Lifetime Of Patient Research Articles

Análisis coste-utilidad de apixabán frente al ácido acetilsalicílico en la prevención del ictus en pacientes con fibrilación auricular no valvular en España

ObjectiveTo assess the cost-effectiveness of apixaban versus acetylsalicylic acid (ASA) in stroke prevention in patients with non-valvular atrial fibrillation (NVAF) with contraindications of vitamin K antagonists in Spain. MethodsA Markov model was adapted, simulating the patient's lifetime. The safety and efficacy of the drugs were obtained from AVERROES clinical trial. The analysis was done from the Spanish National Health System (NHS) and societal perspective. The cost of drugs was calculated according to the recommended doses. The cost of NVAF complications and disease management was obtained from Spanish sources. ResultsIn a cohort of 1,000 patients with NVAF, during their lifetime numerous complications could be avoided with apixaban versus ASA (48 ischemic strokes, 10 systemic embolism and 53 related deaths). In each patient treated with apixaban more life-years (0.303 LYG) and more quality-adjusted life-years (0.277 QALYs) could be gained. Apixaban would generate more costs per patient for the NHS (€1,742 per patient) but savings would result from the social perspective (€2,887 saved per patient). The cost per LYG and QALY gained would be of €5,749 and €6,289 for the NHS. Apixaban would be dominant (more effective with less costs than ASA) from the societal perspective. The results were stable in both deterministic and probabilistic sensitivity analyses. ConclusionsAccording to this model, when costs and estimated lifetime outcomes achieved with apixaban are compared with those of ASA, apixaban was assessed to be a cost-effective treatment for the prevention of stroke in patients with NVAF in Spain.

Sequencing of treatments in metastatic CRPC for patients who have completed all therapeutic interventions.

339 Background: The current treatment paradigm for metastatic, castrate-resistant prostate cancer (mCRPC) has rapidly changed and six therapies [abiraterone (Abi), enzalutamide (Enza), docetaxel (Doc), cabazitaxel (Cab), radium-223 (Ra-223), and sipuleucel-T (Sip-T)] have now been proven to prolong overall survival. Though sequential therapy is the norm, few studies have reported on the variety and prevalence of these agents over the course of patient's lifetime. Herein, we sought to describe the temporal frequencies of mCRPC therapies in patients who completed all of their therapies. Methods: Retrospective chart reviews were conducted on 119 patients who died from mCRPC at Tulane Cancer Center from 2008-2015 (thus completing all possible therapies). Many patients were not treated with multiple life-prolonging therapies given the timing of their death. Post-mCRPC therapies were longitudinally sequenced and a frequency table was generated for first, second, third, etc. line of therapies. Results: Median duration from initial androgen deprivation therapy to mCRPC was 29 months (range: 0-252) and 34.4% of the cohort presented with distant metastatic disease (M1) at diagnosis. The most common front line mCRPC therapies were nilutamide, Doc, Abi, and ketoconazole (Keto) in that order. Keto, Doc, dexamethasone, and Abi were the most common second line therapies. Abi, Doc, DES, and Cab were the most prevalent third line therapies. Doc, Abi, Cab, and Ra-223 were most common fourth line therapies. The median overall survival for our cohort was 69 months (range: 5-270 months) from initial diagnosis. Conclusions: This retrospective analysis provides a temporal snapshot of the timing and frequency of treatments for men dying from mCRPC from 2008-2015. More recent patients are likely to have greater access to contemporary therapies.

Role of imaging in the evaluation of inflammatory bowel disease: How much is too much?

Inflammatory bowel disease (IBD) is a lifelong condition with waxing and waning disease course that requires reassessment of disease status as well as screening for complications throughout a patient's lifetime. Laboratory testing, endoscopic assessment, and fecal biomarkers are often used in the initial diagnosis and ongoing monitoring of a patient with IBD. Imaging plays an integral role in the diagnosis and evaluation of IBD. Different imaging modalities can be used over the course of a patient's lifetime, from the initial screening and diagnosis of IBD, to determining the extent of intestinal involvement, monitoring for disease activity, and evaluating for complications of uncontrolled IBD. The various imaging modalities available to the provider each have a unique set of risks and benefits when considering cost, radiation exposure, need for anesthesia, and image quality. In this article we review the imaging techniques available for the evaluation of IBD including fluoroscopic small bowel follow-through, computed tomography enterography, magnetic resonance enterography, and transabdominal ultrasound with particular focus on the judicious use of imaging and the risks and benefits of each option. We also review the risks of ionizing radiation, strategies to reduce exposure to ionizing radiation, and current imaging guidelines among pediatric and adult patient with IBD.

Prospective Analysis of the Relationship Between the State of Periodontal Tissues and Changes in Selected Cardiovascular Parameters in Patients with Type 2 Diabetes.

Periodontitis is considered a risk factor in many systemic diseases, including cardiovascular pathologies and diabetes. Diabetes can also exacerbate early vascular changes, mainly due to the synthesis of advanced glycosylation end-products and oxidative stress. It has not yet been fully explained whether the additional presence of periodontal disease can affect the course of atherosclerosis and left ventricle hypertrophy in diabetic patients. The aim of the study was to assess the relationship between periodontal and cardiovascular diseases and their progression in patients with type 2 diabetes. The study included 119 patients diagnosed with type 2 diabetes. Periodontal pocket depth (PD), clinical attachment loss (CAL), plaque index (PI) and bleeding index (BOP) were determined. Basic laboratory tests were performed. The intima-media thickness (IMT) and the left ventricular mass index (LVMI) were determined by means of ultrasonography. After one year the examinations were repeated. The statistical analysis included the 84 patients who took part in both the first and second examinations. A positive correlation between the number of deep and active periodontal pockets and LVMI value was observed in men. The IMT value correlated with the mean CAL, PI and BOP, while a negative correlation was found between the IMT and the number of deep pockets, as well as between the IMT and the number of retained teeth. A multivariate analysis demonstrated a significant correlation between CAL and both IMT and LVMI change after one year. A relationship between periodontitis and cardiovascular diseases has been confirmed in diabetic patients. The most significant periodontal parameter in relation to the progression of atherosclerosis and left ventricle hypertrophy was shown to be clinical attachment loss - a measure of the history of periodontal disease during the patient's lifetime.

Overview of current surgical strategies for aortic disease in patients with Marfan syndrome.

Marfan syndrome is a heritable, systemic disorder of the connective tissue with a high penetrance, named after Dr. Antoine Marfan. The most clinically important manifestations of this syndrome are cardiovascular pathologies which cause life-threatening events, such as acute aortic dissections, aortic rupture and regurgitation of the aortic valve or other artrioventricular valves leading to heart failure. These events play important roles in the life expectancy of patients with this disorder, especially prior to the development of effective surgical approaches for proximal ascending aortic disease. To prevent such catastrophic aortic events, a lower threshold has been recommended for prophylactic interventions on the aortic root. After prophylactic root replacement, disease in the aorta beyond the root and distal to the arch remains a cause for concern. Multiple surgeries are required throughout a patient's lifetime that can be problematic due to distal lesions complicated by dissection. Many controversies in surgical strategies remain, such as endovascular repair, to manage such complex cases. This review examines the trends in surgical strategies for the treatment of cardiovascular disease in patients with Marfan syndrome, and current perspectives in this field.

Decision analytic cost-effectiveness model to compare prostate cryotherapy to androgen deprivation therapy for treatment of radiation recurrent prostate cancer

ObjectiveTo determine the cost-effectiveness of salvage cryotherapy (SC) in men with radiation recurrent prostate cancer (RRPC).DesignCost-utility analysis using decision analytic modelling by a Markov model.Setting and methodsCompared SC and androgen...

Pathogenesis of Gastric Cancer.

Gastric cancer (GC) is the fifth most common malignancy and the third leading cause of cancer-related death worldwide. GC is a heterogeneous disease and the endpoint of a long multistep process largely influenced by Helicobacter pylori infection, genetic susceptibility, and environmental factors. In a subset of GC cases, infection with the Epstein-Barr virus (EBV) may also be involved. The development of GC is the consequence of the accumulation of multiple epi/genetic changes during the patient's lifetime that will result in oncogenic activation and/or tumor suppressor pathways' inactivation. This review will focus on the most recent updates on the characterization of the molecular phenotypes of sporadic and hereditary GC. This article will also update the most recent findings on the relationship between H.pylori infection and stem cells at the origin of GC. The understanding of the molecular genetics underlying gastric carcinogenesis is of paramount importance to identify novel potential targets for the development of screening and prognostic markers that can be clinically valuable for the management of GC patients and for the design of clinical trials.

Diagnosis and treatment of patients with bipolar disorder: A review for advanced practice nurses.

PurposeThis review article provides an overview of the frequency, burden of illness, diagnosis, and treatment of bipolar disorder (BD) from the perspective of the advanced practice nurses (APNs).Data sourcesPubMed searches were conducted using the following keywords: “bipolar disorder and primary care,” restricted to dates 2000 to present; “bipolar disorder and nurse practitioner”; and “bipolar disorder and clinical nurse specialist.” Selected articles were relevant to adult outpatient care in the United States, with a prioritization of articles written by APNs or published in nursing journals.ConclusionsBD has a substantial lifetime prevalence in the population at 4%. Because the manic or depressive symptoms of BD tend to be severe and recurrent over a patient's lifetime, the condition is associated with significant burden to the individual, caregivers, and society. Clinician awareness that BD may be present increases the likelihood of successful recognition and appropriate treatment. A number of pharmacological and nonpharmacological treatments are available for acute and maintenance treatments, with the prospect of achieving reduced symptom burden and increased functioning for many patients.Implications for practiceAwareness of the disease burden, diagnostic issues, and management choices in BD has the potential to enhance outcome in substantial proportions of patients.

Irreversible electroporation of stage 3 locally advanced pancreatic cancer: optimal technique and outcomes.

Irreversible electroporation (IRE) of stage 3 pancreatic adenocarcinoma has been used to provide quality of life time in patients who have undergone appropriate induction therapy. The optimal technique has been reported within the literature, but not in video form. IRE of locally advanced pancreatic cancer is technically demanding requiring precision ultrasound use for continuous imaging in multiple needle placements and during IRE energy delivery. Appropriate patients with locally advanced pancreatic cancer should have undergone appropriate induction chemotherapy for a reasonable duration. The safe and effective technique for irreversible electroporation is preformed through an open approach with the emphasis on intra-operative ultrasound and intra-operative electroporation management. The technique of open irreversible electroporation of the pancreas involves bracketing the target tumor with IRE probes and any and all invaded vital structures including the celiac axis, superior mesenteric artery (SMA), superior mesenteric-portal vein, and bile duct with continuous intraoperative ultrasound imaging through a caudal to cranial approach. Optimal IRE delivery requires a change in amperage of at least 12 amps from baseline tissue conductivity in order to achieve technical success. Multiple pull-backs are necessary since the IRE ablation probe lengths are 1 cm and thus needed to achieve technical success along the caudal to cranial plane. Irreversible electroporation in combination with multi-modality therapy for locally advanced pancreatic carcinoma is feasible for appropriate patients with locally advanced cancer. Technical demands are high and require the highest quality ultrasound for precise spacing measurements and optimal delivery to ensure adequate change in tissue resistance.

SU‐E‐T‐542: Measurement of Internal Neutrons for Uniform Scanning Proton Beams

Purpose:In proton radiotherapy, the production of neutrons is a wellknown problem since neutron exposure can lead to increased risk of secondary cancers later in the patient's lifetime. The assessment of neutron exposure is, therefore, important for the overall quality of proton radiotherapy. This study investigates the secondary neutrons created inside the patient from uniform scanning proton beams.Methods:Dose equivalent due to secondary neutrons was measured outside the primary field as a function of distance from beam isocenter at three different angles, 45, 90 and 135 degree, relative to beam axis. Plastic track nuclear detector (CR‐39 PNTD) was used for the measurement of neutron dose. Two experimental configurations, in‐air and cylindrical‐phantom, were designed. In a cylindrical‐phantom configuration, a cylindrical phantom of 5.5 cm diameter and 35 cm long was placed along the beam direction and in an in‐air configuration, no phantom was used. All the detectors were placed at nearly identical locations in both configurations. Three proton beams of range 5 cm, 18 cm, and 32 cm with 4 cm modulation width and a 5 cm diameter aperture were used. The contribution from internal neutrons was estimated from the differences in measured dose equivalent between in‐air and cylindrical‐phantom configurations at respective locations.Results:The measured ratio of neutron dose equivalent to the primary proton dose (H/D) dropped off with distance and ranged from 27 to 0.3 mSv/Gy. The contribution of internal neutrons near the treatment field edge was found to be up to 64 % of the total neutron exposure. As the distance from the field edge became larger, the external neutrons from the nozzle appear to dominate and the internal neutrons became less prominent.Conclusion:This study suggests that the contribution of internal neutrons could be significant to the total neutron dose equivalent.

Management of brain arteriovenous malformations.

Arteriovenous malformations (AVMs) pose a risk of morbidity and mortality throughout an affected patient's lifetime. Over the course of a patient's life, the risk of hemorrhage is approximately 1-4% per year, and after an initial hemorrhage occurs, this risk may be higher. Other causes of morbidity include seizures, headaches, or progressive neurologic deficits. Once an AVM has been discovered, the utility of attempted obliteration or surgical resection compared to the risk of intervention should be entertained. The characteristics of the malformation as well as the patient's overall health status contribute to the decision to intervene on these lesions. For small lesions located in superficial areas without high-risk surgical characteristics (low-grade Spetzler-Martin grades), it is reasonable to consider surgical resection. In lesions that pose high-risk of complications from surgical removal, intra-arterial embolization, radiosurgery, or a combination of the two may be reasonable treatment options. Some AVMs at traditional high surgical risk may be amenable to partial embolization, allowing initially high-risk lesions to become better candidates for surgical resection. In some patients, particularly those who are older or who have multiple medical comorbidities, the risk of intervention as compared to the annual hemorrhage risk may warrant conservative management as opposed to intervention. The overall treatment strategy must be based on patient and AVM characteristics and careful risk-benefit ratio analysis.

Cost-effectiveness of one-time genetic testing to minimize lifetime adverse drug reactions.

We evaluated the cost-effectiveness of one-time pharmacogenomic testing for preventing adverse drug reactions (ADRs) over a patient's lifetime. We developed a Markov-based Monte Carlo microsimulation model to represent the ADR events in the lifetime of each patient. The base-case considered a 40-year-old patient. We measured health outcomes in life years (LYs) and quality-adjusted LYs (QALYs) and estimated costs using 2013 US$. In the base-case, one-time genetic testing had an incremental cost-effectiveness ratio (ICER) of $43,165 (95% confidence interval (CI) is ($42,769,$43,561)) per additional LY and $53,680 per additional QALY (95% CI is ($53,182,$54,179)), hence under the base-case one-time genetic testing is cost-effective. The ICER values were most sensitive to the average probability of death due to ADR, reduction in ADR rate due to genetic testing, mean ADR rate and cost of genetic testing.

Long-Term Cost-Effectiveness of Upper Airway Stimulation for the Treatment of Obstructive Sleep Apnea: A Model-Based Projection Based on the STAR Trial.

Upper airway stimulation (UAS) is a new approach to treat moderate-to-severe obstructive sleep apnea. Recently, 12-month data from the Stimulation Treatment for Apnea Reduction (STAR) trial were reported, evaluating the effectiveness of UAS in patients intolerant or non-adherent to continuous positive airway pressure therapy. Our objective was to assess the cost-effectiveness of UAS from a U.S. payer perspective. A 5-state Markov model was used to predict cardiovascular endpoints (myocardial infarction [MI], stroke, hypertension), motor vehicle collisions (MVC), mortality, quality-adjusted life years (QALYs), and costs. We computed 10-year relative event risks and the lifetime incremental cost-effectiveness ratio (ICER) in $/QALY, comparing UAS therapy to no treatment under the assumption that the STAR trial-observed reduction in mean apnea-hypopnea index from 32.0 to 15.3 events/h was maintained. Costs and effects were discounted at 3% per year. U.S. healthcare system; third-party payer perspective. 83% male cohort with mean age of 54.5 years. UAS vs. no treatment. UAS substantially reduced event probabilities over 10 years (relative risks: MI 0.63; stroke 0.75; MVC 0.34), and was projected to add 1.09 QALYs over the patient's lifetime. Costs were estimated to increase by $42,953, resulting in a lifetime ICER of $39,471/QALY. Relative to the acknowledged willingness-to-pay threshold of $50,000-$100,000/QALY, our results indicate upper airway stimulation is a cost-effective therapy in the U.S. healthcare system.

Cost-effectiveness of quantitative pretest probability intended to reduce unnecessary medical radiation exposure in emergency department patients with chest pain and dyspnea.

Quantitative pretest probability (qPTP) incorporated into a decision support tool with advice can reduce unnecessary diagnostic testing among patients with symptoms suggestive of acute coronary syndrome (ACS) and pulmonary embolism (PE), reducing 30-day costs without an increase in 90-day adverse outcomes. This study estimates long-term (beyond 90-day) costs and outcomes associated with qPTP. The authors hypothesized that qPTP reduces lifetime costs and improves outcomes in low-risk patients with symptoms suggestive of ACS and PE. This was a cost-effectiveness analysis of a multicenter, randomized controlled trial of adult emergency patients with dyspnea and chest pain, in which a clinician encountering a low-risk patient with symptoms suggestive of ACS or PE conducted either the intervention (qPTP for ACS and PE with advice) or the sham (no qPTP and no advice). Effect of the intervention over a patient's lifetime was assessed using a Markov microsimulation model. Short-term costs and outcomes were from the trial; long-term outcomes and costs were from the literature. Outcomes included lifetime transition to PE, ACS, and intracranial hemorrhage (ICH); mortality from cancer, ICH, PE, ACS, renal failure, and ischemic stroke; quality-adjusted life-years (QALYs); and total medical costs compared between simulated intervention and sham groups. Markov microsimulation for a 40-year-old patient receiving qPTP found lifetime cost savings of $497 for women and $528 for men, associated with small gains in QALYs (2 and 6days, respectively) and lower rates of cancer mortality in both sexes, but a reduction in ICH only in males. Sensitivity analysis for patients aged 60years predicted that qPTP would continue to save costs and also reduce mortality from both ICH and cancer. Use of qPTP significantly reduced the lifetime probability of PE diagnosis, with lower probability of death from PE in both sexes aged 40 to 60years. However, use of qPTP reduced the rate of ACS diagnosis and death from ACS at age 40, but increased the death rate from ACS at age 60 for both sexes. Widespread use of a combined qPTP for both ACS and PE has the potential to decrease costs by reducing diagnostic testing, while improving most long-term outcomes in emergency patients with chest pain and dyspnea.

Cost-utility analysis of intravenous immunoglobulin for the treatment of steroid-refractory dermatomyositis in Thailand.

Intravenous immunoglobulin (IVIG) has been shown to be effective in treating steroid-refractory dermatomyositis (DM). There remains no evidence of its cost-effectiveness in Thailand. Our objective was to estimate the cost utility of IVIG as a second-line therapy in steroid-refractory DM in Thailand. A Markov model was developed to estimate the relevant costs and health benefits for IVIG plus corticosteroids in comparison with immunosuppressant plus corticosteroids in steroid-refractory DM from a societal perspective over a patient's lifetime. The effectiveness and utility parameters were obtained from clinical literature, meta-analyses, medical record reviews, and patient interviews, whereas cost data were obtained from an electronic hospital database and patient interviews. Costs are presented in $US, year 2012 values. All future costs and outcomes were discounted at a rate of 3% per annum. One-way and probabilistic sensitivity analyses were also performed. Over a lifetime horizon, the model estimated treatment under IVIG plus corticosteroids to be cost saving compared with immunosuppressant plus corticosteroids, where the saving of costs and incremental quality-adjusted life-years (QALYs) were $US4738.92 and 1.96 QALYs, respectively. Sensitivity analyses revealed that probability of response of immunosuppressant plus corticosteroids was the most influential parameter on incremental QALYs and costs. At a societal willingness-to-pay threshold in Thailand of $US5148 per QALY gained, the probability of IVIG being cost effective was 97.6%. The use of IVIG plus corticosteroids is cost saving compared with treatment with immunosuppressant plus corticosteroids in Thai patients with steroid-refractory DM. Policy makers should consider using our findings in their decision-making process for adding IVIG to corticosteroids as the second-line therapy for steroid-refractory DM patients.

Early Rehabilitation in a Psychiatric Ward for Acute Patients: the Experience of the S.C. Psichiatria, Aou Maggiore Della Carità, Novara, Italy

Introduction Our Psychiatry Ward (SC Psichiatria, Maggiore della Carita Hospital, Novara) has a longstanding tradition in the training of clinicians (psychiatrists, but also non-psychiatrists) about the importance of the approach in helping relationships. This tradition reflects itself in the organization of the assistance to the acute psychiatric inpatients admitted to the Ward. In addition to treatment as usual, patients have the opportunity of being involved in several group activities. The activities are proposed to them, with an approach that varies according to the patient's lifetime diagnosis, current conditions, relational difficulties, etc. In other words, different activities may be proposed to different patients, in different ways. Aims To describe the integrated treatment approach we use in our Psychiatry Ward. Methods Group activities are guided by a group leader who is supported by one or two assistants whose role is to facilitate discussion. Activities include: Newspaper Reading (everyday in the morning, 1 hour); Music Listening Group (once a week; 1 hour); Cinema Group (once a week; 2 hours and a half); Fairytale Group (on alternating days in the evening, 1 hour). Results More details will be supplied regarding the theoretical background for the group, the group features/implementation, and its specific objectives. Conclusions All the group activities integrate themselves in an early rehabilitation project tailored to each patients' characteristics and needs. Briefly, their main objectives include: 1) to help patients endorse their cognitive, emotional and relational skills; 2) to offer support to the crisis they are experiencing, which led them to admission to the Ward.

Éducation thérapeutique et santé publique : questions croisées

In France, the law now recognizes the Therapeutic Patient Education (TPE) and this shows the long road TPE accomplishes since the very first educational programs in oncology, the disease learning for children with chronic pathologies and the dramatic changes obtained by the patients with AIDS, placing the patients in the heart of the processes. As any educational program, TPE aims to enforce patients’ skills in managing its disease and getting more autonomy. This also implies to consider problems such as the time discordance between periods of care, time of disease evolution, social and family time and patient's own perception of time. It also focuses on failures in consistency in patient's lifetime and care process, educational and medical counter-attitudes. Focusing on skills transfer helps also to understand the question of TPE assessment, the main objective remaining to help the patient to live the best possible life in his social context. The development of TPE with concepts such as self – management and therapeutic alliance shows the increasing importance of patients’ empowerment in health care.

Thyroid surgery applicable in developing countries

Thyroid surgery in developing countries is performed by general surgeons with limited diagnostic and therapeutic resources. The aim of this review is to describe the indications for and appropriate type of surgery according to the diseases observed. Endemic goiter (grade 1 and 2) usually regresses with iodine therapy. Surgery is indicated only for its complications: mechanical, neoplastic, or related to hyperthyroidism. The choice of operation depends on the specific disease and also on the likelihood that thyroxine will be continuously available for the patient's lifetime. Total thyroidectomy should be avoided whenever possible if thyroxine supplies are unreliable. Hemithyroidectomy and subtotal thyroidectomy are the techniques that should be used in priority.

Primary Care Clinic Visit Efficiency

A study was done in 2013 regarding Veteran's Affairs primary care clinics in New Mexico. The primary care clinics provide care for a group of patients on regular basis. They also see additional patients as needed. The team consisting of the provider(s), nurse(s), technician(s), and schedulers providing continuous and coordinated care throughout patient's life-time is called Patient Aligned Care Team (PACT). The purpose of the PACT is to maximize patient care using this continuous and familiar care model for the patients. The performance of five out of ten primary care teams were provided using the traditional measures identified by their healthcare system in the Patient Aligned Care Teams Compass Data Definitions. The measurements that were specifically interesting were Ratio of PC Telephone Encounters to All PC Encounters, Ratio of Non-Traditional Encounters, Same Day Appts. w/PC Provider Ratio, Continuity PCP (ER Excluded), Team 2ndDay Post DC Contact Ratio. The data was collected in 2012 and the evaluations, interviews, and analysis was completed in 2013. The team scores was provided and access was obtained to only five out of ten teams which data was available for. The Veteran's Affairs provided data regarding the performance metrics of the PACT teams. The data was evaluated by using statistical correlations. The interview questions were designed to further dissect the performance of each team and their practices. Teams were interviewed and the responses were summarized and analyzed. Responses from each team were converted into team's scores and compared to their PACT performance metrics. The comparison between teams' scores and PACT performance metrics provided insight into each team's perception of its own performance and its PACT performance metrics. The purpose of this project is to identify the value adding and non-value adding activities of the each team. So the management can encourage the promotion of value adding activities, decreasing the variation in the performance of the teams and so maximizing the patient care.

Economic evaluation of ivabradine in the treatment of chronic heart failure in Greece.

BackgroundThe objective of our study was to assess the cost-effectiveness of ivabradine plus standard care (SoC) in chronic heart failure (CHF) patients with sinus rhythm and a baseline heart rate ≥ 75 b.p.m. in Greece, in comparison with current SoC alone.MethodsAn existing cost-effectiveness model consisting of two health states, was adapted to the Greek health care setting. All clinical inputs of the model (i.e. mortality rates, hospitalization rates, NYHA class distribution and utility values) were estimated from SHIFT trial data. All costing data used in the model reflects the year 2013 (in €). An incremental cost effectiveness ratio (ICER) per quality-adjusted life year (QALY) gained was calculated. Deterministic and probabilistic sensitivity analyses (PSA) were conducted. The horizon of analysis was over patient life time and both cost and outcomes were discounted at 3.5% per year. The analysis was conducted from a Greek third party-payer perspective.ResultsThe Markov analysis revealed that the discounted quality-adjusted survival was 4.27 and 3.99 QALYs in the ivabradine plus SoC and SoC alone treatment arms, respectively. The cumulative lifetime total cost per patient was €8,665 and €5,873, for ivabradine plus SoC and SoC alone, respectively. The ICER for ivabradine plus SoC versus SoC alone was estimated as €9,986 per QALY gained. The PSA showed that the likelihood of ivabradine plus SoC being cost-effective at a threshold of €36,000/QALY was found to be 95%.ConclusionsIvabradine plus SoC may be regarded as a cost-effective option for the treatment in CHF patients in Greece.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-014-0631-0) contains supplementary material, which is available to authorized users.