ABSTRACT
Several studies have demonstrated that viral load is a key factor to determine the development of HBV infection and to assess treatment options for the disease. There is a lack of studies analyzing viral load levels in chronic hepatitis B patients in Argentina and the epidemiologic information is limited. The aim of this study was to determine viral load levels and its distribution in patients diagnosed with chronic hepatitis B from geographical areas with high prevalence for HBV in Argentina. Fifty-one per cent of the study population had HBV DNA levels > or = 10(4) copies/ml and a median viral load of 11,910 copies/ml. The viral load was significantly higher in HBeAg seropositive patients compared with those seronegative for HBeAg (P < 0.05). Salta and Entre Ríos provinces showed low viral loads, while Chaco, Misiones and Formosa provinces had a median viral load ranging between 10(4) and 10(5) copies/ ml. This is the first study providing detailed information on viral load in chronic hepatitis B patients from Argentina. Availability of viral load levels in chronic hepatitis B enables evaluation of implementation of actions to analyze follow-up and/or treatment options for preventing disease complications, improving health care and diminishing the potential burden on the health care system.
Subject(s)
Viral Load , Hepatitis B, Chronic/virology , Hepatitis B virus , Adult , Young Adult , Alanine Transaminase/blood , Hepatitis B e Antigens/blood , Argentina/epidemiology , Aspartate Aminotransferases/blood , DNA, Viral/analysis , Female , Hepatitis B, Chronic/epidemiology , Hepatitis B, Chronic/blood , Humans , Male , Prevalence , Hepatitis B virus/immunologyABSTRACT
Objetivo: Estimar la costo efectividad de Abatacept combinado con Metotrexato (MTX) en comparación a otras DARMEs biológicas, en combinación con MTX, en pacientes con AR moderada a severamente activa. Materiales y métodos: Se adaptó un modelo de secuencias de tratamiento para la representación de la invalidez en términos del índice HAQ en un horizonte de 5 años de enfermedad para una cohorte de 1 000 pacientes. Abatacept en combinación con MTX se comparó contra etanercept, rituximab, infliximab, adalimumab y tocilizumab, todas asociadas a MTX. Resultados: El costo de tratamiento con Abatacept es de S/. 169 263 y su efectividad es de 1.96 AVAC. Respecto a etanercept, adalimumab, infliximab y tocilizumab, abatacept se ha mostrado más efectivo en términos de AVACs y menos costoso. Respecto a rituximab, abatacept presenta un índice de costo efectividad incremental de S/ 75 493 por AVAC ganado. Conclusiones: abatacept es dominante frente a Etanercept, Adalimumab, Infliximab y Tocilizumab, desde la perspectiva del Seguro Social de Salud (EsSalud) para el tratamiento de pacientes con AR moderada a severamente activa que han fallado a MTX.
Objective: To estimate the cost-effectiveness of Abatacept in combination with Methotrexate (MTX) versus other biologic DMARDs in combination with MTX in patients with moderately to severely active rheumatoid arthritis. Materials and methods: A sequential therapy model was adapted for representing disability using the HAQ Index in a 5-year horizon period for a 1000-patient cohort. Abatacept in combination with MTX was compared against etanercept, rituximab, infliximab, adalimumab, and tocilizumab, all of them combined with MTX. Results: The cost of abatacept therapy was S/. 169 263 and its effectiveness was found to be 1.96 QALY. Compared to etanercept, adalimumab, infliximab and tocilizumab, abatacept has shown to be the most effective agent in terms of QALYs and the least expensive. Compared to rituximab, abatacept has an incremental cost effectiveness ratio of S/. 75 493 per QALY gained. Conclusions: According to this model, abatacept was found to be superior compared to etanercept, adalimumab, infliximab, and tocilizumab, from the Peruvian Social Security (EsSalud) perspective for the treatment of moderately to severely active Rheumatoid Arthritis in patients who failed using a MTX-based therapy.