Caracterización de la fibrilación auricular y riesgo tromboembólico en pacientes del Hospital León Cuervo Rubio

Introduction: among cardiac pathologies, atrial fibrillation is related to a high incidence of thromboembolic diseases. Objective: to clinically and epidemiologically characterize atrial fibrillation and thromboembolic risk in patients attended at the León Cuervo Rubio Hospital in Pinar del Río between 2017 and 2019. Methods: an observational, descriptive, cross-sectional, descriptive study was conducted on patients with atrial fibrillation attended at the León Cuervo Rubio Hospital in Pinar del Río from 2017 to 2019. The study universe consisted of 198 patients diagnosed with atrial arrhythmias in that hospital, the sample was constituted by 68 patients who met the inclusion and exclusion criteria. Results: female sex predominated (58.8%). The most representative age group was 75 to 85 years old (45.5 %). Some type of heart disease associated with atrial fibrillation was present in 69.1% of patients. Persistent atrial fibrillation predominated (35.2%). Palpitations predominated as symptoms of atrial fibrillation (91.1%). Most patients with atrial fibrillation were in the moderate thromboembolic risk category (66.1%). Conclusions: the predominant sex was female, the most affected age group was over 85 years, ischemic heart disease was the most prevalent history, persistent atrial fibrillation was the most frequent, palpitations were the main symptom, and according to the thromboembolic risk category, most patients were at moderate risk.Introducción: dentro de las patologías cardiacas, la fibrilación auricular se relaciona con una alta incidencia de enfermedades tromboembólicas. Objetivo: caracterizar clínica y epidemiológicamente la fibrilación auricular y el riesgo tromboembólico en pacientes atendidos en el Hospital León Cuervo Rubio de Pinar del Río entre 2017 y 2019. Método: se realizó un estudio observacional, descriptivo, de corte transversal a pacientes con fibrilación auricular atendidos en el Hospital León Cuervo Rubio de Pinar del Río de 2017 a 2019. El universo de estudio estuvo conformado por 198 pacientes con diagnóstico de arritmias auriculares en dicho hospital, la muestra quedó constituida por 68 pacientes que cumplieron con los criterios de inclusión y exclusión. Resultados: predominó el sexo femenino (58,8 %). El grupo etario más representativo fue el de 75 a 85 años (45,5 %). El 69,1 % presentaban algún tipo de cardiopatía asociada a la fibrilación auricular. Predominó la fibrilación auricular de tipo persistente (35,2 %). Predominaron las palpitaciones como síntomas de la fibrilación auricular (91,1 %). La mayoría de los pacientes con fibrilación auricular estaban en la categoría de riesgo tromboembólico moderado (66,1 %). Conclusiones: el sexo que predominó fue el femenino, el grupo etáreo más afectado fue el de más de 85 años, la cardiopatía isquémica fue el antecedente de mayor prevalencia, la fibrilación auricular de tipo persistente fue la más frecuente, las palpitaciones constituyeron el síntoma principal y según la categoría de riesgo tromboembólico la mayoría de los pacientes presentaban riesgo moderado

The Cost Utility of Nonpregnancy Laboratory Monitoring for Persons on Isotretinoin Acne Therapy

We sought to project the 1-year cost utility of nonpregnancy laboratory monitoring cessation among patients initiating isotretinoin. We conducted a model-based cost utility analysis comparing (i) current practice (CP) and (ii) cessation of nonpregnancy laboratory monitoring. Simulated 20-year-old persons initiating isotretinoin were maintained on therapy for 6 months, unless taken off because of laboratory abnormalities in CP. Model inputs included probabilities of cell-line abnormalities (0.12%/wk), early cessation of isotretinoin therapy after detection of an abnormal laboratory result (2.2%/wk, CP only), quality-adjusted life-years (0.84–0.93), and laboratory monitory costs ($5/wk). We collected adverse events, deaths, and quality-adjusted life-years and costs (2020 USD) from a health care payer perspective. Over 1 year, and for 200,000 people on isotretinoin in the United States, the CP strategy resulted in 184,730 quality-adjusted life-years (0.9236 per person), and nonpregnancy laboratory monitoring resulted in 184,770 quality-adjusted life-years (0.9238 per person). The CP and nonpregnancy laboratory monitoring strategies resulted in 0.08 and 0.09 isotretinoin-related deaths, respectively. Nonpregnancy laboratory monitoring was the dominating strategy, realizing$24 million savings per year. No variation of a single parameter across its plausible range changed our cost utility findings. Cessation of laboratory monitoring could realize savings of $24 million per year for the US health care system and improve patient outcomes, with negligible effects on adverse events

The potential cost-effectiveness of novel cord blood therapies in children with autism spectrum disorder.

ObjectiveTo model the long-term clinical and economic outcomes of potential cord blood therapy in autism spectrum disorder (ASD).Study designMarkov microsimulation of ASD over the lifespan was used to compare two strategies: 1) standard of care (SOC), including behavioral and educational interventions, and 2) novel cord blood (CB) intervention in addition to SOC. Input data reflecting behavioral outcomes included baseline Vineland Adaptive Behavior Scale (VABS-3), monthly VABS-3 changes, and CB intervention efficacy on adaptive behavior based on a randomized, placebo-controlled trial (DukeACT). Quality-adjusted life-years (QALYs) were correlated to VABS-3. Costs for children with ASD ($15,791, ages 2-17 years) and adults with ASD ($56,559, ages 18+ years), and the CB intervention (range $15,000-45,000) were incorporated. Alternative CB efficacy and costs were explored.ResultsWe compared model-projected results to published data on life-expectancy, mean VABS-3 changes, and lifetime costs. Undiscounted lifetime QALYs in the SOC and CB strategies were 40.75 and 40.91. Discounted lifetime costs in the SOC strategy were$1,014,000, and for CB ranged from $1,021,000-$1,058,000 with CB intervention cost ($8,000-$45,000). At $15,000 cost, CB was borderline cost-effective (ICER =$105,000/QALY). In one-way sensitivity analysis, CB cost and efficacy were the most influential parameters on CB ICER. CB intervention was cost-effective at costsConclusionsA modestly effective intervention designed to improve adaptive behavior in autism can be cost-effective under certain circumstances. Intervention cost and efficacy most affected the cost-effectiveness results and should be targeted to increase economic efficiency

Clinical Benefits and Cost-Effectiveness of Laboratory Monitoring Strategies to Guide Antiretroviral Treatment Switching in India

Abstract Current Indian guidelines recommend twice-annual CD4 testing to monitor first-line antiretroviral therapy (ART), with a plasma HIV RNA test to confirm failure if CD4 declines, which would prompt a switch to second-line ART. We used a mathematical model to assess the clinical benefits and cost-effectiveness of alternative laboratory monitoring strategies in India. We simulated a cohort of HIV-infected patients initiating first-line ART and compared 11 strategies with combinations of CD4 and HIV RNA testing at varying frequencies. We included adaptive strategies that reduce the frequency of tests after 1 year from 6 to 12 months for virologically suppressed patients. We projected life expectancy, time on failed first-line ART, cumulative 10-year HIV transmissions, lifetime cost (2014 US dollars), and incremental cost-effectiveness ratios (ICERs). We defined strategies as cost-effective if their ICER was <1 × the Indian per capita gross domestic product (GDP, $1,600). We found that the current Indian guidelines resulted in a per person life expectancy (from mean age 37) of 150.2 months and a per person cost of$2,680. Adding annual HIV RNA testing increased survival by ∼8 months; adaptive strategies were less expensive than similar nonadaptive strategies with similar life expectancy. The most effective strategy with an ICER <1 × GDP was the adaptive HIV RNA strategy (ICER $840/year). Cumulative 10-year transmissions decreased from 27.2/1,000 person-years with standard-of-care to 20.9/1,000 person-years with adaptive HIV RNA testing. In India, routine HIV RNA monitoring of patients on first-line ART would increase life expectancy, decrease transmissions, be cost-effective, and should be implemented

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ObjectiveTo model the long-term clinical and economic outcomes of potential cord blood therapy in autism spectrum disorder (ASD).Study designMarkov microsimulation of ASD over the lifespan was used to compare two strategies: 1) standard of care (SOC), including behavioral and educational interventions, and 2) novel cord blood (CB) intervention in addition to SOC. Input data reflecting behavioral outcomes included baseline Vineland Adaptive Behavior Scale (VABS-3), monthly VABS-3 changes, and CB intervention efficacy on adaptive behavior based on a randomized, placebo-controlled trial (DukeACT). Quality-adjusted life-years (QALYs) were correlated to VABS-3. Costs for children with ASD ($15,791, ages 2–17 years) and adults with ASD ($56,559, ages 18+ years), and the CB intervention (range $15,000–45,000) were incorporated. Alternative CB efficacy and costs were explored.ResultsWe compared model-projected results to published data on life-expectancy, mean VABS-3 changes, and lifetime costs. Undiscounted lifetime QALYs in the SOC and CB strategies were 40.75 and 40.91. Discounted lifetime costs in the SOC strategy were$1,014,000, and for CB ranged from $1,021,000-$1,058,000 with CB intervention cost ($8,000-$45,000). At $15,000 cost, CB was borderline cost-effective (ICER =$105,000/QALY). In one-way sensitivity analysis, CB cost and efficacy were the most influential parameters on CB ICER. CB intervention was cost-effective at costsConclusionsA modestly effective intervention designed to improve adaptive behavior in autism can be cost-effective under certain circumstances. Intervention cost and efficacy most affected the cost-effectiveness results and should be targeted to increase economic efficiency.</div

Two-way sensitivity analysis on cord blood intervention efficacy and cost.

This figure shows the effect of varying CB intervention efficacy and cost on cost-effectiveness outcomes. CB intervention efficacy on VABS-3 communication subscale score was varied across the Y-axis, from a mean change of 1.0–6.0. CB intervention cost was varied across the X-axis, ranging from $3,000-$33,000. The projected ICER of each combination of efficacy and cost are shown in the Figure and are color coded: green indicates an ICER $150,000/QALY (Legend). The white star indicates the projected cost-effectiveness of DukeACT intervention basecase parameters. CB: cord blood, VABS: Vineland Adaptive Behavior Scale, ICER: incremental cost-effectiveness ratio.</p

Tornado diagram of cost-effectiveness of one-way sensitivity analyses.

This Figure shows the influence of several individual parameters, varied across their plausible ranges, on cost-effectiveness on the CB intervention. Ranges assessed are presented as (base-case value: value that yields lowest ICER—value that yields highest ICER). The four most influential parameters on cost-effectiveness results were CB cost, CB efficacy, child QOL mapping equation beta parameter, and minor toxicity cost. CB: cord blood, ICER: incremental cost-effectiveness ratio, QALY: quality-adjusted life year, QOL: quality of life, VABS-3: Vineland Adaptive Behavior Scale-3.</p

Lifetime societal costs and quality-adjusted life years.

Lifetime societal costs and quality-adjusted life years.</p

Model input data.

ObjectiveTo model the long-term clinical and economic outcomes of potential cord blood therapy in autism spectrum disorder (ASD).Study designMarkov microsimulation of ASD over the lifespan was used to compare two strategies: 1) standard of care (SOC), including behavioral and educational interventions, and 2) novel cord blood (CB) intervention in addition to SOC. Input data reflecting behavioral outcomes included baseline Vineland Adaptive Behavior Scale (VABS-3), monthly VABS-3 changes, and CB intervention efficacy on adaptive behavior based on a randomized, placebo-controlled trial (DukeACT). Quality-adjusted life-years (QALYs) were correlated to VABS-3. Costs for children with ASD ($15,791, ages 2–17 years) and adults with ASD ($56,559, ages 18+ years), and the CB intervention (range $15,000–45,000) were incorporated. Alternative CB efficacy and costs were explored.ResultsWe compared model-projected results to published data on life-expectancy, mean VABS-3 changes, and lifetime costs. Undiscounted lifetime QALYs in the SOC and CB strategies were 40.75 and 40.91. Discounted lifetime costs in the SOC strategy were$1,014,000, and for CB ranged from $1,021,000-$1,058,000 with CB intervention cost ($8,000-$45,000). At $15,000 cost, CB was borderline cost-effective (ICER =$105,000/QALY). In one-way sensitivity analysis, CB cost and efficacy were the most influential parameters on CB ICER. CB intervention was cost-effective at costsConclusionsA modestly effective intervention designed to improve adaptive behavior in autism can be cost-effective under certain circumstances. Intervention cost and efficacy most affected the cost-effectiveness results and should be targeted to increase economic efficiency.</div