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.
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