The TRAF cohort is the first population-based, whole-country cohort of AF epidemiology, quality of care and outcomes. It provides a unique opportunity to study the patterns, causes and impact of treatments on the incidence and outcomes of AF in a developing country.
Quality was assessed using the criteria for pharmacoeconomic evaluations from the in the most recent ISPOR guidelines and the Serbian pharmacoeconomic guidelines. The impact of the introduction of the new rulebook was assessed by comparing the period following its introduction with the number and quality of submissions in the preceding period. Results: Between September 2013 and April 2014 there were 268 submissions to the NHIF and none were accompanied by the necessary pharmacoeconomic analysis. The new rulebook was published in April 2014, making budget impact analysis an obligatory part of every submission, and cost-effectiveness analysis obligatory for all new INNs. 127 new and renewal submissions were made between April and June 2014, 47 for new INNs, 31 original and 16 for innovative medicines. All 47 completed the obligatory pharmacoeconomic analysis. There was a widespread failure to reach the requirements laid out in either the Guidelines for Pharmacoeconomic Evaluations for Serbia or ISPOR guidelines. ConClusions: The introduction of compulsory pharmacoeconomic component to reimbursement submissions in Serbia has raised the standard of submissions to the NHIF. This standard is still too low to fully facilitate transparent evidence based decision making, however the new rulebook is expected to force both the NHIF and the pharmaceutical industry to increase their skills in evidence based decision making. However, Serbia still suffers from a lack of the information required to construct quality pharmacoeconomic analysis, with limited local cost estimates available and limited supply of health economic skills in the region.
This study aimed to estimate and identify determinants of direct medical costs associated with rheumatoid arthritis (RA) in Turkey using nationwide real-world data. Using the Turkish National Health Insurance Database (2009-2011), RA patients (ages 18-99) were identified using International Classification of Disease Tenth Revision Clinical Modification (ICD-10-CM) codes. Patients were required to have two RA diagnoses at least 60 days apart and were grouped as prevalent and incident cases. The date of the first RA claim was identified for each patient and designated as the index date. Total healthcare costs were examined over the 12-month period following the index date. Descriptive and multivariate analyses are provided. Generalized linear models were used to calculate expected annual costs for incident and prevalent RA patients after controlling for age, gender, region, comorbid conditions and medication. A total of 2,613 patients met all inclusion criteria (693 incident; 1,920 prevalent patients). Prevalent patients were older, less likely to reside in the Marmara region, had higher comorbidity index scores and were more likely to use non-steroidal anti-inflammatory drugs, biologics and disease-modifying anti-rheumatic drugs relative to incident patients. Average direct annual costs were
Objectives: Pharmacogenetic (PG) algorithms of warfarin dosing have been proposed as potential improvement of anticoagulation control. Despite several randomized clinical trials, the clinical benefit was not consistently proven. The objective of this study was to estimate the opportunity cost of introduction of warfarin PG testing into health system using an expected value of perfect information (EVPI) approach. MethOds: Previously developed cost-effectiveness model was employed to evaluate the PG algorithm-based warfarin dosing versus standard treatment. Differences in anticoagulation control, in terms of percentage of time in therapeutic range (TTR), were used to simulate thromboembolic and haemorrhagic events. The outcomes were valued in quality-adjusted life-years (QALY) and 2014 cost. Uncertainty in the model parameters was assessed using probabilistic sensitivity analysis and EVPI was estimated at a threshold of 25,000 EUR/QALY gained. Results: In the base case, where price of PG test was 40 EUR, the ICER of genotype-guided treatment was 8.146 EUR/QALYg compared to the standard treatment. When uncertainty about clinical efficacy was examined, ICER ranged from approximately 1.000 EUR/QALYg to dominated strategy. Another important factor was the price of PG test. In the base case, the treatment using PG algorithm had highest expected net-benefit with opportunity loss surrounding uncertainty about clinical efficacy of 2.9 EUR per treated patient. Conversely, increasing the cost of PG test by 3 times, to 120 EUR, resulted in the highest total expected net-benefit for standard treatment. Selecting the genotype-guided treatment instead of standard therapy would result in opportunity loss of 47.2 EUR, while EVPPI for standard treatment was 0.82 EUR. cOnclusiOns: The price of PG test is an important factor about decision of warfarin PG introduction into health system or investment into additional clinical trials. The smaller cost of PG test means lower opportunity cost, consequentially future research should not have important impact on economic aspect of decision.
IntroductionTo assess excess use of coronary angiography prior to coronary artery bypass graft surgery and its association with mortality, health care costs, and hospital quality in Turkey.MethodsUsing Turkish National Health Insurance Data (2009–2011) that included patients who underwent cardiac surgery, coronary angiography utilization was identified. Propensity score matching was used to compare survival rates and annual health care costs of patients in a coronary angiography excess-use group (>1 angiogram) and in a standard-therapy group (1 angiogram). The empirical Bayesian approach was used to combine mortality and hospital volume for quality index. The relationship between hospital quality and excess use of coronary angiography was assessed using Chi-squared tests.ResultsOut of 20,126 patients identified, 7.27% of patients underwent excessive coronary angiography procedures (excess-use group), with an average annual cost at 9.7% higher than those who had a single angiography (standard-therapy group; P < 0.01). Operational mortality associated with excessive use was significantly higher as well (7.4% versus 5.4%, P < 0.02). There exists variation in the use of coronary angiography across cities and hospitals. Patients who underwent cardiac surgery in high-quality hospitals were less likely to have excessive angiography use than those in low-quality hospitals (7.0% versus 9.5%, P < 0.01).ConclusionIn Turkey, excess use of coronary angiography prior to coronary artery bypass graft surgery is associated with higher operational mortality, higher expenditures, and lower hospital quality.
Objectives. To explore health care costs associated with ankylosing spondylitis (AS) in Turkey. Methods. Research-identified data from a system that processes claims for all Turkish health insurance funds were analyzed. Adult prevalent and incident AS patients with two AS visits at least 60 days apart, identified between June 1, 2010 and December 31, 2010, with at least 1 year of continuous health plan enrollment for the baseline and follow-up years were included in the study. Pharmacy, outpatient, and inpatient claims were compiled over the study period for the selected patients. Generalized linear models were used to estimate the expected annual costs, controlling for baseline demographic and clinical characteristics. Results. A total of 2.986 patients were identified, of which 603 were incident cases and 2.383 prevalent cases. The mean ages were 39 and 41 years, respectively, and 44% and 38% were women for incident and prevalent cases. Prevalent patients had higher comorbidity scores (5.01 versus 2.24, P < 0.001) and were more likely to be prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) (77% versus 72%, P < 0.001) or biologics (35% versus 8%, P < 0.006) relative to incident patients. Seventy-seven percent of prevalent patients were prescribed NSAIDs, followed by biologic and disease-modifying antirheumatic drugs (DMARDs). Total annual medical costs for incident AS patients were €2.253 and €4.233 for prevalent patients. Pharmacy costs accounted for a significant portion of total costs (88% for prevalent patient, 77% for incident patient), followed by physician office visit costs. Prior comorbidities and treatment type also significantly contributed to overall costs. Conclusion. Annual expenditures for AS patients in Turkey were comparable relative to European countries. Pharmaceutical expenditures cover a significant portion of the overall costs. Comparative effectiveness studies are necessary to further decrease health care costs of AS treatment.
leak; (2) the differences in LOS, readmission, post-operative infection, and total inpatient costs between the patients with anastomotic leaks and those without leaks. Chi square test and T test were used to compare outcomes between two cohorts, before and after employing propensity-score matching technique based on a series of baseline covariates. Generalized linear model was also conducted. RESULTS: A total of 6174 (6.18%) patients with colorectal surgeries had 30-day anastomotic leak during 2008-2010.The patients with anastomotic leak had 1.3 times higher 30-day readmission (pϽ0.01), and 1.9 times higher postoperative infection (pϽ0.01) compared to the patient without anastomotic leak. Anastomotic leak incurred additional LOS of 7.3 days and additional average hospital cost of $24,399 for index hospitalization alone. When the extra burden of readmission was added, the average incremental LOS increased to 9.5 days, and the average incremental hospital costs increased to $28,597. CONCLUSIONS: Anastomotic leaks in colorectal surgeries increase clinical and economic burden by 0.5 to 1.8 times in terms of additional readmission, postoperative infection, LOS, and hospital costs. The results underscore the potential advantage of cost reduction by preventing the anastomotic leaks after colorectal surgeries.
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