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T D Szucs

Publications and source records attributed to T D Szucs.

At least 19 recordsLinked to original sources
PubMed2006

Pharmacoeconomics of anticoagulation therapy for stroke prevention in atrial fibrillation: a review.

INTRODUCTION: Atrial fibrillation (AF) increases the risk of ischemic stroke 5-fold and may not only be responsible for as many as 15% of all strokes that occur but also for larger and more disabling strokes than those attributable to other causes which increase the associated costs of care. Anticoagulation with warfarin in the target INR of 2.5 is a major clinical challenge in real-life practice, given that the complex relationship between warfarin dosage and response is readily altered by a variety of factors such as concurrent medications, illnesses, genetic influences, and dietary/lifestyle changes. Consequently, INR values are out of the target range approximately half of the time in real-life studies compared to clinical trial setting. Current anticoagulation therapies are less likely to be cost-effective in routine clinical practice and need improvement. The aim of this review is to discuss the pharmacoeconomic consequences of this management strategy by analysing the optimal treatment option within specific age and risk groups, confirming current guidelines for a health economic perspective and considering the economic impact on health care policy. METHODS: An electronic search of the Medline/PubMed database from 1966 to 2005 was performed to identify articles dealing with all pharmacoeconomic aspects of stroke prevention in atrial fibrillation. The following search terms were used: 'atrial fibrillation', 'stroke', 'cost', 'warfarin'. RESULTS: Treatment with warfarin is cost-effective (versus aspirin or no therapy) in patients with AF at moderate-to-high risk of stroke. The cost-effectiveness of anticoagulation therapy is driven by the achieved risk reduction rather than the potential benefits estimated from clinical trials. Failure to maintain optimal anticoagulation places patients at risk of complications, the management of which is a significant cost driver. CONCLUSION: Improvement could be achieved by optimising physicians and patient's knowledge driven through prevention campaigns by health care policy.

Anticoagulants↗
PubMed2005

[Coverage rates of influenza vaccination in France: a population-based cross-sectional analysis of seasons 2001-2002 and 2002-2003].

INTRODUCTION: Influenza is a serious health problem in Europe. Vaccination is the only preventive measure, reducing mortality and morbidity of influenza in all age groups. OBJECTIVES: The authors had for aim to assess influenza vaccination coverage during two seasons in France, to understand the incentives and barriers to vaccination and to determine vaccination intentions for the following winter. METHODS: A random-sampling, mail-based household survey was made among non-institutionalised individuals aged 15 and over. The surveys for 2001-2002 and 2002-2003 used the same questionnaire and were subsequently pooled. Three target groups were determined for analysis: (1) persons aged 65 and over; (2) people working in the medical field and (3) persons aged 65 and over or working in the medical field. RESULTS: Influenza vaccination coverage in France decreased from 23.0% in 2001-2002 to 22.4% in 2002-2003. Most frequent reasons for being vaccinated were advice from the family doctor (50.8%), influenza considered as a serious illness (45.3%) and free vaccine (44.1%). Reasons for not being vaccinated mentioned by people who had never been vaccinated were young age (27.0%), not considering vaccination (18.9%), and not expecting to catch influenza (13.9%). CONCLUSION: Vaccination coverage decreased during the 2002-2003 season in comparison to the 2001-2002 season. The family doctor is the most important source of encouragement for people to be vaccinated against influenza. We therefore suggest that family doctors be better informed on influenza vaccine and the disease itself, so that they can actively inform their patients on these topics.

Adolescent↗
PubMed2005

[On the prognosis of hip fractures. Assessment of mortality after hip fractures by analyzing overlapping segments of longitudinal data].

BACKGROUND: Data on the treatment of hip fractures in acute care settings have been collected in a report card system for quality assurance in Germany since the beginning of the 1990s. However, there are no data on the long-term outcome and long-term quality of care. MATERIAL AND METHOD: In a retrospective study, data on 1393 patients from 1999 were collected from different sources: from the department of quality assurance at the medical association of Westfalia-Lippe, the Statutory Health Insurance Funds (AOK), and the Medical Review Board of the Statutory Health Insurance Funds (Medizinischer Dienst der Krankenkasse, MDK). Statistical analyses were performed by the Center for Clinical Studies of the University of Düsseldorf. RESULTS: Uni- and multivariate analyses reveal the following prognostic parameters for survival after hip fracture: sex, age, nursing care dependency, living in a nursing home, risk stratification according to ASA, and postoperative complications. Timing of the operation had no affect on survival. CONCLUSIONS: Prognostic factors for the outcome after hip fracture can only be obtained by analyzing data from the hospital stay and the post-hospital setting as well. Chances of survival can be significantly improved by rehabilitative care.

Age Distribution↗
PubMed2004

Comparison of resource utilization and long-term quality-of-life outcomes between laparoscopic and conventional colorectal surgery.

BACKGROUND: The outcomes of laparosopic and conventional colorectal surgery, with special reference to costs of treatment and patients' quality of life, were compared. METHODS: A partly retrospective cohort study was designed to assess the use of resources, and a follow-up interview was undertaken to evaluate patients' quality of life after both to define laparoscopic (LAP) and conventional (CON) surgery. RESULTS: The length of hospital stay was significantly lower in the LAP group (median, 11 days; interquartile range [IQR], 9-15) than in the CON group (median, 16 days; IQR, 13-23; p < 0.0001), which is reflected in lower costs of hospitalization calculated for the three most frequent surgical interventions. Statistically significant improvements were noted between the median scores in the domains of physical functioning (LAP 85 vs CON 68; p < 0.05) and vitality (LAP 85 vs CON 69; p < 0.05). CONCLUSION: Laparoscopy is a promising alternative for the treatment of patients with colorectal diseases, offering lower costs and a better quality of life in the long term.

Aged↗
PubMed2004

[Cost-effectiveness of atorvastatin for the prevention of coronary disease. An analysis of the ASCOT study].

BACKGROUND: Increasing health service expenditure, on the one hand, and the politically declared objective of stability of statutory contributions and restriction of public funds, on the other hand, have been central points in the political and social discussion for several years. PATIENTS AND METHODS: Cost-effectiveness of Atorvastatin in primary prevention was analysed by applying the results of the Anglo Scandinavian Cardiac Outcomes Trial (ASCOT study) to the German health system. Costs and effectiveness were subject to an extensive sensitivity analysis. RESULTS: The cost-effectiveness of Atorvastatin treatment in Germany is approximately 10,102 Euro (95% CI: 9109; 12,881) per life-year gained. Taking 2004 price reductions into consideration, these values are reduced to 7311 Euro [95% CI: 5197; 10,091) per life-year gained. The robustness of this result was substantiated through extensive sensitivity analyses. CONCLUSION: The administration of the lipid lowering compound Atorvastatin in hypertensive patients with additional coronary heart disease risk factors in Germany is cost-effective.

Adult↗
PubMed2003

[Costs and cost-effectiveness of Eptifibatide in the treatment of coronary ischemic syndromes. An analysis based on the PURSUIT study].

AIMS: We analyzed whether using Eptifibatide plus heparin compared to heparin alone in patients with acute coronary ischemic syndromes is cost saving and/or cost-effective from the perspective of German hospitals. Our analysis is based on the clinical results of the PURSUIT study. MATERIALS AND METHODS: We conducted an incremental cost-consequence and cost-effectiveness analysis from the perspective of the admitting hospital. Costs refer to the initial hospitalization following the event. Incremental drug costs are based on a 72 hour infusion of Eptifibatide. Additional costs are analyzed as resulting from the management of complicating myocardial infarctions, including incremental days on the general ward or intensive care unit as well as necessary revascularization procedures. All costs are expressed in EURO (EUR). The estimated costs of managing ischemic complications are based on typical patterns seen in German hospitals. Our estimation of the life-years saved by using Eptifibatide is based on the DEALE method. All calculations are standardized to a hypothetical cohort of 100 treated patients. RESULTS: There are 0.064 saved life-years per patient. Cost-effectiveness of Eptifibatide is EUR 14,464 per life-year saved. CONCLUSION: Eptifibatide is cost-effective compared to other therapies in the treatment of acute coronary ischemic syndromes. The additional costs of using this substance should be reimbursed to the hospitals.

Angina, Unstable↗
PubMed2003

Prospective survey of antibiotic utilization in pediatric hospitalized patients to identify targets for improvement of prescription.

BACKGROUND: The rise in the use of antibiotics has resulted in increasing health care costs and the emergence of resistant bacteria. Little is known about the general misuse of antibiotics in hospitalized children. We evaluated the utilization of antibiotics in a pediatric teaching hospital aiming to identify targets for improvement of prescription. PATIENTS AND METHODS: Clinical, radiological, laboratory and treatment data of patients hospitalized in a pediatric medical and a pediatric surgery ward were prospectively collected during a 6-week period. A subsequent review of the collected data by a pediatric infectious diseases specialist, taking into consideration existing in-house treatment guidelines, was carried out. RESULTS: A total of 125 (36%) of 349 patients was prescribed 246 antibiotics. The median length of hospital stay for children prescribed antibiotics was 5 days (range, 2-30 days) and for those not prescribed 3 days (1-32 days; p < 0.001). Of 154 patients in the medical ward, 64 (42%) received antibiotics, compared to 61 (31%) of 195 patients in the surgical ward (p < 0.05). Empirical prescriptions were more frequent than prophylactic ones, which were more frequent than therapeutic prescriptions (136 [55%] vs 94 [38%] vs 16 [7%]; p < 0.001). Overall, 85% of the prescriptions were considered justified. The rates of inappropriate prescriptions were similar in the medical and surgical ward, and higher for therapeutic (19%) or prophylactic treatment (18%) than for empirical treatment (12%). Higher inappropriate prescription rates were noted for macrolides than for co-trimoxazole and beta-lactams (50% vs 18% and 15%, respectively; p < 0.05). CONCLUSION: Efforts need to be undertaken towards continuous education of medical staff on judicious antibiotic use, as well as ensuring compliance with existing guidelines. Improvement in the availability of rapid diagnostic methods to discern viral from bacterial infections may help reduce the numbers of empiric therapies in favor of pathogen-targeted therapeutic treatments.

Anti-Bacterial Agents↗
PubMed2002

Determinants of costs and resource utilization associated with open heart surgery.

AIMS: This study sought to determine the patient- and the therapy-related determinants of in-hospital costs for patients undergoing heart surgery at the University Hospital in Zurich. METHODS AND RESULTS: We performed a retrospective analysis of all adult cardiac surgical patients from the canton St. Gallen who were covered by a fixed fee arrangement (29,500 Swiss francs (19,470 Euro)) and referred to our institution during 1998. A total of 201 patients (143 (71%) male) with basic insurance were hospitalized in 1998 under the fixed fee arrangement. The mean age of the patients was 61.4 years (95% confidence intervals (CI): 60; 63). With the help of univariate analysis, the following pre-operative characteristics were found to be significantly associated with cost: age (P<0.001), pre-operative cardiac diagnosis (coronary vs valvular heart disease) (P<0.001) and EuroSCORE (P<0.0001). A significant correlation was also found between intra-operative variables and costs (P<0.0001) as well as between postoperative variables and costs (P<0.0001). A linear regression model based on EuroSCORE, operation time and postoperative infection status is able to predict costs for patients (all P -values <0.0001, except for P<0.05 for operation time, R(2)=0.565). CONCLUSIONS: These results suggest that both pre-operative (patient related) and intra-operative (therapy- and patient-related) variables are predictors of costs in cardiac surgical patients.

Analysis of Variance↗
PubMed2001

The estimated economic burden of genital herpes in the United States. An analysis using two costing approaches.

BACKGROUND: Only limited data exist on the costs of genital herpes (GH) in the USA. We estimated the economic burden of GH in the USA using two different costing approaches. METHODS: The first approach was a cross-sectional survey of a sample of primary and secondary care physicians, analyzing health care resource utilization. The second approach was based on the analysis of a large administrative claims data set. Both approaches were used to generate the number of patients with symptomatic GH seeking medical treatment, the average medical expenditures and estimated national costs. Costs were valued from a societal and a third party payer's perspective in 1996 US dollars. RESULTS: In the cross-sectional study, based on an estimated 3.1 million symptomatic episodes per year in the USA, the annual direct medical costs were estimated at a maximum of $984 million. Of these costs, 49.7% were caused by drug expenditures, 47.7% by outpatient medical care and 2.6% by hospital costs. Indirect costs accounted for further $214 million. The analysis of 1,565 GH cases from the claims database yielded a minimum national estimate of $283 million direct medical costs. CONCLUSIONS: GH appears to be an important public health problem from the health economic point of view. The observed difference in direct medical costs may be explained with the influence of compliance to treatment and possible undersampling of subpopulations in the claims data set. The present study demonstrates the validity of using different approaches in estimating the economic burden of a specific disease to the health care system.

Cost of Illness↗
PubMed2001

[Cost effectiveness of clopidogrel in secondary cardiovascular prevention: a cost-effectiveness analysis based on the Caprie Study].

As a result of medical progress each year numerous new therapies are introduced to the medical community, and each of them must prove its usefulness in two arenas. Firstly, does the new therapy improve outcomes relative to conventional therapy? If this test is passed, the second question is: are the improved outcomes worth the extra costs? Controlled clinical trials answer the first question and economic analysis, the second. The CARPIE-Study has proven, that Clopidogrel, a new antiplatelet drug, was superior in secondary prevention of cardiovascular events to aspirin. On the basis of this study we conducted a cost-effectiveness analysis from the perspective of Swiss third party payers. The following costs were included in the analysis: treatment costs of aspirin and clopidogrel, myocardial infarction, ischaemic stroke and primary non-fatal intracranial haemorrhage. For the calculation of the years of life gained the DEALE-method was applied. The net costs of treating 1000 patients, i.e. incremental drug costs less savings of treatment costs, are Fr. 1.5 Mio. The intervention with Clopidogrel lead to an additional gain of 63 life years in compared to aspirin. At additional yearly cost of Fr. 722.--per patient the analysis yield a cost-effectiveness of CHF 24,164 (nominal) Fr. 22,837 (discounted) per additional year of live saved. The results suggest that the cost-effectiveness of Clopidogrel in secondary prevention lie well within the range of other preventive cardiovascular interventions. Therefore, from an economic perspective the use of Clopidogrel in secondary prevention of major cardiovascular events in patients with atherosclerotic vascular disease is justifiable.

Adult↗
PubMed2001

Medical-economical aspects of high sensitivity C-reactive protein assay for the prediction of coronary heart disease. An analysis in Germany and Italy.

BACKGROUND: Elevated plasma concentrations of C-reactive protein (CRP) are associated with increased cardiovascular risk. We studied the cost-effectiveness of CRP determination in primary and secondary prevention settings in two European countries: Germany and Italy. METHODS: Using a decision analytic model we evaluated the costs and consequences of testing or not testing using a high sensitivity (hs)-CRP assay. In a primary prevention model we analyzed a hypothetical cohort of 300000 apparently healthy men divided into three age groups (35-44, 45-54 and 55-64 years). Individuals with CRP levels > 3 mg/l were administered either aspirin or statins according to lipid levels. The cohort was followed for 5 years. In the secondary prevention model hs-CRP testing was evaluated in a cohort of 10000 patients with total cholesterol levels < 4.52 mmol/l and a history of myocardial infarction or unstable angina. The two strategies tested were: 1) administer pravastatin only to those with high CRP values, and 2) treat all patients. The analysis was performed from the societal perspective. Event rates were obtained from epidemiological studies and clinical trials. RESULTS: In the primary prevention model, strategies including testing showed, for men aged 45 years and older, cost-effectiveness ratios between each life year saved (LYS) and cost savings in Germany equal to 10217euro and between each LYS and savings in Italy equal to 16950euro In the age group 35-44 years, therapy with aspirin showed cost-effectiveness ratios of 5318euro and 11203euro per LYS in Germany and in Italy respectively. The widespread use of statins showed an unfavorable cost-effectiveness profile: 44630euro per LYS in Germany and 36270euro per LYS in Italy. In the secondary prevention model, hs-testing for CRP can reduce the cost-effectiveness of pravastatin from 16400 to 6830euro per quality adjusted life year gained. Sensitivity analysis performed on the variables test price and costs of cardiovascular events resulted in minimal changes of the cost-effectiveness ratios. CONCLUSIONS: Both in the primary and the secondary prevention settings, hs-testing for CRP can better target individuals at higher risk, thus improving outcomes and resulting in a more cost-effective strategy.

Adult↗
PubMed2000

[Cost effectiveness of bisoprolol in treatment of heart failure in Germany. An analysis based on the CIBIS-II study].

OBJECTIVES: Economic analysis of bisoprolol plus standard therapy versus placebo plus standard therapy in the treatment of chronic heart failure in Germany. MATERIALS AND METHODS: Prospective analysis of resource use and costs by way of integration into the international, randomized, double-blind CIBIS (Cardiac Insufficiency Bisoprolol Study)-II clinical trial, which treated 1,327 patients with bisoprolol and 1,320 with placebo. Two hundred and fifteen German patients were included in CIBIS-II (bisoprolol: 112, placebo: 103). The German health economic subpopulation comprised 97 patients (bisoprolol: 52, placebo: 45). The economic base analysis valued the resource use of every single patient of this subpopulation in monetary terms, from the perspective of Germany's third party payer (statutory sick funds). RESULTS: Mean observation time was 1.3 years. During this time hospitalization costs of DM 783.--were saved in the bisoprolol group. Total direct medical costs amounted to DM 7,651.--in the bisoprolol group and DM 8,905.--in the placebo group. This means savings of DM 1,254.--per patient, or a 14.1% cost reduction. If mean data of all German CIBIS-II patients are used as a broader basis, bisoprolol therapy saves DM 1,203.--per patient. Bisoprolol therapy induced a mortality rate reduction from 17% to 12% in the overall clinical CIBIS-II population (n = 2,647). This difference is statistically highly significant (p < 0.0001). Altogether 74 lives could be saved by bisoprolol therapy. Saved life years amounted to 0.03 per patient after 65 weeks of therapy (460 days), and to 0.12 per patient after 130 weeks (30 months). As bisoprolol therapy leads to net savings, a formal cost-effectiveness analysis, which would relate incremental clinical efficiency to additional costs, is not needed. CONCLUSION: The use of bisoprolol in the therapy of chronic heart failure is not only clinically effective, it also saves net costs.

Aged↗
PubMed2000

[Medical economy--a new challenge for physicians].

What is medical economics? It stands on three important columns: (1) economic analysis (2) policy and decision analysis and (3) outcomes research. Economic evaluations consist always of two components: resource utilization and outcomes. Cost-benefit-analysis requires that the outcome is expressed in monetary terms, in cost-effectiveness-analysis outcomes are expressed in non-monetary terms and cost-utility analysis requires QUALY's (quality adjusted life years) as output. Why do we need medical economics? On one hand we wish to allocate the restricted means as fairly as possible. On the other hand, we have new but more expensive methods and preventive measures. Medical economics can contribute to this situation: through a systematic assessment of the efficiency of the different methods. The potential of cost savings and arguments for new and more expensive methods can be developed, if they are advantageous in the context of the prevention of disease progression or sequelae. The aim of the department is to promote research, to develop the basis for decision-makers, to give lectures and seminars, to support other researchers in the area of medical economics and to take up and cultivate contacts with different actors of health care systems.

Cost-Benefit Analysis↗
PubMed2000

[Pharmacoeconomic evaluation of pravastatin in coronary secondary prevention in patients with myocardial infarct or unstable angina pectoris. An analysis based on the LIPID Study].

BACKGROUND: Secondary coronary prevention with lipid lowering drugs have become a major issue in health policy formulation due to the large upfront investment in drug therapy. The recently completed LIPID trial with pravastatin in secondary prevention immediately raise the question whether pravastatin might be cost-effective in Switzerland. METHODS: We conducted a cost-effectiveness analysis from the perspective of third party payers. The following costs were included in the analysis: daily treatment costs of pravastatin, non fatal myocardial infarction, coronary bypass operations and stroke. Life years gained was obtained by applying the declining exponential approximation of life expectancy. All calculations were standardized to 1000 treated patients. RESULTS: The net costs of treating 1000 patients (i.e. drug costs minus the costs of sequelae and interventions) are Fr. 3.6 Mio. In addition, a total of 430 life-years may be saved through treatment. The corresponding cost-effectiveness of pravastatin treatment is Fr. 8341 (nominal) Fr. 6985 (discounted). CONCLUSIONS: The results suggest that the cost-effectiveness of pravastatin in secondary prevention lie well within the threshold of other commonly accepted medical interventions and may be considered an economically viable approach for secondary coronary prevention.

Angina, Unstable↗
PubMed2000

Determinants of health care costs and patterns of care of asthmatic patients in Switzerland.

OBJECTIVE: To investigate whether medical resource utilisation, costs and clinical status were influenced by: (1) type of physician (specialist versus GP); (2) treatment modality (on-demand vs long-term continuous therapy); (3) labour force participation; (4) insurance coverage (private vs statutory); (5) geographic area (urban vs rural). MATERIAL AND METHODS: Chart reviews in the last 5 patients seen by treating physicians. Direct medical expenditure included charges for hospitalisation, outpatient services, physicians' services and medication, whereas indirect costs included the value of time lost from work. RESULTS: The overall annual mean cost per patient in 589 patients was CHF 2600 [95% confidence interval: 1956; 3245]. Costs in 117 children were CHF 824 [531; 1116], and CHF 3041 [2244; 3837] in adults. Compared with pulmonologists, adults treated by GPs had a higher rate of hospital admissions, equal specialist referrals and more days off work. Hospital admissions in children were similar in GPs and paediatricians. Total direct costs were highest for internists, followed by GPs. Pulmonologists incurred the lowest direct costs in adults compared to GPs or internists (p < 0.05). Total costs for children were equal for GPs and paediatricians. Differences in costs between on-demand and long-term prophylactic treatment were: CHF 834 [318; 1351] versus CHF 1856 [1488; 2224], (p = 0.002). Highest total costs were observed for unemployed patients and those receiving disability payments. Patients with supplementary insurance cover had a lower overall resource utilisation rate and costs than patients without: CHF 2284 [95% CI: 535; 4034] versus CHF 2670 [1844; 3496] (p = 0.8). Total costs were CHF 2319 [1660; 2979] for patients treated in cities and CHF 3062 [1742; 4382] in rural areas (p < 0.0001) as well as lower in the German-speaking part of the country (CHF 2320 [1743; 2897]) than in the French-speaking region (CHF 3610 [1479; 5740] [p < 0.005]). CONCLUSIONS: Factors determining higher resource utilisation and costs are: treatment by non-specialists, long-term continuous treatment, the absence of supplementary health care insurance, treatment in rural areas, and treatment in the French-speaking cantons.

Adult↗
PubMed2000

[Economic evaluation of different treatment strategies in patients with stable angina pectoris or asymptomatic myocardial ischemia on basis of results from the Asymptomatic-Cardiac-Ischemia Pilot study (ACIP)].

BACKGROUND: In patients with stable angina pectoris or silent myocardial ischemia, who had signs of ischemia in ECG during exercise, the Asymptomatic Cardiac Ischemia Pilot (ACIP) study compared 2 types of medication strategies (ischemia-guided and angina-guided) and a strategy of primary revascularization by PTCA or CABG. ACIP substantiated, after 2 years of observation, a clear advantage of the revascularization strategy compared to both drug strategies in terms of clinical effectiveness. This advantage is even more distinct in patients with very severe angiographic results. PATIENTS AND METHODS: This is a retrospective, incremental cost-effectiveness analysis from the perspective of the German third party payer (statutory sick funds) on the basis of the ACIP study. RESULTS: The direct costs of the revascularization strategy after 2 years are about 2 to 3 times higher than those of the drug therapies. The incremental cost-effectiveness of the ischemia-guided strategy versus an angina-guided strategy is DM 2,600 per life-year saved. Furthermore, the cost-effectiveness of a revascularization strategy versus an angina guided therapy is DM 15,100 per life-year saved. CONCLUSION: A primary revascularization strategy is cost-effective in patients with stable coronary artery disease with proven myocardial ischemia and positive angiographic signs.

Aged↗