The cost of diabetes and obesity in Australia.

AIMS: To assess and compare the direct healthcare and non-healthcare costs and government subsidies by body weight and diabetes status. METHODS: The Australian Diabetes, Obesity and Lifestyle study collected health service utilization and health-related expenditure data at the 2011-2012 follow-up surveys. Costing data were available for 4,409 participants. Unit costs for 2016-2017 were used where available or were otherwise inflated to 2016-2017 dollars. Age- and sex-adjusted costs per person were estimated using generalized linear models. RESULTS: The annual total direct cost ranged from $1,998 per person with normal weight to $2,501 per person with obesity in participants without diabetes. For those with diabetes, total direct costs were $2,353 per person with normal weight, $3,263 per person with overweight, and $3,131 per person with obesity. Additional expenditure as government subsidies ranged from $5,649 per person with normal weight and no diabetes to $8,085 per person with overweight and diabetes. In general, direct costs and government subsidies were higher for overweight and obesity compared to normal weight, regardless of diabetes status, but were more noticeable in the diabetes sub-group. The annual total excess cost compared with normal weight people without diabetes was 26% for obesity alone and 46% for those with obesity and diabetes. LIMITATIONS: Participants included in this study represented a healthier cohort than the Australian population. The relatively small sample of people with both obesity and diabetes prevented a more detailed analysis by obesity class. CONCLUSION: Overweight and obesity are associated with increased costs, which are further increased in individuals who also have diabetes. Interventions to prevent overweight and obesity or reduce weight in people who are overweight or obese, and prevent diabetes, should reduce the financial burden.

Custo-efetividade do fator VII ativado recombinante (rFVIIa) e complexo protrombínico parcialmente ativado (CCPa) no tratamento sob demanda do sangramento leve/moderado de pacientes com hemofilia congênita complicada por inibidores sob a perspectiva do sistema público de saúde do Brasil / Cost-effectiveness of rFVIIa and CCPa in the on-demand treatment of congenital haemophilia with inhibitors in the Brazilian public setting

Objetivo: Fornecer evidências econômicas que suportem o uso do fator VII ativado recombinante (rFVIIa) em comparação ao complexo protrombínico parcialmente ativado (CCPa) para o tratamento do episódio de sangramento leve a moderado devido a hemofilia com anticorpos inibidores no Sistema Único de Saúde (SUS). Métodos: Estudos que investigaram a eficácia clínica dos tratamentos CCPa e rFVIIa indicam diferenças entre eles na capacidade de controlar os sangramentos. A análise de custo-efetividade foi desenvolvida com base em dois modelos de árvore de decisão propostos por You et al. (2009) e Jiménez-Yuste et al. (2013). O desfecho clínico foi o percentual de pacientes que controlam o sangramento e o desfecho econômico incluiu custos médicos diretos. O horizonte de tempo variou com a gravidade da hemorragia. Os custos unitários foram obtidos do Diário Oficial da União (1 µg de rFVIIa R$ 2,09 e 1U de CCPa R$ 2,28). No modelo de You foram considerados também custos com ácido tranexâmico e centro de tratamento, extraídos da CMED (Câmara de Regulação do Mercado de Medicamentos) e do SIGTAP (Sistema de Gerenciamento da Tabela de Procedimentos), respectivamente. Resultados: O modelo de You indicou maior percentual de pacientes que tiveram o sangramento controlado com rFVIIa comparado ao CCPa (89,2% vs. 75,1%) com menor custo de tratamento (R$ 18.921 vs. R$ 28.691). Considerando Jiménez-Yuste, o percentual de pacientes com sangramento controlado também é maior com rFVIIa (79,0% vs. 61,0%), com menor custo de tratamento (R$ 63.446 vs. R$ 68.952). Conclusão: O rFVIIa é uma alternativa cost-saving para o tratamento de pacientes com hemofilia congênita com inibidores comparado ao CCPa.

Objective: To provide economic evidences that support the use of recombinant activated factor VII (rFVIIa) in comparison to activated prothrombin complex concentrate (aPCC) for the treatment of episodes of mild to moderate bleeding due to haemophilia with inhibitors in Sistema Único de Saúde (SUS). Methods: Studies that explored the clinical efficacy of aPCC and rFVIIa treatments have shown differences between them in their capacity for controlling bleeding episodes. The cost-effectiveness analysis was developed based on two decision tree models proposed by You et al. (2009) and Jiménez-Yuste et al. (2013). The clinical outcome was the percentage of patients with controlled bleeding, and the economic outcome was direct medical costs. The time horizon varied according to hemorrhage severity. Drugs unit costs were obtained from the Diário Oficial da União (1 µg of rFVIIa R$ 2.09 and 1U of aPCC R$ 2.28). In You model, also considered the costs with tranexamic acid and treatment center, extracted from CMED (Câmara de Regulação do Mercado de Medicamentos) and SIGTAP (Sistema de Gerenciamento da Tabela de Procedimentos), respectively. Results: You model showed a higher percentage of patients that controlled bleeding with rFVIIa compared to aPCC (89.2% vs. 75.1%) and with lower treatment cost (R$ 18,921 vs. R$ 28,691). Considering Jiménez-Yuste, the percentage of patients that controlled bleeding was also greater with rFVIIa (79.0% vs. 61.0%) with lower treatment cost (R$ 63,446 vs. R$ 68,952). Conclusion: rFVIIa is a cost-saving alternative for the treatment of patients with congenital haemophilia with inhibitors compared to aPCC.

Augmenting drug-carrier compatibility improves tumour nanotherapy efficacy.

A major goal of cancer nanotherapy is to use nanoparticles as carriers for targeted delivery of anti-tumour agents. The drug-carrier association after intravenous administration is essential for efficient drug delivery to the tumour. However, a large number of currently available nanocarriers are self-assembled nanoparticles whose drug-loading stability is critically affected by the in vivo environment. Here we used in vivo FRET imaging to systematically investigate how drug-carrier compatibility affects drug release in a tumour mouse model. We found the drug's hydrophobicity and miscibility with the nanoparticles are two independent key parameters that determine its accumulation in the tumour. Next, we applied these findings to improve chemotherapeutic delivery by augmenting the parent drug's compatibility; as a result, we achieved better antitumour efficacy. Our results help elucidate nanomedicines' in vivo fate and provide guidelines for efficient drug delivery.