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1.
Ann Gen Psychiatry ; 17: 8, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29456588

RESUMO

BACKGROUND: Agitation is a common feature of bipolar disorder and schizophrenia. Previous research indicates that specific symptoms impact caregiver burden in these conditions, but the impact of agitation on caregiver experience is poorly understood. The aim of this study was to characterise caregiver burden in providers of informal care for patients with bipolar disorder and schizophrenia who experience agitation. METHODS: In total, 297 matched patient and caregiver surveys were collected across the UK, Germany and Spain between October 2016 and January 2017. To be eligible, caregivers needed to provide informal care to a patient with a diagnosis of bipolar disorder or schizophrenia with agitation managed in a community setting and participating in the patient survey. The caregiver survey captured information on demographics and their role in managing the patient's agitation. Caregiver burden was assessed using the Involvement Evaluation Questionnaire. Descriptive analysis was conducted. RESULTS: Caregivers provided 38.3 h (SD ± 40.34) a week of support to the patient with 20% providing 50 h or more. Most caregivers reported that they recognised an episode of agitation all of the time (44%, n = 130) or sometimes (40%, n = 119). Verbal de-escalation techniques (talking (80%, n = 239) and soothing (73%, n = 218) were the most commonly reported strategies used by caregivers during an episode of agitation; 14% (n = 43) reported resorting to physically restraining the patient. Caregivers supervised rescue medication administration regularly (41%, n = 69) or occasionally (49%, n = 82). Mean Involvement Evaluation Questionnaire score was 32.2 (± 15.27), equivalent to 28.4 (± 13.56) in Germany, 35.6 (± 16.55) in Spain and 33.3 (± 15.15) in the UK. Involvement Evaluation Questionnaire scores were higher for caregivers who reported hostile (41.7 ± 17.07) lack of control (40.3 ± 16.35) and violent (39.5 ± 16.40) patient behaviours when agitated. Over excitement (31.8 ± 15.05), restless (32.6 ± 14.77) and tense (32.9 ± 15.64) behaviours were associated with a lower Involvement Evaluation Questionnaire score. CONCLUSIONS: Caregivers are active participants in the recognition and management of agitation episodes. The substantial burden reported by these caregivers is impacted by factors including the number of hours of care provided, patient behaviours and country. These may be viable targets for effective interventions to reduce caregiver burden.

2.
Rev. esp. cardiol. (Ed. impr.) ; 70(1): 42-49, ene. 2017. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-159302

RESUMO

Introducción y objetivos: Estimar los beneficios en salud y el coste-efectividad de una intervención con un policomprimido (ácido acetilsalicílico 100 mg, atorvastatina 20 mg y ramipril 10 mg) para la prevención secundaria de eventos cardiovasculares desde la perspectiva del Sistema Nacional de Salud español en comparación con la monoterapia múltiple. Métodos: Se utilizó una versión adaptada de un modelo de Markov publicado recientemente y desarrollado y validado en Microsoft Excel para evaluar el coste-efectividad del policomprimido frente a sus monocomponentes combinados en un horizonte temporal de 10 años. La población incluida en el modelo tenía antecedentes de infarto de miocardio y una media de edad de 64,7 años, y la mayoría eran varones. Los parámetros de entrada se obtuvieron de una revisión sistemática de la literatura que informara sobre eficacia, adherencia, utilidades y costes. Los resultados del modelo se expresan en eventos evitados, costes incrementales, años de vida incrementales, años de vida ajustados por calidad incrementales y la razón de coste-efectividad incremental. Resultados: En 10 años, la utilización de un policomprimido cardiovascular en lugar de sus monocomponentes evitaría 46 eventos cardiovasculares no fatales y 11 fatales por cada 1.000 pacientes tratados. Además, el policomprimido es una estrategia más efectiva y más barata. En el análisis probabilístico del caso base, se observa un 90,9% de probabilidad de que el policomprimido sea una estrategia coste-efectiva para una disposición a pagar 30.000 euros por año de vida ajustado por calidad comparada con la monoterapia múltiple. Conclusiones: Se demuestra que el policomprimido es una estrategia coste-efectiva para el Sistema Nacional de Salud español con potencial beneficio clínico (AU)


Introduction and objectives: To estimate the health benefits and cost-effectiveness of a polypill intervention (aspirin 100 mg, atorvastatin 20 mg, ramipril 10 mg) compared with multiple monotherapy for secondary prevention of cardiovascular events in adults with a history of myocardial infarction from the perspective of the Spanish National Health System. Methods: An adapted version of a recently published Markov model developed and validated in Microsoft Excel was used to compare the cost-effectiveness of the polypill with that of its combined monocomponents over a 10-year time horizon. The population included in the model had a mean age of 64.7 years; most were male and had a history of myocardial infarction. The input parameters were obtained from a systematic literature review examining efficacy, adherence, utilities, and costs. The results of the model are expressed in events avoided, incremental costs, incremental life years, incremental quality-adjusted life years, and the incremental cost-effectiveness ratio. Results: Over a 10-year period, use of the cardiovascular polypill instead of its monocomponents simultaneously would avoid 46 nonfatal and 11 fatal cardiovascular events per 1000 patients treated. The polypill would also be a more effective and cheaper strategy. Probabilistic analysis of the base case found a 90.9% probability that the polypill would be a cost-effective strategy compared with multiple monotherapy at a willingness-to-pay of 30 000 euros per quality-adjusted life year. Conclusions: The polypill would be a cost-effective strategy for the Spanish National Health System with potential clinical benefits (AU)


Assuntos
Humanos , Combinação de Medicamentos , Infarto do Miocárdio/prevenção & controle , Polimedicação , Adesão à Medicação , Quimioterapia Combinada/estatística & dados numéricos , Análise Custo-Benefício , Prevenção Secundária/métodos
3.
Rev Esp Cardiol (Engl Ed) ; 70(1): 42-49, 2017 Jan.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-27474481

RESUMO

INTRODUCTION AND OBJECTIVES: To estimate the health benefits and cost-effectiveness of a polypill intervention (aspirin 100 mg, atorvastatin 20 mg, ramipril 10 mg) compared with multiple monotherapy for secondary prevention of cardiovascular events in adults with a history of myocardial infarction from the perspective of the Spanish National Health System. METHODS: An adapted version of a recently published Markov model developed and validated in Microsoft Excel was used to compare the cost-effectiveness of the polypill with that of its combined monocomponents over a 10-year time horizon. The population included in the model had a mean age of 64.7 years; most were male and had a history of myocardial infarction. The input parameters were obtained from a systematic literature review examining efficacy, adherence, utilities, and costs. The results of the model are expressed in events avoided, incremental costs, incremental life years, incremental quality-adjusted life years, and the incremental cost-effectiveness ratio. RESULTS: Over a 10-year period, use of the cardiovascular polypill instead of its monocomponents simultaneously would avoid 46 nonfatal and 11 fatal cardiovascular events per 1000 patients treated. The polypill would also be a more effective and cheaper strategy. Probabilistic analysis of the base case found a 90.9% probability that the polypill would be a cost-effective strategy compared with multiple monotherapy at a willingness-to-pay of 30 000 euros per quality-adjusted life year. CONCLUSIONS: The polypill would be a cost-effective strategy for the Spanish National Health System with potential clinical benefits.


Assuntos
Aspirina/uso terapêutico , Atorvastatina/uso terapêutico , Doenças Cardiovasculares/prevenção & controle , Custos de Medicamentos/tendências , Previsões , Ramipril/uso terapêutico , Prevenção Secundária/métodos , Adulto , Inibidores da Enzima Conversora de Angiotensina/economia , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Aspirina/economia , Atorvastatina/economia , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/epidemiologia , Análise Custo-Benefício , Quimioterapia Combinada , Feminino , Seguimentos , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/economia , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Incidência , Masculino , Cadeias de Markov , Adesão à Medicação , Pessoa de Meia-Idade , Inibidores da Agregação Plaquetária/economia , Inibidores da Agregação Plaquetária/uso terapêutico , Anos de Vida Ajustados por Qualidade de Vida , Ramipril/economia , Estudos Retrospectivos , Espanha/epidemiologia
4.
Actas esp. psiquiatr ; 44(5): 166-177, sept.-oct. 2016. tab
Artigo em Espanhol | IBECS | ID: ibc-156058

RESUMO

Introducción. La agitación es un problema común en la atención psiquiátrica con graves consecuencias clínicas y económicas. Metodología. El objetivo del estudio fue definir y caracterizar los estados de agitación en la práctica habitual en una unidad de Psiquiatría de Agudos y urgencias psiquiátricas, y describir los paquetes de atención típicos. Se establecieron dos grupos nominales, uno con 7 profesionales de enfermería y otro con 10 de psiquiatría (urgencias y psiquiatría de agudos del Parc Sanitari Sant Joan de Déu). Resultados. El equipo de enfermería describió dos estados principales que formaban los extremos de un espectro que iba de leve (pre-agitación) a grave (agitación). Se describió un tercer estado que se caracterizaba por un comportamiento desorganizado. Diversos paquetes de atención fueron descritos para cada estado de agitación que se dividían en paquetes de primera, segunda y tercera línea. La primera línea (contención verbal) se aplicaba en todos los estados de agitación. Si no fuese eficaz, se implementaban los de segunda y tercera línea, llegando hasta la contención mecánica. El equipo de psiquiatras describió tres estados de agitación: un estado inicial leve (ansiedad e irritabilidad), un estado moderado (pre-agitación sin agresividad) y un estado severo de agitación con agresividad y/o violencia. Conclusiones. Para evitar la progresión a un estado de agitación severa, ambos grupos coincidieron en la importancia de la contención verbal, apropiada para todos los estados. Esto iría seguido de las medidas ambientales y farmacológicas hasta llegar a la contención mecánica dependiendo de la gravedad de la situación


Introduction. Agitation is a common problem in psychiatric care with serious clinical and economic consequences. Methodology. The aim of the study was to define and characterize the agitation states present in usual medical practice in the acute and emergency units of a psychiatric hospital. Two nominal groups, one with 7 nurses and the other with 10 psychiatrists from the Parc Sanitari Sant Joan de Déu, were established. Results. The nurses described two main states forming the endpoints of a spectrum: from mild (pre-agitation) to severe (agitation). A third state was outlined in which agitation was characterized by disorganized behavior problems. Various care packages were described for each agitation state. The care packages were divided into first, second and third line approaches. The first line approaches (i.e., verbal containment) were used on every (pre)agitated patient. If the first line approach was not effective, the second and third line approaches were implemented, culminating with physical restraint. The psychiatrists described 3 states: a mild initial state (anxiety and irritability), moderate (pre-agitation without aggressiveness) and a severe state of agitation with aggressiveness and/or violence. Conclusions. In order to avoid progression to a severely agitated state, both groups agreed on the importance of appropriate verbal containment for all states. This would be followed by environmental measures, medication and mechanical restrain depending on the severity of the state


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Agitação Psicomotora/diagnóstico , Agitação Psicomotora/terapia , Intervenção em Crise/métodos , Enfermagem Psiquiátrica , Pesquisa Qualitativa
5.
Actas Esp Psiquiatr ; 44(5): 166-77, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27644098

RESUMO

INTRODUCTION: Agitation is a common problem in psychiatric care with serious clinical and economic consequences. METHODOLOGY: The aim of the study was to define and characterize the agitation states present in usual medical practice in the acute and emergency units of a psychiatric hospital. Two nominal groups, one with 7 nurses and the other with 10 psychiatrists from the Parc Sanitari Sant Joan de Déu, were established. RESULTS: The nurses described two main states forming the endpoints of a spectrum: from mild (pre-agitation) to severe (agitation). A third state was outlined in which agitation was characterized by disorganized behavior problems. Various care packages were described for each agitation state. The care packages were divided into first, second and third line approaches. The first line approaches (i.e., verbal containment) were used on every (pre)agitated patient. If the first line approach was not effective, the second and third line approaches were implemented, culminating with physical restraint. The psychiatrists described 3 states: a mild initial state (anxiety and irritability), moderate (pre-agitation without aggressiveness) and a severe state of agitation with aggressiveness and/or violence. CONCLUSIONS: In order to avoid progression to a severely agitated state, both groups agreed on the importance of appropriate verbal containment for all states. This would be followed by environmental measures, medication and mechanical restrain depending on the severity of the state.


Assuntos
Agitação Psicomotora/diagnóstico , Agitação Psicomotora/terapia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
6.
Psychiatr Serv ; 67(1): 124-7, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26234333

RESUMO

OBJECTIVE: The study determined hospital costs associated with a diagnosis of agitation among patients at 14 general hospitals in Spain. METHODS: Data from discharge records of adult patients (2008-2012) with a diagnosis of agitation (ICD-9-CM code 293.0) were analyzed. Incremental hospital costs for agitated patients and a control group of patients without agitation were quantified, and the adjusted cost and incremental cost for both groups were compared by use of a recycled-predictions approach. RESULTS: The analysis included 355,496 hospital discharges, 5,334 of which were of patients with a diagnosis of agitation. Among patients with a diagnosis of agitation, hospital stays were significantly longer (12 days versus nine days). A significant difference in mean costs of €472 (95% confidence interval [CI]=€351-€593) was noted between patients with agitation and those in the control group. A recycled-predictions approach showed a difference of €1,593(CI=€1,556-€1,631). CONCLUSIONS: Findings indicate that agitation increased the use of hospital resources by at least 8%.


Assuntos
Custos Hospitalares/estatística & dados numéricos , Tempo de Internação/economia , Agitação Psicomotora/diagnóstico , Agitação Psicomotora/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Classificação Internacional de Doenças , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Espanha , Adulto Jovem
7.
Clín. investig. arterioscler. (Ed. impr.) ; 27(5): 228-238, sept.-oct. 2015. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-143177

RESUMO

Introducción y objetivos: Estimar el coste-efectividad de rosuvastatina frente a simvastatina, atorvastatina y pitavastatina en España, de acuerdo con las guías europeas de tratamiento de las dislipidemias, en pacientes con alto y muy alto riesgo cardiovascular. Métodos: Modelo de Markov de coste-efectividad a largo plazo de rosuvastatina versus simvastatina, atorvastatina y pitavastatina, en pacientes de alto y muy alto riesgo cardiovascular definido por 5 factores (sexo, edad, hábito tabáquico, nivel de colesterol inicial, presión arterial sistólica) según el sistema SCORE. La ratio coste-efectividad incremental se expresa en euros por año de vida ajustado por calidad y se calcula desde la perspectiva del Sistema Nacional de Salud. Resultados: Los resultados indican que rosuvastatina se asocia a un beneficio mayor que las otras estatinas en todos los perfiles considerados. Rosuvastatina es más coste-efectiva con respecto a simvastatina en pacientes con riesgo SCORE ≥ 8% en mujeres y ≥ 6% en hombres, mientras que entre 5% y los valores indicados su coste-efectividad depende del nivel basal de c-LDL del paciente. Rosuvastatina resulta más coste-efectiva frente a atorvastatina a partir de un riesgo SCORE de 11% en mujeres y 10% en hombres. Rosuvastatina resulta dominante frente a pitavastatina, tanto en mujeres como en hombres con riesgo alto y muy alto en el sistema SCORE. Conclusiones: Rosuvastatina es una terapia coste-efectiva en el tratamiento de la hipercolesterolemia, frente a simvastatina, atorvastatina y pitavastatina, especialmente en determinados perfiles de pacientes con factores de riesgo cardiovascular alto y muy alto según el sistema SCORE en España


Introduction and objectives: To estimate the cost-effectiveness of rosuvastatin versus simvastatin, atorvastatin and pitavastatin in Spain, according to the European guidelines for the treatment of dyslipidemias in patients with high and very high cardiovascular risk.Methods: A Markov long-term cost-effectiveness model of rosuvastatin versus simvastatin, atorvastatin and pitavastatin in patients with high and very high cardiovascular risk defined according to 5 factors (sex, age, smoking habit, baseline cholesterol level, and systolic blood pressure) using the SCORE system. The incremental cost-effectiveness ratio is expressed in euros per quality adjusted life years and is calculated according to the perspective of the Spanish National Health System. Results: Rosuvastatin is associated with a greater health benefit than the other statins across the considered profiles. Rosuvastatin is cost-effective compared to simvastatin in patients with SCORE risk ≥8% in females and ≥6% in males, while between 5% and the indicated values its cost-effectiveness is conditional to the patient baseline c-LDL level. Rosuvastatin is more cost-effective versus atorvastatin in female profiles associated with a SCORE risk≥11% and male profiles with SCORE risk ≥10%. Rosuvastatin is superior versus pitavastatin in both female and male profiles with high and very high cardiovascular risk. Conclusions: Rosuvastatin is a cost-effective therapy in the treatment of hypercholesterolemia versus simvastatin, atorvastatin and pitavastatin, especially in specific profiles of patients with high and very high cardiovascular risk factors, according to the SCORE system, in Spain


Assuntos
Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Doenças Cardiovasculares/prevenção & controle , Dislipidemias/tratamento farmacológico , Anticolesterolemiantes/economia , Sinvastatina/uso terapêutico , Fatores de Risco , 50303 , Doença das Coronárias/prevenção & controle
8.
BMJ Open ; 5(5): e007111, 2015 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-25991449

RESUMO

OBJECTIVE: To evaluate the public health and economic benefits of adherence to a fixed-dose combination polypill for the secondary prevention of cardiovascular (CV) events in adults with a history of myocardial infarction (MI) in the UK. DESIGN: Markov-model-based cost-effectiveness analysis, informed by systematic reviews, which identified efficacy, utilities and adherence data inputs. SETTING: General practice in the UK. PARTICIPANTS: Patients with a mean age of 64.7 years, most of whom are men with a recent or non-recent diagnosis of MI and for whom secondary preventive medication is indicated and well tolerated. INTERVENTION: Fixed-dose combination polypill (100 mg aspirin, 20 mg atorvastatin and 2.5, 5, or 10 mg ramipril) compared with multiple monotherapy. PRIMARY AND SECONDARY OUTCOME MEASURES: CV events prevented per 1000 patients; cost per life-year gained; and cost per quality-adjusted life-year (QALY) gained. RESULTS: The model estimates that for each 10% increase in adherence, an additional 6.7% fatal and non-fatal CV events can be prevented. In the base case, over 10 years, the polypill would improve adherence by ∼20% and thereby prevent 47 of 323 (15%) fatal and non-fatal CV events per 1000 patients compared with multiple monotherapy, with an incremental cost-effectiveness ratio (ICER) of £8200 per QALY gained. Probabilistic sensitivity analyses for the base-case assumptions showed an 81.5% chance of the polypill being cost-effective at a willingness-to-pay threshold of £20,000 per QALY gained compared with multiple monotherapy. In scenario analyses that varied structural assumptions, ICERs ranged between cost saving and £21,430 per QALY gained. CONCLUSIONS: Assuming that some 450,000 adults are at risk of MI, a 10 percentage point uptake of the polypill could prevent 3260 CV events and 590 CV deaths over a decade.The polypill appears to be a cost-effective strategy to prevent fatal and non-fatal CV events in the UK.


Assuntos
Fármacos Cardiovasculares/uso terapêutico , Doenças Cardiovasculares/tratamento farmacológico , Adesão à Medicação/estatística & dados numéricos , Saúde Pública/economia , Idoso , Fármacos Cardiovasculares/economia , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/prevenção & controle , Análise Custo-Benefício , Quimioterapia Combinada , Humanos , Cadeias de Markov , Modelos Econômicos , Polimedicação
9.
BMC Psychiatry ; 15: 35, 2015 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-25881240

RESUMO

BACKGROUND: Agitation and containment are frequent in psychiatric care but little is known about their costs. The aim was to evaluate the use of services and costs related to agitation and containment of adult patients admitted to a psychiatric hospital or emergency service. METHODS: Systematic searches of four electronic databases covering the period January 1998-January 2014 were conducted. Manual searches were also performed. Paper selection and data extraction were performed in duplicate. Cost data were converted to euros in 2014. RESULTS: Ten studies met inclusion criteria and were included in the analysis (retrospective cohorts, prospective cohorts and cost-of-illness studies). Evaluated in these studies were length of stay, readmission rates and medication. Eight studies assessed the impact of agitation on the length of stay and six showed that it was associated with longer stays. Four studies examined the impact of agitation on readmission and a statistically significant increase in the probability of readmission of agitated patients was observed. Two studies evaluated medication. One study showed that the mean medication dose was higher in agitated patients and the other found higher costs of treatment compared with non-agitated patients in the unadjusted analysis. One study estimated the costs of conflict and containment incurred in acute inpatient psychiatric care in the UK. The estimation for the year 2014 of total annual cost per ward for all conflict was €182,616 and €267,069 for containment based on updated costs from 2005. CONCLUSIONS: Agitation has an effect on healthcare use and costs in terms of longer length of stay, more readmissions and higher drug use. Evidence is scarce and further research is needed to estimate the burden of agitation and containment from the perspective of hospitals and the healthcare system.


Assuntos
Agressão , Custos de Cuidados de Saúde , Hospitalização/economia , Serviços de Saúde Mental/economia , Serviços de Saúde Mental/estatística & dados numéricos , Agitação Psicomotora/economia , Agitação Psicomotora/terapia , Restrição Física , Humanos
11.
Clin Investig Arterioscler ; 27(5): 228-38, 2015.
Artigo em Espanhol | MEDLINE | ID: mdl-25640158

RESUMO

INTRODUCTION AND OBJECTIVES: To estimate the cost-effectiveness of rosuvastatin versus simvastatin, atorvastatin and pitavastatin in Spain, according to the European guidelines for the treatment of dyslipidemias in patients with high and very high cardiovascular risk. METHODS: A Markov long-term cost-effectiveness model of rosuvastatin versus simvastatin, atorvastatin and pitavastatin in patients with high and very high cardiovascular risk defined according to 5 factors (sex, age, smoking habit, baseline cholesterol level, and systolic blood pressure) using the SCORE system. The incremental cost-effectiveness ratio is expressed in euros per quality adjusted life years and is calculated according to the perspective of the Spanish National Health System. RESULTS: Rosuvastatin is associated with a greater health benefit than the other statins across the considered profiles. Rosuvastatin is cost-effective compared to simvastatin in patients with SCORE risk ≥8% in females and ≥6% in males, while between 5% and the indicated values its cost-effectiveness is conditional to the patient baseline c-LDL level. Rosuvastatin is more cost-effective versus atorvastatin in female profiles associated with a SCORE risk≥11% and male profiles with SCORE risk ≥10%. Rosuvastatin is superior versus pitavastatin in both female and male profiles with high and very high cardiovascular risk. CONCLUSIONS: Rosuvastatin is a cost-effective therapy in the treatment of hypercholesterolemia versus simvastatin, atorvastatin and pitavastatin, especially in specific profiles of patients with high and very high cardiovascular risk factors, according to the SCORE system, in Spain.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Dislipidemias/tratamento farmacológico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Rosuvastatina Cálcica/uso terapêutico , Adulto , Idoso , Atorvastatina/economia , Atorvastatina/uso terapêutico , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/etiologia , Análise Custo-Benefício , Dislipidemias/complicações , Dislipidemias/economia , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/economia , Masculino , Cadeias de Markov , Pessoa de Meia-Idade , Modelos Econômicos , Quinolinas/economia , Quinolinas/uso terapêutico , Fatores de Risco , Rosuvastatina Cálcica/economia , Sinvastatina/economia , Sinvastatina/uso terapêutico , Espanha
12.
Expert Rev Pharmacoecon Outcomes Res ; 14(6): 889-99, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25213317

RESUMO

BACKGROUND: Cost-effectiveness analysis of MammaPrint(®) (70-gene signature) in the diagnosis of early breast cancer as a prognosis assay to study the risk of tumor recurrence to administer adjuvant chemotherapy. METHODS: Markov model assuming a cohort of 60-year-old women with breast cancer. Treatment costs and effects were assessed by comparing the 5-year, 10-year and lifetime risk of recurrence using Adjuvant! Online(®) (online algorithm), 70-gene signature or Oncotype DX(®) (21-gene assay). RESULTS: 70-gene signature showed a life expectancy of 23.55 years at lifetime. Life expectancy was lower for 21-gene assay and online algorithm, with associated quality-adjusted life year gains up to 0.23 and 0.75, respectively, with 70-gene signature. At year 5, the mean cost of 21-gene assay, 70-gene signature and online algorithm was €7100, €6380 and €4580, respectively. 70-gene signature was dominant versus 21-gene assay at any time horizon and would be cost-effective from year 7 versus online algorithm (lifetime: €1457 per quality-adjusted life years gained). CONCLUSIONS: 70-gene signature was a dominant strategy over 21-gene assay and was highly cost-effective versus online algorithm.


Assuntos
Biomarcadores Tumorais/genética , Neoplasias da Mama/economia , Neoplasias da Mama/genética , Perfilação da Expressão Gênica/economia , Testes Genéticos/economia , Custos de Cuidados de Saúde , Programas Nacionais de Saúde/economia , Medicina de Precisão/economia , Algoritmos , Antineoplásicos/economia , Antineoplásicos/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Quimioterapia Adjuvante/economia , Análise Custo-Benefício , Técnicas de Apoio para a Decisão , Custos de Medicamentos , Feminino , Predisposição Genética para Doença , Testes Genéticos/métodos , Humanos , Cadeias de Markov , Pessoa de Meia-Idade , Modelos Econômicos , Recidiva Local de Neoplasia , Fenótipo , Valor Preditivo dos Testes , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Medição de Risco , Fatores de Risco , Espanha , Fatores de Tempo , Resultado do Tratamento
13.
World J Urol ; 26(6): 637-42, 2008 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18594826

RESUMO

OBJECTIVES: Galectin-3 is a member of the glycoprotein family, actively involved in various biological interactions including cell growth, cell adhesion, cell differentiation and apoptosis. The aim of this study was to analyze the expression of galectin-3 in clear cell renal carcinoma and to assess its prognostic significance. METHODS: The expression of galectin-3 was analyzed by immunohistochemistry in 149 clear cell renal carcinomas. The levels were correlated to established clinical parameters such as nuclear grade, pathological stage, lymph node, distant metastasis, and patients' survival. RESULTS: In normal kidney tissue, the expression of galectin-3 was found to be uniformly present in the tubular epithelial cells. A decrease of antigen expression levels were significantly associated with higher T-stages (P < 0.02), unfavourable long-term prognosis in univariate Kaplan-Meier (P < 0.007) and multivariate Cox proportional hazard analyses (P < 0.04). Univariate analysis could demonstrate an association with tumor-specific death with decreased galectin-3 expression, whereas multivariate analysis failed to prove the aforementioned observation. CONCLUSION: Our results suggest that a loss of galectin-3 expression is involved in renal carcinogenesis.


Assuntos
Carcinoma de Células Renais/metabolismo , Carcinoma de Células Renais/mortalidade , Galectina 3/metabolismo , Neoplasias Renais/metabolismo , Neoplasias Renais/mortalidade , Biomarcadores Tumorais/metabolismo , Feminino , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Modelos de Riscos Proporcionais
14.
Med Clin (Barc) ; 120(2): 52-9, 2003 Jan 25.
Artigo em Espanhol | MEDLINE | ID: mdl-12570914

RESUMO

BACKGROUND AND OBJECTIVE: Our goal was to validate the Spanish version of the Brief Pain Inventory (BPI) questionnaire used to measure the intensity of oncological pain and its impact on activities of daily living in patients with cancer. PATIENTS AND METHOD: Patients with oncological pain were consecutively included in the study. These patients filled up the Spanish version of the BPI questionnaire (CBD) and the Rotterdam Symptom Checklist (RCSL) during the inclusion visit and again after 3-5 days (patients with clinically stable oncological pain) or after one month (patients with unstable oncological pain). RESULTS: 126 patients were assessed; 85.1% of them had suffered some episode of irruptive pain 24 hours prior to their inclusion in the study. 86.5% of patients fully completed the questionnaire. The CBD showed mild to moderate correlations with the patients perception of pain severity and with the presence of tumor dissemination. The <> dimension of the RCSL displayed the highest correlation with the dimensions of the BPI (<> and <>). The internal consistency and the test-retest reliability between dimensions were good (0.87 and 0.89) and low to moderate (0.53 and 0.77), respectively. The CBD questionnaire was found to be a tool capable of detecting changes in pain intensity. The changes observed in the two CBD dimensions between study visits fairly reflected the patients perceived changes in pain intensity. CONCLUSIONS: The Spanish version of BPI is valid for measuring the intensity of oncological pain and its impact on activities of daily living in conditions of usual clinical practice.


Assuntos
Idioma , Neoplasias/complicações , Medição da Dor/métodos , Dor/diagnóstico , Traduções , Atividades Cotidianas , Analgésicos/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/tratamento farmacológico , Serviço Hospitalar de Oncologia , Dor/tratamento farmacológico , Dor/etiologia , Clínicas de Dor , Cuidados Paliativos/métodos , Qualidade de Vida , Inquéritos e Questionários , Resultado do Tratamento
15.
Med. clín (Ed. impr.) ; 120(2): 52-59, ene. 2003. tab
Artigo em Es | IBECS | ID: ibc-16036

RESUMO

FUNDAMENTO Y OBJETIVO: Validar la versión española del cuestionario Brief Pain Inventory (BPI) para medir la intensidad del dolor de causa neoplásica y su impacto en las actividades de la vida diaria en pacientes con cáncer. PACIENTES Y MÉTODO: Se incluyó consecutivamente a pacientes con dolor de origen neoplásico. Los pacientes cumplimentaron los cuestionarios BPI (Cuestionario Breve del Dolor o CBD en español) y el Rotterdam Symptom Checklist (RSCL) en la visita de inclusión. El CBD se repitió a los 3-5 días en los pacientes clínicamente estables de su dolor de origen neoplásico y ambos cuestionarios se repitieron al mes en los pacientes no estables de su dolor. RESULTADOS: Se evaluó a 126 pacientes, el 85,1 per cent había sufrido algún episodio de dolor irruptivo en las 24 h previas al inicio del estudio. El 86,5 per cent de los pacientes completó el CBD en su totalidad. Las puntuaciones del CBD se correlacionaron con la percepción del paciente de la intensidad máxima del dolor y con la presencia de tumor diseminado. La dimensión 'síntomas psicológicos' del RSCL fue la que presentó mayor correlación con las dimensiones del CBD ('intensidad del dolor' e 'interferencia en las actividades'). La consistencia interna de las dimensiones fue buena (0,87 y 0,89), y la fiabilidad test-retest entre baja y moderada (0,53 y 0,77). El CBD ha demostrado ser un instrumento capaz de detectar cambios en el nivel de dolor. Los cambios observados en las dos dimensiones del CBD entre las dos visitas de estudio reflejan los cambios percibidos por el propio paciente en la intensidad del dolor. CONCLUSIONES: La versión española del CBD se mostró válida para medir la intensidad del dolor de causa neoplásica y su impacto en las actividades de la vida diaria, en condiciones de práctica clínica habitual (AU)


Assuntos
Adulto , Idoso , Feminino , Masculino , Pessoa de Meia-Idade , Humanos , Medição da Dor/métodos , Limiar da Dor/fisiologia , Neoplasias/fisiopatologia , Sintomas Psíquicos , Estudos Prospectivos , Serviço Hospitalar de Oncologia , Qualidade de Vida , Inquéritos e Questionários , Atividades Cotidianas , Limiar da Dor , Medição da Dor , Reprodutibilidade dos Testes , Neoplasias/complicações
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