Tratamento adjuvante do melanoma com interferon / Adjuvant therapy of melanoma with interferon

Melanoma é um tumor maligno que cresce a partir de células melanocíticas, envolvendo principalmente a pele. Embora seja a neoplasia de pele menos freqüente, ela é responsável por 75% das mortes de câncer. Mesmo com as campanhas de prevenção, a incidência e a mortalidade por esta neoplasia continuam a aumentar. Atualmente, o diagnóstico precoce e a remoção cirúrgica adequada oferecem ao paciente a melhor chance de cura, mas as pessoas com alto risco de recorrência também devem realizar tratamento adjuvante, sendo o interferon o agente mais utilizado. Estudos evidenciam uma redução no risco de recorrência da doença e aumento na sobrevida global dos pacientes que utilizam este tratamento, embora este benefício esteja restrito a uma minoria. Análises de subgrupos apontam um maior benefício em pacientes que apresentam ulceração no tumor ou micrometástases linfonodais.

Cost-effectiveness of hypertension treatment: a population-based study

CONTEXT: The cost-effectiveness of the treatment of hypertension has scarcely been investigated in population-based studies. Most data come from secondary analysis of clinical trials and administrative sources. OBJECTIVE: To describe the healthcare costs for outpatient hypertension treatment in comparison with diabetes mellitus and chronic bronchitis, and to examine the cost-effectiveness of different classes of antihypertensive drugs. DESIGN: Cross-sectional population-based study. SETTING: Urban area of Pelotas, southern Brazil. PARTICIPANTS: Individuals aged 20-69 years, identified through multi-stage probability sampling. METHODS: Participants were interviewed at home. Demographic data, education, income, smoking, previous morbidity, use of medicine and other characteristics were assessed via a pre-tested questionnaire, and blood pressure while seated was measured in a standardized way. RESULTS: Approximately 24 percent of the participants had high blood pressure or were taking antihypertensive drugs, and among these, 33 percent had had a physician consultation during the month preceding the interview. The monthly mean costs of care for hypertension (R$ 89.90), diabetes (R$ 80.64) and bronchitis (R$ 92.63) were similar. Treatment of hypertension consumed 22.9 percent of the per-capita income, corresponding to R$ 392.76 spent per year exclusively on antihypertensive drugs. Most of the direct costs associated with hypertension and diabetes were spent on drugs, while patients with bronchitis had greater expenditure on appointments. The cost-effectiveness relationship was more favorable for diuretics (116.3) and beta blockers (228.5) than for ACE inhibitors (608.5) or calcium channel blockers (762.0). CONCLUSION: The costs of hypertension care are mainly dependent on the expenditure on blood pressure-lowering drugs. Treatment of hypertension with diuretics or beta blockers was more cost-effective than treatment with ACE inhibitors and calcium channel blockers