Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 25
Filtrar
1.
J Intensive Care Med ; 36(1): 70-79, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31741418

RESUMO

INTRODUCTION: Patients with intracranial hemorrhage (including intracerebral hemorrhage, subarachnoid hemorrhage, and traumatic hemorrhage) are commonly admitted to the intensive care unit (ICU). Although indications for oral antiplatelet agents are increasing, the impact of preadmission use on outcomes in patients with intracranial hemorrhage admitted to the ICU is unknown. We sought to evaluate the association between preadmission oral antiplatelet use, in-hospital mortality, resource utilization, and costs among ICU patients with intracranial hemorrhage. METHODS: We retrospectively analyzed a prospectively collected registry (2011-2016) and included consecutive adult patients from 2 hospitals admitted to ICU with intracranial hemorrhage. Patients were categorized on the basis of preadmission oral antiplatelet use. We excluded patients with preadmission anticoagulant use. The primary outcome was in-hospital mortality and was analyzed using a multivariable logistic regression model. Contributors to total hospital cost were analyzed using a generalized linear model with log link and gamma distribution. RESULTS: Of 720 included patients with intracranial hemorrhage, 107 (14.9%) had been using an oral antiplatelet agent at the time of ICU admission. Oral antiplatelet use was not associated with in-hospital mortality (adjusted odds ratio: 1.31 [95% confidence interval [CI]: 0.93-2.22]). Evaluation of total costs also revealed no association with oral antiplatelet use (adjusted ratio of means [aROM]: 0.92 [95% CI: 0.82-1.02, P = .10]). Total cost among patients with intracranial hemorrhage was driven by illness severity (aROM: 1.96 [95% CI: 1.94-1.98], P < .001), increasing ICU length of stay (aROM: 1.05 [95% CI: 1.05-1.06], P < .001), and use of invasive mechanical ventilation (aROM: 1.76 [95% CI: 1.68-1.86], P < .001). CONCLUSIONS: Among ICU patients admitted with intracranial hemorrhage, preadmission oral antiplatelet use was not associated with increased in-hospital mortality or hospital costs. These findings have important prognostic implications for clinicians who care for patients with intracranial hemorrhage.


Assuntos
Custos de Cuidados de Saúde , Unidades de Terapia Intensiva , Hemorragias Intracranianas , Inibidores da Agregação Plaquetária/administração & dosagem , Adulto , Mortalidade Hospitalar , Hospitalização , Humanos , Hemorragias Intracranianas/economia , Tempo de Internação , Estudos Retrospectivos
2.
World Neurosurg ; 131: e606-e613, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31408751

RESUMO

OBJECTIVE: In the present study, we sought to evaluate the timing and outcomes in patients with hemorrhagic stroke who received tracheostomy. METHODS: A retrospective database search was undertaken to identify patients with hemorrhagic stroke between January 2010 and December 2018. Clinical data on basic demographics, clinical features, and outcomes were extracted. The primary outcome was in-hospital mortality and secondary outcomes were hospital stays and hospital costs. Univariate and multivariate analyses were used to compare the characteristics and outcomes between patients with hemorrhagic stroke who underwent tracheostomy early (days 1-6) and late (days 7 or later). RESULTS: A total of 425 patients were identified, 74.4% (n = 316) received an early tracheostomy during the hospitalization. Patients with hemorrhagic stroke who received early tracheostomy had a higher rate of neurosurgical operation (odds ratio, 2.77; 95% confidence interval, 1.54-4.99; P = 0.001) and different types of hemorrhagic stroke (P = 0.001) in comparison with the late tracheostomy patients. In addition, early tracheostomy was associated with shorter hospital stays (odds ratio, 1.02; 95% confidence interval, 1.01-1.03; P = 0.003) and reduced hospital costs (P < 0.001) than with late tracheostomy. However, no significant difference was observed with regard to in-hospital mortality between early and late tracheostomy groups (P = 0.744). CONCLUSIONS: In our cohort, early tracheostomy in patients with hemorrhagic stroke may help reduce hospital stays and hospital costs, but not in-hospital mortality. Future prospective multicenter studies are warranted to validate these findings.


Assuntos
Mortalidade Hospitalar , Hemorragias Intracranianas/terapia , Acidente Vascular Cerebral/terapia , Traqueostomia/métodos , Idoso , Feminino , Custos Hospitalares/estatística & dados numéricos , Humanos , Hemorragias Intracranianas/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Respiração Artificial/economia , Respiração Artificial/métodos , Estudos Retrospectivos , Acidente Vascular Cerebral/economia , Fatores de Tempo , Traqueostomia/economia , Resultado do Tratamento
3.
J Neurointerv Surg ; 11(12): 1187-1190, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31103991

RESUMO

OBJECTIVE: To investigate whether significant differences exist in hospital bills and patient outcomes between patients who undergo endovascular thrombectomy (EVT) alone and those who undergo EVT with pretreatment intravenous tissue plasminogen activator (IV tPA). METHODS: We retrospectively grouped patients in an EVT database into those who underwent EVT alone and those who underwent EVT with pretreatment IV tPA (EVT+IV tPA). Hospital encounter charges (obtained via the hospital's charge capture process), final patient bills (ie, negotiated final bills as per insurance/Medicare rates), demographic information, existing comorbidities, admission and discharge National Institutes of Health Stroke Scale (NIHSS) score, and functional independence data (modified Rankin Scale score 0-2) were collected. Univariate and multivariate statistical analyses were performed. RESULTS: Of a total of 254 patients, 96 (37.8%) underwent EVT+IV tPA. Median NIHSS score at admission was significantly higher in the EVT+IV tPA group than in the EVT group (p=0.006). After adjusting for NIHSS admission score, patient bills and encounter charges in the EVT+IV tPA group were still found to be $3861.64 (95% CI $658.84 to $7064.45, p=0.02) and $158 071.29 (95% CI $134 641.50 to $181 501.08, p < 0.001) greater than in the EVT only group respectively. The EVT+IV tPA group had a higher complication rate of intracranial hemorrhage (ICH) (p=0.005). The EVT and EVT+IV tPA groups did not differ significantly in median discharge NIHSS score (p=0.56), functional independence rate at 90 days (p=0.96), or average length of hospital stay (p=0.21). CONCLUSION: Patients treated with EVT+IV tPA have greater hospital encounter charges and final hospital bills as well as higher rates of ICH than patients who undergo treatment with EVT only.


Assuntos
Preços Hospitalares/tendências , Trombectomia/economia , Terapia Trombolítica/economia , Administração Intravenosa , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Hemorragias Intracranianas/economia , Hemorragias Intracranianas/etiologia , Tempo de Internação/economia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Trombectomia/efeitos adversos , Terapia Trombolítica/efeitos adversos , Ativador de Plasminogênio Tecidual/administração & dosagem , Ativador de Plasminogênio Tecidual/efeitos adversos , Resultado do Tratamento
4.
Clin Neurol Neurosurg ; 181: 21-23, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30974295

RESUMO

This brief communication describes the challenges faced by neurosurgeons in Low- or middle-income countries to treat neurosurgical emergencies from intracranial bleeds (whether traumatic or spontaneous). The authors point out that in low- or middle-income countries and Africa in particular, resources, facilities, and personnel are lacking to follow the guidelines proposed for treating these conditions in high-income countries. The proposal offered here is to move to early surgical intervention because algorithms to monitor patients under conservative management guidelines are often not possible.


Assuntos
Países em Desenvolvimento , Hemorragias Intracranianas/terapia , Neurocirurgiões , Neurocirurgia/economia , Recursos em Saúde/economia , Humanos , Renda , Hemorragias Intracranianas/economia
5.
Crit Care ; 22(1): 225, 2018 09 20.
Artigo em Inglês | MEDLINE | ID: mdl-30236140

RESUMO

BACKGROUND: Neurocritical illness is a growing healthcare problem with profound socioeconomic effects. We assessed differences in healthcare costs and long-term outcome for different forms of neurocritical illnesses treated in the intensive care unit (ICU). METHODS: We used the prospective Finnish Intensive Care Consortium database to identify all adult patients treated for traumatic brain injury (TBI), intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH) and acute ischemic stroke (AIS) at university hospital ICUs in Finland during 2003-2013. Outcome variables were one-year mortality and permanent disability. Total healthcare costs included the index university hospital costs, rehabilitation hospital costs and social security costs up to one year. All costs were converted to euros based on the 2013 currency rate. RESULTS: In total 7044 patients were included (44% with TBI, 13% with ICH, 27% with SAH, 16% with AIS). In comparison to TBI, ICH was associated with the highest risk of death and permanent disability (OR 2.6, 95% CI 2.1-3.2 and OR 1.7, 95% CI 1.4-2.1), followed by AIS (OR 1.9, 95% CI 1.5-2.3 and OR 1.5, 95% CI 1.3-1.8) and SAH (OR 1.8, 95% CI 1.5-2.1 and OR 0.8, 95% CI 0.6-0.9), after adjusting for severity of illness. SAH was associated with the highest mean total costs (€51,906) followed by ICH (€47,661), TBI (€43,916) and AIS (€39,222). Cost per independent survivor was lower for TBI (€58,497) and SAH (€96,369) compared to AIS (€104,374) and ICH (€178,071). CONCLUSION: Neurocritical illnesses are costly and resource-demanding diseases associated with poor outcomes. Intensive care of patients with TBI or SAH more commonly result in independent survivors and is associated with lower total treatments costs compared to ICH and AIS.


Assuntos
Unidades de Terapia Intensiva/economia , Neurologia/economia , Neurologia/normas , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , APACHE , Adolescente , Adulto , Idoso , Lesões Encefálicas Traumáticas/economia , Lesões Encefálicas Traumáticas/epidemiologia , Análise Custo-Benefício , Estado Terminal/economia , Feminino , Finlândia/epidemiologia , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Hemorragias Intracranianas/economia , Hemorragias Intracranianas/epidemiologia , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Doenças do Sistema Nervoso/economia , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/mortalidade , Avaliação de Resultados em Cuidados de Saúde/normas , Estudos Prospectivos , Sistema de Registros/estatística & dados numéricos , Escore Fisiológico Agudo Simplificado , Acidente Vascular Cerebral/economia , Acidente Vascular Cerebral/epidemiologia
6.
Crit Care Med ; 46(5): e395-e403, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29406421

RESUMO

OBJECTIVES: Spontaneous intracranial hemorrhage, including subarachnoid hemorrhage and intracerebral hemorrhage, is associated with significant morbidity and mortality. Although many of these patients will require ICU admission, little is known regarding their outcomes and the costs incurred. We evaluated this population in order to identify outcomes and cost patterns. DESIGN: Retrospective cohort analysis of a health administrative database. SETTING: Two ICUs within a single hospital system. PATIENTS: Eight-thousand four-hundred forty-seven patients admitted to ICU from 2011 to 2014, of whom 332 had a diagnosis of spontaneous intracranial hemorrhage. Control patients were defined as randomly selected age, sex, and comorbidity index-matched nonintracranial hemorrhage ICU patients (1:4 matching ratio). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Mean age of ICU intracranial hemorrhage patients was 60.1 years, and 120 (36.1%) died prior to discharge. Intracranial hemorrhage was associated with a mean total cost of $75,869, compared with $52,471 in control patients (p < 0.01). Mean cost per survivor of intracranial hemorrhage patients was $118,813. Subarachnoid hemorrhage was associated with significantly higher mean total costs than intracerebral hemorrhage ($92,794 vs $53,491; p < 0.01) and higher mean cost per day ($4,377 vs $3,604; p < 0.01). Patients with intracranial hemorrhage who survived to hospital discharge were significantly costlier than decedents ($100,979 vs $30,872; p < 0.01). Intracranial hemorrhage associated with oral anticoagulant use had a mean total cost of $152,373, compared with $66,548 in nonoral anticoagulant intracranial hemorrhage (p < 0.01). CONCLUSIONS: Patients admitted to ICU with intracranial hemorrhage have high costs and high mortality, leading to elevated cost per survivor. Subarachnoid hemorrhage patients incur greater costs than intracerebral hemorrhage patients, and oral anticoagulant-associated intracerebral hemorrhage is particularly costly. Our findings provide novel information regarding financial impact of this common ICU population.


Assuntos
Custos Hospitalares/estatística & dados numéricos , Unidades de Terapia Intensiva/economia , Hemorragias Intracranianas/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/economia , Anticoagulantes/uso terapêutico , Estudos de Casos e Controles , Custos de Medicamentos , Feminino , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Hemorragias Intracranianas/tratamento farmacológico , Hemorragias Intracranianas/mortalidade , Hemorragias Intracranianas/terapia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
7.
Int Forum Allergy Rhinol ; 7(1): 72-79, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27626904

RESUMO

BACKGROUND: Although there has been extensive study evaluating adult pituitary surgery, there has been scant analysis among children. Our objective was to evaluate a population-based resource to characterize nationwide trends in surgical approach, hospital stay, and complications among children undergoing pituitary surgery. METHODS: The Kids' Inpatient-Database (KID) files (2009/2012) were evaluated for pituitary gland excisions. Procedure, patient demographics, length of inpatient stay, inpatient costs, hospital setting, and surgical complications were analyzed. RESULTS: A weighted incidence of 1071 cases were analyzed; the majority (77.6%) underwent transsphenoidal resections. These patients had significantly decreased hospital costs and lengths of stay. Patients undergoing transfrontal approaches had significantly greater rates of postoperative diabetes insipidus (DI) (66.5%), panhypopituitarism (38.8%), hydrocephalus, and visual deficits. Among transsphenoidal patients, males had greater rates of postoperative hydrocephalus (5.5%) and panhypopituitarism (17.5%) than females, and patients ≤10 years old had greater rates of these 2 complications (14.5%, 19.4%, respectively) as well as DI (61.3%). CONCLUSION: A greater proportion of children undergo transfrontal approaches for pituitary lesions than in their adult counterparts. This difference may harbor a potential to influence future sellar resection approaches in children toward a transsphenoidal operation when surgically feasible. Patients undergoing transfrontal procedures have greater risks for many intraoperative and postoperative complications relative to individuals undergoing transsphenoidal resections. Among patients undergoing transsphenoidal approaches, males had significantly greater rates of postoperative hydrocephalus and panhypopituitarism, and younger children had greater rates of postoperative DI, hydrocephalus, and panhypopituitarism. These data reinforce the need for greater vigilance in the postoperative care of younger children undergoing transsphenoidal surgery.


Assuntos
Procedimentos Neurocirúrgicos/efeitos adversos , Hipófise/cirurgia , Complicações Pós-Operatórias/etiologia , Adolescente , Vazamento de Líquido Cefalorraquidiano/economia , Vazamento de Líquido Cefalorraquidiano/etiologia , Criança , Feminino , Custos Hospitalares , Humanos , Hidrocefalia/economia , Hidrocefalia/etiologia , Hipopituitarismo/economia , Hipopituitarismo/etiologia , Hemorragias Intracranianas/economia , Hemorragias Intracranianas/etiologia , Tempo de Internação , Masculino , Procedimentos Neurocirúrgicos/economia , Complicações Pós-Operatórias/economia , Acidente Vascular Cerebral/economia , Acidente Vascular Cerebral/etiologia , Transtornos da Visão/economia , Transtornos da Visão/etiologia
8.
Appl Health Econ Health Policy ; 14(3): 313-22, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26924098

RESUMO

BACKGROUND: Atrial fibrillation (AF) poses a significant economic burden. An increasing number of interventions for AF require cost-effectiveness analysis with decision-analytic modeling to demonstrate value. However, high-quality cost estimates of AF that can be used to inform decision-analytic models are lacking. OBJECTIVES: The objectives of this study were to determine whether phase-based costing methods are feasible and practical for informing decision-analytic models outside of oncology. METHODS: Patients diagnosed with AF between 1 January 2003 and 30 June 2011 in Ontario, Canada were identified based on a hospital admission for AF using administrative data housed at the Institute for Clinical Evaluative Sciences. Patient observations were then divided into phases based on clinical events typically used for decision-analytic modeling (i.e., minor stroke/transient ischemic attack [TIA], moderate to severe ischemic stroke, myocardial infarction, extracranial hemorrhage [ECH], intracranial hemorrhage [ICH], multiple events, death from an event, or death from other causes). First 30-day and greater than 30-day costs of healthcare resources in each health state were estimated based on a validated methodology. All costs are reported in 2013 Canadian dollars (Can$) and from a healthcare payer perspective. RESULTS: Patients (n = 109,002) with AF who did not experience a clinical event incurred costs of Can$1566 per 30 days, on average. The average 30-day cost of experiencing a fatal clinical event was Can$42,871, but the cost of dying from all other causes was much smaller (Can$12,800). The clinical events associated with the highest short-term costs were ICH (Can$22,347) and moderate to severe ischemic stroke (Can$19,937). The lowest short-term costs were due to minor ischemic stroke/TIA (Can$12,515) and ECH (Can$12,261). Patients who had experienced a moderate to severe ischemic stroke incurred the highest long-term costs. CONCLUSIONS: Real-world Canadian data and a phase-based costing approach were used to estimate short- and long-term costs associated with AF-related major clinical events. The results of this study can also inform decision-analytic models for AF.


Assuntos
Fibrilação Atrial/economia , Técnicas de Apoio para a Decisão , Custos de Cuidados de Saúde/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/mortalidade , Causas de Morte , Custos e Análise de Custo , Feminino , Humanos , Hemorragias Intracranianas/economia , Hemorragias Intracranianas/mortalidade , Ataque Isquêmico Transitório/economia , Ataque Isquêmico Transitório/mortalidade , Masculino , Infarto do Miocárdio/economia , Infarto do Miocárdio/mortalidade , Ontário/epidemiologia , Admissão do Paciente/economia , Admissão do Paciente/estatística & dados numéricos , Fatores de Risco , Acidente Vascular Cerebral/economia , Acidente Vascular Cerebral/mortalidade
9.
Stroke ; 47(4): 979-85, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26883499

RESUMO

BACKGROUND AND PURPOSE: Intracranial hemorrhage (ICH) is the most feared adverse event with oral anticoagulant therapy in patients with atrial fibrillation. The health economic aspects of resuming oral anticoagulant therapy after ICH are unknown. The aim was to estimate hospitalization costs of thromboembolism and hemorrhage subsequent to ICH in 2 patient groups with atrial fibrillation surviving the first 90 days post ICH: (1) patients resuming warfarin therapy within 90 days post ICH and (2) patients discontinuing therapy. METHODS: Retrospective data from Danish national registries were linked to identify patients with atrial fibrillation who suffered an ICH between January 1, 1997, and April 1, 2011. Study start was 90 days after incident ICH. Mortality was evaluated using the Kaplan-Meier estimate. Occurrence of hospitalization-requiring thromboembolism and hemorrhage was used to estimate hospitalization costs by linkage of International Classification of Diseases, Tenth Revision, codes to Danish Diagnosis-Related Group tariffs. The effect of resuming warfarin therapy on average 3-year hospitalization costs was estimated by regression analysis adjusted for between-group differences in baseline characteristics. RESULTS: In the inclusion period, 2162 patients had an ICH; 1098 survived the first 90 days and were included for analysis, and of those, 267 resumed warfarin therapy. Therapy resumption reduced the mean 3-year hospitalization cost of hospitalized patients significantly by US$ 1588 (95% confidence interval, -2925 to -251) and was significantly correlated with fewer hospitalization days per hospitalized patient (-4.6 [95% confidence interval, -7.6 to -1.6]). The marginal effect of therapy resumption on hospitalization costs per patient was US$ -407 (95% confidence interval, -815 to 2). CONCLUSIONS: Resuming warfarin therapy within 90 days after ICH in patients with atrial fibrillation is associated with a decrease in average hospitalization costs.


Assuntos
Anticoagulantes/efeitos adversos , Fibrilação Atrial/tratamento farmacológico , Custos de Cuidados de Saúde , Hospitalização/economia , Hemorragias Intracranianas/induzido quimicamente , Varfarina/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/economia , Anticoagulantes/uso terapêutico , Fibrilação Atrial/complicações , Fibrilação Atrial/economia , Feminino , Humanos , Hemorragias Intracranianas/complicações , Hemorragias Intracranianas/economia , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Estudos Retrospectivos , Varfarina/economia , Varfarina/uso terapêutico
10.
J Neurosurg ; 123(2): 406-14, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25955874

RESUMO

OBJECT: This study was designed to assess the relationship between insurance status and likelihood of receiving a neurosurgical procedure following admission for either extraaxial intracranial hemorrhage or spinal vertebral fracture. METHODS: A retrospective analysis of the Nationwide Inpatient Sample (NIS; 1998-2009) was performed. Cases of traumatic extraaxial intracranial hematoma and spinal vertebral fracture were identified using International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes. Within this cohort, those patients receiving a craniotomy or spinal fusion and/or decompression in the context of an admission for traumatic brain or spine injury, respectively, were identified using the appropriate ICD-9 procedure codes. RESULTS: A total of 190,412 patients with extraaxial intracranial hematoma were identified between 1998 and 2009. Within this cohort, 37,434 patients (19.7%) received a craniotomy. A total of 477,110 patients with spinal vertebral fracture were identified. Of these, 37,302 (7.8%) received a spinal decompression and/or fusion. On multivariate analysis controlling for patient demographics, severity of injuries, comorbidities, hospital volume, and hospital characteristics, uninsured patients had a reduced likelihood of receiving a craniotomy (odds ratio [OR] 0.76, 95% confidence interval [CI] 0.71-0.82) and spinal fusion (OR 0.67, 95% CI 0.64-0.71) relative to insured patients. This statistically significant trend persisted when uninsured and insured patients were matched on the basis of mortality propensity score. Uninsured patients demonstrated an elevated risk-adjusted mortality rate relative to insured patients in cases of extraaxial intracranial hematoma. Among patients with spinal injury, mortality rates were similar between patients with and without insurance. CONCLUSIONS: In this study, uninsured patients were consistently less likely to receive a craniotomy or spinal fusion for traumatic intracranial extraaxial hemorrhage and spinal vertebral fracture, respectively. This difference persisted after accounting for overall injury severity and patient access to high- or low-volume treatment centers, and potentially reflects a resource allocation bias against uninsured patients within the hospital setting. This information adds to the growing literature detailing the benefits of health reform initiatives seeking to expand access for the uninsured.


Assuntos
Tomada de Decisões , Hemorragias Intracranianas/cirurgia , Procedimentos Neurocirúrgicos/economia , Padrões de Prática Médica/tendências , Fraturas da Coluna Vertebral/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Craniotomia/economia , Craniotomia/tendências , Descompressão Cirúrgica/economia , Descompressão Cirúrgica/tendências , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Lactente , Recém-Nascido , Hemorragias Intracranianas/economia , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/tendências , Estudos Retrospectivos , Fraturas da Coluna Vertebral/economia , Fusão Vertebral/economia , Fusão Vertebral/tendências , Adulto Jovem
11.
J Thromb Thrombolysis ; 39(2): 149-54, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24973057

RESUMO

Edoxaban, an oral direct factor Xa inhibitor, has been found non-inferior to warfarin for preventing stroke and systemic embolism in patients with non-valvular atrial fibrillation (NVAF), with a lower rate of intracranial bleeding. The aim of our investigation was to assess the cost-effectiveness of edoxaban versus warfarin from the perspective of the Italian health-care system. A Markov decision model was used to evaluate lifetime cost and quality-adjusted life expectancy of NVAF patients treated with warfarin or edoxaban. Transition probabilities were obtained from the ENGAGE AF-TIMI 48 trial, cost estimates were based on Italian prices and tariffs, utilities were obtained from the literature. One-way and second-order sensitivity analyses were performed. In the base case, lifetime costs were €18,658 for edoxaban and €14,060 for warfarin. Discounted quality-adjusted survival was 9.022 years for edoxaban and 8.425 years for warfarin, leading to an incremental cost-utility ratio of €7,713 per quality-adjusted life year (QALY) gained. Results were sensitive to time horizon, time in therapeutic range of warfarin and to the relative impact of warfarin versus edoxaban therapy onto quality of life. Probabilistic sensitivity analysis showed edoxaban to be cost-effective versus warfarin in 92.3 % of the simulations at a willingness-to-pay threshold of €25,000 per QALY. In conclusion, edoxaban proved to be a cost-effective alternative to warfarin in patients with moderate-to-high-risk NVAF.


Assuntos
Fibrilação Atrial , Hemorragias Intracranianas , Piridinas/economia , Acidente Vascular Cerebral , Tiazóis/economia , Varfarina/economia , Anticoagulantes/economia , Anticoagulantes/uso terapêutico , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/economia , Análise Custo-Benefício/métodos , Análise Custo-Benefício/estatística & dados numéricos , Humanos , Hemorragias Intracranianas/induzido quimicamente , Hemorragias Intracranianas/economia , Itália , Cadeias de Markov , Piridinas/uso terapêutico , Anos de Vida Ajustados por Qualidade de Vida , Acidente Vascular Cerebral/economia , Acidente Vascular Cerebral/prevenção & controle , Tiazóis/uso terapêutico , Varfarina/uso terapêutico
12.
Am J Surg ; 208(4): 544-549.e1, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25129426

RESUMO

BACKGROUND: Elderly Americans are at increased risk of head trauma, particularly fall related. The effect of warfarin on head trauma outcomes remains controversial. METHODS: Medicare beneficiaries with head injuries from 2009 to 2011 were identified by International Classification of Diseases (ICD)-9 code. Preinjury warfarin use was determined using Part D claims. Multiple logistic regression models determined the association of preinjury warfarin on need for hospitalization, intensive care unit care, and occurrence of intracranial hemorrhage. Association between warfarin and in-hospital mortality was assessed using a Cox proportional hazard model. RESULTS: Of 11,078 head injured patients, 5.2% were injured while on warfarin. Preinjury warfarin increased the odds of intracranial hemorrhage by 40% and doubled the risk of 30-day in-hospital mortality after adjusting for demographic and clinical factors. CONCLUSIONS: Warfarin at the time of head injury increases the risk of adverse outcomes in Medicare beneficiaries with head injuries. Caution should be used when initiating anticoagulation in elderly Americans at risk for trauma.


Assuntos
Traumatismos Craniocerebrais/terapia , Pacientes Internados , Unidades de Terapia Intensiva , Hemorragias Intracranianas/epidemiologia , Medicare , Medição de Risco , Varfarina/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/economia , Feminino , Seguimentos , Humanos , Incidência , Benefícios do Seguro/economia , Hemorragias Intracranianas/economia , Hemorragias Intracranianas/etiologia , Masculino , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Tromboembolia/complicações , Tromboembolia/prevenção & controle , Estados Unidos/epidemiologia , Varfarina/administração & dosagem
13.
J Pediatr Hematol Oncol ; 36(6): 474-9, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25054457

RESUMO

BACKGROUND: Intracranial hemorrhage (ICH) in the newborn period is a potential cause of serious morbidity and mortality in individuals with hemophilia. The incidence of ICH is estimated to be 2% to 4%; however, depending on the mode of delivery, it may be considerably higher. Considering the varying sensitivities and costs of various imaging modalities, there remains controversy surrounding universal cranial imaging. Cost-utility analysis is the ideal tool to display the consequences of a decision made. METHODS: We constructed a decision tree to evaluate the direct and indirect costs, possible outcomes, and probabilities of ICH in neonates with hemophilia. We created 3 decision analysis models to evaluate the cost-utility of different screening modalities for ICH: ultrasound, computed tomography, and magnetic resonance imaging. Within each model, 3 different strategies were compared: screen all neonates; screen only neonates born by instrumented delivery; and not screen any neonates. A societal perspective was used for all models. The base case models were later reanalyzed in sensitivity analysis to account for uncertainties. RESULTS: Total costs for screening all neonates, screening only neonates born by instrumented delivery, and not screening any neonates were $9501, $9297, and $9347, respectively, for US, and $9761, $9351, and $9353, respectively, for CT. Screening instrumented deliveries using MRI had an incremental cost-effectiveness ratio of $12,440. CONCLUSIONS: Screening newborns born by an instrumented delivery appears to be the most cost-effective strategy irrespective of the imaging modality. Subsequent studies will require a longer time frame to factor in possible late effects of radiation, anesthesia, and the high cost of factor replacement and hospital admission.


Assuntos
Hemofilia A/diagnóstico , Hemofilia A/economia , Hemorragias Intracranianas/diagnóstico , Hemorragias Intracranianas/economia , Triagem Neonatal/economia , Triagem Neonatal/estatística & dados numéricos , Análise Custo-Benefício , Técnicas de Apoio para a Decisão , Árvores de Decisões , Gastos em Saúde , Hemofilia A/epidemiologia , Humanos , Recém-Nascido , Hemorragias Intracranianas/epidemiologia , Imageamento por Ressonância Magnética/economia , Imageamento por Ressonância Magnética/estatística & dados numéricos , Prevalência , Qualidade de Vida , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X/economia , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Ultrassonografia/economia , Ultrassonografia/estatística & dados numéricos , Incerteza
14.
J Stroke Cerebrovasc Dis ; 23(2): e73-83, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24119623

RESUMO

BACKGROUND: Stroke represents a major complication of atrial fibrillation (AF). The current anticoagulation options for stroke prevention increase hemorrhage risk. The objective of the study was to estimate the incidence and costs of hospitalization for stroke and hemorrhage in patients with AF who are eligible for stroke prevention. METHODS: Patients hospitalized for AF were identified from the French National hospital database (Programme Médicalisé des Systèmes d'Information) and a calculated stroke risk score (congestive heart failure, hypertension [blood pressure consistently >140/90 mm Hg], age ≥75 years, diabetes mellitus, and previous stroke, transient ischemic attack [CHADS2]). Adult patients eligible for stroke prevention (CHADS2 >0) were enrolled. The incidence of hospitalization for stroke and hemorrhage was calculated over a 2-year period. Costs of acute care were determined using diagnosis related groups (DRGs) and corresponding National Hospital Tariffs. Rehabilitation costs were analyzed for patients with strokes and classified by stroke severity. RESULTS: Sixty-one thousand five hundred eighty-two patients were identified with a mean age of 75.0 ± 11.0 years and a mean CHADS2 score of 1.90 ± 0.99. The 24-month cumulative incidence of any stroke was 32.1 cases/1,000 patients with AF (ischemic, 60%; hemorrhagic, 24%; unspecified, 16%), and that of hemorrhage was 53.1 cases/1,000 patients with AF (gastrointestinal, 26%; intracranial, 5%; other, 69%). The mean costs of ischemic and hemorrhagic strokes were €4,848 and €7,183 (mild), €10,909 and €14,298 (moderate), €29,065 and €29,701 (severe), and €6,035 and €4,590 (fatal), respectively. The mean costs of hemorrhage by type were €3,601 (gastrointestinal), €7,331 (intracranial), €3,941 (other major), and €2,552 (nonmajor). CONCLUSIONS: The incidence and cost of hospitalization for hemorrhage should be considered in the global burden of AF. These data should be useful for pharmacoeconomic evaluation of new oral anticoagulant medications. Such real-world studies may be relevant for monitoring mid- to long-term morbidity and mortality in the AF population.


Assuntos
Anticoagulantes/efeitos adversos , Anticoagulantes/economia , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/economia , Custos de Cuidados de Saúde , Hemorragia/economia , Hemorragia/epidemiologia , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Custos de Medicamentos , Feminino , França/epidemiologia , Hemorragia Gastrointestinal/induzido quimicamente , Hemorragia Gastrointestinal/economia , Hemorragia Gastrointestinal/epidemiologia , Hemorragia Gastrointestinal/terapia , Recursos em Saúde/economia , Recursos em Saúde/estatística & dados numéricos , Hemorragia/induzido quimicamente , Hemorragia/diagnóstico , Hemorragia/terapia , Custos Hospitalares , Hospitalização/economia , Humanos , Incidência , Hemorragias Intracranianas/induzido quimicamente , Hemorragias Intracranianas/economia , Hemorragias Intracranianas/epidemiologia , Hemorragias Intracranianas/terapia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
15.
J Am Heart Assoc ; 2(6): e000479, 2013 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-24275631

RESUMO

BACKGROUND: Limited data exist on the economic implications of stroke among patients with atrial fibrillation (AF). This study assesses the impact of AF on healthcare costs associated with ischemic stroke (IS), hemorrhagic stroke (HS), or transient ischemic attack (TIA). METHODS AND RESULTS: A retrospective analysis of MarketScan claims data (2005-2011) for AF patients ≥18 years old with ≥1 inpatient claim for stroke, or ≥1 ED or inpatient claim for TIA as identified by ICD-9-CM codes who had ≥12 months continuous enrollment prior to initial stroke. Initial event- and stroke-related costs 12 months post-index were compared among patients with AF and without AF. Adjusted costs were estimated, controlling for demographics, comorbidities, anticoagulant use, and baseline resource use. Data from 23,807 AF patients and 136,649 patients without AF were analyzed. Unadjusted mean cost of the index event was $20,933 for IS, $59,054 for HS, $8616 for TIA hospitalization, and $3395 for TIA ED visit. After controlling for potential confounders, adjusted mean incremental costs (index plus 12-month post-index) for AF patients were higher than those for non-AF patients by: $4726, $7824, and $1890 for index IS, HS, TIA (identified by hospitalization), respectively, and $1700 for TIA (identified by ED) (all P<0.01). In multivariate regression analysis, AF was associated with a 20% (IS), 13% (HS), and 18% (TIA) increase in total stroke-related costs. CONCLUSION: Stroke-related care for IS, HS, and TIA is costly, especially among individuals with AF. Reducing the risk of AF-related stroke is important from both clinical and economic standpoints.


Assuntos
Fibrilação Atrial/economia , Fibrilação Atrial/terapia , Isquemia Encefálica/economia , Isquemia Encefálica/terapia , Custos de Cuidados de Saúde , Hemorragias Intracranianas/economia , Hemorragias Intracranianas/terapia , Acidente Vascular Cerebral/economia , Acidente Vascular Cerebral/terapia , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/economia , Anticoagulantes/uso terapêutico , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/etiologia , Redução de Custos , Análise Custo-Benefício , Custos de Medicamentos , Feminino , Custos Hospitalares , Humanos , Hemorragias Intracranianas/diagnóstico , Hemorragias Intracranianas/etiologia , Ataque Isquêmico Transitório/economia , Ataque Isquêmico Transitório/terapia , Masculino , Pessoa de Meia-Idade , Modelos Econômicos , Prognóstico , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Fatores de Tempo , Estados Unidos
16.
Blood Coagul Fibrinolysis ; 24(1): 23-7, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23080364

RESUMO

Intracranial hemorrhage (ICH) is a significant complication for children with hemophilia. Identifying risk factors may allow us to establish clinically relevant guidelines for the diagnosis and management of ICH. The purpose of this review is to nucleate evidence from the available literature on the incidence, risk factors, presentation, treatment, and outcomes of ICH that can be utilized to develop a clinically useful framework for the diagnosis and management of hemophiliac patients with the condition. An electronic MEDLINE and EMBASE literature search was undertaken using the key words 'intracranial hemorrhage and hemophilia' and setting limits as: Last 10 years and Review or Randomized Controlled Trial (RCT) or Clinical Trial, or Practice Guidelines. Following review of all articles using predetermined search words and criteria, 31 were retrieved with sufficient data to address our objectives. An algorithm is presented for the management of children (≥3 years-18 years) with hemophilia and suspected ICH. A standardized approach to ICH may reduce unnecessary exposure to radiation via computed tomography scan in a select group of children. Currently there is limited scientific evidence to recommend a diagnostic and therapeutic algorithm for neonates with hemophilia.


Assuntos
Hemofilia A/complicações , Hemorragias Intracranianas/etiologia , Adolescente , Algoritmos , Traumatismos do Nascimento/complicações , Fatores de Coagulação Sanguínea/uso terapêutico , Estudos de Casos e Controles , Criança , Pré-Escolar , Comorbidade , Traumatismos Craniocerebrais/complicações , Gerenciamento Clínico , Fator IX/antagonistas & inibidores , Fator IX/imunologia , Fator IX/uso terapêutico , Fator VIII/antagonistas & inibidores , Fator VIII/imunologia , Fator VIII/uso terapêutico , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/economia , Hemorragias Intracranianas/epidemiologia , Hemorragias Intracranianas/terapia , Isoanticorpos/sangue , Tempo de Internação , Masculino , Metanálise como Assunto , Triagem Neonatal , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Fatores de Risco , Tomografia Computadorizada por Raios X , Resultado do Tratamento
17.
J Popul Ther Clin Pharmacol ; 19(2): e166-78, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22580389

RESUMO

BACKGROUND: Idiopathic thrombocytopenic purpura (ITP) is a hematological disorder and can be classified as acute or chronic. The main goal of treatment for acute childhood ITP is the prevention of potentially fatal bleeding complications, the most serious of which is intracranial hemorrhage (ICH). Treatment options for acute childhood ITP include splenectomy, corticosteroids, and blood products such as intravenous immunoglobulin. OBJECTIVES: The objective was to evaluate, from a Canadian perspective, the cost-effectiveness of intravenous immunoglobulin (IVIG) compared to alternative inpatient treatments for acute childhood idiopathic thrombocytopenic purpura (ITP). METHODS: A Markov model with a lifelong time horizon was used to evaluate the costs and quality-adjusted life years (QALYs) for 5 treatments for children hospitalized for ITP: 1) no treatment; 2) IVIG; 3) Anti-D; 4) prednisone; and 5) methylprednisolone. The model predicted the probability of intracranial hemorrhage for each treatment strategy based on the time children spent with platelet counts <20,000µL. The time patients spent with platelet counts <20,000µL with each treatment was estimated by pooling data from published randomized clinical trials. In the basecase analysis, the cohort was assumed to weigh 20kg. Cost and utility model variables were based upon various literature sources. Parameter uncertainty was assessed using probabilistic sensitivity analysis. RESULTS: The treatment strategies that comprised the efficiency frontier were prednisone, Anti-D and IVIG. The incremental cost per QALY was $53,333 moving from prednisone to Anti-D and $53,846 moving from Anti-D to IVIG. Results were sensitive to patient weight. If patient weight is 10kg, IVIG dominates all other strategies and if weight is increased to 30kg, the cost per QALY of IVIG is $163,708. CONCLUSION: Based on common willingness to pay thresholds, IVIG might be considered a cost effective treatment for acute childhood ITP. Cost effectiveness is highly dependent on patient weight.


Assuntos
Custos de Medicamentos , Imunoglobulinas Intravenosas/economia , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/economia , Fatores Imunológicos/uso terapêutico , Púrpura Trombocitopênica Idiopática/tratamento farmacológico , Púrpura Trombocitopênica Idiopática/economia , Doença Aguda , Corticosteroides/economia , Corticosteroides/uso terapêutico , Fatores Etários , Peso Corporal , Canadá , Criança , Análise Custo-Benefício , Custos Hospitalares , Hospitalização/economia , Humanos , Hemorragias Intracranianas/economia , Hemorragias Intracranianas/etiologia , Hemorragias Intracranianas/prevenção & controle , Cadeias de Markov , Modelos Econômicos , Contagem de Plaquetas , Púrpura Trombocitopênica Idiopática/sangue , Púrpura Trombocitopênica Idiopática/complicações , Anos de Vida Ajustados por Qualidade de Vida , Fatores de Tempo , Resultado do Tratamento
18.
Acta Neurochir Suppl ; 111: 337-41, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21725778

RESUMO

As the economic impact of intracranial hemorrhage (ICH) has not been well characterized before, the purpose of this study is to investigate the prognosis of ICH patients with different insurances in southwestern China. This study used hospital data from December 2005 to September 2009. All patients with a final discharge diagnosis of acute ICH were enrolled. Patients were divided by payer sources. Hospital expenditure, length of hospital stay (LOS) and outcome during hospitalization were analyzed. SAS 9.1 software was utilized for the Kruskal-Wallis test and multivariate logistic regression analysis. There were 1,091 adult subjects who met the inclusion criteria of ICH. Hospital costs were remarkably higher for local medical insurance beneficiaries than for the nonlocally insured group and the uninsured group. The locally insured group had the longest LOS compared to the uninsured and nonlocally insured groups. There were significant outcome differences between the locally insured and uninsured groups. However, we noted that locally insured patients seemed to have higher in-hospital mortality from ICH. In spite of acquiring insurance, these ICH subjects did not appear to have better outcomes. The results emphasize the need for improvement in health care policy.


Assuntos
Gastos em Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/economia , Cobertura do Seguro/estatística & dados numéricos , Hemorragias Intracranianas , Adulto , Idoso , China/epidemiologia , Feminino , Custos Hospitalares , Humanos , Hemorragias Intracranianas/economia , Hemorragias Intracranianas/epidemiologia , Hemorragias Intracranianas/terapia , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estatísticas não Paramétricas , Resultado do Tratamento
19.
Acta Neurol Belg ; 111(2): 104-10, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21748928

RESUMO

BACKGROUND: There is only scarce information on the incidence and costs of stroke in Belgium. Knowledge of these figures permits targeted allocation of resources and aids cost efficacy estimates. METHODS: We analysed a nationwide administrative database used for reimbursement of hospitals in Belgium. This database allows analysis of the rate of all hospital admissions for TIA, acute ischemic stroke, intracranial hemorrhage and carotid surgery or angioplasty. We compared the costs of hospitalization for stroke and related disorders with the costs of hospitalization for coronary artery disease. RESULTS: There were 32970 admissions for stroke related disorders in 2007 at a cost of 191.6 million EUROS. There was a decline of 4.7% of the rate of hospitalization for stroke and associated disorders over the period 2002-2007. Despite this decline the total costs did not diminish substantially. In 2007 stroke and related disorders accounted for 2.0% of all Belgian hospitalizations, whereas coronary artery disease hospitalization accounted for 4.4%. The length of stay was longer for stroke and associated disorders. The average cost of hospitalizations in 2007 for stroke related disorders was 6188 EURO and the average cost of coronary artery related disorders was 5026 EURO. CONCLUSION: The cost of hospitalization for stroke and related disorders is high. Although coronary artery disease is more frequent and has a larger impact on the health care expenditures, the average cost per hospitalization is higher for stroke and related diseases. This is mainly due to the longer hospitalization duration for stroke.


Assuntos
Transtornos Cerebrovasculares/economia , Transtornos Cerebrovasculares/epidemiologia , Custos de Cuidados de Saúde , Tempo de Internação/economia , Bélgica/epidemiologia , Transtornos Cerebrovasculares/classificação , Estudos de Coortes , Doença da Artéria Coronariana/economia , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Humanos , Incidência , Hemorragias Intracranianas/economia , Ataque Isquêmico Transitório/economia , Masculino , Reprodutibilidade dos Testes
20.
Stroke ; 42(1): 112-8, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21148442

RESUMO

BACKGROUND AND PURPOSE: in controlled trials, anticoagulation with warfarin reduces stroke risk by nearly two thirds, but the benefit has been less pronounced in clinical practice. This report describes the extent of warfarin use, its effectiveness, and its impact on medical costs among Medicare patients with nonvalvular atrial fibrillation. METHODS: using claims from >2 million beneficiaries in the Centers for Medicare and Medicaid Services 5% Sample Standard Analytic Files, we identified patients with nonvalvular atrial fibrillation from 2004 to 2005. Warfarin use was inferred from 3 or more tests of the international normalized ratio within 1 year. Incidence of ischemic/hemorrhagic stroke and major bleeding was evaluated. Adjusted risk was calculated by Cox proportional-hazards regression. Medical costs (reimbursed amounts in 2006 US dollars) were estimated by multivariate linear regression. RESULTS: of patients with nonvalvular atrial fibrillation (N=119 764, mean age=79.3 years), 58.5% were categorized as warfarin users based on the study definition. During an average of 2.1 years' follow-up, the rate of ischemic stroke was 3.9 per 100 patient-years. After multivariate adjustment, ischemic stroke incidence was 27% lower in patients taking warfarin than in patients not taking warfarin (P<0.0001), with no increase in hemorrhagic stroke and a slightly elevated risk of a major bleed. Use of warfarin was independently associated with lower total medical costs, averaging $9836 per patient per year. CONCLUSIONS: these results indicate that 41.5% of Medicare patients with nonvalvular atrial fibrillation are not anticoagulated with warfarin. The incidence of stroke and overall medical costs were significantly lower in patients treated with warfarin.


Assuntos
Anticoagulantes/economia , Fibrilação Atrial/economia , Medicare/economia , Acidente Vascular Cerebral/economia , Varfarina/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/administração & dosagem , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/epidemiologia , Isquemia Encefálica/economia , Isquemia Encefálica/epidemiologia , Isquemia Encefálica/etiologia , Isquemia Encefálica/prevenção & controle , Custos e Análise de Custo , Feminino , Seguimentos , Humanos , Incidência , Revisão da Utilização de Seguros , Hemorragias Intracranianas/economia , Hemorragias Intracranianas/epidemiologia , Hemorragias Intracranianas/etiologia , Hemorragias Intracranianas/prevenção & controle , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle , Estados Unidos/epidemiologia , Varfarina/administração & dosagem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...