47 research outputs found
Supplementary_material - A Targeted Literature Review of the Disease Burden in Patients With Symptomatic Peripheral Artery Disease
No full textSupplementary_material for A Targeted Literature Review of the Disease Burden in Patients With Symptomatic Peripheral Artery Disease by Rupert Bauersachs, Sebastian Debus, Mark Nehler, Maria Huelsebeck, Janita Balradj, Kevin Bowrin and Jean-Baptiste Briere in Angiology</p
sj-pdf-1-vmj-10.1177_1358863X221096704 – Supplemental material for Assessment of the burden of disease for patients with peripheral artery disease undergoing revascularization in England
No full textSupplemental material, sj-pdf-1-vmj-10.1177_1358863X221096704 for Assessment of the burden of disease for patients with peripheral artery disease undergoing revascularization in England by Laura Portas, Rupert Bauersachs, Kevin Bowrin, Jean-Baptiste Briere, Alexander Cohen, Maria Huelsebeck, Schuyler Jones and Jennifer K Quint in Vascular Medicine</p
Systematic Literature Review of Randomized Trials Comparing Antithrombotic Therapy Following Revascularization Procedures in Patients With Peripheral Artery Disease.
No full textA systematic literature review was conducted to identify and summarize the clinical efficacy and safety of available antithrombotic therapies after peripheral endovascular or surgical revascularization in patients with peripheral artery disease (PAD). Five databases were searched using free-text and Emtree/Mesh terms for PAD, randomized controlled trials (RCTs), and antithrombotic therapies of interest (ie, single antiplatelet therapy, dual antiplatelet therapy, and vitamin K antagonists). Randomized controlled trials were eligible for inclusion if they assessed the risk of thrombotic events (ie, myocardial infarction, ischemic stroke, cardiovascular death, limb ischemia, or limb amputation) or safety profile (ie, minor, moderate, major, or fatal bleeding events) after revascularization. In total, 16 RCTs were identified. Only a few studies reported on treatment effects of the investigated therapies. Myocardial infarction, ischemic stroke, cardiovascular death, and amputation were reported in up to 2.3%, 2.3%, 5.6%, and 7.3% of patients, respectively. Bleeding events were observed in up to 8.4% (major) and 1.5% (fatal) of patients. Despite available treatments, patients with PAD undergoing revascularization remain at risk of thrombotic events. There is a need for new treatments that will help to optimize care for patients with symptomatic PAD undergoing revascularization
The Investigation of Cardiovascular Risk Factors Which Influence Cost and Occurrence of Cardiovascular Events
No full textImperial Users onl
SPLURGE: Scholars Portal Library Usage-Based Recommendation Generation Engine
No full textWe will outline the birth and delivery of SPLURGE (Scholars Portal Library Usage-based Recommendation Generation Engine). SPLURGE came about as an idea to build up a book title recommendation service by pooling circulation data from university libraries in the province of Ontario. Following the precedent of a project that was launched by the Joint Information Systems Committee (JISC) in the United Kingdom, a group of Systems folks in Ontario met and surmised it would be interesting to start collecting circulation data that could then be fed back into the school’s various catalogue interfaces. The data would make it possible to provide context-sensitive book suggestions, to researchers, in the search results: in the manner Amazon or EBay recommends items for purchase to its shoppers.Following the launch of a GitHub site for the project and armed with only a rough outline of the goals, over twenty five people from sixteen institutions gathered for a single hackfest event to explore and discuss the possible paths to further bring SPLURGE into fruition. Is this another add-on that will serve to simply spoon-feed our users? Or, will SPLURGE zestfully put the dip back into serendipity for those researchers who might have otherwise not connected potential resources in their initial catalogue queries? How too, might such a tool be used to aid in a Library’s collection development? All in all, it’s going to be a tool that lets you question the answers. We’ll show how it works, how we built it, how you can use it, and where it could go
CORRECTION
No full textWhen the above article was first published online, the author name ‘David M. Smadja’ and his affiliation was published incorrectly. [...
Real-world cost-effectiveness of rivaroxaban and apixaban vs VKA in stroke prevention in non-valvular atrial fibrillation in the UK
No full textInternational audienceBackground: Morbidity and mortality associated with non-valvular atrial fibrillation (NVAF) imposes a substantial economic burden on the UK healthcare system. Objectives: An existing Markov model was adapted to assess the real-world cost-effectiveness of rivaroxaban and apixaban, each compared with a vitamin K antagonist (VKA), for stroke prevention in patients with NVAF from the National Health Service (NHS) and personal and social services (PSS) perspective. Methods: The model considered a cycle length of 3 months over a lifetime horizon. All inputs were drawn from real-world evidence (RWE): baseline patient characteristics, clinical event and persistence rates, treatment effect (meta-analysis of RWE studies), utility values and resource use. Deterministic and probabilistic sensitivity analyses were performed. Results: The incremental cost per quality-adjusted life year was £14,437 for rivaroxaban, and £20,101 for apixaban, compared with VKA. The probabilities to be cost-effective compared with VKA were 90% and 81%, respectively for rivaroxaban and apixaban, considering a £20,000 threshold. In both comparisons, the results were most sensitive to clinical event rates. Conclusions: These results suggest that rivaroxaban and apixaban are cost-effective vs VKA, based on RWE, considering a £20,000 threshold, from the NHS and PSS perspective in the UK for stroke prevention in patients with NVAF. This economic evaluation may provide valuable information for decision-makers, in a context where RWE is more accessible and its value more acknowledged
Burden of Coronary Artery Disease and Peripheral Artery Disease: A Literature Review
No full textBackground. Atherothrombotic disease, including coronary artery disease (CAD) and peripheral artery disease (PAD), can lead to cardiovascular (CV) events, such as myocardial infarction, stroke, limb ischemia, heart failure, and CV death. Aim. Evaluate the humanistic and economic burden of CAD and PAD and identify unmet needs through a comprehensive literature review. Methods. Relevant search terms were applied across online publication databases. Studies published between January 2010 and August 2017 meeting the inclusion/exclusion criteria were selected; guidelines were also included. Two rounds of screening were applied to select studies of relevance. Results. Worldwide data showed approximately 5–8% prevalence of CAD and 10–20% prevalence of PAD, dependent on the study design, average age, gender, and geographical location. Data from the REACH registry indicated that 18–35% of patients with CAD and 46–68% of patients with PAD had disease in one or more vascular beds. Use of medication to control modifiable CV risk factors was variable by country (lower in France than in Canada); statins and aspirin were the most widely used therapies in patients with chronic disease. Survival rates have improved with medical advancements, but there is an additional need to improve the humanistic burden of disease (i.e., associated disability and quality of life). The economic burden of atherothrombotic disease is high and expected to increase with increased survival and the aging population. Conclusion. CAD and PAD represent a substantial humanistic and economic burden worldwide, highlighting a need for new interventions to reduce the incidence of atherothrombotic disease
Efficacy and safety of rivaroxaban compared with other therapies used in patients with peripheral artery disease undergoing peripheral revascularization: a systematic literature review and network meta-analysis
No full textBackground. The guidelines on antithrombotic treatment in patients with symptomatic peripheral artery disease (PAD) undergoing peripheral revascularization of the lower extremities were developed based on heterogeneous trials, assessing various dose regimens and recruiting patients who were subjected to different revascularization procedures. Objective. To compare efficacy and safety of treatments used in patients with PAD undergoing peripheral revascularization accounting for between-trial heterogeneity and large dispersion of the quality of evidence. Methods. A systematic literature review of randomised controlled trials (RCTs) recruiting adult patients with PAD receiving antithrombotics was conducted until January 2020. Hazard ratios (HR) were pooled using Bayesian network meta-analysis. The estimated between-treatment effects were presented as HR together with 95% credible intervals. The base case analysis included studies recruiting patients following recent peripheral revascularization, who received treatment regimens administered within the recommended therapeutic window, while a sensitivity scenario included all identified trials. Results. Thirteen RCTs were identified (8 RCTs enrolled patients following peripheral revascularization and 5 RCTs regardless of the previous revascularization). Five trials, recruiting an overall of 8349 patients, were considered for the base case analysis. Of those, 6564 patients were recruited in the VOYAGER PAD trial comparing rivaroxaban plus aspirin (RIV plus ASA) versus ASA. RIV plus ASA was associated with a lower risk of repeated peripheral revascularization versus ASA monotherapy ( [0.79, 0.99]), however having a trend towards an increased rate of major bleeding ( [0.98, 2.11]). There was no evidence for differences between RIV plus ASA and dual antiplatelet therapy and vitamin K antagonists plus ASA. Similar results were observed in sensitivity analyses. Conclusions. RIV plus ASA is associated with reduced risk of revascularization compared with ASA monotherapy, but the evidence for other comparators, in particular antiplatelet regimens, was insufficient to guide treatment decisions and highlights the challenge in establishing the magnitude of comparative efficacy using existing RCTs
Cost effectiveness of pregabalin in the treatment of fibromyalgia from a UK perspective
No full textFibromyalgia is a chronic condition associated with widespread pain, sleep disturbance and disability. Disease related costs are high and effective treatment options few. To evaluate the cost effectiveness of pregabalin in the treatment of fibromyalgia. A decision-analytic model was developed comparing pregabalin 300 mg or 450 mg against placebo, duloxetine 60 mg or 120 mg, gabapentin, tramadol and amitriptyline. After a 12 week treatment phase patients who responded to treatment entered an ongoing treatment phase using a Markov model in which patients maintained response, lost response or dropped out. The base case considered patients with severe fibromyalgia defined as a Fibromyalgia Impact Questionnaire score of >= 59 and a pain score of >= 6.5 at baseline. Response rates for pregabalin and placebo were taken from three randomised trials, and a 1 year open-label extension study was used for long-term parameters. Response was defined as a 30% improvement over baseline in pain score and a patient global impression of change rating of much improved or very much improved. Relative rates of response for other comparators over placebo were extracted from a systematic review of published randomised controlled studies. The primary effectiveness endpoint was Quality Adjusted Life Years (QALYs). Utilities gained over baseline were estimated by applying the SF-6D utility algorithm to SF-36 data collected in the pregabalin trials. Resource use associated with fibromyalgia management was estimated from published studies and costs were estimated from the UK NHS perspective at 2008 prices. Costs and QALYs were discounted at 3.5%. Non-parametric bootstrapping analysis was used to generate confidence intervals. In the base case, pregabalin 300 mg and 450 mg increased cost per patient by 601 pound (95% CI: 532, 669) and 653 pound (587, 727) and improved QALYs per patient by 0.03 (-0.03, 0.06) and 0.03 (-0.04, 0.08) respectively compared to placebo. The cost per QALY gained (CQG) was 23,166 pound and 22,533 pound. In the base case population CQG for pregabalin 450 mg against duloxetine 60 mg and 120 mg was 19,224 pound and 14,096 pound, against gabapentin 35,737 pound, against tramadol 98,072 pound, and was dominated by amitriptyline. Sensitivity analysis found the cost effectiveness of pregabalin to be most sensitive to drug price and response rates. Limitations of the analysis include different definitions of response used and lack of subgroup data reported in the published studies synthesised, and limited data on long-term effect of therapies in fibromyalgia. Although the analysis was based on the best available evidence, the comparisons against amitriptyline and tramadol rely on old studies that were not designed to meet current quality criteria. This model found pregabalin 300 mg and 450 mg to be cost effective compared with placebo and, within the limits of available evidence, against duloxetine using standard UK criteria in patients with fibromyalgia experiencing severe pain
