scholarly journals Cost-effectiveness of Comprehensive screening of general population for hypertension: Can it save money and Life? Systematic review of Pharmacoeconomic Studies

2020 ◽  
Author(s):  
Majid Davari ◽  
Mende Mensa Sorato ◽  
Shekoufeh Nikfar
Keyword(s):  
Risk Factors ◽  
Cost Effectiveness ◽  
General Population ◽  
Adult Population ◽  
Cost Effective ◽  
Arterial Disease ◽  
Population Based ◽  
Delayed Presentation ◽  
Early Screening ◽  
Peripheral Arterial

Abstract Background: Hypertension is one of major modifiable risk factors contributing for development of ischemic heart disease, diabetes, kidney disease, cerebrovascular disease and peripheral arterial disease. Silent nature of the disease, delayed presentation of patients to health system after development of significant cardiovascular events and poor access to comprehensive health care are major challenge of hypertension control. Early screening, detection and treatment of hypertension is effective for control of the disease progression. However, there is no robust evidence on whether screening general population for hypertension is cost-effective or not. Therefore, this review was conducted t o generate evidence on cost effectiveness of population-based hypertension screening for asymptomatic individuals as early detection strategy for the primary prevention of cardiovascular diseases. Methods: PubMed/Medline , Scopus, Web of sciences and Google Scholar were searched from January 2000 to 11 December 2019. Two investigators independently selected and reviewed fair and good-quality pharmacoeconomic studies for the cost-effectiveness of asymptomatic screening for hypertension in the community. Quality of selected literatures are evaluated by authors based on comprehensive tool developed for critical appraisal of pharmacoeconomic studies. Results: Eleven included Pharmacoeconomic studies reported favorable results for screening asymptomatic adults for hypertension. Most of studies agreed on cost-effectiveness of screening adults aged 40 years and older. Screening of general adult population for hypertension is not-cost effective. Conclusion: Screening population 40 years and older with or without additional risk factors is cost-effective in reducing hypertension and associated cardiovascular disease morbidity and mortality in developed and developing countries.

Abstract P248: Oxidized Phospholipids and Risk of Peripheral Arterial Disease in Men

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Monica L Bertoia ◽  
Jennifer K Pai ◽  
Sotirios Tsimikas ◽  
Michel M Joosten ◽  
Murray A Mittleman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Peripheral Arterial Disease ◽  
Conditional Logistic Regression ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Population Based ◽  
Oxidized Phospholipids ◽  
Blood Draw ◽  
Peripheral Arterial ◽  
Conventional Risk Factors

Background: Peripheral arterial disease (PAD) is highly prevalent, found in 25% of adults ≥70 years, but its risk factors are less well studied than coronary and carotid atherosclerosis. Proinflammatory oxidized phospholipids (OxPL) are a novel cardiovascular risk factor produced by oxidative stress and are preferentially bound and transported by lipoprotein (a) [Lp(a)] in plasma. Previous studies have shown an association between OxPL on apolipoprotein B-100 (OxPL/apoB) and carotid and femoral atherosclerosis. However, no previous studies have specifically examined the prospective association between OxPL/apoB and risk of PAD in a population-based cohort. Methods: We conducted a nested case-control study among men free of cardiovascular disease within the Health Professionals Follow-up Study (1994–2008) including 143 men with PAD and 429 controls matched on age, month of blood draw, and smoking. OxPL/apoB and Lp(a) were measured in stored baseline plasma. We identified cases of clinically significant PAD based on at least one of the following: (1) amputation, bypass, or other revascularization procedure for occlusive arterial disease, (2) angiogram/ultrasound confirming at least 50% stenosis of at least one artery with congruent symptoms in the ipsilateral limb, (3) ankle-brachial index < 0.9, or (4) physician's diagnosis. We used conditional logistic regression to estimate odds ratios (OR) for PAD according to level of OxPL/apoB. Results: The OR for PAD was 1.24 (95% CI 1.05–1.46) for each 1-standard deviation (SD) increase in OxPL/apoB after adjusting for matching factors. Additional adjustment for family history of MI, triglycerides, HDL-C, LDL-C, C-reactive protein, hemoglobin A1c, pack-years of smoking, physical activity, hypertension, diabetes, hypercholesterolemia, body-mass index, and aspirin use did not change this estimate: 1.24 (95% CI 1.00–1.54). OxPL/apoB was not correlated with any conventional risk factors: Spearman correlation coefficients ranged from 0.0 to 0.13. We observed no interaction with age or LDL-C. Similarly, the OR for PAD was 1.25 (95% CI 0.95–1.63) for each 1- SD increase in ln[Lp(a)] after adjusting for all of the above covariates. Conclusion: OxPL/apoB is positively associated with risk of PAD in men with no appreciable attenuation after adjustment for conventional risk factors.

scholarly journals Analysing cardiovascular risk factors and related outcomes in a middle-aged to older adults population in Iran: a cohort protocol of the Shiraz Heart Study (SHS)

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e026317 ◽  
Author(s):  
Mohammad Javad Zibaeenezhad ◽  
Haleh Ghaem ◽  
Nader Parsa ◽  
Mehrab Sayadi ◽  
Mehrdad Askarian ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mixed Model ◽  
Arterial Disease ◽  
Population Based ◽  
Capital City ◽  
Fars Province ◽  
Heart Study ◽  
Lifestyle Questionnaire ◽  
Underlying Causes ◽  
Peripheral Arterial

IntroductionThe significant increase in the rate of morbidity and mortality due to cardiovascular diseases has become a health challenge globally. Lack of enough knowledge on the underlying causes in Iran and taking the unique characteristics of the Shiraz metropolitan city (the capital city of Fars Province) into consideration prompted us to conduct the Shiraz Heart Study. The aim of this study is to determine the predisposing elements leading to coronary heart disease, cerebrovascular disease and peripheral arterial disease.Methods and analysisIn this population-based, prospective study, family physician clinics will become the executive arms. Participants aged 40–70 years old will be recruited to achieve a sample size of 10 000. Socioeconomicta and anthropometric indices supplemented by physical activity, nutritional and psychological questionnaires, as well as routine blood laboratory tests, medical history and electrocardiographic records, will be collected at enrolment in clinics. In addition, blood samples will be obtained to explore the possible role of genetics in outcome occurrence. Follow-up with blood sampling, completion of a lifestyle questionnaire and evaluation of clinical risk factors will be carried out five times in a 2-year interval for all participants. Advanced statistical methods such as mixed model and time-to-event models will be used for data analysis.Ethics and disseminationThis study is in accordance with the Helsinki Declaration and has been approved by the Research Ethics Committee of Shiraz University of Medical Sciences (No: 2017–358). Signing a written informed consent is the preliminary step. Participants are free to withdraw on their request at any time. Collected data are kept encrypted in a software with authorities’ access only. Findings of the study will be published at a national or international scale through peer-reviewed journals.

scholarly journals Prevalence and risk factors associated with peripheral arterial disease in an adult population from Colombia

2018 ◽  
Vol 88 (2) ◽  
pp. 107-115
Author(s):  
Lorena Urbano ◽  
Eliana Portilla ◽  
Wilson Muñoz ◽  
Albert Hofman ◽  
Carlos H. Sierra-Torres
Keyword(s):  
Risk Factors ◽  
Peripheral Arterial Disease ◽  
Adult Population ◽  
Arterial Disease ◽  
Factors Associated ◽  
Peripheral Arterial

scholarly journals Comparative Study to Evaluate Efficacy & Cost Effectiveness of Olmesartanversus Telmisartan, In Patients of Stage I Hypertension

2020 ◽  
Vol 9 (1) ◽  
pp. PC01-PC06
Author(s):  
Pankaj Kumar Singh ◽  
Sameer Kumar
Keyword(s):  
Cost Effectiveness ◽  
Comparative Study ◽  
Cost Effective ◽  
Arterial Disease ◽  
Stage I ◽  
Group I ◽  
Parallel Group ◽  
Group Ii ◽  
Peripheral Arterial ◽  
Effective Analysis

Background: Hypertension is one of the most common diseases in the world. It is an important and independent risk factor for atherosclerosis, heart failure, renal disease, and peripheral arterial disease. It is directly responsible for 57% of all stroke deaths and 42% of coronary heart disease deaths in India. Aims and Objectives: To evaluate and compare efficacy and cost effectiveness in hypertensive patients receiving Olmesartan and Telmisartan in Stage I hypertensionSubjects and Methods:The present study was an open, prospective, randomized, parallel group comparative study conducted in 60 patients of stage I hypertension over a period of 16 weeks. Patients were randomly allocated to two, age and sex, matched groups of 30 patients each. Group I patients were started on Olmesartan at a dose of 20 mg & Group II patients were put on Telmisartan at a dose of 40 mg. The BP lowering efficacy and cost effective analysis of Olmesartan versus Telmisartan was calculated & compared. The data was entered in Microsoft excel and compiled. Statistical analysis was done using various tests.Results:Maximum patients in both the groups were in age group of 51-60 years. In group I there were 13 males and 17 females. In group II there were 14 males and 16 females. Both Olmesartan and Telmisartan are effective in lowering systolic & diastolic BP in supine & sitting positions & mean BP is also lowerer, more in Olmesartan group. By cost effective analysis Telmisartan was found more cost effective. Incremental cost effective ratio was found to be 218.35.Conclusion: Both Olmesartan and Telmisartan belong to the same antihypertensive drug class, effectively reduce systolic and diastolic blood pressure at various visits. Taking into account Total cost Telmisartan was more cost effective than Olmesartan. ICER was found to be 218.35.

scholarly journals The Peripheral Arterial disease study (PERART/ARTPER): prevalence and risk factors in the general population

2010 ◽  
Vol 10 (1) ◽  
Author(s):  
María Teresa Alzamora ◽  
◽  
Rosa Forés ◽  
José Miguel Baena-Díez ◽  
Guillem Pera ◽  
...  
Keyword(s):  
Risk Factors ◽  
General Population ◽  
Peripheral Arterial Disease ◽  
Arterial Disease ◽  
Peripheral Arterial ◽  
Disease Study

Abstract 322: Cost Effectiveness Analysis of Peripheral Arterial Disease Screening With the Ankle-Brachial Index Test

2017 ◽  
Vol 37 (suppl_1) ◽  
Author(s):  
Nathan K Itoga ◽  
Hataka Minami ◽  
Meena Chelvakumar ◽  
Keon Pearson ◽  
Matthew W Mell ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Medical Therapy ◽  
Medication Compliance ◽  
Ankle Brachial Index ◽  
Cost Effective ◽  
Arterial Disease ◽  
Index Test ◽  
Life Years ◽  
Peripheral Arterial

Introduction: Screening for asymptomatic PAD (aPAD) with the ankle-brachial index (ABI) test may reduce mortality and disease progression by identifying individuals who may benefit from early initiation of cardiovascular (CV) risk reduction therapies. Methods: Using a Markov model, we evaluated the cost-effectiveness of initiating medical therapy (e.g. statin & ACE-inhibitor) after a positive ABI screen in adults 65-years old. We modeled progression to symptomatic PAD (sPAD) and CV mortality with and without screening evaluating quality adjust life years (QALY). Cost of the ABI test, physician visit, new medication, and surgery for sPAD were calculated. Our baseline model estimated 96% of patients already eligible for medical therapy given the similar risk factor profiles of aPAD and CV disease. Repeated screening was considered given the imperfect screening test, development of disease with age, and opportunity to re-initiate therapy given limited medication compliance. Variables with uncertainty underwent a tornado analysis to determine variables with large effects. Results: Our model found an incremental cost of $367 and incremental QALY of 0.0022 with one-time ABI screening resulting in an incremental cost-effectiveness ratio (ICER) of $169,025/QALY over a 35-year period. Removing the benefits of medication on CV mortality increases the ICER by 51%, and removing the benefits of medication on PAD progression increases the ICER by 16%. A tornado diagram shows variables affecting the ICER (Figure). Screening high-risk populations, such as tobacco users where the prevalence of PAD may be 2.5x higher than the general population of 9%, decreases the ICER to $63,500/QALY. Conclusions: Our cost-effective analysis predicts that one-time ABI screening does not meet generally accepted thresholds for cost effectiveness. Disease prevalence and medication adherence had the largest effects on the ICER and are important to consider in implementing ABI screening.

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