Krisztián Kárpáti

The economic impact of dementia in Europe in 2008-cost estimates from the Eurocode project.

Care for demented people is very resource demanding, the prevalence is increasing and there is so far no cure.

Cost-of-illness of patients with systemic sclerosis in a tertiary care centre

OBJECTIVE The aim of our study was to assess the costs of SSc and to analyse cost drivers. METHODS A cross-sectional survey of consecutive patients with SSc was performed in a rheumatology centre in Hungary. Clinical characteristics, the European Scleroderma Study Group activity index, disease severity scale (DSS), scleroderma HAQ (S-HAQ) and health care utilization were recorded. Cost calculation was performed and correlation with clinical variables was analysed. Results were compared with RA and PsA. RESULTS Eighty patients were involved: 72 (90%) women, mean age (s.d.) 57.4 (9.6) years and disease duration of 6.2 (6.6) years and 25% of the cases had dcSSc. Mean total cost was 9619 (s.d. 6444) euros/patient/year with rate of indirect cost being 56%. Disability-related productivity loss (55.2%) and hospitalization (28.3%) were the highest among the cost items. Patients with dcSSc had significantly higher direct costs (P = 0.005) compared with the lcSSc subset. Disease activity showed significant correlation with total costs, DSS and S-HAQ with direct costs. SSc-related costs were higher than in matched RA and PsA cases. CONCLUSIONS The cost-of-illness of SSc is high with a dominance of productivity loss related costs. Moreover, the disease activity is an important cost driver.

Rituximab in patients with rheumatoid arthritis: systematic review

INTRODUCTION Biologic treatments are newly used in rheumatoid arthritis. Three tumornecrosis factor alfa (TNF-alpha) inhibitors--adalimumab, etanercept and infliximab--have been licensed for rheumatoid arthritis in Hungary. B-cell targeted treatment with rituximab is the next biologic treatment. Rituximab was used earlier for the treatment of non-Hodgkins lymphoma. Rituximab was registered to be used in patients with rheumatoid arthritis who have had an inadequate response or an intolerance to one or more TNF-alpha blocking agents. AIM Systematic review in the literature of efficacy of rituximab in rheumatoid arthritis. To assess the efficacy and safety of rituximab treatment in patients with rheumatoid arthritis. METHODS MEDLINE and Cochrane database were searched for randomized controlled trials with rituximab in rheumatoid arthritis. A meta-analysis of trial data was conducted. RESULTS Three randomized controlled trials were identified including 1145 patients. 54% of patients with inadequate response to TNF-alfa inhibitors and severe disease-activity have reached American College of Rheumatology 20 criteria. This ratio is larger with 33% (95% CI, 25-41%) than without treatment, and patients have almost five times (relative risk = 4.77 95% CI, 3.12-7.31) chance to improve. Functional status represented by Health Assessment Questionnaire score improves significantly (p < 0.001) in rituximab arms (-0.4 scores) compared with placebo arms (-0.1 scores). EULAR moderate and good responses in the rituximab group were significant (p < 0.00001) compared with the placebo group, rate difference is 38% (95% CI, 32-44%). Rituximab improves also radiological symptoms of rheumatoid arthritis. CONCLUSIONS New therapeutic options, rituximab is efficacious in patients with rheumatoid arthritis. Rituximab can improve symptoms of patients with inadequate response to or intolerance of TNF-alpha inhibitors.

[The efficacy of indapamide in different cardiovascular outcome--meta-analysis].

BACKGROUND First line antihypertensive treatments drugs have to be able to decrease the cardiovascular morbidity and mortality. This kind of efficacy of thiazides type diuretics were published earlier in several studies. The efficacy of indapamide was investigated in several studies, but there is no analysis which is including all of the indapamide-studies. OBJECTIVE We conducted a meta-analysis of all relevant randomized-controlled-trials with indapamide. Efficacy of indapamide was analyzed in different cardiovascular and safety outcomes. METHODS We searched the MEDLINE database 1995-2005 for indapamide-trials. Only double-blind, parallel-group design trials were involved. Both the fixed effect model and the random effect model were used for data synthesis, results were probed with Mantel-Hanzel test and inverse variance test. RESULTS Data were combined from 9 trials that included 10 108 patients. Indapamide treatment of 48 patients with a history of stroke prevents another stroke (NNT = 47.8 95% CI 29.6-126.6). Data from 5 trials including 7085 patients show that indapamide is superior to placebo in reducing blood pressure, the differences are: 7.28 mm Hg (95% CI: 6.37-8.19) in systolic blood pressure and 3.50 mm Hg (95% CI 2.99-4.01) in diastolic blood pressure. Data from 5 trials including 2856 patients show that indapamide is superior to active controls in reducing systolic blood pressure, the difference is significant: 1.30 mm Hg (95% CI 0.28-2.31). The difference in diastolic blood pressure was not significant. Data of 505 patients show that indapamide reduced left ventricular mass index significantly more than enalapril 20 mg, the difference is 6.50 g/m(2) (95%CI: 0.81-12.19). Data of 6206 patients show that frequency of adverse drug reaction is similar in the indapamide and placebo groups (rr = 0.97 95%CI 0.76-1.22). CONCLUSIONS Indapamide is efficacious in prevention of further stroke, reduces effectively the blood pressure and the left ventricular mass index. Indapamide treatment is well tolerated.

Az akut myocardialis infarctus betegségterhe Magyarországon, 2003-2005

Magyarorszagon jelentős az akut myocardialis infarctust szenvedett betegek szama, ezert elengedhetetlen a betegsegteher (disease burden) pontosabb megismerese. Celkitűzes: Tanulmanyunkban azt vizsgaljuk, hogy mekkora a finanszirozot erintő teher a hospitalizalt, szivinfarktust szenvedett betegek eseten, az aktiv es a kronikus korhazi ellatasban, valamint a jarobeteg- es az alapellatas teruleten, illetve felbecsuljuk, hogy mekkora a tarsadalmat erintő indirekt koltseg. Modszer: Az Orszagos Egeszsegbiztositasi Penztar adatbazisa alapjan elemeztuk az „uj” infarktust szenvedett betegek aktiv es kronikus korhazi ellatasanak koltsegeit a 25 evnel idősebb populacio koreben a 2003. majusi megbetegedest kovető 12 es 24 honapban. A betegeket nemek szerinti, es 25–44, 45–64, 65+ eves alcsoportokba osztottuk. Egyeb koltsegelemkent figyelembe vettuk a hazi-, szakorvosi vizitek, betegszallitas, valamint a munkabol valo kieses atlagkoltsegeit. Eredmenyek: Az akut myocardialis infarctus aktiv korhazi ellatasanak atlagos egeszsegbiztositasi koltsege a megbetegedest kovető 12 honapban a nőknel altalaban magasabb, mint a ferfiaknal: 476,3 ezer Ft vs 391,1 ezer Ft (65+ ev); 429,1 Ft vs 389,4 ezer Ft (45–64 ev) es 229,5 ezer Ft vs 240,6 ezer Ft (25–44 ev). A kronikus ellatas terhe betegenkent 15–40 ezer Ft az első evben, es az aktiv ellatas koltsege is hasonlo nagysagrendű (22–54 ezer Ft/fő) az infarktus utan 13–24 honappal. Kovetkeztetesek: Becslesunk szerint az evente kozel 12 ezer hospitalizalt infarktust szenvedett beteg direkt egeszsegugyi koltsegeire a biztosito 4,4 Mrd Ft-ot koltott a betegseget kovető első 12 honapban, 3,6 Mrd Ft-ot aktiv es 370 millio Ft-ot a kronikus korhazi ellatasban. Egy AMI elkerulesevel 345–565 ezer Ft (kor es nem szerint kulonbozően) direkt egeszsegugyi koltseg takarithato meg az első 12 honapban. Becslesunk szerint az AMI indirekt koltsege a munkakepes koruak koreben meghaladja a 840 millio Ft-ot egy evben (177 829 Ft/fő). | Background: The morbidity of acute myocardial infarction (AMI) is remarkable in Hungary, therefore understanding the disease burden more accurately is inevitable. Aim: We assessed the hospitalized AMI patient’s burden on the financer both in active and chronic hospital care as well as outpatient visits and we estimated the size of indirect social costs. Methods: We assessed the active and chronic hospital care costs of ‘new’ AMI patients having the event in May 2003. The costs were assessed in the subsequent 12 and 24 months to the event in the population over 25 with the morbidity from the database of the National Health Insurance Fund Administration (NHIFA). Data were collected by gender and age (age groups 25–44, 45–64, 65 and over). Costs of GPs, specialist visits, transportations and productivity losses were taken into account as other costs. Results: Average health insurance costs of AMI’s active hospital care in the first 12 months are generally higher in females as in males; 476.3 thousand HUF vs 391.1 thousand HUF (65 and over), 429.1 thousand HUF vs 389.4 thousand HUF (45–64) and 229.5 thousand HUF vs 240.6 thousand HUF (25–44). The burden in the chronic care is 15–40 thousand HUF per patient in the first year, which is similar to the active care costs in the 13–24th months after the AMI (22–54 thousand HUF). Conclusion: NHIFA was estimated to spend 4.4 billion HUF on direct health care on behalf of the nearly 12 thousand annual AMI patients in the first 12 months, 3.6 billion HUF on the active and 370 million on the chronic hospital care. Avoiding one AMI could save 345–565 thousand HUF (depending on gender and age) direct health care cost in the first 12 months. In our estimation the annual indirect costs of AMI exceed 840 million HUF (177 829 HUF/patient) in the working age group.

Development of health technology assessment in Central Europe

To the Editor: Once upon a time in the 1990s, if you wanted to do HTA in the Central and Eastern European countries (CEEs), you got yourself invited by Egon Jonsson and travelled to Stockholm to learn how to do HTA. There you met him and Prof. Banta and other HTA professionals from all over the world—very importantly, motivated healthcare professionals from all CEEs who were eager to learn HTA. These eminent founding fathers were always available, and were never tired if help or assistance was needed. During that time, the telephone number of HTA was known and used extensively, making it a real, living, informal HTA network. Formal HTA collaborations organized by them and funded by the European Commission, such as EUR-ASSESS, HTA EUROPE, ECHTA/ECAHI, were also crucial . . . Therefore, we read with great interest the series of excellent papers on the review of HTA history in different countries and on international level (International Society for Technology Assessment in Health Care and Health Technology Assessment International; International Journal of Technology Assessment in Health Care) (2;3;24). This special issue of the International Journal of Technology Assessment in Health Care provides a comprehensive overview of activities in and development of HTA in the past decades. As it is described in the journal, although development of health technology assessment was difficult in any country, former socialist countries of Eastern-Europe had to face special challenges (21). During the series of healthcare reforms and economic transitions, the Hungarian healthcare system faced two different challenges: the rising health expenditures resulted in a pressure of cutting the budget on the one hand, and the growing demands and needs of patients on the other. For many years, a simple fiscal answer tried to soften the problems focusing mainly on the expenditure side. In the past years, when HTA became more and more stronger and embedded in Hungary, health technology assessment became a promising tool in healthcare decision making. We should emphasize the role of international organizations in the development of HTA in Hungary. As an outstanding achievement of local efforts and international support (a World Bank loan), a Health Services Management Training Center at the Semmelweis University in Budapest and a School of Public Health at the University of Debrecen was established in the middle of 1990s, both serving as an important academic institution for healthcare policy makers and hospital managers not only in Hungary but also in Central and Eastern Europe. The Health Evidence Network (HEN) of the World Health Organization (WHO) had also significant effect on the development of Hungarian HTA. Another important milestone of HTA development in Hungary was the inclusion of HTA into the governmental decision-making process of pharmaceutical reimbursement after 1 May 2004, when Hungary joined to European Union. Although submission of an HTA report is not compulsory in Hungary in course of application for health insurance reimbursement, a health technology assessment report can provide valuable information for health insurance decision makers and can strengthen the application dossier. The current research topics in Hungary—in line with the international literature (17;18;23;26)—covers, for example, osteoporosis and arthritis (14–16;27;28), oncology and cancer screening (4;5;9–13;25), healthcare financing (1;6–8), and coverage policy (19;20;22). In addition to the universities and research centers, the Hungarian National Health Insurance Fund Administration (Országos Egészségbiztosı́tási Pénztár, OEP) played an active role in the publication of scientific papers in the field of HTA. Finally, we would like to highlight the important role of Professors Egon Jonsson and David Banta in the worldwide development of HTA in the past decades, with special respect to their commitment to the introduction, development, and permeation of HTA in Hungary.

Hospital costs of acute myocardial infarction in Hungary; 2003–2005

Magyarorszagon jelentős az akut myocardialis infarctust szenvedett betegek szama, ezert elengedhetetlen a betegsegteher (disease burden) pontosabb megismerese. Celkitűzes: Tanulmanyunkban azt vizsgaljuk, hogy mekkora a finanszirozot erintő teher a hospitalizalt, szivinfarktust szenvedett betegek eseten, az aktiv es a kronikus korhazi ellatasban, valamint a jarobeteg- es az alapellatas teruleten, illetve felbecsuljuk, hogy mekkora a tarsadalmat erintő indirekt koltseg. Modszer: Az Orszagos Egeszsegbiztositasi Penztar adatbazisa alapjan elemeztuk az „uj” infarktust szenvedett betegek aktiv es kronikus korhazi ellatasanak koltsegeit a 25 evnel idősebb populacio koreben a 2003. majusi megbetegedest kovető 12 es 24 honapban. A betegeket nemek szerinti, es 25–44, 45–64, 65+ eves alcsoportokba osztottuk. Egyeb koltsegelemkent figyelembe vettuk a hazi-, szakorvosi vizitek, betegszallitas, valamint a munkabol valo kieses atlagkoltsegeit. Eredmenyek: Az akut myocardialis infarctus aktiv korhazi ellatasanak atlagos egeszsegbiztositasi koltsege a megbetegedest kovető 12 honapban a nőknel altalaban magasabb, mint a ferfiaknal: 476,3 ezer Ft vs 391,1 ezer Ft (65+ ev); 429,1 Ft vs 389,4 ezer Ft (45–64 ev) es 229,5 ezer Ft vs 240,6 ezer Ft (25–44 ev). A kronikus ellatas terhe betegenkent 15–40 ezer Ft az első evben, es az aktiv ellatas koltsege is hasonlo nagysagrendű (22–54 ezer Ft/fő) az infarktus utan 13–24 honappal. Kovetkeztetesek: Becslesunk szerint az evente kozel 12 ezer hospitalizalt infarktust szenvedett beteg direkt egeszsegugyi koltsegeire a biztosito 4,4 Mrd Ft-ot koltott a betegseget kovető első 12 honapban, 3,6 Mrd Ft-ot aktiv es 370 millio Ft-ot a kronikus korhazi ellatasban. Egy AMI elkerulesevel 345–565 ezer Ft (kor es nem szerint kulonbozően) direkt egeszsegugyi koltseg takarithato meg az első 12 honapban. Becslesunk szerint az AMI indirekt koltsege a munkakepes koruak koreben meghaladja a 840 millio Ft-ot egy evben (177 829 Ft/fő). | Background: The morbidity of acute myocardial infarction (AMI) is remarkable in Hungary, therefore understanding the disease burden more accurately is inevitable. Aim: We assessed the hospitalized AMI patient’s burden on the financer both in active and chronic hospital care as well as outpatient visits and we estimated the size of indirect social costs. Methods: We assessed the active and chronic hospital care costs of ‘new’ AMI patients having the event in May 2003. The costs were assessed in the subsequent 12 and 24 months to the event in the population over 25 with the morbidity from the database of the National Health Insurance Fund Administration (NHIFA). Data were collected by gender and age (age groups 25–44, 45–64, 65 and over). Costs of GPs, specialist visits, transportations and productivity losses were taken into account as other costs. Results: Average health insurance costs of AMI’s active hospital care in the first 12 months are generally higher in females as in males; 476.3 thousand HUF vs 391.1 thousand HUF (65 and over), 429.1 thousand HUF vs 389.4 thousand HUF (45–64) and 229.5 thousand HUF vs 240.6 thousand HUF (25–44). The burden in the chronic care is 15–40 thousand HUF per patient in the first year, which is similar to the active care costs in the 13–24th months after the AMI (22–54 thousand HUF). Conclusion: NHIFA was estimated to spend 4.4 billion HUF on direct health care on behalf of the nearly 12 thousand annual AMI patients in the first 12 months, 3.6 billion HUF on the active and 370 million on the chronic hospital care. Avoiding one AMI could save 345–565 thousand HUF (depending on gender and age) direct health care cost in the first 12 months. In our estimation the annual indirect costs of AMI exceed 840 million HUF (177 829 HUF/patient) in the working age group.

[Health care costs of acute myocardial infarction in Hungary, 2003-2005].

Magyarorszagon jelentős az akut myocardialis infarctust szenvedett betegek szama, ezert elengedhetetlen a betegsegteher (disease burden) pontosabb megismerese. Celkitűzes: Tanulmanyunkban azt vizsgaljuk, hogy mekkora a finanszirozot erintő teher a hospitalizalt, szivinfarktust szenvedett betegek eseten, az aktiv es a kronikus korhazi ellatasban, valamint a jarobeteg- es az alapellatas teruleten, illetve felbecsuljuk, hogy mekkora a tarsadalmat erintő indirekt koltseg. Modszer: Az Orszagos Egeszsegbiztositasi Penztar adatbazisa alapjan elemeztuk az „uj” infarktust szenvedett betegek aktiv es kronikus korhazi ellatasanak koltsegeit a 25 evnel idősebb populacio koreben a 2003. majusi megbetegedest kovető 12 es 24 honapban. A betegeket nemek szerinti, es 25–44, 45–64, 65+ eves alcsoportokba osztottuk. Egyeb koltsegelemkent figyelembe vettuk a hazi-, szakorvosi vizitek, betegszallitas, valamint a munkabol valo kieses atlagkoltsegeit. Eredmenyek: Az akut myocardialis infarctus aktiv korhazi ellatasanak atlagos egeszsegbiztositasi koltsege a megbetegedest kovető 12 honapban a nőknel altalaban magasabb, mint a ferfiaknal: 476,3 ezer Ft vs 391,1 ezer Ft (65+ ev); 429,1 Ft vs 389,4 ezer Ft (45–64 ev) es 229,5 ezer Ft vs 240,6 ezer Ft (25–44 ev). A kronikus ellatas terhe betegenkent 15–40 ezer Ft az első evben, es az aktiv ellatas koltsege is hasonlo nagysagrendű (22–54 ezer Ft/fő) az infarktus utan 13–24 honappal. Kovetkeztetesek: Becslesunk szerint az evente kozel 12 ezer hospitalizalt infarktust szenvedett beteg direkt egeszsegugyi koltsegeire a biztosito 4,4 Mrd Ft-ot koltott a betegseget kovető első 12 honapban, 3,6 Mrd Ft-ot aktiv es 370 millio Ft-ot a kronikus korhazi ellatasban. Egy AMI elkerulesevel 345–565 ezer Ft (kor es nem szerint kulonbozően) direkt egeszsegugyi koltseg takarithato meg az első 12 honapban. Becslesunk szerint az AMI indirekt koltsege a munkakepes koruak koreben meghaladja a 840 millio Ft-ot egy evben (177 829 Ft/fő). | Background: The morbidity of acute myocardial infarction (AMI) is remarkable in Hungary, therefore understanding the disease burden more accurately is inevitable. Aim: We assessed the hospitalized AMI patient’s burden on the financer both in active and chronic hospital care as well as outpatient visits and we estimated the size of indirect social costs. Methods: We assessed the active and chronic hospital care costs of ‘new’ AMI patients having the event in May 2003. The costs were assessed in the subsequent 12 and 24 months to the event in the population over 25 with the morbidity from the database of the National Health Insurance Fund Administration (NHIFA). Data were collected by gender and age (age groups 25–44, 45–64, 65 and over). Costs of GPs, specialist visits, transportations and productivity losses were taken into account as other costs. Results: Average health insurance costs of AMI’s active hospital care in the first 12 months are generally higher in females as in males; 476.3 thousand HUF vs 391.1 thousand HUF (65 and over), 429.1 thousand HUF vs 389.4 thousand HUF (45–64) and 229.5 thousand HUF vs 240.6 thousand HUF (25–44). The burden in the chronic care is 15–40 thousand HUF per patient in the first year, which is similar to the active care costs in the 13–24th months after the AMI (22–54 thousand HUF). Conclusion: NHIFA was estimated to spend 4.4 billion HUF on direct health care on behalf of the nearly 12 thousand annual AMI patients in the first 12 months, 3.6 billion HUF on the active and 370 million on the chronic hospital care. Avoiding one AMI could save 345–565 thousand HUF (depending on gender and age) direct health care cost in the first 12 months. In our estimation the annual indirect costs of AMI exceed 840 million HUF (177 829 HUF/patient) in the working age group.

Az akut myocardialis infarctus betegségterhe Magyarországon, 2003–2005@@@Hospital costs of acute myocardial infarction in Hungary; 2003–2005

Magyarorszagon jelentős az akut myocardialis infarctust szenvedett betegek szama, ezert elengedhetetlen a betegsegteher (disease burden) pontosabb megismerese. Celkitűzes: Tanulmanyunkban azt vizsgaljuk, hogy mekkora a finanszirozot erintő teher a hospitalizalt, szivinfarktust szenvedett betegek eseten, az aktiv es a kronikus korhazi ellatasban, valamint a jarobeteg- es az alapellatas teruleten, illetve felbecsuljuk, hogy mekkora a tarsadalmat erintő indirekt koltseg. Modszer: Az Orszagos Egeszsegbiztositasi Penztar adatbazisa alapjan elemeztuk az „uj” infarktust szenvedett betegek aktiv es kronikus korhazi ellatasanak koltsegeit a 25 evnel idősebb populacio koreben a 2003. majusi megbetegedest kovető 12 es 24 honapban. A betegeket nemek szerinti, es 25–44, 45–64, 65+ eves alcsoportokba osztottuk. Egyeb koltsegelemkent figyelembe vettuk a hazi-, szakorvosi vizitek, betegszallitas, valamint a munkabol valo kieses atlagkoltsegeit. Eredmenyek: Az akut myocardialis infarctus aktiv korhazi ellatasanak atlagos egeszsegbiztositasi koltsege a megbetegedest kovető 12 honapban a nőknel altalaban magasabb, mint a ferfiaknal: 476,3 ezer Ft vs 391,1 ezer Ft (65+ ev); 429,1 Ft vs 389,4 ezer Ft (45–64 ev) es 229,5 ezer Ft vs 240,6 ezer Ft (25–44 ev). A kronikus ellatas terhe betegenkent 15–40 ezer Ft az első evben, es az aktiv ellatas koltsege is hasonlo nagysagrendű (22–54 ezer Ft/fő) az infarktus utan 13–24 honappal. Kovetkeztetesek: Becslesunk szerint az evente kozel 12 ezer hospitalizalt infarktust szenvedett beteg direkt egeszsegugyi koltsegeire a biztosito 4,4 Mrd Ft-ot koltott a betegseget kovető első 12 honapban, 3,6 Mrd Ft-ot aktiv es 370 millio Ft-ot a kronikus korhazi ellatasban. Egy AMI elkerulesevel 345–565 ezer Ft (kor es nem szerint kulonbozően) direkt egeszsegugyi koltseg takarithato meg az első 12 honapban. Becslesunk szerint az AMI indirekt koltsege a munkakepes koruak koreben meghaladja a 840 millio Ft-ot egy evben (177 829 Ft/fő). | Background: The morbidity of acute myocardial infarction (AMI) is remarkable in Hungary, therefore understanding the disease burden more accurately is inevitable. Aim: We assessed the hospitalized AMI patient’s burden on the financer both in active and chronic hospital care as well as outpatient visits and we estimated the size of indirect social costs. Methods: We assessed the active and chronic hospital care costs of ‘new’ AMI patients having the event in May 2003. The costs were assessed in the subsequent 12 and 24 months to the event in the population over 25 with the morbidity from the database of the National Health Insurance Fund Administration (NHIFA). Data were collected by gender and age (age groups 25–44, 45–64, 65 and over). Costs of GPs, specialist visits, transportations and productivity losses were taken into account as other costs. Results: Average health insurance costs of AMI’s active hospital care in the first 12 months are generally higher in females as in males; 476.3 thousand HUF vs 391.1 thousand HUF (65 and over), 429.1 thousand HUF vs 389.4 thousand HUF (45–64) and 229.5 thousand HUF vs 240.6 thousand HUF (25–44). The burden in the chronic care is 15–40 thousand HUF per patient in the first year, which is similar to the active care costs in the 13–24th months after the AMI (22–54 thousand HUF). Conclusion: NHIFA was estimated to spend 4.4 billion HUF on direct health care on behalf of the nearly 12 thousand annual AMI patients in the first 12 months, 3.6 billion HUF on the active and 370 million on the chronic hospital care. Avoiding one AMI could save 345–565 thousand HUF (depending on gender and age) direct health care cost in the first 12 months. In our estimation the annual indirect costs of AMI exceed 840 million HUF (177 829 HUF/patient) in the working age group.

Az indapamid hatásosságának elemzése különbözô cardiovascularis végpontok szerint - Metaanalízis

Bevezetes: Az első vonalba tartozo vernyomascsokkentőktől elvarhato, hogy csokkentsek a cardiovascularis morbiditast es mortalitast. A thiazid vizhajtok ez iranyu hatekonysagat tobb metaanalizisben leirtak. Az indapamid hatasossagat bar szamos tanulmany vizsgalja, eddig nem keszult az osszes adatot osszefoglalo elemzes. Celkitűzes: az indapamid hatasossagat vizsgalo osszes randomizalt kontrollalt vizsgalat adatainak szintezise. A tanulmanyok eredmenyeit a kulonboző cardiovascularis es biztonsagi vegpontok szerint elemezzuk. Modszer: A MEDLINE adatbazisban megkerestuk az osszes randomizalt kontrollalt indapamidvizsgalatot 1995 es 2005 kozott. Csak a kettős vak-, parhuzamos lebonyolitasu vizsgalatokat vontuk be. Az adatok metaanaliziset allando es veletlen hatasu modellekben is elvegeztuk, az eredmenyeket Mantel–Haenzel-probaval, inverz varianciaprobaval teszteltuk. Eredmenyek: 9 vizsgalat es 10 108 beteg adatait elemeztuk. 48, stroke-on atesett beteg indapamidkezelesevel megelőzhető egy ujabb stroke-esemen...