RESUMO
OBJECTIVE: Cardiovascular disease (CVD) complicates type 2 diabetes. Empagliflozin and liraglutide have demonstrated improved survival in patients with type 2 diabetes and established CVD. We assessed prevalence and standard of care of patients with type 2 diabetes and established CVD managed in primary care. PATIENTS AND METHODS: A total of 129 general practitioners in both rural and urban areas, responsible for 348 373 patients, identified their patients with type 2 diabetes. The identification was based on a search for International Classification of Primary Health Care 2 codes in the general practitioners' electronic patient record systems. Patients with concomitant CVD were identified and characterized. RESULTS: A total of 17 113 (4.9%) patients were diagnosed with type 2 diabetes. Type 2 diabetes with concomitant CVD was found in 3665 (21.4%) patients, with their mean age being 72 years, and 34.6% were women. Mean estimated glomerular filtration rate was 68.2 ml/min, and 22.2% had microalbuminuria or macroalbuminuria. Standard of care was fair: mean glycated hemoglobin was 52.3 mmol/mol (Diabetes Control and Complications Trial=6.9%), mean blood pressure was 131.4/75.7 mmHg, and mean low-density lipoprotein cholesterol was 2.0 mmol/l. CONCLUSION: In a nationwide database survey in primary care, the prevalence of CVD in patients with type 2 diabetes was high (21.4%). Standard of care was largely in accordance with national guidelines. Identification of eligible patients is possible with existing electronic patient record systems. Identifying this high-risk subgroup of patients with type 2 diabetes and optimizing their treatment might add further cardiovascular benefits as suggested by recent cardiovascular outcome trials.
RESUMO
BACKGROUND: Grass pollen-induced allergic rhinoconjunctivitis constitutes a large burden for society. Up to 20% of European and United States (US) populations suffer from respiratory allergies, including grass pollen-induced allergic rhinoconjunctivitis. The majority of patients are treated with symptomatic medications; however, a large proportion remains uncontrolled despite use of such treatments. Specific immunotherapy is the only treatment documented to target the underlying cause of the disease, leading to a sustained effect after completion of treatment. The aim of this study was to compare the economic consequences of treating patients suffering from allergic rhinoconjunctivitis with either a grass allergy immunotherapy tablet (AIT) or subcutaneous immunotherapy (SCIT). METHODS: A budget impact analysis was applied comparing SQ-standardized grass AIT (Grazax(®); Phleum pratense, 75,000 SQ-T/2,800 BAU; ALK, Denmark) with SCIT (Alutard(®); P. pratense, 100,000 SQ-U/mL; ALK, Denmark). Budget impact analysis included health care utilization measured in physical units based on systematic literature reviews, guidelines, and expert opinions, as well as valuation in unit costs based on drug tariffs, physician fees, and wage statistics. Budget impact analysis was conducted from a Danish health care perspective. RESULTS: Treating patients suffering from allergic rhinoconjunctivitis with grass AIT instead of grass SCIT resulted in a total reduction in treatment costs of 1291 per patient during a treatment course. This cost saving implies that approximately 40% more patients could be treated with grass AIT per year without influencing the cost of treatment. CONCLUSION: Budget impact analysis showed that grass AIT is a cost-saving alternative to SCIT when treating patients with grass pollen-induced allergic rhinoconjunctivitis.
