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Semelhante a Economic And Humanistic Outcomes Of Post Acs In Cardiac Rehabilitation Program At Sarawak General Hospital For Nham 2010
Semelhante a Economic And Humanistic Outcomes Of Post Acs In Cardiac Rehabilitation Program At Sarawak General Hospital For Nham 2010 (20)
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Economic And Humanistic Outcomes Of Post Acs In Cardiac Rehabilitation Program At Sarawak General Hospital For Nham 2010
- 1. 3 Lawrence Anchah , 1, 2 Prof. Dr. Sim Kui Hian, 4 Prof. Dr. Mohd. Izham Mohd Ibrahim, 1, 2 Dr. Alan Fong Yean Yip , 3 Yanti Nasyuhana Sani, 3 Tiong Lee Len, 3 Bibi Faridha Mohd Salleh, 4 Dr Mohd. Azmi Ahmad Hassali, 4 Prof. Dr. Yahaya Hassan, 5 Karen Tang Siew Lang, 1 Hii Ai Ching, 1 Sii Lik Ngoh 1 Dept of Cardiology, Sarawak General Hospital 2 Clinical Research Centre, Sarawak General Hospital 3 Dept of Pharmacy, Sarawak General Hospital 4 School Pharmaceutical Sciences, Universiti Sains Malaysia 5 Dept of Physiotherapy, Sarawak General Hospital The Economic and Humanistic Outcomes of Post Acute Coronary Syndrome in Cardiac Rehabilitation Program: A Quasi-experimental Design of 12-months Follow-up
- 7. METHODOLOGY
- 9. CCRP CONTROL MCRP Inpatient Outpatient
- 12. RESULTS
- 13. Screening and Recruitment process from Jan-Dec 2008
- 14. At baseline there were no difference in demographic, socioeconomic background, or physical characteristic data
- 15. Clinical & Physical Characteristic
- 18. Baseline compare with Malaysian Population Norms
- 20. 12 Months Assessment MH BP, GH & VT
- 21. Nnot MCRP
- 23. Mean Differences after 12 months follow up
- 24. Estimation of the cost of treatment based expenditure (top-down), services, salary, hospital days, medication, procedure cost etc. Admission Cost Stage I, II, III OPD Phase 2 Follow-up Medication Cost COROS TOTAL Cost (Annually) QALY Gain Rx MCRP 1,788.21 43.05 17.21 2,302.72 1,901.24 6,052.43 $7,213.86 CCRP 1,788.21 17.21 2,302.72 1,901.24 6,009.38 $7,162.55 Control 1,788.21 2,302.72 1,901.24 5,992.17 $8,000.23 DES BMS PCI MCRP 16,893.92 43.05 17.21 2,302.72 13,393.92 15,756.90 $18,780.57 CCRP 16,893.92 17.21 2,302.72 13,393.92 15,713.85 $18,729.26 Control 16,893.92 2,302.72 13,393.92 15,696.64 $20,956.79 COROS CABG MCRP 49,341.08 43.05 17.21 2,302.72 1,901.24 53,605.30 $63,891.89 CCRP 49,341.08 17.21 2,302.72 1,901.24 53,562.25 $63,840.58 Control 49,341.08 2,302.72 1,901.24 53,545.04 $71,488.70
- 25. Utility Score from EQ5D Questionnaire Baseline 12 months
- 26. Incremental Cost Ratio * CCRP as a reference point Optimised Medical Therapy TOTAL Cost Annually QALY Incremental Cost Ratio (ICR) MCRP 6,052.43 7,213.86 $51.31 CCRP * 6,009.38 7,162.55 - Control 5,992.17 8,000.23 $837.68 PCI (Angiogram) MCRP 15,756.90 18,780.57 $51.31 CCRP 15,713.85 18,729.26 - Control 15,696.64 20,956.79 $2,227.53 CABG (Bypass) MCRP 53,605.30 63,891.89 $51.31 CCRP 53,562.25 63,840.58 - Control 53,545.04 71,488.70 $7,648.12
- 28. CONCLUSION
- 30. LIMITATION
- 32. THANK YOU Sarawak General Hospital It is not the number that count, but the heart….
Notas do Editor
- Testing
- BRUM study. Nonadherence to prescribed medications bypatients with coronary heart disease (CHD) is associated with an increased incidence of adverse cardiovascular events, but it is not known whether self-reported nonadherence can identify patients at greatest risk of such events. Nonadherence to physician treatment recommendations is an increasingly recognized cause of adverse outcomes and increased health care costs, particularly among patients with cardiovascular disease
- Clinical & Physical Characteristic
- Several dimensions of HRQOL measures were found inproved in MCRP. Comparison of mean difference from baseline MCRP (+10.57; 95%CI: -2.09, 23.23) Reported less bodily pain (BP) than CCRP (+3.72, 95%CI:-8.94, 16.39) and Control (-4.16, 95%CI: -14.92, 6.59).
- Results For a 0-100 score and MCID values from -40 to -10, the difference in success rate between arms ranges from 7.9% to 9.9% (ES = 0.25) and from 15.9% to 19.7% (ES = 0.50). For PASS values from 20 to 50, the difference in success rate between arms ranges from 7.1% to 9.9% (ES = 0.25) and from 15.6% to 19.7% (ES = 0.50).Conclusion The MCID or PASS value has a low impact on the difference in the success rate between the arms in a trial. Tubach, F., Giraudeau, B., & Ravaud, P. (2009). The variability in minimal clinically important difference and patient acceptable symptomatic state values did not have an impact on treatment effect estimates. Journal of Clinical Epidemiology, 62(7), 725-728. The minimal important difference (MID), from the patient perspective, can be defined as "the smallest difference in score in the domain of interest which patients perceive as beneficial and which would cause clinicians to consider a change in patient's management". (Jaeschke et al., 1989; Fayers & Machin, 2007).
- BRUM study. Nonadherence to prescribed medications bypatients with coronary heart disease (CHD) is associated with an increased incidence of adverse cardiovascular events, but it is not known whether self-reported nonadherence can identify patients at greatest risk of such events. Nonadherence to physician treatment recommendations is an increasingly recognized cause of adverse outcomes and increased health care costs, particularly among patients with cardiovascular disease