Direct costs of hypertensive patients admitted to hospital in Vietnam:a bottom-up micro-costing analysis

Background: There is an economic burden associated with hypertension both worldwide and in Vietnam. In Vietnam, patients with uncontrolled high blood pressure are hospitalized for further diagnosis and initiation of treatment. Because there is no evidence on costs of inpatient care for hypertensive patients available yet to inform policy makers, health insurance and hospitals, this study aims to quantify direct costs of inpatient care for these patients in Vietnam. Methods: A retrospective study was conducted in a hospital in Vietnam. Direct costs were analyzed from the health-care provider's perspective. Hospital-based costing was performed using both bottom-up and micro-costing methods. Patients with sole essential or primary hypertension (ICD-code I10) and those comorbid with sphingolipid metabolism or other lipid storage disorders (ICD-code E75) were selected. Costs were quantified based on financial and other records of the hospital. Total cost per patient resulted from an aggregation of laboratory test costs, drug costs, inpatient-days' costs and other remaining costs, including appropriate allocation of overheads. Both mean and medians, as well as interquartile ranges (IQRs) were calculated. In addition to a base-case analysis, specific scenarios were analyzed. Results: 230 patients were included in the study (147 cases with I10 code only and 83 cases with I10 combined with E75). Median length of hospital stay was 6 days. Median total direct costs per patient were US$65 (IQR: 37 -95). Total costs per patient were higher in the combined hypertensive and lipid population than in the sole hypertensive population at US$78 and US$53, respectively. In all scenarios, hospital inpatient days' costs were identified as the major cost driver in the total costs. Conclusions: Costs of hospitalization of hypertensive patients is relatively high compared to annual medication treatment at a community health station for hypertension as well as to the total health expenditure per capita in Vietnam. Given that untreated/undetected hypertension likely leads to more expensive treatments of complications, these findings may justify investments by the Vietnamese health-care sector to control high blood pressure in order to save downstream health care budgets

Models to Predict the Burden of Cardiovascular Disease Risk in a Rural Mountainous Region of Vietnam

Objective: To compare and identify the most appropriate model to predict cardiovascular disease (CVD) in a rural area in Northern Vietnam, using data on hypertension from the communities. Methods: A cross-sectional survey was conducted including all residents in selected communities, aged 34 to 65 years, during April to August 2012 in Thai Nguyen province. Data on age, sex, smoking status, blood pressure, and blood tests (glucose, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol) were collected to identify the prevalence of high blood pressure and to use as input variables for the models. We compared three models, Asian, Chinese Multiple-provincial Cohort Study (CMCS), and Framingham, to estimate cardiovascular risk in the coming years in this context and compare these models and outcomes. Results: The prevalence of high blood pressure in these communities was lower than reported nationally (12.3%). CVD risk differed greatly depending on the model applied: approximately 21% of the subjects according to the CMCS and Asian models, but 37% using the Framingham model, had more than 10% risk for CVD. In the group without current CVD, these numbers decreased to 9% using the CMCS and Asian models but increased to 28% according to the Framingham model. There were no significant differences between the Asian and CMCS models, but differences were highly significant when comparing Asian versus Framingham or CMCS versus Framingham model. Conclusions: The Asian and CMCS models provided similar results in predicting CVD risk in the Vietnamese population in Thai Nguyen. The Framingham model provided vastly different results. The suggestion may be that for the specific Vietnamese setting, the Asian and CMCS models provide most valid and reliable results; however, this has to be investigated in further analyses using real-life data for potential confirmation. © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR)

Kosteneffectiviteit van influenzavaccinatie bij ouderen met inclusie van indirecte medische kosten

To assess the cost-effectiveness of influenza vaccination in the elderly (60+ and 65+) with and without taking into account indirect medical costs. Design and methods Total costs of vaccinating the elderly were calculated by adding health care costs, vaccination costs and indirect medical costs. Indirect medical costs were determined with a newly developed model ‘Practical Application to Include future Disease costs’ (PAID 1.0). These costs were compared with those in a situation of no vaccination. The differences in costs were related to health gains to calculate the net costs per life year gained (LYG). Results are reported with and without including indirect medical costs. Analyses were done for elderly of 60+ and 65+, separately, and in- and excluding indirect medical costs. Results Total costs for influenza vaccination in The Netherlands in 2008 were approximately € 107 million. Cost-effectiveness when including indirect medical costs was € 13,589/LYG for 65+ and € 15,244/ LYG for 60+. When distinguishing high-risk and low-risk elderly,vaccination of high-risk elderly (65+) costed € 12,665/LYG including indirect medicals costs and € 1,071/LYG without indirect medical costs; for low-risk elderly (65+) these costs were respectively € 15,576/LYG and € 7,552/LYG. For specific subgroups, such as low-risk elderly aged 60-64, costs may exceed € 20,000/LYG, but still remain below € 50,000/LYG. Conclusion Even when including indirect medical costs, influenza vaccination of the elderly (65+) is highly cost-effective (< € 20,000/LYG). More transparency is needed on the exact level of the cost-effectiveness threshold, in particular if indirect medical costs are to be included in cost-effectiveness analyses

The therapeutic potential of essential oils in managing inflammatory skin conditions: A scoping review

Conventional therapy is commonly used for the treatment of inflammatory skin conditions, but undesirable effects, such as erythema, dryness, skin thinning, and resistance to treatment, may cause poor patient compliance. Therefore, patients may seek for complementary treatment with herbal plant products including essential oils (EOs). This scoping review aims to generate a complete overview of EOs used to treat inflammatory skin conditions, being acne vulgaris, dermatitis, psoriasis, and/or rosacea, in a clinical setting. The quality, efficacy, and safety of various EOs and preparations thereof are described, and the potential and limitations of EOs in the treatment of inflammatory skin conditions are shown. Twenty-nine eligible studies (case studies, uncontrolled clinical trials, randomized clinical trials) on EO applications for inflammatory skin conditions were retrieved from global electronic databases (PubMed, Embase, Scopus, Cochrane library). Tea tree (Melaleuca alternifolia) oil emerged as the most studied EO. Clinical trials with tea tree oil gel for acne treatment showed efficacy with fewer adverse drug reactions compared to conventional treatment. Uncontrolled studies indicated the potential efficacy of ajwain (Trachyspermum ammi) oil , eucalyptus (Eucalyptus globulus) oil, and cedarwood (Cedrus libani) oil in the treatment of acne, but further research is required to reach conclusive evidence. Placebo-controlled studies revealed positive effects of kanuka (Kunzea ericoides) oil and boswellia (Boswellia sp.) oil (frankincense) in psoriasis and eczema. The quality verification of the EO products was inconsistent, with some studies lacking analyses and transparency on this point. Quality limitations of some trials included small sample sizes, short durations, and the absence of a control group. This scoping review underscores the need for extended, well-designed clinical trials to further assess EO efficacy and safety for treating inflammatory skin conditions with products of ensured quality, and to further elucidate mechanisms of action involved

Role of phosphoinositide metabolism in human bronchial smooth muscle contraction and in functional antagonism by beta-adrenoceptor agonists

The aim of the present investigation was to study in human bronchial smooth muscle (1) the relationship between methacholine and histamine-induced inositol phosphate (IP) production and contraction, (2) the influence of increasing concentrations of methacholine and histamine on the relaxation (pD2 and Emax) by isoproterenol (functional antagonism), and (3) the relation between IP production by methacholine and histamine and the changes of pD2 and Emax values of isoproterenol-induced relaxation. Methacholine and histamine were full agonists in contracting human bronchial smooth muscle, with pD2 values of 6.01 +/- 0.18 and 6.07 +/- 0.04, respectively. With IP production, however, pD2 values of 4.90 +/- 0.06 for methacholine and 5.15 +/- 0.16 for histamine were obtained, indicating a considerable reserve of PI metabolism for contraction. With increasing concentrations of histamine and methacholine (to 1 and 0.1 mM, respectively), subsequently performed dose-relaxation curves with isoproterenol showed decreasing values of pD2 (from 8.25 +/- 0.20 to 7.28 +/- 0.28) and Emax (from 100% to 56.7 +/- 12.4%). No differences were observed between methacholine and histamine in this respect. A significant correlation was found between IP production induced by the various concentrations of methacholine and histamine and the reduction of isoproterenol pD2 and Emax values. The results strongly suggest that PI metabolism may play an important role in the reduced efficacy of beta-adrenoceptor agonists to induce bronchodilation during active and severe asthma