Consumption trends for specific drugs used to treat dementia in the region of Madrid (Spain) from 2002 to 2012.

INTRODUCTION: Analysing drug consumption in large population groups lets us observe consumption trends and compare them between different settings. OBJECTIVE: to analyse the time trends for consumption and costs of specific drugs used to treat dementia in the region of Madrid (Spain) and compare trends by sex and age cohort. METHODS: Descriptive study of cholinesterase inhibitors (N06DA) and memantine (N06DX01) dispensed in Madrid between 2002 and 2012 and covered by the Spain's national health system. Consumption was calculated by analysing changes in DDD (defined daily doses) to find total and yearly increases. The cost was estimated based on DDD price. To compare consumption rates by age and sex, we calculated DDD per 100 inhabitants/day. RESULTS: Between 2002 and 2012, consumption of drugs used to treat dementia increased sixfold. During this period, cholinesterase inhibitors accounted for 76.70% of the drugs consumed and memantine, 23.30%. The estimated cost rose by a by a factor of 5.7 over 11 years (or by a factor of 4 taking into account the use of generic drugs). In 2012, 2.42% of the patients aged 65 or over consumed cholinesterase inhibitors (women 2.82%, men 1.83%) and 0.90% consumed memantine (women 1.10%, men 0.61%). Consumption increased in age cohorts up to 86 to 90 (5.84% for cholinesterase inhibitors and 2.33% for memantine) and declined thereafter. CONCLUSIONS: Consumption of cholinesterase inhibitors and memantine gradually increased, but consumption in 2012 did not reach levels equivalent to dementia prevalence figures. Pharmaceutical expenditure restraint measures may temporarily slow the cost increase temporarily but if the same trend of consumption persists, costs will rise.

[Cost-effectiveness analysis of the treatment of moderate benign prostatic hyperplasia]. / Análisis coste-efectividad del tratamiento de la hiperplasia prostática benigna de grado moderado.

OBJECTIVES: To estimate the most cost-effective alternative of treatment of moderate benign prostatic hyperplasia and to learn whether the outcome can be varied by changing the cost or effectiveness of the alternatives. DESIGN: The study is made by a decision tree in order to test the cost-effectiveness (CE) rate of three treatment strategies: a) watchful waiting; if there is no response a drug is administered and if there is no response transurethral resection of the prostate (TURP) is done, b) pharmacological treatment, and if there is no response TURP is done, and c) to apply TURP initially. The treatment is simulated taking 1000 patients with MBPH and testing the outcome of events and probabilities in a two-year treatment and from the point of view of the health system as services supplier. MEASUREMENTS AND RESULTS: Effectiveness is obtained from an american experts' consensus. Only the direct fangible costs are taken into account, in constant 1998 pts. An univariant simple sensitivity analysis is made considering the cost variables of TURP and from the drugs in an acceptable range of +/- 20%, and the effectiveness of the watchful waiting and the pharmacological treatment. The lower cost alternative per improved patient (IP) is the watchful waiting (77,069 pts./IP) followed by the drug treatment (118,656 pts./IP) and lastly the TURP (456,642 pts./IP). Variations in the variable values make no difference in the relative positions of the tested alternatives. CONCLUSIONS: From the pharmacoeconomics point of view the MBPH treatment must be iniciated by watchful waiting, proceeding to drug administration only if there is a positive response and to make use of TURP when the pharmacological procedures have not been effective.

Análisis coste-efectividad del tratamiento de la hiperplasia prostática benigna de grado moderado / Cost-effectiveness analysis of the treatment of moderate benign prostatic hyperplasia

Objetivos. Determinar la alternativa más coste-efectiva del tratamiento de la hiperplasia prostática benigna de grado moderado (HPB-GM) y conocer si las conclusiones pueden modificarse al variar el coste o efectividad de las estrategias de tratamiento. Diseño. El estudio se modeliza mediante un árbol de decisión para examinar el ratio coste-efectividad de 3 estrategias de tratamiento: a) espera vigilada, y si no hay respuesta se administra un fármaco; si tampoco hay respuesta, se procede a resección transuretral de próstata (RUTP); b) tratamiento farmacológico, y si no hay respuesta se realiza RTUP, o c) aplicar inicialmente RTUP. Se simula el tratamiento de 1.000 pacientes con HPB-GM y su trayectoria de episodios y probabilidades a lo largo de 2 años de tratamiento y desde el punto de vista del sistema sanitario como financiador de servicios. Mediciones y resultados. Los datos de efectividad se obtienen a partir de un consenso americano de expertos. Se consideran únicamente los costes tangibles directos derivados del tratamiento, en pesetas constantes de 1998. Se realiza un análisis de sensibilidad simple univariante considerando las variables de costes de la RTUP y de los fármacos en un rango aceptable de ñ 20 por ciento, y la eficacia de la espera vigilada y del tratamiento farmacológico según los valores incluidos en su intervalo de confianza del 90 por ciento. La alternativa con un menor coste por paciente mejorado (PM) es la espera vigilada (77.069 pts./PM) seguido del tratamiento con fármacos (118.656 pts./PM) y, por último, de la RTUP (456.642 pts./PM). Variaciones en los valores de las variables no hacen modificar las posiciones relativas de las estrategias de tratamiento evaluadas. Conclusiones. Desde el punto de vista farmacoeconómico, el tratamiento de la HPB-GM debe iniciarse con espera vigilada, procediendo a administrar fármacos sólo si no hay respuesta positiva y recurrir a RTUP cuando los procedimientos farmacológicos no hayan resultado efectivos (AU)