NHG-Standaard Perifeer arterieel vaatlijden

Bartelink, M L; Stoffers, H E J H; Boutens, E J; Hooi, J D; Kaiser, V; Boomsma, L J

doi:10.1007/978-90-313-6614-9_11

Cited by 6 publications

(9 citation statements)

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“…1,2 Based on drug and healthcare costs, the average annual incremental healthcare expenditure with DPI versus aspirin was estimated, considering 26% of 730,000 Dutch CAD, and 40% of 569,000 PAD patients eligible. 5,38,39 Validation. In line with the AdViSHE tool, 40 the conceptual model and model inputs were validated against clinical expert opinion and the literature.…”

Section: Resource Use and Costsmentioning

confidence: 99%

Rivaroxaban plus aspirin for the prevention of ischaemic events in patients with cardiovascular disease: a cost-effectiveness study

Petersohn

Pouwels

Ramaekers

et al. 2020

European Journal of Preventive Cardiology

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Background Dual pathway inhibition with 2.5 mg rivaroxaban twice daily plus 100 mg aspirin once daily may be a promising alternative to 100 mg aspirin antiplatelet therapy for the prevention of cardiovascular events in patients with coronary artery disease and/or peripheral arterial disease. However, treatment costs and bleeding risks are higher, and there is another treatment option for peripheral arterial disease, 75 mg clopidogrel. A comprehensive assessment of benefits, risks and costs of dual pathway inhibition versus standard of care is needed. Methods We used a state transition model including cardiovascular, ischaemic limb and bleeding events to compare dual pathway inhibition to aspirin antiplatelet therapy in coronary artery disease, and additionally to clopidogrel antiplatelet therapy in peripheral arterial disease patients. We calculated the incremental cost-effectiveness ratio from costs and quality-adjusted life-years of lifelong treatment, and the cost-effectiveness probability at a €50,000/quality-adjusted life-year threshold. Results Quality-adjusted life-years and costs of dual pathway inhibition were highest, the incremental cost-effectiveness ratios versus aspirin were €32,109 in coronary artery disease and €26,381 in peripheral arterial disease patients, with 92% and 56% cost-effectiveness probability, respectively (clopidogrel was extendedly dominated). Incremental cost-effectiveness ratios were below €20,000 in comorbid peripheral arterial disease patients and coronary artery disease patients younger than 65 years, incremental cost-effectiveness ratios were above €50,000 in carotid artery disease patients and coronary artery disease patients older than 75 years. Conclusion Lifelong preventive treatment of coronary artery disease and peripheral arterial disease patients at risk of cardiovascular events with dual pathway inhibition improves health outcomes and seems overall cost-effective relative to aspirin antiplatelet therapy and also to clopidogrel antiplatelet therapy for peripheral arterial disease, particularly in comorbid patients, but not in older patients and in carotid artery disease patients. These findings may warrant a targeted approach.

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Section: Resource Use and Costsmentioning

confidence: 99%

Rivaroxaban plus aspirin for the prevention of ischaemic events in patients with cardiovascular disease: a cost-effectiveness study

Petersohn

Pouwels

Ramaekers

et al. 2020

European Journal of Preventive Cardiology

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“…The Dutch GP guideline advises aspirin in addition to supervised walking therapy for all patients with PAD. 5 GPs might consider walking therapy as the first step for treating patients presenting with mild asymptomatic PAD. Nevertheless, our results do not reflect this.…”

Section: Discussionmentioning

confidence: 99%

“…The observed treatment strategies were compared with Dutch GP guidelines, 5 the 2005 American College of Cardiology Foundation/American Heart Association guidelines for the management of patients with PAD and its update, 6 9 the 2007 Inter-Society Consensus for the management of PAD (TASC II) guideline and the 2011 European Society of Cardiology (ESC) Guidelines on the diagnosis and treatment of PAD ( table 1 ). 7 8 These guidelines discuss various treatment strategies for PAD.…”

Section: Methodsmentioning

confidence: 99%

“…Guidelines all recommend APT to reduce the risk of future thromboembolic complications and CVE. [5][6][7][8][9] Low-dose aspirin monotherapy (50-325 mg daily) lowers the risk of secondary CVE (defined as non-fatal myocardial infarctions, non-fatal strokes or vascular deaths) with 23%. 14 The CAPRIE trial found that the P2Y12 inhibitor clopidogrel had an additional risk reduction of 8.7% over aspirin (95% CI 0.3% to 16.5%).…”

Section: Open Accessmentioning

confidence: 99%

“…Guidelines define IC through a combination of clinical symptoms and an ankle-brachial index ≤0.9. [5][6][7][8][9] The end-stage of PAD, critical limb ischaemia (CLI), is characterised by severe resting pain, ulceration and tissue loss. These are all stages within the progression of PAD.…”

Section: Introductionmentioning

confidence: 99%

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Platelet aggregation inhibitor prescription for newly diagnosed peripheral arterial disease in the Netherlands: a cohort study

et al. 2021

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ObjectivesPharmacological treatment of peripheral arterial disease (PAD) comprises of antiplatelet therapy (APT), blood pressure control and cholesterol optimisation. Guidelines provide class-I recommendations on the prescription, but there are little data on the actual prescription practices. Our study provides insight into the prescription of medication among patients with PAD in the Netherlands and reports a ‘real-world’ patient journey through primary and secondary care.DesignWe conducted a cohort study among patients newly diagnosed with PAD between 2010 and 2014.SettingData were obtained from the PHARMO Database Network, a population-based network of electronic pharmacy, primary and secondary healthcare setting records in the Netherlands. The source population for this study comprised almost 1 million individuals.Participants‘Newly diagnosed’ was defined as a recorded International Classification of Primary Care code for PAD, a PAD-specific WCIA examination code or a diagnosis recorded as free text episode in the general practitioner records with no previous PAD diagnosis record and no prescription of P2Y12 inhibitors or aspirin the preceding year. The patient journey was defined by at least 1 year of database history and follow-up relative to the index date.ResultsBetween 2010 and 2014, we identified 3677 newly diagnosed patients with PAD. Most patients (91%) were diagnosed in primary care. Almost half of all patients (49%) had no APT dispensing record. Within this group, 33% received other anticoagulant therapy (vitamin K antagonist or direct oral anticoagulant). Mono-APT was dispensed as aspirin (40% of patients) or P2Y12 inhibitors (2.5% of patients). Dual APT combining aspirin with a P2Y12 inhibitor was dispensed to 8.5% of the study population.ConclusionHalf of all patients with newly diagnosed PAD are not treated conforming to (international) guideline recommendations on thromboembolism prevention through APT. At least 33% of all patients with newly diagnosed PAD do not receive any antithrombotic therapy. Evaluation and improvement of APT prescription and thereby improved prevention of (secondary) cardiovascular events is warranted.

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NHG-Standaard Perifeer arterieel vaatlijden

Cited by 6 publications

References 0 publications

Rivaroxaban plus aspirin for the prevention of ischaemic events in patients with cardiovascular disease: a cost-effectiveness study

Rivaroxaban plus aspirin for the prevention of ischaemic events in patients with cardiovascular disease: a cost-effectiveness study

Platelet aggregation inhibitor prescription for newly diagnosed peripheral arterial disease in the Netherlands: a cohort study

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