[Pharmacoeconomic analysis: results of the REACH registry]. / Análisis farmacoeconómico: resultados del registro REACH.

The REACH registry includes patients from 44 countries with established atherosclerotic disease or at risk of this disease (coronary artery disease [CAD], cerebrovascular disease [CVD] and or peripheral artery disease [PAD]). The country with the largest population included in the registry was the United States, representing 38% of the total number of patients. Spain represented 3.7%. A comparative analysis of the populations from both countries as well as of the clinical management of this disease and its cost was performed. To calculate the mean total costs, drug costs, the costs of hospitalization due to vascular causes and the costs of loss of work productivity were taken into account. One of the most important results obtained after analyzing the REACH registry was the discovery of data showing the economic impact of PAD in patients with CAD or CVD. Patients with more than one diseased vascular bed had a higher associated healthcare cost due to an increase in both drug costs and hospitalization costs. Indirect costs could not be estimated for all groups. The differences in total mean costs between treating polyvascular disease and treating a single diseased vascular bed were much higher in the United States for patients with CAD + PAD vs. CAD and were much higher in Spain for patients with CVD + PAD vs. CVD. Analysis of the results of the REACH registry allows us to conclude that the presence of PAD together with CAD or CVD worsens patients' prognosis, which translates into a substantial increase in the cost of treatment, representing a greater economic burden for the Spanish national health system.

Análisis farmacoeconómico: resultados del registro REACH / Pharmacoeconomic analysis: results of the REACH registry

Pacientes provenientes de 44 países con riesgo de o con enfermedad aterosclerótica establecida (enfermedad arterial coronaria [EAC], enfermedad cerebrovascular [ECV] y/o enfermedad arterial periférica [EAP]) fueron incluidos en el registro REACH (REduction of Atherothrombosis for Continued Health). EE.UU. fue el país con mayor población incluida en el REACH, con una aportación del 38% de los pacientes totales. La aportación de España a este registro fue del 3,7%. Se ha realizado un análisis comparativo de las poblaciones de ambos países, así como el control clínico y su coste. Para el cálculo de los costes medios totales se han tenido en cuenta tanto los costes de los fármacos como los costes de hospitalización por causa vascular, así como los costes por pérdida de productividad laboral. Uno de los resultados más importantes obtenidos tras analizar el registro REACH ha sido la obtención de datos que muestran el impacto económico que supone la presencia de EAP en los pacientes con EAC o ECV. Los pacientes que tienen afectado más de un lecho vascular tienen asociado un mayor coste sanitario debido tanto a un incremento en el coste de los fármacos como a un mayor coste debido a las hospitalizaciones. La partida de costes indirectos no se pudo estimar para todos los grupos. Las diferencias en costes totales medios de tratar una enfermedad polivascular a tratar un único lecho vascular afectado son más elevadas en EE.UU. para pacientes con EAC + EAP frente a EAC y más elevadas en España para los pacientes con ECV + EAP frente a ECV. Tras analizar los resultados del registro REACH se puede concluir que la presencia de EAP junto con EAC o ECV empeora el pronóstico de los pacientes, lo que se traduce en un incremento considerable de los costes de tratamiento, lo que supone una mayor carga económica para el Sistema Nacional de Salud español (AU)

The REACH registry includes patients from 44 countries with established atherosclerotic disease or at risk of this disease (coronary artery disease [CAD], cerebrovascular disease [CVD] and or peripheral artery disease [PAD]). The country with the largest population included in the registry was the United States, representing 38% of the total number of patients. Spain represented 3.7%. A comparative analysis of the populations from both countries as well as of the clinical management of this disease and its cost was performed. To calculate the mean total costs, drug costs, the costs of hospitalization due to vascular causes and the costs of loss of work productivity were taken into account. One of the most important results obtained after analyzing the REACH registry was the discovery of data showing the economic impact of PAD in patients with CAD or CVD. Patients with more than one diseased vascular bed had a higher associated healthcare cost due to an increase in both drug costs and hospitalization costs. Indirect costs could not be estimated for all groups. The differences in total mean costs between treating polyvascular disease and treating a single diseased vascular bed were much higher in the United States for patients with CAD + PAD vs. CAD and were much higher in Spain for patients with CVD + PAD vs. CVD. Analysis of the results of the REACH registry allows us to conclude that the presence of PAD together with CAD or CVD worsens patients’ prognosis, which translates into a substantial increase in the cost of treatment, representing a greater economic burden for the Spanish national health system (AU)

Increased plasma fibrinolytic activity in bleeding gastrointestinal angiodysplasia.

OBJECTIVE: Gastrointestinal angiodysplasia is a major cause of recurrent bleeding. Haemostatic abnormalities have been implicated in the haemorrhage from these common vascular lesions but their precise contribution remains to be established. Our aim was to investigate whether bleeding angiodysplasia is associated with any specific coagulation disorder. METHODS: Clinical features and blood samples were prospectively obtained from 21 patients with bleeding gastrointestinal angiodysplasia 3 months after the last episode of haemorrhage. Plasma levels of von Willebrand factor, D-dimer, plasminogen activator inhibitor type 1 (PAI-1), tissue-plasminogen activator activity, tissue factor pathway inhibitor and activated factor VII (FVIIa-rTF) were measured. A group of 14 patients with bleeding duodenal ulcer were similarly studied as controls. RESULTS: Mean plasma von Willebrand factor levels were higher in angiodysplasia patients (208+/-12%) than in controls (143+/-11%) (P<0.05). D-dimer levels (661+/-80 ng/ml) and tissue-plasminogen activator activity levels (2.04+/-0.14 IU/ml) were also higher than in controls: 395+/-99 ng/ml and 1.6+/-0.1 IU/ml, respectively (P<0.05), whereas levels of PAI-1, FVIIa-rTF and tissue factor pathway inhibitor were similar in both groups. However, PAI-1 levels (31.5+/-11 ng/ml) were lower in high-bleeding-rate angiodysplasia (more than two bleeding episodes/year) than in low-bleeding-rate angiodysplasia (< or = 2 bleeding episodes/year) (PAI-1 47+/-14 ng/ml) (P<0.05). In a multivariate regression analysis, the plasma level of PAI-1 was a predictor of haemorrhage from angiodysplasia (P<0.05). CONCLUSIONS: Increased plasma fibrinolytic activity may contribute to bleeding from angiodysplasia. Low plasma PAI-1 levels constitute a risk factor for bleeding tendency in patients with angiodysplasia.