Productivity loss as a major component of disease-related costs in patients with hypercholesterolemia in Germany

Müller‐Nordhorn, Jacqueline; Englert, Heike; Wegscheider, Karl; Berger, Hendrike; Sonntag, Frank; Völler, Heinz; Meyer‐Sabellek, W.; Reinhold, Thomas; Windler, E; Katus, Hugo A.; Willich, Stefan N.

doi:10.1007/s00392-007-0602-0

Cited by 16 publications

(10 citation statements)

References 24 publications

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“…for cardiovascular events associated with suboptimal blood pressure control [17]). As economic modelling should consider all possible incurred costs and should ideally be conducted from the societal perspective [118], indirect costs should also be considered, including those associated with lost productivity [119] and informal care [115].…”

Section: Impact On Resource Use and Costsmentioning

confidence: 99%

Effectiveness, safety and cost of drug substitution in hypertension

Johnston¹,

Stafylas

Stergiou

2010

Brit J Clinical Pharma

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Cost-containment measures in healthcare provision include the implementation of therapeutic and generic drug substitution strategies in patients whose condition is already well controlled with pharmacotherapy. Treatment for hypertension is frequently targeted for such measures. However, drug acquisition costs are only part of the cost-effectiveness equation, and a variety of other factors need to be taken into account when assessing the impact of switching antihypertensives. From the clinical perspective, considerations include maintenance of an appropriate medication dose during the switching process; drug equivalence in terms of clinical effectiveness; and safety issues, including the diverse adverse-event profiles of available alternative drugs, differences in the ‘inactive’ components of drug formulations and the quality of generic formulations. Patients' adherence to and persistence with therapy may be negatively influenced by switching, which will also impact on treatment effectiveness. From the economic perspective, the costs that are likely to be incurred by switching antihypertensives include those for additional clinic visits and laboratory tests, and for hospitalization if required to address problems arising from adverse events or poorly controlled hypertension. Indirect costs and the impact on patients' quality of life also require assessment. Substitution strategies for antihypertensives have not been tested in large outcome trials and there is little available clinical or economic evidence on which to base decisions to switch drugs. Although the cost of treatment should always be considered, careful assessment of the human and economic costs and benefits of antihypertensive drug substitution is required before this practice is recommended.

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Section: Impact On Resource Use and Costsmentioning

confidence: 99%

Effectiveness, safety and cost of drug substitution in hypertension

Johnston¹,

Stafylas

Stergiou

2010

Brit J Clinical Pharma

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“…The central role of dyslipidemia as a major contributor to CVD risk was highlighted by the global case–control INTERHEART study, in which the condition was responsible for 54% of population-attributable risk for myocardial infarction [8]. Further, dyslipidemia is associated with substantial costs for the health care system, for example due to productivity loss [9]. …”

Section: Introductionmentioning

confidence: 99%

Prevalence and overlap of different lipid abnormalities in statin-treated patients at high cardiovascular risk in clinical practice in Germany

et al. 2010

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BackgroundIn line with current guideline recommendations, patients at high cardiovascular risk are usually treated with statins for secondary as well as for primary prevention. While many studies investigated treatment goal achievement with regards to low-density lipoprotein (LDL-C) and total cholesterol (TC) there is paucity of data regarding high density lipoprotein (HDL-C), and/or triglycerides (TG).SettingProspective, cross-sectional study (Dyslipidemia International Survey, DYSIS) with data provided by 748 office-based physicians throughout Germany.MethodsConsecutive patients were eligible for participation, if they were at least 45 years old, currently treated with a statin and had had a documented lipid profile (at least 1 parameter) within the last 6 months. Besides descriptive analyses, logistic regression was performed with backward selection to assess predictors for lipid abnormalities (non-attainment of goals for TC, LDL-C, low HDL-C or elevated TG) classified according to current European Society of Cardiology guidelines.ResultsThe 4,282 documented patients (98.6% Caucasian, 56.4% male; 86.6% at high cardiovascular risk) were predominantly treated with simvastatin (83.9%), pravastatin (7.7%) or atorvastatin (3.9%), usually with doses equivalent to simvastatin 20–40 mg daily. Non-statins were used in at most 12% of patients. No lipid abnormalities were found in 21.0% of patients, one abnormality in 38.5%, two in 31.9%, and all three in 8.5%. LDL-C goals were not attained in 58.1%, elevated TC was found in 66.6%, low HDL-C in 22.7%, and elevated TG in 47.3%. In the multivariate logistic regression model, non-attainment of LDL-C levels was predicted by hypertension (odds ratio, OR 1.4), current smoking (OR 1.3), sedentary lifestyle (OR 1.3), and female gender (OR 1.3). On the other hand, a reduced risk for missing LDL-C targets was noted in the presence of ischemic heart disease (OR 0.6), diabetes (0.5), higher statin doses, ezetimibe treatment, or specialist care, respectively.ConclusionA substantial proportion of statin-treated patients not only missed targets for LDL-C, but also did not attain the normal levels for HDL-C and/or TG. There is a large disconnect between high prevalence of HDL and/or TG disorders, with or without elevated LDL-C, and utilization of therapies targeting these lipids. Particularly in high-risk patients, additional efforts should be made to improve their lipid profile.

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“…They were deemed to fail in meeting the screening criteria on the nature, novelty and/or perspective of the cost analysis, for one of the following reasons: the cost estimates relied on previously published works (seven articles), the full text did not provide sufficient information to identify the perspective of the economic analysis and/or on the resource‐use data sources (three articles) and only aggregated pharmaceutical expenses for a given disease or condition were estimated (two articles). The screening process identified 47 articles that fully met the inclusion/exclusion criteria and were subjected to additional analyses [4–50] Table 1. lists the information on the type of health economic analysis, its perspective, time horizon, cost categories assessed and sources of resource‐use data of the articles selected.…”

Section: Resultsmentioning

confidence: 99%

Cost estimation in health economic evaluations in Germany: a systematic review

Merito¹,

Breitscheidel²

2010

Journal of Pharmaceutical Health Services Research

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Objectives The objectives of this study are (1) to systematically review the methods used in developing cost estimates in the recent German health economic literature and (2) to examine the methodological approaches in terms of analytical framework, cost components, resource‐use and cost data sources in light of the national Institute for Quality and Efficiency in Healthcare guidelines. Methods The MEDLINE database was searched for studies published between 1 January 2006 and 31 December 2008 estimating direct and/or indirect costs of healthcare interventions in Germany. Detailed information on the perspective of the analysis, time horizon for the cost estimation, resource‐use categories analysed, costing approach, valuation of resource use, resource‐use and unit cost/price data sources were systematically collected. Key findings The literature search returned citations to 122 articles, of which 47 fully met the inclusion/exclusion criteria. Nearly half of the selected articles (23) adopted the societal perspective. In nearly three‐quarters of the studies (35) the time horizon of the base case analysis was no longer than 1 year. Among the most common unit cost sources of healthcare services were reimbursement fees for outpatient and hospital services. Conclusions The variability in the studies reviewed was very high, making any categorisation and synthesis difficult. Nevertheless, some common features clearly emerged. Firstly, most cost estimates focus on direct medical costs only. Secondly, a comprehensive list or at least an exhaustive discussion of the relevant resource use is usually missing. Finally, the time horizon is often too short to capture all relevant cost drivers and the assessment of the medical resource use not always consistent with the perspective of the analysis.

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Productivity loss as a major component of disease-related costs in patients with hypercholesterolemia in Germany

Abstract: The considerable economic burden associated with hypercholesterolemia indicates the need to assess long-term cost-effectiveness of health care programs in patients with this disorder.

Cited by 16 publications

References 24 publications

Effectiveness, safety and cost of drug substitution in hypertension

Effectiveness, safety and cost of drug substitution in hypertension

Prevalence and overlap of different lipid abnormalities in statin-treated patients at high cardiovascular risk in clinical practice in Germany

Cost estimation in health economic evaluations in Germany: a systematic review

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