Cost-Effectiveness Analysis of Cardiovascular Disease Treatment in Japan

Kodera, Satoshi; Kiyosue, Arihiro; Ando, Jiro; Akazawa, Hiroshi; Morita, Hiroyuki; Watanabe, Masafumi; Komuro, Issei

doi:10.1536/ihj.17-365

Cited by 26 publications

(24 citation statements)

References 46 publications

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“…Therefore, further study should be conducted from other perspectives like cost-effectiveness. 19) Limitations: There are several limitations to this study. First, this was a retrospective study with a small population in a single institution.…”

Section: Discussionmentioning

confidence: 98%

Short-Term and Long-Term Efficacy of Drug-Coated Balloon for In-Stent Restenosis in Hemodialysis Patients with Coronary Artery Disease

et al. 2019

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The efficacy of drug-coated balloons (DCB) for in-stent restenosis (ISR) in hemodialysis (HD) patients remains unclear.We retrospectively evaluated 153 consecutive patients who underwent DCB for ISR with follow-ups for up to 3 years after the procedure between February 2014 and June 2017. Patients were divided into an HD group (n = 39) and a non-HD group (n = 114). The primary endpoint was target lesion revascularization (TLR). The secondary endpoints were all revascularizations and major adverse cardiac events (MACE) defined as cardiac death, myocardial infarction and cerebral infarction. Kaplan-Meier curves of survival free from TLR were compared between the two groups. We also performed propensity score matching and then compared the two matched groups (n = 27 in each group). The acute procedure success rate was similar for the two groups (100% versus 99.1%, P = 0.56). The incidence of TLR was higher in the HD group than in the non-HD group (41.0% versus 9.6%, P < 0.0001). The rate of revascularizations and MACE combined was significantly higher in the HD group than in the non-HD group (64.1% versus 17.5%, P < 0.0001). Kaplan-Meier analyses showed that survival free from TLR was significantly lower in the HD group than in the non-HD group both before and after propensity score matching (P < 0.0001 and P = 0.005, respectively; log-rank test).Contrary to the similar acute procedure success, recurrent ISR and MACE occurred more frequently in HD patients than in non-HD patients after DCB, which indicates poorer long-term efficacy of DCB in HD patients.

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Section: Discussionmentioning

confidence: 98%

Short-Term and Long-Term Efficacy of Drug-Coated Balloon for In-Stent Restenosis in Hemodialysis Patients with Coronary Artery Disease

et al. 2019

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“…Furthermore, whether the strategies improve cost effectiveness, such as angiotensin converting enzyme inhibitors, angiotensin receptor blockers, and beta blockers for heart failure, should be analyzed. 24) In this study, the parameters of endothelial function (FMD and RHI) were comparable between patients treated with angioplasty and those with surgery. Those values were not affected by the number of times of interventions.…”

Section: Discussionmentioning

confidence: 54%

Endothelial Dysfunction of Conduit Arteries in Patients with Repaired Coarctation of the Aorta

et al. 2018

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Adult patients with repaired coarctation of the aorta (r-CoA) show high prevalence of late hypertension, but the exact mechanisms of this phenomenon are unknown. Endothelial dysfunction has been implicated in this paradoxical hypertension. We evaluated the endothelial function of both conduit and resistance arteries by using flow-mediated dilation (FMD) and digital peripheral artery tonometry (PAT). Seventeen patients with r-CoA and one patient with repaired interrupted aortic arch (r-CoA group) aged 22.0 ± 6.9 years (5 females) underwent FMD of the right brachial artery, PAT of the right finger, blood marker tests, ambulatory blood pressure monitoring, echocardiography, carotid ultrasonography, and brachio-ankle pulse wave velocity measurement. The median age at aortic arch reconstruction was 2.0 months (interquartile range: 15 days to 7.0 years). Results were compared with 17 age-matched healthy subjects (control group). Eight (44%) patients of the r-CoA group were hypertensive (5 received antihypertensive drugs). Patients in the r-CoA group showed significantly lower FMD (3.8 ± 1.5 versus 6.6 ± 2.5%, P < 0.001), larger intimamedia thickness (0.63 ± 0.17 versus 0.47 ± 0.09 mm, P = 0.001), and higher left ventricular mass index (91.4 ± 24.6 versus 73.4 ± 17.3 g/m 2 , P = 0.017) than those in the control group. There were no significant differences in PAT (refractory hyperemia index, 1.86 ± 0.43 versus 1.99 ± 0.59, P = 0.48) and brachio-ankle pulse wave velocity between the two groups. Vascular dysfunction in r-CoA patients, particularly endothelial dysfunction, tends to occur more significantly in conduit arteries than in resistance arteries.

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“…Cilostazol is a PDE3-inhibiting agent and is effective for peripheral arterial diseases 8) and the secondary prevention of cerebral infarction. [9][10][11] Because it increases the HR via upregulating cyclic adenosine monophosphate in the myocardium and sinus node, 12) it is also known to be ef-fective against sinus bradyarrhythmia. 13) In our case, we used cilostazol to treat symptomatic bradycardia and showed its positive chronotropic effect in a transplanted heart.…”

Section: Discussionmentioning

confidence: 99%

Cilostazol Is Useful for the Treatment of Sinus Bradycardia and Associated Hemodynamic Deterioration Following Heart Transplantation

et al. 2019

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Bradycardia is a common complication at the early postoperative period after heart transplantation (HT). The heart rate (HR) usually recovers within a few weeks; however, several patients need a temporary pacemaker or chronotropic agents to stabilize their hemodynamics. Here, we report the first case of transient bradycardia associated with hemodynamic deterioration following HT, which was successfully treated with cilostazol, a phosphodiesterase-3-inhibiting agent. A 59-year-old man received HT for advanced heart failure due to ischemic cardiomyopathy. General fatigue persisted even after the HT. His HR was around 60 beats per minute (bpm) with sinus rhythm. Echocardiography showed no abnormal findings. Right heart catheterization showed that the cardiac index (CI) was 1.9 L/minute/m 2. Continuous intravenous infusion of isoproterenol (0.003 μg/kg/minute) increased the HR to 80 bpm and CI to 2.7 L/minute/m 2 and improved his symptoms. Isoproterenol was switched to oral administration of cilostazol (100 mg, twice a day), which maintained the HR at around 80 bpm and CI of 2.5 L/minute/m 2. The patient's HR gradually recovered and cilostazol could be discontinued three months after the HT. Oral administration of cilostazol can be a therapeutic option for patients with sinus bradycardia following HT, who need positive chronotropic support.

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Cost-Effectiveness Analysis of Cardiovascular Disease Treatment in Japan

Cited by 26 publications

References 46 publications

Short-Term and Long-Term Efficacy of Drug-Coated Balloon for In-Stent Restenosis in Hemodialysis Patients with Coronary Artery Disease

Short-Term and Long-Term Efficacy of Drug-Coated Balloon for In-Stent Restenosis in Hemodialysis Patients with Coronary Artery Disease

Endothelial Dysfunction of Conduit Arteries in Patients with Repaired Coarctation of the Aorta

Cilostazol Is Useful for the Treatment of Sinus Bradycardia and Associated Hemodynamic Deterioration Following Heart Transplantation

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