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Konishi T, Fujiogi M, Michihata N, Ohbe H, Matsui H, Fushimi K, Tanabe M, Seto Y, Yasunaga H. Cost-effectiveness analysis of trastuzumab monotherapy versus adjuvant chemotherapy plus trastuzumab in elderly patients with HER2-positive early breast cancer. Jpn J Clin Oncol 2022; 52:1115-1123. [PMID: 35775313 DOI: 10.1093/jjco/hyac107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 06/16/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In elderly patients with human epidermal growth factor 2-positive breast cancer, adjuvant chemotherapy was associated with decreased quality of life, with relatively small benefits for prognosis. We examined the cost-effectiveness of trastuzumab monotherapy versus adjuvant chemotherapy plus trastuzumab in elderly patients with human epidermal growth factor 2-positive breast cancer. METHODS A Markov model was developed to evaluate the costs and benefits of trastuzumab monotherapy over adjuvant chemotherapy plus trastuzumab for elderly patients with human epidermal growth factor 2-positive breast cancer. We built the model with a yearly cycle over a 20-year time horizon and five health states: disease-free, relapse, post-relapse, metastasis and death. The parameters in the model were based on a previous randomized controlled trial and a nationwide administrative database in Japan. The incremental cost-effectiveness ratio, expressed as Japanese yen per the quality-adjusted life-years, was estimated from the perspective of health care payers. One-way deterministic sensitivity analysis and probabilistic sensitivity analysis with Monte-Carlo simulations of 10 000 samples were conducted. RESULTS The incremental cost-effectiveness ratio of trastuzumab monotherapy over adjuvant chemotherapy plus trastuzumab was $\sim$1.8 million Japanese yen /quality-adjusted life-year. The one-way deterministic sensitivity analysis showed that transition probability from disease-free to metastasis status and cost of metastasis status had the greatest influence on the incremental cost-effectiveness ratio. More than half the estimates in the probabilistic sensitivity analysis were located below a threshold of willingness-to-pay of 5 million Japanese yen /quality-adjusted life-year. CONCLUSION In this first comparative cost-effectiveness analysis of adjuvant chemotherapy plus trastuzumab versus trastuzumab monotherapy in the elderly, the latter was found favorable for elderly patients with human epidermal growth factor 2-positive breast cancer.
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Affiliation(s)
- Takaaki Konishi
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Michimasa Fujiogi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.,Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Masahiko Tanabe
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasuyuki Seto
- Department of Breast and Endocrine Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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Albuquerque de Almeida F, Corro Ramos I, Rutten-van Mölken M, Al M. Modeling Early Warning Systems: Construction and Validation of a Discrete Event Simulation Model for Heart Failure. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1435-1445. [PMID: 34593166 DOI: 10.1016/j.jval.2021.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 03/12/2021] [Accepted: 04/06/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Developing and validating a discrete event simulation model that is able to model patients with heart failure managed with usual care or an early warning system (with or without a diagnostic algorithm) and to account for the impact of individual patient characteristics in their health outcomes. METHODS The model was developed using patient-level data from the Trans-European Network - Home-Care Management System study. It was coded using RStudio Version 1.3.1093 (version 3.6.2.) and validated along the lines of the Assessment of the Validation Status of Health-Economic decision models tool. The model includes 20 patient and disease characteristics and generates 8 different outcomes. Model outcomes were generated for the base-case analysis and used in the model validation. RESULTS Patients managed with the early warning system, compared with usual care, experienced an average increase of 2.99 outpatient visits and a decrease of 0.02 hospitalizations per year, with a gain of 0.81 life years (0.45 quality-adjusted life years) and increased average total costs of €11 249. Adding a diagnostic algorithm to the early warning system resulted in a 0.92 life year gain (0.57 quality-adjusted life years) and increased average costs of €9680. These patients experienced a decrease of 0.02 outpatient visits and 0.65 hospitalizations per year, while they avoided being hospitalized 0.93 times. The model showed robustness and validity of generated outcomes when comparing them with other models addressing the same problem and with external data. CONCLUSIONS This study developed and validated a unique patient-level simulation model that can be used for simulating a wide range of outcomes for different patient subgroups and treatment scenarios. It provides useful information for guiding research and for developing new treatment options by showing the hypothetical impact of these interventions on a large number of important heart failure outcomes.
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Affiliation(s)
| | - Isaac Corro Ramos
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Maureen Rutten-van Mölken
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Maiwenn Al
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Albuquerque de Almeida F, Corro Ramos I, Al M, Rutten-van Mölken M. Home telemonitoring and a diagnostic algorithm in the management of heart failure in the Netherlands: a cost-effectiveness analysis (Preprint). JMIR Cardio 2021; 6:e31302. [PMID: 35925670 PMCID: PMC9389378 DOI: 10.2196/31302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/16/2021] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
Background Objective Methods Results Conclusions
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Affiliation(s)
| | - Isaac Corro Ramos
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Maiwenn Al
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Maureen Rutten-van Mölken
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
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van Voorst H, Arnold AER. Cost and health effects of case management compared with outpatient clinic follow-up in a Dutch heart failure cohort. ESC Heart Fail 2020; 7:1136-1144. [PMID: 32301235 PMCID: PMC7261554 DOI: 10.1002/ehf2.12692] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 03/03/2020] [Accepted: 03/11/2020] [Indexed: 12/28/2022] Open
Abstract
AIMS Heart failure reduces quality of life and life expectancy; hospital admissions are frequent and create a burden on public resources. This study aims to quantify the benefits in terms of health effects [quality-adjusted life years (QALYs)] and costs when heart failure patients receive case management at home compared with outpatient cardiology clinic follow-up. METHODS AND RESULTS A health state transition (Markov) model was written, and transition probabilities were derived from a cohort of 1114 patients and available literature. QALYs in different health states of heart failure patients were retrieved from the literature, and costs were estimated with data from the financial department of the Noordwest Ziekenhuisgroep and public cost sources. Monthly simulation cycles were repeated 60 times to generate 5 years of virtual follow-up data. Baseline willingness to pay is assumed €50 000 per QALY. Sensitivity analyses were performed in a one-way deterministic and a multiway probabilistic approach; the probabilistic approach used uniform and more plausible distributions of the model parameters. Case management reduced costs by €382 and increased QALYs by 0.261 for the baseline simulation; this results in a net monetary benefit of €13 428. Probabilistic sensitivity analysis based on uniform and most plausible distributions of parameters resulted in 96.2% and 83.3% of the simulations, favouring a treatment strategy of case management. CONCLUSIONS Case management is cost effective in 83.3% of the probabilistic simulations and has a tendency towards reducing costs and increasing QALYs when considering a real-world cohort of heart failure patients in the Netherlands.
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Affiliation(s)
- Henk van Voorst
- Department of Cardiology, Amsterdam UMCVrije Universiteit AmsterdamVU Amsterdam Main building, De Boelelaan 1105Amsterdam1081 HVthe Netherlands
- CardiologyNoordwest ZiekenhuisgroepAlkmaarthe Netherlands
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Valuing health-related quality of life in heart failure: a systematic review of methods to derive quality-adjusted life years (QALYs) in trial-based cost-utility analyses. Heart Fail Rev 2020; 24:549-563. [PMID: 30903357 PMCID: PMC6560006 DOI: 10.1007/s10741-019-09780-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The accurate measurement of health-related quality of life (HRQoL) and the value of improving it for patients are essential for deriving quality-adjusted life years (QALYs) to inform treatment choice and resource allocation. The objective of this review was to identify and describe the approaches used to measure and value change in HRQoL in trial-based economic evaluations of heart failure interventions which derive QALYs as an outcome. Three databases (PubMed, CINAHL, Cochrane) were systematically searched. Twenty studies reporting economic evaluations based on 18 individual trials were identified. Most studies (n = 17) utilised generic preference-based measures to describe HRQoL and derive QALYs, commonly the EQ-5D-3L. Of these, three studies (from the same trial) also used mapping from a condition-specific to a generic measure. The remaining three studies used patients’ direct valuation of their own health or physician-reported outcomes to derive QALYs. Only 7 of the 20 studies reported significant incremental QALY gains. Most interventions were reported as being likely to be cost-effective at specified willingness to pay thresholds. The substantial variation in the approach applied to derive QALYs in the measurement of and value attributed to HRQoL in heart failure requires further investigation.
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Dragunov DO, Sokolova AV, Arutyunov GP, Gasanova AD, Latyshev TV. [Quality of life in patients with heart failure with preserved ejection fraction and the bendopnea symptom]. ACTA ACUST UNITED AC 2019; 59:24-32. [PMID: 31340746 DOI: 10.18087/cardio.2507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 07/24/2019] [Indexed: 11/18/2022]
Abstract
PURPOSE The study of quality of life (QOL) in patients with CHF with preserved LVEF (left ventricular ejection fraction) and a symptom of bendopnea with different levels of salt intake. Materials and methods. The study included 66 patients. The main symptoms of CHF were edema in 54.5% of cases, dyspnea in 77% of cases, ascites was detected in only 2 patients, an enlarged liver in 7 patients. Abdominal obesity was detected in 53 patients. Quality of life was assessed by the SF‑36 questionnaire, the level of salt intake was assessed by the Charlton: SaltScreener questionnaire. Results. On average, the time of occurrence of the bendopnea was 22.5±9.3 seconds, the minimum was 5 seconds. The absence of the effect of abdominal obesity on the risk of bendopnea (relative risk 1.18 [0.76; 1.83]) was revealed. According to the SF‑36 questionnaire, a decrease in physical health indicators (median 31.3 points [20.7; 42.3]) and psychological health (average score 43.2±21.7) was found. In patients with bendopnea, QOL was reduced due to both physical and mental health, unlike patients without bendopnea: physical functioning (Physical Functioning - PF) 24.8±16.1 against 47±28.9 points, p=0.001 ; role‑based functioning due to physical condition (Role‑Physical Functioning - RP), 0 [0; 25] vs. 37.5 [0; 100] points, p=0.008; general health (General Health - GH) 29.9±15.8 against 50±14.2 points, p=0.0005, social functioning (Social Functioning - SF) 56 ± 38 against 78.9 ± 17.8 points ; p = 0.004. Multidimensional regression analysis revealed the relationship between the time of occurrence of the symptom bendopnea and the level of salt intake, physical and psychological activity (r2=0.25; p<0.009). The time of onset of the symptom of bendopnea in patients with CHF decompensation was significantly longer (18.9±8.7 vs. 26.2±8.5 seconds, p=0.003). The presence of diseases such as hypertension, COPD, IHD, atrial fibrillation, cerebrovascular disease did not significantly affect QOL (p> 0.05), while the presence of bronchial asthma or chronic kidney disease significantly reduced QOL of patients (p<0.05). Conclusion. The presence of the symptom bendopnea significantly reduces the quality of life of patients with CHF with preserved LVEF (left ventricular ejection fraction).
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Affiliation(s)
- D O Dragunov
- Pirogov Russian National Research Medical University
| | - A V Sokolova
- Pirogov Russian National Research Medical University
| | - G P Arutyunov
- Pirogov Russian National Research Medical University
| | - A D Gasanova
- Municipal Outpatient Hospital #6 of the Moscow Healthcare Department
| | - T V Latyshev
- Pirogov Russian National Research Medical University
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Alarid-Escudero F, Blaes AH, Kuntz KM. Trade-offs Between Efficacy and Cardiac Toxicity of Adjuvant Chemotherapy in Early-Stage Breast Cancer Patients: Do Competing Risks Matter? Breast J 2017; 23:401-409. [DOI: 10.1111/tbj.12757] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Fernando Alarid-Escudero
- Division of Health Policy and Management; University of Minnesota School of Public Health; Minneapolis Minnesota
| | - Anne H. Blaes
- Hematology; Oncology and Transplantation; University of Minnesota; Minneapolis Minnesota
| | - Karen M. Kuntz
- Division of Health Policy and Management; University of Minnesota School of Public Health; Minneapolis Minnesota
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Economic Evaluation of Exercise-Based Cardiac Rehabilitation Programs for Chronic Heart Failure Patients in Colombia. J Cardiopulm Rehabil Prev 2016; 36:12-9. [PMID: 26702862 DOI: 10.1097/hcr.0000000000000150] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE Cardiac rehabilitation (CR) in patients with chronic heart failure (CHF) has met with resistance from third-party payers in low- and middle-income countries because of lack of evidence regarding its cost-effectiveness. We aimed to provide information to help better inform this decision-making process. METHODS Costs associated with a 12-week exercise-based rehabilitation program in Colombia for patients with CHF were estimated. We collected data on all medical resources used in ambulatory care and data on hospital costs incurred for treating patients with uncompensated CHF. A literature search to establish the hospitalization rates because of uncompensated CHF, death because of CHF, and potential decreases in these data because of the utilization of CR was conducted. We modeled incremental costs and effectiveness over a period of 5 years from the perspective of the third-party payer. RESULTS All costs were converted from Colombian pesos to US dollars. For an exercise-based CR program of 12-week duration (36 sessions), costs ranged from US$265 to US$369 per patient. Monthly costs associated with ambulatory care of CHF averaged US$128 ± US$321 per patient, and hospitalization costs were US$3621 ± US$5 444 per event. Yearly hospitalization incidence rates with and without CR were 0.154 and 0.216, respectively. The incremental cost of CR would be US$998 per additional quality-adjusted life-year. Sensitivity analysis did not significantly change these results. CONCLUSIONS Cardiac rehabilitation in patients with CHF in settings such as Colombia can be a cost-effective strategy, with minimal incremental costs and better quality of life, mainly because of decreased rates of hospitalization.
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Louredo ABD, Leite ALC, Salerno GRF, Fernandes M, Blascovi-Assis S. Instruments to assess quality of life in patients with heart failure. FISIOTERAPIA EM MOVIMENTO 2015. [DOI: 10.1590/0103-5150.028.004.ar03] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction : Heart failure (HF) is a complex clinical syndrome representing the common final pathway of various heart diseases. It is characterized by low exercise tolerance, low survival rates and deteriorated quality of life. Several studies mention Quality of Life (QoL) as an important source of information on how disease truly affects patient's lives. In this context, the assessment of QoL is extremely important to provide data that support the choice of a therapeutic strategy and the assessment of the effectiveness of a treatment. Objectives : This study aimed to investigate and identify the most appropriate and widely used instrument for the assessment of quality of life in patients with HF. Methods : We searched the databases of Lilacs, Medline, Pubmed, Scielo and CAPES to identify relevant articles published in English and Portuguese between 2000 and 2010. Results : We found 25 papers that described, quoted or used instruments for the assessment of QoL in patients with HF. Conclusion : The MLHFQ is the most widely used instrument to assess QoL in patients with HF. Its good metric properties have been confirmed in a large number of studies. In addition, it has a simple structure and is easy to administer, which makes it the most recommended instrument for this purpose.
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Berg J, Lindgren P, Mejhert M, Edner M, Dahlström U, Kahan T. Determinants of Utility Based on the EuroQol Five-Dimensional Questionnaire in Patients with Chronic Heart Failure and Their Change Over Time: Results from the Swedish Heart Failure Registry. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2015; 18:439-48. [PMID: 26091598 DOI: 10.1016/j.jval.2015.02.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 01/30/2015] [Accepted: 02/11/2015] [Indexed: 05/13/2023]
Abstract
BACKGROUND There is limited information on drivers of utilities in patients with chronic heart failure (CHF). OBJECTIVES To analyze determinants of utility in CHF and drivers of change over 1 year in a large sample from clinical practice. METHODS We included 5334 patients from the Swedish Heart Failure Registry with EuroQol five-dimensional questionnaire information available following inpatient or outpatient care during 2008 to 2010; 3495 had 1-year follow-up data. Utilities based on Swedish and UK value sets were derived. We applied ordinary least squares (OLS) and two-part models for utility at inclusion and OLS regression for change over 1 year, all with robust standard errors. We assessed the predictive accuracy of both models using cross-validation. RESULTS Patients' mean age was 73 years, 65% were men, 19% had a left ventricular ejection fraction of 50% or more, 23% had 40% to 49%, 27% had 30% to 39%, and 31% had less than 30%. For both models and value sets, utility at inclusion was affected by sex, age, New York Heart Association class, ejection fraction, hemoglobin, blood pressure, lung disease, diabetes, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, nitrates, antiplatelets, and diuretics. The OLS model performed slightly better than did the two-part model on a population level and for capturing utility ranges. Change in utility over 1 year was influenced by age, sex, and (measured at inclusion) disease duration, New York Heart Association class, blood pressure, ischemic heart disease, lung disease, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and antiplatelets. CONCLUSIONS Utilities in CHF and their change over time are influenced by diverse demographic and clinical factors. Our findings can be used to target clinical interventions and for economic evaluations of new therapies.
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Affiliation(s)
- Jenny Berg
- Division of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Solna, Sweden; OptumInsight, Stockholm, Sweden.
| | - Peter Lindgren
- Medical Management Center, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Solna, Sweden; IVBAR, Stockholm, Sweden
| | - Märit Mejhert
- Department of Medicine, Ersta Hospital, Stockholm, Sweden; Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Edner
- Karolinska Institutet, Heart Research Unit, Karolinska University Hospital, Solna, Sweden
| | - Ulf Dahlström
- Departments of Cardiology and Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Thomas Kahan
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
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Aitken EL, Jackson AJ, Hameed H, Chandramohan M, Kasthuri R, Kingsmore DB. Cephalic arch stenosis: angioplasty to preserve a brachiocephalic fistula or new brachiobasilic fistula?: a cost-effectiveness study. Ren Fail 2014; 36:1550-8. [DOI: 10.3109/0886022x.2014.949763] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Agvall B, Paulsson T, Foldevi M, Dahlström U, Alehagen U. Resource use and cost implications of implementing a heart failure program for patients with systolic heart failure in Swedish primary health care. Int J Cardiol 2014; 176:731-8. [PMID: 25131925 DOI: 10.1016/j.ijcard.2014.07.105] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 07/09/2014] [Accepted: 07/26/2014] [Indexed: 01/03/2023]
Abstract
AIM Heart failure (HF) is a common but serious condition which involves a significant economic burden on the health care economy. The purpose of this study was to evaluate cost and quality of life (QoL) implications of implementing a HF management program (HFMP) in primary health care (PHC). METHODS AND RESULTS This was a prospective randomized open-label study including 160 patients with a diagnosis of HF from five PHC centers in south-eastern Sweden. Patients randomized to the intervention group received information about HF from HF nurses and from a validated computer-based awareness program. HF nurses and physicians followed the patients intensely in order to optimize HF treatment according to current guidelines. The patients in the control group were followed by their regular general practitioner (GP) and received standard treatment according to local management routines. No significant changes were observed in NYHA class and quality-adjusted life years (QALY), implying that functional class and QoL were preserved. However, costs for hospital care (HC) and PHC were reduced by EUR 2167, or 33%. The total cost was EUR 4471 in the intervention group and EUR 6638 in the control group. CONCLUSIONS Introducing HFMP in Swedish PHC in patients with HF entails a significant reduction in resource utilization and costs, and maintains QoL. Based on these results, a broader implementation of HFMP in PHC may be recommended. However, results should be confirmed with extended follow-up to verify long-term effects.
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Affiliation(s)
- Björn Agvall
- Department of Medical and Health Sciences, Linkoping University, Department of Primary Health Care, Linkoping, County of Östergötland, Sweden.
| | - Thomas Paulsson
- Global Health Economics and Outcomes Research, Bristol-Myers Squibb, Belgium
| | - Mats Foldevi
- Department of Medical and Health Sciences, Linkoping University, Department of Primary Health Care, Linkoping, County of Östergötland, Sweden
| | - Ulf Dahlström
- Division of Cardiovascular Medicine, Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Department of Cardiology UHL, County Council of Östergötland, Linköping, Sweden
| | - Urban Alehagen
- Division of Cardiovascular Medicine, Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Department of Cardiology UHL, County Council of Östergötland, Linköping, Sweden
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Panasewicz A, Pedersen SS, Veenhuis SJG, Oemrawsingh RM, van der Giessen WJ, van Geuns RJ, Regar E, de Jaegere PP, Serruys PW, van Domburg RT. Health-related quality of life in the elderly three years after percutaneous coronary intervention. EUROINTERVENTION 2014; 9:373-81. [PMID: 23872651 DOI: 10.4244/eijv9i3a60] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Long-term health-related quality of life (HRQOL) in the elderly after percutaneous coronary intervention (PCI) is unknown. We 1) compared HRQOL of elderly (≥70 years) with younger patients (<70 years) at 6, 12, 36 months post-PCI, and 2) examined whether predictors of impaired HRQOL 36 months post-PCI differed between older and younger patients. METHODS AND RESULTS A prospective cohort of 651 PCI patients (26.3% ≥70 years) completed the SF-36 at 6, 12 and 36 months post-PCI. Older patients experienced a poorer physical HRQOL at all time points and worse mental HRQOL with respect to vitality and role emotional functioning (all p-values<0.05). By 36 months, the HRQOL for the older patients worsened in five of the eight subdomains (all p-values<0.05). Younger patients did not experience enduring changes in HRQOL, with the exception of role physical functioning. Predictors of impaired HRQOL were generally different for the elderly (diabetes, previous PCI) compared to younger cohorts (smoking, previous bypass surgery, ACE inhibitors), although poor six-month HRQOL, anxiety and depression were common predictors for both groups. CONCLUSIONS Elderly PCI patients experience a deteriorating and poorer HRQOL than younger patients across three years. Contrary to younger patients, three-year HRQOL of elderly patients is irrespective of adverse events during outcomes.
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Affiliation(s)
- Anna Panasewicz
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
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Ågren S, S Evangelista L, Davidson T, Strömberg A. Cost-effectiveness of a nurse-led education and psychosocial programme for patients with chronic heart failure and their partners. J Clin Nurs 2013; 22:2347-53. [PMID: 23829407 DOI: 10.1111/j.1365-2702.2012.04246.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES This randomised controlled trial was conducted to estimate the cost-effectiveness of a nurse-led education and psychosocial support programme for patients with heart failure (HF) and their partners. BACKGROUND There are few studies evaluating cost-effectiveness of interventions among HF patient-partner dyads. METHODS Dyads randomised to the experimental group received nurse-led counselling, computer-based education and written materials aimed at developing problem-solving skills at two, six and 12 weeks after hospitalisation with HF exacerbation. The dyads in the control group received usual care. A cost-effectiveness analysis that included costs associated with staff time to deliver the intervention and travel costs was conducted at 12 months. Quality-adjusted life-year (QALY) weights for patients and partners were estimated by SF-6D. RESULTS A total of 155 dyads were included. The intervention cost was €223 per patient. Participants in both groups showed improvements in QALY weights after 12 months. However, no significant difference in QALY weights was found between the patients in the two groups, nor among their partners. CONCLUSION The intervention was not proven cost-effective, neither for patients nor for partners. The intervention, however, had trends (but not significant) effects on the patient-partner dyads, and by analysing the QALY gained from the dyad, a reasonable mean cost-effectiveness ratio was achieved. RELEVANCE TO CLINICAL PRACTICE The study shows trends of a cost-effective education and psychosocial care of HF patient-partner dyads.
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Affiliation(s)
- Susanna Ågren
- Thoracic and Vascular Nursing, Department of Medicine and Health Sciences, Linköping University, Division of Nursing Sciences, Linköping University, Linköping, Sweden.
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Granström O, Levin LÅ, Henriksson M. Cost-effectiveness of candesartan versus losartan in the primary preventive treatment of hypertension. CLINICOECONOMICS AND OUTCOMES RESEARCH 2012; 4:313-22. [PMID: 23144565 PMCID: PMC3493257 DOI: 10.2147/ceor.s35824] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background Although angiotensin receptor blockers have different receptor binding properties, no comparative randomized studies with cardiovascular event endpoints have been performed for this class of drugs. The aim of this study was to assess the long-term cost-effectiveness of candesartan (Atacand®) versus generic losartan in the primary preventive treatment of hypertension. Methods A decision-analytic model was developed to estimate costs and health outcomes over a patient’s lifetime. Data from a clinical registry study were used to estimate event rates for cardiovascular complications, such as myocardial infarction and heart failure. Costs and quality of life data were from published sources. Costs were in Swedish kronor and the outcome was quality-adjusted life-years (QALYs). Results Due to reduced rates of cardiovascular complications, candesartan was associated with a QALY gain and lower health care costs compared with generic losartan (0.053 QALYs gained and reduced costs of approximately 4700 Swedish kronor for women; and 0.057 QALYs gained and reduced costs of approximately 4250 Swedish kronor for men). This result was robust in several sensitivity analyses. Conclusion When modeling costs and health outcomes based on event rates for cardiovascular complications from a real-world registry study, candesartan appears to bring a QALY gain and a reduction in costs compared with generic losartan in the primary preventive treatment of hypertension in Sweden.
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Affiliation(s)
- Ola Granström
- AstraZeneca Nordic, Södertälje, Linköping University, Linköping, Sweden
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IIIB or Not IIIB: A Previously Unanswered Question. J Card Fail 2012; 18:367-72. [DOI: 10.1016/j.cardfail.2012.01.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Revised: 01/13/2012] [Accepted: 01/17/2012] [Indexed: 01/11/2023]
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Gallagher R, Sullivan A, Hales S, Gillies G, Burke R, Tofler G. Symptom patterns, duration and responses in newly diagnosed patients with heart failure. Int J Nurs Pract 2012; 18:133-9. [DOI: 10.1111/j.1440-172x.2012.02010.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Jasmine TJX, Wai-Chi SC, Hegney DG. The impact of knowledge and beliefs on adherence to cardiac rehabilitation programs in patients with heart failure: A systematic review. ACTA ACUST UNITED AC 2012; 10:399-470. [PMID: 27820582 DOI: 10.11124/01938924-201210070-00001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Heart failure is a global health problem which affects a large percentage of the older population. Cardiac rehabilitation programs have been implemented to aid patients in successfully managing their heart condition. However, non-adherence to cardiac rehabilitation programs is common in this group of patients. This results in higher morbidity and mortality rates, rehospitalisation and ultimately higher healthcare costs. There is a need to have a better understanding of the impact that knowledge and beliefs have on patients' adherence levels, so that healthcare providers can implement appropriate strategies to promote their adherence. OBJECTIVES This review aimed to establish the best evidence regarding the impact of knowledge and beliefs on adherence to cardiac rehabilitation programs in patients with heart failure; and to make recommendations for healthcare practice and future research. INCLUSION CRITERIA Patients above the age of 18, who had been diagnosed with heart failure and had been admitted to a cardiac rehabilitation program in inpatient or outpatient settings.This review considered studies that evaluated the impact of heart failure patients' knowledge and beliefs of their disease, medication, diet, exercise and other lifestyle change recommendations, on their adherence to cardiac rehabilitation programs.Heart failure patients' knowledge, beliefs and adherence toward their medication regime, low-sodium diet, exercise, and other lifestyle change recommendations.Quantitative study designs published in the English language, up to December 2010 were considered for inclusion. SEARCH STRATEGY Using a three-step search strategy, the following databases were assessed: CINAHL, PubMed, SCOPUS, Web of Science, OvidSP, MDConsult, ScienceDirect, Sociological Abstracts, Mosby's Nursing Consult, Mednar and TRIP. METHODOLOGICAL QUALITY Two independent reviewers assessed each paper for methodological validity prior to inclusion in the review using standardised critical appraisal instruments from the Joanna Briggs Institute. DATA EXTRACTION Information was extracted by two independent reviewers, from each paper using the standardised data extraction tool from the Joanna Briggs Institute. DATA SYNTHESIS The findings are presented in narrative form, as statistical pooling was not possible, due to the different instruments used in measuring the outcomes. RESULTS Twelve quantitative studies were included in this review (one RCT, one pre-test/post-test single group study, and ten descriptive studies). The present findings suggest that the relationship between knowledge and adherence is unclear. However, patient beliefs on medication, symptom monitoring, illness and control were found to have stronger associations of adherence to cardiac rehabilitation programs.Implications for practice Healthcare institutions need to provide adequate support for patients with heart failure; individualise adherence-enhancing interventions to cater for varying patient needs; and work on empowering patients.Implications for research Future quantitative research should be undertaken to investigate the relationship between knowledge and beliefs, determine their combined effect on adherence and examine the effectiveness of strategies used to improve patient knowledge and beliefs. Quantitative and qualitative studies could also be conducted to ascertain the factors correlated with patient knowledge, beliefs, and adherence.
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Affiliation(s)
- Tan Jia Xing Jasmine
- 1National University Hospital Collaborating Centre, Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore
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Ågren S, Evangelista L, Davidson T, Strömberg A. The influence of chronic heart failure in patient-partner dyads--a comparative study addressing issues of health-related quality of life. J Cardiovasc Nurs 2011; 26:65-73. [PMID: 21127426 PMCID: PMC3246077 DOI: 10.1097/jcn.0b013e3181ec0281] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients with chronic heart failure (HF) and their partners face many challenges associated with heart disease. High social support in a close relationship has been found to improve survival in patients with HF. However, caring for a patient with HF may have negative effects on the health-related quality of life (HRQOL) of the partner responsible for the care. The main focus in health care is still on improving patients' HRQOL, but the awareness of partners' and families' role and situation is increasing. Therefore, further studies are needed to clarify these issues and the importance of partners in relation to HRQOL of patients with HF. OBJECTIVES To describe and compare HRQOL, quality-adjusted life-year (QALY) weights, symptoms of depression, and perceived control and knowledge in patients with chronic HF and their partners and to compare HRQOL and QALY weights in the partners with an age- and sex-matched group. METHODS Data were collected from 135 patient-partner dyads at 2 Swedish hospitals. Data on the reference group were collected from the same region. RESULTS Patients had lower HRQOL in all dimensions (P<.001) except in the mental health domain and lower QALY weights compared with their partners (P<.001). Mental health scores were lower in partners compared with the age- and sex-matched references (P<.001). All other HRQOL scores and the QALY weights were comparable between partners and reference group. Patients had more depressive symptoms than did their partners (P<.001). There was no difference in the level of perceived control or knowledge about chronic HF between patients and partners. CONCLUSIONS Our findings confirm that partners of patients with chronic HF have markedly diminished mental health. Interventions focusing on education and psychosocial support may potentially promote mental health in partners and enhance their ability to support the patient.
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Affiliation(s)
- Susanna Ågren
- Susanna Ågren, PhD, RN Medical Doctor, Department of Medical and Health Sciences, Division of Nursing Science, Linköping University; Department of Cardiothoracic Surgery, Linköping University Hospital; and The Swedish Institute for Health Sciences, Lund, Sweden. Lorraine Evangelista, PhD, RN Senior Lecturer, School of Nursing, University of California, Los Angeles. Thomas Davidson, PhD Health Economist, Department of Medical and Health Sciences, Center for Medical Technology Assessment, Linköping University, Sweden. Anna Strömberg, PhD, RN Professor, Department of Medical and Health Sciences, Division of Nursing Science, Linköping University; and Department of Cardiology Linköping University Hospital, Sweden
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Nahm ES, Resnick B, Orwig D, Magaziner J, Degrezia M. Exploration of informal caregiving following hip fracture. Geriatr Nurs 2010; 31:254-62. [PMID: 20682403 DOI: 10.1016/j.gerinurse.2010.01.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Revised: 01/22/2010] [Accepted: 01/25/2010] [Indexed: 12/28/2022]
Abstract
Hip fracture, a significant health issue for older adults, is an acute event in which older adults can recover their prefracture functional abilities. The recovery phase is often difficult for older adults, and the role of informal caregivers is particularly important. The aim of this qualitative study was to explore informal caregivers' experiences with providing care to older adults over the first 6-month trajectory of hip fracture recovery and their support needs. Participants (N = 10) were interviewed twice at 0-2 and 5-6 months. Analyses of the verbatim transcripts revealed multiple shared themes. Some themes were consistent across phases, such as hip fracture as a turning point toward a frailer state, feeling tired, frustration with communication issues in health care delivery, and lack of information about caregiving-related activities. Certain themes were phase-specific. For instance, in the early phase, management of hospital bills and transitions between care settings were especially burdensome. The caregiving situation, however, was viewed as an opportunity to spend more time with their loved ones. Findings from this study revealed unmet support needs expressed by caregivers of older adult hip fracture patients. Ongoing research and clinical interventions are needed to establish effective methods to empower these caregivers.
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Affiliation(s)
- Eun-Shim Nahm
- University of Maryland School of Nursing, Baltimore, MD, USA
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Gallagher R. Self management, symptom monitoring and associated factors in people with heart failure living in the community. Eur J Cardiovasc Nurs 2010; 9:153-60. [PMID: 20093092 DOI: 10.1016/j.ejcnurse.2009.12.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Revised: 12/17/2009] [Accepted: 12/22/2009] [Indexed: 11/27/2022]
Abstract
BACKGROUND Regular symptom monitoring enables early detection and treatment of heart failure exacerbations, reducing preventable hospital admissions. AIM To determine the level of self management and frequency of symptom monitoring and factors associated in patients with moderate severity HF living in the community. METHODS A correlation study of a convenience sample of patients recently admitted or enrolled in treatment for heart failure were interviewed twice, one month apart, on self management and the frequency of monitoring five key heart failure symptoms. RESULTS Participants (n=63) had an age mean of 78.38 years (SD 8.54 years), and approximately half were male (57%) and married (56%). Daily monitoring occurred in 69.8% for peripheral oedema, 65% for weight and 41.3% for fatigue, 38.9% for dyspnea during normal activity and 28.6% for dyspnea at night or at rest. At baseline, better self management was predicted by more comorbid conditions (ss=-2.64) and stronger sense of coherence (ss=-0.24), and one month later, by the baseline self management score (ss=.65). The only predictor of symptom monitoring at one month was the frequency of monitoring at baseline (OR=9.18). CONCLUSIONS Neither self management nor symptom monitoring is ideal in people with HF. As these behaviours did not change with time, interventions are needed early in the illness course.
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Affiliation(s)
- Robyn Gallagher
- Faculty of Nursing, Midwifery and Health, University of Technology, Sydney, PO Box 123 Broadway NSW 2007, Australia.
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Vilches Moraga A, Rodríguez Pascual C. [Heart failure and geriatrics]. Rev Esp Geriatr Gerontol 2009; 44:57-60. [PMID: 19304345 DOI: 10.1016/j.regg.2008.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Revised: 12/09/2008] [Accepted: 12/10/2008] [Indexed: 05/27/2023]
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