Custo-efetividade da trombólise pré-hospitalar vs intra-hospitalar no infarto agudo do miocárdio

Araújo, Denizar Vianna; Tura, Bernardo Rangel; Brasileiro, Antônio Luiz da Silva; Neto, H. L. de Oliveira; Pavão, Ana Luiza Braz; Teich, Vanessa

doi:10.1590/s0066-782x2008000200005

Cited by 10 publications

(7 citation statements)

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“…Tissue plasminogen activator was found to be cost-effective, when used within 6 h of ischemic stroke [ 56 ] and when compared to Streptokinase [ 57 ]. In one study, prehospital thrombolysis was found to be cost-effective compared to in-hospital use [ 58 ]. Streptokinase was moderately cost-effective when used in combination with other BP medication [ 18 , 51 ], but not cost-effective when used alone [ 26 ].…”

Section: Resultsmentioning

confidence: 99%

“…There was only one cost–benefit analysis [ 27 ]. Overall, among the 20 studies which did CEA, life years gained/saved was the predominant benefit measure [ 23 – 25 , 41 , 44 , 45 , 49 , 50 , 52 , 57 , 58 , 62 , 63 ], while the rest of the studies either used drop in blood pressure [ 33 , 34 , 37 , 39 ], avoided CVD [ 24 , 44 , 61 ] or restenosis [ 60 ] event as benefit measure. Out of 38 studies that mentioned their approach to defining an intervention as cost-effective or not, 7 employed the willingness to pay threshold, while the majority (n = 31) used the WHO’s Commission on Macroeconomics and Health (CMH) threshold using the respective countries’ GDP per capita.…”

Section: Resultsmentioning

confidence: 99%

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Primary and secondary prevention interventions for cardiovascular disease in low-income and middle-income countries: a systematic review of economic evaluations

Aminde

Fongwen

Zapata-Diomedi

et al. 2018

Cost Eff Resour Alloc

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BackgroundCardiovascular disease (CVD) is the leading cause of deaths globally, with greatest premature mortality in the low- and middle-income countries (LMIC). Many of these countries, especially in sub-Saharan Africa, have significant budget constraints. The need for current evidence on which interventions offer good value for money to stem this CVD epidemic motivates this study.MethodsIn this systematic review, we included studies reporting full economic evaluations of individual and population-based interventions (pharmacologic and non-pharmacologic), for primary and secondary prevention of CVD among adults in LMIC. Several medical (PubMed, EMBASE, SCOPUS, Web of Science) and economic (EconLit, NHS EED) databases and grey literature were searched. Screening of studies and data extraction was done independently by two reviewers. Drummond’s checklist and the National Institute for Health and Care Excellence quality rating scale were used in the quality appraisal for all studies used to inform this evidence synthesis.ResultsFrom a pool of 4059 records, 94 full texts were read and 50 studies, which met our inclusion criteria, were retained for our narrative synthesis. Most of the studies were from middle-income countries and predominantly of high quality. The majority were modelled evaluations, and there was significant heterogeneity in methods. Primary prevention studies dominated secondary prevention. Most of the economic evaluations were performed for pharmacological interventions focusing on blood pressure, cholesterol lowering and antiplatelet aggregants. The greatest majority were cost-effective. Compared to individual-based interventions, population-based interventions were few and mostly targeted reduction in sodium intake and tobacco control strategies. These were very cost-effective with many being cost-saving.ConclusionsThis evidence synthesis provides a contemporary update on interventions that offer good value for money in LMICs. Population-based interventions especially those targeting reduction in salt intake and tobacco control are very cost-effective in LMICs with potential to generate economic gains that can be reinvested to improve health and/or other sectors. While this evidence is relevant for policy across these regions, decision makers should additionally take into account other multi-sectoral perspectives, including considerations in budget impact, fairness, affordability and implementation while setting priorities for resource allocation.Electronic supplementary materialThe online version of this article (10.1186/s12962-018-0108-9) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Primary and secondary prevention interventions for cardiovascular disease in low-income and middle-income countries: a systematic review of economic evaluations

Aminde

Fongwen

Zapata-Diomedi

et al. 2018

Cost Eff Resour Alloc

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“…Our study has several limitations. First, the study was performed based on a decision-analytic Markov model which was a simplification of reality, where probability data of outcomes occurred in another population and different scenarios from that of 5C trial were inevitably employed, although we used a resource estimate adapted to our reality [ 23 ]. The data sources about probabilities beyond 1 year were partly driven by the clinical event rates observed in the patients with NSTE-ACS or STEMI patients, while the population in 5C trial were combined NSTE-ACS patients and STEMI patients together.…”

Section: Discussionmentioning

confidence: 99%

Chinese Herbal Medicines Might Improve the Long-Term Clinical Outcomes in Patients with Acute Coronary Syndrome after Percutaneous Coronary Intervention: Results of a Decision-Analytic Markov Model

Wang

et al. 2015

Evidence-Based Complementary and Alternative Medicine

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Aims. The priority of Chinese herbal medicines (CHMs) plus conventional treatment over conventional treatment alone for acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI) was documented in the 5C trial (chictr.org number: ChiCTR-TRC-07000021). The study was designed to evaluate the 10-year effectiveness of CHMs plus conventional treatment versus conventional treatment alone with decision-analytic model for ACS after PCI. Methods and Results. We constructed a decision-analytic Markov model to compare additional CHMs for 6 months plus conventional treatment versus conventional treatment alone for ACS patients after PCI. Sources of data came from 5C trial and published reports. Outcomes were expressed in terms of quality-adjusted life years (QALYs). Sensitivity analyses were performed to test the robustness of the model. The model predicted that over the 10-year horizon the survival probability was 77.49% in patients with CHMs plus conventional treatment versus 77.29% in patients with conventional treatment alone. In combination with conventional treatment, 6-month CHMs might be associated with a gained 0.20% survival probability and 0.111 accumulated QALYs, respectively. Conclusions. The model suggested that treatment with CHMs, as an adjunctive therapy, in combination with conventional treatment for 6 months might improve the long-term clinical outcome in ACS patients after PCI.

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“…When available, prehospital thrombolysis was shown to reduce costs in Brazil. 65 The use of electrocardiogram machines for patient triage in primary health centres was shown to be cost-effective in India at $12 per QALY gained. 51 The use of aspirin and β blockers was shown to cost about $10–20 per DALY averted, streptokinase about $700 per QALY gained, and more fibrin-specific thrombolytics (such as tissue plasminogen activator) about $15 000 per QALY.…”

Section: Cost-effectiveness Of Interventions For Cvrdsmentioning

confidence: 99%

Cardiovascular, respiratory, and related disorders: key messages from Disease Control Priorities, 3rd edition

et al. 2018

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Cardiovascular, respiratory, and related disorders (CVRDs) are the leading causes of adult death worldwide, and substantial inequalities in care of patients with CVRDs exist between countries of high income and countries of low and middle income. Based on current trends, the UN Sustainable Development Goal to reduce premature mortality due to CVRDs by a third by 2030 will be challenging for many countries of low and middle income. We did systematic literature reviews of effectiveness and cost-effectiveness to identify priority interventions. We summarise the key findings and present a costed essential package of interventions to reduce risk of and manage CVRDs. On a population level, we recommend tobacco taxation, bans on trans fats, and compulsory reduction of salt in manufactured food products. We suggest primary health services be strengthened through the establishment of locally endorsed guidelines and ensured availability of essential medications. The policy interventions and health service delivery package we suggest could serve as the cornerstone for the management of CVRDs, and afford substantial financial risk protection for vulnerable households. We estimate that full implementation of the essential package would cost an additional US$21 per person in the average low-income country and $24 in the average lower-middle-income country. The essential package we describe could be a starting place for low-income and middle-income countries developing universal health coverage packages. Interventions could be rolled out as disease burden demands and budgets allow. Our outlined interventions provide a pathway for countries attempting to convert the UN Sustainable Development Goal commitments into tangible action.

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Custo-efetividade da trombólise pré-hospitalar vs intra-hospitalar no infarto agudo do miocárdio

Abstract: SummaryBackground: There is evidence that prehospital thrombolysis improves the outcome in ST-elevation myocardial infarction (STEMI).

Cited by 10 publications

References 8 publications

Primary and secondary prevention interventions for cardiovascular disease in low-income and middle-income countries: a systematic review of economic evaluations

Primary and secondary prevention interventions for cardiovascular disease in low-income and middle-income countries: a systematic review of economic evaluations

Chinese Herbal Medicines Might Improve the Long-Term Clinical Outcomes in Patients with Acute Coronary Syndrome after Percutaneous Coronary Intervention: Results of a Decision-Analytic Markov Model

Cardiovascular, respiratory, and related disorders: key messages from Disease Control Priorities, 3rd edition

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