Cost-effectiveness of intensive atorvastatin therapy in secondary cardiovascular prevention in the United Kingdom, Spain, and Germany, based on the Treating to New Targets study

The Treating to New Targets (TNT) clinical trial found that intensive 80 mg atorvastatin (A80) treatment reduced cardiovascular events by 22% when compared to 10 mg atorvastatin (A10) treatment. We evaluated the cost-effectiveness of intensive A80 vs A10 treatment in the United Kingdom (UK), Spain, and Germany. A lifetime Markov model was developed to predict cardiovascular disease-related events, costs, survival, and quality-adjusted life-years (QALYs). Treatment-specific event probabilities were estimated from the TNT clinical trial. Post-event survival, health-related quality of life, and country-specific medical-care costs were estimated using published sources. Intensive treatment with A80 increased both the per-patient QALYs and corresponding costs of care, when compared to the A10 treatment, in all three countries. The incremental cost per QALY gained was € 9,500, € 21,000, and € 15,000 in the UK, Spain, and Germany, respectively. Intensive A80 treatment is estimated to be cost-effective when compared to A10 treatment in secondary cardiovascular prevention.      

Economic burden of obesity and its complications in Germany

This study estimated the economic burden of illness of obesity and selected comorbidities in terms of health outcome and costs to society and healthcare payer in Germany. The proportions of selected diseases (comorbidities) attributable solely to obesity were estimated using odds ratios/relative risks and prevalences based on data from the literature. The top-down approach was employed to match healthcare spending with the number of patients suffering from obesity (BMI 30+) and the major comorbidities to evaluate overall direct and indirect costs. In Germany there are approximately 12.24 million obese adults, 2.06–3.76 million of whom suffer from the selected comorbidities. From a societal perspective the total costs for obesity and comorbidities are €2,701–5,682 million per year and the direct treatment costs alone account for €1,343–2,699 million, imposing a major burden to the healthcare system. In view of the magnitude of the economic burden of illness there is a need for both further research and action at the health policy level.Financial support for this study was provided entirely by a contract with Abbott GmbH & Co KG, Center for Pharmaceutical Appraisal & Outcomes Research. The funding agreement ensured the authors' independence in designing the study, interpreting the data, writing, and publishing the report.     

The present and future burden of previously treated advanced non-small cell lung cancer (NSCLC) by histology and line of therapy in France,Germany, Italy,and Spain: model-based predictions

Background

The burden of advanced non-small cell lung cancer (NSCLC) is not well understood, and the number of patients likely to receive treatment in Europe has not been quantified. The aim of this study was to forecast the annual number of patients with squamous and non-squamous advanced NSCLC likely to receive second and third lines of therapy (LOT) from 2016 to 2020 in France, Germany, Italy, and Spain.

Methods

A patient count model (PCM) was developed in Microsoft Excel to estimate the number of patients with refractory advanced NSCLC eligible to receive systemic treatment. Using historical population-based cancer registry data, segmented linear regression (“Joinpoint”) was used to forecast age- and sex-stratified lung cancer incidence rates in each country through 2020. Yearly incident case count totals by country were apportioned according to NSCLC histology and stage at diagnosis. Country-specific treatment rates came from a recent medical chart review study, and early- to advanced-stage disease progression rates were estimated over a 10-year interval. A probabilistic sensitivity analysis (PSA) was performed to estimate variability in the patient counts.

Results

The combined number of squamous and non-squamous advanced NSCLC patients estimated to receive second and third LOT, respectively, in 2016 were France?=?11,600 and 3500; Germany?=?15,100 and 4900; Italy?=?13,500 and 2500; Spain?=?9400 and 2100. The forecasted numbers of patients receiving second and third LOT, respectively, in 2020 were France?=?13,900 and 4200; Germany?=?16,200 and 5200; Italy?=?15,100 and 2600; Spain?=?11,000 and 2500.

Conclusions

Driven by growth in the incidence of NSCLC among women, the model forecasts an overall increase in the number of patients with advanced-stage squamous and non-squamous NSCLC likely to receive systemic treatment in the year 2020. The results highlight the significant burden of refractory advanced NSCLC and the need for more robust surveillance data to accurately quantify the burden of disease.

     

Cost-effectiveness of extended-release niacin/laropiprant added to a stable simvastatin dose in secondary prevention patients not at cholesterol goal in Germany

Coronary heart disease (CHD) remains the leading cause of death in Germany despite statin use to reduce low-density lipoprotein cholesterol (LDL-C) levels; improving lipids beyond LDL-C may further reduce cardiovascular risk. A fixed-dose combination of extended-release niacin (ERN) with laropiprant (LRPT) provides comprehensive lipid management. We adapted a decision-analytic model to evaluate the economic value (incremental cost-effectiveness ratio [ICER] in terms of costs per life-years gained [LYG]) of ERN/LRPT 2 g over a lifetime in secondary prevention patients in a German setting. Two scenarios were modelled: (1) ERN/LRPT 2 g added to simvastatin 40 mg in patients not at LDL-C goal with simvastatin 40 mg; (2) adding ERN/LRPT 2 g compared with titration to simvastatin 40 mg in patients not at LDL-C goal with simvastatin 20 mg. In both scenarios, adding ERN/LRPT was cost-effective relative to simvastatin monotherapy at a commonly accepted threshold of €30,000 per LYG; ICERs for ERN/LRPT were €13,331 per LYG in scenario 1 and €17,684 per LYG in scenario 2. Subgroup analyses showed that ERN/LRPT was cost-effective in patients with or without diabetes, patients aged ≤65 or >65 years and patients with low baseline high-density lipoprotein cholesterol levels; ICERs ranged from €10,342 to €15,579 in scenario 1, and from €14,081 to €20,462 in scenario 2. In conclusion, comprehensive lipid management with ERN/LRPT 2 g is cost-effective in secondary prevention patients in Germany who have not achieved LDL-C goal with simvastatin monotherapy.     

Epidemiological and economic burden of metabolic syndrome and its consequences in patients with hypertension in Germany,Spain and Italy; a prevalence-based model

Background  

The presence of metabolic syndrome in patients with hypertension significantly increases the risk of cardiovascular disease, type 2 diabetes and mortality. Our aim is to estimate the epidemiological and economic burden to the health service of metabolic syndrome in patients with hypertension in three European countries in 2008 and 2020.     

Prevalence of Dyslipidemia and Hypertension in Indian Type 2 Diabetic Patients with Metabolic Syndrome and its Clinical Significance

Objectives

The present study was designed to estimate the prevalence of dyslipidemia and hypertension based on the National Cholesterol Educational Programme Adult Treatment Panel III definition of metabolic syndrome (MetS). The study also focuses on prevalence for MetS with respect to the duration of disease in Gwalior–Chambal region of Madhya Pradesh, India.

Methods

Type 2 diabetic patients (n = 700) were selected from a cross-sectional study that is regularly being conducted in the School of Studies in Biochemistry, Jiwaji University Gwalior, India. The period of our study was from January 2007 to October 2009. Dyslipidemia and hypertension were determined in type 2 diabetic patients with MetS as per National Cholesterol Educational Programme Adult Treatment Panel III criteria.

Results

The mean age of the study population was 54 ± 9.3 years with 504 (72%) males and 196 (28%) females. The prevalence of MetS increased with increased duration of diabetes in females; however, almost constant prevalence was seen in the males. Notable increase in the dyslipidemia (64.1%) and hypertension (49%) in type 2 diabetic patients were seen. The steep increase in dyslipidemia and hypertension could be the reason for the growing prevalence of diabetes worldwide. The study also noted a close association between age and occurrence of MetS.

Conclusion

Individual variable of MetS appears to be highly rampant in diabetic population. Despite treatment, almost half of patients still met the criteria for MetS. Effective treatment of MetS components is required to reduce cardiovascular risk in diabetes mellitus hence accurate and early diagnosis to induce effective treatment of MetS in Indian population will be pivotal in the prevention of cardiovascular disease and type 2 diabetes.     

Cost of care of colorectal cancers according to health care patterns and stage at diagnosis in France

Little is known about the economic burden associated with colorectal cancer in France. The aim of this study was to evaluate the effects of age, stage at diagnosis, health care pattern and level of comorbidities on the mean cost of the management of colorectal cancers, using data from a population-based registry and the French health care system. We estimated the direct costs of medical care for 384 colorectal cancers diagnosed in 2004, using the three main databases of the National Health Insurance. The cost of management was defined as the sum of all health expenditures over the 12 months following the date of diagnosis. The mean cost for first-year management was 24,966€ (SE 1,195€). There was no significant difference in overall costs in relation to sex, age, Charlson index score, cancer location or health care pattern. Costs increased significantly with cancer extension from 17,596€ for stage I to 35,059€ for stage IV. Hospitalisation charges represented the greatest economic burden (55.2%), followed by medical purchases (24.4%), outpatient care (17.8%) and transportation (2.5%). These results confirm the major economic burden of colorectal cancer and indicate that total costs depend mainly on the stage at diagnosis. By improving stage at diagnosis, mass screening could contribute to decreasing the cost of managing colorectal cancers.     

新型农村合作医疗制度对滕州市农村居民慢性病患者经济负担的影响研究

目的了解新型农村合作医疗制度对农村居民高血压与糖尿病患者疾病负担的影响。方法通过对山东省滕州市农村居民家庭抽样调查,了解其慢性病患病情况,并计算高血压、糖尿病患者的直接经济负担。结果高血压患者的年例均直接经济负担为785.55元,糖尿病患者年例均直接经济负担为1918.50元。结论慢性病患者家庭经济负担依然较重,加强慢性病患者早期保健,筛选适宜控制方案,提高防治工作效率是缓解慢性病家庭经济负担的主要措施。     

Resource use and costs associated with patients treated for depression in primary care

We investigated medical resource consumption, productivity loss and costs associated with patients treated with antidepressants for depression in primary care in Sweden. Patients on treatment for depression were followed naturalistically for six months, and data on patients’ characteristics, daily activity and resource-use were collected. The total cost per patient was estimated at € 5,500 (95%CI € 5,000—6,100) over six months in 2005 prices. Direct costs were estimated at € 1,900 (€ 1,700–2,200), 35% of total costs, and indirect costs at € 3,600 (€ 3,100–4,100), 65% of total costs. The cost for antidepressants represented only 4% of the total costs. We conclude that the burden of depression is high, both to the individual as well as to wider society, and there seems to be a particular need for therapies that have the potential to improve productivity in depressed patients.      

Infertility and subfecundity in population-based samples from Denmark, Germany, Italy, Poland and Spain

Background: No uniform data which give basic Information onthe societal burden of infertility and subfecundity exists inEurope. Methods: In a population-based survey the prevalenceof subfecundity was ascertained by means of a standardized interviewwith women in Denmark, Germany, Poland, Italy and Spain. Thetime of unprotected intercourse (TUI) either leading or notleading to pregnancy was applied as a uniform measure of fecundity.Population-based samples of women 25–44 years of age wererecruited. Results: Altogether 6,630 women participated in thestudy. With regard to the first pregnancy, 19% of all coupleshad a TUI of more than 12 months, which is within the rangeof most previous findings. Regarding the most recent and firstTUI in individual lives, if it had occurred within previous5 years, 23.4% overall did not conceive within 12 months (inPoland 33.3%, in north Italy and Germany 26.2%, in Denmark 23.3%,in Spain 18.6% and in south Italy 14.8%). Secondary subfecunditywas more prevalent in Poland. When stratifying for planningof a pregnancy, the differences between countries diminished,particularly for the most recent TUI. However, the pattern ofa higher prevalence of subfecundity in Poland, north Italy,Denmark and Germany and a lower prevalence (<20%) in Spainand south italy remains. Conclusions: Important differencesin the prevalence of subfecundity exist between the six Europeanregions investigated. Comparisons should first consider TUIsor planned TUIs to reduce the impact of distorting factors,which are mainly due to differing cultures of family planningin Europe.     

The direct medical cost of cardiovascular diseases,hypertension, diabetes,cancer, pregnancy and female infertility in a large HMO in Israel

ObjectivesThe aim of this study was to assess the direct medical cost of treating major chronic illnesses in Maccabi Healthcare Services, a 1.8 million member health maintenance organization in Israel.MethodsDirect medical costs were calculated for each member in 2006. We used multiple linear regression models to evaluate the overall costs of chronic conditions (cardiovascular diseases, diabetes mellitus, hypertension, female infertility treatments, and cancer), pregnancy and treatments for female infertility.ResultsAccording to the study model, hypertension was associated with the largest direct medical costs in both sexes. Cardiovascular diseases accounted for 9.5% of the total direct medical costs in men, but only 5.9% in women. Diabetes mellitus accounted for 3.5% of the total medical costs both in men and women and is comparable to the total pregnancy-related costs in women.ConclusionsThe findings indicate that hypertension, diabetes mellitus and female infertility treatments impose a considerable economic burden on public healthcare services in Israel which is comparable with the costs of cancer and cardiovascular diseases.     

The direct and indirect cost of diabetes in Italy: a prevalence probabilistic approach

Introduction

Diabetes mellitus is a chronic degenerative disease associated with a high risk of chronic complications and comorbidities. However, very few data are available on the associated cost. The objective of this study is to identify the available information on the epidemiology of the disease and estimate the average annual cost incurred by the National Health Service and Society for the Treatment of Diabetes in Italy.

Methods

A probabilistic prevalence cost of illness model was developed to calculate an aggregate measure of the economic burden associated with the disease, in terms of direct medical costs (drugs, hospitalizations, monitoring and adverse events) and indirect costs (absenteeism and early retirement). A systematic review of the literature was conducted to determine both the epidemiological and economic data. Furthermore, a one-way and probabilistic sensitivity analysis with 5,000 Monte Carlo simulations was performed to test the robustness of the results and define a 95 % CI.

Results

The model estimated a prevalence of 2.6 million patients under drug therapies in Italy. The total economic burden of diabetic patients in Italy amounted to €20.3 billion/year (95 % CI €18.61 to €22.29 billion), 54 % of which are associated with indirect costs (95 % CI €10.10 to €11.62 billion) and 46 % with direct costs only (95 % CI €8.11 to €11.06 billion).

Conclusions

This is the first study conducted in Italy aimed at estimating the direct and indirect cost of diabetes with a probabilistic prevalence approach. As might be expected, the lack of information means that the real burden of diabetes is partly underestimated, especially with regard to indirect costs. However, this is a useful approach for policy makers to understand the economic implications of diabetes treatment in Italy.

     

Long-term cost-effectiveness of clopidogrel in patients with acute coronary syndrome without ST-segment elevation in Germany

Patients with acute coronary syndrome without ST-segment elevation receiving clopidogrel in addition to acetylsalicylic acid (ASA) showed a 20% risk reduction in comparison to patients receiving ASA monotherapy (CURE trial). Economic models for assessing the impact on costs exist for several countries but not for Germany on a long-term basis. The objective of this model adaptation is to assess the long-term economic impact of clopidogrel taken in addition to ASA in Germany. A Markov model with six states [at risk, first year with stroke, following years with stroke, first year with new myocardial infarction (MI), following years with MI, and death] was adapted for Germany. Model outcome was life-years saved. Effects of 1-year treatment were calculated based on the CURE trial. Resource use for the different health states was based on published data, which included costs for drugs, outpatient care, hospitalization, rehabilitation and nursing. Risk data for MI and stroke were based on Swedish data and validated for the German adaptation. The model calculates lifetime costs and survival length. Costs were estimated from the payers’ perspective. A series of one-way sensitivity analyses was conducted (follow-up costs, discount rates). The Markov analysis predicts a survival of 8.89 years in the placebo treatment group and 9.02 years in the clopidogrel treatment group. The cumulated costs were €8,548 and €8,953, respectively. The incremental cost-effectiveness ratio (ICER) was €3,113 for each life-year saved. The model was robust regarding variations in key parameters in the sensitivity analysis, resulting in a range of ICER from €1,338 to €9,322. Our results are in line with the results for other healthcare systems. Adding clopidogrel to ASA for patients with acute coronary syndrome without ST-segment elevation generated an additional life-year saved at a comparably low value of €3,113. One-year treatment with clopidogrel is a cost-effective treatment option in patients with acute coronary syndrome from the perspective of a third-party payer in Germany.

深圳市福田区高血压和糖尿病流行特征 及疾病经济负担研究

摘要:目的　研究深圳市福田区居民高血压和糖尿病流行特征以及疾病经济负担,为开展慢性病防控工作提供科学依据。方法　采用整群随机抽样方法,共抽取1191名18岁以上常住居民。通过问卷调查和体格测量获得个人资料及血压、血糖值,利用第四次卫生服务调查数据,估算福田区高血压和糖尿病疾病经济负担。结果　深圳市福田区居民高血压患病率12.5%（标化患病率14.6%）,糖尿病患病率5.6%（标化患病率6.6%）;福田区高血压直接经济负担11791.17万元,糖尿病直接经济负担8097.33万元。结论　深圳市福田区慢性病患病率增长迅速,疾病经济负担高,建议巩固医疗改革“保基本”的方针,深化慢性病防控工作。     

阜新市农村居民慢性疾病患病及经济负担调查

目的调查辽宁省阜新市(高血压、冠心病、脑卒中、糖尿病)的患病率及经济负担。方法2004~2006年,对辽宁省阜新市农村地区8个乡镇、85个自然村的35岁及以上的45 925名常住居民进行调查。应用患病比值比和人群归因危险度,计算超重和肥胖造成这4种慢性疾病的直接经济负担。结果阜新市农村居民高血压、冠心病、脑卒中和糖尿病的患病率分别为37.8%,4.2%,2.5%和1.9%,而这4种慢性疾病造成的直接经济负担分别为5.2亿元,1.3亿元,1.7亿元和1.4亿元。其中归因于超重和肥胖的直接经济负担为2.3亿元,占4种病合计直接疾病负担的24.4%。结论超重和肥胖对农村居民所造成的高血压、冠心病、脑卒中和糖尿病的直接经济负担较重,应加强农村居民健康教育,提高对肥胖危害的认识及预防措施。     

Modelling the 5-year cost effectiveness of tiotropium, salmeterol and ipratropium for the treatment of chronic obstructive pulmonary disease in Spain

Our objective was to assess the 5-year cost effectiveness of bronchodilator therapy with tiotropium, salmeterol or ipratropium for chronic obstructive pulmonary disease (COPD) from the perspective of the Spanish National Health System (NHS). A probabilistic Markov model was designed wherein patients moved between moderate, severe or very severe COPD and had the risk of exacerbation and death. Probabilities were derived from clinical trials. Spanish healthcare utilisation, costs and utilities were estimated for each COPD and exacerbation state. Outcomes were exacerbations, exacerbation-free months, quality-adjusted life years (QALYs), and cost(-effectiveness). The mean (SE) 5-year number of exacerbations was 3.50 (0.14) for tiotropium, 4.16 (0.40) for salmeterol and 4.71 (0.54) for ipratropium. The mean (SE) number of QALYs was 3.15 (0.08), 3.02 (0.15) and 3.00 (0.20), respectively. Mean (SE) 5-year costs were €6,424 (€305) for tiotropium, €5,869 (€505) for salmeterol, and €5,181 (€682) for ipratropium (2005 values). Ipratropium and tiotropium formed the cost-effectiveness frontier, with tiotropium being preferred when willingness to pay (WTP) exceeded €639 per exacerbation-free month and €8,157 per QALY. In Spain, tiotropium demonstrated the highest expected net benefit for ratios of the willingness to pay per QALY, well within accepted limits. This study was financially supported by Boehringer Ingelheim International and Pfizer Global Pharmaceuticals.     

Utility loss and indirect costs following cardiovascular events in hypertensive patients: the ASCOT health economic substudy

This study assessed the loss of utility and indirect costs associated with first cardiovascular events. Data was collected (using EQ-5D) prospectively at 3, 6, and 12 months following an event in the Swedish part of the Anglo—Scandinavian cardiac outcomes trial (ASCOT), including patients with mild to moderate hypertension and additional risk factors. Sixty patients were eligible for analysis. An event was associated with a one-year utility loss of 0.075 (95% CI: 0.038–0.114). For a stroke, the reduction was 0.145 (CI: 0.059–0.249) and for acute coronary syndromes (myocardial infarction or unstable angina) the loss was 0.051 (−0.003 to 0.103). The utility at baseline was no different to the utility in a control group. The indirect cost over the first 12 months (2003 Swedish Kronor, SEK) was 90028 SEK (CI: 46027–146754), 9866 € for patients in the workforce. These results are helpful in future economic evaluations of primary preventive measures in cardiovascular medicine.     

Analysis of the Association between Metabolic Syndrome and Disease in a Workplace Population over Time

ObjectivesWhile research has confirmed an association between metabolic syndrome (MetS) and diseases such as heart disease and diabetes, none of these studies have been conducted in a worksite population. Because corporations are often the primary payer of health-care costs in the United States, they have a vested interest in identifying the magnitude of MetS risk factors in employed populations, and also in knowing if those risk factors are associated with other health risks or medical conditions.MethodsThis study identified the prevalence of MetS risk factors and self-reported disease in employees (N = 3285) of a manufacturing corporation who participated in a health risk appraisal and biometric screening in both 2004 and 2006. Health-care costs, pharmacy costs, and short-term disability costs were compared for those with and without MetS and disease.ResultsThe prevalence of MetS increased from 2004 to 2006 in this employed population. Those with MetS were significantly more likely to self-report arthritis, chronic pain, diabetes, heartburn, heart disease, and stroke. Employees with MetS in 2004 were also significantly more likely to report new cases of arthritis, chronic pain, diabetes, and heart disease in 2006. The costs of those with MetS and disease were 3.66 times greater than those without MetS and without disease.ConclusionsMetS is associated with disease and increased costs in this working population. There is an opportunity for health promotion to prevent MetS risk factors from progressing to disease status which may improve vitality for employees, as well as limit the economic impact to the corporation.     

Depression: cost-of-illness studies in the international literature, a review

BACKGROUND: Depression is one of the most ancient and common diseases of the human race and its burden on society is really impressive. This stems both from the epidemiological spread (lifetime prevalence rate, up to 30 years of age, was estimated as greater than 14.4% by Angst et al.) and from the economic burden on healthcare systems and society, but also as it pertains to patient well-being. AIMS OF THE STUDY: The scope of this review was to examine studies published in the international literature to describe and compare the social costs of depression in various countries. METHODS: A bibliographic search was performed on international medical literature databases (Medline, Embase), where all studies published after 1970 were selected. Studies were carefully evaluated and only those that provided cost data were included in the comparative analysis; this latter phase was conducted using a newly developed evaluation chart. RESULTS: 10 abstracts were firstly selected; 46 of them underwent a subsequent full paper reading, thus providing seven papers, which were the subject of the in-depth comparative analysis: three studies investigated the cost of depression in the USA, three studies in the UK and one study was related to Italy. All the studies examined highlight the relevant economic burden of depression; in 1990, including both direct and indirect costs, it accounted for US$ 43.7 billion in the US (US$ 65 billion, at 1998 prices) according to Greenberg and colleagues, whilst direct costs accounted for ￡417 million in the UK (or US$ 962.5 million, at 1998 prices), according to Kind and Sorensen. Within direct costs, the major cost driver was indeed hospitalization, which represented something in between 43 and 75% of the average per patient cost; conversely, drug cost accounted for only 2% to 11% in five out of seven studies. DISCUSSION: Indeed, our review suggests that at the direct cost level, in both the United States and the United Kingdom, the burden of depression is remarkable, and this is confirmed by a recent report issued by the Pharmaceutical Research and Manufacturers Association (PhRMA) where prevalence and cost of disease were compared for several major chronic diseases, including Alzheimer, asthma, cancer, depression, osteoporosis, hypertension, schizophrenia and others: in this comparison, depression is one of the most significant diseases, ranked third by prevalence and sixth in terms of economic burden. Moreover, in terms of the average cost per patient, depression imposes a societal burden that is larger than other chronic conditions such as hypertension, rheumatoid arthritis, asthma and osteoporosis. The application of economic methods to the epidemiological and clinical field is a relatively recent development, as evidenced by the finding that, out of the seven studies examined, three refer to the US environment, three to the UK and one to Italy, while nothing was available about the cost of depression for large countries such as France, Germany, Spain, Japan and others. IMPLICATION FOR HEALTH CARE PROVISION AND USE: The high incidence of hospitalization, and the finding that drug cost represents only a minor component of the total direct cost of the disease, suggests that room is still available for disease management strategies that, while effectively managing the patient's clinical profile, could also improve health economic efficiency. IMPLICATION FOR HEALTH POLICIES: Disease management strategies, with particular emphasis on education, should be targeted not only at patients and medical professionals but also at health decision makers in order "to encourage effective prevention and treatment of depressive illness". IMPLICATIONS FOR FURTHER RESEARCH: Cost of illness studies are a very useful tool allowing cost data comparisons across countries and diseases: for this reason, we suggest that further research is needed especially in some western European countries to assess the true economic burden of depression on societies.     

Management of the metabolic syndrome

The metabolic syndrome (MetS) represents the co-occurrence of insulin resistance, hypertension, central adiposity, atherogenic dyslipidemia, and a pro-inflammatory and pro-thrombotic state. Patients with this syndrome are at increased risk for the development of type 2 diabetes mellitus and cardiovascular disease. Epidemiologic studies reveal a prevalence of the MetS that increases with age and obesity. Patients with the MetS should be recognized as being at high risk for cardiovascular complications. Ongoing research focuses on the underlying pathophysiology of this disorder and the use of drug therapy to directly target insulin resistance and endothelial dysfunction. Currently, the standard of care includes active identification and aggressive management of traditional cardiovascular risk factors with an emphasis on healthy lifestyle changes to reduce weight and increase physical fitness.