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ABSTRACT: Atrial fibrillation (AF), a supraventricular tachycardia disorder, is the most common sustained cardiac arrhythmia affecting 1-2 % of the general population. Prevalence is highly related to age, with every fourth individual older than 40 years old developing AF during his lifetime. Due to an aging population, the prevalence of AF is estimated to at least double within the next 50 years. This article presents AF-related cost-of-illness studies and reviews 19 cost-effectiveness studies and six cost studies published roughly over the past decade, which have compared different antiarrhythmic medications for AF. A systematic literature search for studies published between June 2000 and December 2011 was conducted in PubMed using the combination of keywords ((atrial fibrillation OR atrial flutter) AND cost). Current cost-effectiveness analyses of dronedarone and the pill-in-the-pocket strategy are subject to substantial uncertainties with regard to clinical benefit. Comparing rate control with rhythm control, a cost-effectiveness advantage for rate control was shown in several but not all studies. Within antiarrhythmic drug treatments, magnesium added onto ibutilide was shown to be more cost effective than ibutilide alone. Comparing chemical and electrical cardioversion, the latter was recommended as more cost effective from the healthcare system perspective in all reviewed studies but one. Catheter ablation appeared more cost effective than antiarrhythmic drugs in the medium to long run after 3.2-63.9 years. Admissions to hospital, inpatient care and interventional procedures as well as mortality benefit are key drivers for the cost effectiveness of AF medications. No clear cost-effectiveness advantage emerged for one specific antiarrhythmic drug from the studies that compared antiarrhythmic agents. Rate control as well as catheter ablation appear more cost effective than rhythm control in the treatment of AF. Rate control treatment also seems more cost effective than electrical cardioversion in AF patients.
PharmacoEconomics 03/2013; 31(3):195-213. · 2.66 Impact Factor
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ABSTRACT: Purpose:The GERSHWIN study (German Stent Health Outcome and Economics Within Normal Practice) was designed to evaluate long-term effects
of treatment of coronary artery disease (CAD) with sirolimus-eluting stents (SES), as compared to bare-metal stents (BMS).
Patients and Methods:Within a multicenter, prospective intervention study in 35 hospitals throughout Germany, CAD patients with coronary stenosis
and elective percutaneous coronary intervention (PCI) indication were treated either with SES or BMS (sequential control design
with a case-to-control ratio of 2 : 1). Standardized questionnaires were completed by patients and their physicians at baseline,
3, 6, 12, and 18 months following PCI to document re-PCI for restenosis, myocardial infarction (MI), coronary bypass surgery
(CABG), and death. Angiographic PCI documentation was evaluated by an independent expert.
Results:From April 2003 until June 2005, 658 patients were treated with SES (mean age 63 ± 9 years, 87% male) and 294 patients with
BMS (mean age 64 ± 10 years, 79% male). Significant baseline differences were found by age, gender, household status, threevessel
disease, and number of implanted stents. After 18 months, 8% of the SES versus 17% of the BMS group had undergone target vessel
revascularization (p adjusted < 0.0001). There were no significant differences between BMS and SES regarding MI, CABG, or
death. Re-PCI of target and new non-target vessel lesions was performed at a significantly lower degree of stenosis in SES
than in BMS.
Conclusion:Compared to patients with BMS, patients with implantation of SES experienced considerably fewer target vessel revascularizations.
The threshold to perform re-PCI appeared lower in SES than in BMS. An extended evaluation of the effects of SES will be available
from the 3-year follow-up of the GERSHWIN study.
Ziel:Die GERSHWIN-Studie (German Stent Health Outcome and Economics Within Normal Practice) untersucht die Folgeereignisse nach
Implantation von Sirolimus freisetzenden Stents („sirolimus-eluting stent“ [SES]) im Vergleich zu unbeschichteten Metallstents
(„bare-metal stents“ [BMS]) bei der Behandlung der koronaren Herzerkrankung (KHK).
Patienten und Methodik:Im Rahmen einer multizentrischen, kontrollierten Studie wurden KHK-Patienten in 35 Kliniken in Deutschland mit Koronarstenosen
und Indikation zur elektiven perkutanen Koronarintervention (PCI) mit SES oder konventionellen BMS behandelt (sequentielles
Kontrolldesign mit Fall-Kontroll-Ratio von 2 : 1). Die Nachbeobachtung umfasste standardisierte Erhebungen bei den Patienten
und den weiterbehandelnden Ärzten zu Studienbeginn, nach 3, 6, 12 und 18 Monaten mit Dokumentation von Re-PCI im behandelten
Gefäß, Myokardinfarkt (MI), Bypassoperation (CABG) und Tod. Angiographiebefunde wurden von einem unabhängigen Begutachter
beurteilt.
Ergebnisse:Von April 2003 bis Juni 2005 wurden 658 Patienten mit SES (87% männlich, 63 ± 9 Jahre) und 294 Patienten mit BMS (79% männlich,
64 ± 10 Jahre) behandelt. Signifikante Unterschiede der beiden Patientengruppen zu Studienbeginn zeigten sich bei Alter, Geschlecht,
Haushaltsstatus, Dreigefäßerkrankung und Anzahl der implantierten Stents. In den ersten 18 Monaten traten bei SES 8% und bei
BMS 17% Restenosen im behandelten Gefäß auf (p adjustiert < 0,0001). Es gab keine signifikanten Unterschiede zwischen den
beiden Gruppen bei MI, CABG oder Tod. Re-PCI der behandelten Gefäße bzw. neue Läsionen außerhalb des behandelten Gefäßes wurden
bei SES schon bei einem geringeren Stenosegrad durchgeführt als bei BMS.
Schlussfolgerung:Patienten mit SES haben im Vergleich zu BMS nach 18 Monaten deutlich weniger Re-PCI im behandelten Gefäß. Die Bereitschaft,
bei SES eine Re-PCI durchzuführen, scheint höher zu sein als bei BMS. Für die klinische Gesamtbetrachtung ist eine Langzeitkontrolle
notwendig. Weitere Hinweise werden aus der zusätzlichen Nachbeobachtung der GERSHWIN-Studie bis 36 Monate erwartet.
Herz 04/2012; 32(8):650-655. · 0.92 Impact Factor
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ABSTRACT: The objective of the study was to depict treatment strategies, health care utilisation and cost evaluation of hip and knee
replacement surgery in Germany, with a particular emphasis on thrombosis prophylaxis (TP) for the prevention of deep vein
thrombosis (DVT). In this multi-centre prospective cohort study, medical record data (socio-demographics, risk factors for
thrombosis, thrombosis prophylaxis, course of hospital stay) were collected for patients undergoing either total hip replacement
(THR) or total knee replacement (TKR). One and three months post-operatively, post-operative outcomes and health care resource
use were documented by patient and physician questionnaires. A total of 309 patients participated in the study (59% female,
mean age 66 [SD 10] years). Parenteral anticoagulation was administered for a mean of 38 (SD 16) days. 27 (9%) patients received
subsequent oral anticoagulation for a mean of 38 (SD 21) additional days. Symptomatic DVT was reported by four (1.3%) patients.
Mean overall direct costs associated with surgery from baseline to 3 months were EUR 11 264 (median 11 564, SD 2 481). Hospital
and rehabilitation accounted for 97% of direct costs; costs for medications, physical therapy, physician office visits, out-of-pocket
expenses, as well as complication costs accounted for an additional 3% of direct costs. Within these direct costs, a mean
of EUR 348 (SD 361) was related to thrombosis prophylaxis, accounting for 3% of direct costs. Mean overall cost was EUR 11
926 (SD 2 481), including 6% indirect costs of productivity loss. Extended thrombosis prophylaxis was observed in the usual
care setting of the study and associated with low incidence of symptomatic DVT. Thrombosis prophylaxis is — within the considerable
economic burden of joint replacement surgery — a relatively small cost component.
Central European Journal of Medicine 04/2012; 2(1):47-65. · 0.31 Impact Factor
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ABSTRACT: Heart failure is an increasing burden for all healthcare systems with prevalence reaching over 20 million patients worldwide and direct costs of disease requiring ∼1% of healthcare budget expenditures. Beyond traditional pharmaceutical treatment, medical devices and remote monitoring tools were introduced to ensure a closely managed control of patients. In this context, a decision-maker needs to know whether the new technology provides clinical benefit towards patients and what resource use is attached to them.
Health services research is a complementary approach to clinical trials providing results to the impact of the technology in real life settings. As an example this study reports of a secondary data analysis of one of the largest health insurance companies in Germany, comparing resource use of heart failure patients receiving a cardiac resynchronization therapy (CRT) device coupled with a fluid status monitoring and alert function with patients receiving conventional CRT, ICD (implantable cardioverter defibrillator), or no intervention.
Disease-associated expenses can be attributed to far more than 50% to heart failure. Although implementation of the CRT device with alert function was most expensive (31,794 Euros compared to 27,659 Euros in the conventional CRT group, 24,128 Euros in the ICD group, and 3735 Euros in the no intervention group) in the first year after implementation, the least costs have been caused in this group (7000 Euros compared to more than 11,000 Euros in all other groups).
This article highlights potential health services research approaches focusing on the example of a CRT device coupled with a pulmonary diagnostic and alert function. Although this retrospective analysis holds a number of limitations (e.g., small number of patients in intervention group, cost calculations only from the payer perspective), and despite the need for randomized controlled trials, it was shown that secondary data research in this field is a valuable approach.
Journal of Medical Economics 03/2012; 15(4):737-45.
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Europace 08/2011; · 1.98 Impact Factor
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ABSTRACT: Since atrial fibrillation (AFib) is one of the most frequent cardiac disorders, the primary aim of the present study was to assess the disease-related costs as well as the course of costs associated with AFib. The study was focused on a hospitalized patient subgroup with cardiac comorbidities.
We undertook a retrospective review of the medical, hospital, and drug claims data in the database of a German statutory health insurance company covering ∼5 million insured persons. The data of patients suffering from AFib were extracted by using documented hospital International Classification of Diseases Revision 10 codes during 2004 and 2005. For these patients we reviewed and summarized all the charges incurred over a 1-year period after the initial index event on the basis of weekly costs and from the third-party payer's perspective. We included 14 798 patients with primary diagnosis of AFib (44.6% male patients, mean age of 72.2 ± 10.1 years). The average weekly total first-year cost after AFib was calculated at ∼148 ± 875 Euro per patient. The cumulative total cost was ∼7688 ± 954 Euro per patient for the first year. Thirty per cent of these total costs were directly associated with Afib (2,234 ± 838 Euro).
Atrial fibrillation is associated with significant economic costs from the perspective of statutory health insurance. Since the largest part of costs is attributable to inpatient stays and drug usage, an efficient management of inpatient treatment structures as well as a cost-outcome-oriented drug regime seems to be outstandingly important.
Europace 04/2011; 13(9):1275-80. · 1.98 Impact Factor
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ABSTRACT: To determine the cost-effectiveness of adding eptifibatide to the standard treatment for selected high-risk patients undergoing coronary stenting in Germany. Furthermore, to investigate the impact of several extrapolation methods on the results.
A Markov model was developed to reflect the clinical events in this specific patient population, including target vessel revascularization, myocardial infarction, and death. To extrapolate clinical data beyond 1 year, a linear, an exponential, and a Weibull survival curves were estimated. Patient characteristics and transition probabilities were derived from a high-risk subgroup of the ESPRIT trial; patient-level utility data came from a published Dutch study. Costs were calculated from a hospital and from a third-party payer perspective.
For both perspectives, the additional treatment with eptifibatide is the considered dominant alternative. The incremental net benefit of its use exceeds €10,000 for both perspectives. Results proved stable in probabilistic sensitivity analysis as well as under the different extrapolation scenarios.
Eptifibatide is likely to be dominant strategy with 77.7 and 96.7% of the simulations leading to QALYs gained and generating cost savings from both the hospital and the third-party payer perspective. Eptifibatide offsets its additional treatment costs by avoiding costly repeat procedures and leads to positive QALY gains by preventing cardiovascular events lending themselves to transient or permanent lower quality of life. The method used to extrapolate the short-term risks did not impact on results, mainly due to similar clinical risk profiles between the two treatment groups in the long term.
The European Journal of Health Economics 04/2011; 13(4):381-91. · 1.50 Impact Factor
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ABSTRACT: Restless legs syndrome (RLS) is a common and often underestimated neurological disorder, with a prevalence ranging from approximately 2.5% to 10% in Western industrialized countries. The aim of the present study was to summarize the research findings on the human and economic costs associated with RLS in populations without any co-morbidities or potentially confounding health conditions. A further objective was to identify studies on the cost effectiveness of RLS treatments. A systematic literature search was performed. Two researchers independently assessed the relevance of each publication. Studies published before August 2008 were included if they assessed quality of life in patients suffering from RLS, determined total or patient-related costs attributable to RLS, and/or evaluated the cost effectiveness of treatment options for RLS. A total of 725 references were identified, including 100 full-text articles. Fifteen of these publications met all of the selection criteria and were included in the present review. Seven abstracts that focused on the economic burden of RLS and/or the cost effectiveness of different treatment strategies in RLS patients were also included. RLS was associated, in the included studies, with reductions in quality of life similar to those seen in patients with other chronic conditions. The cost-of-illness studies were heterogeneous but indicated that RLS was associated with a substantial economic burden, resulting in high direct and indirect costs to society. Although effective and cost-effective treatments appear to be available, further research is warranted, especially regarding the economic burden of RLS and the cost effectiveness of available treatment options.
PharmacoEconomics 02/2009; 27(4):267-79. · 2.66 Impact Factor
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ABSTRACT: Specific immunotherapy is the only potentially curative treatment in patients with allergic rhinitis and allergic asthma. Health economic evaluations on this treatment, particularly in a German context, are sparse.
To evaluate the cost-effectiveness of specific subcutaneous immunotherapy (SCIT) in addition to symptomatic treatment (ST) compared with ST alone in a German health care setting.
The analysis was performed as a health economic model calculation based on Markov models. In addition, we performed a concomitant expert board composed of allergy experts in pediatrics, dermatology, pneumology, and otolaryngology. The primary perspective of the study was societal. Additional sensitivity analyses were performed to prove our results for robustness.
The SCIT and ST combination was associated with annual cost savings of Euro140 per patient. After 10 years of disease duration, SCIT and ST reach the breakeven point. The overall incremental cost-effectiveness ratio (ICER) was Euro-19,787 per quality-adjusted life-year (QALY), with a range that depended on patient age (adults, Euro-22,196; adolescents, Euro-14,747; children, Euro-12,750). From a third-party payer's perspective, SCIT was associated with slightly additional costs. Thus, the resulting ICER was Euro8,308 per QALY for all patients.
Additional SCIT was associated with improved medical outcomes and cost savings compared with symptomatic treatment alone according to a societal perspective. Taking a European accepted ICER threshold of up to Euro50,000 per QALY into account, additional SCIT is considered clearly cost-effective compared with routine care in Germany. The degree of cost-effectiveness is strongly affected by costs related to SCIT and the target population receiving such treatment.
Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 10/2008; 101(3):316-24. · 2.83 Impact Factor
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ABSTRACT: The GERSHWIN study (German Stent Health Outcome and Economics Within Normal Practice) was designed to evaluate long-term effects of treatment of coronary artery disease (CAD) with sirolimus-eluting stents (SES), as compared to bare-metal stents (BMS).
Within a multicenter, prospective intervention study in 35 hospitals throughout Germany, CAD patients with coronary stenosis and elective percutaneous coronary intervention (PCI) indication were treated either with SES or BMS (sequential control design with a case-to-control ratio of 2 : 1). Standardized questionnaires were completed by patients and their physicians at baseline, 3, 6, 12, and 18 months following PCI to document re-PCI for restenosis, myocardial infarction (MI), coronary bypass surgery (CABG), and death. Angiographic PCI documentation was evaluated by an independent expert.
From April 2003 until June 2005, 658 patients were treated with SES (mean age 63 +/- 9 years, 87% male) and 294 patients with BMS (mean age 64 +/- 10 years, 79% male). Significant baseline differences were found by age, gender, household status, three vessel disease, and number of implanted stents. After 18 months, 8% of the SES versus 17% of the BMS group had undergone target vessel revascularization (p adjusted < 0.0001). There were no significant differences between BMS and SES regarding MI, CABG, or death. Re-PCI of target and new non-target vessel lesions was performed at a significantly lower degree of stenosis in SES than in BMS.
Compared to patients with BMS, patients with implantation of SES experienced considerably fewer target vessel revascularizations. The threshold to perform re-PCI appeared lower in SES than in BMS. An extended evaluation of the effects of SES will be available from the 3-year follow-up of the GERSHWIN study.
Herz 12/2007; 32(8):650-5. · 0.92 Impact Factor
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ABSTRACT: Atrial fibrillation (AF) is the most common heart arrhythmia, affecting 6% of people over 65 years, and carries a 4.5% average annual stroke risk, which can be reduced by appropriate anticoagulation. A multi-centre observational study, Management and Outcomes in the Care of Atrial fibrillation in Germany (MOCA) was conducted to evaluate the current anticoagulation treatment pattern in patients with AF in Germany.
Patients with AF were recruited from December 2003 to June 2004 in physician practices. Clinical data including International Normalised Ratio (INR) values and anticoagulation strategy were obtained from the physician chart and the patient follow-up, documenting hospitalisations, medications, and complications, was conducted at three and six months. Main outcome measures included anticoagulation methods, practice guidelines adherence and time within recommended anticoagulation range.
361 patients with AF (mean age 71+/-9, 61% male) were recruited in 45 physician practices. 90% of all patients had been treated with Vitamin K-Antagonists (VKA) at some time since AF-diagnosis, 88% were still treated. 10% of patients received aspirin as their anticoagulation therapy. Monitoring occurred at least once a month in over 70% of patients. Monitored INR values were 56% of the time within, 14% below and 30% over the recommended target range. A gap of 40% existed between the guideline recommendations and actual practice. Younger patients (<60 years of age) with no documented risk factors for stroke were over-treated with VKAs and patients older than 75 years without contraindications for anticoagulation were under-treated.
This study presents 'real-life' data in treating patients with AF in Germany and identifies the potential to advance the quality of care with respect to anticoagulation.
Journal of Thrombosis and Thrombolysis 08/2007; 24(1):65-72. · 1.48 Impact Factor
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ABSTRACT: The demand for, and the potential of, evidence-based medicine (EBM) in everyday general practice have not been studied systematically yet.
For six months we offered all general practitioners (n = 190) practising in one of Berlin's city districts to conduct a systematic search for, and critical assessment of, the medical literature on any patient-related questions that participating physicians might have had. The primary aim of the study was to motivate general practitioners to ask patient-related questions and, in the long run, to integrate EBM into their medical practice. At the end of the project, attitudes towards EBM were assessed using standardized questionnaires.
Only four questions, all referring to the field of therapy/prevention, were asked by the general practitioners in the district in which we offered our services. The average time required to supply an answer was 6.25 hours. For the subsequent evaluation of the service, the response rate was 34%. Reasons for not taking advantage of the service included lack of time, doubts about how the questioner would benefit from the service, and "being unaware" of the offering.
Only rarely did general practitioners make use of the research service offered. The reasons included lack of time and the general practitioners' doubts that the service would be of benefit to their patients. In addition, we cannot exclude the possibility that the project may not have been adequately integrated into physicians' everyday practice. Nevertheless, the participants indicated that they were interested in EBM and that they considered scientific or evidence-based information to be relevant to the care of patients. This is why it is important to develop some type of continuing medical education model that can be effectively integrated into everyday medical practice.
Zeitschrift für ärztliche Fortbildung und Qualitätssicherung. 02/2006; 100(5):383-7.
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ABSTRACT: To compare the costs and effectiveness of adjustable maintenance dosing with budesonide/formoterol in a single inhaler versus fixed dosing in adults with asthma.
In this prospective, randomised, open-label, parallel-group, multicentre trial conducted in Germany, patients with asthma received budesonide/formoterol 160 microg/4.5 microg in a single inhaler (Symbicort Turbuhaler with two inhalations twice daily for a 4-week run-in period. Patients were then randomised to either adjustable maintenance dosing (one inhalation twice daily, stepping up to four inhalations twice daily for 1 week if asthma worsened; n=1679) or fixed dosing (two inhalations twice daily; n=1618) for 12 weeks. The primary efficacy variable was the change in health-related quality of life (HR-QOL), measured using the Asthma Quality of Life Questionnaire (standardised) during the randomised treatment period. Resource utilisation data were collected in parallel and combined with German unit costs to estimate direct and indirect costs (year 2001 values).
Both treatment regimens were equally effective in maintaining HR-QOL and asthma control during the randomised treatment period. However, overall, patients in the adjustable maintenance dosing group took fewer daily inhalations of budesonide/formoterol than those in the fixed-dosing group (mean: 2.63 vs 3.82 inhalations; p<0.001). Adjustable maintenance dosing was associated with significantly lower asthma-related direct costs compared with fixed dosing (mean: 221 euro vs 292 euro; p<0.001). This pattern was maintained when patients were stratified into those with peak expiratory flow (PEF) of 60% to <80% predicted normal and those with PEF of>/=80% predicted normal and when total costs were considered.
Adjustable maintenance dosing with budesonide/formoterol in a single inhaler maintained HR-QOL in adult patients with asthma at a significantly lower cost than fixed dosing.
PharmacoEconomics 02/2005; 23(7):723-31. · 2.66 Impact Factor
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ABSTRACT: Evidence-based medicine (EBM) is considered complicated and its realization in everyday medical practice causes difficulties. Therefore, in the course of the present study we made each physician of a university hospital the offer that we would undertake for them a systematic search for and critical assessment of the medical literature on a particular patient-related question they might have. One to two weeks after we had supplied our answers, the influence our answers had had on the medical decisions taken and the overall satisfaction with our offer were evaluated using standardized questionnaires. RESULTS: A total of 34 EBM questions were asked, 31 (91%) of which had a shape that permitted an answer to be obtained. The median time required for supplying an answer was 7 hours (within a range of 3 to 32). In the course of the subsequent evaluation process it was possible to analyze 19 questionnaires (the equivalent of a response rate of 61%). In general our EBM answers were considered good, comprehensible and transparent. For 2/3 of the participants the answers supplied by us satisfied their informational requirements and could be applied satisfactorily in clinical practice. CONCLUSIONS: The offer of external high-quality search-and-assessment of medical literature is useful, but the process is time consuming. Easier access to medical information and knowledge of how to search for and assess literature are important preconditions for the successful implementation of EBM. To achieve the latter evidence-based secondary literature and the development of evidence-based guidelines appear to be reasonable alternatives.
Zeitschrift für ärztliche Fortbildung und Qualitätssicherung. 07/2002; 96(5):325-31.
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ABSTRACT: Atrial fibrillation (AF) is an increasing burden on health-care systems because of an aging population. This study aimed to estimate health-care resource use and costs of treating AF in Germany.
A 6-month multicenter prospective observational cohort study with additional 3-month retrospective clinical data collection was performed in physician practices. AF-related resource use was documented by 3-month retrospective and 6-month prospective clinical data from physician charts and prospectively by patient questionnaires at 3 and 6 months. Cost calculation was from the health-care payer perspective.
A total of 361 patients (mean age 71 +/- 9 years, 61% male) were recruited from 45 physician practices. Of 311 (86.1%) patients with complete data, 75% had persistent AF; oral anticoagulation and/or aspirin were prescribed in 98%. A rhythm-control strategy was applied in 27%, rate control in 58%, and 15% received neither antiarrhythmic medication nor cardioversion. A higher proportion of rhythm-control patients had paroxysmal AF (P < 0.001). Mean annual AF-related per-patient cost was 827 Euro +/- 1476 (median 386 Euro). 50% of total costs were incurred by 11% of patients, driven by AF-related hospitalizations (44%). Antiarrhythmics and stroke prophylaxis accounted for 20% and 15% of expenditures, respectively. Mean annualized costs were higher for rhythm-control patients than for rate-control patients or those without antiarrhythmic treatment (1572 vs. 780 vs. 544 Euro, P < 0.001).
This evaluation provides an overview of current treatment modalities and cost of AF management in Germany. Efforts to reduce the economic burden of AF should focus on avoidance of AF hospital admissions and optimization of stroke prevention and rhythm control.
Value in Health 12(2):293-301. · 2.19 Impact Factor
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ABSTRACT: Atrial fibrillation (AF) is an important risk factor for stroke. The primary purpose of this study was to determine the resource use for patients admitted to hospital with acute stroke and to calculate stroke-related direct costs, stratifying the results according to the presence of AF as a risk factor.
Data from 558 consecutive patients hospitalized with confirmed acute stroke between August 2000 and July 2001 were analyzed as part of the Berlin Acute Stroke Study. Sociodemographic variables were assessed by direct interview, while hospital data were derived from patient medical records. Patients or their carers completed a follow-up questionnaire about resource utilization and absenteeism from work during the 12-month period after hospital admission.
Out of the 367 patients with follow-up data and ECG findings, 71 (19%) had AF. Patients with AF were generally older, more likely to be female, and had more severe strokes compared with those without AF. Mean direct costs per patient were significantly higher in those with AF-related strokes (EURO 11,799 vs EURO 8817 for non-AF-related strokes; P < 0.001). After adjustment for confounding factors, direct costs were comparable in the two groups, except for acute hospitalization costs, which remained significantly higher in the group with AF (P < 0.05).
Medical care for stroke patients with AF is associated with higher costs compared with those without AF; this is explained mainly by confounding factors and driven essentially by a significant difference in acute hospitalization costs.
Value in Health 10(2):137-43. · 2.19 Impact Factor
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ABSTRACT: Background: Health economic parameters are increasingly considered as variables in health care decisions, but decision makers are interested in country-specific evaluations. However, a large number of studies are performed in foreign countries or in a multinational setting, which limits the transferability to a single nation’s context. Objective: The present analysis summarises several of the most common international methods for generating health economic analyses based on clinical studies from different settings. Methods: A narrative literature review was performed to identify potential reasons for limited transferability of health economic evaluation results from one country to another. Based on these results, we searched the methodological literature for analytic approaches to handle the restrictions. Additionally we describe the possibility of transferring foreign economic study results to the country of interest by matching trial data with routine data of national databases. Results: The main factors for limited transferability of health economic findings were found in country-specific differences in resource consumption and the resulting costs. These differences are affected by a number of influencing cofactors (demography, epidemiology and individual patient’s factors) and the overall health care system structures (e.g. payment systems, health provider incentives). However, despite the limitations country-specific health economic assessments could be realised using the pooled/ split analyses approach, some statistical approaches and modelling approaches. Conclusion: A variety of methods for identifying and adjusting country-specific differences in costs, effects and cost-effectiveness was established during the past decades. Multinational studies will continue to play a crucial role in the evaluation of cost-effectiveness at national levels. It seems likely that the growing interest in multinational studies will lead to continued developments in adaptation methods.
Journal of Public Health.
