"QCOR 2014 presentation start today. 2 CUTEHeart posters to present: ""Comparison of the Healthcare Systems of the United States and Portugal: Epidemiology and Management of Coronary Heart Disease""

1. 0,3
0,1
7,7
1,1
0,2
0,1
6,8
0,9
0 2 4 6 8
0,5
0,4
7,2
1,4
7,2
1,7
8 6 4 2 0
SOURCES:
* Area Health Resources Files (AHRF). 2012-2013. HCUP, PT Medical
Association, Government reports,
** NHANES 2006-08 and AMÁLIA study 2006/07, Age-standardized rates,
Overweight prevalence based on BMI
^ OECD
+ CDC Wonder and Eurostat, Age-sex-standardized deaths rates
† Year of approval in the US
Sources: FDA, personal communication with BBraun PT, SPC-interventional
cardiology group
*PT dates refer to first use dates in Santa Cruz Hospital
** Not aproved in the US, March 31st 2014 was used to produce the difference
† Year of approval in the US
Sources: FDA/approval dates and INFARMED/commercialization dates
**Not available/commercialized in one of the countries, March 31st 2014 was
used to produce the difference
Healthcare Systems Comparison Between the United States and
Portugal | Epidemiology and Management of Coronary Heart Disease
Lobo MF • Azzone V • Melica B • Freitas A • Rocha-Gonçalves F • Soares AJ • Normand SLT • Teixeira-Pinto A •
Pereira-Miguel J • Costa-Pereira A
What is Known Findings
// The United States (US) and Portugal (PT) have health care
systems with different characteristics
// Different health systems have different abilities to adopt
new technologies
// Coronary heart disease (CHD) remains one of the leading
causes of death with significant economic costs
// Comprehensive literature review based on data from
governmental agencies, international organizations, professional
associations and scientific journals
// Personal communication with the medical device industry
representatives
// Health technologies access lag defined by the difference of
approval/commercialization/first use dates (US – PT)
// Direct standardization of mortality and self-reported risk
factors rates to the PT 2006 population
To expose the main similarities and differences
between the health care systems of the US and PT
in the context of CHD management
Aim
Disclosures: Nothing to disclose. Funded by FCT, QREN, COMPETE (HMSP-ICT/0013/2011)
Methods
Country United States Portugal
Year
Population
Total (million)
≥ 65 years (% of population)
Uninsured (% of population)
Total hospital beds (1,000 population)
Beds in public hospitals (1,000 population)
Health Status
Life expectancy at birth (years)
All-cause Deaths per 100,000*
2000
281.4
12.4
13.1
3.5
0.9
76.7
1,486
2010
308.7
13.1
16.3
3.1
0.8
78.71
1,329.9
2000
10.3
16.2
0
3.7
2.9
76.71
1,153.7
2010
10.6
18.4
0
Total expenditure (% of GDP) 13.7 17.7 9.3 10.8
Government share (% of total expenditure) 43.0 47.6 66.6 65.9
Out-of-Pocket (% of total expenditure) 14.9 11.7 24.3 25.8
3.4
2.5
79.8
916
Health Coverage
Health Costs
Hospital Capacity
Sources: OECD, CDC, US Bureau Statistics, Statistics Portugal, Eurostat
*All years, Age-sex standardize death rates
Technologies Approval Mechanisms
MEDICAL DEVICES:
// Centralized medical device approval system in the US (federal
level, FDA), but decentralized in PT (EU – European Union level)
// The EU approval system is faster than the US without more recalls
DRUGS:
// Centralized drug approval system in the US, may vary in PT
// Approval and commercialization dates may differ in PT,
whereas, in the US, they are coincidental
// Access and use of health technologies differ greatly between
the two health care systems for CHD care
// The approval and commercialization process of drugs may
delay their availability to PT patients
// Access lag favors the US and use patterns are larger in US
// Compared to the US, lower deaths due to AMI or CHD in PT
What this Study Adds
Cardiothoracic surgeon
Cardiologist
Hospital with PCI
Hospital with
Cardiac Surgery
Overweight/Obesity
Hypercholesterolemia
Hypertension
Daily Smoking
Diabetes
Inpatient cases
(per 100,000 population)^
CABG
PTCA
Deaths (per 100,000 population)+
Aged 20 years or more
AMI or
Recurrent AMI
CHD
Drug-Eluting Stent
US first year†
year†
PT firstMedical Device/Procedure
1980
1990
1993
1993
2000
2003
2014Drug-Eluting Balloon Catheter**
Rotablator*
Coronary Brachytherapy*
Bare-Metal Stent*
Directional Atherectomy*
PTCA Balloon Catheter
Difference (in months)
Health Technologies Access Lag
US first PT firstActive Substance
-200 -150 -100 -50 0 50 100 150 200
Nicorandil**
Apixaban**
Ticagrelor
Rivaroxaban
Dabigatran etexilate
Prasugrel**
Ranolazine**
Bivalirudin
GP IIb/IIIa inhibitor - Eptifibatide
GP IIb/IIIa inhibitor - Tirofiban
Clopidogrel
GP IIb/IIIa inhibitor - Abciximab
Ticlopidine
Difference (in months)
www.cuteheart.com
marianalobo@med.up.pt
2000
2010
2000
2010
2000
2009
2000
2009
2000
2010
2000
2010
193,3
79,0
195,7
111,0
250 200 150 100 50 0
118,1
39,7
45,5
22,9
0 50 100 150 200 250
183,9
59,2
305,0
114,5
400 300 200 100 0
81,9
54,6
125,2
88,6
0 100 200 300 400
12,7
19,1
44,1
42,4
71,5
80 60 40 20 0
8,9
16,3
23,5
19,7
51,6
806040200
1991
1993
1997
1998
1998
2000
2006
2009
2010
2011
2011
2012
2014
-200 -100 -50 50-150 0 100 150 200