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Haapanen MJ, Törmäkangas T, von Bonsdorff ME, Strandberg AY, Strandberg TE, von Bonsdorff MB. Midlife cardiovascular health factors as predictors of retirement age, work-loss years, and years spent in retirement among older businessmen. Sci Rep 2023; 13:16526. [PMID: 37783715 PMCID: PMC10545670 DOI: 10.1038/s41598-023-43666-x] [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: 06/13/2023] [Accepted: 09/27/2023] [Indexed: 10/04/2023] Open
Abstract
Cardiovascular disease (CVD) is one of the leading causes of premature retirement. However, the relationship between CVD risk factors and workforce participation is not well known. We studied the relationship between midlife CVD risk, age at retirement, work-loss years, and survival in retirement. Middle-aged Finnish men (initial n = 3490, mean age = 47.8 years) were assessed for CVD risk factors and general health in the 1970s. They worked as business executives and provided information on their retirement status in the year 2000. Survival was followed up to the 9th decade of life with a follow-up of up to 44 years. Work-loss years were calculated as death or retirement occurring at age ≤ 65 years. Smoking, body mass index, and alcohol use were used as covariates, excluding models of CVD risk, which were adjusted for alcohol use only. Higher risk of 10-year fatal CVD was associated with 0.32 more years (relative risk < 1 vs. 1, covariate-adjusted β = 0.32, 95% CI = 0.13, 0.53) of work-loss. Higher risk of 5-year incident (covariate-adjusted time-constant HR = 1.32, 95% CI = 1.19, 1.47) and 10-year fatal (covariate-adjusted time-dependent HR = 1.55, 95% CI = 1.30, 1.85) CVD in midlife were associated with fewer years spent in retirement. Poorer self-rated health and physical fitness and higher levels of triglycerides were associated with increased hazard of earlier retirement, more work-loss years, and fewer years spent in retirement. Poorer health and greater midlife CVD risk may be associated with earlier exit from the workforce and fewer years spent in retirement. Management of CVD risk in midlife may support people to work longer.
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Affiliation(s)
- Markus J Haapanen
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
- Folkhälsan Research Centre, Helsinki, Finland.
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Timo Törmäkangas
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Monika E von Bonsdorff
- Management and Leadership, Jyväskylä University School of Business and Economics, University of Jyväskylä, Jyväskylä, Finland
| | - Arto Y Strandberg
- Department of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Timo E Strandberg
- Department of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Centre for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Mikaela B von Bonsdorff
- Folkhälsan Research Centre, Helsinki, Finland
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Zhu J, Wang W, Wang J, Zhu L. Change in coronary heart disease hospitalization after chronic disease management: a programme policy in China. Health Policy Plan 2023; 38:161-169. [PMID: 36420873 PMCID: PMC9923378 DOI: 10.1093/heapol/czac101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 11/04/2022] [Accepted: 11/23/2022] [Indexed: 11/25/2022] Open
Abstract
This study aims at examining changes in coronary heart disease (CHD) hospitalization associated with a novel county-scale chronic disease management (CDM) programme policy implemented in March 2019 in China during the 13th Five-Year period (2016-2020). The CDM programme was designed to improve the health of populations with chronic diseases by means of an integrated way involving both county-level public hospitals and primary care institutes. Data originated from the medical files of CHD inpatients discharged from a secondary hospital from January 2017 to December 2020. A total of 6111 CHD patient records were collected. Univariate and multivariate regression analyses were performed to assess changes in hospitalization direct medical costs and length of stay of CHD patients. The mean direct medical cost of CHD hospitalization was 8419.73 Yuan, and the mean length of stay was 7.57 days. Results suggested that the implementation of CDM reduced hospitalization direct medical cost and bed days by about 23% (1956.12 Yuan at means) and 11.5% (almost 1 day at means), respectively. In addition, a further decreasing trend in medical costs over time was associated with chronic disease management. It is implied that chronic disease management is an effective way of relieving the medical and financial burden of hospitalization.
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Affiliation(s)
- Jingmin Zhu
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 7HB, United Kingdom
| | - Wei Wang
- Department of Social and Preventive Medicine, University of Malaya, Level 5, Block I, Kuala Lumpur 50603, Malaysia
| | - Jun Wang
- Center for Health Policy Research and Evaluation, School of Public Administration and Policy, Renmin University of China, No. 59 Zhongguancun Street, Haidian District, Beijing 100872, China
| | - Liang Zhu
- Henan Province Yongcheng Central Hospital, Zhongyuan Road, Yongcheng, Shangqiu 476610, China
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Barsasella D, Gupta S, Malwade S, Aminin, Susanti Y, Tirmadi B, Mutamakin A, Jonnagaddala J, Syed-Abdul S. Predicting length of stay and mortality among hospitalized patients with type 2 diabetes mellitus and hypertension. Int J Med Inform 2021; 154:104569. [PMID: 34525441 DOI: 10.1016/j.ijmedinf.2021.104569] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 08/22/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) and hypertension (HTN), both non-communicable diseases, are leading causes of death globally, with more imbalances in lower middle-income countries. Furthermore, poor treatment and management are known to lead to intensified healthcare utilization and increased medical care costs and impose a significant societal burden, in these countries, including Indonesia. Predicting future clinical outcomes can determine the line of treatment and value of healthcare costs, while ensuring effective patient care. In this paper, we present the prediction of length of stay (LoS) and mortality among hospitalized patients at a tertiary referral hospital in Tasikmalaya, Indonesia, between 2016 and 2019. We also aimed to determine how socio-demographic characteristics, and T2DM- or HTN-related comorbidities affect inpatient LoS and mortality. METHODS We analyzed insurance claims data of 4376 patients with T2DM or HTN hospitalized in the referral hospital. We used four prediction models based on machine-learning algorithms for LoS prediction, in relation to disease severity, physician-in-charge, room type, co-morbidities, and types of procedures performed. We used five classifiers based on multilayer perceptron (MLP) to predict inpatient mortality and compared them according to training time, testing time, and Area under Receiver Operative Curve (AUROC). Classifier accuracy measures, which included positive predictive value (PPV), negative predictive value (NPV), F-Measure, and recall, were used as performance evaluation methods. RESULTS A Random forest best predicted inpatient LoS (R2, 0.70; root mean square error [RMSE], 1.96; mean absolute error [MAE], 0.935), and the gradient boosting regression model also performed similarly (R2, 0.69; RMSE, 1.96; MAE, 0.935). For inpatient mortality, best results were observed using MLP with back propagation (AUROC 0.899; 69.33 and 98.61 for PPV and NPV, respectively). The other classifiers, stochastic gradient descent with regression loss function, Huber, and random forest models all showed an average performance. CONCLUSIONS Linear regression model best predicted LoS and mortality was best predicted using MLP. Patients with primary diseases such as T2DM or HTN may have comorbidities that can prolong inpatient LoS. Physicians play an important role in disseminating health related information. These predictions could assist in the development of health policies and strategies that reduce disease burden in resource-limited settings.
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Affiliation(s)
- Diana Barsasella
- International Center for Health Information Technology, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan; Department of Medical Records and Health Information, Health Polytechnic of the Ministry of Health Tasikmalaya, Tasikmalaya, West Java, Indonesia
| | - Srishti Gupta
- Vellore Institute of Technology, Vellore, Tamil Nadu, India
| | - Shwetambara Malwade
- International Center for Health Information Technology, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Aminin
- Regional Public Hospital of Tasikmalaya, Tasikmalaya, West Java, Indonesia
| | - Yanti Susanti
- Regional Public Hospital of Tasikmalaya, Tasikmalaya, West Java, Indonesia
| | - Budi Tirmadi
- Regional Public Hospital of Tasikmalaya, Tasikmalaya, West Java, Indonesia
| | - Agus Mutamakin
- Dr Cipto Mangunkusumo National Central General Hospital, Salemba, Jakarta, Indonesia
| | | | - Shabbir Syed-Abdul
- International Center for Health Information Technology, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.
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Lyra P, Machado V, Proença L, Mendes JJ, Botelho J. Tooth Loss and Blood Pressure in Parkinson's Disease Patients: An Exploratory Study on NHANES Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18095032. [PMID: 34068631 PMCID: PMC8126086 DOI: 10.3390/ijerph18095032] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 04/26/2021] [Accepted: 05/04/2021] [Indexed: 12/15/2022]
Abstract
Objectives: To evaluate tooth loss severity in PD patients and the impact of missing teeth on blood pressure (BP) and glycated hemoglobin (Hba1c) levels. Methods: All adults reporting specific PD medication regimens with complete dental examinations were included from the NHANES 2001 to 2018 databases. Sociodemographic, systolic BP (SBP), diastolic BP (DBP) and Hba1c data were compared according to tooth loss severity, and linear regression analyses on the impact of tooth loss on SBP, DBP and Hba1c levels were conducted. Results: The 214 included participants presented 9.7 missing teeth, 23.8% severe tooth loss and 18.2% total edentulousness. Severe tooth loss cases were significantly older (p < 0.001), had higher smoking prevalence (p = 0.008), chronic medical conditions (p = 0.012) and higher Hba1c (p = 0.001), SBP (p = 0.015) and DBP (p < 0.001) levels. Crude and adjusted linear models revealed a relationship between SBP, DBP and missing teeth; however, age confounded these links (SBP: B = 0.10, SE = 0.16, p < 0.05; DBP: B = 0.16, SE = 0.10, p < 0.05). Tooth loss presented no significant relationship with Hba1c levels. Conclusions: Severe tooth loss is prevalent among PD patients. Blood pressure levels showed a positive linear relationship with the number of missing teeth, although age was a confounding factor. Furthermore, tooth loss and Hba1c levels revealed no significant linear relationship.
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Affiliation(s)
- Patrícia Lyra
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Clinical Research Unit (CRU), Egas Moniz—Cooperativa de Ensino Superior, 2829-511 Caparica, Portugal; (P.L.); (V.M.); (J.J.M.)
| | - Vanessa Machado
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Clinical Research Unit (CRU), Egas Moniz—Cooperativa de Ensino Superior, 2829-511 Caparica, Portugal; (P.L.); (V.M.); (J.J.M.)
- Evidence-Based Hub, CRU, CiiEM, Egas Moniz—Cooperativa de Ensino Superior, 2829-511 Caparica, Portugal;
| | - Luís Proença
- Evidence-Based Hub, CRU, CiiEM, Egas Moniz—Cooperativa de Ensino Superior, 2829-511 Caparica, Portugal;
- Quantitative Methods for Health Research (MQIS), CiiEM, Egas Moniz—Cooperativa de Ensino Superior, 2829-511 Caparica, Portugal
| | - José João Mendes
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Clinical Research Unit (CRU), Egas Moniz—Cooperativa de Ensino Superior, 2829-511 Caparica, Portugal; (P.L.); (V.M.); (J.J.M.)
- Evidence-Based Hub, CRU, CiiEM, Egas Moniz—Cooperativa de Ensino Superior, 2829-511 Caparica, Portugal;
| | - João Botelho
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Clinical Research Unit (CRU), Egas Moniz—Cooperativa de Ensino Superior, 2829-511 Caparica, Portugal; (P.L.); (V.M.); (J.J.M.)
- Evidence-Based Hub, CRU, CiiEM, Egas Moniz—Cooperativa de Ensino Superior, 2829-511 Caparica, Portugal;
- Correspondence: ; Tel.: +351-969-848-394
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Groenland EH, Bots ML, Asselbergs FW, de Borst GJ, Kappelle LJ, Visseren FLJ, Spiering W. Apparent treatment resistant hypertension and the risk of recurrent cardiovascular events and mortality in patients with established vascular disease. Int J Cardiol 2021; 334:135-141. [PMID: 33932429 DOI: 10.1016/j.ijcard.2021.04.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/13/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
AIM To quantify the relation between apparent treatment resistant hypertension (aTRH) and the risk of recurrent major adverse cardiovascular events (MACE including stroke, myocardial infarction and vascular death) and mortality in patients with stable vascular disease. METHODS 7455 hypertensive patients with symptomatic vascular disease were included from the ongoing UCC-SMART cohort between 1996 and 2019. aTRH was defined as an office blood pressure ≥140/90 mmHg despite treatment with ≥3 antihypertensive drugs including a diuretic. Cox proportional hazard models were used to quantify the relation between aTRH and the risk of recurrent MACE and all-cause mortality. In addition, survival for patients with aTRH was assessed, taking competing risk of non-vascular mortality into account. RESULTS A total of 1557 MACE and 1882 deaths occurred during a median follow-up of 9.0 years (interquartile range 4.8-13.1 years). Compared to patients with non-aTRH, the 614 patients (8%) with aTRH were at increased risk of cardiovascular mortality (HR 1.27; 95% CI 1.03-1.56) and death from any cause (HR 1.25; 95% CI 1.07-1.45) but not recurrent MACE (HR 1.13; 95% CI 0.95-1.34). At the age of 50 years, patients with aTRH after a first cardiovascular event on average had a 6.4 year shorter median life expectancy free of recurrent MACE than patients with non-aTRH. CONCLUSION In hypertensive patients with clinically manifest vascular disease, aTRH is related to a higher risk of vascular death and death from any cause. Moreover, patients with aTRH after a first cardiovascular event have a 6.4 year shorter median life expectancy free of recurrent cardiovascular disease.
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Affiliation(s)
- Eline H Groenland
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Folkert W Asselbergs
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Institute of Cardiovascular Science and Institute of Health Informatics, Faculty of Population Health Sciences, University College London, London, United Kingdom
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - L Jaap Kappelle
- Department of Neurology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Wilko Spiering
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
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Mendes JJ, Viana J, Cruz F, Pereira D, Ferreira S, Pereira P, Proença L, Machado V, Botelho J, Rua J, Delgado AS. Blood Pressure and Tooth Loss: A Large Cross-Sectional Study with Age Mediation Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18010285. [PMID: 33401662 PMCID: PMC7795250 DOI: 10.3390/ijerph18010285] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 12/29/2020] [Accepted: 12/29/2020] [Indexed: 12/11/2022]
Abstract
We aimed to investigate the association between blood pressure (BP) and tooth loss and the mediation effect of age. A cross-sectional study from a reference dental hospital was conducted from September 2017 to July 2020. Single measures of BP were taken via an automated sphygmomanometer device. Tooth loss was assessed through oral examination and confirmed radiographically. Severe tooth loss was defined as 10 or more teeth lost. Additional study covariates were collected via sociodemographic and medical questionnaires. A total of 10,576 patients were included. Hypertension was more prevalent in severe tooth loss patients than nonsevere tooth lost (56.1% vs. 39.3%, p < 0.001). The frequency of likely undiagnosed hypertension was 43.4%. The adjusted logistic model for sex, smoking habits and body mass index confirmed the association between continuous measures of high BP and continuous measures of tooth loss (odds ratio (OR) = 1.05, 95% CI: 1.03–1.06, p < 0.001). Age mediated 80.0% and 87.5% of the association between periodontitis with both systolic BP (p < 0.001) and diastolic BP (p < 0.001), respectively. Therefore, hypertension and tooth loss are associated, with a consistent mediation effect of age. Frequency of undiagnosed hypertension was elevated. Age, gender, active smoking, and BMI were independently associated with raised BP.
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Affiliation(s)
- José João Mendes
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz—Cooperativa de Ensino Superior, 2829-511 Caparica, Portugal; (J.J.M.); (J.V.); (F.C.); (D.P.); (V.M.); (J.R.); (A.S.D.)
- Evidenced-Based Hub, CiiEM, Egas Moniz—Cooperativa de Ensino Superior, 2829-511 Caparica, Portugal;
| | - João Viana
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz—Cooperativa de Ensino Superior, 2829-511 Caparica, Portugal; (J.J.M.); (J.V.); (F.C.); (D.P.); (V.M.); (J.R.); (A.S.D.)
| | - Filipe Cruz
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz—Cooperativa de Ensino Superior, 2829-511 Caparica, Portugal; (J.J.M.); (J.V.); (F.C.); (D.P.); (V.M.); (J.R.); (A.S.D.)
| | - Dinis Pereira
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz—Cooperativa de Ensino Superior, 2829-511 Caparica, Portugal; (J.J.M.); (J.V.); (F.C.); (D.P.); (V.M.); (J.R.); (A.S.D.)
| | - Sílvia Ferreira
- Patologia Clínica, Centro Hospitalar Lisboa Ocidental, 1449-005 Lisboa, Portugal;
| | - Paula Pereira
- Grupo de Estudos em Nutrição Aplicada (GENA), CiiEM, Egas Moniz—Cooperativa de Ensino Superior, 2829-511 Caparica, Portugal;
| | - Luís Proença
- Evidenced-Based Hub, CiiEM, Egas Moniz—Cooperativa de Ensino Superior, 2829-511 Caparica, Portugal;
- Quantitative Methods for Health Research (MQIS), CiiEM, Egas Moniz—Cooperativa de Ensino Superior, 2829-511 Caparica, Portugal
| | - Vanessa Machado
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz—Cooperativa de Ensino Superior, 2829-511 Caparica, Portugal; (J.J.M.); (J.V.); (F.C.); (D.P.); (V.M.); (J.R.); (A.S.D.)
- Evidenced-Based Hub, CiiEM, Egas Moniz—Cooperativa de Ensino Superior, 2829-511 Caparica, Portugal;
| | - João Botelho
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz—Cooperativa de Ensino Superior, 2829-511 Caparica, Portugal; (J.J.M.); (J.V.); (F.C.); (D.P.); (V.M.); (J.R.); (A.S.D.)
- Evidenced-Based Hub, CiiEM, Egas Moniz—Cooperativa de Ensino Superior, 2829-511 Caparica, Portugal;
- Correspondence: ; Tel.: +351-969-848-394
| | - João Rua
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz—Cooperativa de Ensino Superior, 2829-511 Caparica, Portugal; (J.J.M.); (J.V.); (F.C.); (D.P.); (V.M.); (J.R.); (A.S.D.)
| | - Ana Sintra Delgado
- Clinical Research Unit (CRU), Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz—Cooperativa de Ensino Superior, 2829-511 Caparica, Portugal; (J.J.M.); (J.V.); (F.C.); (D.P.); (V.M.); (J.R.); (A.S.D.)
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Yin H, Ma X, He Y, Liang R, Wang Y, Zhang M, Mao L, Jing M. Effect of an outpatient copayment scheme on health outcomes of hypertensive adults in a community-managed population in Xinjiang, China. PLoS One 2020; 15:e0238980. [PMID: 32915916 PMCID: PMC7485825 DOI: 10.1371/journal.pone.0238980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 08/27/2020] [Indexed: 11/17/2022] Open
Abstract
Hypertension remains the leading risk factor for death and disability in China, and the ability of hypertensive patients to pay for outpatient care and medication has become a critical issue. To report the effect of an outpatient copayment scheme on health outcomes of hypertensive adults in a community-managed population in Xinjiang, we compared changes in outcomes between insured and uninsured groups from baseline to the first follow-up appointment in a community-managed hypertensive population and evaluated these changes based on propensity score matching and the difference-in-difference method. A total of 1,095 individuals in a community-managed hypertension population were selected for investigation at baseline, among which 805 (73.5%) had follow-up data and 749 (68.4%) were included in our analysis. After accounting for the self-reported severity of hypertension and individual characteristics, there were statistically significant improvements in drug treatment of hypertension and self-reported health. We also found increases in drug treatment for hypertension between groups, after correcting for confounding variables (Odds Ratio, OR 8.05, 95% Confidence interval, CI, 1.31-49.35), and in self-reported health between groups after correcting confounders (OR 1.96, 95% CI, 1.12 to 3.42). Adjusted estimates (confounding variables) were corrected for age, sex, income, marital status, education level, employment, family size, self-reported severity of hypertension, course of hypertension, and number of medications. As a result, decreased outpatient copayment was associated with an increase in antihypertensive treatment coverage, and an improvement in self-reported health among community-managed hypertensive populations in Xinjiang, China.
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Affiliation(s)
- Hongpo Yin
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Xiaochen Ma
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Yanli He
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Rujiang Liang
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Yongxin Wang
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Mei Zhang
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Lu Mao
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, China
| | - Mingxia Jing
- Department of Public Health, Shihezi University School of Medicine, Shihezi, Xinjiang, China
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Wan EYF, Yu EYT, Chin WY, Fong DYT, Choi EPH, Tang EHM, Lam CLK. Burden of CKD and Cardiovascular Disease on Life Expectancy and Health Service Utilization: a Cohort Study of Hong Kong Chinese Hypertensive Patients. J Am Soc Nephrol 2019; 30:1991-1999. [PMID: 31492808 DOI: 10.1681/asn.2018101037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 06/17/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The relative effects of combinations of CKD, heart disease, and stroke on risk of mortality, direct medical costs, and life expectancy are unknown. METHODS In a retrospective cohort study of 506,849 Chinese adults in Hong Kong with hypertension, we used Cox regressions to examine associations between all-cause mortality and combinations of moderate CKD (eGFR of 30-59 ml/min per 1.73 m2), severe CKD (eGFR of 15-29 ml/min per 1.73 m2), heart disease (coronary heart disease or heart failure), and stroke, and modeling to estimate annual public direct medical costs and life expectancy. RESULTS Over a median follow-up of 5.8 years (2.73 million person-years), 55,666 deaths occurred. Having an increasing number of comorbidities was associated with incremental increases in mortality risk and medical costs and reductions in life expectancy. Compared with patients who had neither CKD nor cardiovascular disease, patients with one, two, or three conditions (heart disease, stroke, and moderate CKD) had relative risk of mortality increased by about 70%, 160%, and 290%, respectively; direct medical costs increased by about 70%, 160%, and 280%, respectively; and life expectancy at age 60 years decreased by about 5, 10, and 15 years, respectively. Burdens were higher with severe CKD. CONCLUSIONS This study demonstrated extremely high mortality risk and medical cost increases for severe CKD, exceeding the combined effects from heart disease and stroke. Mortality risks and costs for moderate CKD, heart disease, and stroke were similar individually and roughly multiplicative for any combination. These findings suggest that to reduce mortality and health care costs in patients with hypertension, CKD prevention and intervention merits priority equal to that of cardiovascular disease.
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Affiliation(s)
- Eric Yuk Fai Wan
- Departments of Family Medicine and Primary Care and .,Pharmacology and Pharmacy, and
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Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, Cooney MT, Corrà U, Cosyns B, Deaton C, Graham I, Hall MS, Hobbs FDR, Løchen ML, Löllgen H, Marques-Vidal P, Perk J, Prescott E, Redon J, Richter DJ, Sattar N, Smulders Y, Tiberi M, Bart van der Worp H, van Dis I, Verschuren WMM. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Atherosclerosis 2018; 252:207-274. [PMID: 27664503 DOI: 10.1016/j.atherosclerosis.2016.05.037] [Citation(s) in RCA: 339] [Impact Index Per Article: 56.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Ugo Corrà
- Societie: European Society of Cardiology (ESC)
| | | | | | - Ian Graham
- Societie: European Society of Cardiology (ESC)
| | | | | | | | | | | | - Joep Perk
- Societie: European Society of Cardiology (ESC)
| | | | - Josep Redon
- Societie: European Society of Hypertension (ESH)
| | | | - Naveed Sattar
- Societie: European Association for the Study of Diabetes (EASD)
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2016 European Guidelines on cardiovascular disease prevention in clinical practice. Int J Behav Med 2017; 24:321-419. [DOI: 10.1007/s12529-016-9583-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Cardiovascular Disease and Health Care System Impact on Functionality and Productivity in Argentina: A Secondary Analysis. Value Health Reg Issues 2016; 11:35-41. [PMID: 27986196 DOI: 10.1016/j.vhri.2016.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 10/27/2015] [Accepted: 01/19/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To examine the impact of cardiovascular disease (CVD) events on patient functionality and productivity on the basis of patient use of public or social/private institution health care. METHODS A secondary analysis was conducted of data drawn from records of Argentinian patients, 3 to 15 months posthospitalization after a CVD event, who had originally participated in a multicountry, cross-sectional study assessing the microeconomic impact of a CVD event. Respondents were stratified according to their use of health care institution (public or social/private). Among these groups, pre- and post-CVD event changes in functionality and productivity were compared. RESULTS Participants' (N = 431) mean age was 56.5 years, and 73.5% were men. Public sector patients reported significantly higher rates of decline in ability to perform moderate activities (P < 0.05), a greater decrease in time spent at work (P < 0.01), a greater limit in the type of work-related activities (P < 0.01), and a higher rate of emotional problems (P < 0.01). Having health insurance (private or social) (odds ratio [OR] = 0.55; 95% confidence interval [CI] 0.35-0.85; P < 0.01) and a higher income (OR = 0.99; 95% CI 0.99-0.99; P < 0.01) were inversely and significantly associated with loss of productivity. Cerebrovascular disease (OR = 2.55; 95% CI 1.42-4.60; P < 0.01) was also significantly associated with productivity loss. CONCLUSIONS In Argentina, patients receiving care in the public sector experienced a greater impact on functionality and productivity after their hospitalization for a CVD event. Lack of insurance, low income, and cerebrovascular disease event were the major determinants of productivity loss. Further investigation is needed to better understand contributors to these differences.
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Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, Cooney MT, Corrà U, Cosyns B, Deaton C, Graham I, Hall MS, Hobbs FDR, Løchen ML, Löllgen H, Marques-Vidal P, Perk J, Prescott E, Redon J, Richter DJ, Sattar N, Smulders Y, Tiberi M, van der Worp HB, van Dis I, Verschuren WMM. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2016; 37:2315-2381. [PMID: 27222591 PMCID: PMC4986030 DOI: 10.1093/eurheartj/ehw106] [Citation(s) in RCA: 4457] [Impact Index Per Article: 557.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Massimo F. Piepoli
- Corresponding authors: Massimo F. Piepoli, Heart Failure Unit, Cardiology Department, Polichirurgico Hospital G. Da Saliceto, Cantone Del Cristo, 29121 Piacenza, Emilia Romagna, Italy, Tel: +39 0523 30 32 17, Fax: +39 0523 30 32 20, E-mail: ,
| | - Arno W. Hoes
- Arno W. Hoes, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500 (HP Str. 6.131), 3508 GA Utrecht, The Netherlands, Tel: +31 88 756 8193, Fax: +31 88 756 8099, E-mail:
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Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, Cooney MT, Corrà U, Cosyns B, Deaton C, Graham I, Hall MS, Hobbs FDR, Løchen ML, Löllgen H, Marques-Vidal P, Perk J, Prescott E, Redon J, Richter DJ, Sattar N, Smulders Y, Tiberi M, van der Worp HB, van Dis I, Verschuren WMM, De Backer G, Roffi M, Aboyans V, Bachl N, Bueno H, Carerj S, Cho L, Cox J, De Sutter J, Egidi G, Fisher M, Fitzsimons D, Franco OH, Guenoun M, Jennings C, Jug B, Kirchhof P, Kotseva K, Lip GYH, Mach F, Mancia G, Bermudo FM, Mezzani A, Niessner A, Ponikowski P, Rauch B, Rydén L, Stauder A, Turc G, Wiklund O, Windecker S, Zamorano JL. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts): Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur J Prev Cardiol 2016; 23:NP1-NP96. [PMID: 27353126 DOI: 10.1177/2047487316653709] [Citation(s) in RCA: 579] [Impact Index Per Article: 72.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | - Ugo Corrà
- Societies: European Society of Cardiology (ESC)
| | | | | | - Ian Graham
- Societies: European Society of Cardiology (ESC)
| | | | | | | | | | | | - Joep Perk
- Societies: European Society of Cardiology (ESC)
| | | | | | | | - Naveed Sattar
- European Association for the Study of Diabetes (EASD)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Leslie Cho
- Societies: European Society of Cardiology (ESC)
| | | | | | | | - Miles Fisher
- European Association for the Study of Diabetes (EASD)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Lars Rydén
- Societies: European Society of Cardiology (ESC)
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Mutowo MP, Lorgelly PK, Laxy M, Renzaho AMN, Mangwiro JC, Owen AJ. The Hospitalization Costs of Diabetes and Hypertension Complications in Zimbabwe: Estimations and Correlations. J Diabetes Res 2016; 2016:9754230. [PMID: 27403444 PMCID: PMC4925986 DOI: 10.1155/2016/9754230] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 05/24/2016] [Accepted: 05/24/2016] [Indexed: 01/23/2023] Open
Abstract
Objective. Treating complications associated with diabetes and hypertension imposes significant costs on health care systems. This study estimated the hospitalization costs for inpatients in a public hospital in Zimbabwe. Methods. The study was retrospective and utilized secondary data from medical records. Total hospitalization costs were estimated using generalized linear models. Results. The median cost and interquartile range (IQR) for patients with diabetes, $994 (385-1553) mean $1319 (95% CI: 981-1657), was higher than patients with hypertension, $759 (494-1147) mean $914 (95% CI: 825-1003). Female patients aged below 65 years with diabetes had the highest estimated mean costs ($1467 (95% CI: 1177-1828)). Wound care had the highest estimated mean cost of all procedures, $2884 (95% CI: 2004-4149) for patients with diabetes and $2239 (95% CI: 1589-3156) for patients with hypertension. Age below 65 years, medical procedures (amputation, wound care, dialysis, and physiotherapy), the presence of two or more comorbidities, and being prescribed two or more drugs were associated with significantly higher hospitalization costs. Conclusion. Our estimated costs could be used to evaluate and improve current inpatient treatment and management of patients with diabetes and hypertension and determine the most cost-effective interventions to prevent complications and comorbidities.
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Affiliation(s)
- Mutsa P. Mutowo
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Paula K. Lorgelly
- Centre for Health Economics, Monash University, Melbourne, VIC 3800, Australia
| | - Michael Laxy
- Helmholtz Zentrum München (GmbH), German Research Center for Environmental Health, Institute of Health Economics and Health Care Management (IGM), Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
| | - Andre M. N. Renzaho
- School of Social Science and Psychology, University of Western Sydney, Sydney, NSW 2751, Australia
| | | | - Alice J. Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
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Promoción de la salud desde el lugar de trabajo. HIPERTENSION Y RIESGO VASCULAR 2015; 32:97-9. [DOI: 10.1016/j.hipert.2015.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 06/11/2015] [Indexed: 11/18/2022]
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Turin TC, Ahmed SB, Tonelli M, Manns B, Ravani P, James M, Quinn RR, Jun M, Gansevoort R, Hemmelgarn B. Kidney function, albuminuria and life expectancy. Can J Kidney Health Dis 2014; 1:33. [PMID: 25780622 PMCID: PMC4349777 DOI: 10.1186/s40697-014-0033-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 12/05/2014] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Lower estimated glomerular filtration rate is associated with reduced life expectancy. Whether this association is modified by the presence or absence of albuminuria, another cardinal finding of chronic kidney disease, is unknown. OBJECTIVE Our objective was to estimate the life expectancy of middle-aged men and women with varying levels of eGFR and concomitant albuminuria. DESIGN A retrospective cohort study. SETTING A large population-based cohort identified from the provincial laboratory registry in Alberta, Canada. PARTICIPANTS Adults aged ≥30 years who had outpatient measures of serum creatinine and albuminuria between May 1, 2002 and March 31, 2008. MEASUREMENTS PREDICTOR Baseline levels of kidney function identified from serum creatinine and albuminuria measurements. OUTCOMES all cause mortality during the follow-up. METHODS Patients were categorized based on their estimated glomerular filtration rate (eGFR) (≥60, 45-59, 30-44, and 15-29 mL/min/1 · 73 m(2)) as well as albuminuria (normal, mild, and heavy) measured by albumin-to-creatinine ratio or urine dipstick. The abridged life table method was applied to calculate the life expectancies of men and women from age 40 to 80 years across combined eGFR and albuminuria categories. We also categorized participants by severity of kidney disease (low risk, moderately increased risk, high risk, and very high risk) using the combination of eGFR and albuminuria levels. RESULTS Among men aged 50 years and with eGFR ≥60 mL/min/1.73 m(2), estimated life expectancy was 24.8 (95% CI: 24.6-25.0), 17.5 (95% CI: 17.1-17.9), and 13.5 (95% CI: 12.6-14.3) years for participants with normal, mild and heavy albuminuria respectively. Life expectancy for men with mild and heavy albuminuria was 7.3 (95% CI: 6.9-7.8) and 11.3 (95% CI: 10.5-12.2) years shorter than men with normal proteinuria, respectively. A reduction in life expectancy was associated with an increasing severity of kidney disease; 24.8 years for low risk (95% CI: 24.6-25.0), 19.1 years for moderately increased risk (95% CI: 18.7-19.5), 14.2 years for high risk (95% CI: 13.5-15.0), and 9.6 years for very high risk (95% CI: 8.4-10.8). Among women of similar age and kidney function, estimated life expectancy was 28.9 (95% CI: 28.7-29.1), 19.8 (95% CI: 19.2-20.3), and 14.8 (95% CI: 13.5-16.0) years for participants with normal, mild and heavy albuminuria respectively. Life expectancy for women with mild and heavy albuminuria was 9.1 (95% CI: 8.5-9.7) and 14.2 (95% CI: 12.9-15.4) years shorter than the women with normal proteinuria, respectively. For women also a graded reduction in life expectancy was observed across the increasing severity of kidney disease; 28.9 years for low risk (95% CI: 28.7-29.1), 22.5 years for moderately increased risk (95% CI: 22.0-22.9), 16.5 years for high risk (95% CI: 15.4-17.5), and 9.2 years for very high risk (95% CI: 7.8-10.7). LIMITATIONS Possible misclassification of long-term kidney function categories cannot be eliminated. Possibility of confounding due to concomitant comorbidities cannot be ruled out. CONCLUSION The presence and degree of albuminuria was associated with lower estimated life expectancy for both gender and was especially notable in those with eGFR ≥30 mL/min/1.73 m(2). Life expectancy associated with a given level of eGFR differs substantially based on the presence and severity of albuminuria.
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Affiliation(s)
- Tanvir Chowdhury Turin
- />Department of Family Medicine, University of Calgary, Room G012F, 3330 Hospital Drive Northwest, Calgary, Alberta T2N 4N1 Canada
- />Department of Community Health Sciences, University of Calgary, Calgary, Alberta Canada
- />Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta Canada
- />Institute of Public Health, University of Calgary, Calgary, Alberta Canada
| | - Sofia B Ahmed
- />Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta Canada
- />Department of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Marcello Tonelli
- />Department of Medicine, University of Alberta, Edmonton, Alberta Canada
| | - Braden Manns
- />Department of Community Health Sciences, University of Calgary, Calgary, Alberta Canada
- />Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta Canada
- />Institute of Public Health, University of Calgary, Calgary, Alberta Canada
- />Department of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Pietro Ravani
- />Department of Community Health Sciences, University of Calgary, Calgary, Alberta Canada
- />Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta Canada
- />Institute of Public Health, University of Calgary, Calgary, Alberta Canada
- />Department of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Matthew James
- />Department of Community Health Sciences, University of Calgary, Calgary, Alberta Canada
- />Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta Canada
- />Institute of Public Health, University of Calgary, Calgary, Alberta Canada
- />Department of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Robert R Quinn
- />Department of Community Health Sciences, University of Calgary, Calgary, Alberta Canada
- />Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta Canada
- />Institute of Public Health, University of Calgary, Calgary, Alberta Canada
- />Department of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Min Jun
- />Department of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Ron Gansevoort
- />Department of Nephrology, University Medical Center Groningen, Groningen, The Netherlands
| | - Brenda Hemmelgarn
- />Department of Community Health Sciences, University of Calgary, Calgary, Alberta Canada
- />Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta Canada
- />Institute of Public Health, University of Calgary, Calgary, Alberta Canada
- />Department of Medicine, University of Calgary, Calgary, Alberta Canada
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Krzysztoszek J, Koligat D, Ratajczak P, Bryl W, Cymerys M, Hoffmann K, Wierzejska E, Kleka P. Economic aspects of hypertension treatment in Poland. Arch Med Sci 2014; 10:607-17. [PMID: 25097594 PMCID: PMC4107239 DOI: 10.5114/aoms.2013.32853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 05/16/2012] [Accepted: 09/26/2012] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The aim of this study was to assess the costs associated with mild hypertension (HTN) in Poland and to compare the costs of 3-year ambulatory care for those diagnosed with mild HTN (group A) and those diagnosed with mild HTN and comorbidities (group B). MATERIAL AND METHODS The researchers undertook a retrospective study of a group of 120 patients treated for 3 years (2006-2008) (60%, n = 72 women and 40%, n = 48 men), taking into account the broadest possible social perspective. Medical and non-medical direct costs as well as indirect costs were calculated. RESULTS The total costs of the 3-year pharmacotherapy in group A equalled 49,985.65 EUR, or 833.09 EUR per patient, whereas in group B the costs were twice as high: 105,691.55 EUR in total or 1,761.53 EUR per patient. Indirect costs for group A patients totalled 3,468.80 EUR (578.13 EUR per patient) and 4,579.20 EUR for group B patients (572.40 EUR per patient). Total direct costs (medical and non-medical) and indirect costs for group B patients were much higher, amounting to 130,228.14 EUR and 2,666.55 EUR per patient, which was double the costs in group A, where costs were 74,184.96 EUR and 1,756.73 EUR per patient. CONCLUSIONS The costs of HTN treatment in Poland are very high and are growing, like in other countries. Potential solutions include developing better patientdoctor communication to improve compliance, and increasing the chances of more effective and less expensive therapy by prescribing cheaper generic drugs, limiting polypharmacy and improving availability of novel therapeutic methods.
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Affiliation(s)
- Jana Krzysztoszek
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, Poznan, Poland
| | - Dorota Koligat
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, Poznan, Poland
| | - Piotr Ratajczak
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, Poznan, Poland
| | - Wiesław Bryl
- Department of Internal Medicine, Metabolic Disorders and Hypertension, Poznan University of Medical Sciences, Poznan, Poland
| | - Maciej Cymerys
- Department of Internal Medicine, Metabolic Disorders and Hypertension, Poznan University of Medical Sciences, Poznan, Poland
| | - Karolina Hoffmann
- Department of Internal Medicine, Metabolic Disorders and Hypertension, Poznan University of Medical Sciences, Poznan, Poland
| | - Ewelina Wierzejska
- Laboratory of International Health, Department of Preventive Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Paweł Kleka
- Institute of Psychology, Adam Mickiewicz University, Poznan, Poland
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Treated and untreated hypertension, hospitalization, and medical expenditure: an epidemiological study in 314622 beneficiaries of the medical insurance system in Japan. J Hypertens 2013; 31:1032-42. [PMID: 23449017 DOI: 10.1097/hjh.0b013e32835f5747] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE This study investigated the effect of hypertension on hospitalization risk and medical expenditure according to treatment status in a Japanese population. METHODS A total of 314 622 beneficiaries of the medical insurance system in Japan, aged 40-69 years, without a history of cardiovascular, cerebrovascular, or end-stage renal disease were classified into seven blood pressure categories. These categories were used to compare the risk of undergoing hospitalization in the 1 year after the baseline survey and to examine the percentage of inpatient medical expenditure attributable to overall hypertension relative to total medical expenditure in the study population. RESULTS During the follow-up period, 6.6% of men and 5.1% of women were hospitalized. In men and women aged 40-54 years, cases of hypertension, especially grade 3 untreated hypertension, led to more frequent hospitalization, compared with optimal blood pressure. Individuals who were hospitalized, especially long-term, incurred considerably higher medical expenditure compared with those who were not hospitalized, regardless of their hypertension status. In women aged 55-69 years, there was little variation in hospitalization risk across blood pressure categories. The inpatient medical expenditure attributable to overall hypertension represented 7.2 and 6.9% of the total medical expenditure for men aged 40-54 and 55-69 years, whereas it represented 2.8 and 3.8% for women, respectively. CONCLUSION Although cases of hypertension were an economic burden especially in men, grade 3 untreated hypertension was more likely to incur extremely high medical expenditure as a result of hospitalization, compared with other cases.
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Abstract
OBJECTIVE To analyze whether noise sensitivity increases the risk of disability pension (DP). METHODS Questionnaire data of a sample of 706 Finnish twin individuals (age range, 31 to 65 years) with record linkage to information on DP during 16 years of follow-up were analyzed using individual and pairwise Cox proportional hazards models. RESULTS Noise sensitivity increased the risk of DP (hazard ratio = 1.41; 95% confidence interval [CI]: 1.03 to 1.93) and DP due to musculoskeletal disorders (hazard ratio = 1.63; 95% CI: 1.00 to 2.66). In within-pair analyses, noise sensitivity increased the risk of DP: among all twin pairs, odds ratio was 1.80 (95% CI: 1.08 to 3.06). CONCLUSIONS Noise sensitivity may be a potential risk factor for disability retirement. It is associated with DP independently of familial background and genetic factors.
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Calvo-Bonacho E, Ruilope LM, Sanchez-Chaparro MA, Cerezo C, Catalina-Romero C, Martinez-Munoz P, Banegas JR, Waeber B, Gonzalez-Quintela A, Zanchetti A. Influence of high cardiovascular risk in asymptomatic people on the duration and cost of sick leave: results of the ICARIA study. Eur Heart J 2013; 35:299-306. [DOI: 10.1093/eurheartj/eht156] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Turin TC, Murakami Y, Miura K, Rumana N, Kita Y, Hayakawa T, Okamura T, Okayama A, Ueshima H. Hypertension and life expectancy among Japanese: NIPPON DATA80. Hypertens Res 2012; 35:954-8. [DOI: 10.1038/hr.2012.86] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Turin TC, Tonelli M, Manns BJ, Ravani P, Ahmed SB, Hemmelgarn BR. Chronic kidney disease and life expectancy. Nephrol Dial Transplant 2012; 27:3182-6. [PMID: 22442392 DOI: 10.1093/ndt/gfs052] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Life expectancy is commonly used as an indicator of health and reflects disease burden in the population. The life expectancy for patients with lower levels of kidney function has not been reported. METHODS The abridged life table method was applied to calculate the life expectancies of men and women from age 30 to 85 years, by levels of kidney function as defined by estimated glomerular filtration rate (eGFR): ≥ 60, 45-59, 30-44 and 15-29 mL/min/1.73 m(2). RESULTS Men and women aged 40 years had a life expectancy of 30.5 and 34.6 years at eGFR ≥ 60 mL/min/1.73 m(2), 24.5 and 28.7 years at eGFR 45-59 mL/min/1.73 m(2), 14.5 and 16.5 years at eGFR 30-44 mL/min/1.73 m(2) and 10.4 and 9.1 years at eGFR 15-29 mL/min/1.73 m(2), respectively. Life expectancy was longer for women compared with men at all ages and eGFR categories, other than for eGFR 15-29 mL/min/1.73 m(2) where there was no difference in life expectancy by gender. CONCLUSION A lower level of kidney function is associated with a reduction in life expectancy for both men and women.
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Tsuji RLG, Silva GVD, Ortega KC, Berwanger O, Mion Júnior D. An economic evaluation of antihypertensive therapies based on clinical trials. Clinics (Sao Paulo) 2012; 67:41-8. [PMID: 22249479 PMCID: PMC3248600 DOI: 10.6061/clinics/2012(01)07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2011] [Revised: 09/20/2011] [Accepted: 09/20/2011] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Hypertension is a major issue in public health, and the financial costs associated with hypertension continue to increase. Cost-effectiveness studies focusing on antihypertensive drug combinations, however, have been scarce. The cost-effectiveness ratios of the traditional treatment (hydrochlorothiazide and atenolol) and the current treatment (losartan and amlodipine) were evaluated in patients with grade 1 or 2 hypertension (HT1-2). For patients with grade 3 hypertension (HT3), a third drug was added to the treatment combinations: enalapril was added to the traditional treatment, and hydrochlorothiazide was added to the current treatment. METHODS Hypertension treatment costs were estimated on the basis of the purchase prices of the antihypertensive medications, and effectiveness was measured as the reduction in systolic blood pressure and diastolic blood pressure (in mm Hg) at the end of a 12-month study period. RESULTS When the purchase price of the brand-name medication was used to calculate the cost, the traditional treatment presented a lower cost-effectiveness ratio [US$/mm Hg] than the current treatment in the HT1-2 group. In the HT3 group, however, there was no difference in cost-effectiveness ratio between the traditional treatment and the current treatment. The cost-effectiveness ratio differences between the treatment regimens maintained the same pattern when the purchase price of the lower-cost medication was used. CONCLUSIONS We conclude that the traditional treatment is more cost-effective (US$/mm Hg) than the current treatment in the HT1-2 group. There was no difference in cost-effectiveness between the traditional treatment and the current treatment for the HT3 group.
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Affiliation(s)
- Rosana Lima Garcia Tsuji
- Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Nephrology Division, Hypertension Unit, Brazil.
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Piñol C, Alegría E, Langham S. Carga epidemiológica y económica de la hipertensión arterial en pacientes con síndrome metabólico en España: un modelo basado en la prevalencia. HIPERTENSION Y RIESGO VASCULAR 2011. [DOI: 10.1016/j.hipert.2011.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Loukine L, Waters C, Choi BCK, Ellison J. Health-Adjusted Life Expectancy among Canadian Adults with and without Hypertension. Cardiol Res Pract 2011; 2011:612968. [PMID: 21738858 PMCID: PMC3123912 DOI: 10.4061/2011/612968] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Accepted: 04/11/2011] [Indexed: 11/20/2022] Open
Abstract
Hypertension can lead to cardiovascular diseases and other chronic conditions. While the impact of hypertension on premature death and life expectancy has been published, the impact on health-adjusted life expectancy has not, and constitutes the research objective of this study. Health-adjusted life expectancy (HALE) is the number of expected years of life equivalent to years lived in full health. Data were obtained from the Canadian Chronic Disease Surveillance System (mortality data 2004-2006) and the Canadian Community Health Survey (Health Utilities Index data 2000-2005) for people with and without hypertension. Life table analysis was applied to calculate life expectancy and health-adjusted life expectancy and their confidence intervals. Our results show that for Canadians 20 years of age, without hypertension, life expectancy is 65.4 years and 61.0 years, for females and males, respectively. HALE is 55.0 years and 52.8 years for the two sexes at age 20; and 24.7 years and 22.9 years at age 55. For Canadians with hypertension, HALE is only 48.9 years and 47.1 years for the two sexes at age 20; and 22.7 years and 20.2 years at age 55. Hypertension is associated with a significant loss in health-adjusted life expectancy compared to life expectancy.
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Affiliation(s)
- Lidia Loukine
- Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada (PHAC), Government of Canada, Ottawa, ON, Canada K1A 0K9
| | - Chris Waters
- Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada (PHAC), Government of Canada, Ottawa, ON, Canada K1A 0K9
| | - Bernard C. K. Choi
- Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada (PHAC), Government of Canada, Ottawa, ON, Canada K1A 0K9
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON, Canada
- Shantou University Medical College, Shantou 515041, China
| | - Joellyn Ellison
- Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada (PHAC), Government of Canada, Ottawa, ON, Canada K1A 0K9
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Wille E, Scholze J, Alegria E, Ferri C, Langham S, Stevens W, Jeffries D, Uhl-Hochgraeber K. Modelling the costs of care of hypertension in patients with metabolic syndrome and its consequences, in Germany, Spain and Italy. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2011; 12:205-218. [PMID: 20405160 DOI: 10.1007/s10198-010-0223-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Accepted: 02/02/2010] [Indexed: 05/29/2023]
Abstract
The presence of metabolic syndrome in patients with hypertension significantly increases the risk of cardiovascular disease, type 2 diabetes and mortality. Our aim is to estimate the economic burden to the health service of metabolic syndrome (MetS) in patients with hypertension and its consequences, in three European countries in 2008, and to forecast future economic burden in 2020 using projected demographic estimates and assumptions around the growth of MetS. An age-, sex- and risk group-structured prevalence-based cost of illness model was developed using the United States Adult Treatment Panel III of the National Cholesterol Education Program criteria to define MetS. Data sources included published information and public use databases on disease prevalence, incidence of cardiovascular events, prevalence of type 2 diabetes, treatment patterns and cost of management in Germany, Spain and Italy. The economic burden to the health service of MetS in patients with hypertension has been estimated at 24,427 euro, 1,900 euro and 4,877 euro million in Germany, Spain and Italy, and is forecast to rise by 59, 179 and 157%, respectively, by 2020. The largest components of costs included the management of prevalent type 2 diabetes and incident cardiovascular events. Mean annual costs per hypertensive patient were around three-fold higher in subjects with MetS compared to those without and rose incrementally with the additional number of MetS components present. In conclusion, the presence of MetS in patients with hypertension significantly inflates economic burden, and costs are likely to increase in the future due to an aging population and an increase in the prevalence of components of MetS.
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Affiliation(s)
- Eberhard Wille
- Fakultät für Volkswirtschaftslehre, L 7, 3-5, 2. OG, Raum 21, 68131, Mannheim, Germany.
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Scholze J, Alegria E, Ferri C, Langham S, Stevens W, Jeffries D, Uhl-Hochgraeber K. Epidemiological and economic burden of metabolic syndrome and its consequences in patients with hypertension in Germany, Spain and Italy; a prevalence-based model. BMC Public Health 2010; 10:529. [PMID: 20813031 PMCID: PMC2940918 DOI: 10.1186/1471-2458-10-529] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Accepted: 09/02/2010] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The presence of metabolic syndrome in patients with hypertension significantly increases the risk of cardiovascular disease, type 2 diabetes and mortality. Our aim is to estimate the epidemiological and economic burden to the health service of metabolic syndrome in patients with hypertension in three European countries in 2008 and 2020. METHODS An age, sex and risk group structured prevalence based cost of illness model was developed using the United States Adult Treatment Panel III of the National Cholesterol Education Program criteria to define metabolic syndrome. Data sources included published information and public use databases on disease prevalence, incidence of cardiovascular events, prevalence of type 2 diabetes, treatment patterns and cost of management in Germany, Spain and Italy. RESULTS The prevalence of hypertension with metabolic syndrome in the general population of Germany, Spain and Italy was 36%, 11% and 10% respectively. In subjects with hypertension 61%, 22% and 21% also had metabolic syndrome. Incident cardiovascular events and attributable mortality were around two fold higher in subjects with metabolic syndrome and prevalence of type 2 diabetes was around six-fold higher. The economic burden to the health service of metabolic syndrome in patients with hypertension was been estimated at €24,427, €1,900 and €4,877 million in Germany, Spain and Italy and forecast to rise by 59%, 179% and 157% respectively by 2020. The largest components of costs included the management of prevalent type 2 diabetes and incident cardiovascular events. Mean annual costs per hypertensive patient were around three-fold higher in subjects with metabolic syndrome compared to those without and rose incrementally with the additional number of metabolic syndrome components present. CONCLUSION The presence of metabolic syndrome in patients with hypertension significantly inflates economic burden and costs are likely to increase in the future due to an aging population and an increase in the prevalence of components of metabolic syndrome.
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Affiliation(s)
- Jürgen Scholze
- Department of Medicine, Outpatient Clinic, CCM, Charite-Universitatsmedizin Berlin, Luisenstrasse 11-13, 10117 Berlin, Germany.
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Berto P, Lopatriello S. Long-term social costs of hypertension. Expert Rev Pharmacoecon Outcomes Res 2010; 3:33-40. [PMID: 19807493 DOI: 10.1586/14737167.3.1.33] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
According to published studies, much of the cost of hypertension is due to antihypertensive drug treatment. However, the cost of hypertension also includes the cost of an increased frequency of cardiovascular events when hypertension is not controlled. Although conceptually accepted by the scientific community, the achievement of appropriate blood pressure levels is less feasible than expected and studies demonstrate that only 13-27% of hypertensive patients are adequately informed, treated and controlled for their hypertension. This puts a tremendous burden on the healthcare system and society, since uncontrolled hypertension leads to higher rates of cardiovascular events and ultimately death. This paper demonstrates the paucity of reliable cost-of-illness estimates for the long-term consequences of uncontrolled hypertension and suggests that it is understandable that public and private payers focus on the immediate short-term costs of treating hypertension, paying less attention to potential cost savings of fewer cardiovascular events, as these costs are far less well defined. This paper also suggests that hypertension as a disease is an ideal candidate for disease management strategies and programs, as prevention of its long-term consequences should be the focus of medical treatment and could be better achieved through an integrated multispecialist and multisetting approach.
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Affiliation(s)
- Patrizia Berto
- pbe Consulting, via Cappello, 12 - 37121, Verona, Italy.
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Kark M, Rasmussen F. High systolic blood pressure increases the risk of obtaining a disability pension because of cardiovascular disease: a cohort study of 903 174 Swedish men. ACTA ACUST UNITED AC 2009; 16:597-602. [DOI: 10.1097/hjr.0b013e32832d7ce0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Malin Kark
- Child and Adolescent Public Health Epidemiology Group, Department of Public Health Sciences, Karolinska Institute, Sweden
| | - Finn Rasmussen
- Child and Adolescent Public Health Epidemiology Group, Department of Public Health Sciences, Karolinska Institute, Sweden
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Tarride JE, Lim M, DesMeules M, Luo W, Burke N, O'Reilly D, Bowen J, Goeree R. A review of the cost of cardiovascular disease. Can J Cardiol 2009; 25:e195-202. [PMID: 19536390 DOI: 10.1016/s0828-282x(09)70098-4] [Citation(s) in RCA: 151] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
In Canada, 74,255 deaths (33% of all deaths) in 2003 were due to cardio-vascular disease (CVD). As one of the most costly diseases, CVD represents a major economic burden on health care systems. The purpose of the present study was to review the literature on the economic costs of CVD in Canada and other developed countries (United States, Europe and Australia) published from 1998 to 2006, with a focus on Canada. Of 1656 screened titles and abstracts, 34 articles were reviewed including six Canadian studies and 17 American studies. While considerable variation was observed among studies, all studies indicated that the costs of treating CVD-related conditions are significant, outlining a convincing case for CVD prevention programs.
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Affiliation(s)
- Jean-Eric Tarride
- St Joseph's Healthcare Hamilton and McMaster University, Hamilton, Canada.
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Kark M, Karnehed N, Rasmussen F. Blood pressure in young adulthood and later disability pension. A population‐based study on 867 672 men from Sweden. Blood Press 2009; 16:362-6. [PMID: 17852095 DOI: 10.1080/08037050701538113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Hypertension is a common chronic condition and can lead to an economic burden for society because of the costs of treatment for high blood pressure and most likely also because of disabilities related to hypertension and its co-morbidities. The aim of this study was to investigate to what extent moderate/severe hypertension in young adulthood increases the risk of becoming a disability pensioner later in life. All Swedish men born 1951 to 1970, who had their systolic blood pressure measured at age 18-19 years in the compulsory military conscription examination were followed from 1990 to 2001 with respect to receiving disability pension. Among 867 672 men (84.3% of the target population), the hazard ratio was 1.33 (95% CI 1.15-1.52) for being granted disability pension because of moderate/severe hypertension compared with men with normal systolic blood pressure after adjustment for conscription centre, body mass index and socio-economic conditions in childhood and adulthood. Men with mild hypertension had also an increased hazard ratio (1.09, 95% CI 1.05-1.13) compared with men with normal systolic blood pressure. This study showed that hypertension in young adulthood increased the risk of disability pension in later life.
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Affiliation(s)
- Malin Kark
- Child and Adolescent Public Health Epidemiology Group, Department of Public Health Sciences, Karolinska Institute, Sweden.
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Barengo NC, Kastarinen M, Antikainen R, Nissinen A, Tuomilehto J. The effects of awareness, treatment and control of hypertension on cardiovascular and all-cause mortality in a community-based population. J Hum Hypertens 2009; 23:808-16. [DOI: 10.1038/jhh.2009.30] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Coca A. Economic benefits of treating high-risk hypertension with angiotensin II receptor antagonists (blockers). Clin Drug Investig 2008; 28:211-20. [PMID: 18345711 DOI: 10.2165/00044011-200828040-00002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Hypertension is one of the leading risk factors for cardiovascular disease and represents a major health and economic burden. Most patients with high- or very high-risk hypertension have multiple cardiovascular risk factors with or without accompanying subclinical organ damage or established cardiovascular or renal disease. Patients with severe hypertension or with moderate hypertension and one to two additional risk factors have absolute 10-year risks of cardiovascular disease of 21-30% and 15-20%, respectively. Current European treatment guidelines recommend that antihypertensive therapy be initiated rapidly and aggressively in patients with high-risk hypertension. Most patients require two or more antihypertensive agents to achieve the strict blood pressure target of <130/80 mmHg. This article reviews the existing cost-effectiveness data on the use of angiotensin II receptor antagonists (blockers) [ARBs] in patients with high-risk hypertension. Aggressive ARB treatment of patients in the early (microalbuminuric) stages of diabetic nephropathy has a significant renoprotective effect, delaying the onset of overt (proteinuric) nephropathy. By slowing the progression of these patients to end-stage renal disease, substantial cost savings can be made. There is a paucity of cost-effectiveness data regarding the use of fixed-dose ARB plus thiazide diuretic combination therapies. Longitudinal cost-benefit studies of this attractive and efficacious first-line treatment option are needed.
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Affiliation(s)
- Antonio Coca
- Hypertension Unit, Department of Internal Medicine, Institute of Medicine and Dermatology, Hospital Clínico, University of Barcelona, Barcelona, Spain.
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Booth N, Jula A, Aronen P, Kaila M, Klaukka T, Kukkonen-Harjula K, Reunanen A, Rissanen P, Sintonen H, Mäkelä M. Cost-effectiveness analysis of guidelines for antihypertensive care in Finland. BMC Health Serv Res 2007; 7:172. [PMID: 17958883 PMCID: PMC2174470 DOI: 10.1186/1472-6963-7-172] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2006] [Accepted: 10/24/2007] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Hypertension is one of the major causes of disease burden affecting the Finnish population. Over the last decade, evidence-based care has emerged to complement other approaches to antihypertensive care, often without health economic assessment of its costs and effects. This study looks at the extent to which changes proposed by the 2002 Finnish evidence-based Current Care Guidelines concerning the prevention, diagnosis, and treatment of hypertension (the ACCG scenario) can be considered cost-effective when compared to modelled prior clinical practice (the PCP scenario). METHODS A decision analytic model compares the ACCG and PCP scenarios using information synthesised from a set of national registers covering prescription drug reimbursements, morbidity, and mortality with data from two national surveys concerning health and functional capacity. Statistical methods are used to estimate model parameters from Finnish data. We model the potential impact of the different treatment strategies under the ACCG and PCP scenarios, such as lifestyle counselling and drug therapy, for subgroups stratified by age, gender, and blood pressure. The model provides estimates of the differences in major health-related outcomes in the form of life-years and costs as calculated from a 'public health care system' perspective. Cost-effectiveness analysis results are presented for subgroups and for the target population as a whole. RESULTS The impact of the use of the ACCG scenario in subgroups (aged 40-80) without concomitant cardiovascular and related diseases is mainly positive. Generally, costs and life-years decrease in unison in the lowest blood pressure group, while in the highest blood pressure group costs and life-years increase together and in the other groups the ACCG scenario is less expensive and produces more life-years. When the costs and effects for subgroups are combined using standard decision analytic aggregation methods, the ACCG scenario is cost-saving and more effective. CONCLUSION The ACCG scenario is likely to reduce costs and increase life-years compared to the PCP scenario in many subgroups. If the estimated trade-offs between the subgroups in terms of outcomes and costs are acceptable to decision-makers, then widespread implementation of the ACCG scenario is expected to reduce overall costs and be accompanied by positive outcomes overall.
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Affiliation(s)
- Neill Booth
- Tampere School of Public Health, University of Tampere, Tampere, Finland
| | - Antti Jula
- Department of Health and Functional Capacity, National Public Health Institute, Helsinki, Finland
| | - Pasi Aronen
- Finnish Office for Health Technology Assessment (FinOHTA), National Research and Development Centre for Welfare and Health (STAKES), Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Minna Kaila
- Finnish Office for Health Technology Assessment (FinOHTA), National Research and Development Centre for Welfare and Health (STAKES), Helsinki, Finland
- Paediatric Research Centre, Tampere University Hospital and University of Tampere, Tampere, Finland
| | - Timo Klaukka
- Research Department, Social Insurance Institution, Helsinki, Finland
| | | | - Antti Reunanen
- Department of Health and Functional Capacity, National Public Health Institute, Helsinki, Finland
| | - Pekka Rissanen
- Tampere School of Public Health, University of Tampere, Tampere, Finland
| | - Harri Sintonen
- Finnish Office for Health Technology Assessment (FinOHTA), National Research and Development Centre for Welfare and Health (STAKES), Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Marjukka Mäkelä
- Finnish Office for Health Technology Assessment (FinOHTA), National Research and Development Centre for Welfare and Health (STAKES), Helsinki, Finland
- University of Copenhagen, Copenhagen, Denmark
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van Helvoort-Postulart D, Dirksen CD, Nelemans PJ, Kroon AA, Kessels AGH, de Leeuw PW, Vasbinder GBC, van Engelshoven JMA, Hunink MGM. Renal Artery Stenosis: Cost-effectiveness of Diagnosis and Treatment. Radiology 2007; 244:505-13. [PMID: 17581886 DOI: 10.1148/radiol.2442060713] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To use a decision analytic model to determine the cost-effectiveness of performing diagnostic digital subtraction angiography (DSA), computed tomographic (CT) angiography, or magnetic resonance (MR) angiography or proceeding immediately to tentative percutaneous revascularization in patients suspected of having renovascular hypertension. MATERIALS AND METHODS With use of a Markov-Monte Carlo decision model, cost-effectiveness analysis was performed from a societal perspective. Data were derived from the Renal Artery Diagnostic Imaging Study in Hypertension and from published literature. The base-case analyses were used to evaluate a 50-year-old patient with a diastolic blood pressure higher than 95 mm Hg and one or more clinical clues suggestive of renovascular hypertension. Outcome measures were quality-adjusted life-year (QALY), lifetime costs, and incremental cost-effectiveness. RESULTS For a 50-year-old male patient, immediate tentative revascularization was the least costly (euro54 415) and most effective (12.265 QALYs) strategy. For the other strategies, costs and QALYs, respectively, were euro55 570 and 12.195 for DSA, euro55 191 and 12.163 for CT angiography, and euro56 890 and 12.088 for MR angiography. For a 50-year-old female patient, costs and QALYs, respectively, were euro66 731 and 13.731 for MR angiography, euro63 970 and 13.749 for CT angiography, and euro63 079 and 13.902 for DSA. Immediate tentative revascularization yielded more QALYs (13.937) and was more costly (euro63 329) than DSA. The incremental cost-effectiveness ratio was euro7143 per QALY. As the prior probability increased, use of a more invasive diagnostic imaging strategy became justified. Also, the sensitivities of CT angiography and MR angiography and the costs of DSA influenced the results. CONCLUSION Given currently accepted incremental cost-effectiveness ratios, immediate tentative percutaneous revascularization is a cost-effective strategy for the diagnosis of renal artery stenosis. Management decisions should be conditional on the prior probability.
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Affiliation(s)
- Debby van Helvoort-Postulart
- Department of Clinical Epidemiology and Medical Technology Assessment, University Hospital Maastricht, P Debyelaan 25, 6229 HX Maastricht, the Netherlands.
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Halpern MT, Khan ZM, Schmier JK, Burnier M, Caro JJ, Cramer J, Daley WL, Gurwitz J, Hollenberg NK. Recommendations for Evaluating Compliance and Persistence With Hypertension Therapy Using Retrospective Data. Hypertension 2006; 47:1039-48. [PMID: 16651464 DOI: 10.1161/01.hyp.0000222373.59104.3d] [Citation(s) in RCA: 147] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Okubo Y, Miyamoto T, Suwazono Y, Kobayashi E, Nogawa K. The Effects of Job‐Related Factors and Lifestyle on the Five‐Year Cumulative Incidence of Hypertension in Japanese Steelworkers. J Occup Health 2006. [DOI: 10.1539/joh.42.304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Yasushi Okubo
- Department of HygieneSchool of Medicine, Chiba University
| | | | | | | | - Koji Nogawa
- Department of HygieneSchool of Medicine, Chiba University
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Akobundu E, Ju J, Blatt L, Mullins CD. Cost-of-illness studies : a review of current methods. PHARMACOECONOMICS 2006; 24:869-90. [PMID: 16942122 DOI: 10.2165/00019053-200624090-00005] [Citation(s) in RCA: 181] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
The number of cost-of-illness (COI) studies has expanded considerably over time. One outcome of this growth is that the reported COI estimates are inconsistent across studies, thereby raising concerns over the validity of the estimates and methods. Several factors have been identified in the literature as reasons for the observed variation in COI estimates. To date, the variation in the methods used to calculate costs has not been examined in great detail even though the variations in methods are a major driver of variation in COI estimates. The objective of this review was to document the variation in the methodologies employed in COI studies and to highlight the benefits and limitations of these methods. The review of COI studies was implemented following a four-step procedure: (i) a structured literature search of MEDLINE, JSTOR and EconLit; (ii) a review of abstracts using pre-defined inclusion and exclusion criteria; (iii) a full-text review using pre-defined inclusion and exclusion criteria; and (iv) classification of articles according to the methods used to calculate costs. This review identified four COI estimation methods (Sum_All Medical, Sum_Diagnosis Specific, Matched Control and Regression) that were used in categorising articles. Also, six components of direct medical costs and five components of indirect/non-medical costs were identified and used in categorising articles.365 full-length articles were reflected in the current review following the structured literature search. The top five cost components were emergency room/inpatient hospital costs, outpatient physician costs, drug costs, productivity losses and laboratory costs. The dominant method, Sum_Diagnosis Specific, was a total costing approach that restricted the summation of medical expenditures to those related to a diagnosis of the disease of interest. There was considerable variation in the methods used within disease subcategories. In several disease subcategories (e.g. asthma, dementia, diabetes mellitus), all four estimation methods were represented, and in other cases (e.g. HIV/AIDS, obesity, stroke, urinary incontinence, schizophrenia), three of the four estimation methods were represented. There was also evidence to suggest that the strengths and weaknesses of each method were considered when applying a method to a specific illness. Comparisons and assessments of COI estimates should consider the method used to estimate costs both as an important source of variation in the reported COI estimates and as a marker of the reliability of the COI estimate.
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Affiliation(s)
- Ebere Akobundu
- Pharmaceutical Health Services Research Department, School of Pharmacy, University of Maryland, Baltimore, Maryland 21201, USA.
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Franco OH, Peeters A, Bonneux L, de Laet C. Blood Pressure in Adulthood and Life Expectancy With Cardiovascular Disease in Men and Women. Hypertension 2005; 46:280-6. [PMID: 15983235 DOI: 10.1161/01.hyp.0000173433.67426.9b] [Citation(s) in RCA: 169] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Limited information exists about the consequences of hypertension during adulthood on residual life expectancy with cardiovascular disease. We aimed to analyze the life course of people with high blood pressure levels at age 50 in terms of total life expectancy and life expectancy with and without cardiovascular disease compared with normotensives. We constructed multistate life tables for cardiovascular disease, myocardial infarction, and stroke using data from 3128 participants of the Framingham Heart Study who had their 50th birthday while enrolled in the study. For the life table calculations, we used hazard ratios for 3 transitions (healthy to death, healthy to disease, and disease to death) by categories of blood pressure level and adjusted by age, sex, and confounders. Irrespective of sex, 50-year-old hypertensives compared with normotensives had a shorter life expectancy, a shorter life expectancy free of cardiovascular disease, myocardial infarction, and stroke, and a longer life expectancy lived with these diseases. Normotensive men (22% of men) survived 7.2 years (95% confidence interval, 5.6 to 9.0) longer without cardiovascular disease compared with hypertensives and spent 2.1 (0.9 to 3.4) fewer years of life with cardiovascular disease. Similar differences were observed in women. Compared with hypertensives, total life expectancy was 5.1 and 4.9 years longer for normotensive men and women, respectively. Increased blood pressure in adulthood is associated with large reductions in life expectancy and more years lived with cardiovascular disease. This effect is larger than estimated previously and affects both sexes similarly. Our findings underline the tremendous importance of preventing high blood pressure and its consequences in the population.
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Affiliation(s)
- Oscar H Franco
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands.
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Hernelahti M, Tikkanen HO, Karjalainen J, Kujala UM. Muscle fiber-type distribution as a predictor of blood pressure: a 19-year follow-up study. Hypertension 2005; 45:1019-23. [PMID: 15837823 DOI: 10.1161/01.hyp.0000165023.09921.34] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The known association between physical activity and low blood pressure may be influenced by inherited characteristics. Skeletal muscle consists of type I (slow-twitch) and type II (fast-twitch) muscle fibers, with proportions highly variable between individuals and mostly determined by genetic factors. A high percentage of type I fibers (type I%) has been associated with low blood pressure in cross-sectional studies. We investigated whether type I percentage predicts future blood pressure levels and explains part of the association between physical activity and blood pressure. At baseline, in 1984, muscle fiber-type distribution, physical activity, and body mass index (BMI) were determined in 64 healthy men (age, 32 to 58 years). At follow-up, in 2003, blood pressure, physical activity, and BMI were determined in these men. In subjects without antihypertensive medication (n=43), type I percentage accounted for 5%/18% of the variation in systolic/diastolic blood pressure. A high type I percentage predicted, independent of both baseline (in 1984) and follow-up (in 2003), physical activity, BMI, and low systolic and diastolic blood pressure. Adjusted for all baseline covariates, a 20-unit higher type I percentage predicted a 11.6-mm Hg lower systolic blood pressure (P=0.018) and a 5.0-mm Hg lower diastolic blood pressure (P=0.018). High levels of physical activity in 1984 predicted low diastolic blood pressure, but this association was lost when type I percentage was included into the model. A high proportion of type I fibers in skeletal muscle is an independent predictor of low blood pressure and explains part of the known association between high levels of physical activity and low blood pressure.
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Affiliation(s)
- Miika Hernelahti
- Unit for Sports and Exercise Medicine, of Clinical Medicine, University of Helsinki, Finland.
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Lloyd A, Schmieder C, Marchant N. Financial and health costs of uncontrolled blood pressure in the United Kingdom. PHARMACOECONOMICS 2003; 21 Suppl 1:33-41. [PMID: 12648033 DOI: 10.2165/00019053-200321001-00004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Uncontrolled hypertension is associated with an elevated risk of all cardiovascular disease, especially stroke. However, many patients with hypertension do not achieve agreed targets for blood pressure. OBJECTIVE To estimate the cost and morbidity consequences of uncontrolled hypertension in the UK. DESIGN Descriptive epidemiological study. METHODS The study used a burden-of-disease model combining data on the prevalence of hypertension, the incidence of major cardiovascular (CV) events and the costs of treating these events. The prevalence of uncontrolled hypertension was taken from the 1998 Health Survey for England. The incidences of three CV events, acute myocardial infarction, congestive heart failure and stroke, at different levels of achieved blood pressure, were estimated using results from the Hypertension Optimal Treatment study. Costs were taken from published sources. We estimated the number of major CV events and acute hospital costs that would be avoided if all people with hypertension had blood pressure treated to target levels. RESULTS The model estimated that in the UK 5.7 million adults (12% of the population aged >16 years) have actual blood pressure above 160/95 mm Hg, and a further 10.3 million (21%) have blood pressure in the range 140/90-160/95 mm Hg. An estimated 58000 major CV events per year occur in these patients that would be avoided if their blood pressure was at target levels. If all patients had blood pressure treated to target, the cost to the NHS of managing major CV events would fall by pound 97.2 million per year at 2000/01 prices (95% CI: pound 56- pound 144 million). CONCLUSION Failure to achieve blood pressure targets contributes substantially to avoidable NHS costs and to the number of CV events in the UK.
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Affiliation(s)
- Adam Lloyd
- Fourth Hurdle Consulting Ltd, London, UK.
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McIntyre H, Costa FV, Düsing R, Ambrosioni E, Gerth W. The role of losartan in cost-effective hypertension control. Curr Med Res Opin 2002; 18:139-45. [PMID: 12094823 DOI: 10.1185/030079902125000499] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Despite recent guidelines emphasising the need for aggressive treatment in patients with elevated blood pressure, the control of hypertension in Europe and the USA is poor, imposing a considerable burden in terms of patient morbidity and mortality, and associated healthcare costs. A major factor contributing to the suboptimal control of hypertension is the failure of patients to adhere to their prescribed therapy. Drug side-effects are an important cause of non-compliance and prescribing a well-tolerated agent that promotes good compliance is therefore the key to the cost-effective management of hypertension. Several studies have demonstrated that patients are more likely to remain on therapy with the angiotensin II antagonist losartan than other antihypertensives. Although the acquisition costs of new antihypertensives such as losartan are greater than for older drugs, such costs represent only a small proportion of the total cost of prescribing antihypertensive therapy. When accessory costs are also considered, the total cost of care with newer antihypertensives is comparable with those for diuretics. The costs involved if therapy has to be switched due to unacceptable side-effects also need to be taken into account when assessing relative cost effectiveness. Furthermore, savings may accrue from the non-haemodynamic benefits of losartan, such as improved cognitive function and renal protection. Further studies will increase awareness of the true cost effectiveness of antihypertensive drugs.
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Affiliation(s)
- H McIntyre
- Conquest Hospital, East Sussex, Hastings, UK.
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Bradford WD, Kleit AN, Krousel-Wood MA, Re RN. Testing efficacy with detection controlled estimation: an application to telemedicine. HEALTH ECONOMICS 2001; 10:553-564. [PMID: 11550295 DOI: 10.1002/hec.606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Detection controlled estimation (DCE) is a powerful new econometric estimator in the family of missing data estimators. By collecting measures from a variety of inspectors or inspection technologies, DCE is able to make inferences about the entire population, even when that population is not directly observed. Using this innovative method, we were able to assess whether telemedicine technology could be substituted for in-person visits when providing maintenance care for patients with hypertension. Our findings indicate that there is no support for the proposition that telemedicine is less effective than in-person visits for determining whether patients have high blood pressure. Indeed, our results imply that telemedicine misses 7% fewer cases of high blood pressure than in-person visits do. The results of this study indicate that DCE may be an effective tool for use in cost-effectiveness or cost-benefit analysis in health care.
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Affiliation(s)
- W D Bradford
- Center for Health Care Research, Medical University of South Carolina, USA
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Affiliation(s)
- F O Simpson
- University of Otago Medical School, Dunedin, New Zealand.
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