15 research outputs found
Estimation of the Direct Cost of HIV-Infected Patients in Greece on an Annual Basis
AbstractObjectiveHIV infection is currently regarded as a global chronic disease. The purpose of this study was to assess the direct cost of illness per patient per year in Greece.MethodsA retrospective study for the estimation of the direct cost of HIV infection was performed from the third-party payer perspective. Data from 447 patients monitored in a general hospital of Athens were collected from their medical records. The survey involved all services and treatments that patients (stratified into three health states according to the number of CD4 cells/ml as defined by the Centers for Disease Control and Prevention classification system for HIV infection) received in 1 year, as well as demographic data.ResultsThe annual direct cost per patient was calculated at €6859 ± €4699. Antiretroviral therapy cost was estimated at €5741, while the annual cost of providing health care services regardless of health state was computed at €1118, with laboratory investigation and imaging studies representing €924 (13.5%), outpatient visits €34 (0.5%), and hospitalization €160 (2.3%) of total cost, respectively. Overall, direct cost per patient was found to increase as the CD4 T lymphocytes decreased, leading to prolonged hospitalization and an increase in the number of laboratory tests. Direct cost for patients with more than 500 CD4 cells/μl was estimated at €6067, whereas for those with 200 to 499 cells/μl and less than 200 cells/μl, it was assessed at €6857 and €7654, respectively.ConclusionsThe direct cost of HIV infection per patient increased as CD4 T lymphocytes decreased. The largest part of expenses was attributed to antiretroviral therapy, followed by laboratory tests/imaging studies, hospitalization, and finally outpatient visits
Blood pressure variability assessed by office, home, and ambulatory measurements: comparison, agreement, and determinants
The present study compared the blood pressure variability (BPV) among
office (OBP), home (HBP), and ambulatory blood pressure (ABP)
measurements and assessed their determinants, as well as their agreement
in identifying individuals with high BPV. Individuals attending a
hypertension clinic had OBP measurements (2-3 visits) and underwent HBP
monitoring (3-7 days, duplicate morning and evening measurements) and
ABP monitoring (24 h, 20-min intervals). BPV was quantified using the
standard deviation (SD), coefficient of variation (CV), and variability
independent of the mean (VIM) using all BP readings obtained by each
method. A total of 626 participants were analyzed (age 52.8 +/- 12.0
years, 57.7% males, 33.1% treated). Systolic BPV was usually higher
than diastolic BPV, and out-of-office BPV was higher than office BPV,
with ambulatory BPV giving the highest values. BPV was higher in women
than men, yet it was not different between untreated and treated
individuals. Associations among BPV indices assessed using different
measurement methods were weak (r 0.1-0.3) but were stronger between
out-of-office BPV indices. The agreement between methods in detecting
individuals with high BPV was low (30-40%) but was higher between
out-of-office BPV indices. Older age was an independent determinant of
increased OBP variability. Older age, female sex, smoking, and
overweight/obesity were determinants of increased out-of-office BPV.
These data suggest that BPV differs with different BP measurement
methods, reflecting different pathophysiological phenomena, whereas the
selection of the BPV index is less important. Office and out-of-office
BP measurements appear to be complementary methods in assessing BPV
Cost-effectiveness of Ingenol Mebutate Gel for the Treatment of Actinic Keratosis in Greece
Purpose: The present study aimed to perform a cost-effectiveness
analysis of ingenol mebutate (IM) versus other topical alternatives for
the treatment of actinic keratosis (AK).
Methods: The analysis used a decision tree to calculate the clinical
effects and costs of AK first-line treatments, IM (2-3 days), diclofenac
3% (for 8 or 12 weeks), imiquimod 5% (for 4 or 8 weeks), during a 24
month horizon, using discrete intervals of 6 months. A hypothetical
cohort of immunocompetent adult patients with clinically confirmed AK on
the face and scalp or trunk and extremities was considered. Clinical
data on the relative efficacy were obtained from a network
meta-analysis. Inputs concerning resource use derived from an expert
panel. All costs were calculated from a Greek third-party payer
perspective.
Findings: IM 0.015% and 0.05% were both cost-effective compared with
diclofenac and below a willingness-to-pay threshold of (sic)30,000 per
quality adjusted life-year (QALY) (sic)199 and (sic)167 per QALY,
respectively). Comparing IM on the face and scalp AK lesions for 3 days
versus imiquimod for 4 weeks resulted in an incremental
cost-effectiveness ratio of (sic)10,868 per QALY. IM was dominant during
the 8-week imiquimod period. IM use on the trunk and extremities
compared with diclofenac (8 or 12 weeks) led to incremental
cost-effectiveness ratios estimated at (sic)1584 and (sic)1316 per QALY
accordingly. Results remained robust to deterministic and probabilistic
sensitivity analyses. (C) 2017 Elsevier HS Journals, Inc. All rights
reserved
Quantifying the economic benefits of prevention in a healthcare setting with severe financial constraints: the case of hypertension control
Hypertension significantly contributes to the increased cardiovascular
morbidity and mortality, thus leading to rising healthcare costs. The
objective of this study was to quantify the clinical and economic
benefits of optimal systolic blood pressure (SBP), in a setting under
severe financial constraints, as in the case of Greece. Hence, a Markov
model projecting 10-year outcomes and costs was adopted, in order to
compare two scenarios. The first one depicted the “current setting”,
where all hypertensives in Greece presented an average SBP of 164 mmHg,
while the second scenario namely “optimal SBP control” represented a
hypothesis in which the whole population of hypertensives would achieve
optimal SBP (i.e. 5140 mmHg). Cardiovascular events’ occurrence was
estimated for four sub-models (according to gender and smoking status).
Costs were calculated from the Greek healthcare system’s perspective
(discounted at a 3% annual rate). Findings showed that compared to the
“current setting”, universal “optimal SBP control” could, within
a 10-year period, reduce the occurrence of non-fatal events and deaths,
by 80 and 61 cases/1000 male smokers; 59 and 37 cases/1000 men
non-smokers; whereas the respective figures for women were 69 and 57
cases/1000 women smokers; and accordingly, 52 and 28 cases/1000 women
non-smokers. Considering health expenditures, they could be reduced by
approximately E83 million per year. Therefore, prevention of
cardiovascular events through BP control could result in reduced
morbidity, thereby in substantial cost savings. Based on clinical and
economic outcomes, interventions that promote BP control should be a
health policy priority
Cost Effectiveness of Apixaban versus Warfarin or Aspirin for Stroke Prevention in Patients with Atrial Fibrillation: A Greek Perspective
Background Strokes attributed to atrial fibrillation (AF) represent a
major cause of adult disability and a great burden to society and
healthcare systems.
Objectives Our objective was to assess the cost effectiveness of
apixaban, a direct acting oral anticoagulant (DOAC), versus warfarin or
aspirin for patients with AF in the Greek healthcare setting.
Methods We used a previously published Markov model to simulate clinical
events for patients with AF treated with apixaban, the vitamin K
antagonist (VKA) warfarin, or aspirin. Clinical events (ischemic and
hemorrhagic stroke, intracranial hemorrhage, other major bleed,
clinically relevant non-major bleed, myocardial infarction, and
cardiovascular [CV] hospitalizations) were modeled using efficacy data
from the ARISTOTLE and AVERROES clinical trials. The cohort’s baseline
characteristics also sourced from these trials. Among VKA-suitable
patients, 64.7% were men with a mean age of 70 years and average
CHADS(2) (cardiac failure, hypertension, age, diabetes, stroke(2)) score
of 2.1, whereas 58.5% of VKA-unsuitable patients were men with a mean
age of 70 years and a CHADS(2) score of 2.0. A panel of experts
(cardiologists and internists) provided information on the resource use
associated with the management of AF. Cost calculations reflect the
local clinical setting and a third-party payer perspective (epsilon,
discounted at 3%).
Results Based on a simulation of 1000 VKA-suitable patients over a
lifetime horizon, the use of apixaban versus warfarin resulted in 26
fewer strokes and systemic embolisms in total, 65 fewer bleeds, 41 fewer
myocardial infarctions, and 29 fewer CV-related deaths, with an
incremental cost-effectiveness ratio (ICER) of epsilon
14,478/quality-adjusted life-year (QALY). For VKA-unsuitable patients,
apixaban versus aspirin resulted in 72 fewer strokes and systemic
embolisms and 57 fewer CV-related deaths, with an ICER of
(sic)7104/QALY. Sensitivity analyses indicated that results were robust.
Conclusions Based on the present analysis, apixaban represents a
cost-effective treatment option versus warfarin and aspirin for the
prevention of stroke in patients with AF from a Greek healthcare payer
perspective over a lifetime horizon
Determinants of the direct cost of heart failure hospitalization in a public tertiary hospital
Background: Heart failure (HF) is the first reason for hospital
admission in the elderly and represents a major financial burden, the
greatest part of which results from hospitalization costs. We sought to
analyze current HF hospitalization-related expenditure and identify
predictors of cost in a public tertiary hospital in Europe.
Method: We performed a retrospective chart review of 197 consecutive
patients, aged 56 +/- 16 years, 80% male, with left ventricular
ejection fraction (LVEF) of 30 +/- 10%, hospitalized for HF in a major
university hospital in Athens, Greece. The survey involved the number of
hospitalization days, laboratory investigations and medical therapies.
Patients who were hospitalized in CCU/ICU or underwent interventional
procedures or device implantations were excluded from analysis. Costs
were estimated based on the Greek healthcare system perspective in 2013.
Results: Patients were hospitalized for a median of 7 days with a total
direct cost of (sic)3198 +/- 3260/patient. The largest part of the
expenses (79%) was attributed to hospitalization (ward), while
laboratory investigations and medical treatment accounted for 17% and
4%, respectively. In multivariate analysis, pre-admission New York
Heart Association NYHA class (p = 0.001), serum creatinine (p = 0.003)
and NT-proBNP (p = 0.004) were significant independent predictors of
hospitalization cost.
Conclusion: Direct cost of HF hospitalization is high particularly in
patients with more severe symptoms, profound neurohormonal activation
and renal dysfunction. Strategies to lower hospitalization rates are
warranted in the current setting of financial constraints faced by many
European countries. (C) 2014 Elsevier Ireland Ltd. All rights reserved
Estimation of the economic burden of atrial fibrillation-related stroke in Greece
Background: Stroke is aleading cause of death and disability, with
atrial fibrillation (AF) being among key risk factors and AF-related
stroke inflicting significant burden on healthcare systems and society.
The present study was undertaken for estimating the total annual
socioeconomic burden of AF-related stroke in Greece and identifying the
key cost contributors. Research design and methods: A cost-of-illness
model was developed for estimating the total annual economic burden of
AF-related stroke in Greece, from asocietal perspective (year 2018).
Atargeted literature review and an advisory board consisting of key
experts in the management of AF and AF-related stroke were performed for
collecting local resource use and epidemiological data. Results: The
total annual socioeconomic burden of AF-related stroke was estimated at
euro175million, in 2018. Direct and indirect costs accounted for 59%
and 41%, respectively. Main contributors were informal care (21.1%),
patients’ productivity losses (19.7%) and hospitalizations (15.0%),
accounting for more than half of the total costs of AF-related stroke
events. Conclusion: A F-related stroke imposes asignificant
socioeconomic burden in Greece. Despite results relying on estimations,
it seems that ensuring efficient reallocation of resources in
appropriate prevention and early intervention strategies could decrease
AF-related stroke’s burden but also enhance healthcare systems’
efficiency
Relationship between office and home blood pressure with increasing age: The International Database of HOme blood pressure in relation to Cardiovascular Outcome (IDHOCO)
Home blood pressure (HBP) measurements are known to be lower than conventional office blood pressure (OBP) measurements. However, this difference might not be consistent across the entire age range and has not been adequately investigated. We assessed the relationship between OBP and HBP with increasing age using the International Database of HOme blood pressure in relation to Cardiovascular Outcome (IDHOCO). OBP, HBP and their difference were assessed across different decades of age. A total of 5689 untreated subjects aged 18-97 years, who had at least two OBP and HBP measurements, were included. Systolic OBP and HBP increased across older age categories (from 112 to 142 mm Hg and from 109 to 136 mm Hg, respectively), with OBP being higher than HBP by ∼7 mm Hg in subjects aged >30 years and lesser in younger subjects (P=0.001). Both diastolic OBP and HBP increased until the age of ∼50 years (from 71 to 79 mm Hg and from 66 to 76 mm Hg, respectively), with OBP being consistently higher than HBP and a trend toward a decreased OBP-HBP difference with aging (P<0.001). Determinants of a larger OBP-HBP difference were younger age, sustained hypertension, nonsmoking and negative cardiovascular disease history. These data suggest that in the general adult population, HBP is consistently lower than OBP across all the decades, but their difference might vary between age groups. Further research is needed to confirm these findings in younger and older subjects and in hypertensive individuals.status: publishe