RESUMO
Objective: To evaluate the cost-effectiveness of insertable cardiac monitors (ICMs) compared with standard of care (SoC) for detecting atrial fibrillation (AF) in patients at high risk of stroke (CHADS2 >2), using a UK National Health Service (NHS) perspective. Methods: Using patient characteristics and clinical data from the REVEAL AF trial, a Markov model assessed the cost-effectiveness of detecting AF with an ICM compared with SoC. Costs and benefits were extrapolated across modelled patient lifetime. Ischaemic and haemorrhagic strokes, intracranial and extracranial haemorrhages and minor bleeds were modelled. Diagnostic and device costs were included, plus costs of treating stroke and bleeding events and costs of oral anticoagulants (OACs). Costs and health outcomes, measured as quality-adjusted life years (QALYs), were discounted at 3.5% per annum. One-way deterministic and probabilistic sensitivity analyses (PSA) were undertaken. Results: The total per-patient cost for ICM was £13 360 versus £11 936 for SoC (namely, annual 24 hours Holter monitoring). ICMs generated a total of 6.50 QALYs versus 6.30 for SoC. The incremental cost-effectiveness ratio (ICER) was £7140/QALY gained, below the £20 000/QALY acceptability threshold. ICMs were cost-effective in 77.4% of PSA simulations. The number of ICMs needed to prevent one stroke was 21 and to cause a major bleed was 37. ICERs were sensitive to assumed proportions of patients initiating or discontinuing OAC after AF diagnosis, type of OAC used and how intense the traditional monitoring was assumed to be under SoC. Conclusions: The use of ICMs to identify AF in a high-risk population is cost-effective for the UK NHS.
RESUMO
OBJECTIVE: To investigate the frequency, distribution, and mortality of systemic lupus erythematosus (SLE) in a defined area of northwest Greece. METHODS: Cases were recorded from 3 sources: inpatients and outpatients referred to the rheumatology clinic of the Ioannina University Hospital; inpatients and outpatients referred to the rheumatology clinic of Ioannina General Hospital; and patients referred to private rheumatologists practicing in the study area. All patients identified between January 1, 1982, and December 31, 2001, resident in the study area were included. Diagnosis was confirmed by the 1982 revised criteria of the American College of Rheumatology. Incidence and prevalence rates were calculated as number of cases per hundred thousand inhabitants. Population data were based on the 1981, 1991, and 2001 National Census. RESULTS: A total of 178 cases of SLE were diagnosed during the study period, giving a mean annual incidence rate of 1.9 cases/100,000 inhabitants (95% CI 1.49-2.31). The female/male ratio was 7.4. A significant variation of SLE rates among different districts of the study area was observed. Incidence rates were higher for the urban population. The peak of incidence was observed in the 30-49 age group for both sexes. There was a slight increase in the incidence of SLE during the study period. The 5 year survival rate was 96.8% and the 10 year survival rate was 90.3%. CONCLUSION: We found a relatively low frequency of SLE in northwest Greece. Age at diagnosis was younger than expected.
