Emiliano Rossi

Cost-effectiveness of a hypertension management programme in an elderly population: a Markov model

BackgroundMounting evidence shows that multi-intervention programmes for hypertension treatment are more effective than an isolated pharmacological strategy. Full economic evaluations of hypertension management programmes are scarce and contain methodological limitations. The aim of the study was to evaluate if a hypertension management programme for elderly patients is cost-effective compared to usual care from the perspective of a third-party payer.MethodsWe built a cost-effectiveness model using published evidence of effectiveness of a comprehensive hypertension programme vs. usual care for patients 65 years or older at a community hospital in Buenos Aires, Argentina. We explored incremental cost-effectiveness between groups. The model used a life-time framework adopting a third-party payers perspective. Incremental cost-effectiveness ratio (ICER) was calculated in International Dollars per life-year gained. We performed a probabilistic sensitivity analysis (PSA) to explore variable uncertainty.ResultsThe ICER for the base-case of the Hypertension Programme versus the Usual care approach was 1,124 International Dollars per life-year gained. PSA did not significantly influence results. The programme had a probability of 43% of being dominant (more effective and less costly) and, overall, 95% chance of being cost-effective.DiscussionResults showed that Hypertension Programme had high probabilities of being cost-effective under a wide range of scenarios. This is the first sound cost-effectiveness study to assess a comprehensive hypertension programme versus usual care. This study measures hard outcomes and explores robustness through a probabilistic sensitivity analysis.ConclusionsThe comprehensive hypertension programme had high probabilities of being cost-effective versus usual care. This study supports the idea that similar programmes could be the preferred strategy in countries and within health care systems where hypertension treatment for elderly patients is a standard practice.

Aortic Annulus Enlargement vs. Conventional Surgery in Patients with Small Aortic Annulus Undergoing Aortic Valve Replacement

Background: The goal of aortic valve replacement for severe stenosis is to relieve symptoms and prevent the mortality associated with the disease. Appropriate prosthetic valve size must be selected for each patient according to body surface area to avoid patientprosthesis mismatch. Objective: The aim of this study was to evaluate transvalvular gradient reduction at one-year follow-up in patients with small aortic annulus undergoing valve replacement with annular enlargement vs. conventional replacement surgery. Methods: A retrospective cohort study was performed including patients with small aortic annulus undergoing valve replacement from January 2011 to December 2015. Two groups were selected: Group AAE consisting of patients in whom aortic annular enlargement was necessary and Group RVA19 involving patients in whom a #19 mm prosthetic valve was conventionally implanted. Results: Postoperative gradients (within the first 3 months and at one year) were significantly lower in the group with aortic annular enlargement. Median cardiopulmonary bypass time increased 14 minutes in Group AAE. Bioprostheses were used in most cases. There was no statistically significant difference in mortality between the groups. Conclusions: Aortic annular enlargement improves postoperative, short-term and at one year follow-up transvalvular gradients.