BackgroundThe prevalence of atrial fibrillation is increasing rapidly; however, to date, population-based data are lacking on the attributable cost of illness of atrial fibrillation from a societal perspective, including both direct and indirect costs.MethodsThe study was an incidence-based cost-of-illness study based on national registries covering the entire population of Denmark. We identified all patients with a first-time hospital diagnosis of atrial fibrillation between 2001 and 2012. For every atrial fibrillation patient, we identified three age- and sex-matched controls from the general population. Both the total and the attributable costs of atrial fibrillation were estimated based on individual level information on hospital care (in- and out-patient contacts), primary sector care, use of prescription drugs and productivity loss.ResultsAverage 3-year societal costs per patient attributable to atrial fibrillation were estimated to be €20,403–26,544 during the study period. The costs were highest during the first year after diagnosis of atrial fibrillation. Admission costs constituted the largest cost component, whereas primary sector costs and medicine costs only constituted minor components. The attributable costs were more than two-fold higher among patients experiencing a stroke. The total 3-year cost attributable to atrial fibrillation in Denmark was estimated to be €219–295 million.ConclusionsThe societal costs attributable to atrial fibrillation are significant. Reducing the need for hospitalizations, in particular from stroke, is a key factor in controlling the costs.

The results of the economic model consistently showed that, over a 5-year period, rivaroxaban is a cost-effective alternative to 14 days of LMWH for VTE prophylaxis in Sweden.

Introduction Testosterone replacement therapy (TRT) has been recommended for the treatment of primary and secondary hypogonadism. However, long-term implications of TRT have not been investigated extensively. Aim The aim of this analysis was to evaluate health outcomes and costs associated with life-long TRT in patients suffering from Klinefelter syndrome and late-onset hypogonadism (LOH). Methods A Markov model was developed to assess cost-effectiveness of testosterone undecanoate (TU) depot injection treatment compared with no treatment. Health outcomes and associated costs were modeled in monthly cycles per patient individually along a lifetime horizon. Modeled health outcomes included development of type 2 diabetes, depression, cardiovascular and cerebrovascular complications, and fractures. Analysis was performed for the Swedish health-care setting from health-care payer's and societal perspective. One-way sensitivity analyses evaluated the robustness of results. Main Outcome Measures The main outcome measures were quality-adjusted life-years (QALYs) and total cost in TU depot injection treatment and no treatment cohorts. In addition, outcomes were also expressed as incremental cost per QALY gained for TU depot injection therapy compared with no treatment (incremental cost-effectiveness ratio [ICER]). Results TU depot injection compared to no-treatment yielded a gain of 1.67 QALYs at an incremental cost of 28,176 EUR (37,192 USD) in the Klinefelter population. The ICER was 16,884 EUR (22,287 USD) per QALY gained. Outcomes in LOH population estimated benefits of TRT at 19,719 EUR (26,029 USD) per QALY gained. Results showed to be considerably robust when tested in sensitivity analyses. Variation of relative risk to develop type 2 diabetes had the highest impact on long-term outcomes in both patient groups. Conclusion This analysis suggests that lifelong TU depot injection therapy of patients with hypogonadism is a cost-effective treatment in Sweden. Hence, it can support clinicians in decision making when considering appropriate treatment strategies for patients with testosterone deficiency.

BackgroundWorldwide, coronary heart disease accounts for 7 million deaths each year. In Sweden, acute coronary syndrome (ACS) is a leading cause of hospitalization and is responsible for 1 in 4 deaths.ObjectiveThe aim of this analysis was to assess the cost-effectiveness of rivaroxaban 2.5 mg twice daily (BID) in combination with standard antiplatelet therapy (ST-APT) versus ST-APT alone, for the secondary prevention of ACS in adult patients with elevated cardiac biomarkers without a prior history of stroke/transient ischemic attack (TIA), from a Swedish societal perspective, based on clinical data from the global ATLAS ACS 2-TIMI 51 trial, literature-based quality of life data and costs sourced from Swedish national databases.MethodsA Markov model was developed to capture rates of single and multiple myocardial infarction (MI), ischemic and hemorrhagic stroke, thrombolysis in myocardial infarction (TIMI) major, minor, and “requiring medical attention” bleeds, revascularization events, and associated costs and utilities in patients who were stabilized after an initial ACS event. Efficacy and safety data for the first 2 years came from the ATLAS ACS 2-TIMI 51 trial. Long-term probabilities were extrapolated using safety and effectiveness of acetylsalicylic acid data, which was estimated from published literature, assuming constant rates in time. Future cost and effects were discounted at 3.0%. Univariate and probabilistic sensitivity analyses were conducted.ResultsIn the base case, the use of rivaroxaban 2.5 mg BID was associated with improvements in survival and quality-adjusted life years (QALYs), yielding an incremental cost per QALY of 71,246 Swedish Krona (SEK) (€8045). The outcomes were robust to changes in inputs. The probabilistic sensitivity analysis demonstrated rivaroxaban 2.5 mg BID to be cost-effective in >99.9% of cases, assuming a willingness-to-pay threshold of SEK 500,000 (€56,458).ConclusionCompared with ST-APT alone, the use of rivaroxaban 2.5 mg BID in combination with ST-APT can be considered a cost-effective treatment option for ACS patients with elevated cardiac biomarkers without a prior history of stroke/TIA in Sweden.FundingBayer Pharma AG.Electronic supplementary materialThe online version of this article (doi:10.1007/s40119-015-0041-3) contains supplementary material, which is available to authorized users.

To assess clinical efficacy and cost-effectiveness of human recombinant interferon-␣2b in neonates with intrauterine infections in neonatal intensive care unit (NICU). METHODS: We observed 151 neonates (gestational age (GA) 25-40 weeks) with severe intrauterine infections in NICU. Group 1 included 94 neonates with severe intrauterine infections treated with interferon-␣2b, 150 000 IU per suppositorium twice a day per rectum during 7 days in addition to combined antibacterial and supportive therapy; group 2 consisted of 57 neonates under standard treatment without additional immunotherapy. Initially neonates of both groups were comparable. Effectiveness data were used to populate a decision model to estimate the cost-effectiveness of interferon-␣2b and standard therapy. Direct and indirect costs were measured. Published cost data were applied to assess differences in treatment costs. RESULTS: Low mitogen-induced interferon-␣ production (Ͻ12 pg/ml) was detected in 25% [18%; 33%] of neonates with severe intrauterine infections, its association with significantly higher incidence of pneumonia (Ͻ0.001), necrotizing enterocolitis (Ͻ0.001) and urinary tract infections (ϭ0.026) was proved. Administration of human recombinant interferon-␣2b to neonates, suffering from severe infections, provides improvement of mitogen-induced production of interferon-␣, reduces hospital length of stay and mortality rates (ϭ0.009, OR ϭ 0.21 [0.05; 0.67], RR ϭ 0.26 [0.07; 0.69], NNTϭ8 [4; 29]). Interferon-␣2b administration for severe early-onset neonatal infections decreases direct costs per patient by 20% (direct costs per patient € 6,802 and € 8,549 for interferon-␣2b and control groups, respectively). Interferon-␣2b administration for intrauterine infections leads to substantial cost savings (up to € 69,247 per patient). CONCLUSIONS: Immunotherapy with interferon-␣2b is a cost-effective intervention improves the clinical course and outcome in case of severe intrauterine infections.