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Huizing E, Vos CG, van den Akker PJ, Schreve MA, de Borst GJ, Ünlü Ç. A systematic review of patch angioplasty versus primary closure for carotid endarterectomy. J Vasc Surg 2019; 69:1962-1974.e4. [PMID: 30792057 DOI: 10.1016/j.jvs.2018.10.096] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 10/09/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND Guidelines recommend routine patching after carotid endarterectomy (CEA) on the basis of a lower restenosis rate and presumed lower procedural stroke rate than with primary repair. Underlying evidence is based on studies performed decades ago with perioperative care that significantly differed from current standards. Recent studies raise doubt about routine patching and have suggested that a more selective approach to patch closure (PAC) might be noninferior for procedural safety and long-term stroke prevention. The objective was to review the literature on the procedural safety and perioperative stroke prevention of PAC compared with primary closure (PRC) after CEA. METHODS MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases were searched from January 1966 to September 2017. Two authors independently performed the search, study selection, assessment of methodologic quality, and data extraction. Articles were eligible if they compared PAC and PRC after CEA, were published in English, included human studies, and had a full text available. Methodologic quality for nonrandomized studies was assessed using the Methodological Index for Non-Randomized Studies score; randomized controlled trials were assessed using Grading of Recommendations Assessment, Development, and Evaluation. Nonrandomized studies with a score ≤15 were excluded. The primary outcome measure was 30-day stroke risk. Secondary outcome measures were long-term restenosis (>50%) and postoperative bleeding. RESULTS Twenty-nine articles met the inclusion criteria, 9 randomized studies and 20 nonrandomized studies, for a total of 12,696 patients and 13,219 CEAs. Overall 30-day stroke risk was higher in the PRC group (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.2-2.9). After exclusion of nonrandomized studies, this difference was not statistically significant anymore (OR, 1.8; 95% CI, 0.8-3.9). The restenosis rate was higher after PRC (OR, 2.2; 95% CI, 1.4-3.4). There were no differences in bleeding complications. Methodologic quality of the nonrandomized studies was moderate, and seven were excluded. Quality of the evidence according to Grading of Recommendations Assessment, Development, and Evaluation was moderate for restenosis, 30-day stroke, and bleeding. CONCLUSIONS In this systematic review, on the basis of moderate-quality evidence, perioperative stroke rate was lower after PAC compared with PRC. The rate of restenosis was higher after PRC, although the clinical significance of this finding in terms of long-term stroke prevention remained unclear.
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Affiliation(s)
- Eline Huizing
- Department of Surgery, Northwest Clinics, Alkmaar, The Netherlands.
| | - Cornelis G Vos
- Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | | | | | - Gert J de Borst
- Department of Vascular Surgery, UMCU, Utrecht, The Netherlands
| | - Çağdaş Ünlü
- Department of Surgery, Northwest Clinics, Alkmaar, The Netherlands
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Lobo MF, Azzone V, Azevedo LF, Melica B, Freitas A, Bacelar-Nicolau L, Rocha-Gonçalves FN, Nisa C, Teixeira-Pinto A, Pereira-Miguel J, Resnic FS, Costa-Pereira A, Normand SL. A comparison of in-hospital acute myocardial infarction management between Portugal and the United States: 2000-2010. Int J Qual Health Care 2017; 29:669-678. [PMID: 28992151 DOI: 10.1093/intqhc/mzx092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 07/04/2017] [Indexed: 12/26/2022] Open
Abstract
Objective To compare healthcare in acute myocardial infarction (AMI) treatment between contrasting health systems using comparable representative data from Europe and USA. Design Repeated cross-sectional retrospective cohort study. Setting Acute care hospitals in Portugal and USA during 2000-2010. Participants Adults discharged with AMI. Interventions Coronary revascularizations procedures (percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG) surgery). Main Outcome Measures In-hospital mortality and length of stay. Results We identified 1 566 601 AMI hospitalizations. Relative to the USA, more hospitalizations in Portugal presented with elevated ST-segment, and fewer had documented comorbidities. Age-sex-adjusted AMI hospitalization rates decreased in USA but increased in Portugal. Crude procedure rates were generally lower in Portugal (PCI: 44% vs. 47%; CABG: 2% vs. 9%, 2010) but only CABG rates differed significantly after standardization. PCI use increased annually in both countries but CABG decreased only in the USA (USA: 0.95 [0.94, 0.95], Portugal: 1.04 [1.02, 1.07], odds ratios). Both countries observed annual decreases in risk-adjusted mortality (USA: 0.97 [0.965, 0.969]; Portugal: 0.99 [0.979, 0.991], hazard ratios). While between-hospital variability in procedure use was larger in USA, the risk of dying in a high relative to a low mortality hospital (hospitals in percentiles 95 and 5) was 2.65 in Portugal when in USA was only 1.03. Conclusions Although in-hospital mortality due to an AMI improved in both countries, patient management in USA seems more effective and alarming disparities in quality of care across hospitals are more likely to exist in Portugal.
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Affiliation(s)
- Mariana F Lobo
- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n 4200-450 Porto, Portugal
| | - Vanessa Azzone
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA
| | - Luís Filipe Azevedo
- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n 4200-450 Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n 4200-450 Porto, Portugal
| | - Bruno Melica
- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n 4200-450 Porto, Portugal.,Serviço de Cardiologia, Unidade de Diagnóstico e Intervenção Cardiovascular, Centro Hospitalar de Vila Nova de Gaia e Espinho, R. Conceição Fernandes 1079, Vila Nova de Gaia Portugal
| | - Alberto Freitas
- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n 4200-450 Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n 4200-450 Porto, Portugal
| | - Leonor Bacelar-Nicolau
- Institute of Preventive Medicine and Public Health and ISAMB - Institute of Environmental Health, Faculdade de Medicina, Universidade de Lisboa, Av. Professor Egas Moniz, 1649-028 Lisbon, Portugal
| | - Francisco N Rocha-Gonçalves
- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n 4200-450 Porto, Portugal.,Portuguese Institute of Oncology Porto, R. Dr. António Bernardino de Almeida 62, 4200-162 Porto, Portugal
| | - Cláudia Nisa
- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n 4200-450 Porto, Portugal
| | - Armando Teixeira-Pinto
- School of Public Health, Faculty of Medicine, Edward Ford Building (A27), The University of Sidney, NSW 2006, Australia
| | - José Pereira-Miguel
- Institute of Preventive Medicine and Public Health and ISAMB - Institute of Environmental Health, Faculdade de Medicina, Universidade de Lisboa, Av. Professor Egas Moniz, 1649-028 Lisbon, Portugal
| | - Frederic S Resnic
- Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, MA 01805, USA.,Tufts University School of Medicine, Boston, MA 02111, USA
| | - Altamiro Costa-Pereira
- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n 4200-450 Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, s/n 4200-450 Porto, Portugal
| | - Sharon-Lise Normand
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA.,Department of Biostatistics, Havard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
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Lobo MF, Azzone V, Resnic FS, Melica B, Teixeira-Pinto A, Azevedo LF, Freitas A, Nisa C, Bacelar-Nicolau L, Rocha-Gonçalves FN, Pereira-Miguel J, Costa-Pereira A, Normand SL. The Atlantic divide in coronary heart disease: Epidemiology and patient care in the US and Portugal. Rev Port Cardiol 2017; 36:583-593. [PMID: 28886892 DOI: 10.1016/j.repc.2016.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 09/04/2016] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES We aimed to compare access to new health technologies to treat coronary heart disease (CHD) in the health systems of Portugal and the US, characterizing the needs of the populations and the resources available. METHODS We reviewed data for 2000 and 2010 on epidemiologic profiles of CHD and on health care available to patients. Thirty health technologies (16 medical devices and 14 drugs) introduced during the period 1980-2015 were identified by interventional cardiologists. Approval and marketing dates were compared between countries. RESULTS Relative to the US, Portugal has lower risk profiles and less than half the hospitalizations per capita, but fewer centers per capita provide catheterization and cardiothoracic surgery services. More than 70% of drugs were available sooner in the US, whereas 12 out of 16 medical devices were approved earlier in Portugal. Nevertheless, at least five of these devices were adopted first or diffused faster in the US. Mortality due to CHD and myocardial infarction (MI) was lower in Portugal (CHD: 72.8 vs. 168 and MI: 48.7 vs. 54.1 in Portugal and the US, respectively; age- and gender-adjusted deaths per 100000 population, 2010); but only CHD deaths exhibited a statistically significant difference between the countries. CONCLUSIONS Differences in regulatory mechanisms and price regulations have a significant impact on the types of health technologies available in the two countries. However, other factors may influence their adoption and diffusion, and this appears to have a greater impact on mortality, due to acute conditions.
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Affiliation(s)
- Mariana F Lobo
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Vanessa Azzone
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States
| | - Frederic S Resnic
- Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington and Tufts University School of Medicine, Boston, MA, United States
| | - Bruno Melica
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal; Serviço de Cardiologia, Unidade de Diagnóstico e Intervenção Cardiovascular, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Armando Teixeira-Pinto
- School of Public Health, Faculty of Medicine, The University of Sydney, Sydney, Australia
| | - Luís Filipe Azevedo
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal; Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Alberto Freitas
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal; Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Cláudia Nisa
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Leonor Bacelar-Nicolau
- Institute of Preventive Medicine and Public Health and ISAMB - Institute of Environmental Health, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Francisco Nuno Rocha-Gonçalves
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal; Portuguese Institute of Oncology Porto (IPO-Porto), Porto, Portugal
| | - José Pereira-Miguel
- Institute of Preventive Medicine and Public Health and ISAMB - Institute of Environmental Health, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Altamiro Costa-Pereira
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal; Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Sharon-Lise Normand
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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The Atlantic divide in coronary heart disease: Epidemiology and patient care in the US and Portugal. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2016.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Fischer KE, Rogowski WH, Leidl R, Stollenwerk B. Transparency vs. closed-door policy: do process characteristics have an impact on the outcomes of coverage decisions? A statistical analysis. Health Policy 2013; 112:187-96. [PMID: 23664301 DOI: 10.1016/j.healthpol.2013.04.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 02/28/2013] [Accepted: 04/16/2013] [Indexed: 10/26/2022]
Abstract
The aim of this study was to analyze influences of process- and technology-related characteristics on the outcomes of coverage decisions. Using survey data on 77 decisions from 13 countries, we examined whether outcomes differ by 14 variables that describe components of decision-making processes and the technology. We analyzed the likelihood of committees covering a technology, i.e. positive (including partial coverage) vs. negative coverage decisions. We performed non-parametric univariate tests and binomial logistic regression with a stepwise variable selection procedure. We identified a negative association between a positive decision and whether the technology is a prescribed medicine (p=0.0097). Other significant influences on a positive decision outcome included one disease area (p=0.0311) and whether a technology was judged to be (cost-)effective (p<0.0001). The first estimation of the logistic regression yielded a quasi-complete separation for technologies that were clearly judged (cost-)effective. In uncertain decisions, a higher number of stakeholders involved in voting (odds ratio=2.52; p=0.03) increased the likelihood of a positive outcome. The results suggest that decisions followed the lines of evidence-based decision-making. Despite claims for transparent and participative decision-making, the phase of evidence generation seemed most critical as decision-makers usually adopted the assessment recommendations. We identified little impact of process configurations.
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Affiliation(s)
- Katharina E Fischer
- Hamburg Center for Health Economics, Universität Hamburg, Esplanade 36, 20354 Hamburg, Germany; Institute of Health Economics and Health Care Management, Helmholtz Zentrum München - German Research Center for Environmental Health, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany.
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Should the decision-making process of reimbursing medicines be improved? Int J Technol Assess Health Care 2012; 28:347-8. [PMID: 22995143 DOI: 10.1017/s026646231200061x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Pharmaceutical sales totaled an estimated USD 700 billion in OECD countries in 2011, approximately one-fifth of total healthcare spending (5). In the past, pharmaceutical expenditure has increased faster than total healthcare expenditure in many countries. The increase in pharmaceutical expenditure has slowed down in recent years due to the economic recession, patent expirations of important blockbusters, and cost-containment measures already taken. However, pharmaceutical expenditure still continues to rise, albeit at a reduced rate. Alongside an increased consumption of medicines, an important reason for growing costs is the adoption of new—and typically more expensive—products. To ensure that pharmaceutical expenditure does not become excessive and that patients have access to medicines they need, most countries now weigh up what products are to be included in the reimbursement system and at what price. Both the criteria to assess products and the processes to make reimbursement decisions vary from country to country and so far there have been no analytically oriented comparison studies.
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Hernandez JF, Mantel-Teeuwisse AK, van Thiel GJMW, Belitser SV, Warmerdam J, de Valk V, Raaijmakers JAM, Pieters T. A 10-year analysis of the effects of media coverage of regulatory warnings on antidepressant use in The Netherlands and UK. PLoS One 2012; 7:e45515. [PMID: 23029065 PMCID: PMC3447767 DOI: 10.1371/journal.pone.0045515] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 08/21/2012] [Indexed: 11/28/2022] Open
Abstract
Background In 2003–2004 and 2007–2008, the regulatory banning of SSRI use in pediatrics and young adults due to concerns regarding suicidality risk coincided with negative media coverage. SSRI use trends were analyzed from 2000–2010 in the Netherlands (NL) and the UK, and whether trend changes might be associated with media coverage of regulatory warnings. Methods Monthly SSRIs sales were presented as DDDs/1000 inhabitants/day. SSRI-use trends were studied using time-series segmented regression analyses. Timing of trend changes was compared with two periods of media coverage of warnings. Annual Dutch SSRI prescription data were analyzed by age group. Results Trend changes in SSRI use largely corroborated with the periods of media coverage of warnings. British SSRI use declined from 3.9 to 0.7 DDDs/month (95%CI 3.3;4.5 & 0.5;0.9, respectively) before the first warning period (2003–2004). A small decrease of −0.6 DDDs/month (−1.2; −0.05) was observed in Dutch SSRI use shortly after 2003–2004. From 2007–2008, British SSRI use stabilized, whilst Dutch SSRI use diminished to −0.04 DDDs/month (−0.4;0.3). Stratified analyses showed a rapid decrease of −1.2 DDDs/month (−2.1; −1.7) in UK paroxetine use before 2003–2004, but only a minimal change in Dutch paroxetine use (−0.3 DDDs/month −0.8;0.2). Other SSRI use, especially (es)citalopram, increased during 2003–2004 in both countries. Significant reductions in Dutch paroxetine use were observed in pediatrics, adolescents, and young adults after 2003–2004. Conclusion Changes in SSRI use (NL & UK) were associated with the timing of the combined effect of media coverage and regulatory warnings. Our long-term assessment illustrates that changes in SSRI use were temporal, drug-specific and more pronounced in pediatrics and young adults. The twofold increase in SSRI use over one decade indicates that regulatory warnings and media coverage may come and go, but they do not have a significant impact on the overall upward trend of SSRI use as a class in both countries.
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Affiliation(s)
- Juan Francisco Hernandez
- Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Aukje K. Mantel-Teeuwisse
- Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | | | - Svetlana V. Belitser
- Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | | | - Vincent de Valk
- Genees-en hulpmiddelen Informatie Project (GIP – Drug Information Project), Healthcare Insurance Board (CVZ), Diemen, The Netherlands
| | - Jan A. M. Raaijmakers
- Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
- GlaxoSmithKline, External Scientific Collaborations Europe, Zeist, The Netherlands
| | - Toine Pieters
- Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
- EMGO, VU Medical Centre, Amsterdam, The Netherlands
- * E-mail:
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Hoebert JM, Mantel-Teeuwisse AK, van Dijk L, Bijlsma JWJ, Leufkens HGM. Do rheumatoid arthritis patients have equal access to treatment with new medicines?: tumour necrosis factor-alpha inhibitors use in four European countries. Health Policy 2011; 104:76-83. [PMID: 22079753 DOI: 10.1016/j.healthpol.2011.10.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Revised: 10/12/2011] [Accepted: 10/19/2011] [Indexed: 01/05/2023]
Abstract
PURPOSE To explore the use of the biological tumour necrosis factor alpha (TNFalpha) inhibitors used in the treatment of rheumatoid arthritis as a measure of access to treatment with new medicines. In addition, characteristics both related to national health systems and spending will be assessed to explore possible differences in international utilisation. METHODS Data from four European countries were included: Ireland, The Netherlands, Norway and Portugal. Annual utilisation rates of TNFalpha inhibitors (2003-2007) were expressed as defined daily doses (DDDs)/1000 inhabitants/day. Qualitative data such as country characteristics, national health policy characteristics, guidelines were obtained from the literature. In addition, interviews were held with leading rheumatologists of each country to put obtained results into (cultural) context. RESULTS Utilisation of TNFalpha inhibitors varied widely from 0.32 (Portugal) to 1.89 (Norway) DDDs/1000 inhabitants/day (2007). A major driver for the utilisation of TNFalpha inhibitors seemed to be the country's total health expenditure (R(2)=0.81). When the use of TNFalpha inhibitors became more established, the association seemed stronger. Differences in health expenditure were nevertheless not the only determinant of usage. Cultural aspects such as difference in recognition of guidelines also come into play when looking at differences in TNFalpha utilisation between countries. CONCLUSIONS The prospects of patients receiving TNFalpha inhibitor treatment depend on the country where they are living. In case uniformity of management and treatment would be considered to provide health benefits, the extent and the causes of variation should feature prominently on future public health agendas.
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Affiliation(s)
- Joëlle M Hoebert
- Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, The Netherlands
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Hoebert JM, Mantel-Teeuwisse AK, van Dijk L, Laing RO, Leufkens HG. Quality and completeness of utilisation data on biological agents across European countries: tumour necrosis factor alpha inhibitors as a case study. Pharmacoepidemiol Drug Saf 2011; 20:265-71. [DOI: 10.1002/pds.2093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Revised: 10/26/2010] [Accepted: 11/23/2010] [Indexed: 11/10/2022]
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Martikainen JE, Enlund H. New chemical entities and their market penetration in Finland during the years 1996 through 2005. Clin Ther 2009; 31:668-76. [DOI: 10.1016/j.clinthera.2009.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2009] [Indexed: 11/26/2022]
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