1
|
Teimourizad A, Jafari A, Esmaeilzadeh F. Budget impact analyses for treatment of heart failure. A systematic review. Heart Fail Rev 2024; 29:785-797. [PMID: 38492179 DOI: 10.1007/s10741-024-10397-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 03/18/2024]
Abstract
Heart failure (HF) is increasing globally and turning out to be a serious worldwide public health problem with significant morbidity and mortality. This study aims to systemically review the budget impact analysis of heart failure treatments on health care expenditure worldwide. Scientific databases such as PubMed, Web of Science, Scopus, and Google Scholar were searched for budget impact analysis and heart failure treatments, over January 2001 to August 2023. The quality assessment of the selected studies was evaluated through ISPOR practice guideline. Nineteen studies were included in this systematic review. Based on ISPOR recommendations, most studies were performed on a 1-year time horizon and used a government (public health) or health system perspective. Data for selected studies was mainly collected from randomized clinical trials, published literature, pharmaceutical companies, and registry data. Only direct costs were reported in the studies. Sensitivity analyses were stated in almost all studies. However, studies conducted in high-income countries reported sensitivity analyses more elaborately than those performed in low- and middle-income countries. In many published articles related to the budget impact analyses of heart failure treatment, addition of new treatments to the health system's formularies can lead to a reduction in cardiovascular hospitalization rates, re-hospitalization rates, cardiac-associated mortality rates, and an improvement in heart failure class, which can decrease the costs of hospitalizations, specified care visits, primary care visits, and other related treatments.
Collapse
Affiliation(s)
| | - Abdosaleh Jafari
- Health Human Resources Research Centre, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Firooz Esmaeilzadeh
- Department of Public Health, School of Public Health, Maragheh University of Medical Sciences, Maragheh, Iran
| |
Collapse
|
2
|
Şanal L, Günaydın S, Tatar M. Cost-Effectiveness and Budget Impact Analyses of Patient Blood Management in a Cardiovascular Surgery Department at Ankara Bilkent City Hospital in Turkey. Adv Ther 2024; 41:716-729. [PMID: 38110651 PMCID: PMC10838852 DOI: 10.1007/s12325-023-02733-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/09/2023] [Indexed: 12/20/2023]
Abstract
INTRODUCTION Anemia and transfusion of blood products are risk factors associated with poor patient outcomes across all elective surgeries. Patient blood management (PBM) is a patient-centered approach to optimize patient's endogenous red cell mass, to minimize blood loss in patients undergoing surgery, and to harness and optimize patient-specific physiological tolerance to anemia. This study aimed to assess (1) the impact of PBM on blood product usage in cardiovascular surgeries in a state hospital setting, (2) cost-effectiveness of PBM with a model based on transfusion of red blood cells (RBCs) in cardiovascular surgeries, and (3) the budget impact of PBM implementation based on transfusion of RBCs. METHODS Cost-effectiveness and budget impact models, based on the numbers of avoided transfusions and avoided complications after implementation of the PBM program, were compared between pre- and post-PBM periods at the cardiovascular surgery department of Ankara Bilkent City Hospital between February 11, 2019 and July 24, 2022. The probabilities of transfusions and complications with and without PBM were taken from recent meta-analyses. Data from the Ankara Bilkent City Hospital transfusion center informed the pre- and post-PBM calculations. Costs were calculated from the Social Security Institution's perspective. RESULTS There was a 21% decrease in the use of RBCs and a 23.7% decrease in use of all blood products after the implementation of PBM. The number of RBC packs per patient reduced by 0.88 packs (21%). The cost saving from reduction of RBC transfusions per patient was 518.68 Turkish lira (TRY) and for the hospital it was 1,635,948 TRY. Fewer complications and lower costs in favor of the post-PBM arm were demonstrated in the cost-effectiveness analysis. On the basis of the budget impact model, in 20 months, the hospital's cardiovascular surgery department saved 6,596,934 TRY (€342,302). CONCLUSION This hospital-based study demonstrated that PBM is a budget-saving and cost-effective option in Turkey.
Collapse
Affiliation(s)
- Laser Şanal
- Transfusion Center, Ministry of Health, Ankara Bilkent City Hospital Campus, Ankara, Turkey.
| | - Serdar Günaydın
- Department of Cardiovascular Surgery, University of Health Sciences, Ankara Bilkent City Hospital Campus, Ankara, Turkey
| | - Mehtap Tatar
- Vitale Health Economics, Policy and Consultancy, London, UK
| |
Collapse
|
3
|
McEwan P, Harrison C, Binnie R, Lewis RD, Cohen-Solal A, Lund LH, Ohlsson M, von Haehling S, Comin-Colet J, Pascual-Figal DA, Wächter S, Dorigotti F, de Arellano AR, Ponikowski P, Jankowska EA. Impact of ferric carboxymaltose for iron deficiency at discharge after heart failure hospitalization: a European multinational economic evaluation. Eur J Heart Fail 2023; 25:389-398. [PMID: 36718652 DOI: 10.1002/ejhf.2788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/20/2023] [Accepted: 01/30/2023] [Indexed: 02/01/2023] Open
Abstract
AIMS Iron deficiency (ID) is comorbid in up to 50% patients with heart failure (HF) and exacerbates disease burden. Ferric carboxymaltose (FCM) reduced HF hospitalizations and improved quality of life when used to treat ID at discharge in patients hospitalized for acute HF with left ventricular ejection fraction <50% in the AFFIRM-AHF trial. We quantified the effect of FCM on burden of disease and the wider pharmacoeconomic implications in France, Germany, Poland, Spain and Sweden. METHODS AND RESULTS The per country eligible population was calculated, aligning with the 2021 European Society of Cardiology (ESC) HF guidelines and the AFFIRM-AHF trial. Changes in burden of disease with FCM versus standard of care (SoC) were represented by disability-adjusted life years (DALYs), hospitalization episodes and bed days, using AFFIRM-AHF data. A Markov model was adapted to each country to estimate cost-effectiveness and combined with epidemiology data to calculate the impact on healthcare budgets. Between 335 (Sweden) and 13 237 (Germany) DALYs were predicted to be avoided with FCM use annually. Fewer hospitalizations and shorter lengths of stay associated with FCM compared to SoC were projected to result in substantial annual savings in bed days, from 5215 in Sweden to 205 630 in Germany. In all countries, FCM was predicted to be dominant (cost saving with gains in quality-adjusted life years), resulting in net savings to healthcare budgets within 1 year. CONCLUSIONS This comprehensive evaluation of FCM therapy highlights the potential benefits that could be realized through implementation of the ESC HF guideline recommendations regarding ID treatment.
Collapse
Affiliation(s)
- Phil McEwan
- Health Economics and Outcomes Research Ltd, Cardiff, UK
| | - Cale Harrison
- Health Economics and Outcomes Research Ltd, Cardiff, UK
| | - Rhona Binnie
- Health Economics and Outcomes Research Ltd, Cardiff, UK
| | - Ruth D Lewis
- Health Economics and Outcomes Research Ltd, Cardiff, UK
| | - Alain Cohen-Solal
- Hospital Lariboisière, AP-HP, INSERM U948 MASCOT, Université Paris Cité, Paris, France
| | - Lars H Lund
- Department of Medicine, Karolinska Institutet and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Marcus Ohlsson
- Department of Internal Medicine, Malmö University Hospital, Malmö, Sweden
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center and German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Josep Comin-Colet
- Cardiology Department, Hospital Universitari Bellvitge, University of Barcelona and IDIBELL, Barcelona, Spain
| | - Domingo A Pascual-Figal
- Cardiology Department, Hospital Virgen de la Arrixaca, University of Murcia, Murcia, Spain; and Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | | | | | | | - Piotr Ponikowski
- Institute of Heart Diseases, Wroclaw Medical University, Wrocław, Poland
| | - Ewa A Jankowska
- Institute of Heart Diseases, University Hospital, Wrocław, Poland
| |
Collapse
|
4
|
McEwan P, Ponikowski P, Shiri T, Rosano GMC, Coats AJS, Dorigotti F, Ramirez de Arellano A, Jankowska EA. Clinical and economic impact of ferric carboxymaltose treatment for iron deficiency in patients stabilized following acute heart failure: a multinational study. J Med Econ 2023; 26:51-60. [PMID: 36476095 DOI: 10.1080/13696998.2022.2155375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To estimate clinical events and evaluate the financial implications of introducing ferric carboxymaltose (FCM) to treat iron deficiency (ID) at discharge in patients hospitalized for acute heart failure (AHF) with left ventricular ejection fraction (LVEF) <50% in the UK, Switzerland and Italy. METHODS A decision analytic cost-offset model was developed to evaluate the costs associated with introducing FCM for all eligible patients in three countries compared to a world without FCM, over a five-year time horizon. Data from AFFIRM-AHF clinical trial were used to model clinical outcomes, using an established cohort state-transition Markov model. Country-specific prevalence estimates were derived using data from real-world studies to extrapolate number of events and consequent cost totals to the population at risk on a national scale. RESULTS The cost-offset modeling demonstrated that FCM is projected to be a cost-saving intervention in all three country settings over a five-year time horizon. Savings were driven primarily by reduced hospitalizations and avoided cardiovascular deaths, with net cost savings of -£14,008,238, -CHF25,456,455 and -€105,295,146 incurred to the UK, Switzerland and Italy, respectively. LIMITATIONS Although AFFIRM-AHF was a multinational trial, efficacy data per country was not sufficiently large to enable country-specific analysis, therefore overall clinical parameters have been assumed to apply to all countries. CONCLUSIONS This study provides further evidence of the potential cost savings achievable by treating ID with FCM at discharge in patients hospitalized for AHF with LVEF <50%. The value of FCM treatment within the healthcare systems of the UK, Switzerland and Italy was demonstrated even within a limited time frame of one year, with consistent cost savings indicated over a longer term.
Collapse
Affiliation(s)
- Phil McEwan
- Health Economics and Outcomes Research Ltd, Cardiff, UK
| | - Piotr Ponikowski
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | | | - Giuseppe M C Rosano
- Cardiovascular and Cell Sciences Research Institute, St George's University, London, UK
| | | | | | | | - Ewa A Jankowska
- Institute of Heart Diseases, University Hospital, Wrocław, Poland
| |
Collapse
|
5
|
Almenar Bonet L, Blasco Peiró MT, Laiz Marro B, Camafort Babkowski M, Buño Soto A, Crespo-Leiro MG. Specific test panels for patients with heart failure: implementation and use in the Spanish National Health System. ADVANCES IN LABORATORY MEDICINE 2022; 3:65-78. [PMID: 37359437 PMCID: PMC10197348 DOI: 10.1515/almed-2022-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/17/2021] [Indexed: 06/28/2023]
Abstract
Objectives The use of specific test panels (STP) for heart failure (HF) could help improve the management of this condition. The purpose of this study is to gain an insight into the level of implementation of STPs in the management of HF in Spain and gather the opinions of experts, with a special focus on parameters related to iron metabolism. Methods The opinions of experts in HF were gathered in three stages STAGE 1 as follows: level of implementation of STPs (n=40). STAGE 2: advantages and disadvantages of STPs (n=12). STAGE 3: level of agreement with the composition of three specific STPs for HF: initial evaluation panel, monitoring panel, and de novo panel (n=16). Results In total, 62.5% of hospitals used STPs for the clinical management of HF, with no association found between the use of STPs and the level of health care (p=0.132) and location of the center (p=0.486) or the availability of a Heart Failure Unit in the center (p=0.737). According to experts, the use of STPs in clinical practice has more advantages than disadvantages (8 vs. 3), with a notable positive impact on diagnostics. Experts gave three motivations and found three limitations to the implementation of STPs. The composition of the three specific STPs for HF was viewed positively by experts. Conclusions Although the experts interviewed advocate the use of diagnostic and monitoring STPs for HF, efforts are still necessary to achieve the standardization and homogenization of test panels for HF in Spanish hospitals.
Collapse
Affiliation(s)
- Luis Almenar Bonet
- Unit of Heart Failure and Transplant, Service of Cardiology, University and Polytechnic La Fe Hospital of Valencia, Valencia, Spain
- University of Valencia, Valencia, Spain
- Spanish Network-Center for Cardiovascular Biomedical Research (CIBERCV), Madrid, Spain
| | - Mᵃ Teresa Blasco Peiró
- Unit of Heart Failure and Transplant, Service of Cardiology, Miguel Servet University Hospital, Zaragoza, Spain
- University of Zaragoza, Zaragoza, Spain
| | - Begoña Laiz Marro
- Laboratory Analysis Service, University and Polytechnic La Fe Hospital of Valencia, Valencia, Spain
| | - Miguel Camafort Babkowski
- Service of Internal Medicine, ICMiD, Hospital Clínic, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Antonio Buño Soto
- Laboratory Analysis Service, La Paz University Hospital, Madrid, Spain
| | - Maria Generosa Crespo-Leiro
- Unit of Heart Failure and Heart Transplant, Service of Cardiology, A Coruña Hospital Complex, CHUAC, A Coruña (UDC), Spain
- Biomedical Research Institute of A Coruña (INIBIC), A Coruña, Spain
- University of A Coruña, A Coruña, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| |
Collapse
|
6
|
A budget impact analysis of iron polymaltose and ferric carboxymaltose infusions. Int J Clin Pharm 2021; 44:110-117. [PMID: 34498215 DOI: 10.1007/s11096-021-01320-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/20/2021] [Indexed: 10/20/2022]
Abstract
Background In Australia, iron deficiency anaemia can be managed by ferric carboxymaltose, and iron polymaltose given via either a traditional slow or new rapid infusion protocol. These differ in their manufacturing, administration, and monitoring requirements, with unknown associated costs. Aim To compare the direct costs of iron infusions used in Australia; and explore potential savings associated with increased uptake of the least-expensive option at a local hospital. Method A time-motion method was used to determine the labour and consumables associated with each infusion protocol. Secondly, a frequency analysis identified the most common iron infusion doses prescribed at the study site. The total direct costs per protocol were compared at these doses and then the potential savings from switching to the lowest-costing of these protocols where possible were explored. Results The most common doses were 0.5 g, 1 g, 1.5 g and 2 g. At these dose points, ferric carboxymaltose infusions are the least expensive, but only if national health subsidies are applied. In cases where they do not apply, iron polymaltose prepared from ampoules and infused using the rapid protocol ('Iron Polymaltose Ampoules Rapid') is the least expensive. Switching all applicable ferric carboxymaltose infusions and iron polymaltose infusions administered using the slow infusion protocol to Iron Polymaltose Ampoules Rapid is projected to yield up to $12,000 worth of savings annually. Conclusions Increased use of the Iron Polymaltose Ampoules Rapid protocol when government-subsidised options are not available is projected to have cost-saving outcomes. Investigation of implementation strategies to increase the use of this protocol are warranted.
Collapse
|