467FFR guided acute complete revascularization versus culprit lesion only treatment in patients presenting with STEMI; 3-year cost-analysis data from COMPARE-ACUTE trial

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
P C Smits ◽  
M Abdel-Wahab ◽  
F J Neumann ◽  
B M Boxma-De Klerk ◽  
P L Laforgia ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Health Care ◽  
Cost Analysis ◽  
Health Care Costs ◽  
Average Cost ◽  
Long Term Results ◽  
Complete Revascularization ◽  
Culprit Lesion ◽  
Care Costs

Abstract Background Compare-Acute trial showed a 1-year superior outcome of FFR-guided acute complete revascularization (FFR-CR) compared to culprit-lesion-only revascularization (CLO) in patients presenting with ST-segment elevation myocardial infarction (STEMI) and multi-vessel disease (MVD). Long-term results and financial impact of this strategy are unknown. Purpose To evaluate if FFR-CR strategy is superior to CLO strategy in terms of health care costs at 3 year follow-up. Methods Compare-Acute is a multicenter, investigator-initiated prospective randomized controlled trial that involved 24 sites. Patients with STEMI and MVD were randomized 1:2 after successful primary PCI, towards FFR-CR or CLO treatment strategies (295 vs 590 pts). All stenosis ≥50% by angiography in the non-infarct artery were investigated by FFR in both arms. In the FFR-CR arm, all non-culprit (NC) lesions with a FFR ≤0.80 were treated by PCI. In the CLO arm pts underwent blinded FFR procedure of the NC lesions. Further treatment of these lesions was based on symptoms and/or ischemia testing during follow-up with an allowed treatment window of 45 days. The primary endpoint was defined as a composite of all-cause mortality, non-fatal myocardial infarction, any revascularization and cerebrovascular events (MACCE) at 12 months. The major secondary endpoints are MACCE and health care costs from both strategies up to 3-year follow-up. Cost-analysis is done from an insurance/governmental perspective in countries that use Diagnosis Related Group (DRG) costs: the Netherlands, Germany, Sweden and Poland. Results 1-year results have already been published and showed superior outcome of patients in the FFR-CR arm. According to the Dutch system, at 1 year of follow-up the average cost per patient was 8.150€ in the FFR-CR arm, and 10.319€ in the CLO arm (−21%). The better cost-effectiveness of FFR-CR strategy remained at 3 years of follow-up: average cost per patient was 8.653€ in the FFR-CR arm and 11.100€ in the CLO arm (−22%). Same 3-year data was confirmed using DRG analysis according to the German system (FFR-CR 4.887€ vs CLO 5.200€; −6.0%) and the Swedish system (FFR-CR 6.205€ vs CLO 8.133€; −23.7%). FFR-CR strategy was not more costly according to the Polish system (FFR-CR 3.704€ vs CLO 3.685€; +0.5%). Moreover, the better outcome of the FFR-CR group was mantained at 3 year follow-up (data not shown). Figure 1 Conclusion Our cost-analysis of the Compare Acute Trial shows that the strategy of FFR-guided complete revascularization in patients with STEMI and MVD is not only superior in terms of outcome, but also in terms of health care costs at 1 year. This benefit is maintained at 3 years follow-up.

Cost-effectiveness of a graded exercise therapy program for patients with chronic shoulder complaints

2006 ◽  
Vol 22 (1) ◽  
pp. 76-83 ◽  
Author(s):  
Jacques J. X. R. Geraets ◽  
Mariëlle E. J. B. Goossens ◽  
Camiel P. C. de Bruijn ◽  
Imelda J. M. de Groot ◽  
Albère J. S. Köke ◽  
...  
Keyword(s):  
Health Care ◽  
Cost Effectiveness ◽  
Treatment Period ◽  
Health Care Costs ◽  
Daily Activities ◽  
Graded Exercise Therapy ◽  
Graded Exercise ◽  
Health Related ◽  
Care Costs

Objectives:The present study evaluated the cost-effectiveness of a behavioral graded exercise therapy (GET) program compared with usual care (UC) in terms of the performance of daily activities by patients with chronic shoulder complaints in primary care.Methods:A total of 176 patients were randomly assigned either to GET (n=87) or to UC (n=89). Clinical outcomes (main complaints, shoulder disability [SDQ] and generic health-related quality of life [EQ-5D], and costs [intervention costs, direct health care costs, direct non–health-related costs, and indirect costs]) were assessed during the 12-week treatment period and at 52 weeks of follow-up.Results:Results showed that GET was more effective than UC in restoring daily activities as assessed by the main complaints instrument after the 12-week treatment period (p=.049; mean difference, 7.5; confidence interval [CI], 0.0–15.0). These effects lasted for at least 52 weeks (p=.025; mean difference 9.2; CI, 1.2–17.3). No statistically significant differences were found on the SDQ or EQ5D. GET significantly reduced direct health care costs (p=.000) and direct non–health care costs (p=.029). Nevertheless, total costs during the 1-year follow-up period were significantly higher (p=.001; GET=€530 versus UC=€377) due to the higher costs of the intervention. Incremental cost-effectiveness ratios for the main complaints (0–100), SDQ (0–100), and EQ-5D (−1.0–1.0) were €17, €74, and €5,278 per unit of improvement, respectively.Conclusions:GET proved to be more effective in the short- and long-term and reduces direct health care costs and direct non–health care costs but is associated with higher costs of the intervention itself.

scholarly journals Factors contributing to post-stroke health care utilization and costs. Secondary results from the Life After Stroke (LAST) study, a pragmatic randomized controlled trial

2020 ◽  
Author(s):  
Øystein Døhl ◽  
Vidar Halsteinli ◽  
Torun Askim ◽  
Mari Gunnes ◽  
Hege Ihle Hansen ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Costs ◽  
Gait Speed ◽  
Standard Care ◽  
Controlled Trial ◽  
Health Care Use ◽  
Post Stroke ◽  
Randomized Controlled ◽  
Care Costs

Abstract Background The result from the Life After Stroke (LAST) study showed that an 18-month follow up program as part of the primary health care, did not improve maintenance of motor function for stroke survivors. In this study we evaluated whether the follow-up program could lead to a reduction in the use of health care compared to standard care. Furthermore, we analyse to what extent differences in health care costs for stroke patients could be explained by individual need factors (such as physical disability, cognitive impairment, age, gender and marital status), and we tested whether a generic health related quality of life (HRQoL) is able to predict the utilisation of health care services for patients post-stroke as well as more disease specific indexes. Methods The Last study was a multicentre, pragmatic, single-blinded, randomized controlled trial. Adults (age ≥18 years) with first-ever or recurrent stroke, community dwelling, with modified Rankin Scale <5. The study included 380 persons recruited 10 to 16 weeks post-stroke, randomly assigned to individualized coaching for 18 months (n=186) or standard care (n=194). Individual need was measured by the Motor assessment scale (MAS), Barthel Index, Hospital Anxiety and Depression Scale (HADS), modified Rankin Scale (mRS) and Gait speed. HRQoL was measured by EQ-5D-5L. Health care costs were estimated for each person based on individual information of health care use. Multivariate regression analysis was used to analyse cost differences between the groups and the relationship between individual costs and determinants of health care utilisation. Results There were higher total costs in the intervention group. MAS, Gait speed, HADS and mRS were significant identifiers of costs post-stroke, as was EQ-5D-5L. Conclusion Long term, regular individualized coaching did not reduce health care costs compared to standard care. We found that MAS, Gait speed, HADS and mRS were significant predictors for future health care use. The generic EQ-5D-5L performed equally well as the more detailed battery of outcome measures, suggesting that HRQoL measures may be a simple and efficient way of identifying patients in need of health care after stroke and targeting groups for interventions. Clinical Trial Registration : https://www.clinicaltrials.gov NCT01467206.

Relationship between compliance with imatinib mesylate and medical costs for patients with CML and GIST

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 6618-6618
Author(s):  
R. Halpern ◽  
V. Barghout ◽  
D. Williams
Keyword(s):  
Health Care ◽  
Imatinib Mesylate ◽  
Health Care Costs ◽  
Kinase Inhibitor ◽  
Medication Possession Ratio ◽  
Medical Costs ◽  
Poor Compliance ◽  
Good Compliance ◽  
Care Costs

6618 Background: Imatinib mesylate, an oral tyrosine kinase inhibitor for treatment of chronic myeloid leukemia (CML) and gastrointestinal stromal tumors (GIST), has been found both effective and cost-effective. This study examines the relationship between imatinib compliance and health care costs for patients (pts) with CML and GIST. Methods: This retrospective study used claims data from a large national US health plan. Pts had =2 imatinib claims from 6/1/01–3/31/05; =1-year follow-up after the 1st imatinib claim; and diagnosis of CML (ICD9 205.1x) or GIST (ICD9 159.0, 159.8, 159.9 or evaluation of claims and attribution of GIST by independent hematologist/oncologist). Compliance was measured with a medication possession ratio ((days of imatinib during follow-up / days of follow- up)*100). Compliance categories were good, =90%; medium, 70–89.9%; poor, <70%. Total follow-up medical and health care (medical + pharmacy) costs were measured and compared across compliance categories; t-tests compared mean costs. Results: 374 CML and 91 GIST pts had mean age of 52.1 ± 14.0 years. 274 (59%) pts were male. 234 (50%) of pts had 12–24 months follow-up; 231 (50%) had 25–57 months. Mean and median compliance across all pts were 69.4% and 79.7%, respectively. 122 (33%) CML and 32 (35%) GIST pts had good compliance; 149 (40%) CML and 42 (46%) GIST pts had poor compliance. Mean medical costs across all pts were lower and less variable with good compliance ($22,882 ± 22,791) than with medium ($40,366 ± 68,186), p=0.007) and poor ($104,961 ± 190,559), p<0.001). Similarly, mean medical costs for CML pts with good, medium, and poor compliance were $21,456 (±22,127), $41,537 (±72,238, p=0.008), and $117,004 (±211,292, p<0.001), respectively. Mean medical costs for GIST pts were: good=$28,318 (±24,781); medium=$33,270 (±35,356, p=0.584); and poor=$62,235 (±68,751, p<0.001). Mean total health care costs were 21.7% lower for pts with good compliance relative to those with poor. Conclusions: Good imatinib compliance was associated with significantly lower medical costs. Mean total medical costs were 78% lower with good compliance relative to poor. Compliance is an important treatment issue for both clinical and medical cost outcomes. No significant financial relationships to disclose.

What are the health care costs for chronic lymphocytic leukemia?

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 15-15 ◽  
Author(s):  
Matthew J. Matasar ◽  
Stacey DaCosta Byfield ◽  
Cori Blauer-Peterson ◽  
Melissa Montez ◽  
Carolina Reyes ◽  
...  
Keyword(s):  
Health Care ◽  
Chronic Lymphocytic Leukemia ◽  
Health Care Costs ◽  
Fixed Number ◽  
Lymphocytic Leukemia ◽  
New Drugs ◽  
Patient Treatment ◽  
Medicare Advantage ◽  
Care Costs

15 Background: New drugs for chronic lymphocytic leukemia (CLL) have recently been approved, including oral therapies. We examined total health care costs, including drug and patient out-of-pocket (OOP) costs, in patients (pts) initiating CLL treatment. Methods: This retrospective studyused a U.S. health insurance claims database. Adult commercially insured and Medicare Advantage pts from 5/2013 - 6/2015, with ≥2 medical claims for CLL were included. Pts required ≥1 claim for NCCN-recommended systemic cancer therapy. Pts were categorized based on first-line of therapy. Aggregate costs during a fixed 9-month follow-up period (treatment switch or discontinuation were possible) were investigated. Mean and standard deviation (SD) of total healthcare costs, regimen costs, and pt OOP regimen costs are presented. Results: A total of 707 CLL pts met all study criteria during the study period; 40% were commercially insured and 60% had Medicare Advantage. Mean age was 70 years (SD 11). Some of the most common regimens received included Bendamustine+Rituximab (BR) (N=186), Ibrutinib (Ibr) (N=101), Fludarabine, Cyclophosphamide, and Rituximab (FCR) (N=62), and Obinutuzumab +/- Chlorambucil (Ob+/-Chl) (N=51). Mean length of therapy varied by regimen; BR 4.2 months (m) (SD 2.7), Ibr 6.7m (SD 4.8), FCR 4.7m (SD 2.1), and Ob±Chl 4.0m (SD 2.1). The table shows aggregate costs among pts with ≥ 9 months follow-up. Ob±Chl had lower costs compared to other cohorts. Ibr had the highest drug costs. Conclusions: While the study has limited follow-up, Ob+/-Cl had the lowest drug and total costs. Oral therapy with Ibr had the highest drug and OOP costs compared to those associated with a prescribed fixed number of cycles. The magnitude of the difference between orals and infusions is expected to be greater with a longer follow-up and is a consideration in patient treatment decision-making in CLL.[Table: see text]

Estimating health care costs for advanced metastatic bladder cancer patients who are lost to follow-up: Applications of the Kaplan-Meier sampling average (KMSA).

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 21-21
Author(s):  
Binglin Yue ◽  
Maria L. Lankford ◽  
Pamela Landsman-Blumberg
Keyword(s):  
Health Care ◽  
Bladder Cancer ◽  
Cancer Patients ◽  
Health Care Costs ◽  
Traditional Method ◽  
Total Cost ◽  
Metastatic Bladder Cancer ◽  
Lost To Follow Up ◽  
Care Costs

21 Background: There is an increasing need to evaluate the quality and cost of care within oncology. Estimating health care costs for patients who are lost to follow-up or censored often results in underestimating costs, biasing comparative assessments. This study compared traditional costing approaches with that of KMSA methods for patients treated for metastatic bladder cancer. Methods: Advanced metastatic bladder cancer patients receiving second line chemotherapy were identified from the Truven Health MarketScan Claims Databases (04/2011 to 09/2014). All-cause health care costs represent the total dollars paid to all providers of care regardless of diagnosis and were inflated to 2014 USD. Total, medical, pharmacy, and site-of-care costs from treatment initiation to death, end-of-enrollment, or end-of-study period were compared using the KMSA and traditional methods. In KMSA, the follow-up period is divided into small uniform intervals; total cost in each interval is then multiplied by the individual patient’s survival probability at the beginning of each interval and then summed across the intervals. Results: The censoring rate of patients’ follow-up was 49%. The mean per patient total health care captured by traditional method was only 72% of the total cost estimated by KMSA method or $32,930 less per patient. Overall, underestimates ranged from 28% to 41% with pharmacy, ER, and lab service costs underestimated the largest when using the traditional method. Conclusions: The KMSA produced estimates more reflective of actual patient-level health care costs in this claims-based observational cancer study compared to traditional methods by accounting for the effect of censoring. Researchers should consider KMSA when evaluating and comparing costs of care in the presence of variable follow-up.[Table: see text]

Depression and health-care costs during the first year following myocardial infarction

2000 ◽  
Vol 48 (4-5) ◽  
pp. 471-478 ◽  
Author(s):  
Nancy Frasure-Smith ◽  
François Lespérance ◽  
Ginette Gravel ◽  
Aline Masson ◽  
Martin Juneau ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Health Care ◽  
Health Care Costs ◽  
First Year ◽  
Care Costs
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