Self-management of oral anticoagulation.

BACKGROUND: Properly dosed oral anticoagulation effectively prevents thromboembolic events. It is unclear whether adult patients with an indication for long-term oral anticoagulation can benefit from self-management in terms of patient-oriented endpoints and improved coagulation values. METHOD: We selectively searched the Medline database for high-quality systematic reviews based on randomized controlled trials of self-measurement or self-management of oral anticoagulation, compared to standard treatment. RESULTS: We identified eight review articles based on overlapping sets of ran - domized clinical trials. In all of these systematic reviews, patients who performed self-measurement or self-management had a 40% to 50% lower rate of thromboembolic events; in six of them, the mortality was also significantly lower, by 30% to 50%. Subgroup analysis revealed that these effects were present exclusively in patients who performed self-management, and not in those who only performed self-measurement. None of the review articles revealed any difference in the frequency of severe hemorrhagic events. Quality of life and patient satisfaction were rated in five reviews, which, however, used different instruments, with the result that no clear conclusions could be drawn. All of the review articles documented an improvement in coagulation values, but information on statistical significance was mostly lacking. CONCLUSION: Adults with an indication for long-term oral anticoagulation benefit from self-management, as compared to standard treatment with management of dosing by a physician. A limitation of this study is that the multiple review articles on which it is based were largely analyses of the same group of clinical trials.

Cost per patient and potential budget implications of denosumab compared with zoledronic acid in adults with bone metastases from solid tumours who are at risk of skeletal-related events: an analysis for Austria, Sweden and Switzerland.

OBJECTIVES: To assess cost implications per patient, per year, and to predict the potential annual budget impact when patients with bone metastases secondary to solid tumours at risk of skeletal-related events (SREs) transition from zoledronic acid (ZA; 4 mg every 3-4 weeks) to denosumab (120 mg every 4 weeks) in Austria, Sweden and Switzerland. METHODS: Country specific costs for medication and administration, patient management and SREs (defined as pathologic fracture, radiation to bone, surgery to bone and spinal cord compression) were assessed over a 1-year time horizon. Drug administration and patient management costs were taken from available public sources. SRE costs were based on local unit costs applied to country specific healthcare resources obtained from a multinational retrospective chart review study. Due to lack of real world data for the included countries, SRE rates were derived from phase III clinical trials in patients with advanced cancer and bone metastases. These trials demonstrated that denosumab was superior to ZA in the reduction of SREs. RESULTS: Estimated total annual cost savings for each patient transitioned from ZA to denosumab varied by country and cancer type, ranging from €1583 to €2375 in Austria, from €1980 to €2319 in Sweden (9.1 SEK/€) and from €3408 to €3857 in Switzerland (1.2 CHF/€). Cost savings were mainly driven by the lower SRE related costs and lower administration costs of denosumab compared with ZA. CONCLUSIONS: Denosumab offers superior efficacy compared with ZA in patients with solid tumours and bone metastases. Cost savings are predicted in the Austrian, Swedish and Swiss healthcare systems following treatment transition from ZA to denosumab.

Attitudes towards insulin pump therapy among adolescents and young people.

PURPOSE: This study investigated reasons for the rejection and discontinuation of insulin pump therapy and explored general attitudes towards this mode of therapy among young patients with type 1 diabetes. METHODS: A questionnaire was developed using a focus group of young people with diabetes. It was then used to survey a random sample of adolescents and young people identified by physicians specializing in diabetes care and participating in a voluntary quality improvement initiative in Germany. The physicians were also surveyed. RESULTS: Eighty-eight patients participated in the survey (22 had never used the pump, 20 had formerly used the pump, and 46 were using the pump at that time, with an average age of between 20 and 22 years, depending on the group). Those who had never used the pump had had diabetes for a significantly shorter length of time and had undergone their first diabetes education more recently. Current pump users were significantly younger at the time of the first diabetes education. There were no significant differences between patients concerning where they obtained their information about the condition and treatment options. Although clinical factors were named, social and psychological factors were prominent as reasons both in reluctance to try the pump therapy and in discontinuing therapy. Technical problems as a disadvantage of the pump (aside from the catheter) were less likely to be named. Responses among physicians confirmed discipline and compliance were essential prerequisites for this therapy and supported findings that patients discontinuing pump therapy at their own request tend to do so for nonclinical reasons. CONCLUSIONS: Although the technical reliability of the insulin pump was generally accepted by all patients regardless of current treatment, clinical disadvantages relating to the use of the pump but more commonly social/psychological factors were named, which resulted in patients being reluctant to try this therapy or discontinuing use of it.

Use of personal computers, electronic medical records and availability of Internet among office based GPs and internists in Austrian province of Styria.

We conducted a survey of personal computer (PC), electronic medical record (EMR) usage, and Internet accessibility among Austrian office based general practitioners and internists. PCs were available to 97% of responders, and among PC users, 91% used EMRs.

A model to analyse costs and benefit of intensified diabetic foot care in Austria.

RATIONALE, AIMS AND OBJECTIVES: The diabetic foot is a common late complication among diabetic patients and due to its consequences an important financial burden for society. Intensified treatment has proved to reduce amputation rates, but in Austria so far no data have been available about financial implications and long-term effects of intensified treatment. The objective was to retrieve cost data for intensified treatment of diabetic foot ulcers and to estimate the long-term outcome. METHODS: A retrospective data analysis of 119 ulcers was done to get outcomes and costs for intensified treatment in a specialized outpatient hospital department in an Austrian setting. One-year results were categorized according to the San Antonio wound classification. Using a Markov model upon these data, long-term outcomes and costs for intensified treatment and for standard care were calculated. RESULTS: Costs for intensified treatment until healing vary from euro 1071 (range: 99-4089) per case to euro 7844 (range: 104-25 615) depending on the lesion's grade. One-year healing rates are 85.2% for grade A and 71.7%, 84.6% and 33.3% for the grades B, C and D respectively. The model-based comparison for treatment costs shows a cost reduction of 29.8% per patient year in grade A ulcerations and 49.7% in grade D for intensified versus standard treatment due to lower amputation rates. CONCLUSIONS: These results are the first cost data for diabetic foot care in Austria and demonstrate the advantages of intensified care over standard care in terms of patient-oriented outcome and financial impact pleading for the implementation of specialized foot care facilities and referral guidelines to standardize and improve treatment.