Willingness to pay for a reduction in the mortality risk after a myocardial infarction: an aplication of the contingent valuation method to the case of eplerenone

Background: In order to allocate health care resources more efficiently it is necessary to relate health improvements provided by new medicines with their cost. It is necessary to ascertain when the additional cost of introducing a new health technology is justified by the additional health gain produced. Eplerenone is a new medicine that reduces the risk of death after myocardial infarction (MI) but produces additional cost to the health system. The contingent valuation approach can be used to measure the monetary value of this risk reduction. Objective: to estimate society’s willingness to pay (WTP) for a new medicine that reduces by 2% the risk of death after MI. Methods: We used a contingent valuation approach to evaluate WTP amongst members of the general population. We used the ex-ante and the ex-post approach. In the ex-ante approach subjects are asked if they would accept an increase in their taxes in order to have access to Eplerenone should they need it in the future. In the ex-post approach subjects are asked if they would pay a certain amount of money as co-payment per month during five years if they suffered a MI. We used the Dichotomous Choice method, using five bids in each approach. The WTP was estimated using both single-bound and double-bound dichotomous choice (SBDC, DBDC). Extensive piloting (n=187) preceded the final survey (n=350). Results: The WTP in the ex-ante case was €58 per year under both SBDC and DBDC. In the ex-post case monthly WTP was €144 for the SBDC and €85 for the DBDC. Subjects with higher income and subjects with a higher perception of risk showed a higher WTP (pcontingent valuation, myocardial infarction, mortality, cost-benefit.

Aspectos epidemiológicos, farmacoeconómicos, psicosociales y terapéuticos de la relación entre la enfermedad cardiovascular y el tabaquismo en España

Tesis doctoral inédita, leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Medicina. Fecha de lectura: 03 de mayo de 201

Use of aspirin for primary and secondary prevention of cardiovascular disease in diabetic patients in an ambulatory care setting in Spain

<p>Abstract</p> <p>Background</p> <p>This study was conducted in order to determine the use of aspirin and to assess the achievement of therapeutic targets in diabetic patients according to primary (PP) or secondary prevention (SP).</p> <p>Methods</p> <p>This is a retrospective, observational study including patients ≥18 years with diabetes mellitus followed in four primary care centers. Measurements included demographics, use of aspirin and/or anticoagulant drugs, co-morbidities, clinical parameters and proportion of patient at therapeutic target (TT). Descriptive statistics, chi-square test and logistic regression model were used for significance.</p> <p>Results</p> <p>A total of 4,140 patients were analyzed, 79.1% (95% confidence intervals [CI]: 77.7–80.5%) in PP and 20.9% (95% CI: 18.2–23.7%) in SP. Mean age was 64.1 (13.8) years, and 49.3% of patient were men (PP: 46.3, SP: 60.7, p = 0.001). Aspirin was prescribed routinely in 20.8% (95% CI: 19.4–22.2%) in PP and 60.8% (95% CI: 57.6–64.0%) in SP. Proportion of patient at TT was 48.0% for blood pressure and 59.8% for cholesterol. Use of aspirin was associated to increased age [OR = 1.01 (95% CI: 1.00–1.02); p = 0.011], cardiovascular-risk factors [OR = 1.14 (95% CI: 1.03–1.27); p = 0.013], LDL-C [OR = 1.42 (95% CI: 1.06–1.88); p = 0.017] and higher glycated hemoglobin [OR = 1.51 (95% CI: 1.22–1.89); p = 0.000] were covariates associated to the use of aspirin in PP.</p> <p>Conclusion</p> <p>Treatment with aspirin is underused for PP in patients with diabetes mellitus in Primary Care. Achievement of TT should be improved.</p

Mortalidad por cualquier causa e incidencia de enfermedad cardiovascular en hipertensos con perfil tipo Anglo-Scandinavian Cardiac Outcomes Trial en un ámbito poblacional español

ResumenObjetivosLas poblaciones mediterráneas se han asociado, tradicionalmente, con incidencias más bajas en enfermedades cardiovasculares (ECV). Sin embargo, este dato no se puede homogeneizar para todo tipo de paciente. El objeto del estudio fue comparar la incidencia en ECV y la mortalidad por cualquier causa en pacientes hipertensos con perfil tipo Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) con el resto de hipertensos.DiseñoAnálisis retrospectivo de una base de datos sanitaria. Pacientes hipertensos sin enfermedad cardiovascular conocida incluidos en el tratamiento antihipertensivo durante el año 2006 se siguieron durante 2 años consecutivos para comprobar la incidencia de muerte y los ECV. Los ECV incluían enfermedad coronaria, infarto agudo de miocardio, angina, ictus, accidente isquémico transitorio y arteriopatía periférica. Los pacientes con el perfil tipo ASCOT y tipo ASCOT-Lipid Lowering Arm (LLA) se identificaron y se compararon con hipertensos sin estos perfiles.ResultadosSe incluyó a un total de 11.104 sujetos en el análisis; edad media de 68,0±11,4 años, el 41,6% varones. Más del 73% de los pacientes reunía criterios para considerarse con perfil tipo ASCOT. Los datos de mortalidad por cualquier causa fueron numéricamente más altos en los pacientes tipo ASCOT y ASCOT-LLA comparados con el resto; razón de tasas (intervalo de confianza del 95%=1,3 [0,8–1,9] y 1,6 [0,9–2,8], respectivamente). Sin embargo, la incidencia de cualquier acontecimiento cardiovascular no mortal fue significativamente más alta tanto en tipo ASCOT como ASCOT-LLA (2,3 [1,8–2,8; p<0,001] y 1,8 [1,3–2,4; p<0,001], respectivamente).ConclusionesLos pacientes hipertensos en tratamiento tipo ASCOT presentan más probabilidades de tener cualquier ECV que los pacientes sin ese perfil en un contexto mediterráneo español.AbstractObjectivesMediterranean populations are traditionally considered to be associated with lower incidence of cardiovascular events (CVE). However, this might not be homogeneous throughout different patient strata. The goal was to compare the incidence of CVE and all-causes mortality in hypertensive patients with an ASCOT-type profile with that of the rest hypertensive subjects.MethodsA retrospective analysis was carried out using a claim database. Hypertensive patients without known cardiovascular disease on antihypertensive therapy included during year 2006 were followed up for two consecutive years to ascertain the incidence of all-causes mortality and any CVE. CVE included any of the following: coronary heart disease, acute myocardial infarction (AMI), angina, stroke, transient ischemic attack (TIA) and peripheral artery disease. Patients with ASCOT and ASCOT-LLA type profiles were identified and compared with non-ASCOT-type profile hypertensive subjects.ResultsA total of 11,104 were included in the analysis; 68.0±11.4 years, 41.6% males. More than 73% of subjects fulfilled criteria for ASCOT-type profile. All-causes mortality were numerically higher in ASCOT and ASCOT-LLA subjects compared with non-ASCOT-type; hazard ratio (95% CI)=1.3 (0.8–1.9) and 1.6 (0.9–2.8), respectively. However, any-coronary event rate was significantly higher in ASCOT-type [2.3 (1.8–2.8), p<0.001], as well as in ASCOT-LLA subjects [1.8 (1.3–2.4), p<0.001].ConclusionsHypertensive patients on treatment with ASCOT-type profile are more likely to have any cardiovascular event than those hypertensive patients without ASCOT profile in a Mediterranean setting in Spain