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Ghosh S, Antunes A, Rinta-Kokko H, Chaparova E, Lay-Flurrie S, Tricotel A, Andersson FL. Estimating excess mortality and economic burden of Clostridioides difficile infections and recurrences during 2015-2019: The RECUR England study. Int J Infect Dis 2024; 142:106967. [PMID: 38368927 DOI: 10.1016/j.ijid.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/05/2024] [Accepted: 02/13/2024] [Indexed: 02/20/2024] Open
Abstract
OBJECTIVES To generate real-world evidence on all-cause mortality and economic burden of Clostridioides difficile infections (CDIs) and recurrences (rCDIs) in England. METHODS We conducted a cohort study using retrospective data from Clinical Practice Research Datalink linked to Hospital Episode Statistics. Patients diagnosed with CDI in hospital and community settings during 2015-2018 were included and followed for ≥1 year. All-cause mortality was described at 6, 12, and 24 months. Healthcare resource usage (HCRU) and associated costs were assessed at 12 months of follow-up. A cohort of non-CDI patients, matched by demographic and clinical characteristics including Charlson Comorbidity Index score, was used to assess excess mortality and incremental costs of HCRU. RESULTS All-cause mortality among CDI patients at 6, 12, and 24 months was 15.87%, 20.37%, and 27.03%, respectively. A higher proportion of rCDI patients died at any point during follow-up. Compared with matched non-CDI patients, excess mortality was highest at 6 months with 1.81 and 2.53 deaths per 100 patient-months among CDI and ≥1 rCDI patients. Hospitalizations were the main drivers of costs, with an incremental cost of £1209.21 per CDI patient. HCRU and costs increased with rCDIs. CONCLUSION CDI poses a substantial mortality and economic burden, further amplified by rCDIs.
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Affiliation(s)
- Subrata Ghosh
- College of Medicine and Health, University College Cork, Cork, Ireland; University of Birmingham, Birmingham, United Kingdom
| | - Ana Antunes
- IQVIA, Global Database Studies, Real World Solutions, Lisbon, Portugal.
| | - Hanna Rinta-Kokko
- IQVIA, Global Database Studies, Real World Solutions, Espoo, Finland
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Moreels N, Boven A, Gressani O, Andersson FL, Vlieghe E, Callens S, Engstrand L, Simin J, Brusselaers N. The combined effect of systemic antibiotics and proton pump inhibitors on Clostridioides difficile infection and recurrence. J Antimicrob Chemother 2024; 79:608-616. [PMID: 38267263 PMCID: PMC10904719 DOI: 10.1093/jac/dkae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 01/03/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Antibiotics and proton pump inhibitors (PPI) are recognized risk factors for acquisition and recurrence of Clostridioides difficile infection (CDI), yet combined effects remain unclear. OBJECTIVES To assess the short- and long-term effects of antibiotics and PPIs on CDI risk and recurrence. METHODS Population-based study including all 43 152 patients diagnosed with CDI in Sweden (2006-2019), and 355 172 matched population controls without CDI. The impact of antibiotics and PPIs on CDI risk and recurrence was explored for recent (0-30 days) and preceding (31-180 days) use prior to their first CDI diagnosis, using multivariable conditional logistic regression presented as odds ratios (ORs) and 95% confidence interval, adjusted for demographics, comorbidities and other drugs. RESULTS Compared to controls, the combined effect of recent PPIs and antibiotics [ORAB+PPI = 17.51 (17.48-17.53)] on CDI risk was stronger than the individual effects [ORAB = 15.37 (14.83-15.93); ORPPI = 2.65 (2.54-2.76)]. Results were less pronounced for exposure during the preceding months. Dose-response analyses showed increasing exposure correlated with CDI risk [recent use: ORAB = 6.32 (6.15-6.49); ORPPI = 1.65 (1.62-1.68) per prescription increase].Compared to individuals without recurrence (rCDI), recent [ORAB = 1.30 (1.23-1.38)] and preceding [ORAB = 1.23 (1.16-1.31); ORPPI = 1.12 (1.03-1.21)] use also affected the risk of recurrence yet without significant interaction between both. Recent macrolides/lincosamides/streptogramins; other antibacterials including nitroimidazole derivates; non-penicillin beta lactams and quinolones showed the strongest association with CDI risk and recurrence, particularly for recent use. PPI use, both recent and preceding, further increased the CDI risk associated with almost all antibiotic classes. CONCLUSION Recent and less recent use of PPIs and systemic antibiotics was associated with an increased risk of CDI, particularly in combination.
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Affiliation(s)
- Nele Moreels
- Department of Microbiology, Centre for Translational Microbiome Research, Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden
- I-BioStat, Data Science Institute, Hasselt University, Hasselt, Belgium
| | - Annelies Boven
- Department of Microbiology, Centre for Translational Microbiome Research, Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden
- Department of Family Medicine and Population Health, Global Health Institute, Antwerp University, Antwerp, Belgium
| | - Oswaldo Gressani
- I-BioStat, Data Science Institute, Hasselt University, Hasselt, Belgium
| | | | - Erika Vlieghe
- Department of Family Medicine and Population Health, Global Health Institute, Antwerp University, Antwerp, Belgium
| | - Steven Callens
- Department of Internal Medicine and Pediatrics, General Internal Medicine, Ghent University, Ghent, Belgium
| | - Lars Engstrand
- Department of Microbiology, Centre for Translational Microbiome Research, Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Johanna Simin
- Department of Microbiology, Centre for Translational Microbiome Research, Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Nele Brusselaers
- Department of Microbiology, Centre for Translational Microbiome Research, Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden
- Department of Family Medicine and Population Health, Global Health Institute, Antwerp University, Antwerp, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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Ghosh S, Antunes A, Rinta-Kokko H, Chaparova E, Lay-Flurrie S, Tricotel A, Andersson FL. Clostridioides difficile infections, recurrences, and clinical outcomes in real-world settings from 2015 to 2019: The RECUR England study. Int J Infect Dis 2024; 140:31-38. [PMID: 38185320 DOI: 10.1016/j.ijid.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/27/2023] [Accepted: 01/02/2024] [Indexed: 01/09/2024] Open
Abstract
OBJECTIVE To estimate the epidemiological and clinical burden of Clostridioides difficile infections (CDIs) and recurrences (rCDIs) in England. METHODS This retrospective study included adult patients diagnosed with CDI (community or hospital settings) over 2015-2019 from Clinical Practice Research Datalink and Hospital Episode Statistics databases. Incidences of CDI and rCDI were determined annually. Time to subsequent rCDI was estimated by Kaplan-Meier method. Rates of complications were assessed within 12 months from index episode. Association of risk factors with complications was evaluated using a Cox regression model. RESULTS A total of 52,443 CDI episodes were recorded among 36,913 patients. Of these, 75% were aged ≥65 years, 59% were women; 73% were treated in community settings. CDI incidence remained stable (111 episodes per 100,000 patients in 2019). Around 21% of patients had ≥1 rCDI. Sepsis (12%) was the most common complication, followed by colectomy and ulcerative colitis. Age, gender, comorbidities, rCDI, preindex medical procedures, hospitalizations and consultations, and CDI treatment in hospital, were found to increase the risk of complication. CONCLUSIONS CDI remains a concern in England. The study highlights the importance of managing primary and rCDI episodes via effective and improved therapies to prevent fatal complications.
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Affiliation(s)
- Subrata Ghosh
- College of Medicine and Health, University College Cork, Cork, Ireland; University of Birmingham, Birmingham, UK
| | - Ana Antunes
- IQVIA, Global Database Studies, Real World Solutions, Lisbon, Portugal.
| | - Hanna Rinta-Kokko
- IQVIA, Global Database Studies, Real World Solutions, Espoo, Finland
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4
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Mueller ER, Weiss JP, Bosch JLHR, Chughtai B, Rosenberg MT, Bacci ED, Simeone JC, Andersson FL, Juul K, Coyne KS, Chapple CR. Nocturnal polyuria in women: results from the EpiNP study. Int Urogynecol J 2023; 34:1743-1751. [PMID: 36708403 DOI: 10.1007/s00192-022-05432-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/22/2022] [Indexed: 01/29/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Data from a large US population-based, cross-sectional, epidemiological study (the EpiNP Study) were used to assess the symptoms and bother experienced by women with nocturnal polyuria (NP). METHODS Consenting participants recruited from an online panel completed the baseline EpiNP survey online (Lower Urinary Tract Symptoms Tool and urological comorbidities). All reporting ≥2 voids/night and a random sample of 100 respondents, each reporting 0 or 1 void/night were asked to complete a 3-day web-based bladder diary recording time, volume, and urgency rating of each void. NP was calculated by the proportion of urine production that occurred during nocturnal hours using a Nocturnal Polyuria Index (NPI33) threshold of >0.33 or nocturnal urine production of >90 ml/h (NUP90). The frequency of participants reporting LUTS and bother was determined by age and NP: idiopathic NP, NP associated with overactive bladder (NPOAB), NP associated with comorbidities (NPCom), and no NP (did not meet NP criteria). RESULTS A total of 5,290 women completed the baseline survey. Mean age (range) was 54.9 (30-95) years; 1,841 (34.8%) reported ≥2 nocturnal voids. The prevalence of LUTS increased across the lifespan; however, bother associated with each LUTS decreased with increasing age. The percentage of women rating bother by nocturia episodes ≥2 "> somewhat" ranged from 40.3% to 68.3%, with bother ratings highest in the NPOAB and No NP groups. CONCLUSIONS NP is prevalent in women with considerable bother and is often associated with other urinary symptoms. Multifactorial causes and potential treatments of NP should be considered, particularly at a later age.
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Affiliation(s)
| | - Jeffrey P Weiss
- SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | | | | | | | | | | | | | | | - Karin S Coyne
- Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD, 20814, USA.
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Boven A, Vlieghe E, Engstrand L, Andersson FL, Callens S, Simin J, Brusselaers N. Clostridioides difficile infection-associated cause-specific and all-cause mortality: A population-based cohort study. Clin Microbiol Infect 2023:S1198-743X(23)00315-4. [PMID: 37473840 DOI: 10.1016/j.cmi.2023.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/29/2023] [Accepted: 07/10/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVES Clostridioides difficile infection (CDI) is a common healthcare-associated infection and leading cause of gastroenteritis-related mortality worldwide. However, data on CDI-associated mortality are scarce. We aimed to examine the association between CDI and all-cause and cause-specific mortality. We additionally explored contributing causes of mortality, including recurrent CDI (rCDI), hospital- or community-acquired CDI, chronic comorbidities, and age. METHODS This nationwide population-based cohort study (from 2006-2019) compared individuals with CDI to the entire Swedish background population using standardized mortality ratios (SMRs). Additionally, a matched cohort design (1:10), utilizing multivariable Poisson regression models, provided incidence rate ratios (IRRs) with 95% confidence intervals (CIs). RESULTS This study included 43,150 individuals with CDI and 355,172 controls. In total, 69.7% were ≥65 years, and 54.9% were female. CDI was associated with a 3- to 7-fold increased mortality rate (IRR=3.5, 95% CI: 3.3-3.6; SMR=6.8, 95% CI:6.7-6.9) compared to the matched controls and Swedish background population, respectively. Mortality rates were highest for hospital-acquired CDI (IRR=2.4, 95% CI: 1.9-3.2) and during the first CDI episode (IRR=0. 2, 95% CI: 0.2-0.3 for recurrent versus first CDI). Individuals with CDI had more chronic comorbidities than controls, yet mortality remained higher among CDI cases even after adjustment and stratification for comorbidity; CDI was associated with increased mortality (IRR=6.1, 95% CI: 5.5-6.8), particularly among those without any chronic comorbidities. CONCLUSIONS CDI was associated with elevated all-cause and cause-specific mortality, despite possible confounding by ill health. Mortality rates were consistently increased across both sexes, all age groups, and comorbidity groups.
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Affiliation(s)
- Annelies Boven
- Centre for Translational Microbiome Research, Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden; Department of Family Medicine and Population Health, Antwerp University, Antwerp Belgium
| | - Erika Vlieghe
- Department of Family Medicine and Population Health, Antwerp University, Antwerp Belgium; General Internal Medicine, Antwerp University Hospital, Antwerp, Belgium
| | - Lars Engstrand
- Centre for Translational Microbiome Research, Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | | | - Steven Callens
- General Internal Medicine, Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
| | - Johanna Simin
- Centre for Translational Microbiome Research, Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden; Department of Family Medicine and Population Health, Antwerp University, Antwerp Belgium
| | - Nele Brusselaers
- Centre for Translational Microbiome Research, Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden; Department of Family Medicine and Population Health, Antwerp University, Antwerp Belgium; Department of Head and Skin, Ghent University, Ghent, Belgium.
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Skedgel C, Cubi-Molla P, Mott D, Gameiro S, Boivin J, Al-Janabi H, Brazier J, Markert M, Andersson FL, Jofre-Bonet M. Unmet Parenthood Goals, Health-Related Quality of Life and Apparent Irrationality: Understanding the Value of Treatments for Infertility. Pharmacoecon Open 2023; 7:337-344. [PMID: 36920719 PMCID: PMC10016171 DOI: 10.1007/s41669-023-00402-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 05/11/2023]
Abstract
An increasing number of prospective parents are experiencing infertility along with associated negative impacts on mental health and life satisfaction that can extend across a network of individuals and family members. Assistive reproductive technologies (ART) can help prospective parents achieve their parenthood goals but, like any health technology, they must demonstrate acceptable 'value for money' to qualify for public funding. We argue that current approaches to understanding the value of ART, including quality-adjusted life-year (QALY) gains based on changes in health-related quality of life (HRQOL) and, more often, cost per live birth, are too narrow to capture the full impact of unmet parenthood goals and ART. We see a fundamental disconnect between measures of HRQOL and broader measures of wellbeing associated with met and unmet parenthood goals. We also suggest that simple concepts such as 'patient' and 'carer' are of limited applicability in the context of ART, where 'spillovers' extend across a wide network of individuals, and the person receiving treatment is often not the infertile individual. Consideration of individual and societal wellbeing beyond HRQOL is necessary to understand the full range of negative impacts associated with unmet parenthood goals and the corresponding positive impacts of successful ART. We suggest moving towards a wellbeing perspective on value to achieve a fuller understanding of value and promote cross-sector allocative efficiency.
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Affiliation(s)
- Chris Skedgel
- Office of Health Economics, Goldings House, 2nd Floor, Hay's Galleria, 2 Hay's Lane, London, SE1 2HB, UK.
| | - Patricia Cubi-Molla
- Office of Health Economics, Goldings House, 2nd Floor, Hay's Galleria, 2 Hay's Lane, London, SE1 2HB, UK
| | - David Mott
- Office of Health Economics, Goldings House, 2nd Floor, Hay's Galleria, 2 Hay's Lane, London, SE1 2HB, UK
| | - Sofia Gameiro
- School of Psychology, University of Cardiff, Cardiff, UK
| | - Jacky Boivin
- School of Psychology, University of Cardiff, Cardiff, UK
| | - Hareth Al-Janabi
- Health Economics Unit, Institute of Applied Health Research, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
| | - John Brazier
- School of Health & Related Research, University of Sheffield, Sheffield, UK
| | | | | | - Mireia Jofre-Bonet
- Office of Health Economics, Goldings House, 2nd Floor, Hay's Galleria, 2 Hay's Lane, London, SE1 2HB, UK
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7
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Cortesi PA, Fiorino G, Peyrin-Biroulet L, Mantovani LG, Jairath V, Paridaens K, Andersson FL, Danese S. Non-invasive monitoring and treat-to-target approach are cost-effective in patients with mild-moderate ulcerative colitis. Aliment Pharmacol Ther 2023; 57:486-495. [PMID: 36377366 DOI: 10.1111/apt.17261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/07/2022] [Accepted: 10/09/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND There are no data to assess the value associated with a treat-to-target (T2T) strategy based on tight control of mild-moderate ulcerative colitis (UC). AIM To assess the cost-effectiveness of a T2T approach based on the normalisation of clinical signs and faecal calprotectin (FC) METHODS: A decision analytical Markov model was developed to compare T2T algorithm combining clinical symptoms and FC levels to define treatment response and the possible switch to the next treatment line (T2T-FC), and the reference strategy based only on symptoms. The model included five treatment lines and was conducted from the Italian national health service (NHS) perspective using a 3-year time horizon. The model calculated the incremental cost-effectiveness ratio as € per relapse avoided. Deterministic and probabilistic sensitivity analyses were conducted. RESULTS The cost-effectiveness analysis produced an increased time spent by a patient in clinical remission and FC ≤ 100 level (+0.177 years; about 2 months) and a decreasing number of relapses (-0.1937; -20.9%) per patient using a T2T-FC approach compared to only symptoms. Furthermore, the T2T-FC was associated with higher cost (+€1795). The ICER estimated was €9263 per relapse avoided. These results were confirmed by sensitivity analyses. CONCLUSIONS T2T-FC approach resulted in a higher benefit for mild-moderate UC patients in terms of time in remission and incidence of relapse but was associated with higher costs. Clinical trials and real-world clinical studies are needed to provide additional data on the cost-benefit of this approach.
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Affiliation(s)
- Paolo Angelo Cortesi
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy
| | - Gionata Fiorino
- Department of Gastroenterology and Digestive Endoscopy, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, Nancy University Hospital, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Lorenzo Giovanni Mantovani
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy.,IRCCS, Istituto Auxologico Italiano, Milan, Italy
| | - Vipul Jairath
- Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada
| | | | - Fredrik L Andersson
- Ferring Pharmaceuticals A/S - International PharmaScience Center, Kastrup, Denmark
| | - Silvio Danese
- Department of Gastroenterology and Digestive Endoscopy, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
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Hafner M, Yerushalmi E, Andersson FL, Burtea T. Partially different? The importance of general equilibrium in health economic evaluations: An application to nocturia. Health Econ 2023; 32:654-674. [PMID: 36424887 PMCID: PMC10100343 DOI: 10.1002/hec.4638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 09/29/2022] [Accepted: 10/20/2022] [Indexed: 06/16/2023]
Abstract
Both the human capital approach and the friction cost approach are frequently used to quantify the productivity costs associated with illness, disability or death in health economic evaluations. In this paper we argue that these approaches have one major, but common shortcoming: they only capture partial equilibrium (PE) effects and therefore underestimate the true potential productivity costs associated with health conditions. They neglect the sizable, indirect, ripple effects in the economy captured by general equilibrium (GE) models. To demonstrate our point, we compare a traditional PE with a GE approach for the application to nocturia, a condition characterized by the need to frequently wake up at night to urinate. Nocturia is associated with substantial impairment of daytime functioning and work productivity. We employ large-scale United Kingdom (UK) employer-employee survey data to estimate the prevalence and productivity loss. These estimates are then used as shared inputs to drive both approaches. We find that the traditional PE approach underestimates the annual productivity cost of clinically relevant nocturia by around 16%. We propose a generalized GE/PE multiplier to approximate the GE effect for other health conditions. Our findings stress the importance of accounting for sizable GE effects when conducting health economic evaluations.
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Affiliation(s)
| | - Erez Yerushalmi
- Birmingham City Business SchoolBirmingham City UniversityBirminghamUK
| | | | - Teodor Burtea
- Ferring International Center SASaint‐PrexSwitzerland
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Chapple CR, Rosenberg MT, Mueller ER, Chughtai B, Weiss JP, Juul K, Brooks AB, Bacci ED, Andersson FL, Coyne KS, Bosch JR. The patient burden of nocturnal polyuria in the United States: Results from the epidemiology of nocturnal polyuria (EpiNP) study. Neurourol Urodyn 2023; 42:573-585. [PMID: 36655731 DOI: 10.1002/nau.25126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/29/2022] [Accepted: 12/19/2022] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To explore the impact of nocturnal polyuria (NP) on health-related quality of life (HRQoL), work productivity, mental health, fatigue, bother, and daytime sleepiness. MATERIALS AND METHODS This large-scale, US population-representative epidemiologic study was conducted in two parts: a web-based survey and 3-day bladder diary. Consenting participants completed the baseline Epidemiology of NP (EpiNP) survey online (Lower Urinary Tract Symptoms [LUTS] Tool, comorbidities, burden, and multiple HRQoL measures). Participants who reported ≥2 voids/night, and a random sample of 100 respondents each reporting 0 or 1 void/night, were sent urine measurement containers and asked to complete the 3-day bladder diary. NP was defined as Nocturnal Polyuria Index >0.33 (NPI33) or nocturnal urine production >90 ml/h (NUP90). Five subgroups were created: Idiopathic NP (NP with no underlying cause), NP associated with symptoms of overactive bladder (NPOAB) or bladder outlet obstruction (NPBOO; men only), NP associated with other comorbidities (NPCOM; e.g., diabetes, hypertension, heart disease, sleep apnea), and no NP (did not meet NP criteria). RESULTS A total of 4893 men and 5297 women completed the EpiNP survey; mean age was 54.4 (SD = 14.7). Significantly greater patient burden (p < 0.0001) was evidenced in the nocturia group (≥2 voids/night) versus no nocturia group (0-1 void/night) on daily impact of nocturia, LUTS Bother, prostate symptoms (men only), work productivity, physical and mental health component scores, depression, fatigue, and daytime sleepiness. NP subgroup analyses showed men in the NPBOO group and women in the NPOAB group reported the greatest impact on LUTS bother, fatigue, physical health, work productivity impairment, daytime sleepiness, and depression (women only). CONCLUSION This was the first large-scale, epidemiologic study to explore the impact of different forms of NP on patients' HRQoL. Findings demonstrate that NP associated with other urologic or comorbid conditions appears to have greater patient burden than idiopathic NP, in particular for women.
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Affiliation(s)
- Christopher R Chapple
- Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, University of Sheffield, Sheffield, UK
| | - Matt T Rosenberg
- Department of Family Medicine, Mid Michigan Health Center, Jackson, Michigan, USA
| | - Elizabeth R Mueller
- Departments of Obstetrics/Gynecology & Urology, Division Female Pelvic Medicine & Reconstructive Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, New York City, New York, USA
| | - Jeffrey P Weiss
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Kristian Juul
- Global Value and Access, Ferring Pharmaceuticals A/S, Copenhagen, Denmark
| | - Anne B Brooks
- Patient Centered Research, Former employee at Evidera, Bethesda, Maryland, USA
| | | | | | - Karin S Coyne
- Patient Centered Research, Evidera, Bethesda, Maryland, USA
| | - Jlh Ruud Bosch
- Department of Urology, Franciscus G&V Hospital, Rotterdam, The Netherlands
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10
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Weiss JP, Bosch JLHR, Chapple CR, Bacci ED, Simeone JC, Rosenberg MT, Mueller ER, Andersson FL, Juul K, Chughtai B, Coyne KS. The Prevalence of Nocturnal Polyuria in the United States: Results from the Epidemiology of Nocturnal Polyuria Study. Eur Urol Focus 2022; 8:1415-1423. [PMID: 35039242 DOI: 10.1016/j.euf.2021.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 12/28/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND The prevalence of nocturnal polyuria (NP), which is passing large volumes of urine during the main sleep period, has been investigated primarily in middle-aged to older men. There is thus a gap in the NP evidence base for women and for younger individuals. OBJECTIVE To estimate the prevalence of nocturia due to NP in the USA. DESIGN, SETTING, AND PARTICIPANTS This large epidemiologic study used a US population-representative sample of men and women aged ≥30 yr to assess the prevalence of NP (NCT04125186). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Consenting participants completed an online survey (Lower Urinary Tract Symptoms Tool and comorbidities). All who reported two or more voids per night and 100 random respondents each reporting no or one void per night were asked to complete a 3-d bladder diary. Two NP definitions were used: nocturnal urine production >90 ml/h (NUP90) and Nocturnal Polyuria Index >0.33 (NPI33). Crude and population-adjusted prevalence results were calculated from completed diaries for the following subgroups by sex and age: idiopathic NP; NP with overactive bladder (NP-OAB) or bladder outlet obstruction (NP-BOO; men only); NP associated with other comorbidities; and no NP (did not meet the NPI33 or NUP90 definition). RESULTS AND LIMITATIONS Among the 10,190 respondents who completed the survey, the mean age was 54.4 yr (range 30-95); 3,339 reported two or more nocturnal voids and 1,763 completed the 3-d diary (response rate 49.3%). The adjusted overall NP prevalence was 31.5% among men and 38.5% among women using the NPI33 definition, and 23.8% among men and 18.1% among women using NUP90. The adjusted idiopathic NP prevalence was lower among men (NPI33: 5.2%; NUP90: 1.4%) than among women (NPI33: 9.8%; NUP90: 4.0%). The prevalence of idiopathic NP decreased with age as NP associated with other possible causes increased with age in men (most common, BOO) and women (most common, OAB). CONCLUSIONS This is the first population-based study of NP prevalence to include men, women, and young adults. NP is common; a multifactorial etiology should be considered, particularly as age increases. PATIENT SUMMARY In this population-based US study, we examined the frequency of nighttime urination among men and women aged ≥30 y and older. We found that nighttime urination is common among men and women. Many conditions can lead to increased nighttime urination as people age.
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Affiliation(s)
- Jeffrey P Weiss
- SUNY Downstate Health Sciences University, Brooklyn, NY, USA
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11
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Matthijsse S, Andersson FL, Gargano M, Yip Sonderegger YL. Cost-effectiveness analysis of carbetocin versus oxytocin for the prevention of postpartum hemorrhage following vaginal birth in the United Kingdom. J Med Econ 2022; 25:129-137. [PMID: 35007465 DOI: 10.1080/13696998.2022.2027669] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIMS To assess the cost-effectiveness of carbetocin versus oxytocin for the prevention of postpartum hemorrhage (PPH) following vaginal birth from the perspective of the UK National Health Service (NHS). MATERIALS AND METHODS A decision tree model was designed to analyze the cost per PPH event avoided associated with utilizing carbetocin versus oxytocin for prophylactic treatment of PPH in women following vaginal birth from a UK perspective. It modelled the potential for women to require an additional uterotonic after prophylaxis, and to still experience a PPH event and receive associated treatment. Inpatient recovery and follow-up periods post-PPH were also included in the model. Costs associated with drug acquisition and administration, PPH management (i.e. additional staffing and possible operating theater and high dependency unit utilization), inpatient hospitalization, and follow-up visits were all considered. Adverse event management costs were not included. Resource utilization varied depending on the severity of the PPH event (as defined by the amount of blood lost). PPH events avoided were estimated. In an exploratory analysis, quality adjusted life years (QALYs) were estimated as well. RESULTS In the deterministic base case, costs were £55 lower and PPH events were 0.0342 lower per woman with carbetocin use compared to oxytocin use. Across the cohort of 100 women the reduction in PPH events led to the largest cost savings (£4,233 saved) out of all cost categories, with total cost savings of £5,495. Carbetocin utilization amongst the entire cohort led to 3.42 avoided PPH events compared to oxytocin utilization, comprised of 3.03 fewer mild/moderate PPH events and 0.39 fewer severe PPH events. Carbetocin utilization led to 0.0001 additional QALYs per woman. CONCLUSION Carbetocin utilization leads to lower prophylactic treatment costs and less PPH events versus oxytocin when utilized for the prevention of PPH following vaginal birth in the UK.
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Hudgens S, Howerter A, Polek E, Andersson FL. Psychometric validation and interpretation of the Nocturia Impact Diary in a clinical trial setting. Qual Life Res 2021; 31:1837-1848. [PMID: 34932192 PMCID: PMC9098619 DOI: 10.1007/s11136-021-03060-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2021] [Indexed: 12/02/2022]
Abstract
Purpose Psychometric evaluation of the Nocturia Impact (NI) Diary was conducted to support its use as a trial endpoint. Methods As part of a randomized, controlled Phase 2 clinical trial investigating a novel drug candidate for nocturnal polyuria, adult nocturia patients completed the NI Diary and a voiding diary for three nights preceding their clinic visit at Baseline and Weeks 1, 4, 8, and 12 (end of treatment). Exit interviews were conducted to obtain patient impressions of the NI Diary. Results A total of N = 302 participants were included. Confirmatory factor analysis (CFA) indicated that the 11-item measure is unidimensional with values of CFI, TLI, and RMSEA meeting relevant thresholds. Good internal consistency (Cronbach’s α 0.941) and test–retest reliability (intra-class correlation coefficients 0.730–0.880). Convergent validity with two reference measures was demonstrated with strong correlations of 0.573–0.730 were shown. Significant differences (P = 0.0018, standardized effect size = 0.372) between groups defined by number of night-time voids supported known-groups validity. Exit interviews in 66 patients indicated all participants experienced improvement in at least 1 NI Diary item and that a 1-point improvement on the item response scale and 1-void reduction per night (associated with an average best cut point on ROC analysis of − 11.6) constituted meaningful improvement. Anchor and distribution-based analyses identified a meaningful change threshold of − 15 to − 18 points on the NI Diary. Conclusion The NI Diary is a reliable and valid patient-reported psychometric instrument which is fit-for-purpose to evaluate the impact of nocturia on patient quality of life in the clinical trial setting. Trial registration number and registration date NCT03201419; June 28, 2017. Supplementary Information The online version contains supplementary material available at 10.1007/s11136-021-03060-4.
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Affiliation(s)
- Stacie Hudgens
- Clinical Outcomes Solutions, Tucson, AZ, USA. .,Clinical Outcomes Solutions, 1820 E River Rd, Ste 220, Tucson, AZ, 85718, USA.
| | | | - Ela Polek
- Clinical Outcomes Solutions, Folkestone, UK
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Finn E, Andersson FL, Madin-Warburton M. Burden of Clostridioides difficile infection (CDI) - a systematic review of the epidemiology of primary and recurrent CDI. BMC Infect Dis 2021; 21:456. [PMID: 34016040 PMCID: PMC8135979 DOI: 10.1186/s12879-021-06147-y] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 05/06/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Clostridioides difficile is a Gram-positive anaerobic bacterium, which causes Clostridioides difficile infection (CDI). It has been recognised as a leading cause of healthcare-associated infections and a considerable threat to public health globally. This systematic literature review (SLR) summarises the current evidence on the epidemiology and clinical burden of CDI. METHODS A SLR was conducted to identify CDI and recurrent CDI (rCDI) epidemiology studies, to evaluate patient and disease characteristics, incidence rates, epidemiological findings and risk factors. Embase, MEDLINE and the Cochrane Library databases were searched for English articles from 2009 to 2019. Included territories were the United Kingdom, France, Germany, Italy, Spain, Poland, US, Canada, Australia, Japan and China. RESULTS Of 11,243 studies identified, 165 fulfilled the selection criteria. An additional 20 studies were identified through targeted review of grey literature. The most widely reported findings were incidence and risk factors for CDI and rCDI. Among key studies reporting both healthcare-associated (HA-CDI) and community-associated CDI (CA-CDI) incidence rates for each country of interest, incidence rates per 10,000 patient days in the US were 8.00 and 2.00 for HA-CDI and CA-CDI, respectively. The highest incidence in Europe was reported in Poland (HA-CDI: 6.18 per 10,000 patient days, CA-CDI: 1.4 per 10,000 patient days), the lowest from the UK, at 1.99 per 10,000 patient days and 0.56 per 10,000 patient days for HA-CDI and CA-CDI, respectively. No clear trend for incidence over time emerged, with most countries reporting stable rates but some either a decrease or increase. Rates of recurrent CDI varied based on geographical setting. The rate of recurrence was lower in community-associated disease compared to healthcare-associated disease. Independent CDI risk factors identified common to both initial CDI and recurrent CDI included increasing age, antibiotic use, recent hospitalisation, and proton pump inhibitor (PPI) use. In addition, leukocyte count, length of hospital stays, and Charlson comorbidity index score featured as statistically significant risk factors for recurrent CDI, but these are not reported among the most common statistically significant risk factors for initial CDI. CONCLUSIONS Despite considerable heterogeneity, evidence suggests substantial incidence of recurrent and primary CDI, even after considerable efforts in the last decade.
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Affiliation(s)
- Elaine Finn
- IQVIA, 210 Pentonville Road, London, N1 9JY, UK.
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Williams V, Qin S, Romano CD, Lewis S, Williams N, Yarr S, Juul KV, Andersson FL. Psychometric evaluation of the Nocturia Sleep Quality Scale based on data from a prospective observational study. J Clin Sleep Med 2021; 17:691-701. [PMID: 33206043 PMCID: PMC8020686 DOI: 10.5664/jcsm.9010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The Nocturia Sleep Quality Scale (NSQS), a novel patient-reported outcomes measure, was developed to assess the impact of sleep disturbance from nocturia. The objective of this study was to assess the psychometric properties of the NSQS, including its structure, reliability, and validity. METHODS Data were collected in the context of a web-based, prospective, longitudinal, observational study. Participants with nocturia were randomized 1:1 to either a group that received sleep hygiene instructions, including instructions to limit liquids at nighttime and empty bladder prior to bedtime, or one that did not receive sleep instructions. All participants were asked to provide responses to the web-based questionnaires from day 1 to day 10. Psychometric analyses, aligned with current regulatory guidance, were conducted to evaluate the daily scores and 3-day average scores of NSQS items and potential composites. Item-level analyses were conducted first, followed by composite-level analyses. RESULTS The NSQS items and supporting measures demonstrated very slight improvement in patient-perceived sleep disturbance from nocturia over the course of the study. NSQS test-retest reliabilities were generally satisfactory. Correlations between NSQS items and related patient-reported measures tended to support the construct validity of the NSQS, and the known-groups analyses supplied evidence of its discriminating ability. NSQS responsiveness statistics were small. CONCLUSIONS The NSQS is a reliable and valid measure of the impact of nocturia on patients' sleep. The present analyses lay the psychometric groundwork for the use of the NSQS in future clinical trials to support product approval and labeling claims.
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Affiliation(s)
| | - Shanshan Qin
- RTI Health Solutions, Research Triangle Park, North Carolina
| | | | - Sandy Lewis
- RTI Health Solutions, Research Triangle Park, North Carolina
| | - Nicole Williams
- RTI Health Solutions, Research Triangle Park, North Carolina
| | - Stuart Yarr
- RTI Health Solutions, Research Triangle Park, North Carolina
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Juul KV, Andersson FL, Yamaguchi O. Achieving clinically meaningful quality of life benefits in nocturia takes time: Results from a long-term, multicenter phase 3 study of desmopressin in Japanese patients. Low Urin Tract Symptoms 2020; 13:129-138. [PMID: 32914581 DOI: 10.1111/luts.12347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/11/2020] [Accepted: 08/07/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate the long-term efficacy, quality of life (QoL), and safety of desmopressin orally disintegrating tablets (ODTs) in Japanese patients with nocturia. METHODS A long-term, multicenter phase 3 study was conducted that enrolled Japanese male and female patients with nocturia (NCT03051009). Male patients received desmopressin 25- or 50-μg ODTs, and female patients received desmopressin 25-μg ODTs for up to 1 year. The primary endpoint was safety. Secondary endpoints included change from baseline in number of nocturnal voids, time to first awakening to void, and QoL assessments (nocturia-specific zQoL [N-QoL], Insomnia Severity Index [ISI], and Hsu bother score). RESULTS Overall, 503 patients were enrolled. Reductions from baseline in mean number of nocturnal voids were observed in all treatment groups from week 1 (-0.62 to -1.00), with improvements continuing through week 52 (-1.39 to -1.71). Changes from baseline above or approximating a clinically meaningful improvement were seen by week 52 in the disease-specific N-QoL total score (improved by 11.5-22.6), ISI (improved by -3.9 to -7.1), and Hsu bother scores (improved by -1.5 to -2.0). Adverse events (AEs) were reported in 54.9% of desmopressin-treated patients. Most AEs were mild or moderate in severity. CONCLUSIONS Desmopressin ODTs (25 and 50 μg) demonstrated long-term efficacy, improved QoL, and were well tolerated in Japanese male and female patients with nocturia treated for up to 1 year. Clinically meaningful improvements in patients' QoL, assessed by N-QoL, sleep quality, and bother, occur later than objective symptom improvements, such as voids.
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Affiliation(s)
- Kristian V Juul
- Ferring International Pharmascience Center, Copenhagen, Denmark
| | | | - Osamu Yamaguchi
- Division of Lower Urinary Tract Symptom Research, Nihon University School of Engineering, Koriyama, Japan
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Hafner M, Andersson FL, Burtea T, van Stolk C, Whitmore M, Yerushalmi E, Troxel WM. Assessing the burden of nocturia in the workplace: the associations between nocturnal voiding, subjective well-being, work engagement and productivity. J Med Econ 2020; 23:994-1003. [PMID: 32397770 DOI: 10.1080/13696998.2020.1767631] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Aims: Nocturia (getting up at night to urinate, where each urination being followed by sleep or intention to sleep) is a bothersome symptom with potentially negative consequences for individual health and daytime functioning. This study assessed the burden of nocturia in the workplace by investigating associations between nocturia and subjective well-being (SWB), work engagement and productivity.Methods: Using large-scale international workplace survey data, the associations between nocturia, SWB, work engagement (Utrecht Work Engagement Scale, UWES-9) and productivity (Work Productivity and Activity Impairment, WPAI) were assessed. Bivariate and multivariate regression analysis was used with adjustment for a large set of confounding factors, including sleep duration and sleep quality.Results: Across a study sample of 92,129 observations, aged 18-70, an average of 10% of the survey population reported ≥2 nocturnal voids (generally considered clinically significant nocturia), with prevalence of nocturia increasing with age. Individuals with nocturia reported a 35.7% (p < .001) higher relative sleep disturbance score and were 10.5 percentage points (pp) (p < .001) more likely to report short sleep. Adjusted for covariates, nocturia was associated with a 3.5% (p < .001) lower relative SWB score and a 2% (p < .001) lower relative UWES-9 work engagement score. Nocturia was associated with a 3.9 pp (p < .001) higher work impairment due to absenteeism and presenteeism (WPAI). Adjusting additionally for sleep disturbance and sleep duration reduced the magnitude of the estimated effects, suggesting a key role for poor sleep in explaining the relationship between nocturia and the outcomes (SWB, UWES-9, WPAI) assessed.Conclusions: A key contribution of this study is the assessment of the association between nocturia and a range of work performance outcomes in a sizeable study using validated instruments to measure work engagement and productivity. The study highlights the importance of taking sleep into account when assessing the relationship between nocturia and associated outcomes.
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Affiliation(s)
| | - Fredrik L Andersson
- International PharmaScience Center, Ferring Pharmaceuticals A/S, Copenhagen, Denmark
| | - Teodor Burtea
- Ferring International Center S.A., Saint-Prex, Switzerland
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Zeng VY, Milligan G, Piercy J, Anderson P, Andersson FL. Impact of nocturia on patients' health-related quality of life and healthcare resource utilisation compared with OAB and BPH: Results from an observational survey in European and American patients. Int J Clin Pract 2019; 73:e13408. [PMID: 31456335 PMCID: PMC9285556 DOI: 10.1111/ijcp.13408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/09/2019] [Accepted: 08/23/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate the impact of nocturia on patients' quality of life and healthcare resource utilisation (HRU) compared with overactive bladder (OAB) and benign prostatic hyperplasia (BPH). METHODS Data were drawn from a multinational (France, Germany, Spain, UK and US) survey of physician and patient-reported outcomes. The patient groups of interests were those diagnosed with only nocturia, with only OAB, and with only BPH. Health-related quality of life (HRQoL) and productivity measures were derived from the EuroQoL-5D, OAB-q and the Work Productivity and Activity Impairment Questionnaire (WPAI). Measures of HRU included lower urinary tract symptoms (LUTS)-relevant surgeries, hospitalisations, current use of pads and related physician visits. Bivariate and multivariate regression analyses were used to evaluate associations between HRQoL/HRU/Productivity and nocturia status. Multivariate analysis was used to address any potential confounding factors among the groups, ie age, gender, body mass index (BMI), ethnicity and comorbidities. RESULTS A total of 3552 patients were identified including 358 nocturia patients, 1415 OAB patients and 1779 BPH patients. The mean age of the nocturia patients was 61.2 years with a mean BMI of 27.3. About 60.6% were women, 87.2% were Caucasian, and their most common comorbidities included depression, hypertension and diabetes. In terms of impact, nocturia patients were significantly worse off than OAB patients in their HRQoL. There was no significant difference regarding HRU and productivity measurement. Nocturia patients also presented with significantly worse HRQoL and lower productivity compared with BPH patients. Nocturia patients also had more physician visits. CONCLUSIONS Nocturia should be emphasised as a standalone LUTS disease with substantial patient impact. Compared with OAB and/or BPH, nocturia patients presented with a significant reduction on patients' quality of life, reduced work productivity and increased utilisation of healthcare resources.
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Affiliation(s)
- Veronica Y. Zeng
- Ferring Pharmaceuticals A/SCopenhagenDenmark
- Present address:
AstraZeneca LtdSingapore CitySingapore
| | | | | | | | - Fredrik L. Andersson
- Ferring Pharmaceuticals A/SCopenhagenDenmark
- Center for Medical Technology Assessment (CMT)Linköping UniversityLinköpingSweden
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Everaert K, Anderson P, Wood R, Andersson FL, Holm-Larsen T. Nocturia is more bothersome than daytime LUTS: Results from an Observational, Real-life Practice Database including 8659 European and American LUTS patients. Int J Clin Pract 2018; 72:e13091. [PMID: 29767479 DOI: 10.1111/ijcp.13091] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 03/25/2018] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Lower urinary tract symptoms (LUTS) encompass several diagnoses, including overactive bladder (OAB) and benign prostatic hyperplasia (BPH). Nocturia is a standalone symptom, but also included in OAB and BPH. Current discussion addresses whether the overlap of the diagnoses is too broad, leading to misdiagnosis. This study explored the differences in level, causes and consequences for patients with a diagnosis of daytime LUTS compared with a diagnosis of nocturia, and discussed whether people are being treated for the symptoms that truly bother them the most. PATIENTS AND METHODS Data were drawn from a survey of physicians and patients in France, Germany, Spain, UK and USA. Physicians filled out patient record forms (PRFs) for patients with LUTS diagnosis. The patients completed the patient self-completion form (PSC). Three PRO questionnaires were included; the OAB-q SF, NI-Diary and WPAI. Patients were grouped based on the diagnoses assigned to them by their physicians in a real-life setting. RESULTS Eight thousand seven hundred and thirty eight patients had a LUTS diagnosis and 5335 completed a PSC. Patients diagnosed with night-time symptoms were significantly more bothered by their LUTS than only daytime LUTS patients (all questionnaires P < .0001). Patients with nocturia reported being tired "always" or "usually" more often than patients with daytime problems only (P < .0001). Only 13% of patients with nocturia had an initial sleep period of more than 2-3 hours. CONCLUSION In this population of real-life patients, those with a diagnosis of nocturia reported significantly higher impact on their quality of life than patients with a diagnosis of daytime LUTS only. The underlying causes of bother were related to sleep problems. It is essential that nocturia is understood, treated and monitored as a distinct problem from OAB and BPH, to ensure that patients are treated for their main symptom.
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Affiliation(s)
- Karel Everaert
- Nopia research group, Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Peter Anderson
- Adelphi Real World, Adelphi Mill, Bollington, Macclesfield, UK
| | - Robert Wood
- Adelphi Real World, Adelphi Mill, Bollington, Macclesfield, UK
| | - Fredrik L Andersson
- Ferring Pharmaceuticals A/S, Copenhagen, Denmark
- Center for Medical Technology Assessment (CMT), Linköping University, Linköping, Sweden
| | - Tove Holm-Larsen
- Nopia research group, Department of Urology, Ghent University Hospital, Ghent, Belgium
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Trigg A, Andersson FL, Aldhouse NVJ, Bliwise DL, Kitchen H. Patients' Lived Experiences of Nocturia: A Qualitative Study of the Evening, the Night, and the Next Day. Patient 2017; 10:711-718. [PMID: 28425062 PMCID: PMC5681617 DOI: 10.1007/s40271-017-0241-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Nocturia, waking to urinate two or more times during the night, is a chronic condition associated with significant patient burden due to sleep disruption. This study aimed to explore the lived experiences of patients with nocturia in terms of the disruption to their lives during the night and day. METHODS Adult patients in the US diagnosed with nocturia were recruited for face-to-face qualitative interviews. Thematic analysis of patients' narratives, taking a phenomenological interpretative approach, summarised their experiences throughout the night and day, including any apparent contrasts between patients. RESULTS Twenty patients (10 male, 10 female) aged between 39 and 80 years, averaging three night-time voids, were interviewed. Analysis revealed that nocturia has a substantial impact on sleep quality and quantity, with the frequency of night-time voids a key driver of this. In addition to night-time phenomena, patients faced various difficulties the next day, including day-time tiredness, lack of energy and concerns related to emotional wellbeing, social functioning and cognitive functioning. All of these limited patients' capacity to work, perform daily activities or fulfil role responsibilities. Patients' lifestyles influenced experience, where younger patients in employment more readily emphasised the day-time physical and psychosocial burdens. Patients employed coping behaviours in an attempt to lessen the severity of nocturia and its impact, which were both physician-led and self-taught. CONCLUSIONS While the symptom of nocturia only occurs during the night, the impact is longer lasting, affecting functioning and wellbeing throughout the following day. Patients' circumstances can affect the extent of their burden; recognising this can improve effective delivery of patient-centred care.
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Affiliation(s)
- Andrew Trigg
- Clinical Outcomes Assessment, DRG Abacus, Manchester, UK
| | - Fredrik L. Andersson
- Global Health Economics and Outcomes Research, Ferring Pharmaceuticals A/S, Copenhagen, Denmark
| | | | | | - Helen Kitchen
- Clinical Outcomes Assessment, DRG Abacus, Manchester, UK
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Weidlich D, Andersson FL, Oelke M, Drake MJ, Jonasson AF, Guest JF. Annual direct and indirect costs attributable to nocturia in Germany, Sweden, and the UK. Eur J Health Econ 2017; 18:761-771. [PMID: 27678109 PMCID: PMC5486451 DOI: 10.1007/s10198-016-0826-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 08/25/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Our aim was to estimate the prevalence-based cost of illness imposed by nocturia (≥2 nocturnal voids per night) in Germany, Sweden, and the UK in an average year. METHODS Information obtained from a systematic review of published literature and clinicians was used to construct an algorithm depicting the management of nocturia in these three countries. This enabled an estimation of (1) annual levels of healthcare resource use, (2) annual cost of healthcare resource use, and (3) annual societal cost arising from presenteeism and absenteeism attributable to nocturia in each country. RESULTS In an average year, there are an estimated 12.5, 1.2, and 8.6 million patients ≥20 years of age with nocturia in Germany, Sweden, and the UK, respectively. In an average year in each country, respectively, these patients were estimated to have 13.8, 1.4, and 10.0 million visits to a family practitioner or specialist, ~91,000, 9000, and 63,000 hospital admissions attributable to nocturia and 216,000, 19,000, and 130,000 subjects were estimated to incur a fracture resulting from nocturia. The annual direct cost of healthcare resource use attributable to managing nocturia was estimated to be approximately €2.32 billion in Germany, 5.11 billion kr (€0.54 billion) in Sweden, and £1.35 billion (€1.77 billion) in the UK. The annual indirect societal cost arising from both presenteeism and absenteeism was estimated to be approximately €20.76 billion in Germany and 19.65 billion kr (€2.10 billion) in Sweden. In addition, in the UK, the annual indirect cost due to absenteeism was an estimated £4.32 billion (€5.64 billion). CONCLUSIONS Nocturia appears to impose a substantial socioeconomic burden in all three countries. Clinical and economic benefits could accrue from an increased awareness of the impact that nocturia imposes on patients, health services, and society as a whole.
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Affiliation(s)
- Diana Weidlich
- Catalyst Health Economics Consultants, 34b High Street, Northwood, Middlesex, HA6 1BN, UK
| | - Fredrik L Andersson
- Ferring Pharmaceuticals, Copenhagen, Denmark
- Center for Medical Technology Assessment (CMT), Linköping University, Linköping, Sweden
| | - Matthias Oelke
- Department of Urology, Hanover Medical School, Hannover, Germany
| | | | - Aino Fianu Jonasson
- Division of Obstetrics and Gynaecology, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Julian F Guest
- Catalyst Health Economics Consultants, 34b High Street, Northwood, Middlesex, HA6 1BN, UK.
- Faculty of Life Sciences and Medicine, King's College, London, UK.
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Miller PSJ, Hill H, Andersson FL. Nocturia Work Productivity and Activity Impairment Compared with Other Common Chronic Diseases. Pharmacoeconomics 2016; 34:1277-1297. [PMID: 27581788 DOI: 10.1007/s40273-016-0441-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The International Continence Society defines nocturia as the need to void one or more times during the night, with each of the voids preceded and followed by sleep. The chronic sleep disturbance and sleep deprivation experienced by patients with nocturia affects quality of life, compromising both mental and physical well-being. This paper aims to characterise the burden of nocturia by comparing published data from patients with nocturia with data from patients with any of 12 other common chronic conditions, specifically focusing on its impact on work productivity and activity impairment, as measured by the instrument of the same name (WPAI). METHODS A systematic literature review of multiple data sources identified evaluable studies for inclusion in the analysis. Study eligibility criteria included use of the WPAI instrument in patients with one of a predefined list of chronic conditions. We assessed the quality of each included study using the Newcastle-Ottawa scale and extracted basic study information, work and activity impairment data. To assess how work and activity impairment from nocturia compares with impairment from other common chronic diseases, we conducted two data syntheses (pooled and unpooled). RESULTS The number of evaluable studies and the range of overall work productivity impairment reported, respectively, were as follows: nocturia (3; 14-39 %), overactive bladder (5; 11-41 %), irritable bowel syndrome/constipation (14; 21-51 %), gastroesophageal reflux disease (GERD) (13; 6-42 %), asthma/allergies (11; 6-40 %), chronic obstructive pulmonary disease (COPD) (7; 19-42 %), sleep problems (3; 12-37 %), arthritis (13; 21-69 %), pain (9; 29-64 %), depression (4; 15-43 %) and gout (2; 20-37 %). CONCLUSIONS The overall work productivity impairment as a result of nocturia is substantial and was found to be similar to impairment observed as a result of several other more frequently researched common chronic diseases. Greater awareness of the burden of nocturia, a highly bothersome and prevalent condition, will help policy makers and healthcare decision makers provide appropriate management of nocturia.
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Affiliation(s)
- Paul S J Miller
- Miller Economics Ltd., BioHub Alderley Edge, Alderley Park, SK10 4TG, UK.
| | - Harry Hill
- Centre for Health Economics, Institute of Population Health/School of Dentistry, University of Manchester, 4.306, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Fredrik L Andersson
- Global Health Economics and Outcomes Research, Ferring Pharmaceuticals A/S, Kay Fiskers Plads 11, 2300, Copenhagen, Denmark
- Center for Medical Technology Assessment (CMT), Linköping University, 581 83, Linköping, Sweden
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Brüggenjürgen B, Rossnagel K, Roll S, Andersson FL, Selim D, Müller-Nordhorn J, Nolte CH, Jungehülsing GJ, Villringer A, Willich SN. The impact of atrial fibrillation on the cost of stroke: the berlin acute stroke study. Value Health 2007; 10:137-43. [PMID: 17391422 DOI: 10.1111/j.1524-4733.2006.00160.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
OBJECTIVES Atrial fibrillation (AF) is an important risk factor for stroke. The primary purpose of this study was to determine the resource use for patients admitted to hospital with acute stroke and to calculate stroke-related direct costs, stratifying the results according to the presence of AF as a risk factor. METHODS Data from 558 consecutive patients hospitalized with confirmed acute stroke between August 2000 and July 2001 were analyzed as part of the Berlin Acute Stroke Study. Sociodemographic variables were assessed by direct interview, while hospital data were derived from patient medical records. Patients or their carers completed a follow-up questionnaire about resource utilization and absenteeism from work during the 12-month period after hospital admission. RESULTS Out of the 367 patients with follow-up data and ECG findings, 71 (19%) had AF. Patients with AF were generally older, more likely to be female, and had more severe strokes compared with those without AF. Mean direct costs per patient were significantly higher in those with AF-related strokes (EURO 11,799 vs EURO 8817 for non-AF-related strokes; P < 0.001). After adjustment for confounding factors, direct costs were comparable in the two groups, except for acute hospitalization costs, which remained significantly higher in the group with AF (P < 0.05). CONCLUSION Medical care for stroke patients with AF is associated with higher costs compared with those without AF; this is explained mainly by confounding factors and driven essentially by a significant difference in acute hospitalization costs.
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Affiliation(s)
- Bernd Brüggenjürgen
- Institute for Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Germany
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Weiss K, Buxton M, Andersson FL, Lamm CJ, Liljas B, Sullivan SD. Cost-effectiveness of early intervention with once-daily budesonide in children with mild persistent asthma: results from the START study. Pediatr Allergy Immunol 2006; 17 Suppl 17:21-7. [PMID: 16573705 DOI: 10.1111/j.1600-5562.2006.00381.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The inhaled Steroid Treatment As Regular Therapy in early asthma (START) study has shown that early intervention with inhaled budesonide in mild persistent asthma improves clinical outcomes in both adults and children. The aim of this study was to estimate the incremental cost-effectiveness of early treatment with budesonide Turbuhaler in children aged 5-10 yr who participated in START. Direct and indirect costs associated with asthma were determined for 1974 children participating in the double-blind, 3-year part of the study. Randomization was to placebo or to budesonide 200 microg once daily in each case in addition to usual asthma care. Cost-effectiveness ratios were calculated from the healthcare payer's and societal perspectives (using US prices). The addition of once-daily budesonide therapy to usual asthma care was associated with 16 additional symptom-free days (SFDs) per child over the 3-yr period (p < 0.001), with a substantial reduction (50%) in the mean number of days spent in hospital, and with reduced frequency of emergency room visits and missed school and caregiver work days. From the healthcare payer's perspective (direct costs), the increase in mean direct cost over 3 yr with budesonide was 169 dollars, which translated into an incremental cost of early intervention with budesonide in children of 10.50 dollars (95% CI 1.20-33.30 dollars) per SFD gained. From the societal perspective, there was a cost reduction over 3 yr of 192 dollars with budesonide relative to placebo. From a societal perspective, budesonide was therefore dominant. In conclusion, early intervention with once-daily budesonide added to usual asthma care in children with mild persistent asthma is cost-saving from a societal perspective and is acceptably cost-effective when viewed from a healthcare payer perspective.
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Affiliation(s)
- Kevin Weiss
- Institute for Health Studies, Midwest Center for Health Services and Policy Research, Hines, VA, USA.
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Andersson FL, Svensson K, Gerhardsson de Verdier M. Hospital use for COPD patients during the last few years of their life. Respir Med 2005; 100:1436-41. [PMID: 16343887 DOI: 10.1016/j.rmed.2005.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2005] [Revised: 11/01/2005] [Accepted: 11/02/2005] [Indexed: 10/25/2022]
Abstract
Little is known about what happens to COPD patients during their final years of life, in particular in terms of hospital use. We linked the Swedish Mortality and Inpatient Registers to examine this research question during the period 1987-2000. In year 2000, 2331 fatalities were diagnosed with COPD as the underlying cause of death. About 3% of individuals had not been admitted to hospital at all prior to their death, whereas 15% had never been admitted for COPD (but for other reasons). More than 68% of all COPD admissions and 74% of all days in hospital occurred in the 3.5 years before death, indicating longer stays closer to death. The last 6 months of life accounted for 22% and 28% of all COPD admissions and days, respectively. Other causes accounted for nearly 50% of all admissions, with a more limited increase during the final years. In conclusion, there is a very variable hospital use among these COPD patients. Use increases almost exponentially as the end approaches. Finally, COPD patients often have a number of concomittant diseases which may affect diagnosis and healthcare resource use. The economic and policy implications of these main findings need to be further examined.
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Affiliation(s)
- Fredrik L Andersson
- Health Economics & Outcomes Research, AstraZeneca R&D, and Department of Respiratory Medicine and Allergology, Lund University Hospital, 221 87, Sweden.
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McMurray JJV, Andersson FL, Stewart S, Svensson K, Solal AC, Dietz R, Vanhaecke J, van Veldhuisen DJ, Ostergren J, Granger CB, Yusuf S, Pfeffer MA, Swedberg K. Resource utilization and costs in the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) programme. Eur Heart J 2005; 27:1447-58. [PMID: 16754631 DOI: 10.1093/eurheartj/ehl016] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS More treatments are needed to improve clinical outcomes in chronic heart failure (HF). It is, however, important that treatments for a condition as common as HF are affordable. We have carried out a prospective economic analysis of the Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) programme. METHODS AND RESULTS Patients with NYHA class II-IV HF and LVEF < or =0.40 were randomized to CHARM-Alternative if intolerant of an ACE-inhibitor or to CHARM-Added if taking an ACE-inhibitor. Patients with a LVEF >0.40 were randomized in CHARM-Preserved. Each trial compared the effect of candesartan to placebo on the primary outcome of cardiovascular death or HF hospitalization. Detailed information was prospectively collected on hospital admissions, procedures/operations and drugs. A cost-consequence analysis was performed for France, Germany and the UK for CHARM-Overall and a cost-effectiveness analysis for the low LVEF trials. The cost of candesartan was substantially offset by a reduction in hospital admissions, especially for HF. In the cost-consequence analysis, candesartan was cost-saving in most scenarios for CHARM-Alternative and Added but the marginal annual net cost per patient was upto 372 euros per year in CHARM-Preserved, in which candesartan did not reduce the primary outcome significantly. In the cost-effectiveness analysis of patients with a LVEF < or = 0.40, candesartan was cost-saving in some scenarios and in the others the maximum cost per life year gained was 3881 euros. CONCLUSION Candesartan improves functional class, reduces the risk of hospital admission, and increases survival in patients with a HF and a LVEF < or =0.40 at an acceptable cost.
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Affiliation(s)
- John J V McMurray
- Department of Cardiology, Level 4, Western Infirmary, Glasgow, Scotland, UK.
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Abstract
BACKGROUND AND PURPOSE Stroke outcomes in patients with atrial fibrillation (AF) tend to be worse than those in patients without AF. The objective of this study was to evaluate whether the cost benefits of anticoagulation for stroke prevention in AF may currently be underestimated by existing economic models that do not distinguish between different stroke outcomes. METHODS A literature review was conducted in 3 areas: (1) studies comparing stroke outcomes in AF and non-AF patients; (2) studies providing long-term cost of stroke estimates; and (3) studies modeling the cost-effectiveness of anticoagulation with a vitamin K antagonist (eg, warfarin) in AF patients. RESULTS There is considerable evidence that stroke in AF patients has a worse outcome than in patients without AF, including higher mortality, severity, and recurrence rates, and greater functional impairment and dependency. Estimates of the long-term cost of stroke of different severities were between US 24,991 dollars for a mild stroke over 5 years and US 142,251 dollars for a major ischemic stroke over a lifetime (2004 prices). The cost of a severe ischemic stroke may typically be 3-times that of mild stroke. However, cost-effectiveness models for anticoagulation in patients with AF have used average (not AF-specific) cost-of-stroke data, and most have used stroke severity distributions derived from clinical trials, which may differ from those in clinical practice. CONCLUSIONS Existing economic models underestimate the cost benefits of anticoagulation for stroke prevention because they do not adjust for poorer outcomes associated with cardioembolic strokes.
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Affiliation(s)
- Paul S J Miller
- AstraZeneca, HEOR/Clinical Science, Parklands FE2 D/4, Alderley Park, SK10 4TG UK.
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Björholt I, Andersson FL, Kahan T, Ostergren J. The cost-effectiveness of ramipril in the treatment of patients at high risk of cardiovascular events: a Swedish sub-study to the HOPE study. J Intern Med 2002; 251:508-17. [PMID: 12028506 DOI: 10.1046/j.1365-2796.2002.00990.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate if long-term treatment with ramipril is cost-effective in patients at high risk of cardiovascular events. DESIGN Randomized double-blind and placebo controlled. Information was gathered prospectively for a number of direct medical, direct nonmedical and indirect costs. SETTING AND SUBJECT This is a sub-study to the Heart Outcomes Prevention Evaluation (HOPE) study performed in Swedish patients. All Swedish centres (19; n= 554) were invited to take part and 18 centres agreed to do so (n=537). The patients were managed in a specialist setting with a mean follow-up period of 4.5 years. Main outcome measures. The number of life-years saved was derived from the global HOPE study (n=9297) and subsequently the estimated life expectancy of those who completed the clinical study alive was added to the calculation. Direct medical costs related to cardiovascular disease only were considered in the primary analysis, whilst all kinds of costs and costs for all kinds of diseases were included in subsequent analyses. The cost of added years of life, according to the future cost method, was included in sensitivity analyses. RESULTS The cost per life-year gained was SEK 16 600 (Euro 1940) when direct medical costs for cardiovascular reasons only were considered and SEK 45 400 (Euro 5300) when direct medical costs for all diseases were considered. The corresponding costs when direct nonmedical and indirect cost were added to the estimate were SEK 16 100 (Euro 1880) and SEK 54 600 (Euro 6380), respectively. When the future cost method was applied, the cost per life-year gained was SEK 208 300 (Euro 24 300). CONCLUSION Ramipril is highly cost-effective in the treatment of patients at high risk of cardiovascular events.
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Affiliation(s)
- I Björholt
- Department of Health Economics, AstraZeneca Sverige AB, Mölndal, Sweden.
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