Chronic heart failure (CHF) affects millions of people across the world, with increasing trends in prevalence, putting ever increasing pressure on the healthcare system. The aim of this study was to assess the financial burden of CHF hospital care on the public healthcare sector in Romania by estimating the number of inpatient episodes and the associated costs. Additionally, societal costs associated with missed work and premature death of CHF patients were also estimated. The national claims database was analyzed to estimate the number of CHF patients. Cost data was extracted from a pool of nine public hospitals in Romania. In 2019, 375,037 CHF patient episodes were identified on specific wards at the national level. The average cost calculated for the selected nine hospitals was EUR 996. The calculated weighted national average cost per patient episode was EUR 1002, resulting in a total cost of EUR 376 million at the national level. The cost of workdays missed summed up to EUR 122 million, while the annual costs associated with the premature death of CHF patients was EUR 230 million. In conclusion, the prevalence of CHF in Romania is high, accounting for a large proportion of hospitalizations, which translates into large costs for the national payer.
Background: Ferric carboxymaltose (FCM) treatment in case of iron deficient (ID) patients with chronic heart failure (CHF) has shown great promise according to the findings of recent studies in improvement of symptoms and quality of life, New York Heart Association (NYHA) classification, and exercise capacity. Aim of the study: The purpose of the current study is to assess the budget impact of treating CHF patients with FCM in a sample of Romanian hospitals. Material and methods: Calculations have been based on the budget impact model developed by Theidel et al. The assumptions and clinical outcomes of the current study were based on a multivariate statistical approach used in the same German study. The predicted outcomes were based on data pooled from four double-blind randomized controlled trials. The time horizon of the model was 1 year. Budget impact calculations were performed from the public payer perspective. Two scenarios have been handled: one without applying the Clawback tax and one with applying the tax to the cost of medication. Results: The yearly budget impact of FCM vs. no iron-replacement treatment without applying the tax ranged between €678,383 and €641,588 for 1,000 patients, resulting in €37 of additional costs per patient per year. The yearly budget impact of FCM vs. no iron-replacement treatment with applying the tax ranged between €616,934 and €641,588 for 1,000 patients, resulting in €9 of cost reduction per patient per year. Key cost drivers included the cost of outpatient visits and the cost of hospitalization due to HF worsening. Sensitivity analysis for both scenarios proved the robustness of the results. Conclusions: The FCM treatment of CHF patients has a moderate budget impact. Moreover, this budget impact/saving translates into a reduction of the rate and length of hospitalization stay and a better symptomatic profile of the patients.
Background Economic evaluations are widely used to predict the economic impact of new treatment alternatives. Comprehensive economic reviews in the field of chronic lymphocytic leukemia (CLL) are warranted to supplement the existing analyses focused on specific therapeutic areas. Methods A systematic literature review was conducted based on literature searches in Medline and EMBASE to summarize the published health economics models related to all types of CLL therapies. Narrative synthesis of relevant studies was performed focusing on compared treatments, patient populations, modelling approaches and key findings. Results We included 29 studies, the majority of which were published between 2016 and 2018, when data from large clinical trials in CLL became available. Treatment regimens were compared in 25 cases, while the remaining four studies considered treatment strategies with more complex patient pathways. Based on the review results, Markov modelling with a simple structure of three health states (progression-free, progressed, death) can be considered as the traditional basis to simulate cost effectiveness. However, more recent studies added further complexity, including additional health states for different therapies (e.g. best supportive care or stem cell transplantation), for progression-free state (e.g. by differentiating between with or without treatment), or for response status (i.e. partial response and complete response). Conclusions As personalized medicine is increasingly gaining recognition, we expect that future economic evaluations will also incorporate new solutions, which are necessary to capture a larger number of genetic and molecular markers and more complex patient pathways with individual patient-level allocation of treatment options and thus economic assessments. Supplementary Information The online version contains supplementary material available at 10.1007/s40259-023-00583-9.
Bevezetés: A kelet- és közép-európai régióban – Csehországot és Szlovákiát követve – Magyarországon a harmadik legmagasabb a melanoma malignum incidenciája. A melanomaszűrés és -diagnosztika hatékonyságának javítására az elmúlt években számos technológiai fejlesztés történt: az egyik ilyen, széles körben ismertté vált technológia az integrált automatizált teljestest-feltérképezés és digitális dermatoszkópia. Célkitűzés: A jelen célzott irodalomkutatás célja, hogy bemutassa a teljestest-anyajegyvizsgálatra kifejlesztett új digitális technológiákban rejlő lehetőségeket a melanomaszűrésre vonatkozóan. Módszer: A melanomaszűrésre és teljestest-anyajegyvizsgálatra alkalmas szűrési technológiára vonatkozó információk összegyűjtésére célzott irodalomkutatást végeztünk. Publikusan elérhető online adatbázisokban kerestünk szakmai irányelveket és ajánlásokat, valamint tudományos közleményeket. Eredmények: Irodalomkeresésünk során 15 nemzetközi irányelvet és ajánlást azonosítottunk, melyek a melanoma malignum szűrését és korai felismerését összegezték. Melanomaszűréssel foglalkozó hazai irányelvet nem azonosítottunk. A digitális dermatoszkóp és a teljestest-anyajegyvizsgálatra alkalmas szűrési technológia eredményességére vonatkozóan 2 klinikai, 5 megfigyeléses vizsgálatot és 8 összefoglaló közleményt elemeztünk. 10 nemzetközi vizsgálatot elemeztünk, melyek a gépi tanulási algoritmusok kiegészítő szerepét vizsgálták a melanomaszűrésben. Megbeszélés: A digitális dermatoszkópia és a teljes testről készült fényképfelvételek elősegítik a rosszindulatúvá váló képletek vagy az új melanoma azonosítását magas kockázatnak kitett személyekben. Nem áll rendelkezésre megbízható adat a melanomaszűrő-programoknak a daganat okozta halálozásra kifejtett hatásáról, így a korlátozott bizonyítékok miatt a populációs szintű melanomaszűrést a nemzetközi irányelvek nem ajánlják. Következtetés: Megállapítható, hogy a nemzetközi irányelvek kiemelik a teljes testről készült fényképfelvételek és a szekvenciális digitális dermatoszkópos képalkotó eljárások szerepét a melanoma emelkedett kockázatának kitett személyek szűrésében. Orv Hetil. 2022; 163(49): 1943–1951.
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