ABSTRACT
Objetivo: Hacer una análisis de costo-efectividad en el uso del ácido gadotérico en resonancia magnética para pacientes con insuficiencia renal crónica tipo 4 y 5, en comparación con otros medios de contraste gadolínicos. Métodos: Mediante un modelo de árbol de decisión, desde la perspectiva del tercero pagador, se compararon diferentes medios de contraste gadolínicos. El desenlace de análisis fue sobrevida medida en años de vida ganados, para una esperanza de vida de 64,5 años y una edad promedio de 60 años. Se manejaron los precios del mercado obtenidos del Sistema de Información de Precios de Medicamentos, en pesos colombianos de 2013. Se evaluó el costo de las tecnologías para una presentación de 15 ml. Resultado: La efectividad de medios de contraste se evaluó en términos de seguridad. La principal complicación se encontró en la fibrosis sistémica nefrogénica luego del uso de estos medios de contraste en pacientes con enfermedad renal avanzada, siendo letal en más del 56 % de los casos. Se encontró que no se informan casos de fibrosis sistémica nefrogénica con el uso de ácido gadotérico y de gadobutrol. El primero mostró un promedio de años de vida de 1,706 y fue el menos costoso de todos. En el análisis tipo Montecarlo con variaciones de ±50 %, mantiene su dominancia en el 100 % de las iteraciones. Conclusiones: El ácido gadotérico es la opción más favorable por su dominancia y mejor o igual en efectividad frente a los demás medios de contraste gadolínicos.
Objective: To evaluate the cost - effectiveness of the use of gadoteric acid in magnetic resonance in patients with type 4 and 5 chronic renal failure, versus other gadolinic contrast media methods. Methods: From the perspective of a third party payer, different gadolinic contrast media were compared using a decision tree model. The analysis outcome was survival measured in years of life gained, for a life expectancy of 64.5 years an average age of 60 years. Market prices obtained from the Information System on Drug Prices for Colombia were handled in Colombian pesos (2013). The technology costs for a 15 ml presentation were evaluated. Result: The effectiveness of contrast media was assessed in terms of security. The main complication was nephrogenic systemic fibrosis in the use of these contrast media in patients with advanced renal disease. It was lethal in over 56% of cases. We found no cases of nephrogenic systemic fibrosis reported using gadoteric acid and gadobutrol. The first showed an average life of 1,706 years; and was the least expensive compared to all the analyzed ones. In the Monte Carlo analysis with variations of + / -50 %, it maintains its dominance in 100% of iterations. Conclusions: Gadoteric acid is the most favorable option due to its dominance. Its effectiveness is greater than or equal to the effectiveness of other contrast media.
Subject(s)
Humans , Gadolinium , Magnetic Resonance Imaging , Contrast Media , Nephrogenic Fibrosing DermopathyABSTRACT
Nephrogenic systemic fibrosis is a chronic, progressive condition that develops in some patients with renal impairment after exposure to gadolinium-based contrast agents used in magnetic resonance imaging. Thickening of the skin is typical, usually affecting the extremities. Visceral organs can also be affected. The diagnosis of the disease requires careful clinicopathological correlation. Treatment aims at restoring renal function, which is associated with delayed progression and, eventually, remission of skin changes. Reduction and prevention of nephrogenic systemic fibrosis cases are based on limiting the use of gadolinium-based contrast agents in patients with kidney disorders (especially in patients with advanced renal failure at stages 4 and 5), and restricting their use to situations in which they are essential to diagnosis/follow-up. Other than limiting exposure to gadolinium based contrast agents, no effective preventive methods have been reported. Due to increased awareness about the disease among radiologists and nephrologists, the incidence of nephrogenic systemic fibrosis is declining.
Fibrose nefrogênica sistêmica é condição crônica, progressiva, desenvolvida caracteristicamente em pacientes nefropatas após exposição a contrastes radiológicos que contenham gadolínio. O espessamento cutâneo é aspecto típico, envolvendo predominantemente as extremidades. Envolvimento visceral pode ocorrer. O diagnóstico da doença requer cuidadosa correlação clínico-patológica. O tratamento visa à restauração da função renal, que se associa ao retardo da progressão e, eventualmente, remissão das alterações cutâneas. A prevenção da ocorrência e redução da incidência baseiam-se na limitação do uso de contrastes à base de gadolínio em nefropatas (especialmente na insuficiência renal avançada em estágios 4 e 5), restringindo-os às condições nas quais seja imprescindível ao diagnóstico/acompanhamento. À exceção da restrição de exposição aos agentes de contraste a base de gadolínio, não há métodos preventivos efetivos relatados. Devido à ampla divulgação da doença entre radiologistas e nefrologistas, a incidência da fibrose nefrogênica sistêmica está em declínio.
Subject(s)
Humans , Nephrogenic Fibrosing Dermopathy , Contrast Media/adverse effects , Diagnosis, Differential , Disease Progression , Gadolinium/adverse effects , Nephrogenic Fibrosing Dermopathy/chemically induced , Nephrogenic Fibrosing Dermopathy/diagnosis , Nephrogenic Fibrosing Dermopathy/therapy , PrognosisABSTRACT
A prevalência da doença renal crônica aumentou nos últimos anos. Os efeitos dessa doença são complexos e podem levar à disfunção de múltiplos órgãos, entre eles, a pele. A maioria dos pacientes apresenta pelo menos uma alteração dermatológica. Algumas vezes, esses sintomas podem ser o primeiro sinal evidente de doença renal. Este artigo aborda as manifestações cutâneas relacionadas a disfunção renal grave ou doença renal terminal, divididas em não específicas e específicas, revisando quadro clínico, etiopatogenia e opções terapêuticas dessas dermatoses. Seu reconhecimento e trata mento precoces diminuem a morbidade, melhorando a qualidade de vida desses doentes.
The prevalence of chronic kidney disease has increased over the last years. The effects of this disease are complex and may lead to dysfunction of multiple organs, including the skin, with most patients presenting with at least one dermatologic alteration. Sometimes these symptoms can be the first clear sign of kidney disease. This article discusses the skin manifestations related to severe renal impairment or end-stage renal disease (ESRD), which are divided into nonspecific and specific, and reviews the clinical features, etiopathogenesis and therapeutic options for these dermatoses. Early recognition and treatment reduce morbidity and improve these patients' quality of life.