Costes y adherencia del tratamiento antirretroviral / No disponible

Objetivo Desarrollar una sistemática de manejo de datos que permita estimar comparativamente la eficiencia de los diferentes esquemas de tratamiento antirretroviral (TAR).Método Estudio observacional retrospectivo en pacientes infectados por el VIH con TAR estable. Se determinó para cada paciente su adherencia y el coste unitario de su tratamiento. Se calculó el coste/paciente/día y, multiplicando por un factor de adherencia (fADH), el (coste/paciente/día)ADH. La comparación de ambos permitió obtener el Δcoste/paciente, que estima la desviación de costes originada por la falta de adherencia. Se calculó el coste-efectividad-incremental (CEI) agrupando los resultados en los diferentes fármacos coformulados («combos»). Se realizó un estudio de impacto presupuestario de dichos combos. Resultados Se evaluaron 468 pacientes (62% adherentes). La adherencia media fue de 88±18%. El valor medio del (coste/paciente/día)ADH fue significativamente superior al coste/paciente/día (27,3±9,8€ frente 24,3±7,6€, p<0 001 al igual que para el f ADH, no se encontraron diferencias en el Δcoste/paciente entre las diferentes combinaciones de TAR. El combo con menor desviación del coste/paciente/día debida a la falta de adherencia fue el constituido por abacavir/zidovudina/lamivudina (ABC/AZT/3TC,Δcoste/paciente=8,72±14,18%), y el de mayor desviación el AZT/3TC (Δcoste/paciente=13,52±17,68%). No se encontraron diferencias significativas en los CEI calculados para ningún combo. Los esquemas de TAR que incluyeron abacavir/lamivudina(ABC/3TC) obtuvieron el menor impacto presupuestario. Conclusiones (..) (AU)

Objective To develop a system of data management that allows us to estimate the comparative effectiveness of the various antiretroviral treatment (ART) regimens. Method Restrospective observational study in patients infected with HIV with stable ART. Adherence to treatment and unit cost for each patient's treatment was determined. The cost/patient/day was calculated and, multiplying by an adherence factor (fADH), the (cost/patient/day)ADH. The comparison of both allowed us to obtain the Δcost/patient, which estimates the additional costs caused by lack of adherence. The incremental cost-effectiveness (iCER), grouping the results by the various coformulated drugs (“combos”). A study of the budgetary impact of these combos was carried out.Results468 patients were evaluated (62% adherent). Average adherence was 88±18%. The average value of (cost/patient/day) ADH was significantly higher than the cost/patient/day (27.3 ± 9.8€ compared to 24.3±7.6€. p < 0.001). Just as with the fADH, no differences were found in the Δcost/patient between the different ART combinations. The combo with the least deviation from the cost/patient/day due to lack of adherence was that composed of abacavir/zedovudine/lamivudine (ABC/AZT/3TC,Δcost/patient=8.72±14.18%), and that with the greatest deviation AZT/3TC (Δcost/patient=13.52±17.68%). No significant differences were found in the iCER calcluated for any combo. The ART that included abacavir/lamivudine (ABC/3TC) obtained the least budgetary impact. Conclusions The greatest cost and percentage of adherent patients associated with the combos composed of Tenovovir/Emtricitabine(TDF/FTC) and ABC/3TC, and the least cost and effectiveness of those composed of AZT/#TC and ABC/AZT/3TC, does not allow us to identify any option as significantly dominant. The regimens with ABC/3TC were shown to be the most favourable from the combined point of view of cost and adherence (AU)

[Costs and adherence to antiretroviral treatment]. / Costes y adherencia del tratamiento antirretroviral.

OBJECTIVE: To develop a system of data management that allows us to estimate the comparative effectiveness of the various antiretroviral treatment (ART) regimens. METHOD: Retrospective observational study in patients infected with HIV with stable ART. Adherence to treatment and unit cost for each patient's treatment was determined. The cost/patient/day was calculated and, multiplying by an adherence factor (fADH), the (cost/patient/day)(ADH). The comparison of both allowed us to obtain the Δcost/patient, which estimates the additional costs caused by lack of adherence. The incremental cost-effectiveness (iCER), grouping the results by the various coformulated drugs ("combos"). A study of the budgetary impact of these combos was carried out. RESULTS: 468 patients were evaluated (62% adherent). Average adherence was 88±18%. The average value of (cost/patient/day) (ADH) was significantly higher than the cost/patient/day (27.3±9.8€ compared to 24.3±7.6€. p<0.001). Just as with the f(ADH), no differences were found in the Δcost/patient between the different ART combinations. The combo with the least deviation from the cost/patient/day due to lack of adherence was that composed of abacavir/zedovudine/lamivudine (ABC/AZT/3TC,Δcost/patient=8.72±14.18%), and that with the greatest deviation AZT/3TC (Δcost/patient=13.52±17.68%). No significant differences were found in the iCER calculated for any combo. The ART that included abacavir/lamivudine (ABC/3TC) obtained the least budgetary impact. CONCLUSIONS: The greatest cost and percentage of adherent patients associated with the combos composed of Tenovovir/Emtricitabine(TDF/FTC) and ABC/3TC, and the least cost and effectiveness of those composed of AZT/#TC and ABC/AZT/3TC, does not allow us to identify any option as significantly dominant. The regimens with ABC/3TC were shown to be the most favourable from the combined point of view of cost and adherence.

Efectividad de la palifermina en la prevención de la mucositis oral en pacientes oncohematológicos / Effectiveness of palifermin in the prevention of oral mucositis in patients with haematological cancers

Objetivo Evaluar la efectividad de la palifermina en la prevención de la mucositis oral (MO) en pacientes oncohematológicos. Método Estudio observacional retrospectivo de cohortes en pacientes con neoplasias hematológicas, sometidos a tratamiento mieloablativo de acondicionamiento y posterior transplante autólogo de progenitores hematopoyéticos, y que reciben como profilaxis de la mucositis palifermina u otro tratamiento convencional. La variable principal evaluada fue la duración de la MO. Las variables secundarias fueron la incidencia de mucositis, neutropenia febril o sepsis y la administración de opiáceos o nutrición parenteral. Resultados Se incluyeron 36 pacientes en el estudio, 11 en el grupo de palifermina y 25 en el grupo control. La duración de la MO fue de 4,6±3,1 días (mediana: 5 días) en los pacientes tratados con palifermina respecto a 7,4±4,0 días (mediana: 6 días) en los tratados con profilaxis convencional (p<0,05). Sin embargo, no se observaron diferencias significativas en la incidencia de mucositis, sepsis o neutropenia febril, la administración de opiáceos o la utilización de nutrición parenteral. Conclusiones El tratamiento profiláctico con palifermina permite reducir la duración de la MO en pacientes oncohematológicos. Se necesitan más estudios y con un tamaño muestral mayor para poder evaluar el papel de la palifermina sobre otras variables, tales como la incidencia de la mucositis, sepsis, neutropenia febril, etc (AU)

Objective To assess the effectiveness of palifermin for the prevention of oral mucositis in patients with haematological cancers. Methods Retrospective observational study of cohorts of patients with haematological cancer undergoing cytotoxic therapy causing hematopoietic ablation. The main variable assessed was the duration of the oral mucositis. Secondary variables assessed were incidence of mucositis, febrile or septic neutropenia and the administration of opioids and parenteral nutrition. Results We included 36 patients in this study, 11 in the group that received palifermin and 25 in the control group. The duration of oral mucositis was 4.6±3.1 days (median: 5 days) in the patients treated with palifermin in comparison with 7.4±4.0 days (median: 6 days) in patients treated with conventional prophylactic therapy (p<0.05). However, no significant differences were seen in the incidence of mucositis, febrile or septic neutropenia, opioid administration of the use of parenteral nutrition. Conclusions Prophylactic treatment with palifermin reduces the duration of oral mucosities in patients with haematological cancer. Further studies are necessary with larger samples to be able to assess palifermin and its influence on other variables, such as incidence of mucositis, sepsis, febrile neutropenia, etc (AU)

[Effectiveness of palifermin in the prevention of oral mucositis in patients with haematological cancers]. / Efectividad de la palifermina en la prevención de la mucositis oral en pacientes oncohematológicos.

OBJECTIVE: To assess the effectiveness of palifermin for the prevention of oral mucositis in patients with haematological cancers. METHODS: Retrospective observational study of cohorts of patients with haematological cancer undergoing cytotoxic therapy causing hematopoietic ablation. The main variable assessed was the duration of the oral mucositis. Secondary variables assessed were incidence of mucositis, febrile or septic neutropenia and the administration of opioids and parenteral nutrition. RESULTS: We included 36 patients in this study, 11 in the group that received palifermin and 25 in the control group. The duration of oral mucositis was 4.6+/-3.1 days (median: 5 days) in the patients treated with palifermin in comparison with 7.4+/-4.0 days (median: 6 days) in patients treated with conventional prophylactic therapy (p<0.05). However, no significant differences were seen in the incidence of mucositis, febrile or septic neutropenia, opioid administration of the use of parenteral nutrition. CONCLUSIONS: Prophylactic treatment with palifermin reduces the duration of oral mucosities in patients with haematological cancer. Further studies are necessary with larger samples to be able to assess palifermin and its influence on other variables, such as incidence of mucositis, sepsis, febrile neutropenia, etc.