Calidad de vida del paciente asmático con beclometasona/formoterol. Análisis de coste-utilidad / Quality of life of patients with asthma on beclomethasone/formoterol. Cost-utility analysis

Objetivo. Realizar un estudio de coste-utilidad en pacientes asmáticos en tratamiento con beclometasona/formoterol en combinación fija en Atención Primaria de Salud. Material y métodos. Se seleccionó de forma no probabilística un grupo de pacientes asmáticos con severidad persistente moderada/grave (GEMA 2009), en tratamiento con beclometasona/formoterol a dosis fijas, mayores de 18 años, que habían otorgado su consentimiento informado. El período de observación del estudio fue de 6 meses. Las variables estudiadas fueron: edad, sexo, duración de la enfermedad, recursos sanitarios empleados, análisis de la calidad de vida relacionada con la salud mediante EQ-5D y SF-36, y el cuestionario específico Asthma Quality of Life Questionnaire. Para las variables cualitativas se analizó la frecuencia y la proporción. Para las cuantitativas, la media, la DE y el IC 95%. En la estadística inferencial se utilizaron los test de Chi-cuadrado, t de Student y ANOVA. Las comparaciones se realizaron con una significación estadística de 0,05. Resultados. Sesenta y cuatro pacientes completaron el estudio; el 59,4% eran mujeres. La edad media fue de 49 años y la duración media de la enfermedad fue de 93 meses. Para el control del asma el 53% de los pacientes tenían una pauta prescrita de uno/12 h. Todas las escalas de calidad de vida relacionada con la salud se modificaron respecto del inicio del estudio y las diferencias fueron estadísticamente significativas. Nuestros pacientes lograron mejores puntuaciones en calidad de vida relacionada con la salud que la cohorte española de asma. El coste-utilidad incremental de beclometasona/formoterol frente a la opción habitual de tratamiento fue de 6.256 €/AVAC (AU)

Aim. To perform a cost-utility analysis on asthmatic patients on beclomethasone/formoterol fixed combination in Primary Health Care. Material and methods Non-probability sampling was used to select a group of asthmatic patients with moderate/severe persistent severity (GEMA 2009), treated with beclomethasone/formoterol fixed combination, over 18 years, had given their informed consent. The study observation period was 6 months. The variables studied were: age, sex, duration of disease, health resources used, analysis of health related quality of life by EQ-5D and SF-36, and the specific Asthma Quality of Life Questionnaire. For the qualitative variables, the frequency and percentages were calculated, and for the quantitative variables, the mean, SD and 95% CI. Chi-square, Student t-test and ANOVA were used for statistical inference. Comparisons were made with a statistical significance of 0.05. Results. Of the 64 patients that completed the study, 59.4% were female. The mean age was 49 years, and mean disease duration was 93 months. For asthma control, 53% of patients had a prescription pattern of one/12 h. All health related quality of life scales were modified with respect to the baseline and the differences were statistically significant. Our patients had a better health related quality of life than Spanish asthma cohort. The incremental cost utility beclomethasone/formoterol versus usual treatment option was € 6,256/QALY (AU)

Effectiveness of surgery in liver metastasis from colorectal cancer: experience and results of a continuous improvement process

Purpose. The aim of this study was to estimate the effectiveness of surgery in liver metastasis from colorectal cancer. Methods. We conducted a prospective and observational study of patients with colorectal liver metastasis operated on at the San Cecilio University Hospital of Granada from March 2003 until June 2013. The primary variables of the result were survival and morbidity before 30 days of the post-operative period. We also measured preoperative and surgical variables. Results. A total of 147 patients with liver metastasis of colorectal origin underwent surgical removal during the period of study, 38 of whom had repeat surgery. 34 had a second resection, 3 had a third one and one only patient had a fourth one, for a total of 185 registered operations. The global 5-year survival rate was 38 and 17 % after 10 years. There were 115 patients who had neither radiofrequency nor exploratory laparotomy, 38 % of them survived over 60 months. The average disease-free time was 23.6 months ± 47.3, with significant differences observed between types of procedures. Patients that were operated on just once (n = 25) had a five-year actuarial survival rate of 35 %, a morbidity rate of 24 % and a mortality rate of 0.6 % (1 patient only). The average hospital stay was 13.8 days and the disease-free time was 15.8 months. Conclusion. The results obtained in our surgical unit in terms of morbidity, mortality and five-year actuarial survival rates are comparable to those of other units at large institutions, which are currently considered the standards of quality (AU)

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Salud y crisis / Health and crisis

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Resultados en salud y eficiencia del fentanilo intranasal en pectina en el dolor irruptivo en la práctica clínica habitual / No disponible

OBJETIVO: Conocer la efectividad y eficiencia del fentanilo intranasal en pectina comparado con otros tratamientos empleados en el dolor irruptivo oncológico a través de un análisis farmacoeconómico. RESULTADOS Y CONCLUSIONES: En la evaluación farmacoeconómica realizada, todas las opciones analizadas fueron coste-efectivas para una disposición a pagar (invertir) de 30.000 € por AVAC ganado (ratio coste/efectividad < 30.000 €). La opción más eficiente (mayor efectividad y menor coste) en todos los casos analizados es el espray intranasal de fentanilo en pectina (FPNS). En el análisis incremental, FPNS fue la opción dominante sobre todas las demás evaluadas: FST, OTFC, FBT e INFS. Del análisis de los datos de nuestro estudio de modelización de coste/efectividad del espray intranasal de fentanilo en pectina FPNS se concluye: - INFS sin proporcionar más eficacia ha demostrado ser significativamente más caro (+15 %). - FST, OTFC, FBT han demostrado una efectividad un 18 % menor que FPNS y además ser significativamente más caros (+9 %; +15 %; +10 %, respectivamente). Abreviaturas: AVAC: años ganados con buena calidad de vida. FPNS: PecFent®. FST: Abstral®. OTFC: Actiq®. FBT: Effentora®. INFS: Instanyl®

OBJECTIVE: Determine, with a pharmacoeconomic evaluation, the effectiveness and efficiency of fentanyl pectin intranasal spray for BTPc versus other indicated treatments. RESULTS AND CONCLUSIONS: All the treatments analyzed in the pharmacoeconomic evaluation were cost-effective in terms of a willingness to pay (invest) of € 30,000 per AVAC gained (cost / effectiveness ratio < € 30,000). The most efficient option (greater effectiveness and lower cost) of all the treatments analyzed was the fentanyl pectin nasal spray (FPNS). In the incremental analysis FPNS was the dominant treatment option over all the others evaluated: FST, OTFC, FBT and INFS. From the analysis of the data of our cost/effectiveness modeling study of the fentanyl pectin nasal spray, FPNS, we can conclude: - INFS without providing greater effectiveness has been shown to be significantly more expensive (+15 %). - FST, OTFC, FBT have demonstrated -18 % less effectiveness and also been shown to be significantly more expensive than FPNS (+9 %; +15 %; +10 %, respectively). Abbreviations: AVAC: Years gained with good quality of life. FPNS: PecFent®. FST: Abstral®. OTFC: Actiq®. FBT: Effentora®. INFS: Instanyl®