ABSTRACT
Hepatitis B virus infection is an important public-health issue. Chronic patients have a higher risk of death due to complications, which increases health-care expenses in. Cost-effectiveness analysis of entecavir (ETV) versus lamivudine (LVD) for treatment of chronic hepatitis B, in e antigen (AgHBe)-positive and negative patients, based on two phase 3, controlled and randomized studies. A decision analysis model was developed, using the following endpoints: cost per patient with undetectable viral load and cost per quality life year (QALY) gained. Risks for complications (compensated or decompensated cirrhosis and hepatocellular carcinoma) were based on the cohort study REVEAL, published in 2006. The REVEAL parameters were applied to the results of the viral load levels obtained from the clinical assay data. The complication costs were based on a study of the disease cost conducted in Brazil, in 2005. The cost data were obtained predominantly from Sistema Único de Saúde [SUS - Brazilian public health system] payment tables and drug price lists. The utility data were obtained from literature and life expectancy information was based on IBGE data. The analysis perspective was that of SUS. A discount rate of 3 percent per year was used. For the horizon of time of 10 years, the ETV had an incremental cost of approximately two million Brazilian Reais (R$) compared to LVD. Reducing the number of complications, ETV treatment reduced costs by around 3 million, reducing final costs by 1 million, for AgHBe-positive patients. ETV also reduced the incremental cost per QALY gained. ETV was found to be the most cost-effective alternative for AgHBe-positive and negative patients.
Subject(s)
Humans , Antiviral Agents/economics , Guanine/analogs & derivatives , Hepatitis B, Chronic/virology , Lamivudine/economics , Virus Replication/drug effects , Antiviral Agents/therapeutic use , Clinical Trials, Phase III as Topic , Cost-Benefit Analysis , Decision Support Techniques , Guanine/economics , Guanine/therapeutic use , Hepatitis B virus/physiology , Hepatitis B, Chronic/drug therapy , Hepatitis B, Chronic/economics , Lamivudine/therapeutic use , Quality of Life , Quality-Adjusted Life Years , Randomized Controlled Trials as Topic , Viral LoadABSTRACT
Estima-se que um por cento da população tenha esquizofrenia, a qual atinge indivíduos jovens e coloca crescente sobrecarga econômica à sociedade. É importante o tratamento precoce e com uma medicaçaõ eficaz,bem tolerável e segura, para maximizar a adesão ao tratamento o prognóstico a longo prazo. O fato de al-guns antipsicóticos de primeira e segunda geração estarem associados a um aumento significante do peso e outros eventos adversos pode piorar a já precária adesão ao tratamento e favorecer a recaída. Diferente dos demais antipsicóticos ( antagonistas puros de dopamina), os agonistas parciais de dopamina são drogas co afinidade total de ligação ao receptor dopaminérgico e certa atividade intrínseca no mesmo, o que possibilita um perfil superior de segurança e tolerabilidade; o aripiprazol é a mais recente adição desta nova classe de antipsicóticos, com comprovada eficácia na eaquizofrenia. Os dados sobre seu mecanismo de ação, eficácia e segurança são apresentados, e sugerem ser o aripiprazol uma importante adição ao arsenal terapêutica da esquizofrênia.