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Dao TD, Tran HTB, Vu QV, Nguyen HTT, Nguyen PV, Vo TQ. The annual economic burden incurred by heart failure patients in Vietnam: a retrospective analysis. J Pharm Policy Pract 2024; 17:2381099. [PMID: 39081708 PMCID: PMC11288205 DOI: 10.1080/20523211.2024.2381099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 07/11/2024] [Indexed: 08/02/2024] Open
Abstract
Introduction Heart failure (HF) is a chronic condition associated with substantial mortality and hospitalisation, resulting in costly inpatient visits. The healthcare systems of several countries, including Vietnam, experience considerable difficulty in dealing with the enormous fiscal burden presented by HF. This study aims to analyse the direct medical costs associated with HF inpatient treatment from the hospital perspective. Materials and methods This study retrospectively analysed the electronic medical records of patients diagnosed with HF from 2018 to 2021 at Military Hospital 175 in Vietnam. The sample consisted of 906 hospitalised patients (mean age: 71.2 ± 14.1 years). The financial impact of HF was assessed by examining the direct medical expenses incurred by the healthcare system, and the costs of pharmaceutical categories used in treatment were explored. Results The cumulative economic burden of HF from 2018 to 2021 was US$1,068,870, with annual costs ranging from US$201,670 to US$443,831. Health insurance covered 72.7% of these costs. Medications and infusions, and medical supplies accounted for the largest expenses, at 29.8% and 22.1%, respectively. The medication HF group accounted for 13.01% of these expenses, of which the costliest medications included nitrates (2.57%), angiotensin II receptor blockers (0.51%), ivabradine (0.39%), diuretics (0.24%), and mineralocorticoid receptor antagonists (0.23%). Comorbidities and the length of hospital stay significantly influenced annual treatment costs. Conclusion The study reveals that HF significantly impacts Vietnam's healthcare system and citizens, requiring a comprehensive understanding of its financial implications and efficient management of medical resources for those diagnosed. This study highlights the substantial economic burden of HF on Vietnam's healthcare system, with medication costs, particularly antithrombotic drugs, representing the largest expense. Most healthcare costs were covered by health insurance, and expenses were significantly influenced by comorbidity and length of hospital stay. These findings can inform healthcare policy, resource allocation and optimise management strategies in Vietnam.
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Affiliation(s)
| | - Hien Thi Bich Tran
- Faculty of Pharmacy, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Quynh Van Vu
- Faculty of Pharmacy, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Huong Thi Thanh Nguyen
- Faculty of Pharmaceutical Management and Economic, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Pol Van Nguyen
- Faculty of Pharmacy, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Trung Quang Vo
- Faculty of Pharmacy, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
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High-normal diastolic blood pressure as a risk factor for left ventricular diastolic dysfunction in healthy postmenopausal women. Hypertens Res 2022; 45:1891-1898. [PMID: 36202980 DOI: 10.1038/s41440-022-01024-w] [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: 06/05/2022] [Revised: 08/22/2022] [Accepted: 08/25/2022] [Indexed: 11/09/2022]
Abstract
Left ventricular (LV) diastolic dysfunction is associated with heart failure with preserved ejection fraction, and metabolic syndrome (MetS) is a risk factor. However, there is limited knowledge regarding the metabolic factors that contribute to LV dysfunction in postmenopausal women without comorbidities. This study aimed to analyze the relationship between LV diastolic dysfunction and MetS, as well as other cardiovascular risk factors, and to determine risks for LV diastolic dysfunction. Postmenopausal women without hypertension, diabetes mellitus, LV systolic dysfunction, or other heart diseases underwent physical examinations, including echocardiography. The study participants were diagnosed with LV diastolic dysfunction based on several echocardiographic parameters. Logistic regression analyses of LV diastolic dysfunction and cardiovascular risk factors were performed. Of the 269 postmenopausal women examined, 29 (10.7%) and 40 (14.9%) had MetS and LV diastolic dysfunction, respectively. Abnormal diastolic blood pressure (odds ratio, 3.6; 95% confidence interval, 1.16-10.9; P < 0.05) and age (odds ratio, 1.1; 95% confidence interval, 1.07-1.19; P < 0.01) were predictors of LV diastolic dysfunction. In healthy postmenopausal women, high-normal diastolic blood pressure was the only independent risk factor for LV diastolic dysfunction, and it thus may be a useful predictor of diastolic heart failure during routine physical examinations.
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Filippatos G, Angermann CE, Cleland JGF, Lam CSP, Dahlström U, Dickstein K, Ertl G, Hassanein M, Hart KW, Lindsell CJ, Perrone SV, Guerin T, Ghadanfar M, Schweizer A, Obergfell A, Collins SP. Global Differences in Characteristics, Precipitants, and Initial Management of Patients Presenting With Acute Heart Failure. JAMA Cardiol 2021; 5:401-410. [PMID: 31913404 DOI: 10.1001/jamacardio.2019.5108] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance Acute heart failure (AHF) precipitates millions of hospital admissions worldwide, but previous registries have been country or region specific. Objective To conduct a prospective contemporaneous comparison of AHF presentations, etiologic factors and precipitants, treatments, and in-hospital outcomes among global regions through the International Registry to Assess Medical Practice with Longitudinal Observation for Treatment of Heart Failure (REPORT-HF). Design, Setting, and Participants A total of 18 553 adults were enrolled during a hospitalization for AHF. Patients were recruited from the acute setting in Western Europe (WE), Eastern Europe (EE), Eastern Mediterranean and Africa (EMA), Southeast Asia (SEA), Western Pacific (WP), North America (NA), and Central and South America (CSA). Patients with AHF were approached for consent and excluded only if there was recent participation in a clinical trial. Patients were enrolled from July 23, 2014, to March 24, 2017. Statistical analysis was conducted from April 18 to June 29, 2018; revised analyses occurred between August 6 and 29, 2019. Main Outcomes and Measures Heart failure etiologic factors and precipitants, treatments, and in-hospital outcomes among global regions. Results A total of 18 553 patients were enrolled at 358 sites in 44 countries. The median age was 67.0 years (interquartile range [IQR], 57-77), 11 372 were men (61.3%), 9656 were white (52.0%), 5738 were Asian (30.9%), and 867 were black (4.7%). A history of HF was present in more than 50% of the patients and 40% were known to have a prior left-ventricular ejection fraction lower than 40%. Ischemia was a common AHF precipitant in SEA (596 of 2329 [25.6%]), WP (572 of 3354 [17.1%]), and EMA (364 of 2241 [16.2%]), whereas nonadherence to diet and medications was most common in NA (306 of 1592 [19.2%]). Median time to the first intravenous therapy was 3.0 (IQR, 1.4-5.6) hours in NA; no other region had a median time above 1.2 hours (P < .001). This treatment delay remained after adjusting for severity of illness (P < .001). Intravenous loop diuretics were the most common medication administered in the first 6 hours of AHF management across all regions (65.4%-89.9%). Despite similar initial blood pressure across all regions, inotropic agents were used approximately 3 times more often in SEA, WP, and EE (11.3%-13.5%) compared with NA and WE (3.1%-4.3%) (P < .001). Older age (odds ratio [OR], 1.0; 95% CI, 1.00-1.02), HF etiology (ischemia: OR, 1.65; 95% CI, 1.11-2.44; valvular: OR, 2.10; 95% CI, 1.36-3.25), creatinine level greater than 2.75 mg/dL (OR, 1.85; 95% CI, 0.71-2.40), and chest radiograph signs of congestion (OR, 2.03; 95% CI, 1.39-2.97) were all associated with increased in-hospital mortality. Similarly, younger age (OR, -0.04; 95% CI, -0.05 to -0.02), HF etiology (ischemia: OR, 0.77; 95% CI, 0.26-1.29; valvular: OR, 2.01; 95% CI, 1.38-2.65), creatinine level greater than 2.75 mg/dL (OR, 1.16; 95% CI, 0.31-2.00), and chest radiograph signs of congestion (OR, 1.02; 95% CI, 0.57-1.47) were all associated with increased in-hospital LOS. Conclusions and Relevance Data from REPORT-HF suggest that patients are similar across regions in many respects, but important differences in timing and type of treatment exist, identifying region-specific gaps in medical management that may be associated with patient outcomes.
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Affiliation(s)
- Gerasimos Filippatos
- University of Cyprus School of Medicine, Cyprus, Greece.,Attikon University Hospital, Department of Cardiology, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Christiane E Angermann
- Comprehensive Heart Failure Center, University Hospital, Department of Medicine I-Cardiology, University of Würzburg, Würzburg, Germany
| | - John G F Cleland
- Robertson Centre for Biostatistics and Clinical Trials, Institute of Health & Well-Being, University of Glasgow, Glasgow, United Kingdom.,National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore.,Cardiovascular Academic Clinical Program, Duke-National University of Singapore, Singapore.,Department of Cardiology, University Medical Centre Groningen, Groningen, the Netherlands
| | - Ulf Dahlström
- Department of Cardiology, Department of Medical and Health Sciences, Linkoping University, Linkoping, Sweden
| | | | - Georg Ertl
- Comprehensive Heart Failure Center, University Hospital, Department of Medicine I-Cardiology, University of Würzburg, Würzburg, Germany
| | - Mahmoud Hassanein
- Department of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Kimberly W Hart
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Sergio V Perrone
- El Cruce Hospital by Florencio Varela, Lezica Cardiovascular Institute, Sanctuary of the Trinidad Miter, Buenos Aires, Argentina
| | | | | | | | | | - Sean P Collins
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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Kwak MJ, Rasu R, Morgan RO, Lee J, Rianon NJ, Holmes HM, Dhoble A, Kim DH. The Association of Economic Outcome and Geriatric Syndromes among Older Adults with Transcatheter Aortic Valve Replacement (TAVR). JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2020; 7:175-181. [PMID: 33088843 PMCID: PMC7549540 DOI: 10.36469/jheor.2020.17423] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/04/2020] [Accepted: 09/11/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The association of geriatric syndromes and economic outcomes among patients who are undergoing transcatheter aortic valve replacement (TAVR) remains unknown. METHODS AND RESULTS A retrospective observational study using the National Inpatient Sample (NIS) from 2011 to 2014 was conducted with 7078 patients who were 65 years or older and underwent TAVR. The average hospital cost was US$58 703 (± SD 29 777) and length of stay (LOS) was 8.1 days (±7.20). The rates of delirium, dementia, and frailty were 8.0%, 6.1%, and 10.5%, respectively. From a multivariable generalized linear regression, delirium increased the cost by 31.5% (95% CI 25.41~37.92) and LOS by 70.3% (95% CI 60.20~83.38). Frailty increased the cost by 7.4% (95% CI 3.44~11.53) and the LOS by 22.6% (95% CI 15.15~30.55). Dementia had no significant association with either outcome. When the interactions of the geriatric syndromes were tested for association with the outcomes, delirium in the absence of dementia but presence of frailty showed the strongest association with cost (increase by 45.1%, 95% CI 26.45~66.45), and delirium in the absence of both dementia and frailty showed the strongest association with LOS (increase by 74.5%, 95% CI 62.71~87.13). When the average hospital cost and LOS were predicted using the model with interaction terms, patients with delirium and frailty (but without dementia) had the highest value (total hospital cost US$86 503 and LOS 14.9 days). CONCLUSION Among TAVR patients, delirium was significantly associated with increased hospital cost and LOS, and the association was significantly higher in the absence of dementia. The results of this study will be a great asset for health care providers and administrators in planning for efficient care strategy to lower health care expenditure in the hospital for older adults who underwent TAVR.
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Affiliation(s)
- Min Ji Kwak
- University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Rafia Rasu
- University of North Texas Health Science Center, Fort Worth, TX
| | - Robert O. Morgan
- University of Texas Health Science Center at Houston, School of Public Health, Houston, TX
| | - Jessica Lee
- University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Nahid J. Rianon
- University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Holly M. Holmes
- University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Abhijeet Dhoble
- University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Dae Hyun Kim
- Beth Israel Deaconess Medical Center, Harvard University, Boston, MA
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Ryder S, Fox K, Rane P, Armstrong N, Wei CY, Deshpande S, Stirk L, Qian Y, Kleijnen J. A Systematic Review of Direct Cardiovascular Event Costs: An International Perspective. PHARMACOECONOMICS 2019; 37:895-919. [PMID: 30949988 DOI: 10.1007/s40273-019-00795-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION There is a lack of comprehensive cost information for cardiovascular events since 2013. OBJECTIVE A systematic review on the contemporary cost of cardiovascular events was therefore undertaken. METHODS Methods complied with those recommended by the Cochrane Collaboration and the Centre for Reviews and Dissemination. Studies were unrestricted by language, were from 2013 to 23 December 2017, and included cost-of-illness data in adults with the following cardiovascular conditions: myocardial infarction (MI), stroke, transient ischaemic attack (TIA), heart failure (HF), unstable angina (UA), coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI), or peripheral artery disease (PAD). Seven electronic databases were searched, namely Embase (Ovid), MEDLINE (Ovid), MEDLINE In-Process Citations and Daily Update (Ovid), NHS Economic Evaluation Database (NHS EED), Health Technology Assessment (HTA) database, Cochrane Central Register of Controlled Trials (CENTRAL), and PubMed. The included studies reported data from a variety of years (sometimes prior to 2013), so costs were inflated and converted to $US, year 2018 values, for standardization. RESULTS After de-duplication, 29,945 titles and abstracts and then 403 full papers were screened; 82 studies (88 papers) were extracted. Year 1 average cost ranges were as follows: MI ($11,970 in Sweden to $61,864 in the USA), stroke ($10,162 in Spain to $46,162 in the USA), TIA ($6049 in Sweden to $25,306 in the USA), HF ($4456 in China to $49,427 in the USA), UA ($11,237 in Sweden to $31,860 in the USA), PCI ($17,923 in Italy to $45,533 in the USA), CABG ($17,972 in the UK to $76,279 in the USA). One Swedish study reported PAD costs in a format convertible to $US, 2018 values, with a mean annual cost of $15,565. CONCLUSIONS There was considerable unexplained variation in contemporary costs for all major cardiovascular events. One emerging theme was that average costs in the USA were considerably higher than anywhere else.
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Affiliation(s)
- Steve Ryder
- Kleijnen Systematic Reviews Ltd, Unit 6, Escrick Business Park, Riccall Road, Escrick, York, YO19 6FD, UK.
| | - Kathleen Fox
- Strategic Healthcare Solutions LLC, 133 Cottonwood Creek Lane, Aiken, SC, 29803, USA
| | - Pratik Rane
- Amgen Inc, One Amgen Center Drive, Thousand Oaks, CA, 91320-1799, USA
| | - Nigel Armstrong
- Kleijnen Systematic Reviews Ltd, Unit 6, Escrick Business Park, Riccall Road, Escrick, York, YO19 6FD, UK
| | - Ching-Yun Wei
- Kleijnen Systematic Reviews Ltd, Unit 6, Escrick Business Park, Riccall Road, Escrick, York, YO19 6FD, UK
| | - Sohan Deshpande
- Kleijnen Systematic Reviews Ltd, Unit 6, Escrick Business Park, Riccall Road, Escrick, York, YO19 6FD, UK
| | - Lisa Stirk
- Kleijnen Systematic Reviews Ltd, Unit 6, Escrick Business Park, Riccall Road, Escrick, York, YO19 6FD, UK
| | - Yi Qian
- Amgen Inc, One Amgen Center Drive, Thousand Oaks, CA, 91320-1799, USA
| | - Jos Kleijnen
- School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
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