Expert panel on cost analysis of atrial fibrillation

Fak, Ali Serdar; Küçükoğlu, Mehmet Serdar; Fak, Nazire Afşar; Demir, Mesut; Ağır, Ayşen; Demirtaş, Mustafa; Köse, Sedat; Özdemir, Murat

doi:10.5152/akd.2013.004

Cited by 6 publications

(15 citation statements)

References 17 publications

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“…They calculated the daily cost of HF patients as 258 TL and the total cost per admission as 2351 TL (14). These findings were very similar to a recent data based on expert panel views conducted in Turkey by Fak et al (15), where cost for HF was reported as 2435 TL per patient. When all these observations are taken into account, an up-to-date documentation of the cost of HF management considering both in-patient and out-patient source utilization in Turkey may help to demonstrate the economic burden of HF in actual clinical practice in Turkey.…”

Section: Introductionsupporting

confidence: 92%

“…A cost analysis study by Fak et al (15) was based on identification of total costs related to management of acute coronary syndrome, HF, stroke, and the drug related adverse events in patients with atrial fibrillation, the average total cost of HF was reported as 4,524 TL (2,436 TL within the first month and 2,088 TL within a year excluding the first month) according to experts’ view. In our analysis, the total annual cost of HF management was found to be 1,537 TL.…”

Section: Discussionmentioning

confidence: 99%

“…The retrospective cost-of-illness study conducted in a university hospital setting in Turkey in 2008 by Sözmen et al (14) calculated the total cost of HF patients per admission as 2351 TL. The recent data based on expert panel views by Fak et al (15), reported the cost for HF as 2435 TL per patient.…”

Section: Discussionmentioning

confidence: 99%

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Cost of heart failure management in Turkey: results of a Delphi Panel

et al. 2016

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Objective:To analyze health-related cost of heart failure (HF) and to evaluate health-related source utilization aiming to provide data on the economic burden of HF in actual clinical practice in Turkey.Methods:The study used the Delphi process of seeking expert consensus of opinion including 11 cardiologists who are experienced in HF. The standardized questionnaire comprised items to reflect the opinion of the expert panelists on the distribution of the HF patients in terms of demographic and clinical characteristics and background disease states. Costs related to out-patient follow-up, in-patient follow-up, medications, and other therapies were also evaluated.Results:34.1% of the HF patients were in the age range of 60–69 years, and 62.3% were males. Coronary heart disease was the leading cause of HF (59.6%); 63.6% of the HF patients had reduced ejection fraction (rEF) and 42.3% were in New York Heart Association (NYHA)-II class. Approximately 75 % of the patients were followed up by a cardiology unit. The total annual visit number was estimated as 3.41. Approximately 32% of HF patients were hospitalized 1.64 times a year, for an average of 6.77 days each time. The total annual costs of all HF patients and HF-rEF patients were estimated as 1.537 TL and as 2.141 TL, respectively.Conclusion:The analysis demonstrating the magnitude of the economic impact of HF management on Turkey’s healthcare system may help facilitate health and social policy interventions to improve the prevention and treatment of HF. (Anatol J Cardiol 2016; 16: 554-62)

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Section: Introductionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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Cost of heart failure management in Turkey: results of a Delphi Panel

et al. 2016

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“…In other countries, earlier studies have determined the treatment costs of CVDs, but they did not compare patient subgroups and included only a limited number of determinants for costs (10, 11). Therefore, this study aimed to determine the degree of association of costs for acute myocardial infarction, heart failure, and angina pectoris in a university hospital setting.…”

Section: Introductionmentioning

confidence: 99%

Determinants of inpatient costs of angina pectoris, myocardial infarction, and heart failure in a university hospital setting in Turkey

Sözmen¹,

Pekel²,

Yilmaz³

et al. 2015

Anatol J Cardiol

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Objective:This study aimed to determine the correlates of in-hospital costs for angina pectoris (AP), myocardial infarction (MI), and heart failure (HF) in a university hospital setting.Methods:This is a retrospective cost-of-illness study using data from the records of patients who were admitted with AP, MI, or HF to Dokuz Eylül University Hospital during 2008. Direct medical costs were calculated from the Social Security Institute perspective using a bottom-up approach. Socio-demographic and clinical information was abstracted from patient files. Costs were presented in Turkish lira (TL). A generalized linear model was used in the multivariate analysis.Results:We included 337 in-patients in total in the study. AP was present in 26.4% (n=89), MI was present in 55.8% (n=188), and HF was present in 17.8% (n=60) of patients. MI was the most costly disease (2760 TL), followed by HF (2350 TL) and AP (1881 TL). The largest proportion of the total cost was formed by medical interventions (27.5%), followed by surgery (22.2%). Presence of DM, smoking, diagnosis of MI, HF, need for intensive care, and resulting in death were strong predictors of treatment costs.Conclusion:Both preadmission characteristics of patients (diabetes mellitus, smoking, use of anti-aggregant before admission) and in-patient characteristics (diagnosis, coronary artery bypass grafting, intensive care need, death) predicted the hospital cost of cardiovascular diseases (CVDs) independently. Our results may be used as input for health-economic models and economic evaluations to support the decision-making of reimbursement and the cost-effectiveness of public health interventions in healthcare.

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“…This identified 261 records, of which eight papers [99][100][101][102][103][104][105][106] not previously identified were considered relevant after title and abstract screening and a further four papers [107][108][109][110] were highlighted as providing information on costs.…”

Section: Outcomes Of the Economic Evaluationmentioning

confidence: 99%

Screening strategies for atrial fibrillation: a systematic review and cost-effectiveness analysis

Welton

McAleenan

Thom

et al. 2017

Health Technol Assess

118

122

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BackgroundAtrial fibrillation (AF) is a common cardiac arrhythmia that increases the risk of thromboembolic events. Anticoagulation therapy to prevent AF-related stroke has been shown to be cost-effective. A national screening programme for AF may prevent AF-related events, but would involve a substantial investment of NHS resources.ObjectivesTo conduct a systematic review of the diagnostic test accuracy (DTA) of screening tests for AF, update a systematic review of comparative studies evaluating screening strategies for AF, develop an economic model to compare the cost-effectiveness of different screening strategies and review observational studies of AF screening to provide inputs to the model.DesignSystematic review, meta-analysis and cost-effectiveness analysis.SettingPrimary care.ParticipantsAdults.InterventionScreening strategies, defined by screening test, age at initial and final screens, screening interval and format of screening {systematic opportunistic screening [individuals offered screening if they consult with their general practitioner (GP)] or systematic population screening (when all eligible individuals are invited to screening)}.Main outcome measuresSensitivity, specificity and diagnostic odds ratios; the odds ratio of detecting new AF cases compared with no screening; and the mean incremental net benefit compared with no screening.Review methodsTwo reviewers screened the search results, extracted data and assessed the risk of bias. A DTA meta-analysis was perfomed, and a decision tree and Markov model was used to evaluate the cost-effectiveness of the screening strategies.ResultsDiagnostic test accuracy depended on the screening test and how it was interpreted. In general, the screening tests identified in our review had high sensitivity (> 0.9). Systematic population and systematic opportunistic screening strategies were found to be similarly effective, with an estimated 170 individuals needed to be screened to detect one additional AF case compared with no screening. Systematic opportunistic screening was more likely to be cost-effective than systematic population screening, as long as the uptake of opportunistic screening observed in randomised controlled trials translates to practice. Modified blood pressure monitors, photoplethysmography or nurse pulse palpation were more likely to be cost-effective than other screening tests. A screening strategy with an initial screening age of 65 years and repeated screens every 5 years until age 80 years was likely to be cost-effective, provided that compliance with treatment does not decline with increasing age.ConclusionsA national screening programme for AF is likely to represent a cost-effective use of resources. Systematic opportunistic screening is more likely to be cost-effective than systematic population screening. Nurse pulse palpation or modified blood pressure monitors would be appropriate screening tests, with confirmation by diagnostic 12-lead electrocardiography interpreted by a trained GP, with referral to a specialist in the case of an unclear diagnosis. Implementation strategies to operationalise uptake of systematic opportunistic screening in primary care should accompany any screening recommendations.LimitationsMany inputs for the economic model relied on a single trial [the Screening for Atrial Fibrillation in the Elderly (SAFE) study] and DTA results were based on a few studies at high risk of bias/of low applicability.Future workComparative studies measuring long-term outcomes of screening strategies and DTA studies for new, emerging technologies and to replicate the results for photoplethysmography and GP interpretation of 12-lead electrocardiography in a screening population.Study registrationThis study is registered as PROSPERO CRD42014013739.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Expert panel on cost analysis of atrial fibrillation

Cited by 6 publications

References 17 publications

Cost of heart failure management in Turkey: results of a Delphi Panel

Cost of heart failure management in Turkey: results of a Delphi Panel

Determinants of inpatient costs of angina pectoris, myocardial infarction, and heart failure in a university hospital setting in Turkey

Screening strategies for atrial fibrillation: a systematic review and cost-effectiveness analysis

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