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PCV1 |
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COST-EFFECTIVENESS ANALYSIS
OF CLOPIDOGREL IN ACUTE CORONARY SYNDROMES IN
SOUTH KOREA BASED ON CURE TRIAL
Ko S1, Park D2, Yang BM2, 1Health Insurance
Review Agency, Seoul, South Korea, 2Seoul National
University, Seoul, South Korea OBJECTIVE:
This study was carried out to evaluate the
long-term cost-effectiveness of clopidogrel in
addition to aspirin in Acute Coronary Syndromes (ACS)
in South Korea. METHODS:
A
cost-effectiveness analysis was conducted from the
societal perspective and incremental
cost-effectiveness ratios (ICER) were estimated
using a long-term Markov process model, in which
transition probabilities were estimated through
the survival analysis using the Korean health
insurance claims and the cause of death registers
data. Treatment effects were based on the
‘Clopidogrel in Unstable Angina to prevent
Recurrent ischemic Events (CURE)’ trial and it was
assumed that patients were treated for one year.
The costs included direct and indirect costs as
well as cost in added years of life and were
estimated from the Korean health insurance claims
and the National Health and Nutrition Survey. Both
costs and effectiveness were discounted by 5
percent. Sensitivity and subgroup analyses were
conducted on the discounting rate and on the
baseline population structure to test the
robustness of the results. RESULTS:
In the
base case scenario, the model predicted a longer
survival in the ‘clopidogrel in addition to
aspirin’ arm (7.705 years vs. 7.439 years
incremental LYG=0.266 years) and higher costs in
the ‘aspirin alone’ arm (6,944,249 vs. 6,876,536
Korean Won; incremental costs=67,713 Kwon)(US $1 =
approximately 1000 Korean won). The cost was lower
while the effectiveness was better; therefore, the
‘clopidogrel in addition to aspirin’ arm was
dominant over ‘aspirin alone’ arm in
cost-effectiveness. Sensitivity and subgroup
analyses showed that ‘clopidogrel in addition to
aspirin’ remained cost effective regardless of the
population structure and discount rate change.
CONLUSIONS:
The combination clopidogrel with
aspirin is cost effective in patients with ACS in
South Korea compared to aspirin alone.
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PCV2 |
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COST-EFFECTIVENESS ANALYSIS
OF SINGLE VS. DUAL CHAMBER PACEMAKERS IN THE
TREATMENT OF BRADYCARDIA IN SPAIN.
Mercader-Cuesta J1, Rodriguez JM2,
Serrano-Contreras D2, Caro JJ3, Ward AJ3, Malik
F4, 1Hospital de Granollers, Granollers,
Barcelona, Spain, 2Medtronic Iberica, Madrid,
Spain, 3Caro Research Institute, Concord, MA, USA,
4Medtronic S.A, Tolochenaz, Morges, Switzerland
Implantation of pacemakers has become an
established approach to bradycardia due to
sinoatrial node disease or atrioventricular block
and is becoming a more common procedure. Two
different types of pacemakers are available to
treat bradycardia, single and dual chamber
pacemakers. Despite dual chamber pacemaker have
shown to have a better cardiac rhythm control, it
use is nowadays limited in Spain. OBJECTIVE:
To adapt an existing economic model of managing
bradycardia with a dual vs. single chamber
ventricular pacemaker to estimate the long-term
economic and health impact of these devices in
Spain. METHODS:
A discrete event simulation
model was adapted for the Spanish setting. A
cohort of 1,000 patients was created,
characteristics were assigned to each individual
and then each patient is cloned. One clone
received a dual chamber device, the other a single
chamber one. During the simulation, each patient
may develop different clinical events,
complications and adverse events. Clinical data
were retrieved from published trials, and resource
use and costs were obtained from the Hospital of
Granollers. Time horizon contemplated was 5 years.
The perspective of the analysis was the NHS, so
only direct costs were included. Costs and
benefits were discounted at 3%. RESULTS:
Based on 100 replications, the
mean costs per patient in the dual chamber arm
exceeded in Û331 respect single chamber patients.
The dual chamber patients were predicted to
increase the discounted QALY by a mean 0.09 years.
The mean cost-effectiveness ratio was Û3,678 per
discounted QALY. Sensitivity analyses showed the
results to be consistent over broad ranges.
CONLUSIONS:
The use of dual chamber devices
in patients with bradycardia due to sinoatrial
node disease or atrioventricular block, is an
efficient technology compared to single chamber,
in the Spanish setting, with a C/E rate below the
accepted Spanish threshold (30,000/QALY).
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PCV3 |
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COST-EFFECTIVENESS OF
EPLERENONE IN PATIENTS WITH HEART FAILURE AFTER
ACUTE MYOCARDIAL INFARCTION WHO WERE TAKING BOTH
ACE INHIBITORS AND β-BLOCKERS: RESULTS FROM
EPHESUS
Zhang Z, Weintraub WS, Christiana Care
Health System, Newark, DE, USA OBJECTIVE:
The EPHESUS trial showed that the use of
eplerenone in the setting of heart failure after
acute myocardial infarction is highly
cost-effective. This analysis considers the
cost-effectiveness of eplerenone in patient
population who were taking both ACE inhibitors/ARBs
and blockers at baseline from EPHESUS. METHODS:
A total of 6632 patients were randomized to
eplerenone 25-50 mg/day (n=3319) or placebo
(n=3313) used concurrently with standard therapy
and followed for up to 2.5 years. Of these, 4359
(66%) patients (eplerenone: 2162; placebo: 2197)
were taking both ACE inhibitors/ARBs and
?-blockers at baseline. Trial wide efficacy and
resource utilization were used in the analysis.
Resources included hospitalizations, outpatient
services, and medications. Eplerenone was priced
at $3.6/day. The incremental cost-effectiveness of
eplerenone in cost per life-year gained (LYG) and
cost per quality-adjusted life year (QALYs) gained
was estimated using data from the Framingham,
Saskatchewan and Worcester studies to project
long-term survival. Both costs and effectiveness
were discounted at 3%. RESULTS:
As in the
overall study population, the costs tended to be
similarly higher in the eplerenone arm for
patients who were taking both ACE inhibitors and
?-blockers (cost difference=$ 1697). The number of
LYG with eplerenone was 0.1637 based on
Framingham, 0.0970 with Saskatchewan, and 0.2121
with Worcester data. The incremental
cost-effectiveness ratio (ICERs) was $10,372 per
LYG with Framingham (99% under $50,000 per LYG),
$17,493 with Saskatchewan, and $8,003 with
Worcester. The ICERs are systematically higher
when calculated in cost per QALY gained ($15,021,
$25,283, and $11,499 per QALY gained,
respectively), as the utilities were below 1 with
no difference between the treatment arms.
CONLUSIONS:
As was for the entire EPHESUS
population, aldosterone blockade with eplerenone
is effective in reducing mortality and, is
cost-effective in increasing years of life for
EPHESUS subgroup patients who were taking both ACE
inhibitors and ?-blockers.
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PCV4 |
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A HEALTH ECONOMIC EVALUATION
OF ASPIRIN IN THE PRIMARY PREVENTION OF
CARDIOVASCULAR DISEASE
Lamotte M1, Annemans L2, Evers T3, Kubin
M3, Hu S4, 1HEDM - IMS Health, Brussels, Belgium,
2IMS Health and Ghent University, Brussels,
Belgium, 3Bayer Healthcare AG, Wuppertal, Germany,
4Fudan University (former Shanghai Medical
University), Shanghai, China OBJECTIVE:
Low-dose Aspirin is
standard care in patients with a history of
cardiovascular disease (CVD). In primary
prevention the use of low-dose Aspirin is not yet
fully established although meta-analyses and US
and European guidelines support its use in persons
at increased CVD risk. This study assessed the
health-economic consequences of the use of
low-dose Aspirin in the primary prevention of CVD
in China. METHODS:
Based on results
benefits and harms) reported in the meta-analyses
of Hayden and Eidelman, a Markov model was
developed to predict the cost-effectiveness of
low-dose Aspirin in the primary prevention of CVD.
The model consists of 5 health states: no history
of CVD, history of stroke, history of myocardial
infarction, history of CVD and death. A 10-year
time horizon and 1-year cycles were used.
Secondary prevention data were derived from the
Aspirin group of the CAPRIE-study (1996). Direct
costs (years 2000-2003) from the payer’s
perspective were used (sources: Chinese Ministry
of health for acute and a Delphi-panel for
follow-up costs). Effects were expressed in
Life-Years (LY) and Quality-Adjusted-Life-Years
QALY). Utility data (TTO) were obtained from
published data. Discounting was applied (3% on
effects and costs). One-way and Probabilistic
sensitivity analysis was applied. RESULTS:
For subjects with a 10-year risk of coronary heart
disease (CHD) of 15% the model results in a
10-year cost (±StErr) of 11,233±1,995Yuan
(1,060±188Û) without and 10,304±1,537Yuan
(972±145Û) with Aspirin. Low-dose Aspirin
treatment saves on average 929±781Yuan (88±74Û)
per patient. LY were respectively 8.33±0.01 and
8.36±0.02, QALY 8.20±0.02 and 8.24±0.03. Monte
Carlo analysis showed Aspirin-dominance in 87.1%
of cases. Savings start in the fourth year.
CONLUSIONS:
Administering low-dose Aspirin to
individuals with a ten-year risk of CHD of 15% and
more is life and cost-saving from the Chinese
health care payer’s perspective. Sensitivity
analyses (CHD risk and bleedings) proved the
results robustness.
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PCV5 |
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FACTORS AFFECTING COST OF
STATIN THERAPY IN HONG KONG
Cheng C1, Chan JC2, Tomlinson B2, Woo KS3, You
JH4, 1Chinese University of Hong Kong, Shatin,
Hong Kong, 2The Chinese University of Hong Kong,
Hong Kong, China, 3The Chinese University of Hong
Kong, Shatin, Hong Kong, 4The Chinese University
of Hong Kong, Shatin, N.T, Hong Kong OBJECTIVE:
Aim of present study was
to identify factors affecting direct medical cost
associated with statin therapy in Chinese patients
at high risk of coronary heart disease (CHD).
METHODS:
Chinese patients at high risk of CHD
who had been initiated on statin monotherapy for
12 months were recruited at the outpatient clinics
of a public teaching hospital in Hong Kong.
Patients’ demographic information and clinical
characteristics were collected at the entry of
study. Patient adherence was assessed by the
Medication Event Monitoring System over six
months. The target types of healthcare resources
included clinic visits, statin medications,
laboratory tests on lipids and management of CHD
events if any. Total direct medical cost per
member per month (cPMPM) for each patient was
calculated. A multiple regression model was used
to identify demographic, clinical factors and
patient adherence with significant association to
cPMPM. RESULTS:
83 patients were included
in the analysis. The mean age was 60 +/- 13 years
and 51 (61%) of the patients were male. The median
cPMPM of all 83 patients was USD43 (25th–75th
percentile = USD38-45). Association between
adherence levels and cPMPM was determined by
backward multiple regression, controlling for
other covariates. Nine factors identified by the
model were male gender, monthly household income,
primary education (< 6 years), dosetime adherence
to statins, history of diabetes mellitus,
congestive heart failure, coronary
atherosclerosis, coronary artery bypass graft and
percutaneous transluminal coronary angioplasty.
Male gender, history of diabetes mellitus,
congestive heart failure and coronary
atherosclerosis were significantly associated with
higher consumption of healthcare resources.
CONLUSIONS:
Male gender, history of diabetes
mellitus, congestive heart failure and coronary
atherosclerosis were significantly associated with
higher consumption of healthcare resources.
Adherence to statin therapy did not appear to
affect the cost of treatment.
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PCV6 |
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TREND ANALYSIS OF PRICE AND
UTILIZATION OF STATIN DRUGS IN U.S. MEDICAID
PROGRAMS
Jing Y, Chen Y, Kelton CM, Guo JJ,
University of Cincinnati, Cincinnati, OH, USA
OBJECTIVE:
Statins are used to treat abnormal
blood lipids for reducing cholesterol and are
prescribed for the elderly and other high-risk
populations. The objective of this study is to
compare drug price, cost, utilization, and
market-share trends across statin drugs in order
to shed light on the effects of both interbrand
and generic competition in the market for statins.
METHODS:
Using data from First DataBank, we
calculated the monthly average wholesale price (AWP)
per daily dose for each branded and generic statin
drug over the period 1989-2002. We also analyzed
national Medicaid pharmacy data to construct
quarterly prescription numbers (and market shares
by dividing by total number of statin
prescriptions) and per-prescription reimbursement
figures for each drug from 1991-2004. RESULTS:
Total expenditure by U.S. Medicaid programs on
statin drugs increased from $41.8 million in 1991
to $1.37 billion in 2003. The top three drugs
reimbursed by Medicaid in 2004 included Lipitor,
Zocor, and Pravachol, with market shares of 49.0%,
29.1%, and 9.7%, respectively. Whereas Zocor,
Mevacor, and Pravachol have a relatively high AWP
per daily dose (between $4.00 and $6.50 since
1993), the AWP for Lipitor is much lower. A rapid
increase of Lipitor prescriptions was observed
from 2290 in 1st quarter 1997 to two million in
2004. The average reimbursement per statin
prescription in Medicaid increased from $68.70 in
1991 to $101.90 in 2004. When the generic
lovastatin was introduced at two-thirds the
branded AWP, there is no drop in the price of
Mevacor, though Medicaid does face a lower cost
per Mevacor prescription. CONLUSIONS:
Our
results give little indication of effective
interbrand competition in the statin market.
Neither price nor utilization of other branded
medications falls in response to new branded
entry. Use of a branded drug does fall following
generic entry.
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PCV8 |
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ANALYSES FOR PRICE AND
UTILIZATION OF CALCIUM CHANNEL BLOCKERS IN US
MEDICAID PROGRAMS
Chen Y, Guo JJ, Jing YH, Wigle P,
University of Cincinnati, Cincinnati, OH, USA
OBJECTIVE:
To analyze price and utilization
trends for Calcium Channel Blockers (CCB) drugs,
and to compare the price difference between
brand-name and generic CCB drugs over a specific
time interval. METHODS:
CCB drugs with an
indication for hypertension were selected for this
study. The First DataBank® drug files and National
Medicaid Pharmacy data were used to calculate the
monthly Average Wholesaler Prices (AWP), quarterly
prescription use and reimbursement. Descriptive
time-series trend analyses were performed to
assess price trends and drug utilization patterns.
The market shares were calculated as the
proportion of total number of prescriptions.
RESULTS:
The average AWP per daily dose for
CCBs included three tiers: the highest with $2 or
more per day for Cardizem®, Plendil®, and
Procardia XL®, the lowest with $1 or less per day
for Isoptin® and verapamil, and middle for Norvasc
® and Cardene®. The generic dilatizem AWP
decreased from $0.84 in 1996 to $0.34 in 2004,
while its brand Cardizem AWP increased over time.
Use of branded drugs (Calan®, Procardia, and
Cardizem) decreased while use of generics (verapamil,
nifedipine, and diltiazem) increased. The
utilization of the dihydropyridine CCBs (e.g.
Norvasc®, Procardia®) was about two-fold that of
the non-dihydropyridine CCBs in 2004. Total
expenditure for brand name drugs increased from
$28.87 million per quarter in 1991 to $1.15
billion per quarter in 2004. The market-share of
Procardia ® decreased sharply from 64.26% in 1991
to 3.9% in 2001, while Norvasc® increased from
5.78% in 1993 to 73.98 % in 2004. CONLUSIONS:
The generic AWP decreased due to competition,
but there was little impact on its brand-name AWP.
Increased use of Norvasc® might be associated with
its safety profile. Decreased use of brand-name
CCBs might be due to Medicaid policy of generic
drug use.
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PCV9 |
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DRUG PRICE AND UTILIZATION OF
BETA BLOCKERS IN US MEDICAID PROGRAMS
Jing Y, Chen Y, Wigle P, Guo JJ, University
of Cincinnati, Cincinnati, OH, USA
OBJECTIVE:
Beta-blockers (BB) were the fifth
most widely prescribed class of medications in
2004. The objective of this study was to analyze
the drug price trends of brand-name and generic
beta blockers, and to assess drug utilization and
market-share competition in US Medicaid Programs.
METHODS:
The monthly average wholesale
price (AWP) per daily dose for each
antihypertensive beta-blocker available between
1986 and 2002 was evaluated using data extracted
from First DataBank. National Medicaid pharmacy
data files were also analyzed to construct the
quarterly prescription numbers and
per-prescription reimbursement figures for each
drug in the time frame of 1990 through 2004. The
market- share of beta-blockers was calculated
based on numbers of prescriptions. RESULTS:
Since 1993, the average AWP for
brand-name drugs increased over time, while
generic drug prices decreased or changed slightly.
The only exception was propranolol. Reimbursement
cost per prescription showed a similar pattern.
The expenditure for BBs in US Medicaid programs in
2003 was $206 million (114.8 million for
brand-name drugs, 91.6 million for generics).
While the market share of brand-name BB
prescriptions dropped from 63.1% in 1991 to 25.5 %
in 2003, Toprol prescriptions has increased
sharply to 870,037 in 2nd quarter 2004 since entry
to the market in early 1992. The prescriptions for
Tenormin and Lopressor decreased over time due to
availability of generic products. The
prescriptions of atenolol and metoprolol increased
sharply after they were introduced into the
market. CONLUSIONS:
Large increases in BB
expenditures paralleled the increased number of
prescriptions. The increased use of BB might be
due to the blood pressure benefit for diabetic
patients and mortality benefit for post-MI
patients with heart failure. The market share
competition between brand-name and generic drugs
was observed in U.S. Medicaid programs.
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PCV10 |
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PHYSICAL INACTIVITY IS
ASSOCIATED WITH INCREASED HEALTHCARE USE AND
EXPENDITURES IN INDIVIDUALS WITH HYPERTENSION
Iyer R1, Modi A2, 1University of Appalachia
College of Pharmacy, Grundy, VA, USA, 2Purdue
University, Indianapolis, IN, USA The importance of
physical activity in reducing morbidity and
mortality is well established, but the effect of
physical inactivity on direct medical costs is
less clear. OBJECTIVE:
To examine the
health care use and health care expenditure
associated with physical inactivity in
hypertensive patients. An additional objective was
to compare differences in the perceived physical
health and perceived mental health in these
patients. METHODS:
Crosssectional analysis
of the 2001 Medical Expenditure Panel Survey that
included US civilian men and non-pregnant women
aged 15 and older who were not in institutions in
2001. Patients with hypertension were identified
by ICD-9-CM code of 401.00. The outcome measures
were health care use health care expenditure. We
used analysis of covariance to determine
differences in health care use and expenditures,
adjusting for age, sex, race, marital status, and
income status. RESULTS:
After adjusting for
covariates the expenditures for prescription
medications were higher in physically inactive
individuals than in physically active individuals
with hypertension ($ 736 vs. $621, p = 0.0003).
There were no statistically significant
differences in other expenditure categories. The
total direct cost were significantly different for
hypertensive patients who were physically active
and those who were not. ($806.80 vs $ 687.04, P =
0.006). Of the individuals with hypertension,
those who were physically active reported being in
good to excellent health compared to their
counterparts who were physically inactive. (56 vs.
39%, P = 0.009). Similarly, physically inactive
hypertensive patients reported poor mental health
(31 vs. 13%, P = 0.002) than physically active
hypertensive patients. CONLUSIONS:
The
mean net annual benefit of physical activity in
hypertensive patients was $ 120 per person in 2003
dollars. Our results suggest that increasing
participation in regular moderate physical
activity among these patients could reduce the
annual national health care spending by a
significant amount.
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PCV11 |
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STATINS UTILIZATION FOR
SECONDARY PREVENTION IN PATIENTS WITH ACUTE
MYOCARDIAL INFARCTION IN HONG KONG
Lee VWY1, Chan WK2, Lee BS3, Tomlinson B4,
Chong AC5, Wong JC3, Lee KK1, 1The Chinese
University of Hong Kong, Shatin, China,
2Department of Medicine & Geriatrics, United
Christian Hospital, Kwun Tong, China, 3Department
of Pharmacy, Prince of Wales Hospital, Shatin,
China, 4Department of Medicine & Therapeutics, The
Chinese University of Hong Kong, Hong Kong, China,
5United Christian Hospital, Kwun Tong, China The
use of statin therapy for secondary prevention of
coronary heart disease is highly efficacious and
cost-effective in high-risk patients.
OBJECTIVE:
The current study was to investigate the local
utilization pattern of statin for secondary
prevention in patients with history of myocardial
infarction (MI) and the low-density lipoprotein
cholesterol (LDL-C) goal attainment. METHODS:
Patients who had admitted to the United Christian
Hospital and Prince of Wales Hospital due to acute
MI between September 1, 2001 to December 31, 2001
were recruited. Retrospective chart review was
conducted for a period of 2 years, starting from
the date of hospital admission. Patients’
demographics, baseline and follow-up cholesterol
laboratory values and statins treatment data were
collected. RESULTS:
A total of 292 patients (209
males; mean age 65.2 ± 12.7 years; mean baseline LDL-C 3.26±1.09 mmol/L) were included. Statins
were prescribed in 66% patients and 1% were
prescribed gemfibrozil. Among those receiving
statins, simvastatin was the most commonly
prescribed statin and it was utilized in 47% of
patients. Low-dose statin (simvastatin 10 mg or
lower potency) was given in 45% of patients as
initial regimen. At the end of 2-year study
period, 42% of them were on low-dose statin
therapy. LDL-C goal of <2.6 mmol/L was reached in
52% of patients at the end of 2-year study period;
20% of them were not at goal. The mean final LDL-C
was 2.27± 0.65 mmol/L. The LDL-C levels at the end
of study period were not documented in 28%
patients. Of the 292 patients, recurrent MI and
stroke occurred in 13% and 5% respectively.
Adverse effects associated with statin therapy
were found in 3% of patients. CONLUSIONS:
Overall
lipid-lowering management was encouraging but
there is room for improvement. Routine cholesterol
laboratory measurements dosage titration of statin
should be made according to individual LDLC level.
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PCV12 |
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THE COST-EFFECTIVENESS OF
CRYOPLASTY IN THE TREATMENT OF FEMOROPOPLITEAL
ARTERIAL DISEASE
Audi S, Coles T, Boston Scientific Ltd, St.
Albans, United Kingdom
OBJECTIVE:
To analyze the treatment cost and
cost-effectiveness of cryoplasty, a minimally
invasive treatment for peripheral arterial disease
(PAD), compared to angioplasty treatment in
patients with Femoropopliteal Arterial Disease in
the UK at 12-months. METHODS:
A decision-analytic
model combining clinical data from several sources
on patency rates with UK unit costs for medical
resources. RESULTS:
The total average per patient
hospital cost at 12-months were £3,433 for cryoplasty and £3,922 for angioplasty. The total
cost included initial treatment cost, stenting
cost post-procedure, and reintervention costs.
Although the initial treatment and stenting costs
with cryoplasty were higher (£2,835 vs. £2,233 for
angioplasty), these costs were outweighed by the
savings from lower reintervention costs of
cryoplasty (£599 vs. £1,690 for angioplasty).
Because cryoplasty offered improved clinical
patency at a lower cost, it was a dominant
treatment. CONLUSIONS:
Endovascular treatment
options for patients with Femoropopliteal Arterial
Disease offer a clinical alternative to surgery
and, in severe cases, amputation. Cyroplasty may
offer an improvement in clinical patency compared
to angioplasty, and may do so at a lower cost. As
these results depend on local treatment practices,
centers must apply their own data to understand
local impact.
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PCV13 |
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COST-SAVING OF PHARMACIST
INTERVENTION ON WARFARIN THERAPY IN PATIENTS WITH
MECHANICAL HEART VALVES.
Rojsutee S, Musikachai P, Pongchareonsuk P,
Chaikledkaew U, Mahidol University, Bangkok,
Thailand OBJECTIVE:
To evaluate
the cost-saving of pharmacist intervention on
warfarin therapy in Thai patients with mechanical
heart valves from provider perspective.
METHODS:
Decision tree model was used to
estimate the cost saving of pharmacist
intervention on warfarin therapy. Only direct cost
was used in the simulations. Estimates were based
on the study evaluating the impact of education
and counseling by clinical pharmacists on
anticoagulation therapy in patients with
mechanical heart valves of Siriraj Hospital cost
data were obtained from Siriraj Hospital.
RESULTS:
The mode estimates that pharmacist
intervention can save cost on warfarin therapy in
Thai patients with mechanical heart valves
12,049.89 baht ( $301.25 ) per patient per year
(3,313,172.43 baht ( $82829.31 ) for total per
year) CONLUSIONS:
Pharmacist intervention
can provide substantial saving and present a
favorable economic profile in the treatment of
warfarin therapy in Thai patients with mechanical
heart valves |
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