PHARMACOECONOMIC ASPECTS OF NICOTINE ADDICTION TREATMENT IN PATIENTS WITH ANGINA REQUIRING CARDIAC SURGERY
Abstract
Smoking is a major risk factor in patients with angina pectoris. Interventions that facilitate the rejection of it are an important part of the treatment. Aim. To analyze the cost effectiveness of the partial agonist of nicotinic receptors, varenicline, in patients with angina who require cardiac interventions. Material and methods. The estimation was conducted using a Markov model based on the results of clinical trials and epidemiological studies. The cost of treatment of complications were calculated on the basis of compulsory medical insurance rates for St. Petersburg in 2011. Results. The varenicline therapy in 70-year-old patients before cardiac surgery reduces hospital mortality at an extremely high cost-effectiveness (the cost of preventing one death - 148.8 thousand rubles). The cost/effectiveness ratio in the analysis for the period of survival of patients in this situation was 31.3 thousand rubles for 1 additional year of life. Life expectancy will be increased by an average of 0.147 years. Analysis for the period of survival of 50-year-old patients has shown that in patients after cardiac surgery cost-effectiveness of varenicline is extremely high (in the analysis from the perspective of the health care system the cost/effectiveness ratio was 36.0 thousand rubles for 1 additional year of life, in the analysis, taking into account the social perspective – 17.9 thousand rubles for 1 additional year of life). Increase in the life expectancy of 50 year-old patients will be 0.291 year in average. Conclusion. Varenicline therapy of patients with angina pectoris is the economy before cardiac surgery , and after their execution, and this applies not only young, but older patients. The desirability of varenicline including to federal and regional programs to reduce cardiovascular morbidity and mortality is shown.
About the Authors
A. V. Rudakova
Saint-Petersburg Chemical-Pharmaceutical Academy
Russian Federation
Russian Federation
M. S. Berezhnova
Saint-Petersburg Chemical-Pharmaceutical Academy
Russian Federation
Russian Federation
References
1. National guidelines for diagnosis and treatment of stable angina. Kardiovaskulyarnaya Terapiya i Profilaktika 2008; 7(6) suppl 4: 1–36. Russian (Национальные рекомендации по диагностике и лечению стабильной стенокардии. Кардиоваскулярная Терапия и Профилактика 2008; 7(6) Приложение 4: 1–36).
2. Turan A., Mascha E.J., Roberman D., et al. Smoking and perioperative outcomes. Anesthesiology 2011; 114(4): 837–46.
3. Mills E., Eyawo O., Lockhart I., et al. Smoking cessation reduces postoperative complications: A systematic review and meta-analysis. Am J Med 2011; 124 (2): 144–154.
4. Rigotti N., Pipe A., Benowitz N., et al. Efficacy and safety of varenicline for smoking cessation in patients with cardiovascular disease: a randomized trial. Circulation 2010; 121: 221–229.
5. Jones R., Nyawo B., Jamieson S., Clark S. Current smoking predicts increased operative mortality and morbidity after cardiac surgery in the elderly. Interactive CardioVascular and Thoracic Surgery 2011; 12 (3): 449–53.
6. Hasdai D., Garratt K., Grill D. Effect of smoking status on the long-term outcome after successful percutaneous coronary revascularization. N Engl J Med 1997; 336: 755–61.
7. Rudakova A.V. Statins in the treatment of coronary heart disease: pharmacoeconomic considerations. Serdtse 2008; 7(3): 85–90. Russian (Рудакова А.В. Статины в терапии ишемической болезни сердца: фармакоэкономические аспекты. Сердце 2008; 7(3): 85–90).
8. van Domburg R., Meeter K., van Berkel D., et al. Smoking cessation reduces mortality after coronary artery bypass surgery: a 20-year follow-up study. J Am Coll Cardiol 2000; 36: 878–883.
9. The General Agreement on Tariffs tariffs for health care (medical services) and the conditions of payment for medical assistance under the existing territorial program of compulsory medical insurance of citizens of the Russian Federation in St. Petersburg at 2011 Available at: http://www.spboms.ru / kiop / getdoc? doc_id = 4778. Date of access: 06/03/2012. Russian (Генеральное тарифное соглашение по тарифам на медицинскую помощь (медицинские услуги) и условиям оплаты медицинской помощи, оказываемой в рамках действующей Территориальной программы обязательного медицинского страхования граждан Российской Федерации в Санкт-Петербурге на 2011 г. Доступно на: http://www.spboms.ru/kiop/getdoc?doc_id=4778. Дата доступа: 06.03.2012).
10. State Medicaid Coverage for Tobacco-Dependence Treatments United States, 2006. JAMA 2008; 299 (15):1766–1768.
11. Bertram M., Lim S., Wallace A., Vos T. Costs and benefits of smoking cessation aids: making a case for public reimbursement of nicotine replacement therapy in Australia. Tob Control 2007; 16: 255– 260.
12. West R., DiMarino M., Gitchell J., McNeill A. Impact of UK policy initiatives on use of medicines to aid smoking cessation. Tob Control 2005; 14: 166–171.
13. Penz E., Manns B., Hebert P., Stanbrook M. Governments, pay for smoking cessation. CMAJ 2010;182(18):E810
Review
For citations:
Rudakova A.V., Berezhnova M.S. PHARMACOECONOMIC ASPECTS OF NICOTINE ADDICTION TREATMENT IN PATIENTS WITH ANGINA REQUIRING CARDIAC SURGERY. Rational Pharmacotherapy in Cardiology. 2012;8(3):424-427. (In Russ.) https://doi.org/10.20996/1819-6446-2012-8-3-424-427
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