Effectiveness of carbohydrates as a functional ingredient in glycemic control

High postprandial glycemia in the non-diabetic population is one of the known universal mechanisms for the progression of noncommunicable diseases (NCDs), which have impacted the finances of both individuals and of health systems. In order to highlight the role of carbohydrates in glycemic control and its implications on health, the International Life Sciences Institute Brazil held an international workshop on "Carbohydrates, Glycemia and Health". Carbohydrate digestion rate is related to glycemic response, which mainly depends on the quality and amount of carbohydrate ingested, and thus it may be modulated by intrinsic and extrinsic factors. These effects can be verified by using different methods which evidence how physiology adapts in the uptake of glucose. Consumers can be aided with the knowledge/awareness of the benefits of high postprandial glycemia control in non-diabetic subjects. Multisectorial actions can contribute to decrease the onset and worsening of NCDs. A strategy indicated to the public in general to expand the availability of products that do not result in a sudden increase of postprandial plasma glucose and/or insulin would be to use alternative ingredients and/or technology in addition to making the legally allowed communication of benefits, which are supported by scientific studies.

Cost-effectiveness analysis of medical treatment of benign prostatic hyperplasia in the Brazilian public health system

OBJECTIVE: To perform a cost-effectiveness analysis of medical treatment of benign prostatic hyperplasia (BPH) under Brazilian public health system perspective (Unified Health System - "Sistema Único de Saúde (SUS)"). MATERIAL AND METHODS: A revision of the literature of the medical treatment of BPH using alpha-blockers, 5-alpha-reductase inhibitors and combinations was carried out. A panel of specialists defined the use of public health resources during episodes of acute urinary retention (AUR), the treatment and the evolution of these patients in public hospitals. A model of economic analysis(Markov) predicted the number of episodes of AUR and surgeries (open prostatectomy and transurethral resection of the prostate) related to BPH according to stages of evolution of the disease. Brazilian currency was converted to American dollars according to the theory of Purchasing Power Parity (PPP 2010: US$ 1 = R$ 1.70). RESULTS: The use of finasteride reduced 59.6% of AUR episodes and 57.9% the need of surgery compared to placebo, in a period of six years and taking into account a treatment discontinuity rate of 34%. The mean cost of treatment was R$ 764.11 (US$449.78) and R$ 579.57 (US$ 340.92) per patient in the finasteride and placebo groups, respectively. The incremental cost-effectiveness ratio (ICERs) was R$ 4.130 (US$ 2.429) per episode of AUR avoided and R$ 2.735 (US$ 1.609) per episode of surgery avoided. The comparison of finasteride + doxazosine to placebo showed a reduction of 75.7% of AUR episodes and 66.8% of surgeries in a 4 year time horizon, with a ICERs of R$ 21.191 (US$ 12.918) per AUR episodes avoided and R$ 11.980 (US$ 7.047) per surgery avoided. In the sensitivity analysis the adhesion rate to treatment and the cost of finasteride were the main variables that influenced the results. CONCLUSIONS: These findings suggest that the treatment of BPH with finasteride is cost-effective compared to placebo in the Brazilian public health system perspective.

Análise de custo-efetividade do ácido zoledrônico na prevenção da fratura osteoporótica proximal de fêmur no cenário do Sistema Suplementar de Saúde Brasileiro / Cost-effectiveness analysis of zoledronic acid for the prevention of osteoporotic hip fracture in the private health care system in Brazil

Objetivo: realizar análise de custo-efetividade do ácido zoledrônico na prevenção de fraturas osteoporóticas proximais de fêmur. Método: modelo analítico de decisão para comparar ácido zoledrônico versus risedronato, na prevenção de fraturas, no ano 2007. A população-alvo da análise foi uma coorte hipotética de mulheres com osteoporose, idade inicial de 65 anos, horizonte de tempo de cinco anos. Dados epidemiológicos e eficácia dos fármacos foram obtidos de revisão e análise crítica da literatura. Custos foram valorados para o Sistema Suplementar de Saúde. O desfecho analisado foi o custo por fratura de fêmur evitada. Resultados: no cenário base, o ácido zoledrônico reduziu a incidência de fraturas (0,297 fraturas versus 0,460 fraturas), com custo anual do ácido zoledrônico de R$ 21.630,85 versus R$ 21.872,55 do risedronato. Conclusão: o uso do ácido zoledrônico comparado ao risedronato pode prevenir mais fraturas proximais de fêmur, com menores custos, no cenário do Sistema Suplementar de Saúde.

Objective: To assess cost-effectiveness of zoledronic acid for the prevention of osteoporotic hip fracture. Methods: Decision analytic model to compare zoledronicacid versus risedronate, for the prevention of fracture, in 2007. The target population was a hypothetic cohort of women with osteoporosis aged 65 years in a time horizon of five years. The epidemiological data related to osteoporosisand drug’s efficacy were obtained from critical appraisal of scientific literature. The costs were collected from electronic claims databases of patients enrolled in Brazilian health plans. The outcome analyzed was the cost per hip fracture avoided. Results: In the base case scenario, zoledronic acid reduced the incidenceof fractures (0.297 fractures against 0.460 fractures), with annual costs of R$21,630.85 versus R$ 21,872.55 for the risedronate. Conclusions: The use of zoledronic acid compared to risedronate could prevent more hip fractures, withless costs in the Brazilian private health system.