Kosten-Nutzen-Effektivität von Clopidogrel bei akutem Koronarsyndrom: Langzeitbehandlung, sekundäre Prophylaxe, Koronarintervention

Zusammenfassung: Kardiovaskuläre Erkrankungen verursachen weltweit immense Kosten im Gesundheitswesen. Neue Therapieoptionen können Ereignisse und teure Folgehospitalisationen vermeiden. Der Arzt möchte seinen Patienten die bestmögliche Therapie zukommen zu lassen. Bei gestiegenem Kostenbewusstsein besonders im niedergelassenen Bereich ist es jedoch notwendig zu untersuchen, welche Patientengruppen von diesen neuen und häufig ebenfalls kostenintensiven Therapien langfristig profitieren. Diese besonders vor dem Hintergrund der ethischen Verantwortung recht zwiespältige Situation macht Kosten-Nutzen-Untersuchungen auch in der Zukunft unverzichtbar. Der vorliegenden Übersicht kann entnommen werden, in welchen Konstellationen die Gabe von Clopidogrel sowohl auf Kosten- als auch auf medizinischer Nutzenseite besonders geeignet ist. In den meisten hier zitierten Arbeiten erwies sich die Gabe als gerechtfertigt und lag im Rahmen anderer kosteneffektiver Therapien bei kardiovaskulären Krankheite

Influenza Vaccination Coverage Rates in Germany: A Population-Based Cross-Sectional Analysis of the Seasons 2002/2003 and 2003/2004

Abstract : Background and Purpose: : Influenza continues to be a considerable health problem in Europe. Vaccination is the only preventive measure, reducing mortality and morbidity of influenza in all age groups. The objectives of this survey were to assess the level of influenza vaccination coverage in the 2002/2003 season compared with the 2003/2004 season in Germany, to understand the driving forces and barriers to vaccination, and to determine vaccination intentions for the following winter. Methods: : The authors conducted a random-sampling, telephone-based household survey among noninstitutionalized individuals representative of the population aged ≥ 14. The surveys for 2002/2003 and 2003/2004 used the same questionnaire and were subsequently pooled. Four target groups were determined for analysis: (1) persons aged ≥ 60; (2) people working in the medical field; (3) persons suffering from chronic illness; and (4) a group composed of persons aged ≥ 60 or working in the medical field or suffering from a chronic illness. Results: : The overall sample consisted of 4,011 people. The influenza vaccination coverage rate in Germany increased from 22.3% in 2002/2003 to 25.1% in 2003/2004. This increase is not significant. The most frequent reasons for being vaccinated given by vaccinees were: influenza considered to be a serious illness, which people wanted to avoid (90.1%), having received advice from the family doctor or nurse to be vaccinated (71.3%), and not wanting to infect family and friends (70.4%). Reasons for not being vaccinated mentioned by people who have never been vaccinated were: thinking about it, however, not being vaccinated in the end (47.7%), not expecting to catch influenza (43.6%), and not having received a recommendation from the family doctor to be vaccinated (36.6%). Options encouraging influenza vaccination are: recommendation by the family doctor or nurse (66.6%), more available information on the vaccine regarding efficacy and tolerance (54.2%), and more information available about the disease (52.4%). Conclusion: : The vaccination coverage in the 2003/2004 season increased in comparison to the 2002/2003 season, although not significantly. The family doctor is the most important source of encouragement for people to be vaccinated against influenza. It seems that the public would be more likely to be vaccinated if they had more information on the efficacy and tolerance of the vaccine, as well as the disease. It is therefore suggested that family doctors be better informed on influenza vaccine and the disease itself, so that they can actively inform their patients on these topic

Cost-Effectiveness of Losartan Versus Atenolol in Treating Hypertension—An Analysis of the LIFE Study from a Swiss Perspective

Aims: To determine the economic benefit of losartan versus atenolol in patients with essential hypertension from the perspective of the Swiss healthcare system. Methods and results: The cost-effectiveness of losartan versus atenolol in the treatment of hypertension was analyzed by applying the results of the LIFE study to the Swiss healthcare system using a decision analysis framework. The cost-effectiveness shows the losartan cohort to provide an additional life expectancy of 0.05 years per patient compared to the atenolol cohort, over a mean follow-up period of 4.8 years. Losartan therapy in hypertensive patients produced net cost savings of CHF 24 per patient and per 4.8 years compared to atenolol from the perspective of the Swiss health care system. This result was robust after varying costs of medication, stroke, myocardial infarction and life expectancy. Conclusion: The use of a losartan-based regimen in hypertensive patients with left ventricular hypertrophy in Switzerland is net cost-saving compared with a atenolol-based regime

Grippeimpfung in Deutschland: Eine bevölkerungsbezogene Querschnittsanalyse der drei Influenzasaisons von 2002 bis 2005

Zusammenfassung: Hintergrund und Ziel:: Die Influenza ist weltweit ein bedeutendes Gesundheitsproblem. Die Impfung ist die einzige Präventivmaßnahme, welche Mortalität und Morbidität in allen Alterskategorien zu reduzieren vermag. Ziele der vorliegenden Untersuchung waren eine Erhebung der Influenzaimpfungsraten in den Saisons 2002/2003, 2003/2004 und 2004/2005 in Deutschland, die Verbesserung des Verständnisses der Beweg- und Ablehnungsgründe der Impfung und die Erfassung der Zahl der beabsichtigten Impfungen für den folgenden Winter. Methodik:: Die Autoren führten eine zufallsgesteuerte Telefonumfrage in Haushalten durch. Zu der Zielgruppe gehörten nicht institutionalisierte Personen, repräsentativ für die Alterskategorie ≥14 Jahre. Der bei der Untersuchung verwendete Fragebogen war in allen Saisons identisch, und die Antworten konnten gepoolt werden. Für die Analyse wurden vier Zielgruppen identifiziert: 1. Personen im Alter von ≥60 Jahren; 2. Personen, die im medizinischen Bereich tätig sind; 3. Personen mit chronischen Erkrankungen; 4. eine zusammengesetzte Gruppe aus allen vorhergehenden Gruppen, d.h. Personen im Alter von ≥60 Jahren oder Personen, die im medizinischen Bereich beschäftigt oder chronisch erkrankt sind. Ergebnisse:: Die Stichprobengröße betrug 5 990 Personen. Die Impfungsrate nahm von 22,3% in der Saison 2002/2003 über 25,1% in der Saison 2003/2004 bis auf 26,5% in der Saison 2004/2005 zu. Dieser Anstieg ist statistisch signifikant (p = 0,007). Die Impfungsrate der zusammengesetzten Gruppe erhöhte sich von 40,0% (2002/2003) auf 42,2% (2004/2005). Die Beweg- und Ablehnungsgründe der Schutzimpfung haben sich in diesen Jahren nicht verändert. Zu den am häufigsten genannten Beweggründen für eine Schutzimpfung gehören: 1. die Einschätzung, dass Influenza eine schwerwiegende Erkrankung ist, die vermieden werden sollte; 2. eine Empfehlung vom Hausarzt oder Pflegepersonal; 3. die Vermeidung der Ansteckung von Familienmitgliedern und Freunden. Zu den erwähnten Gründen gegen eine Impfung bei Personen, die noch nie geimpft wurden, gehören: 1. Impfung wurde in Erwägung gezogen, am Ende jedoch nicht durchgeführt; 2. Erwartung, sich sowieso nicht mit Influenza anzustecken; 3. keine Empfehlung vom Hausarzt für die Impfung. Als Hauptmotivationsfaktoren für eine Influenzaschutzimpfung wurden angegeben: 1. Empfehlung vom Hausarzt oder Pflegepersonal; 2. weitergehende Informationen über den Impfstoff hinsichtlich der Wirksamkeit und Verträglichkeit; 3. Erhältlichkeit von weiterführenden Informationen über die Krankheit. Schlussfolgerung:: Der Durchimpfungsgrad erhöhte sich über drei Saisons hinweg um insgesamt 4,2%. Die Motivation für eine Influenzaschutzimpfung wird vor allem durch Empfehlungen des Hausarztes positiv beeinflusst. Es scheint außerdem, als würden Informationen über die Wirksamkeit und Verträglichkeit des Impfstoffs sowie über die Krankheit die Impfmotivation der Öffentlichkeit positiv beeinflussen. Die Autoren schlagen daher vor, dass sich Hausärzte besser über den Influenzaimpfstoff und die Erkrankung informieren, damit sie die Informationen über diese Themen aktiv an ihre Patienten weitergeben könne

Pharmacotherapy of Acute Coronary Syndromes: Medical Economics with an Emphasis on Clopidogrel

Summary: Acute coronary syndromes account worldwide for a significant burden of hospital- and societal costs. Pharmacotherapy of acute coronary syndromes consists of a combined antithrombotic therapy. Remarkable therapeutic advances have been made with the introduction of glycoprotein IIb/IIIa receptor inhibitors, low molecular weight heparins and thienopyridines, such as clopidogrel. Based on positive clinical data of large randomized trials numerous cost studies have been undertaken to analyse the cost-effectiveness of these new drugs. Most of them are showing an acceptable level of cost-effectiveness for the new treatments. Taking all available cost-studies into account, we conclude that new antithrombotic treatments are cost-effective as long as their use is limited to selected patient population

Epidemiology and costs of gastroesophageal reflux disease in Switzerland: a population-based study

Summary: Objectives: Assessment of the prevalence, health care resource use and cost of gastroesophageal reflux disease in Switzerland. Methods: A population-based telephone survey was conducted in German and French speaking Switzerland. Reflux cases were defined using a questionnaire proposed by the German Gastro League and answered additional questions on their personal characteristics and resource use. Results: 1274 out of 7222 participants were positively screened. The prevalence of reflux disease in Swiss adults was estimated at 17.6% (95% CI: 15.6%-19.7%) or 993000 individuals. Regular treatment with medication was reported by 38.0% of the reflux positive sample. Reflux-induced general practitioner consultations during the last year were reported by 25.9%. On average, there were 0.84 general practitioner consultations, 0.19 specialist consultations, 0.08 gastroscopies and 0.01 hospitalisations annually. Mean direct medical costs, dominated by medication costs, were CHF 185 per patient-year (95 % CI: CHF 140-230) or 0.5% of Switzerland's total health care expenditures. Total costs were CHF 234 (95% CI: CHF 185-284) per patient-year. Conclusions: The prevalence of reflux disease in Switzerland is similar to that in other industrialised countries. Reflux disease causes considerable costs, in the medical system and at the societal leve

Economic Impact of Hyperhomocysteinemia in Switzerland

Summary: Since more than 20 years elevated homocysteine plasma levels have been associated with an elevated cardiovascular risk. It can be assumed that approx. 5-7% of the Swiss population suffers from hyperhomocysteinemia. These people have an odds ratio of 1.7 (95% confidence interval: 1.5-1.9) to develop a myocardial infarction and an odds ratio of 2.5 (95% confidence interval 2-3) of developing a stroke. These significant cardiovascular endpoints have monetary implications and lead to a loss in life years. The cost consequences and total life years lost were determined with an incidence-based epidemiological model utilizing a Swiss third party payer perspective. We could demonstrate that hyperhomocysteinemia-related sequelae (myocardial infarction and stroke) amount to 41.1-110.2 million CHF. In addition it can be estimated that 6′941-18′478 life years may be lost. Comparing these data with the total costs for cardiovascular disease in Switzerland of CHF 987 million, we estimate the share of the economic burden of hyperhomocysteinemia at approximately 10%. Preventive measures could thus yield a positive impact on total health care expenditure in the Swiss healthcare system and warrants further researc

Predictors of family communication of one’s organ donation intention in Switzerland

OBJECTIVES: Family members continue to play a prominent role in decisions to donate organs at the time of death. Prior knowledge of the deceased's intention to donate was identified as an important influential factor in the donation decision-making process. This study examined what factors lead to family communication of a person's wish regarding organ donation. METHODS: A population-based survey was used to identify the prevalence of people who had informed family members of their intention to donate. Associated factors were evaluated using bivariate and multivariate analyses. RESULTS: Multivariate analysis revealed that communication to a family member of the intention to donate organs was more likely if the respondent had a signed donor card (OR = 10.23, CI = 5.25-19.93), had a family discussion on organ donation or transplantation (OR = 7.12, CI = 4.91-10.34), had a partner and knew his or her attitude to organ donation (OR = 5.76, CI = 4.20-7.90), had previously personally had a good look at the issue of organ donation (OR = 2.59, CI = 1.79-3.75), was rather younger (OR = 0.98, CI = 0.97-0.99), was of Swiss nationality (OR = 2.21, CI = 1.25-3.91), felt that he or she was sufficiently informed (OR = 2.10, CI = 1.50-2.94), had the information necessary to come to an appropriate decision on organ donation and-although this relation may be weaker-were (rather) willing to become an organ donor after death (OR = 1.41, CI = 1.01-1.97). CONCLUSIONS: Our findings highlight the need for public education and community campaigns to promote the need to share with others, the intention to donate and to increase people's knowledge on this issue

Statistical Modeling of Epistasis and Linkage Decay using Logic Regression

Logic regression has been recognized as a tool that can identify and model non-additive genetic interactions using Boolean logic groups. Logic regression, TASSEL-GLM and SAS-GLM were compared for analytical precision using a previously characterized model system to identify the best genetic model explaining epistatic interaction of vernalization-sensitivity in barley. A genetic model containing two molecular markers identified in vernalization response in barley was selected using logic regression while both TASSEL-GLM and SAS-GLM included spurious associations in their models. The results also suggest the logic regression can be used to identify dominant/recessive relationships between epistatic alleles through its use of conjugate
operators