Societal Costs of First-Incident Ischemic Stroke in Patients with Atrial Fibrillation-A Danish Nationwide Registry Study.

BACKGROUND: Oral anticoagulation therapy reduces the risk of ischemic stroke in patients with atrial fibrillation (AF). However, more data on the costs of stroke in patients with AF are needed to assess how this therapy affects societal costs. OBJECTIVES: The aim of the study was to estimate the average 3-year societal costs of first-incident ischemic stroke in Danish patients with AF, including costs of health care, social care services, and productivity loss. METHODS: The study was designed as an incidence-based cost-of-illness study covering the entire Danish population. All patients with a hospital diagnosis of AF were identified, and propensity score-matched analyses were used to estimate costs attributable to first-incident stroke among patients with AF in the period 2002 to 2012. All data were obtained from nationwide registries. RESULTS: A total of 21,673 patients with AF were identified with a first-incident stroke. The average 3-year costs attributable to stroke were US $30,925 per patient (present value) corresponding to US $19,989 in the incidence year and US $7,683 and US $5,176 1 and 2 years after the stroke, respectively. Health care accounted for 66% of the 3-year costs, with hospitalizations in the incidence year as the main cost driver. After the incidence year, costs of social care services exceeded health care costs. Sensitivity analyses showed that the cost estimates were relatively robust. CONCLUSIONS: The societal costs of first-incident stroke in patients with AF are substantial. This new evidence can be valuable as an input for decision making regarding the treatment of AF and prevention of future strokes.

The effects and costs of a group-based education programme for self-management of patients with Type 2 diabetes. A community-based study.

The worldwide epidemic of Type 2 diabetes necessitates evidence-based self-management education programmes. The purpose of this study was to investigate the effects and costs of an empowerment-based structured diabetes self-management education programme in an unselected group of patients with Type 2 diabetes. Seven hundred and two patients undergoing treatment by general practitioners (GPs) were included. The education comprised three modules over a 12-month period. It was based on the empowerment philosophy. The education followed a written curriculum, and the educators were given special training in its use. Glycemic control (HbA1c) was found to improve from 7.34 ± 1.34 to 6.88 ± 1.09%, P < 0.001 and body weight decreased from 90.9 ± 19.3 to 87.1 ± 18.1 kg, P < 0.001, following the education programme. Moreover, significant improvements were found in terms of fasting blood glucose, blood pressure, female waist circumference, lipid profile, quality of life, physical activity and the patients' knowledge of diabetes whilst the number of visits to GPs declined. This study supports the use of an empowerment vision as a basis for an interdisciplinary group-based education programme with individuals with Type 2 diabetes. Moreover, the costs of implementing this education programme were found to be minimal.

Cost-effective faster wound healing with a sustained silver-releasing foam dressing in delayed healing leg ulcers--a health-economic analysis.

The aim of this analysis was to examine the cost-effectiveness of Contreet Foam (A) in comparison with three other commonly used venous leg ulcer treatment protocols: Aquacel Ag (B), Actisorb Silver (C) and Iodoflex (D). A health-economic analysis reflecting the UK treatment practice and cost structure was performed. The analysis was set up to assess the cost of relative wound area reduction over a 4-week treatment period. The model was validated by a UK expert panel consisting of four wound care specialists. To assure that the 4-week model had a realistic link to cost-effectiveness of complete wound healing, a Markov analysis was also performed. Sensitivity analyses were carried out to ensure validity. Protocol A and C proved to be the most effective treatments. The mean relative reduction in wound area after 4 weeks of treatment was 50.2% (protocol A), 23.9% (protocol B), 44.6% (protocol C) and 36.0% (protocol D). Cost-effectiveness ratios showed that protocol A proved to be the most cost-effective treatment, and protocol B the least. The cost per percentage reduction in wound area was 9.50 UK pounds for protocol A, compared to 16.50-17.60 UK pounds for the other treatment options. The cost-effectiveness of complete healing (Markov analysis) and sensitivity analyses confirmed these results. Using Contreet Foam instead of the other dressing alternatives may imply savings of 2.2-4.4 million UK pounds per year to the National Health Service.