AIM: To estimate the burden of failing to achieve targets for blood pressure (BP) control in France, Germany, Italy, Sweden and the UK. METHODS: A cost of illness model was constructed to estimate the impact of uncontrolled hypertension to each national healthcare system. Prevalence of uncontrolled hypertension was taken from published data. Relationships between achieved BP and the cardiovascular events of symptomatic acute myocardial infarction, congestive heart failure and stroke were estimated from the HOT study. Costs were taken from public sources. The acute medical costs of these events were estimated at current prevalence of uncontrolled hypertension and if BP were treated to target. RESULTS: The model estimated that 29 million adults in the five countries (13% population) have BP levels above 160/95 mmHg, and an additional 46 million (21% population) have BP in the range 140/90-160/95 mmHg. The model estimated that healthcare system costs of 1.26 billion euros could be avoided if hypertension management did achieve BP targets. This does not consider the cost of interventions required to reduce the risk of cardiovascular disease. CONCLUSIONS: Failing to achieve BP targets contributes substantially to healthcare system costs and preventable events in the countries studies.
OBJECTIVE: To determine the impact of overactive bladder (OAB) symptoms on issues related to employment, social interactions, and emotional well-being in a population aged 40-64 years. SUBJECTS AND METHODS: The study comprised a cross-sectional population-based survey of 11 521 individuals aged 40-64 years, conducted in France, Germany, Italy, Spain, Sweden, and the UK. The survey involved a two-stage screening procedure. Initially, individuals with any lower urinary tract symptoms were identified. Those whose only symptom/(s) was suggestive of a urinary tract infection, stress incontinence, or prostate obstruction were excluded from further study. Respondents were asked questions about the impact that their symptoms had on their emotional well-being, social interactions and productivity at home and at work. RESULTS: Of those with OAB, approximately 32% (1272) reported that having these symptoms made them feel depressed, and 28% reported feeling very stressed. There were statistically significant differences in reported feelings of stress and depression when OAB symptoms were stratified by OAB with incontinence (OAB+) vs those with OAB with no incontinence (OAB-), with values for emotional stress of OAB+ 36.4% vs OAB- 19.6%, for depression of OAB+ 39.8% vs OAB- 23.3%. Participants with OAB+ were significantly more likely than those with OAB- to express worry about having accidents and concern about participating in activities away from home because of their bladder symptoms. In addition, those with OAB+ were significantly more likely to report that these bladder symptoms were a source of great concern and made them feel uncomfortable in social situations compared to those with OAB-. Men were significantly more likely than women to report OAB+ having an impact on their daily work life, including worry about interrupting meetings, impact on decisions about work location and hours, and voluntary termination or early retirement. This effect was primarily in men reporting OAB+. CONCLUSION: OAB symptoms have a significant effect on the emotional well-being and productivity of those affected, both at home and at work.
INTRODUCTION: The objective of this analysis was to evaluate the health economic benefits of using amlodipine in patients undergoing angioplasty procedures in Canada and Norway. METHODS: A decision tree model was constructed to find the total expected cost per patient for a 4-month time period following an initial angioplasty. The model used clinical data from the Coronary Angioplasty Amlodipine Restenosis Study (CAPARES), a prospective, randomized, double blind, placebo-controlled trial conducted to investigate the effects of amlodipine on restenosis and clinical events in patients undergoing percutaneous transluminal coronary angioplasty (PTCA). Outcomes of interest to this analysis included MI, repeat PTCA, CABG, and all-cause mortality. Clinical experts from Canada and Norway were enlisted and a modified Delphi study approach was used to quantify healthcare resources consumed for each clinical outcome. RESULTS: The use of amlodipine decreased the rates of MI, PTCA, and CABG by 2.0, 4.7, and 2.7%, respectively. The total expected cost per patient using amlodipine was $6,398.30 (US$4,323) in Canada and kr 59,993.27 (US$6,846) in Norway. The total expected cost per patient not using amlodipine was $6,519.37 (US$4,405) in Canada and kr 64,292.17 (US$7,337) in Norway. The model demonstrated potential cost-savings over a 4-month follow up period resulting from the improved clinical outcomes for patients using amlodipine with PTCA--$121,071 (US$81,844) per 1000 patients in Canada and kr 4,298,899 (US$490,074) per 1000 patients in Norway. CONCLUSIONS: The adjunctive use of amlodipine is a cost-effective therapeutic strategy to achieve more favorable clinical outcomes in patients undergoing PTCAs in Canada and Norway.
To estimate symptom bother and health care seeking among individuals with overactive bladder (OAB; ie, cases) using current International Continence Society definitions.
This was a nested case-controlled analysis of data from the EPIC study, a population-based, cross-sectional survey of adults in five countries. Cases and matched controls were asked about risk factors, use of coping techniques, and health care seeking for urinary symptoms. Cases were asked about symptom bother and assessed with the Overactive Bladder-Validated 8 and Patient Perception of Bladder Condition instruments.
Among cases (n=1434), 54% reported symptom bother; rates were similar between men (54%) and women (53%). Significantly more men with urinary incontinence (UI) reported bother (77%) than women with UI (67%; p