Consenso multidisciplinar español sobre las características de los pacientes con asma grave en tratamiento con biológicos susceptibles de pasar a tratamiento domiciliario / Spanish multidisciplinary consensus on the characteristics of severe asthma patients on biologic treatment who are candidates for at-home administration

Antecedentes y objetivo Es bien sabido que las terapias biológicas reducen las exacerbaciones y mejoran el tratamiento del asma grave no controlada. La administración domiciliaria de biológicos ha aumentado durante la pandemia de COVID-19, pero aún no se han identificado las características de los pacientes con asma grave no controlada que pueden beneficiarse de la administración domiciliaria de terapia biológica. Materiales y métodos Este proyecto se basa en la metodología Delphi, diseñada para alcanzar un consenso entre expertos a través de un comité científico multidisciplinar que aborda las siguientes cuestiones: características clínicas, adherencia al tratamiento, capacidad de administración del paciente o cuidador, autocuidado del paciente, relación con el profesional sanitario, preferencias del paciente y acceso al hospital. Resultados Ciento treinta y un profesionales sanitarios (neumólogos, alergólogos, enfermeros y farmacéuticos hospitalarios) cumplimentaron las dos rondas de consenso del cuestionario Delphi. Se identificaron 14 ítems como características prioritarias, siendo los cinco primeros: 1. El paciente sigue las indicaciones/recomendaciones del equipo sanitario para controlar su enfermedad. 2. El paciente es capaz de detectar cualquier deterioro de su enfermedad y de identificar los factores desencadenantes de las exacerbaciones. 3. El paciente recibe tratamiento biológico y tiene una enfermedad estable sin riesgo vital. 4. El paciente se responsabiliza de su autocuidado y 5. el paciente tiene obligaciones laborales/educativas que le impiden acudir al hospital con regularidad (AU)

Background and objective Biologic therapies are known to reduce exacerbations and improve severe uncontrolled asthma management. The at-home administration of biologics has increased during the COVID-19 pandemic, but the characteristics of severe uncontrolled asthma patients who may benefit from at-home administration of biologic therapy have yet to be identified. Materials and methods This project is based on the Delphi method, designed to reach an expert consensus through a multidisciplinary scientific committee addressing the following questions: clinical characteristics, treatment adherence, patient or caregiver administration ability, patient self-care, relationship with the healthcare professional, patient preference, and access to the hospital. Results One hundred and thirty-one healthcare professionals (pulmonologists, allergists, nurses, and hospital pharmacists) completed two Delphi consensus questionnaires. Fourteen items were identified as priority characteristics, the first five being: 1. The patient follows the healthcare team's indications/recommendations to control their disease, 2. The patient is capable of detecting any deterioration in their disease and of identifying exacerbation triggers, 3. The patient receives biologic therapy and has stable disease with no vital risk, 4. The patient takes responsibility for their self-care, 5. The patient has occupational/educational obligations that prevent them from going to the hospital regularly. Conclusions Disease stability and control plus the ability to identify exacerbation triggers are the most important characteristics when opting for at-home administration for a patient with severe uncontrolled asthma on biologic therapy. These recommendations could be applicable in clinical practice (AU)

Spanish multidisciplinary consensus on the characteristics of severe asthma patients on biologic treatment who are candidates for at-home administration.

BACKGROUND AND OBJECTIVE: Biologic therapies are known to reduce exacerbations and improve severe uncontrolled asthma management. The at-home administration of biologics has increased during the COVID-19 pandemic, but the characteristics of severe uncontrolled asthma patients who may benefit from at-home administration of biologic therapy have yet to be identified. MATERIALS AND METHODS: This project is based on the Delphi method, designed to reach an expert consensus through a multidisciplinary scientific committee addressing the following questions: clinical characteristics, treatment adherence, patient or caregiver administration ability, patient self-care, relationship with the healthcare professional, patient preference, and access to the hospital. RESULTS: One hundred and thirty-one healthcare professionals (pulmonologists, allergists, nurses, and hospital pharmacists) completed two Delphi consensus questionnaires. Fourteen items were identified as priority characteristics, the first five being: 1. The patient follows the healthcare team's indications/recommendations to control their disease, 2. The patient is capable of detecting any deterioration in their disease and of identifying exacerbation triggers, 3. The patient receives biologic therapy and has stable disease with no vital risk, 4. The patient takes responsibility for their self-care, 5. The patient has occupational/educational obligations that prevent them from going to the hospital regularly. CONCLUSION: Disease stability and control plus the ability to identify exacerbation triggers are the most important characteristics when opting for at-home administration for a patient with severe uncontrolled asthma on biologic therapy. These recommendations could be applicable in clinical practice.

[Recommendations for the use of social networks by hospital pharmacists (12 advises that one should consider before jumping into the network)]. / Recomendaciones para el uso de las redes sociales para farmacéuticos de hospital (12 consejos que deberías tener en cuenta antes de lanzarte a la red).

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Tasa de mutaciones genotípicas y resistencia a antirretrovirales en un hospital general / Rate of Genotypic Mutations and Resistance to Antiretroviral Drugs in a General Hospital

Objetivo El objetivo es describir la tasa de mutaciones de resistencia en los genes de la proteasa y la transcriptasa inversa y la sensibilidad de los diferentes antirretrovirales en nuestro medio. Métodos Estudio observacional, descriptivo en el cual se estudiaron las muestras remitidas al laboratorio de inmunología clínica desde abril de 2004 hasta abril de 2009. Se analizaron tanto los test de resistencias, como el análisis de sensibilidad a los diferentes fármacos de pacientes en fracaso terapéutico mediante Trugene Hiv-1 Genotyping Kit®. Resultados Se registraron las muestras de 242 pacientes, en 61 de ellos no se detectaron resistencias. Las mutaciones más prevalentes según familia de fármacos fueron: para los inhibidores de la transcriptasa inversa análogos nucleosídicos T215a/C/D/F/L/N/S/Y (24,10%), M184g/I/V/W (14,66%), M41j/L/R/T/W (11,24%) y K219e/G/H/N/R/T/W (10,24%). La estavudina y la lamivudina/emtricitabina fueron los que más resistencias presentaron, y el tenofovir es el que tiene menos resistencias en nuestro medio. En cuanto a los no análogos fueron K103N/R (23,98%), V179d/E/I/M/T (10,82%), A98e/G/S (10,53%) y K101e/P/Q/R (9,06%). Nevirapina presentó más resistencias que efavirenz. Respecto a los inhibidores de la proteasa fueron L10F/I/V (15,95%), M36I/L (13,81%), A71I/T/V (13,10%) y I54l/S/V (7,38%). La combinación darunavir/ritonavir fue la que menos resistencias presentó junto con tipranavir/ritonavir, en contraposición lopinavir/ritonavir fue el que más resistencias obtuvo. Conclusión La resistencia y sensibilidad al tratamiento antirretroviral en nuestro medio fueron similares a las de otros estudios realizados en nuestro país, pero difiere y destaca un alto grado de resistencia a lamivudina/emtricitabina y lopinavir/ritonavir (AU)

Objectives The objective is to describe the resistance mutation rate in protease and reverse transcriptase genes and sensitivity to different antiretrovirals in our environment. Methods We performed an observational descriptive study in which we examined the samples provided at the Clinical Immunology Laboratory between April 2004 and April 2009. We analysed both the resistance tests and the sensitivity to different drugs in patients with therapeutic failure using Trugene HIV-1 Genotyping Kits®. Results We registered samples from 242 patients, 61 of which had no detectable resistance. The most prevalent mutations according to drug families were: for nucleoside analog reverse transcriptase inhibitors T215A/C/D/F/L/N/S/Y (24.10%), M184G/I/V/W (14.66%), M41J/L/R/T/W (11.24%) and K219E/G/H/N/R/T/W (10.24%). The highest levels of resistance corresponded to stavudine and lamivudine/emtricitabine, and tenofovir produced the least resistance in our environment. The non-analogues were K103N/R (23.98%), V179D/E/I/M/T (10.82%), A98E/G/S (10.53%) and K101E/P/Q/R (9.06%). Nevirapine presented greater resistance than efavirenz. Protease inhibitors were L10F/I/V (15.95%), M36I/L (13.81%), A71I/T/V (13.10%) and 154L/S/V (7.38%). The darunavir/ritonavir combination was that which presented the least resistance, and tipranavir/ritonavir and lopinavir/ritonavir the most resistance. Conclusions Antiretroviral resistance and sensitivity to retroviral treatment in our environment was similar to results from other studies in Spain, but differed in the high level of resistance to lamivudine/emtricitabine and lopinavir/ritonavir (AU)

[Rate of genotypic mutations and resistance to antiretroviral drugs in a general hospital]. / Tasa de mutaciones genotípicas y resistencia a antirretrovirales en un hospital general.

OBJECTIVES: The objective is to describe the resistance mutation rate in protease and reverse transcriptase genes and sensitivity to different antiretrovirals in our environment. METHODS: We performed an observational descriptive study in which we examined the samples provided at the clinical immunology laboratory between April 2004 and April 2009. We analysed both the resistance tests and the sensitivity to different drugs in patients with therapeutic failure using trugene hiv01 genotyping kits(®). RESULTS: We registered samples from 242 patients, 61 of which had no detectable resistance. The most prevalent mutations according to drug families were: for nucleoside analog reverse transcriptase inhibitors T215A/C/D/F/L/N/S/Y (24.10%), M184G/I/V/W (14.66%), M41J/L/R/T/W (11.24%) and K219E/G/H/N/R/T/W (10.24%). The highest levels of resistance corresponded to stavudine and lamivudine/emtricitabine, and tenofovir produced the least resistance in our environment. The non-analogues were K103N/R (23.98%), V179D/E/I/M/T (10.82%), A98E/G/S (10.53%) y K101E/P/Q/R (9.06%). Nevirapine presented greater resistance than efavirenz. Protease inhibitors were L10F/I/V (15.95%), M36I/L (13.81%), A71I/T/V (13.10%) and 154L/S/V (7.38%). The combination darunavir/ritonavir combination was that which presented the least resistance, and tipranavir/ritonavir and lopinavir/ritonavir the most resistance. CONCLUSIONS: Antiretroviral resistance and sensitivity to retroviral treatment in our environment was similar to results from other studies in Spain, but differed in the high level of resistance to lamivudine/emtricitabine and lopinavir/ritonavir.

[The role of the hospital pharmacist in the prevention, treatment and management of the side effects associated with antiretroviral treatment]. / Papel del farmacéutico de hospital en la prevención, identificación y manejo de los efectos adversos asociados al tratamiento antirretroviral.

At present, the side effects associated with antiretroviral treatment are the main reasons for discontinuation of this kind of therapy, both in clinical trials and in regular clinical practise. On the other hand, due to the change of direction that our profession has suffered in recent years, we face the need to establish a different relationship with the patient, achieving direct and effective Pharmaceutical Care within a framework of shared responsibility for therapeutic results. Pharmacist interventions should be aimed at improving the quality of life of patients, which can only be achieved with a multidisciplinary approach and individualised and adjusted to new patterns of toxicity of the drugs currently used. The pharmacist who does this work must know how to interpret these side effects, giving accurate information to the patient about both pharmacological and non-pharmacological treatment and correct pharmaceutical follow-up which clearly sets forth the criteria for referral to medical appointments. The aim of this paper is to establish baselines so that the hospital pharmacist can perform clearly and uniformly in the prevention, identification and management of major side effects: gastrointestinal, cardiovascular, dermatological, at the central nervous system and kidney level, associated with antiretroviral therapy.

[Quality of life of patients with rheumatoid arthritis undergoing out-patient treatment with TNF inhibitors]. / Calidad de vida en pacientes con artritis reumatoide en tratamiento ambulatorio con anti-TNF.

OBJECTIVE: To assess the quality of life of patients with rheumatoid arthritis undergoing out-patient treatment with TNF inhibitors (etanercept and adalimumab). METHOD: Observational, descriptive and multi-centre study. A specific validated questionnaire was used (QOL-RA Scale) in its Spanish version, with complete confidentiality ensured. To measure the reliability of the results, the Cronbach Alpha Coefficient was used. A descriptive analysis was carried out to compare the results obtained with those obtained from studies in the USA and Colombia. RESULTS: A total of 82 patients were selected who mainly consisted of married housewives who had not undergone any previous studies. The average amount of years from diagnosis was 11.81 years (SD: 7.30) and the average duration of treatment with TNF inhibitors was 1.71 years (SD: 1.03). The results of the questionnaire were: physical ability 5.42 (SD: 1.67), pain 5.10 (SD: 1.83), social life 7.08 (SD: 1.96), support 7.45 (SD: 2.10), mood 6.02 (SD: 2.03), stress 5.50 (SD: 2.01), arthritis 5.15 (SD: 1.86), health 5.50 (SD: 1.77). The results obtained were similar to those from the USA, although they showed a lower score for mood and stress categories. However, the high score in the support and social-life categories was more similar to that obtained with the Colombian questionnaire. All patients considered their quality of life to have improved with the use of TNF inhibitors. CONCLUSIONS: The quality of life in patients with Rheumatoid Arthritis is low, determined by pain and symptoms of depression. The patients believe that TNF inhibitors have improved their quality of life.

Calidad de vida en pacientes con artritis reumatoide en tratamiento ambulatorio con anti-TNF / Quality of life of patients with rheumatoid arthritis undergoing out-patient treatment with TNF inhibitors

Objetivo: Evaluar la calidad de vida en pacientes con artritis reumatoideen tratamiento ambulatorio con anti-TNF (etanercept y adalimumab).Método: Estudio observacional, descriptivo y multicéntrico. Se utilizóun cuestionario específico validado (QOL-RA Scale) en su versión enespañol, manteniendo la confidencialidad al máximo. Para medir lafiabilidad de los resultados se utilizó el coeficiente alfa de Cronbach.Se ha realizado un análisis descriptivo para comparar los resultadosobtenidos con estudios realizados en la población estadounidense ycolombiana.Resultados: Se seleccionaron 82 pacientes. Destacó el perfil de amade casa, casada y con ningún estudio o estudios primarios. La mediade años de diagnóstico fue 11,81 ± 7,30 años y la de tratamiento conanti-TNF fue de 1,71 ± 1,03 años. Los resultados para la encuesta fueron:habilidad física 5,42 ± 1,67), dolor 5,10 ± 1,83, vida social 7,08± 1,96, apoyo 7,45 ± 2,10), estado de ánimo 6,02 ± 2,03, tensiónnerviosa 5,50 ± 2,01, artritis 5,15 ± 1,86), salud 5,50 ± 1,77. Los resultadosobtenidos fueron similares a los encontrados en la poblaciónestadounidense, aunque destaca una menor puntuación en elánimo y la tensión nerviosa. Sin embargo, la alta puntuación en lo referenteal apoyo y la vida social fue más parecida a la obtenida en lapoblación colombiana. Todos los pacientes consideraron que su calidadde vida había mejorado con la medicación anti-TNF.Conclusiones: La calidad de vida en pacientes con artritis reumatoidees baja, determinada por el dolor y los síntomas depresivos. Lospacientes tienen la percepción de que los anti-TNF han mejorado sucalidad de vida

Objective: To assess the quality of life of patients with rheumatoidarthritis undergoing out-patient treatment with TNF inhibitors (etanerceptand adalimumab).Method: Observational, descriptive and multi-centre study. A specificvalidated questionnaire was used (QOL-RA Scale) in its Spanish version,with complete confidentiality ensured. To measure the reliabilityof the results, the Cronbach Alpha Coefficient was used. A descriptiveanalysis was carried out to compare the results obtained withthose obtained from studies in the USA and Colombia.Results: A total of 82 patients were selected who mainly consisted ofmarried housewives who had not undergone any previous studies.The average amount of years from diagnosis was 11.81 years (SD:7.30) and the average duration of treatment with TNF inhibitors was1.71 years (SD: 1.03). The results of the questionnaire were: physicalability 5.42 (SD: 1.67), pain 5.10 (SD: 1.83), social life 7.08 (SD:1.96), support 7.45 (SD: 2.10), mood 6.02 (SD: 2.03), stress 5.50(SD: 2.01), arthritis 5.15 (SD: 1.86), health 5.50 (SD: 1.77). The resultsobtained were similar to those from the USA, although they showeda lower score for mood and stress categories. However, the highscore in the support and social-life categories was more similar tothat obtained with the Colombian questionnaire. All patients consideredtheir quality of life to have improved with the use of TNF inhibitors.Conclusions: The quality of life in patients with Rheumatoid Arthritisis low, determined by pain and symptoms of depression. The patientsbelieve that TNF inhibitors have improved their quality of life

[Suitability of the use of low-molecular-weight heparins in the prevention of venous thromboembolism]. / Adecuación de la utilización de heparinas de bajo peso molecular en la prevención de la enfermedad tromboembólica venosa.

OBJECTIVE: To investigate the prevalence of low-molecular-weight heparin (LMWH) prescription in venous thromboembolism prophylaxis in a general hospital and the suitability of the recommendations from the clinical practice guidelines. METHOD: A descriptive, observational and cross-sectional study of the indication-prescription type, carried out on patients admitted to medical departments and for surgery. RESULTS: 345 patients were included. The prevalence of HBPM use was 44.6% (95% CI, 39.3-50.1). Depending on the risk of thromboembolism, the decision to treat prophylactically (or not) was appropriate in 261 cases (75.7%; 95% CI, 70.7-80.1), and the action guidelines were not suitable for the remainder of patients. 55 patients (15.9%; 95% CI, 12.2-20.2) presented a high risk and were not prescribed prophylactically (underuse); and 29 patients (8.4%; 95% CI, 5.7-11.8) at low risk were treated prophylactically (overuse). There was a relationship between the appropriateness of the prescription and the type of patient (p<0.01). In the group of medical patients the prevalence of prescription was 22.6% (95% CI, 16.9-29.1) and only 33.3% of patients with a high to moderate risk of thromboembolism received prophylaxis. The prevalence of prescription in general surgery was 84.2% and 91.3% in traumatology. CONCLUSIONS: The degree of prophylaxis is adequate in surgical patients, but there was a significant percentage of medical patients with a high to moderate risk who did not receive suitable prophylaxis (underuse), despite recommendations with scientific and professional backing.

[Medication errors and non-compliance in polymedicated elderly patients]. / Errores de medicación e incumplimiento terapéutico en ancianos polimedicados.

OBJECTIVE: To detect and describe medication errors and adherence to therapy in polymedicated (> 5 drugs) elderly patients (> 65 years). METHOD: A descriptive, observational study using a phone survey to polymedicated elderly outpatients. Sociodemographic, clinical, and pharmacotherapeutic data were collected, as well as information on their functional and mental capability. The number, type and severity of medication errors were measured, as was non-adherence. RESULTS: Errors were detected in 42.5% of 73 responders, with a total of 55 errors, and a mean 1.77 errors per patient. Most commonly found errors included inappropriate administration frequency and therapeutic duplicity. Regarding adherence, 43.8% were non-compliants, being sporadic in 68.8% and sequential in 31.2% of the cases. A positive relationship between error number and drug number or adherence was found. CONCLUSIONS: Actions are required from a multidisciplinary standpoint to reduce this high percentage of errors.

Estudio de utilización de Tenofovir DF en el tratamiento antirretroviral de gran actividad / Use study of tenofovir DF in higly active anti-retroviral therapy

Objetivo: Describir la eficacia y seguridad de tenofovir. Métodos: Estudio descriptivo, observacional. Análisis por intención de tratar. La variable principal fue la proporción de pacientes con supresión de la carga viral plasmática del VIH hasta indetectable. Las variables secundarias fueron la respuesta inmunológica, proporción de pacientes con variación positiva del número de CD4+ y la seguridad (eventos adversos clínicos y valores bioquímicos y hematológicos). Se midió la causalidad por el algoritmo de Naranjo. Resultados: Se seleccionaron 154 pacientes, 12 fueron excluidos de todos los análisis. Las variables de eficacia fueron: La proporción de pacientes que disminuyeron la carga viral a 50 copias/ml o menos fue 28,16%, la media de descenso fue -1,29 ± 0,97 log10 copias/ml. La media de aumento de CD4 fue de 40,27 ± 141,50 cel/mm3 La seguridad fue similar a la ficha técnica, destacando tres casos de Síndrome de Fanconi. Conclusión: Tenofovir supone un antirretroviral de gran efectividad en el hospital con un perfil de seguridad óptimo

Objective: Describe the efficacy and safety of tenofovir. Methods: Observational, descriptive study. Data were analyzed for the intention-to-treat sample. The primary efficacy end-point included the proportion of patients with HIV-1 RNA level of 50 copies/ml or less. Secondary efficacy end points was the increase of the CD4 cell count at week 48. The primary safety end-point was the number of patients with abnormalities (clinical adverse events and laboratory toxicities). The causality of the adverse effects was measured by the Naranjo algorithm Results: 154 subjects were enrolled; 12 were excluded from all analyses. Efficacy end points: Plasma HIV-1 RNA response: -1.29 ± 0.97 log10 copies/ml; Patients with HIV-1 RNA levels of 50 copies/ml or less: 28.16%; CD4 cell count response: 40.27 ± 141.50 cel/mm3. Safety profile was similar to showed at prescribing information, 3 Fanconi Syndrome were detected. Conclusion: Tenofovir supposes an antiretroviral of high effectiveness in our hospital, with an optimum safety profile

[Use study of tenofovir DF in highly active anti-retroviral therapy]. / Estudio de utilización de Tenofovir DF en el tratamiento antirretroviral de gran actividad.

OBJECTIVE: Describe the efficacy and safety of tenofovir. METHODS: Observational, descriptive study. Data were analyzed for the intention-to-treat sample. The primary efficacy end-point included the proportion of patients with HIV-1 RNA level of 50 copies/ml or less. Secondary efficacy end points was the increase of the CD4 cell count at week 48. The primary safety end-point was the number of patients with abnormalities (clinical adverse events and laboratory toxicities). The causality of the adverse effects was measured by the Naranjo algorithm. RESULTS: 154 subjects were enrolled; 12 were excluded from all analyses. Efficacy end points: Plasma HIV-1 RNA response: -1.29 +/- 0.97 log10 copies/ml; Patients with HIV-1 RNA levels of 50 copies/ml or less: 28.16%; CD4 cell count response: 40.27 +/- 141.50 cel/mm3. Safety profile was similar to showed at prescribing information, 3 Fanconi Syndrome were detected. CONCLUSION: Tenofovir supposes an antiretroviral of high effectiveness in our hospital, with an optimum safety profile.

[Cost-effectiveness analysis of tenofovir versus zidovudine in combination therapy with efavirenz and lamivudine for the treatment of HIV in naive patients]. / Análisis coste-eficacia de tenofovir versus zidovudina en terapia combinada con efavirenz y lamivudina para el tratamiento de VIH en pacientes no pretratados.

OBJECTIVES: To assess tenofovir + lamivudine + efavirenz versus zidovudine + lamivudine + efavirenz in treatment-naive patients using a cost-effectiveness analysis. METHODS: A decision tree was designed. Effectiveness was estimated from clinical trials. Viral load and CD4 cells count were chosen as endpoints for health outcome. Both healthcare and treatment costs were considered, and univariate sensitivity tests were performed. RESULTS: The regimen including tenofovir would have a yearly cost of 10,116.61 Euros when effective, and of 12,140.40 Euros in case of therapeutic failure. The regimen including zidovudine would have a yearly cost of 7,470.36 Euros when effective, and of 8,964.90 Euros in case of therapeutic failure. The cost of switching to the regimen with tenofovir represents 14,765.86 Euros per year per additional patient with non-detectable viral load. After 3 years, the expected yearly cost is 8,765.83 Euros for the regimen including tenofovir versus 8,894.36 Euros for the regimen including zidovudine. CONCLUSION: The regimen including zidovudine is less costly in the short run when compared to the regimen including tenofovir. Both regimens become financially similar when extending the study horizon.

Análisis coste-eficacia de tenofovir versus zidovudina en terapia combinada con efavirenz y lamivudina para el tratamiento de VIH en pacientes no pretratados / Cost-effectiveness analysis of tenofovir versus zidovudine in combination therapy with efavirenz and lamivudine for the treatment of HIV in naive patients

Objetivos: Evaluar los regímenes en pacientes no pretratados de tenofovir + lamivudina + efavirenz versus zidovudina + lamivudina + efavirenz mediante un estudio coste-eficacia. Métodos: Se diseñó un árbol de decisiones. Se estimó la eficaciaa través de ensayos clínicos. Para valorar la medida sobre los resultados de la salud se consideró la carga viral y los CD4. Se consideraron costes asistenciales y de tratamiento, y se realizó un análisis de sensibilidad univariante. Resultados: El régimen con tenofovir tendría un coste anual, en caso de ser efectivo, de 10.116,61 €, mientras que si existefallo terapéutico el coste sería de 12.140,40 €. El régimen que incluye zidovudina tendría un coste anual de 7.470,36 € en caso de ser efectivo, y un coste de 8.964,90 €, en caso de fallo terapéutico.El coste de pasar al régimen que incluye tenofovir supone 14.765,86 € al año por paciente adicional con carga viral indetectable. En 3 años, el coste anual esperado es de 8.765,83 € para el régimen que incluye tenofovir frente a 8.894,36 € del régimen que incluye zidovudina. Conclusión: El régimen que incluye zidovudina es menos costoso a corto plazo que el que incluye tenofovir. Si ampliamos el horizonte del estudio, los dos regímenes se equiparan económicamente

Objectives: To assess tenofovir + lamivudine + efavirenz versus zidovudine + lamivudine + efavirenz in treatment-naive patients using a cost-effectiveness analysis. Methods: A decision tree was designed. Effectiveness was estimated from clinical trials. Viral load and CD4 cells count were chosen as end points for health outcome. Both healthcare and treatment costs were considered, and univariate sensitivity tests were performed. Results: The regimen including tenofovir would have a yearly cost of € 10,116.61 when effective, and of € 12,140.40 in case of therapeutic failure. The regimen including zidovudine would have a yearly cost of € 7,470.36 when effective, and of € 8,964.90 incase of therapeutic failure. The cost of switching to the regimen with tenofovir represents € 14,765.86 per year per additional patient with non-detectable viral load. After 3 years, the expected yearly cost is € 8,765.83 for the regimen including tenofovir versus € 8,894.36 for the regimen including zidovudine. Conclusion: The regimen including zidovudine is less costly in the short run when compared to the regimen including tenofovir. Both regimens become financially similar when extending the study horizon