Cost-benefits of incorporating levosimendan into cardiac surgery practice: German base case
| Autor: | Matthias Heringlake, Marjo Apajasalo, Matti Kivikko, Piero Pollesello, S Mardiguian, Caitlin Smare, Evelina Bertranou |
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| Rok vydání: | 2015 |
| Předmět: |
Inotrope
medicine.medical_specialty Cardiotonic Agents Cost-Benefit Analysis 030204 cardiovascular system & hematology German 03 medical and health sciences 0302 clinical medicine Dobutamine Germany medicine Humans 030212 general & internal medicine Cardiac Surgical Procedures Intensive care medicine Adverse effect health care economics and organizations Simendan Insurance Health business.industry Health Policy Hydrazones Levosimendan Perioperative Length of Stay language.human_language Markov Chains Cardiac surgery Cost savings Pyridazines language business Models Econometric medicine.drug |
| Zdroj: | Journal of medical economics. 19(5) |
| ISSN: | 1941-837X |
| Popis: | To evaluate the cost-benefit of using levosimendan compared with dobutamine, in the perioperative treatment of patients undergoing cardiac surgery who require inotropic support.A two-part Markov model was designed to simulate health-state transitions of patients undergoing cardiac surgery, and estimate the short- and long-term health benefits of treatment. Hospital length of stay (LOS), mortality, medication, and adverse events were key clinical- and cost-inputs. Cost-benefits were evaluated in terms of costs and bed stays within the German healthcare system. Drug prices were calculated from the German Drug Directory (€/2014) and published literature, with a 3% annual discount rate applied. The base case analysis was for a 1-year time horizon.The use of levosimendan vs dobutamine was associated with cost savings of €4787 per patient from the German hospital perspective due to reduced adverse events and shorter hospital LOS, leading to increased bed capacity and hospital revenue.A pharmacoeconomic calculation for the specific situation of the German healthcare system that is based on international clinical trial carries a substantial risk of disregarding potentially relevant but unknown confounding factors (i.e., ICU-staffing, co-medications, standard-ICU care vs fast-tracking, etc.) that may either attenuate or increase the outcome pharmacoeconomic effects of a drug; however, since these conditions would also apply for patients treated with comparators, their net effects may not necessarily influence the conclusions.The use of levosimendan in patients undergoing cardiac surgery who require inotropic support appears to be cost-saving. The results of the analysis provide a strong rationale to run local clinical studies with pharmacoeconomic end-points which would allow a much more precise computation of the benefits of levosimendan. |
| Databáze: | OpenAIRE |
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