Modelling the costs of care of hypertension in patients with metabolic syndrome and its consequences,in Germany,Spain and Italy

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 economic burden to the health service of metabolic syndrome (MetS) in patients with hypertension and its consequences, in three European countries in 2008, and to forecast future economic burden in 2020 using projected demographic estimates and assumptions around the growth of MetS. An age-, sex- and risk group-structured prevalence-based cost of illness model was developed using the United States Adult Treatment Panel III of the National Cholesterol Education Program criteria to define MetS. Data sources included published information and public use databases on disease prevalence, incidence of cardiovascular events, prevalence of type 2 diabetes, treatment patterns and cost of management in Germany, Spain and Italy. The economic burden to the health service of MetS in patients with hypertension has been estimated at 24,427 €, 1,900 € and 4,877 € million in Germany, Spain and Italy, and is forecast to rise by 59, 179 and 157%, respectively, by 2020. The largest components of costs included the management of prevalent type 2 diabetes and incident cardiovascular events. Mean annual costs per hypertensive patient were around three-fold higher in subjects with MetS compared to those without and rose incrementally with the additional number of MetS components present. In conclusion, the presence of MetS in patients with hypertension significantly inflates economic burden, and costs are likely to increase in the future due to an aging population and an increase in the prevalence of components of MetS.     

The economic burden of obesity in Italy: a cost-of-illness study

The European Journal of Health Economics - Obesity is a complex health disorder that significantly increases the risk of several chronic diseases, and it has been associated with a 5–20-year...     

患有代谢综合征的高血压患者血压达标及影响因素

目的 了解患有MS的高血压患者的血压达标情况及其影响因素。方法 2017年1月至2018年12月,通过心血管病高危人群早期筛查与综合干预项目在福建省采用方便抽样法邀请7.8万名35~75岁常住居民参与筛查,完成体格及实验室检查,将其中具有高血压组分的5 281名MS患者纳入研究。结果 患有MS的高血压患者中高血压治疗率为55.5%,达标率为7.2%。具有高龄、女性、高文化程度、心血管病史及家族史的患者血压达标率更高。多因素分析结果显示,城乡、心血管病史、糖尿病、尿蛋白、BMI等变量对高血压的治疗和达标均有影响。心血管病家族史、年龄、自我管理小组、血脂异常、腰围、饮酒对治疗,性别对达标有影响。结论 患有MS的高血压患者血压治疗率不理想、达标率较低,在干预工作中应重点关注乡镇、男性、低龄群体,坚持定期开展高血压自我管理小组活动。     

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 burden of disease, economic costs and clinical consequences of tuberculosis in the Philippines

OBJECTIVE: To provide a multidisciplinary and comprehensive analysis on the impact of tuberculosis (TB) in a high incidence country. METHODS: Data from several large scale surveys, carried out between 1997 and 2001 in the Philippines, were used to: (1) perform a burden of disease (BoD) analysis, (2) model the economic costs to society due to lost wages, and (3) determine the clinical outcomes, including the costs of care, for a hypothetical cohort of TB cases. RESULTS: Over 500 000 disability-adjusted life years (DALYs) are lost due to illness and premature mortality from TB in the Philippines annually. This is equal to 9% of all years of life lost (YLL) in the Philippines. The combined economic losses due to premature mortality and morbidity total PhP 8 billion (approximately USD $145 million). Clinically, only 28% of patients with incident active TB are diagnosed and successfully treated, while 20% of patients will die without ever being diagnosed and 6% more will die after they are diagnosed because they do not receive adequate care. The costs of treating all expected cases requires between PhP 475-1625 million (approximately USD $8-29 million) annually. CONCLUSION: The high burden of disease from TB, large economic losses from mortality and morbidity from TB and the poor clinical outcomes all suggest that there is an urgent need for an increased investment in TB control. The costs of providing this treatment appear to be significantly lower than the current economic losses.     

Phycocyanin prevents hypertension and low serum adiponectin level in a rat model of metabolic syndrome

Endothelial dysfunction is associated with hypertension, atherosclerosis, and metabolic syndrome. Phycocyanin is a pigment found in the blue-green algae, Spirulina, which possesses antihypertensive effect. In this study, we hypothesized that phycocyanin derived from Spirulina exerts antihypertensive actions by improving endothelial dysfunction in metabolic syndrome. Spontaneously hypertensive/NIH-corpulent (SHR/NDmcr-cp) rats were divided into 4 groups then fed a normal diet with or without phycocyanin (2500-, 5000-, or 10?000-mg/kg diet) for 25 weeks. At 34 weeks of age, although systolic blood pressure was not significantly different among groups, phycocyanin-fed groups exhibited a dose-dependent decrease in blood pressure. Serum levels of adiponectin and messenger RNA levels of adiponectin and CCAAT/enhancer-binding protein α in the adipose tissue of rats fed diets containing phycocyanin tended to be higher than those of rats fed a normal diet, but the differences were not statistically significant. Immunohistochemistry analysis showed a significant and positive correlation between aortic endothelial nitric oxide synthase (eNOS) expression levels, a downstream target of the adiponectin receptor, and serum adiponectin levels, although there were no significant differences in eNOS expression among groups. There was also no significant correlation between eNOS expression levels and systolic blood pressure. These results suggest that long-term administration of phycocyanin may ameliorate systemic blood pressure by enhancing eNOS expression in aorta that is stimulated by adiponectin. Phycocyanin may be beneficial for preventing endothelial dysfunction-related diseases in metabolic syndrome.     

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.     

Global spending on orphan drugs in France, Germany, the UK, Italy and Spain during 2007

Background

Orphan drugs are indicated for the treatment of rare diseases which, in the EU, are defined as those with a prevalence of <5 per 10 000 inhabitants. Characteristically, these diseases negatively affect health-related quality of life and may be life threatening. The EU has passed legislation to encourage pharmaceutical companies to invest in research programmes into rare diseases, with the aim of developing new, safe and effective orphan drugs.

Objectives

To describe the status of orphan drugs in five countries in the EU (France, Germany, the UK, Italy and Spain), estimate the mean annual cost per patient and indication of these orphan drugs, and determine the associated cost of these drugs in comparison with overall spending on drugs in each country (year 2007 values).

Methods

The analysis was limited solely to costs of orphan drugs with sales data available for 2007. The mean annual cost per patient was estimated using recommended regimens for maintenance dose and duration from the summary of product characteristics. Likewise, the ratio between annual costs per patient for treatment of each disease and its prevalence was calculated. Sales data were available for at least one of the countries studied for 38 of the 44 orphan drugs authorized by the European Medicines Agency. Only 21 products had data available for all five countries studied.

Results

Germany was the country with access to the largest number of orphan drugs (36), followed by the UK (34), Spain (28), France (27) and Italy (25). The mean annual cost per patient and indication of the 38 orphan drugs on the market ranged widely from €331 to €337 501. It appears that orphan drugs indicated to treat diseases with a prevalence of <2 per 10 000 inhabitants have higher annual per-patient costs than those indicated to treat diseases with a higher prevalence. The percentage of total drug spending accounted for by orphan drugs in 2007 was 1.7% in France, 2.1% in Germany, 1.0% in the UK, 1.5% in Italy and 2.0% in Spain, with an average overall percentage of 1.7% for these five countries.

Conclusions

In 2007, spending on orphan drugs in five European countries was acceptable in terms of the percentage of these countries’ overall drug expenditure. Mean annual costs per patient of orphan drugs varied widely, with costs being related to the prevalence of the disease for which the product is indicated.     

Epidemiology and economic burden of meningococcal disease in Germany: A systematic review

IntroductionInvasive meningococcal disease (IMD) is a notifiable disease in Germany and other European countries. Due to the high lethality of the disease and the risk of long-term consequences, IMD prevention is of high public health relevance despite the low number of cases in the population. This study aims to describe key epidemiological and economic parameters of IMD in Germany to support national decision-making processes for implementing enhanced prevention measures.MethodsBased on a systematic literature review in PubMed and EMBASE, all publications on the burden of disease and costs of IMD published up to May 2020 were evaluated. Additionally, notification data were used to report the annual case numbers and incidence of IMD in Germany until the end of 2019.ResultsThirty-six studies were included, of which 35 reported data on the epidemiological burden of disease and three reported data on economic aspects of IMD. The type of reported endpoints and results on the incidence of IMD differed widely by reporting year, population, and data source used. Most of the data are reported without specific information about a serogroup. Data on the economic burden of disease and healthcare resource use are scarce. Based on mandatory notification data, a decrease in the incidence of notified IMD cases has been observed since 2004. Currently, the nationwide annual incidence in Germany is at 0.3 cases per 100,000 persons and has gradually decreased. While the overall decline is mainly attributable to MenB, cases with MenY and MenW are the only ones that have increased on a low level in recent years.ConclusionWhile IMD is a rare disease, high direct and indirect costs illustrate the relevance of the disease for patients, caregivers, as well as for the health care system. Future research should concentrate on quantifying the long-term economic burden and indirect costs of meningococcal disease. Integrated IMD surveillance with isolate characterisation remains crucial to inform public health policies.     

A multivariate analysis of risk factors associated with death by Covid-19 in the USA,Italy, Spain,and Germany

Journal of Public Health - Our aim was to investigate the risk factors associated with death from COVID-19 in four countries: The USA, Italy, Spain, and Germany. We used data from the Institute for...     

Health burden and economic impact of measles-related hospitalizations in Italy in 2002–2003

Background  

A large measles outbreak occurred in Italy in 2002–2003. This study evaluates the health burden and economic impact of measles-related hospitalizations in Italy during the specified period.     

The economic burden of pulmonary arterial hypertension (PAH) in the US on payers and patients

Background

Pulmonary arterial hypertension (PAH) is a rare condition that can ultimately lead to right heart failure and death. In this study we estimated the health care costs and resource utilization associated with PAH in a large US managed care health plan.

Methods

Subjects with claims-based evidence of PAH from 1/1/2004 to 6/30/2010 (identification period) were selected. To be included in the final PAH study sample, subjects were required to have ≥2 claims with a primary PH diagnosis; ≥2 claims with a PAH related-diagnosis (connective tissue diseases, congenital heart diseases, portal hypertension); and ≥1 claim with evidence of a PAH-indicated medication. The earliest date of a claim with evidence of PAH-indicated medication during the identification period was set as the index date. Health care costs and resource utilization were compared between an annualized baseline period and a 12 month follow-up period.

Results

504 PAH subjects were selected for the final study cohort. Estimated average total health care costs were approximately 16% lower in the follow-up period compared to the baseline period (follow-up costs?=?$98,243 [SD?=?110,615] vs. baseline costs?=?$116,681 [SD?=?368,094], p?<?0.001), but substantively high in each period relative to costs reported for other chronic diseases. Pharmacy costs were significantly higher in the follow-up period vs. the baseline period, ($38,514 [SD?=?34,817] vs. $6,440 [SD?=?12,186], p?<?0.001) but medical costs were significantly lower in the follow-up vs. baseline ($59,729 [SD?=?106,683] vs. $110,241 [SD?=?368,725], p?<?0.001). These costs were mirrored in health-care resource utilization estimates. The average counts of ambulatory visits and inpatient stays were lower in the follow-up vs. the baseline (both p?<?0.001). Results varied in exploratory analyses when less restrictive subject identification algorithms were used.

Conclusions

Subjects with evidence of PAH had substantively high health care costs. Medical costs appeared to decrease following PAH medication use, but with a concomitant increase in pharmacy costs.

     

代谢综合征对中青年高血压患者颈动脉内膜中层厚度的影响

[目的]探讨代谢综合征(MS)对中青年原发性高血压(EH)患者颈动脉内膜中层厚度(IMT)的影响。[方法]将168例中青年EH患者按是否合并MS分为MS组(88例)和非MS组(80例),采用超声检测仪测定颈动脉IMT,同时测定体质指数(BMI)、腰围(WC)、收缩压(SBP)、舒张压(DBP)、空腹血糖(FPG)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)等相关数据进行比较。[结果]MS组的BMI、WC、FPG、TC、TG、LDL-C、IMT均明显高于非MS组,而HDL-C明显低于非MS组(P值均<0.05)。多因素Logistic回归分析显示,年龄、SBP、FPG、LDL-C为颈动脉IMT增厚的相关因素。[结论]MS对中青年EH患者的IMT有显著影响,其与高血压共同参与动脉粥样硬化过程,在治疗中除降低血压外,还要及早纠正代谢紊乱,预防动脉硬化引起并发症。     

成都市社区慢性阻塞性肺疾病患者直接经济负担及其影响因素分析

目的了解成都社区慢性阻塞性肺疾病(COPD)患者的直接经济负担及其影响因素。方法随机整群抽取成都市6个社区卫生服务试点社区的所有COPD患者作为调查对象,采用逐户走访填写问卷并结合查阅病案的方法对446名患者进行调查,调查内容涉及患者的一般社会人口学特征,疾病相关内容,对待疾病的态度,以及直接经济负担相关费用和人均收入等。结果(1)成都市社区COPD患者年直接经济负担的中位数为1280元,男女两性间以及各年龄组间差异无统计学意义(P>0.05)。首发患者的年直接经济负担中位数为1540元,既往患者的年直接经济负担中位数1090元,首发患者的年直接经济负担显著性高于既往患者(P<0.05)。中年组的门诊费、住院费、住院食宿费及上门诊治费显著性高于老年组(P<0.05),而长期自费用药费则显著性低于老年组(P<0.05)。(2)社区COPD患者全年的住院总费用、门诊总费用、长期自费用药总费用等3项费用为医疗总费用的91.77%;而患者在冬季的医疗总费用占全年医疗总费用的50.17%。(3)影响COPD患者直接经济负担的因素有住院次数、病情严重程度、对疾病的态度、职业和医疗费用负担形式。结论成都市社区COPD患者的直接经济负担是调查人群家庭平均年收入的近1/4,因此,COPD给该地区社区人口带来的直接经济负担是巨大的。国家应及时制定相应政策,并对患者医疗费用的影响因素进行干预和调节。     

贫困农村地区高血压及其合并症的经济负担研究

目的:对贫困农村地区高血压及其合并症的经济负担进行测量和估算,为降低农村心脑血管慢性病家庭的疾病经济风险提供政策建议.方法:采取面对面的问卷调查方式收集高血压及其合并症的经济负担资料,对疾病负担进行定量分析,计算高血压及其合并症的直接医疗费用、直接非医疗费用以及间接经济负担指标.结果:高血压年例均经济负担为1322.67元;脑卒中年例均经济负担为6458.70元;冠心病年例均经济负担为3426.65元.高血压直接经济负担占63.7%,间接经济负担占36.3%;脑卒中直接经济负担占68.1%,间接经济负担占31.9%;冠心病直接经济负担占76.5%,间接经济负担占23.5%.结论:贫困农村高血压及其合并症家庭经济负担较重,政府要从健康安全和社会发展的战略高度上控制农村心脑血管疾病发生和流行.