Pcv27 Costs and Outcomes After First Heart Failure Hospital Admission: A Longitudinal Study Using Administrative Databases

Morsanutto, Andrea; Mantovani, LG; Ros, Bárbara Zas; Portu, Simona de; Spazzapan, D; Tosolini, Francesca

doi:10.1016/s1098-3015(10)67439-6

Cited by 4 publications

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“…We added h1200 patient to the tariff, an approximate evaluation of costs associated with hospitalization sequelae, including drugs, specialist visits, and examinations. This value was based on the finding of emergent costs after the first hospitalization in patients with heart failure; this study was performed by Morsanutto and colleagues [32] using a local administrative database.…”

Section: Costsmentioning

confidence: 99%

The Cost Effectiveness and Cost Utility of Valsartan in Chronic Heart Failure Therapy in Italy

Pradelli¹,

Iannazzo²,

Zaniolo³

2009

American Journal Cardiovascular Drugs

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To evaluate the cost effectiveness and cost utility of the use of valsartan in addition to standard therapy for the treatment of patients with chronic heart failure with low left ventricular ejection fraction (LVEF). The study was conducted by means of a cohort simulation based on a probabilistic Markov model and projecting the 23-month follow-up results of the Val-HeFT (Valsartan Heart Failure Trial) study over a 10-year time horizon. The model included four states (New York Heart Association [NYHA] classes II, III, IV, and death), and had a cycle duration of 1 month. Probabilistic simulations were performed using the WinBUGS software for Bayesian analysis. The distribution of patient parameters (sex, age, use of beta-adrenoceptor antagonists, and ACE inhibitors) in the simulated population were derived from the Italian heart failure patient population. Individual mortality data were derived from general mortality data by multiplying by a NYHA state-specific relative risk, while the probability of changing NYHA class was taken from the Val-HeFT data. Costs (2007 values) were calculated from the perspective of the Italian Health Service (IHS) and included costs for drugs and heart failure hospitalizations. Quality-of-life (QOL) weights were obtained by using published health-related QOL data for heart failure patients. A 3.5% annual discount rate was applied. Probabilistic sensitivity analysis was performed on each parameter using original-source 95% confidence interval (CI) values, or a +/-10% range when 95% CI values were unavailable. For the 10-year time horizon, patients were estimated to live for an average of 2.3 years or 1.7 quality-adjusted life-years (QALYs), with slight increases in the valsartan group. In this group, hospitalizations for worsening heart failure were predicted to be significantly reduced and overall treatment costs per patient to decrease by about and U20AC;550. In subgroup analyses, valsartan lost dominance in patients in NYHA II, and in those receiving beta-adrenoceptor antagonists or ACE inhibitors; the mean incremental cost-utility ratio for these groups was 21 240, 129 200, and 36 500 and U20AC;/QALY, respectively. Valsartan in addition to standard therapy is predicted to dominate standard therapy alone in Italian patients with mild to severe heart failure and low LVEF. There are relevant differences among various patient subgroups, and valsartan is expected to be good value for money particularly in the treatment of the most severe and less intensively treated (no ACE inhibitors, no beta-adrenoceptor antagonist) heart failure patients.

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Section: Costsmentioning

confidence: 99%

The Cost Effectiveness and Cost Utility of Valsartan in Chronic Heart Failure Therapy in Italy

Pradelli¹,

Iannazzo²,

Zaniolo³

2009

American Journal Cardiovascular Drugs

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“…Ai regimi senza glitazoni è stato assegnato un rischio pari a quello della popolazione diabetica in generale [28]. Il costo per scompenso cardiaco incidente è stato valorizzato pari a 5.896,54 euro [29].…”

Section: Individuazione Delle Alternative Terapeuticheunclassified

Budget impact of vildagliptin

Zaniolo

Sacchi

Pradelli

2008

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Introduction: to evaluate the impact on the Italian National Health Service (NHS) budget of the recent introduction of the DPP-4 inhibitor vildagliptin in combination treatment for NIDDM patients. Methods: NIDDM patients eligible to vildagliptin treatment were identified and quantified based on approved indications and prevalence data review; adequate alternative strategies were identified; direct medical costs associated with competing strategies were calculated according to national practice and prices (drug acquisition, therapeutic monitoring, cost for managing severe adverse events -severe hypoglycemia events, fractures, new heart failure cases) and the NHS budgetary impact was estimated according to market penetration assumptions (base-case: 5% and 10% for the first and second year, respectively). Results: patients estimated eligible for vildagliptin in Italy are about 237,500: pts inadequately controlled with metformin monotherapy (166,500), pts inadequately controlled with sulfonylurea monotherapy and intolerant/ contraindicated to metformin (70,200), and those inadequately controlled with thiazolidinedione monotherapy (800). Costing and comparing of the vildagliptin-based and competing strategies revealed differences in both directions, depending on patient subgroup. Assuming uniform penetration among identified patient subgroups, vildagliptin introduction is expected to raise NHS costs by 2,750,000 Euro in the first and by 5,500,000 Euro in the second year, respectively representing 1,6% and 3,2% of the estimated total management cost of this patient population. Conclusions: the introduction of vildagliptin in the treatment of Italian NIDDM patients offers a new therapeutic option for three inadequately controlled NIDDM subpopulations; the financial impact on Italian NHS expenditures depends on patient selection and can be expected not to exceed 2-3% of the currently dedicated budget in the first two years. . È da notare che tale valutazione si basa su una stima della prevalenza del diabete di tipo 2 pari al 3%, mentre le stime più recenti indicano valori superiori di almeno il 50%, incremento che ovviamente si riflette anche sul costo complessivo di malattia. Il CODE-2 ha rilevato che la maggioranza delle risorse economiche assorbite dalla patologia è imputabile alle cure ospedaliere, seguite da quelle ambulatoriali e infine dai farmaci; più della metà delle spese sanitarie per la popolazione diabetica riguardano i ricoveri, necessari però solo al 13% dei pazienti. Viceversa, i costi per gli ipoglicemizzanti orali non superano il 4% della spesa totale nonostante siano utilizzati da oltre il 60% dei diabetici [3]. Inoltre lo studio ha evidenziato che la maggior parte della spesa farmaceutica annua per paziente non è attribuibile ai trattamenti specifici per il diabete (ipoglicemizzanti orali e insulina), bensì ad altre cure, in particolare ai farmaci Keywords INTROduzIONEIl diabete di tipo 2 è tra le patologie croniche più diffuse nei paesi industrializzati; in Italia esso presenta una prevalen...

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“…A questo importo è stata aggiunta una stima approssimata di costi legati alle sequelae del ricovero, pari a circa € 1.200 per paziente e comprendente farmaci, visite ed esami. Questa stima è basata sulla rilevazione dei costi emergenti in pazienti con scompenso dopo una prima ospedalizzazione, eseguita da Morsanutto e colleghi [22] sulla base dei dati registrati nel database del SSR del Friuli Venezia Giulia.…”

Section: Costiunclassified

Pharmacoeconomic analysis of valsartan for the treatment of chronic congestive heart failure in Italy

Iannazzo

Pradelli

Zaniolo

2008

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Objective: to evaluate pharmacoeconomic implications of the use of valsartan, an angiotensin II antagonist in addition to standard therapy for the treatment of chronic congestive heart failure (CHF). Methods: the study was conducted performing cost-utility and budget impact (B.I.) analyses by means of a cohort simulation based on a probabilistic Markov model and projecting 23-months follow-up results in the Val-HeFT trial study over a 10-years time horizon. The model included four states (class NYHA I, II and III and death), and had a cycle of 1 year. Two probabilistic simulations (varying first patients parameters and after model parameters) were performed using WinBUGS, a software for bayesian analysis. The distributions of patients parameters (sex, age, use of ACE inhibitors) corresponding to Val-HeFT inclusion criteria in the simulated population were derived from the Italian CHF patients population. Individual mortality was derived from general mortality by adjusting with a NYHA state-specific HR, and the probability of changing NYHA class from Val-HeFT. Costs were calculated in the perspective of the Italian NHS and account for drugs and CHF hospitalizations. Quality of life weights were obtained by elaborating published HRQoL data of CHF patients. A 3.5% annual discount rate was applied; probabilistic sensitivity analysis was performed on each parameter using original-source 95% CI, or a ±10% range where it was unavailable. Results: in the 10 years horizon, patients were estimated to live an average of 4.4 years or 3.2 QALYs, with slight increases in the valsartan group. In this group, hospitalizations are predicted to be sensitively reduced and overall costs decreased by about 500 €/pz. In subgroup analysis, valsartan loses dominance in NYHAII and ACE-using patients, for which ICURs are 17,330 and 27,000 €/QALY, respectively. B.I. analysis predicts a saving of about 172 millions €. Conclusions: valsartan in addition to standard therapy is predicted to be a cost/effective strategy for Italian patients with mild-to-severe CHF and cost-saving from the perspective of the NHS.Keywords: valsartan, chronic congestive heart failure, cost-utility, budget impact, Italy Farmeconomia e percorsi terapeutici 2008; 9(3): 125-135 (vasocostrizione, ipertensione), renali (ritenzione di liquidi) e neuro-ormonali responsabile delle manifestazioni cliniche del paziente con scompenso cardiaco. Le principali linee guida per il trattamento farmacologico dello scompenso cardiaco [1][2][3] raccomandano come terapia di prima linea la somministrazione di ACE-inibitori, o di antagonisti dei recettori per l'angiotensina II nel caso in cui i primi non siano tollerati, per pazienti con LVEF (frazione di eiezione ventricolare sinistra) ridotta (< 40-45%), indipendentemente dalla presenza di sintomi. In presenza di edema polmonare o periferico è inoltre raccomandata l'associazione con terapia diuretica e l'aggiunta di betabloccante nei pazienti con scompenso sintomatico di classe NYHA (New York Heart Association) II-IV (Tabe...

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Pcv27 Costs and Outcomes After First Heart Failure Hospital Admission: A Longitudinal Study Using Administrative Databases

Cited by 4 publications

References 0 publications

The Cost Effectiveness and Cost Utility of Valsartan in Chronic Heart Failure Therapy in Italy

The Cost Effectiveness and Cost Utility of Valsartan in Chronic Heart Failure Therapy in Italy

Budget impact of vildagliptin

Pharmacoeconomic analysis of valsartan for the treatment of chronic congestive heart failure in Italy

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