A475compare the effectiveness with CAS and CEA in 677 patients with symptomatic carotid artery stenosis in korean clinical practice. Methods: From January 1 2008 to December 31 2011, retrospective cohort study was conducted in 677 symptomatic carotid stenosis patients with more than 50% stenosis) (CAS= 346, CEA= 331) in the Korean hospitals (Asan medical center, Samsung medical center, Severance hospital, Inha university hospital, Chonnam university hospital). The primary outcome was stroke, myocardial infarction, or death during periprocedural (30-day) and postprocedural period. Results: For 677 patients over 2-year follow-up period, All death, major stroke, minor stroke were higher in CAS group than CEA (1.45% vs. 0.30%, 4.05% vs. 1.81%, 3.47% vs. 3.02%, 0.58% vs. 0%). All outcomes were higher in CAS than in CEA within 30-day after treatment and in subsequent years, except the incidence of 30 days-minor stroke. ConClusions: CEA was superior to CAS in symptomatic patients with carotid stenosis. This study suggests that CEA can be considered the first-line therapy for symptomatic carotid artery stenosis in South Korea.
In Ukraine, the efficacy of treatment of arterial hypertension is only 19% in urban areas and 8 % in rural populations. The most important reasons of low efficiency of antihypertensive therapy (AHT) are a wrong choice of tactics of the patient management and low adherence of patients to treatment. The latter decreases with increasing amounts of prescribed drugs. One possible way to increase patients’ compliance to treatment and the effectiveness of therapy is to use fixed-dose combinations (FDCs) of antihypertensive drugs (AHDs). The share of FDCs consumption (in terms of DDDs/1000/day) in Ukraine in the total structure of AHDs consumption is 25%, which is significantly less than the proportion of patients (60%), requiring combined AHDs. This is an indirect evidence of low compliance of Ukrainian patients to HD treatment and the need of pharmacoeconomic study of benefits of antihypertensive therapy using FDCs. As a result of pharmacoeconomic cost-effectiveness analysis it has been found that antihypertensive therapy in patients with moderate and severe AH using triple FDC Val+Aml+HCTZ compared with three dual FDC: Val+HCTZ, Val+Aml, Aml+HCTZ provides greater clinical efficacy (the number of patients with the achieved target level of blood pressure). This triple FDC Val+Aml+HCTZ has pharmacoeconomic benefits (greater cost efficiency), compared with only one dual FDC Val+HCTZ. This gives the opportunity to save money, presents additional advantages in efficiency and justifies benefits from its use by hypertensive patients in need of appointing the third AHD CCB amlodipine in addition to the existing dual one using valsartan and hydrochlorothiazide.
Aspirin, dipyridamole and clopidogrel are three widely used antithrombotic drugs for the purpose of the secondary prevention of stroke. Based on the results of many clinical studies it has been shown that aspirin and clopidogrel are effective, but both have potentially serious side effects, however, clopidogrel is more expensive than aspirin. The article presents the results of the evaluation of cost-effectiveness of using antiplatelet agents of clopidogrel compared to aspirin in patients with atherosclerosis with ischemic stroke (IS), myocardial infarction (MI) and peripheral artery disease for prevention of acute ischemic stroke and cardiovascular mortality according to the results of CAPRIE randomized clinical research. For pharmacoeconomic analysis such methods as mathematical modeling and decision tree analysis «cost-effectiveness» have been used. The results of CAPRIE randomized clinical trial have shown that the long-term use of clopidogrel in patients with atherosclerotic vascular disease is more effective than aspirin in reducing the combined risk of IS, MI, or cardiovascular death. The common safety profile of clopidogrel is the same as for aspirin. The results of pharmacoeconomic analysis indicate that the use of clopidogrel as an antiplatelet agent in patients with cardiovascular disease for prevention of stroke compared to acetylsalicylic acid is more expensive for the payer, but provides additional effectiveness-two surviving lives when treating 1 000 patients.
higher medical costs in six European settings. METHODS: The Archimedes model was used to simulate cohorts of individuals ages 40 to 75 with no prior history of diabetes, cardiovascular disease, or chronic kidney disease, in Denmark, France, Germany, Italy, Poland and the UK. Individuals were simulated for 10 years and the incidences of diabetes and MACE were tracked, along with mean total medical costs per person. A risk score was computed for each simulated person, with baseline data on age, gender, BMI, waist, smoking, family histories of diabetes and cardiovascular disease, and antihypertensive usage. For each country, the subpopulations of individuals with above median risk score (TOP50), and individuals in the top risk score quartile (TOP25) were compared to the full cohorts. RESULTS: Diabetes and MACE incidences were higher in the TOP50 and TOP25 subgroups, as were total medical costs. In each country, the mean 10-year discounted medical costs for the full cohorts vs. the TOP50 subgroups were: Denmark €8,482 (95%CI 8,027 -8,937) vs. €11,292 (10,614 -11,969); France €6,264 (5,917 -6,611) vs. €8,492 (7,953 -9,031); Germany €8,717 (8,218 -9,217) vs. €11,974 (11,204 -12,743); Italy €7,688 (7,273 -8,104) vs. €10,279 (9,643 -10,914); Poland €1,798 (1,707 -1,888) vs. €2,418 (2,274 -2,561); UK €4,100 (3,885 -4,314) vs. €5,580 (5,238 -5,921). Medical costs were even higher in the TOP25 subgroup. CONCLUSIONS: This risk score could be an effective tool for identifying individuals likely to incur higher health care costs due to diabetes and MACE. Targeting individuals with such scores could make screening programs more efficient, provided validation in real-world populations.OBJECTIVES: Two approaches recanalization or restoration of adequate perfusion and neuroprotection are identified as a pathogenic treatment of acute ischemic stroke (AIS). Timely mechanical revascularization and thrombolytic therapy prevent the development of neurons necrosis and significantly improve survival and quality of patient life. Unfortunately, in Ukraine these methods are difficult of access for patients due to high cost, late diagnostics and contraindications. The
Objectives: Describe incidence of severe chronic kidney disease (CKD) and comorbidity profiles by patient body mass index (BMI) using real-world claims and electronic health records (EHR) database. Methods: Adults age $18 newly diagnosed with severe CKD (stage 4, 5, and end stage) between 6/30/2007 and 6/3/2017 were identified in the IBM® MarketScan® Explorys® Claims-EHR Data Set, which includes detailed medical and pharmacy claims data and clinical information in patient health records. Incidence of severe CKD were stratified by BMI measured during 1-year prior to CKD diagnosis (index event). The following BMI categories were used (kg/ m 2): Underweight ,18.5, normal weight 18.5 to 24.9, overweight 25 to 29.9, obese 30 to 39.9, morbidly obese $ 40. Comorbid conditions and hemoglobin A1C (HbA1c) level during the 1-year pre-index were stratified by BMI. Patients with evidence of pregnancy or primary cancers were excluded. Results: 7,724 patients were newly diagnosed with severe CKD, with 2% underweight, 22% normal weight, 30% overweight, 36% obese, and 10% morbidly obese (Mean age 71; 52% male). Prevalent of comorbid conditions increasing from underweight to morbidly obese categories were type 2 diabetes (T2DM) from 28% to 77%, dyslipidemia 45% to 68%, hypertension 80% to 92%, and congestive heart failure 38% to 47%. Depression (18-19%), COPD (36-37%), and pain (77-78%) were similar between underweight and morbidly obese categories but higher than normal (16%, 29%, 71%), overweight (13%, 27%, 70%) and obese (14%, 29%, 72%). Among a subset with HbA1c results, the mean HbA1c increased from 6.7 in normal weight to 7.2 in morbidly obese categories. Conclusions: While incidence of severe CKD diagnosis were higher in obese patients, patient BMI categories revealed different comorbidity profiles. Prevalence of T2DB and other metabolic syndrome conditions increased with BMI, while other conditions were highest among patients at the opposite ends of BMI spectrum.
formula. Prescription drug cost and activity trends were analysed at a drug-class (BNF chapter) and regional level. Regions were defined by sustainability and transformation plan (STP) area. Risk-adjustment helped determine what cost we would 'expect' based on each STP's risk profile compared to the English average. Costs were projected over a five-year period under various scenarios, using expected changes in population size and structure published by the NHS. Results: The reduction in expenditure is driven by a combination of lower average costs (3.83% decrease) and lower levels of activity (0.92% decrease). These decreases in total cost are slightly offset by the 1.19% increase in the English population size. The research highlights particular BNF chapters and STP regions that are driving these trends as well as how STP regions' experience compares to the English average on a risk-adjusted basis. The projection model shows that prescription drug costs can be expected to decrease by 3.6% p.a. over the next five years if historical trends persist. Conclusions: The insights provided by this research can help stakeholders with experience analysis and planning by identifying cost and activity drivers on a population risk-adjusted basis as well as having a view of how demand may develop over the projection period.
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