252), 15 months for methotrexate (n = 185), 5 months for sulfasalazine (n = 49), and 5 months for other mono/combination therapy (n = 85) (p < 0.0001). The average monthly cost of care was $853, of which $294 (34%) was for RA-coded medical services. In multivariate analyses, monthly RA-coded costs varied significantly by initial DMARD. RA costs and duration of initial therapy varied significantly by initial DMARD.