The cost-effectiveness evaluations showed that dabigatran can be considered the dominant treatment strategy compared to rivaroxaban in the patients' sub-groups considered, given the projected marginally higher clinical benefits and lower treatment costs.
The relative efficacy and safety of dabigatran etexilate and warfarin have been evaluated in two head-to-head, phase III, treatment of acute venous thromboembolism (VTE) trials, and one extended prophylaxis trial, in patients with high risk of recurrent VTE. Dabigatran etexilate demonstrated similar efficacy to warfarin, and was associated with a reduced risk of major or clinically relevant bleeds. Based on results of these trials, and real-life disease prognosis following discontinuation of anticoagulation treatment, we evaluated the cost-utility of dabigatran etexilate compared with warfarin in six months anticoagulation, and in extended, up to 24 months anticoagulation, in patients with acute VTE, acute deep-vein thrombosis (DVT) or acute, symptomatic, pulmonary embolism (PE). Costs were analysed from the perspective of the National Health Services (NHS) and Public Social Services (PSS) in England and Wales. Outcomes were quantified in quality-adjusted life years (QALY). The estimated incremental, lifetime cost/QALY gain following acute, symptomatic VTE (DVT or PE) was £1,252/QALY when dabigatran etexilate or warfarin were administered for up to six months treatment. In treatment of acute, symptomatic PE and in DVT respective ratios were £1,767/QALY and £1,075/QALY. In extended, up to 24 months anticoagulation, dabigatran etexilate projected costs/QALY of £8,242/QALY, when compared with warfarin. Results obtained herein were robust across a number of sensitivity analyses and suggest dabigatran etexilate to be a cost-effective alternative to current standard of care when evaluated in six months treatment and in extended anticoagulation following acute VTE (DVT and/or PE).
OBJECTIVES: Diabetes mellitus (DM) represents a challenging problem to healthcare systems globally as it requires a high level of expenditure. In Algeria, nearly US$264 million was spent on DM in 2010; this is expected to rise to US$461 million by 2030. The aim of this study was to collect 2011 direct medical costs of the management and treatment of DM-related complications from the Algerian Social Insurance perspective. METHODS: A structured literature search was conducted to search for the published costs of interest but no relevant publications were identified. Consequently, IMS collected the required costs from official sources identified using its local resources. Six groups of costs were created based mainly on type of complications: management costs, cardiovascular complications, renal complications, acute events, eye-disease and neuropathy/foot ulcers which were presented as first-year costs and costs in subsequent years following an event in 2011
OBJECTIVES: Diabetic patients with chronic renal failure are at risk of developing hypoglycemia and metabolic acidosis. The purpose of this study was to estimate the health care resource utilization and costs associated with these complications. METHODS: Patients covered by the Quebec provincial drug reimbursement program (RAMQ) who had a diagnosis of diabetes, had used a hypoglycemic agent, and who had experienced hypoglycemia or metabolic acidosis in the period from January 2005 to December 2010 were selected. Health care resources in terms of physician visits, hospitalization, intensive care unit stay, hospital outpatient clinic visits, and emergency room visits were estimated for the 10-day period before and the 30-day period after a complication event. The resources consumed during a 40-day period one year before the event, corresponding to a period without any complication event, was deducted to estimate the incremental costs associated with these complications. RESULTS: A total of 4889 patients had a diagnosis of diabetes with chronic renal failure (average age 69.2 years (SDϭ10.1)). Of these, 530 (10.8%) experienced a hypoglycemic event and 95 (1.9%) an episode of metabolic acidosis. Estimated incremental costs of medical resources were $3859 for hypoglycemia and $5019 for metabolic acidosis. In both cases, hospitalization was the major cost coponent: $2560 and $3065 for hypoglycemia and metabolic acidosis, respectively. CONCLUSIONS: A significant proportion of diabetic patients with chronic renal failure experienced hypoglycemia or metabolic acidosis, with substantial associated costs. Treatment options that minimize the risk of these complications should be considered.
OBJECTIVES: Diabetic patients with chronic renal failure are at risk of developing hypoglycemia and metabolic acidosis. The purpose of this study was to estimate the health care resource utilization and costs associated with these complications. METHODS: Patients covered by the Quebec provincial drug reimbursement program (RAMQ) who had a diagnosis of diabetes, had used a hypoglycemic agent, and who had experienced hypoglycemia or metabolic acidosis in the period from January 2005 to December 2010 were selected. Health care resources in terms of physician visits, hospitalization, intensive care unit stay, hospital outpatient clinic visits, and emergency room visits were estimated for the 10-day period before and the 30-day period after a complication event. The resources consumed during a 40-day period one year before the event, corresponding to a period without any complication event, was deducted to estimate the incremental costs associated with these complications. RESULTS: A total of 4889 patients had a diagnosis of diabetes with chronic renal failure (average age 69.2 years (SDϭ10.1)). Of these, 530 (10.8%) experienced a hypoglycemic event and 95 (1.9%) an episode of metabolic acidosis. Estimated incremental costs of medical resources were $3859 for hypoglycemia and $5019 for metabolic acidosis. In both cases, hospitalization was the major cost coponent: $2560 and $3065 for hypoglycemia and metabolic acidosis, respectively. CONCLUSIONS: A significant proportion of diabetic patients with chronic renal failure experienced hypoglycemia or metabolic acidosis, with substantial associated costs. Treatment options that minimize the risk of these complications should be considered.
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