Purpose: Evaluation of the cost and effectiveness of therapy for patients with the wet form of age-related macular degeneration (AMD) in routine clinical practice. Methods: A retrospective multicentre evaluation of changes in the best-corrected visual acuity in applied kinds of therapy and a comparison with the cost of individual therapeutic procedures. Results: An overall total of 788 eyes of 763 patients with an average age of 73.2 ± 8.6 years was evaluated for a 1-year minimum period. In the ranibizumab and pegaptanib therapy groups, a reduction of 1.3 letters (p = 0.303) and 1.4 letters (p = 0.197) was found, respectively. In the group of photodynamic therapy (PDT) with verteporfin, a reduction of 5.2 letters was achieved (p < 0.001). Under the conditions of routine practice in the Czech Republic, the annual cost is highest (EUR 5,467.63/patient) in patients with pegaptanib therapy. The annual cost in patients with ranibizumab therapy is lower by EUR 1,220.16. The cost is nearly half (EUR 2,783.65) in the group treated with PDT with verteporfin. Conclusion: An initiation of AMD therapy by ranibizumab is cost-effective as compared to pegaptanib. Both ranibizumab and pegaptanib are significantly more efficient as compared to PDT with verteporfin. Therapy with ranibizumab and pegaptanib, as compared to PDT with verteporfin, prevents the loss of 1 line of vision on the ETDRS chart for EUR 1,225.98 and 2,286.18, respectively.
Východiska: Bevacizumab je rekombinantní chimérická monoklonální protilátka, která se selektivně váže na vaskulární endoteliální růstový faktor. Kombinace bevacizumabu s chemoterapií je hrazena v České republice u pacientů s metastazujícím kolorektálním karcinomem (metastatic colorectal cancer-mCRC) v 1. a vyšších liniích léčby. Pokusili jsme se proto s využitím dat z komplexního onkologického centra náklady na podání bevacizumabu v 1. linii stanovit. Soubor pacientů a metody: Celkem bylo v naší analýze hodnoceno 218 pacientů. Finanční náklady na výkony, medikaci a hospitalizaci byly kalkulovány od zahájení léčby bevacizumabem do doby hodnocení odpovědi nádoru na léčbu při využití RECIST kritérií (complete response-CR, partial response-PR, stable disease-SD, progressive disease-PD) a/ nebo do úmrtí. Všichni pacienti byli sledováni minimálně po dobu 28 měsíců nebo do úmrtí. Výsledky: Progrese byla zaznamenána u 194 pacientů (89 % souboru). Průměrné náklady v období do progrese onemocnění (PD; medián doby do progrese 9,1 měsíce) byly 1 002 076,30 Kč, přičemž největší podíl byl vynaložen na medikaci-průměrně 917 048,60 Kč na jednoho pacienta. Medián do dosažení protinádorové odpovědi (
Background: To assess the distribution of costs associated with Cardiology Unit hospitalization due to acute heart failure (AHF) and evaluate, from the perspective of the healthcare payer, the heterogeneity of resources use according to AHF etiology in patients from 2005 to 2009. Methods: The type and etiology of AHF was determined upon hospital admission. The cost of in-patient care was based on the individual hospital account of each patient (1759 patients in total; 58.7% male; mean age 71 years). Results: The median hospital stay was 7 days and the mean total cost of in-patient care was €3364. A Coronary Care Unit (CCU) stay was recorded in 67.4% patients (median 3 days). Signifi cantly higher costs were found in de-novo AHF patients (mean €3678) with a greater need for CCU care, a longer stay in the CCU and a greater need for intervention (particularly that of percutaneous coronary intervention [PCI]), than in patients with acute decompensation of chronic heart failure (mean cost €2878; p < 0.001). Acute coronary syndrome was a major precipitating factor, with the highest costs (€4429) resulting from having received PCI (63.3% of patients) and CCU admission (91.7% of patients). Variations in length of stay according to AHF etiology were minor (median, 6-8 days). In-hospital mortality was 15.0%. Conclusions: Hospitalization costs as they relate to AHF are high, particularly in new-onset AHF patients. The heterogeneity of resources use is largely a refl ection of interventions undertaken, particularly if revascularization or anti-arrhythmic therapy is provided.
SOUHRNCíl: Stanovení nákladů na hospitalizaci pacientů s akutním srdečním selháním (ASS) hospitalizovaných v letech 2005-2009 na kardiologické klinice z pohledu plátce zdravotní péče a následné zhodnocení heterogenity výdajů dle etiologie ASS. Metodologie: Typ ASS a jeho etiologie byla určena při přijetí pacienta na kliniku. Náklady na péči vycházejí z individuálního hospitalizačního účtu každého pacienta (celkem 1 759 pacientů; 58,7 % mužů; průměrný věk 71 let).
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