20.500.12556/DKUM-65284 Simulation analysis of economic burden in hypertension and myocardial infarction treatment with beta blockers Simulacijsko vrednotenje ekonomskega bremena zdravljenja hipertenzije in miokardnega infarkta z uporabo beta blokatorjev Background: Hypertension has become a very frequent chronic disease worldwide and Slovenia is no exception. It is defined as a serious risk factor for developing different cardiovascular diseases. Several important studies proved that cardiovascular diseases are the main reason of deaths in more than 50 % of cases in the developed countries. All mentioned facts are indicating that treatment costs in patients with hypertension and cardiovascular diseases represent an important economic burden, which cannot be neglected. It may also be expected that in the next few decades the situation will become even worse. The reasons are the expected earlier disease development due to unhealthy life style and the fact that people live longer and populations are growing older. The mentioned facts have motivated the study, which would enable the estimation of patients’ number in the observed population and the evaluation of economic burden when using beta blockers, drugs which have become an important choice in antihypertensive treatment and are also used in patients with different cardiovascular complications. The projections indicating the expected trends of mentioned problems in the forthcoming decades would also be of interest. Methods: To answer some of the indicated questions, a simulation model was developed, which enabled the prediction of patients with hypertension and the influence of this disease to the development of myocardial infarction. Modeling was performed using the available statistical data and published studies. Main attention was devoted to the circumstances in Slovenia, but the results were also verified using the available data for some other countries. Combination of simulation results with demographic data enabled the estimation of the number of patients observed. In addition, expenses for the observed groups of patients were evaluated and, based on that, the economic burden was estimated. The mentioned expenses include hospitalizations, drugs required and the estimated mortality-related expenses. The developed model was accomplished with dynamical mathematical structure predicting the development of population number in Slovenia in the forthcoming decades, taking into account that the demographic properties remain unchanged. Also the observation of potential scenario regarding patients’ number and thus expected economic burden distribution among younger and older population is made possible. Results: In the paper simulation results are presented which enable the estimation of patients with hypertension and their connection with those who have experienced myocardial infarction. It is possible to observe the prevalence and the number of patients in Slovenia by age. In addition, economic burden associated with the observed groups of patients is calculated taking into account needed drugs, hospitalizations and patient mortality. In such circumstances it is possible to expect that in the group of one million people approximately 264,000 are patients with hypertension for whom, when healed optimally with beta blockers, over EUR 13 million is needed per year. In the same group of one million people are also patients with myocardial infarction. Among them 11 % experienced infarction within the current year. This amounts to more than 22,000 such patients and over EUR 22 million needed for them each year. In the case of unchanged statistical demographic characteristics in the future, it can be expected that in 50 years relative economic burden for active population would become twice as high as it is now. Conclusions: For optimal treatment, hospitalization and due to mortality more than EUR 35 million per year would be needed for patients with hypertension (around 260,000 patients) and for those who have experienced myocardial infarction (around 22,000) if observing the population of one million people. As the population is growing older, it can be expected that the relative economic burden will become significantly greater for active population in the forthcoming decades. Izhodišča: Hipertenzija je kronična bolezen, ki je dosegla že zelo zaskrbljujoče razsežnosti, pri čemer tudi Slovenija ni izjema. Opredeljena je kot pomemben dejavnik tveganja za razvoj različnih srčno-žilnih bolezni. Analize kažejo, da so srčno-žilne bolezni vzrok smrtnosti že v več kot 50 % v državah razvitega sveta. Vse to opozarja na dejstvo, da je zdravljenje bolnikov z visokim krvnim tlakom in srčno-žilnimi boleznimi za družbo postalo nezanemarljivo ekonomsko breme. Pričakujemo, da se bo v naslednjih desetletjih stanje še slabšalo. Razloge za takšno napoved pripisujejo vse zgodnejšemu razvoju bolezni zaradi nezdravega načina življenja pa tudi staranju prebivalstva. Omenjena dejstva so spodbudila študij možnosti določanja števila teh bolnikov v opazovani populaciji in vrednotenja stroškov ustreznega zdravljenja pri uporabi blokatorjev beta, ki so postali zdravilo izbire pri antihipertenzivnem zdravljenju, uporabljajo pa se tudi pri zdravljenju bolnikov z različnimi srčno-žilnimi zapleti. Zelo zanimive bi bile tudi projekcije, ki bi nakazale trende te problematike v prihodnjih letih oz. desetletjih. Metode: Da bi odgovorili na zastavljena vprašanja, smo zgradili simulacijski model, ki napoveduje razvoj prevalence bolnikov s hipertenzijo ter vpliv te bolezni na razvoj miokardnega infarkta. Modeliranje smo temeljili na razpoložljivih statističnih podatkih in objavljenih študijah. Osrednjo pozornost smo namenili razmeram v Sloveniji, rezultate modeliranja pa smo vrednotili tudi glede na dosegljive podatke v nekaterih drugih državah. Kombinacija rezultatov modeliranja z demografskimi podatki je omogočila tudi izračun števila opazovanih bolnikov. Nadalje smo ovrednotili tudi stroške, povezane z opazovanima skupinama bolnikov, in na takšen način omogočili tudi oceno ekonomskega družbenega bremena. V prikazanem izračunu smo upoštevali stroške zdravil pri optimalnem zdravljenju, hospitalizaciji in smrtnosti. Razviti model smo dopolnili še z dinamičnim matematičnim modelom razvoja prebivalstva v Sloveniji ob upoštevanju predpostavke, da demografske značilnosti ostajajo nespremenjene. S tem smo omogočili opazovanje nekaterih možnih scenarijev razvoja številčnosti opazovanih bolnikov v prihodnosti in prerazporejanja bremena stroškov zdravljenja med mlajšimi in starejšimi v naslednjih desetletjih. Rezultati: V prispevku smo predstavili simulacijske rezultate, ki omogočajo oceno števila bolnikov s hipertenzijo in njihovo povezavo z bolniki, ki so doživeli miokardni infarkt. Predstavljena je prevalenca teh bolnikov in njihova številčnost v Sloveniji glede na njihovo starost. Ovrednotili smo tudi ekonomsko breme, povezano z opazovanimi bolniki in sicer tako, da smo določili stroške, povezane s potrebnimi zdravili, hospitalizacijo in smrtnostjo. Ugotovitve je mogoče tudi ekstrapolirati na države s primerljivim ekonomskim, socialnim in demografskim stanjem. V takšnih razmerah pričakujemo, da bo v milijonski skupini ljudi približno 264 000 oseb s hipertenzijo, za katere bi ob optimalnem zdravljenju z blokatorji beta potrebovali letno prek 13 milijonov evrov. V isti skupini se nahajajo seveda tudi bolniki, ki so doživeli miokardni infarkt, med katerimi je kar 11 % takšnih, ki so infarkt doživeli v obdobju, ki je krajše od enega leta. Na milijon prebivalcev se pričakuje, da jih je prek 22 000 takšnih, ki so že doživeli miokardni infarkt. V povezavi z njimi je letno potrebno preko 22 milijonov evrov. V primeru, da se statistične demografske značilnosti v prihajajočih letih ne bodo bistveno spreminjale, pričakujemo izrazito staranje populacije, ekonomsko breme aktivne populacije v zvezi s hipertenzijo in miokardnim infarktom pa bo čez 50 let vsaj dvakrat višje. Zaključki: Glede na predstavljene rezultate pričakujemo, da bi letno potrebovali prek 35 milijonov evrov na milijon prebivalcev za bolnike s hipertenzijo (okrog 260 000 oseb) in za tiste, ki so doživeli miokardni infarkt (okrog 22 000 oseb). Ker se prebivalstvo stara, se je potrebno zavedati, da postaja za aktivno populacijo to ekonomsko breme sorazmerno vse večje. hypertension myocardial infarction beta blockers economic burden modelling simulation hipertenzija miokardni infarkt beta blokatorji ekonomsko breme modeliranje simulacija true false true Angleški jezik Slovenski jezik Znanstveno delo 2017-03-28 12:39:01 2017-03-28 12:40:03 2022-07-07 03:09:06 2019-07-11 15:13:27 2012 0 0 str. 105-118 št. 2 Letn. 81 feb. 2012 0000-00-00 Zaloznikova Objavljeno NiDoloceno 0000-00-00 0000-00-00 0000-00-00 1318-0347 616.12-008.331.1 32893696 8956244 1318-0347 URN:SI:UM:DK:2SEADQKW Zdravniski_vestnik_2012_Atanasijevic-Kunc_et_al._Simulation_analysis_of_economic_burden_in_hypertension_and_myocardial_infarction_treatm.pdf Zdravniski_vestnik_2012_Atanasijevic-Kunc_et_al._Simulation_analysis_of_economic_burden_in_hypertension_and_myocardial_infarction_treatm.pdf 1 E71E27DC749C5EC13527F067D7C9C99B 595668fe7a410a6de2075da779f9625a1537e587c8791e5cd95821113b9399b1 07ba63ea-7c0e-11eb-bb7a-00155d0001ca https://dk.um.si/Dokument.php?lang=slv&id=110267 http://vestnik.szd.si/index.php/ZdravVest/article/view/559 1 https://dk.um.si/Dokument.php?lang=slv&id=110266 Medicinska fakulteta 0 0 0