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Comparative cost-effectiveness of anticoagulation with bivalirudin or heparin with and without a glycoprotein IIb/IIIa-receptor inhibitor in patients undergoing percutaneous coronary intervention in Sweden: a decision-analytic model.

https://arctichealth.org/en/permalink/ahliterature79202
Source
Clin Ther. 2006 Nov;28(11):1947-59
Publication Type
Article
Date
Nov-2006
Author
Borg Sixten
Persson Ulf
Allikmets Kristina
Ericsson Karin
Author Affiliation
Swedish Institute for Health Economics, Lund, Sweden.
Source
Clin Ther. 2006 Nov;28(11):1947-59
Date
Nov-2006
Language
English
Publication Type
Article
Keywords
Angioplasty, Transluminal, Percutaneous Coronary - economics
Cost-Benefit Analysis
Decision Making
Female
Hemorrhage - economics - prevention & control
Heparin - administration & dosage - economics
Hirudins - administration & dosage - economics
Humans
Ischemia - economics - prevention & control
Male
Middle Aged
Models, Theoretical
Peptide Fragments - administration & dosage - economics
Platelet Aggregation Inhibitors - administration & dosage - economics
Platelet Glycoprotein GPIIb-IIIa Complex
Prospective Studies
Randomized Controlled Trials
Recombinant Proteins - administration & dosage - economics
Sweden
Abstract
OBJECTIVE: This study modeled the comparative costs and effectiveness of anticoagulation with bivalirudin alone, heparin alone, and heparin combined with a glycoprotein IIb/IIIa-receptor inhibitor (GPI) in patients undergoing percutaneous coronary intervention (PCI) in Sweden. METHODS: GPIs are prescribed for -40% to 50% of patients undergoing PCI in Sweden. However, because treatment practices vary between hospitals, the model analyzed a cohort in which different proportions of patients (0%-100%) would receive a GPI in addition to heparin and the remaining patients would receive heparin monotherapy. This mixed cohort was compared with a cohort treated with bivalirudin. Abciximab was used as the GPI comparator, as this is the only GPI currently approved in Sweden for patients undergoing PCI. Pooled data from 3 studies (REPLACE-2 [second Randomized Evaluation of PCI Linking Angiomax to Reduced Clinical Events], ESPRIT [European/Australasian Stroke Prevention in Reversible Ischaemia Trial], and EPISTENT [Evaluation of Platelet IIb/IIIa Inhibitor for Stenting]) were used as the source for the probabilities of myocardial infarction (MI), urgent revascularization (UR), major and minor bleeding (Thrombolysis in Myocardial Infarction study definitions), and death. Treatment costs associated with these complications were obtained from 4 Swedish hospitals, and official drug prices were obtained from the Swedish Pharmacopoeia. All costs were presented in 2006 Swedish kronor (SEK). The model was evaluated over a 30-day time frame from the perspective of a Swedish hospital. The modeled patient population was 63 years old, weighed 78 kg, and was 75% male. RESULTS: Compared with a pattern in which heparin plus a GPI was used in 50% of all PCIs and heparin alone was used in the remaining 50%, bivalirudin treatment was associated with a significant reduction in all complications in the model (P
PubMed ID
17213015 View in PubMed
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Cost-effectiveness analysis of intravascular ultrasound guided percutaneous coronary intervention versus conventional percutaneous coronary intervention.

https://arctichealth.org/en/permalink/ahliterature53912
Source
Scand Cardiovasc J. 2001 Mar;35(2):80-5
Publication Type
Article
Date
Mar-2001
Author
A L Gaster
U. Slothuus
J. Larsen
P. Thayssen
T. Haghfelt
Author Affiliation
Department of Cardiology, Odense University Hospital, Denmark.
Source
Scand Cardiovasc J. 2001 Mar;35(2):80-5
Date
Mar-2001
Language
English
Publication Type
Article
Keywords
Adult
Aged
Angioplasty, Transluminal, Percutaneous Coronary - economics - methods
Comparative Study
Coronary Disease - economics - therapy
Cost-Benefit Analysis
Denmark
Direct Service Costs
Female
Follow-Up Studies
Humans
Male
Middle Aged
Reoperation
Research Support, Non-U.S. Gov't
Stents
Treatment Outcome
Ultrasonography, Interventional - economics
Abstract
OBJECTIVE: Investigation of the cost-effectiveness of intravascular ultrasound (IVUS) guided percutaneous coronary intervention (PCI) compared to PCI guided by coronary angiography (CAG). METHODS: One hundred and eight men referred for PCI, were randomized to IVUS or CAG guided PCI. After 6 months, the patients were subjected to a study related clinical and invasive follow-up investigation by CAG, IVUS and intracoronary Doppler flow measurements. Incremental costs of IVUS guided procedures and costs of re-interventions were estimated using the Activity Based Costing (ABC) method. RESULTS: Patients randomized to IVUS guided PCI experienced an improved clinical outcome, with lower angina levels than patients in the CAG guided group. The initial cost of performing IVUS guidance was increased due to extra procedure time, IVUS catheters and slightly more balloons and stents, but fewer patients in the IVUS guided group needed re-intervention. Overall, these savings outweighed the initial cost increase. CONCLUSION: Our data suggest that when performing IVUS guided PCI, costs as well as benefits increase. The increased benefits measured as cost savings resulting from less restenosis outweigh the cost increase from performing the IVUS guided PCI as opposed to CAG guided PCI.
PubMed ID
11405501 View in PubMed
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Long-term effects of integrated rehabilitation in patients with advanced angina pectoris: a nonrandomized comparative study.

https://arctichealth.org/en/permalink/ahliterature51916
Source
J Altern Complement Med. 2004 Oct;10(5):777-83
Publication Type
Article
Date
Oct-2004
Author
Soeren Ballegaard
E. Borg
B. Karpatschof
J. Nyboe
A. Johannessen
Author Affiliation
The Ballegaard Acupuncture Center, Klampenborg, Denmark. sb@drballegaard.com
Source
J Altern Complement Med. 2004 Oct;10(5):777-83
Date
Oct-2004
Language
English
Publication Type
Article
Keywords
Acupressure - economics
Acupuncture Therapy - economics
Aged
Angina Pectoris - economics - mortality - rehabilitation
Angioplasty, Transluminal, Percutaneous Coronary - economics
Combined Modality Therapy
Comparative Study
Coronary Artery Bypass - economics
Cost-Benefit Analysis
Delivery of Health Care, Integrated - economics
Denmark
Female
Humans
Life Style
Male
Medicine, Chinese Traditional - economics
Middle Aged
Research Support, Non-U.S. Gov't
Self Care - economics
Stress, Psychological - complications
Survival Rate
Abstract
OBJECTIVES: An evaluation of Integrative Rehabilitation (IR) of patients with angina pectoris with respect to death rate, the need for invasive treatment, and cost effectiveness. DESIGN: A report from a clinical database. Death rates were compared to those of the general Danish population matched for age, gender, and observation period, as well as with data from the literature concerning medical and invasive treatments. SETTING: The treatment was carried out as an ambulatory treatment in a private clinic. SUBJECTS: One hundred and sixty-eight (168) patients with angina pectoris, of whom 103 were candidates for invasive treatment and 65 for whom this had been rejected. INTERVENTIONS: Integrated rehabilitation consists of acupuncture, a self-care program including acupressure, Chinese health philosophy, stress management techniques, and lifestyle adjustments. OUTCOME MEASURES: Death rate from any cause, the need for invasive treatment, and health care expenses. RESULTS: The 3-year accumulated risk of death was 2.0% (95% confidence limits: 0.0%-4.7%) for the 103 candidates for invasive treatment, 6.4% for the general Danish population, 5.4% (4.7%-6.1%), and 8.4% (7.7%-9.1%) for patients who underwent percutaneous transluminal balloon angioplasty and coronary artery bypass grafting, respectively, in New York. For the 65 inoperable patients the risk of death due to heart disease was 7.7% (3.9%-11.5%), compared to 16% (10%-34%) and 25% (18%-36%) for American patients, who were treated with laser revascularization or medication, respectively. Of the 103 candidates for invasive treatment, only 19 (18%) still required surgery. Cost savings over 3 years were US 36,000 dollars and US 22,000 dollars for surgical and nonsurgical patients, respectively. These were mainly achieved by the reduction in the use of invasive treatment and a 95% reduction in in-hospital days. CONCLUSIONS: Integrated rehabilitation was found to be cost effective, and added years to the lives of patients with severe angina pectoris. The results invite further testing in a randomized trial.
PubMed ID
15650466 View in PubMed
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A pharmacoeconomic evaluation of results from the Coronary Angioplasty Amlodipine Restenosis Study (CAPARES) in Norway and Canada.

https://arctichealth.org/en/permalink/ahliterature53705
Source
Int J Cardiol. 2002 Jul;84(1):23-30; discussion 30-2
Publication Type
Article
Date
Jul-2002
Author
Erik Thaulow
Bjorn Jorgensen
John J Doyle
Roman Casciano
Julian Casciano
Zoe Kopp
Steve Arikian
Renee Kim
Author Affiliation
Department of Cardiology, Rikshospitalet, University of Oslo, Oslo, Norway.
Source
Int J Cardiol. 2002 Jul;84(1):23-30; discussion 30-2
Date
Jul-2002
Language
English
Publication Type
Article
Keywords
Amlodipine - economics - therapeutic use
Angioplasty, Transluminal, Percutaneous Coronary - economics
Calcium Channel Blockers - economics - therapeutic use
Canada
Coronary Artery Bypass - economics
Coronary Restenosis - economics - prevention & control
Cost Control
Decision Trees
Double-Blind Method
Drug Costs
Economics, Pharmaceutical
Humans
Norway
Prospective Studies
Research Support, Non-U.S. Gov't
Treatment Outcome
Abstract
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.
PubMed ID
12104059 View in PubMed
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Variations in hospitalisation costs for acute myocardial infarction - a comparison across Europe.

https://arctichealth.org/en/permalink/ahliterature86772
Source
Health Econ. 2008 Jan;17(1 Suppl):S33-45
Publication Type
Article
Date
Jan-2008
Author
Tiemann Oliver
Author Affiliation
Department of Health Care Management, Berlin University of Technology, Germany. oliver.tiemann@tu-berlin.de
Source
Health Econ. 2008 Jan;17(1 Suppl):S33-45
Date
Jan-2008
Language
English
Publication Type
Article
Keywords
Analysis of Variance
Angioplasty, Transluminal, Percutaneous Coronary - economics - utilization
Cross-Cultural Comparison
Europe
European Union - economics
Hospital Costs
Humans
Insurance, Health, Reimbursement - economics
Male
Middle Aged
Myocardial Infarction - economics - therapy
Regression Analysis
Stents - economics - utilization
Abstract
The aim of this study was to determine whether between-country variations in hospital costs are larger than within-country variations and, furthermore, to explore reasons for this variability. For this purpose, we chose the primary treatment of patients with acute myocardial infarction (AMI) as an episode of care. We obtained hospitalisation costs and reimbursement rates from 45 hospitals in nine different EU member states (i.e. Denmark, England, France, Germany, Hungary, Italy, Netherlands, Poland, and Spain) for the year 2005. To further analyse the variations in hospital costs, we employed a hierarchical random effects model based on treatment and hospital characteristics and using purchasing power parities (PPPs) as a proxy for country-specific price levels. The between-country standard error was estimated at 2473 euros, whereas the within-country standard error was estimated at 1242 euros. Our regression analysis showed that percutaneous coronary intervention was associated with significantly increased hospitals costs compared to other treatment strategies. We were able to distinguish between three groups of countries with different cost levels based on the number of hospitals that were able to provide these services (i.e. percutaneous transluminal coronary angioplasty (PTCA) with intracoronary stenting). Excluding Hungary, Poland, and Spain, where none of the participating hospitals were able to provide these procedures, the between-country standard error decreased to 1632 euros, whereas the within-country standard error increased to 1416 euros. Finally, we observed exogenous price-level effects between countries and within countries for hospitals located in urban areas.
PubMed ID
18186036 View in PubMed
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