Glenn M. Davies

Burden of Aspergillosis-Related Hospitalizations in the United States

In the United States in 1996, there were an estimated 10,190 aspergillosis-related hospitalizations (95% confidence interval [CI], 9000-11,380); these resulted in 1970 deaths (95% CI, 1659-2280), 176,272 hospital days (95% CI, 147,163-206,275), and

Lipid-modifying therapy and attainment of cholesterol goals in Europe: the Return on Expenditure Achieved for Lipid Therapy (REALITY) study

633.1 million in costs (95% CI,

Cost-effectiveness of ezetimibe coadministration in statin-treated patients not at cholesterol goal: application to Germany, Spain and Norway.

492.0-

Population-based health-economic evaluation of the secondary prevention of coronary heart disease in Finland

780.2 million). The average hospitalization lasted 17.3 days (95% CI, 16.1-18.6) and cost

Projected cost-effectiveness of ezetimibe/simvastatin compared with doubling the statin dose in the United Kingdom: findings from the INFORCE study.

62,426 (95% CI,

State transition model: vorapaxar added to standard antiplatelet therapy to prevent thrombosis post myocardial infarction or peripheral artery disease

52,670-

Improvement in Health-Related Quality of Life with Rizatriptan 10mg Compared with Standard Migraine Therapy

72,181). Although aspergillosis-related hospitalizations account for a small percentage of hospitalizations in the United States, patients hospitalized with the condition have lengthy hospital stays and high mortality rates.

Cost–effectiveness of adding ezetimibe to atorvastatin vs switching to rosuvastatin therapy in Portugal

ABSTRACT Background: Few studies have been conducted in actual clinical practice settings to evaluate the ways in which dyslipidemia is managed using lipid-modifying therapies. Objective: To determine lipid-modifying therapy practices and their effects on low-density lipoprotein cholesterol (LDL‐C) and/or total cholesterol (TC) goal attainment in Europeans based on prevailing guidelines at the time of therapy in each country. Methods: Retrospective cohort analysis involving 58 223 patients initiated on lipid-modifying therapies in 10 European countries, with a median patient follow-up on lipid-modifying therapy of 15.3 months. Data on prescriptions of lipid-modifying therapies, laboratory data including LDL‐C and TC, achievement of cholesterol goals for LDL‐C and/or TC, and hospitalizations were obtained from healthcare administrative databases and/or patient chart reviews. Results: Across Europe, statin monotherapy was the initial lipid-modifying treatment in 51 786 (89.3%) of 58 009 patients with available data. In addition, 38 853 (89.5%) of 43 410 patients with available follow-up statin potency data were initiated on statin regimens of medium or lower equipotency. Low-equipotency regimens include atorvastatin 5 mg, simvastatin 10 mg, and pravastatin 20 mg, whereas medium-equipotency regimens include atorvastatin 10 mg, simvastatin 20 mg, and pravastatin 40 mg. Regimens were adjusted to higher equipotency via either up-titration or switches to combination regimens in 16.2% of patients. On average, 40.5% of patients across Europe who were not initially at guideline recommended cholesterol goals (either LDL‐C or TC) and had follow-up data attained recommended cholesterol levels, including < 30% of patients in Spain, Italy, or Hungary. In many countries, the likelihood of goal attainment was inversely associated with baseline cardiovascular risk and/or LDL‐C levels. Conclusions: Lipid management strategies in Europe during the study period were dominated by statin monotherapy. Even after prolonged follow-up on lipid-modifying therapy, approximately 60% of Europeans studied did not achieve guideline recommended cholesterol goals. Future emphasis must be placed on subsequent lipid panel monitoring, as well as the use of more efficacious, well-tolerated lipid-modifying therapies such as dual cholesterol inhibitors to enable more European patients to attain their recommended cholesterol goals.

Modeling Long-Term Cost-Effectiveness of Sitagliptin and SGLT2i Combination Therapy for the Treatment of Type 2 Diabetes

AbstractBackground: Despite the growing use of statins, many hypercholesterolaemic patients fail to reach their lipid goal and remain at elevated risk of coronary heart disease (CHD). Alternative treatment strategies, such as ezetimibe coadministration and statin titration, can help patients achieve greater lipid control, and thereby lower their CHD risk. But is it cost effective to more aggressively lower cholesterol levels across a broad range of current statin users? Methods: Using a decision-analytic model based on epidemiological and clinical trials data, we project the lifetime benefit and cost of alternative lipid-lowering treatment strategies for CHD and non-CHD diabetic patients in Germany, Spain and Norway. Results: It is projected that from 40% to 76% of these patients who have failed to reach their lipid goal with their current statin treatment will be able to reach their goal with ezetimibe coadministration; this represents a gain of up to an additional absolute 14% who will be able to reach their goal compared with a ‘titrate to goal’ strategy where patients are titrated in order to reach their lipid goal (up to the maximum approved dose). For CHD patients, the estimated incremental cost-effectiveness ratio for ezetimibe coadministration is under €18 000 per life-year gained (€/LYG) and 26 000 €/LYG compared with strategies based on the observed titration rates and the aggressive ‘titrate to goal’ strategy, respectively; for non-CHD diabetic patients, these ratios are under 26 000 €/LYG and 48 000 €/LYG for ezetimibe coadministration compared with the two titration strategies. Conclusion: Compared with statin titration, ezetimibe coadministration is projected to be cost effective in the populations and countries studied.

Ezetimibe in high-risk, previously treated statin patients: a systematic review and network meta-analysis of lipid efficacy

Abstract Objective: To evaluate the cost-effectiveness of generic atorvastatin 20 mg (A20), branded rosuvastatin 10 mg (R10), generic simvastatin 40 mg (S40) and the combination of generic S40 + branded ezetimibe 10 mg (S40 + EZ10) for the secondary prevention of coronary heart disease (CHD) in Finnish patients not meeting the target goal of low-density lipoprotein cholesterol (LDL-C) with S40. Research design and methods: A probabilistic Markov model was employed to evaluate the costs and health outcomes of the different therapies based on the cardiovascular events avoided. The model included Framingham risk equations, Finnish population characteristics, event rates, quality of life estimates, resource use and unit costs. The LDL-C lowering efficacies were gathered from a systematic literature review, based on a search of Medline carried out in June 2008 (no time limit). Main outcome measures: Incremental cost per quality-adjusted life year (QALY) gained and incremental cost per life year gained (LYG). Results: The efficacy (LDL-C decrease) gained from switching S40 to S40 + EZ10 was consistent in the literature review, whereas the LDL-C decrease gained from switching S40 to A20/R10 was uncertain. The incremental cost per QALY gained from switching generic S40 was lowest for S40 + EZ10 (€22,841 [€24,017] and €26,595 [€46,686] for diabetic and non-diabetic men [women], respectively). The respective incremental cost per QALY gained for S40 + EZ10 vs. A20 were €19,738 (€21,405) and €23,596 (€40,087). A20 dominated R10. Based on the cost-effectiveness acceptability frontier with a willingness-to-pay value of €30,000 per QALY gained, the probability of cost-effectiveness for switching generic S40 to S40 + EZ10 was 100% for men and diabetic women. Sensitivity analyses showed that results were robust. Conclusions: In the Finnish secondary prevention population that is not at goal on S40, switching generic S40 to S40 + EZ10 is more cost-effective than switching S40 to generic A20 or R10.