Cost Effectiveness Of Renal Denervation Therapy For The Treatment Of Resistant Hypertension In The Netherlands

Abstract

Objectives: The objective of the present study was to assess efficiency of rehabilitation programs for patients after traumatic brain injury and acute cerebrovascular accident (stroke) in Russia. MethOds: Short-term clinical and social outcomes (health status and disability rates) of rehabilitation were analyzed in the database of the Moscow Center of Speech Pathology and Neurological Rehabilitation. Changes in the officially registered disability rates and clinical outcomes were assessed for 3 different strategies of rehabilitation: hospital, day care and home care. The decision tree model was constructed to simulate disability rates, direct and indirect costs of rehabilitation vs "no rehabilitation" scenario under conditions when officially registered disability corresponds to real health and functional status of patients. TreeAge Pro 2009 and Microsoft Excel 2010 software were used for modeling. Results: Use of officially registered disability as an endpoint does not reflect the actual effectiveness of rehabilitation programs. 90% of patients are able to live without assistance after discharge but still are registered as 1 st degree disabled (most severe degree of disability in Russia) in order to receive social benefits. According to preliminary results of modeling total cost of rehabilitation may be less than cost of "no rehabilitation" scenario if disability correlates with actual health and functional status of individuals, for example annual total cost is € 25,923 for home care rehabilitation and € 28,124 for "no rehabilitation" scenario. cOnclusiOns: It's necessary to improve approaches to official disability registration in Russia in order to make rehabilitation programs efficient.Objectives: We aimed at estimating and comparing the total management costs of patients admitted to the emergency department (ED) with recent (< 48 hours) atrial fibrillation (AF) between three types of cardioversion: direct current cardioversion (DCC), intravenous amiodarone or intravenous vernakalant. MethOds: A decision analytic model was developed to mimic the pathways of patients admitted via the ED with recent AF and to calculate an average AF management cost per strategy. The cardioversion success rates were based on published observational studies (DCC 90%, amiodarone 68%, vernakalant 70%). In case of successful conversion the patient was released directly from the ED to home (DCC 50%, amiodarone 25%, vernakalant 100%) or admitted to the hospital for a median of 1 day (DCC) or 2 days (amiodarone) reflecting cardioversion-specific times to sinus rhythm. After a failed pharmacological cardioversion, patients were assumed to receive a DCC; failed DCC was followed by intravenous amiodarone. The associated inpatient costs were retrieved from the IMS Hospital Disease Database (HDD2011). ED treatments were costed using the national health care payer tariffs. Univariate and probabilistic sensitivity analyses were performed. Results: The total AF management costs from ED to discharge were estimated at € 952 (DCC), € 1,894 (amio...