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Controlled Clinical Trial
- Economic Value of the Sirolimus Eluting Stent (CYPHER(TM)) in Treating Acute Coronary Heart Disease.
- Hoo Yeon Lee, Eun cheol Park
- Korean J Prev Med. 2003;36(4):339-348.
- 2,184 View
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Abstract
PDF - OBJECTIVE
To quantify the economic value of the Sirolimus Eluting Stent (CYPHER(TM)) in treating acute coronary heart disease (CHD), and to assist in determining an adequate level of reimbursement for CYPHER(TM) in Korea. METHODS: A decision-analytical model, developed by the Belgium Health Economics Disease Management group, was used to investigate the incremental cost-effectiveness of CYPHER(TM) versus conventional stenting. The time horizon was five years. The probabilities for clinical events at each node of the decision model were obtained from the results of large, randomized, controlled clinical trials. The initial care and follow-up direct medical costs were analyzed. The initial costs consisted of those for the initial procedure and hospitalization. The follow-up costs included those for routine follow-up treatments, adverse reactions, revascularization and death. Depending on the perspective of the analysis, the costs were defined as insurance covered or total medical costs (=sum of insurance covered and uncovered medical costs). The cost data were obtained from the administrative data of 449 patients that received conventional stenting from five participating Korean hospitals during June 2002. Sensitivity analyses were performed for discount rates of 3, 5 and 7%. Since the major clinical advantage of CYPHER(TM) over conventional stenting was the reduction in the revascularization rates, the economic value of CYPHER(TM), in relation to the direct medical costs of revascularization, were evaluated. If the incremental cost of CYPHER(TM) per revascularization avoided, compared to conventional stenting, was no higher than that of a revascularization itself, CYPHER(TM) would be considered as being cost-effective. Therefore, the maximum acceptable level for the reimbursement price of CYPHER(TM) making the incremental cost-effectiveness ratio equal to the cost of a revascularization was identified. RESULTS: The average weighted initial insurance covered and total medical costs of conventional stenting were about 6, 275, 000 and 8, 058, 000 Won, respectively. The average weighted sum of the initial and 5-year follow-up insurance covered and total medical costs of conventional stenting were about 13, 659, 000 and 17, 353, 000 Won, respectively. The estimated maximum level of reimbursement price of CYPHER(TM) from the perspectives of the insurer and society were 4, 126, 897 ~ 4, 325, 161 and 4, 939, 939 ~ 5, 078, 781 Won, respectively. CONCLUSION: By evaluating the economic value of CYPHER(TM), as an alternative to conventional stenting, the results of this study are expected to provide a scientific basis for determining the acceptable level of reimbursement for CYPHER(TM). -
SummaryOriginal Articles
- A Nested Case Control Study on Risk Factors for Coronary Heart Disease in Korean.
- Ki Soon Kim, So Yeon Ryu, Jong Park, Jong Ku Park, Chun Bae Kim, Byung Yeol Chun, Tae Yong Lee, Kang Sook Lee, Duk Hee Lee, Kwang Wook Koh, Sun Ha Jee, Il Suh
- Korean J Prev Med. 2001;34(2):149-156.
- 2,949 View
- 138 Download
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Abstract
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- OBJECTIVE
To elucidate risk factors for coronary heart diseases among Korean males. METHODS: A nested case control study was conducted among a Korea Medical Insurance Cooperation(KMIC) cohort composed of 108,802 males. The cases included 246 male patients who were admitted to hospital due to coronary heart diseases from 1993 to 1997 (I20-25 by ICD) and whose diagnosis was confirmed by the protocol by WHO MONICA Project(1994). The control group was composed of 483 patients selected by frequency matching considering age and resident area from an inpatient care group without coronary heart disease during the same period. For study cases and the controls, the results of a health check-up in 1990 and a questionnaire on life style in 1992 were received through the KMIC. Some additional information was collected by telephone interviews during October 1999. RESULTS: Multiple logistic regression analysis showed that the odds ratio(OR) of coronary heart diseases among past smokers and current smokers as compared to non-smokers were 1.94(95% CI : 1.14-3.31) and 2.20(95% CI : 1.35-3.59), respectively. The OR among persons who drank 4 cups or more of caffeinated beverages such as coffee or tea daily as compared to persons who drank one cup for 2-3 days was 2.56(95% CI : 1.07-6.12). The OR among persons with high normal BP and stage 3 hypertension against normotension were 2.51(95% CI : 1.44-4.37) and 5.08(95% CI : 2.38-10.84). The OR among persons whose blood cholesterol were 240 mg/dL or more against lower than 200mg/dL was 2.24(95% CI : 1.43-3.49). CONCLUSION: Smoking, drinking of excessive caffeinated beverages, hypertension and high blood cholesterol were proven to be significant risk factors for coronary heart diseases among Korean males. -
SummaryTOP
- Meta-analysis on the Blood Lipids as Risk Factors of Coronary Heart Diseases in Koreans.
- So Yeon Ryu, Ki Soon Kim, Yang ok Kim, Jong Park, Jong Ku Park, Chun Bae Kim, Sun Ha Jee
- Korean J Prev Med. 1999;32(4):491-493.
- 2,255 View
- 21 Download
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Abstract
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- OBJECTIVES
To determine the relations between seven blood lipids such as total cholesterol(TC), triglyceride(TG), HDL-cholesterol(HDL), LDL-cholesterol(LDL), apolipoprotein A-1(Apo A1), apolipoprotein B(Apo B) and lipoprotein(a)(Lp(A)) and the coronary heart diseases(CHD), the quantitative techniques of meta-analysis were applied to studies of blood lipids and CHD in Koreans. METHODS: We searched the Korean and the English literature published from 1980 to August, 1997 by manual search and bibliography review. Information on sample size, study design, participant characteristics(gender, age) and blood lipid levels were abstracted by reviewers using inclusion criteria. Estimates of the effect sizes of blood lipid levels on CHD in Koreans and corresponding 95% confidence intervals were calculated using random-effect models. RESULTS: We identified 16 case-control studies to apply meta-analysis. The overall effect sizes for CHD were 20.3(95% CI : 14.23-26.22) in TC, 24.8(95% CI : 12.6-36.86) in TG, 15.16(95% CI : 3.99 - 26.33) in LDL, -3.48(95% CI : -5.79 - -1.17) in HDL, -9.78(95% CI : -16.98 - -2.58) in Apo-a1, 17.88(95% CI : 9.72 - 26.05) in Apo B and 18.95(95% CI : 17.88 - 20.02) in Lp(a). CONCLUSIONS: Our results suggested that seven blood lipids were significantly associated with CHD in Koreans. Well-designed and prospective studies between blood lipids and CHD in Koreans should be performed. -
Summary
- The Incidence Rate of Coronary Heart Disease in City Area.
- Byung Yeol Chun, Kwon Bae Kim, Kee Sik Kim, Young Jo Kim, Yoon Nyun Kim, Chang Yoon Kim, Wee Hyun Park, Dong Gu Shin, Bong Sub Shin, Jong Joo Lee, Choong Won Lee, Sung Gug Chang, Jae Eun Jun, Yong Keun Cho, Shung Chuil Chae, Gi Yong Choi, Young Ae Ha, Young Sook Lee
- Korean J Prev Med. 1998;31(3):395-403.
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- 30 Download
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Abstract
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- To estimate the incidence rate of coronary heart disease in Korea, of all residents of the Taegu city aged 25 or above, those who had an acute MI or fatal coronary event between 1 July 1996 and 30 June 1997 were registered. Seven hundreds and eight patients were registered during the study period(685 were identified at hospital and 23 were autopsy cases). Age-standardized annual incidence rate of men in city area was 93 per 100,000(95% CI; 61-142) and 33(95% CI; 16-67) in women(100 in men and 20 in women aged 35-64). The incidence was rapidly increased after age 40 in men, however, in women after age 60. Twenty-eight-days case fatality rate was 45% in men and 47% in women. However, in the age group of 45-59 case fatality rate in women was two times higher than that in men. In conclusion, crude annual incidence rate of CHD in city area was 73 per 100,000 in men and 33 in women. The age-standardized annual incidence of CHD in men(93 per 100,000) was 3.2 times higher than that in women (33 per 100,000) in Korea.
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Summary
- The Case-Control Study on the Risk Factors of Cerebrovascular Diseases and Coronary heart Diseases.
- Jong Ku Park, Hun Joo Kim, Keum Soo Park, Sung Su Lee, Sei Jin Chang, Kye Chul Shin, Sang Ok Kwon, Sang Baek Ko, Eun kyoung Lee
- Korean J Prev Med. 1996;29(3):639-656.
- 2,306 View
- 37 Download
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Abstract
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- Cerebrovascular disease and coronary heart disease are the first and the fourth common causes of death among adults in Korea. Reported risk factors of one of these diseases may prevent other diseases. Therefore, we tried to compare and discriminate the risk factors of these diseases. We recruited four case groups and four control groups among the inpatients who were admitted to Wonju Christian Hospital from March, 1994 to November, 1995. Four control groups were matched with each of four case groups by age and sex. The number of patients in each of four case and control groups were 106 and 168 for acute myocardial infarction(AMI), 84 and 133 for subarachnoid hemorrhage(SAH), 102 and 148 for intracerebral hemorrhage(ICH), and 91 and 182 for ischemic stroke(IS) respectively. Factors whose levels were significantly higher in AMI and IS than in responding control group(RCG) were education, economic status, and triglyceride. Factors whose levels were significantly lower in hemorrhagic stroke than in RCG were age of menarch, and prothrombin time. The factor whose level was higher in AMI than in RCG was uric acid. The factor whose level was higher in AMI, ICH, and SAH than in RCG was blood sugar. Factors whose levels were significantly higher in all the case groups than in RCG were earlobe crease, Quetelet index, white blood cell count, hemoglobin, hematocrit, and total cholesterol. The list of risk factors were somewhat different among the four diseases, though none of the risk factors to the one disease except prothrombin time acted as a preventive factor to the other diseases. The percent of grouped cases correctly classified was higher in the discrimination of ischemic diseases(AMI and IS) from hemorrhagic diseases(SAH and ICH) than in the discrimination of cerebrovascular disease from AMI. The factors concerned in the discrimination of ischemic diseases from hemorrhagic diseases were prothrombin time, earlobe crease, gender, age uric aci, education, albumin, hemoglobin, the history of taking steroid, total cholesterol, and hematocrit according to the selection order through forward selection.
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