Depression is associated with a substantial utilization of resources in the German healthcare system. A typical symptom in depression is loss of drive, which possibly contributes to non-adherence and ...increased costs.
The study is based on routine healthcare data and tested the hypothesis that telephone coaching in cases of depression leads to a reduction in total healthcare costs.
Based on approximately 80 covariates and using propensity score matching, a total of 1586 persons who had received telephone coaching for depression and covered by a German statutory health insurance fund were matched to a comparable cohort of patients with depression to whom telephone coaching had not been provided.
Within the study period of 12 months (3rd quarter 2012-4th quarter 2013) a positive program effect was observed for the intervention group by a significant reduction of total healthcare costs (2332 € vs. 2626 €, p = 0.0015) resulting in total savings to the statutory health insurance fund of 415,532 €. Investment costs amounted to 256,683.42 € leading to a return on investment of 1.62 € (total savings/total investment). The coaching program was well accepted by patients.
Telephone coaching for depression was able to significantly reduce total healthcare expenditure and the intervention was well accepted by patients.
Background
Non-vitamin K antagonist oral anticoagulants (NOACs) are at least as effective and safe as vitamin K antagonists (VKAs) for stroke prevention in atrial fibrillation (AF). All pivotal ...trials have compared NOACs to warfarin. However, other VKAs are commonly used, for instance phenprocoumon.
Patients and methods
A retrospective cohort study using a German claims database assessed the comparative risks of bleeding leading to hospitalization during therapy with NOACs and phenprocoumon in AF patients. Endpoints consisted of major bleeding, gastrointestinal bleeding, and any bleeding. Data were collected from January 1, 2013 to March 31, 2015. Patients newly initiated on dabigatran, apixaban, rivaroxaban, or phenprocoumon were included. Hazard Ratios for bleeding events were derived from Cox proportional hazard models, adjusting for differences in baseline characteristics. Propensity score matching was performed as a sensitivity analysis.
Results
A total of 35,013 patients were identified, including 3138 on dabigatran, 3633 on apixaban, 12,063 on rivaroxaban, and 16,179 on phenprocoumon. Patients prescribed apixaban or phenprocoumon were older compared to those on dabigatran or rivaroxaban and had a higher CHA
2
DS
2
-VASc score. After adjusting for baseline confounders, apixaban was associated with lower risks of major bleeding (HR 0.68, 95% CI 0.51–0.90,
p
= 0.008), gastrointestinal bleeding (HR 0.53, 95% CI 0.39–0.72,
p
< 0.001), and any bleeding (HR 0.80, 95% CI 0.70–0.92,
p
= 0.002) compared to phenprocoumon. There were no significant differences in bleeding risk between dabigatran and phenprocoumon. Rivaroxaban was associated with more gastrointestinal bleeding (HR 1.39, 95% CI 1.21–1.60,
p
< 0.001) and any bleeding (HR 1.19, 95% CI 1.10–1.28,
p
< 0.001). Sensitivity analysis using propensity score matching confirmed these observations.
Conclusions
Apixaban therapy is associated with a significantly reduced risk of bleeding compared to phenprocoumon. Bleeding risk with dabigatran was similar to that of phenprocoumon but bleeding risk with rivaroxaban was higher.
OBJECTIVES: Patients with non-valvular atrial fibrillation (NVAF) are five times more likely to suffer a stroke, resulting in enormous personal, social and economic costs. For more than 50 years, ...vitamin K antagonists (VKAs) have been the primary medication for stroke prevention. Nevertheless, VKA therapy requires frequent monitoring, is limited by a narrow therapeutic window and is associated with an increased risk of bleeding. Apixaban, a non-vitamin K oral anticoagulant (NOAC), has shown superior efficacy and reduced risk of major bleeding compared to VKA in the ARISTOTLE trial. In this study we extrapolate the health benefits of apixaban compared to VKA therapy to the German NVAF population to quantify the potential societal effects of apixaban from 2017 through 2030. METHODS: We estimated the size of the apixaban population according to a claims-data based analysis in Germany and the predicted market share of apixaban. A Markov model based on the ARISTOTLE trial comparing apixaban and VKA for anticoagulation was applied to the German social health insurance (SHI) data to calculate the occurrence of strokes and systemic embolisms (SE), major bleeds and deaths on the patient level. To extrapolate the results of the Markov model to the entire German NVAF population, we created a dynamic population model. It links population forecast with epidemiological data and uses the event risks from the Markov model to quantify the potential for reducing mortality and morbidity. RESULTS: In comparison to VKA therapy the administration of apixaban prevents 52,185 additional major clinical events in the assumed German NVAF population from 2017 through 2030. This includes 15,383 non-fatal strokes or SEs, 22,483 non-fatal major bleeds, and 14,319 deaths, corresponding to 109,887 gained life years. CONCLUSIONS: We showed that utilization of apixaban instead of VKA for stroke prevention can lead to considerable reduction of mortality and morbidity in the German NVAF patient population.
Austrian efforts directed toward the eastern Adriatic were concentrated on strengthening Trieste as the main maritime and trading centre and consequently the establishment of nautical schools along ...the Adriatic was aimed actually to provide adequately qualified personnel for Austrian merchant shipping and navy. The premises of the present Nautical School was built at Lapad in the period 1952-1954. The Nautical Educational Centre was the result of the merger between the Merchant Marine College and the Nautical School of Dubrovnik in 1969. The Faculty of Maritime Studies of Dubrovnik was established in 1984. and the Polytechnic of Dubrovnik late in 1996 and early in 1997, later to develop into the University of Dubrovnik late in 2003. Under the sponsorship of the local shipping company "Atlantska plovidba", Nautical School was recently equipped by simulators and similar equipment, as a contribution to mutual respect for the continued tradition of nautical education in Dubrovnik and the RC to be carried on.
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