Evidências clínicas e econômicas do uso de TachoSil® para hemostasia em procedimentos cirúrgicos hepáticos, pulmonares e renais / Clinical and economic evidence of the use of Tachosil® for hemostasis in hepatic, pulmonary and renal surgical procedures

OBJETIVO: Avaliar o benefício clínico e econômico de TachoSil® comparado a técnicas convencionais para hemostasia em cirurgias hepáticas, pulmonares e renais. MÉTODOS: Realizou-se revisãoda literatura em busca de revisões sistemáticas e ensaios clínicos randomizados (ECRs) que comparassem TachoSil® a técnicas convencionais de hemostasia nas cirurgias hepáticas, pulmonares erenais. Foi realizada análise de custos, sob a perspectiva do Sistema Suplementar de Saúde, contemplando custos de materiais, tempo de internação e transfusão de hemoderivados. No cenário base o uso de recursos foi baseado em estudo econômico e no cenário alternativo, nos ECRs originais. RESULTADOS: Foram encontrados 142 estudos, sendo selecionados 6 ECRs avaliando TachoSil® em cirurgia pulmonar, 4 em cirurgia hepática e 2 em cirurgia renal, além de 4 revisões sistemáticas e 2estudos não randomizados considerados relevantes. Os resultados de todos estes estudos consideraram TachoSil® uma boa alternativa às técnicas convencionais. Com base nos ECRs, TachoSil® é capaz de reduzir o tempo de internação após cirurgia pulmonar em 1,49 dia (IC 95%: 0,52 - 2,45,p<0,003) e, após cirurgia hepática, em 3 dias. A análise de custos demonstrou que TachoSil® reduz o custo em R$10.349,77, R$10.686,11 e R$4.677,46, respectivamente, nas cirurgias pulmonar, hepática e renal, quando comparado às técnicas convencionais, no cenário base. No cenário alternativo as reduções foram de R$2.020,09, R$4.872,22 e R$3.997,17 nas indicações pulmonar, hepática e renal, respectivamente. CONCLUSÕES: O maior benefício clínico de TachoSil®, quando comparado a técnicas convencionais, foi demonstrado em diversos estudos clínicos. O uso de TachoSil® levou a reduções de custo, mostrando-se uma alternativa cost-saving em relação às técnicas de hemostasia convencionais, com maior eficácia e menores custos

OBJECTIVE: To evaluate the clinical and economic benefit of TachoSil® for hemostasis in liver, lung and kidney surgery compared to conventional techniques. METHODS: A literature review was conducted looking for systematic reviews and randomized controlled trials (RCTs) that compared TachoSil ® to conventional techniques for hemostasis in liver, lung and kidney surgeries. A cost analysis was performed under the perspective of the Brazilian Private Healthcare System, considering costs of materials, hospitalization and blood transfusions. At the base case scenario, the resources were based on an international economic evaluation and in the alternative scenario, on the original RCTs. RESULTS: The review shows up 142 studies. Six RCTs evaluating TachoSil® in pulmonary surgery, 4 inhepatic surgery and 2 in renal surgery were selected, besides 4 systematic reviews and 2 non-randomized studies that had been considered relevant. The results of all those studies confirmed TachoSil® as a good alternative to conventional techniques. Based on the RCTs, TachoSil® might reduce the period of hospitalization after pulmonary surgery in 1.49 day (95% CI: 0.52 - 2.45), p<0.003) and in 3.00 days after hepatic surgery. The cost analysis demonstrated that, when compared to conventional techniques in base case, TachoSil® reduces the costs of lung, liver and kidney surgeries in $10,349.77, $10,686.11 and $4,677.46. In the alternative scenario the reductions might be of $2,020.09 $4,872.22 and $3,997.17 in lung, liver and renal surgeries, respectively. CONCLUSIONS: The superior clinical benefit of TachoSil® when compared to conventional techniques was demonstrated in several clinical trials. The use of TachoSil® leads to cost reductions, being a cost-saving alternative (with superior efficacy and lower costs)

Outcomes of autologous transplantation for multiple myeloma according to different induction regimens

Background: Induction therapy followed by high-dose chemotherapy and autologous transplantation is the standard treatment for suitable patients with multiple myeloma. Objective: The aim of this study was to assess whether induction therapy with thalidomidecontaining regimens was associated with improved results compared to vincristine, doxorubicin, and dexamethasone, and whether cyclophosphamide, thalidomide, and dexamethasone were associated with better results than thalidomide and dexamethasone. Methods: The records of 152 patients who underwent autologous transplantation at this institution from August of 2004 to January of 2012 were reviewed, selecting those with at least partial response to a maximum of eight cycles of induction therapy and sufficient follow-up information for analysis. Results: This study included 89 patients; 44 were female, with a mean age of 55 years (there was a significant trend for increasing age over the years of the study).The median number of induction therapy cycles was four, again with a trend of increase over the years.At least a very good partial response to induction therapy was achieved more often in the cyclophosphamide, thalidomide, and dexamethasone group (61.1%) and in the thalidomide and dexamethasone group (59.2%) than in the vincristine, doxorubicin, and dexamethasone group (16.2%). The overall median progression-free survival was 34 months, with no statistically significant difference between the three groups. The overall median survival was not reached, and there was no significant difference between the three groups; the estimated five-year overall survival was 55%. Conclusion: Although the quality of responses appeared to be better with thalidomidecontaining regimens, these improvements did not translate into improved long-term outcomes. Given its track record, cyclophosphamide, thalidomide, and dexamethasone is currently considered the preferred regimen for first-line ...