Reduced costs with bisoprolol treatment for heart failure - An economic analysis of the second Cardiac Insufficiency Bisoprolol Study (CIBIS-II)

Background Beta-blockers, used as an adjunctive to diuretics, digoxin and angiotensin converting enzyme inhibitors, improve survival in chronic heart failure. We report a prospectively planned economic analysis of the cost of adjunctive beta-blocker therapy in the second Cardiac Insufficiency BIsoprolol Study (CIBIS II). Methods Resource utilization data (drug therapy, number of hospital admissions, length of hospital stay, ward type) were collected prospectively in all patients in CIBIS . These data were used to determine the additional direct costs incurred, and savings made, with bisoprolol therapy. As well as the cost of the drug, additional costs related to bisoprolol therapy were added to cover the supervision of treatment initiation and titration (four outpatient clinic/office visits). Per them (hospital bed day) costings were carried out for France, Germany and the U.K. Diagnosis related group costings were performed for France and the U.K. Our analyses took the perspective of a third party payer in France and Germany and the National Health Service in the U.K. Results Overall, fewer patients were hospitalized in the bisoprolol group, there were fewer hospital admissions perpatient hospitalized, fewer hospital admissions overall, fewer days spent in hospital and fewer days spent in the most expensive type of ward. As a consequence the cost of care in the bisoprolol group was 5-10% less in all three countries, in the per them analysis, even taking into account the cost of bisoprolol and the extra initiation/up-titration visits. The cost per patient treated in the placebo and bisoprolol groups was FF35 009 vs FF31 762 in France, DM11 563 vs DM10 784 in Germany and pound 4987 vs pound 4722 in the U.K. The diagnosis related group analysis gave similar results. Interpretation Not only did bisoprolol increase survival and reduce hospital admissions in CIBIS II, it also cut the cost of care in so doing. This `win-win' situation of positive health benefits associated with cost savings is Favourable from the point of view of both the patient and health care systems. These findings add further support for the use of beta-blockers in chronic heart failure

The additional value of patient-reported health status in predicting 1-year mortality after invasive coronary procedures: A report from the Euro Heart Survey on Coronary Revascularisation

Objective: Self-perceived health status may be helpful in identifying patients at high risk for adverse outcomes. The Euro Heart Survey on Coronary Revascularization (EHS-CR) provided an opportunity to explore whether impaired health status was a predictor of 1-year mortality in patients with coronary artery disease (CAD) undergoing angiographic procedures. Methods: Data from the EHS-CR that included 5619 patients from 31 member countries of the European Society of Cardiology were used. Inclusion criteria for the current study were completion of a self-report measure of health status, the EuroQol Questionnaire (EQ-5D) at discharge and information on 1-year follow-up, resulting in a study population of 3786 patients. Results: The 1-year mortality was 3.2% (n = 120). Survivors reported fewer problems on the five dimensions of the EQ-5D as compared with non-survivors. A broad range of potential confounders were adjusted for, which reached a p<0.10 in the unadjusted analyses. In the adjusted analyses, problems with self-care (OR 3.45; 95% CI 2.14 to 5.59) and a low rating (≤ 60) on health status (OR 2.41; 95% CI 1.47 to 3.94) were the most powerful independent predictors of mortality, among the 22 clinical variables included in the analysis. Furthermore, patients who reported no problems on all five dimensions had significantly lower 1-year mortality rates (OR 0.47; 95% CI 0.28 to 0.81). Conclusions: This analysis shows that impaired health status is associated with a 2-3-fold increased risk of all-cause mortality in patients with CAD, independent of other conventional risk factors. These results highlight the importance of including patients' subjective experience of their own health status in the evaluation strategy to optimise risk stratification and management in clinical practice

Supply increase in the Latvian markets of ecological cat furniture manufactured in Latvia

Maģistra darba “Latvijā ražotu ekoloģisku kaķu mēbeļu piedāvājuma palielināšana Latvijas tirgū” mērķis ir paplašināt ilgtspējīgu, Latvijā ražotu, kaķiem paredzētu mēbeļu piedāvājumu Latvijas tirgū. Pirmajā nodaļā sniegts izklāsts par ekoloģiska dizaina un otrreizēji pārstrādātu materiālu izmantošanas tendencēm. Otrajā nodaļā autore izstrādā tehniski ekonomisko pamatojumu projekta priekšlikumam, uz kā bāzes trešajā nodaļā tiek izstrādāta projekta “Latvijā ražotu ekoloģisku kaķu mēbeļu piedāvājuma palielināšana Latvijas tirgū” rokasgrāmata. Darba noslēgumā izteikti secinājumi un priekšlikumi. Darbs sastāv no 77 lappusēm, 12 tabulām, 15 attēliem, 37 pielikumiem. Atslēgvārdi: projektu vadīšana, ekoloģisks, otrreizēji pārstrādāti materiāli, kaķu mēbeles.The objective of the Master's thesis “Supply increase in the Latvian markets of ecological cat furniture manufactured in Latvia” is to increase the supply of sustainable furniture made in Latvia for cats in the Latvian market. The first chapter outlines trends in ecodesign and the usage of recycled materials. In the second chapter, the author develops an economical basis for the project proposal of which in the third chapter develops the project manual of the project “Increasing the supply of ecological cat furniture made in Latvia in the Latvian market”. In the final part of the Paper author provides conclusions and proposals. Thesis consists of 77 pages, 12 tables, 15 images, 37 annexes. Keywords: project management, ecological, recycled materials, cat furniture