[Cost-minimization analysis of subcutaneous abatacept in the treatment of rheumatoid arthritis in Spain]. / Análisis de minimización de costes de abatacept subcutáneo en el tratamiento de la artritis reumatoide en España.

OBJECTIVE: To compare the cost of treating rheumatoid arthritis patients that have failed an initial treatment with methotrexate, with subcutaneous abatacept versus other first-line biologic disease-modifying antirheumatic drugs. METHOD: Subcutaneous abatacept was considered comparable to intravenous abatacept, adalimumab, certolizumab pegol, etanercept, golimumab, infliximab and tocilizumab, based on indirect comparison using mixed treatment analysis. A cost-minimization analysis was therefore considered appropriate. The Spanish Health System perspective and a 3 year time horizon were selected. Pharmaceutical and administration costs (Euros 2013) of all available first-line biological disease-modifying antirheumatic drugs were considered. Administration costs were obtained from a local costs database. Patients were considered to have a weight of 70 kg. A 3% annual discount rate was applied. Deterministic and probabilistic sensitivity analyses were performed. RESULTS: Subcutaneous abatacept proved in the base case to be less costly than all other biologic antirrheumatic drugs (ranging from Euros -831.42 to Euros -9,741.69 versus infliximab and tocilizumab, respectively). Subcutaneous abatacept was associated with a cost of Euros 10,760.41 per patient during the first year of treatment and Euros 10,261.29 in subsequent years. The total 3-year cost of subcutaneous abatacept was Euros 29,953.89 per patient. Sensitivity analyses proved the model to be robust. Subcutaneous abatacept remained cost-saving in 100% of probabilistic sensitivity analysis simulations versus adalimumab, certolizumab, etanercept and golimumab, in more than 99.6% versus intravenous abatacept and tocilizumab and in 62.3% versus infliximab. CONCLUSIONS: Treatment with subcutaneous abatacept is cost-saving versus intravenous abatacept, adalimumab, certolizumab, etanercept, golimumab, infliximab and tocilizumab in the management of rheumatoid arthritis patients initiating treatment with biological antirheumatic drugs.

OBJETIVO: Comparar, desde la perspectiva del Sistema Sanitario, el coste del tratamiento con abatacept subcutáneo en pacientes con artritis reumatoide tras fracaso a metotrexato, frente al resto de fármacos antirreumáticos modificadores de la enfermedad disponibles en España con indicación en primera línea de terapia biológica. MÉTODOS: Una comparación indirecta demostró eficacia y seguridad de abatacept subcutáneo comparables a abatacept intravenoso, adalimumab, certolizumab, etanercept, golimumab, infliximab y tocilizumab, por lo que se optó por una minimización de costes. El análisis incluyó costes farmacológicos y de administración (, 2013) para un paciente "tipo" de 70 kg y un horizonte temporal de tres años. Se aplicó una tasa anual de descuento del 3%. Se realizaron análisis de sensibilidad determinísticos y probabilísticos. RESULTADOS: Abatacept subcutáneo tuvo un coste anual de 10.760,41 durante el primer año, 10.261,29 en los años siguientes, y un coste total de 29.953,89 a los tres años, generando ahorros (rango -831,41 versus infliximab a -9.741,69 versus tocilizumab) frente a los demás antirreumáticos modificadores de la enfermedad. Las mayores diferencias entre fármacos se observaron durante el primer año de tratamiento. Abatacept subcutáneo se asoció a ahorros en el 100% de las simulaciones del análisis de sensibilidad probabilístico versus adalimumab, certolizumab, etanercept y golimumab, en más del 99,6% versus abatacept intravenoso y tocilizumab y en el 62,3% versus infliximab. CONCLUSIONES: En base a los resultados, el tratamiento con abatacept subcutáneo genera ahorros frente a abatacept intravenoso, adalimumab, certolizumab, etanercept, golimumab, infliximab y tocilizumab en pacientes con artritis reumatoide que inician tratamiento con fármacos antirreumáticos biológicos.

Análisis de minimización de costes de abatacept subcutáneo en el tratamiento de la artritis reumatoide en España / Cost-minimization analysis of subcutaneous abatacept in the treatment of rheumatoid arthritis in Spain

Objetivo: Comparar, desde la perspectiva del Sistema Sanitario, el coste del tratamiento con abatacept subcutáneo en pacientes con artritis reumatoide tras fracaso a metotrexato, frente al restode fármacos antirreumáticos modificadores de la enfermedad disponibles en España con indicación en primera línea de terapia biológica. Métodos: Una comparación indirecta demostró eficacia y seguridad de abatacept subcutáneo comparables a abatacept intravenoso, adalimumab, certolizumab, etanercept, golimumab, infliximab y tocilizumab, por lo que se optó por una minimización de costes. El análisis incluyó costes farmacológicos y de administración (Euros, 2013) para un paciente "tipo" de 70 kg y un horizonte temporal de tres años. Se aplicó una tasa anual dedescuento del 3%. Se realizaron análisis de sensibilidad determinísticos y probabilísticos. Resultados: Abatacept subcutáneo tuvo un coste anual de 10.760,41 Euros durante el primer año, 10.261,29 Euros en los años siguientes, y un coste total de 29.953,89 Euros a los tres años, generando ahorros (rango -831,41 € versus infliximab a -9.741,69 € versus tocilizumab) frente a los demás antirreumáticos modificadores de la enfermedad. Las mayores diferencias entre fármacos se observaron durante el primer año de tratamiento. Abatacept subcutáneo se asoció a ahorros en el 100% de las simulaciones del análisis de sensibilidad probabilístico versus adalimumab, certolizumab, etanercept y golimumab, en más del 99,6% versus abatacept intravenoso y tocilizumab y en el 62,3% versus infliximab. Conclusiones: En base a los resultados, el tratamiento con abatacept subcutáneo genera ahorros frente a abatacept intravenoso, adalimumab, certolizumab, etanercept, golimumab, infliximab y tocilizumab en pacientes con artritis reumatoide que inician tratamiento con fármacos antirreumáticos biológicos

Objective: To compare the cost of treating rheumatoid arthritis patients that have failed an initial treatment with methotrexate, with subcutaneous aba tacept versus other first-line biologic disease-modifying antirheumatic drugs. Method: Subcutaneous abatacept was considered comparable to intravenous abatacept, adalimumab, certolizumab pegol, etanercept, golimumab,infliximab and tocilizumab, based on indirect comparison using mixed treatment analysis. A cost-minimization analysis was therefore considered appropriate. The Spanish Health System perspective and a 3 year time horizon were selected. Pharmaceutical and administration costs (Euros ,2013) of all available first-line biological disease-modifying antirheumatic drugs were considered. Administration costs were obtained from a local costs database. Patients were considered to have a weight of 70 kg. A 3%annual discount rate was applied. Deterministic and probabilistic sensitivity analyses were performed. Results: Subcutaneous abatacept proved in the base case to be less costly than all other biologic antirrheumatic drugs (ranging from € -831.42 to € -9,741.69 versus infliximab and tocilizumab, respectively). Subcutaneous abatacept was associated with a cost of € 10,760.41 per patient during the first year of treatment and €10,261.29 in subsequent years. The total 3-year cost of subcutaneous abatacept was € 29,953.89 per patient. Sensitivity analyses proved the model to be robust. Subcutaneous abatacept remained cost-saving in 100% of probabilistic sensitivity analysis simulations versus adalimumab, certolizumab, etanercept and golimumab, in more than 99.6% versus intravenous abatacept and tocilizumab and in 62.3% versus infliximab. Conclusions: Treatment with subcutaneous abatacept is cost-saving versus intravenous abatacept, adalimumab, certolizumab, etanercept, golimumab, infliximab and tocilizumab in the management of rheumatoid arthritis patients initiating treatment with biological antirheumatic drugs

Hospitalizaciones por hipoglucemia grave en pacientes con diabetes mellitus en España / Hospitalizations due to severe hypoglycemia in patients with diabetes mellitus in Spain

Antecedentes y objetivo. Una de las complicaciones terapéuticas más importantes en los pacientes con diabetes mellitus (DM) es la hipoglucemia. Hemos estimado el número de hospitalizaciones por hipoglucemia grave en los pacientes con DM tipo 1 (DM1) y tipo 2 (DM2). Pacientes y métodos. El universo hospitalario se definió a partir del Catálogo Nacional de Hospitales (CNH) de 2007 (últimos datos disponibles), y se incluyeron 260 hospitales generales del Sistema Nacional de Salud. El número de hospitalizaciones por hipoglucemia grave fue extraído del Conjunto Mínimo Básico de Datos (CMBD) para 183 hospitales. Para los 77 restantes se estimó a partir de la información disponible. Resultados. En el año 2007 se produjeron un total de 26.701 (0,82%) hospitalizaciones con hipoglucemia. En los enfermos con DM2 se reportaron 8.242 (0,25%) ingresos como diagnóstico principal y 16.649 (0,51%) como secundario. En los pacientes con DM1 se reportaron 1.157 (0,04%) y 653 (0,02%) ingresos como diagnóstico principal y secundario, respectivamente. La incidencia global en DM2 fue de 1,82 episodios/10.000 habitantes/año, y osciló entre los 1,10 episodios/10.000 habitantes/año en Canarias y los 3,37 episodios en Castilla y León. Conclusiones. La hipoglucemia grave es una causa importante de hospitalización en los pacientes con DM en España, con una gran variabilidad entre CCAA (AU)

Background and objectives One of the most important therapeutic complications in patients with diabetes mellitus (DM) is hypoglycemia. This study has estimated the number of hospitalizations due to severe hypoglycemia in patients with type DM1 and DM2. Patients and methods. The study hospital population was defined using the National Catalogue of Hospitals (CNH) 2007 (last available data), and has included 260 general hospitals of the National Health System. The number of hospitalizations due to severe hypoglycemia was obtained from the Basic Minimum Data Set (BMDS) for the 183 hospitals. For the remaining 77 hospitals, this number was estimated based on the available information. Results. In 2007, there were 26,701 (0.82%) hospitalizations with hypoglycemia. In DM2 patients, 8,242 (0.25%) episodes were reported as primary diagnosis and 16,649 (0.51%) as secondary. In DM1 patients, 1,157 (0.04%) and 653 (0.02%) episodes were reported as primary and secondary diagnosis, respectively. Overall incidence in DM2 was 1.82 episodes/10,000 inhabitants-year, this ranging between 1.10 episodes/10,000 inhabitants-year in the Islas Canarias to 3.37 in Castilla y León. Conclusions. Severe hypoglycemia is an important reason for hospitalization of patients with DM in Spain, there being great variability according to the Autonomous Regions (AU)

Hospitalizations due to severe hypoglycemia in patients with diabetes mellitus in Spain.

BACKGROUND AND OBJECTIVES: One of the most important therapeutic complications in patients with diabetes mellitus (DM) is hypoglycemia. This study has estimated the number of hospitalizations due to severe hypoglycemia in patients with type DM1 and DM2. PATIENTS AND METHODS: The study hospital population was defined using the National Catalogue of Hospitals (CNH) 2007 (last available data), and has included 260 general hospitals of the National Health System. The number of hospitalizations due to severe hypoglycemia was obtained from the Basic Minimum Data Set (BMDS) for the 183 hospitals. For the remaining 77 hospitals, this number was estimated based on the available information. RESULTS: In 2007, there were 26,701 (0.82%) hospitalizations with hypoglycemia. In DM2 patients, 8,242 (0.25%) episodes were reported as primary diagnosis and 16,649 (0.51%) as secondary. In DM1 patients, 1,157 (0.04%) and 653 (0.02%) episodes were reported as primary and secondary diagnosis, respectively. Overall incidence in DM2 was 1.82 episodes/10,000 inhabitants-year, this ranging between 1.10 episodes/10,000 inhabitants-year in the Islas Canarias to 3.37 in Castilla y León. CONCLUSIONS: Severe hypoglycemia is an important reason for hospitalization of patients with DM in Spain, there being great variability according to the Autonomous Regions.

Análisis farmacoeconómico de risedronato semanal frente a alendronato semanal en España / Pharmacoeconomical analysis of weekly risedronate vs. weekly alendronate in Spain

Objetivos. Realizar una evaluación económica que examine la relación costeefectividad de risedronato (Actonel(R)) frente a alendronato genérico, teniendo en cuenta tanto fracturas de cadera como calidad de vida de las pacientes. Métodos. Se ha llevado a cabo un análisis coste-efectividad-coste utilidad comparando la administración semanal durante un año de tratamiento de risedronato, 35 mg (Actonel(R)) y alendronato, 70 mg. Los datos de efectividad se han obtenido del estudio REAL. Los datos epidemiológicos y de costes se han obtenido de la literatura española. Se han realizado análisis de sensibilidad para comprobar la robustez de los resultados. Resultados. En el caso base (mujeres de 75 años con osteoporosis y fractura vertebral previa), risedronato (Actonel(R)), comparado con alendronato, tiene un coste por fractura de cadera evitada de 5.318 ¿ y un coste por año de vida ajustado por calidad de 10.636 ¿. Conclusiones. En el tratamiento de la osteoporosis posmenopáusica, y teniendo en cuenta los límites tradicionalmente usados en España, risedronato (Actonel(R)) es un tratamiento coste-efectivo frente a todas las presentaciones de alendronato(AU)

Objectives. To assess cost-effectiveness of risedronate (Actonel(R)) vs. alendronate, considering hip fractures and patients' quality of life. Methods. A cost-effectiveness and cost-utility analysis has been performed comparing weekly administration during one year of risedronate 35 mg (Actonel(R)) and alendronate 70 mg treatment. Effectiveness data has been derived from the REAL study. Epidemiology data and unitary costs were derived from Spanish literature. Several sensitivity analyses on patients' profile have been performed to assess robustness of the results. Results. In the base case scenario (75 year old women with established osteoporosis and previous vertebral fracture), and based on real life data, risedronate (Actonel(R)(R) has a cost per hip fracture avoided of 5,318 ¿ and a cost per QALY gained of 10,636 ¿. Conclusions. In the treatment of post-menopausal osteoporosis, and according to the usually established criteria for Spain, risedronate (Actonel(R)) is a cost-effective treatment compared with generic alendronate. Sensitivity analysis confirms robustness of the results(AU)