Análisis de coste-efectividad en el tratamiento farmacológico del síndrome de fibromialgia en México / Cost-effectiveness analysis of pharmacologic treatment of fibromyalgia in Mexico

Objetivo. Identificar desde la perspectiva del proveedor de servicios de salud pública en México el tratamiento más coste-efectivo para pacientes con síndrome de fibromialgia (SFM). Material y métodos. Mediante un modelo de Markov con 3 estados de salud, definidos por la intensidad del dolor (ausencia o presencia de dolor leve; moderado o severo), en ciclos de 3 meses, se estimaron los costes y las efectividades de amitriptilina (50mg/día), fluoxetina (80mg/día), duloxetina (120mg/día), gabapentina (900mg/día), pregabalina (450mg/día), tramadol/acetaminofén (150mg/1300mg/día) y amitriptilina/fluoxetina (50mg/80mg/día) en el tratamiento del SFM. El resultado clínico de interés fue el porcentaje de control del dolor al año de tratamiento. Las probabilidades asignadas al modelo se obtuvieron de la literatura publicada. Los costes médicos directos del tratamiento SFM se calcularon a través bases de datos del Instituto Mexicano del Seguro Social (IMSS) en 2006 y se expresaron en pesos mexicanos de 2010. El análisis de sensibilidad fue probabilístico. Resultados. El mejor control del dolor se obtiene con el uso de pregabalina (44,8%), seguido de gabapentina (38,1%) y duloxetina (34,2%). El tratamiento con menor coste, fue con amitriptilina ($ 9.047,01), seguido de fluoxetina ($ 10.183,89) y amitriptilina/fluoxetina ($ 10.866,01). Al comparar pregabalina vs amitriptilina, el coste anual adicional por paciente con control del dolor se encuentra entre $ 50.000 y $ 75.000 y resulta ser coste-efectivo entre el 70 y el 80% de los casos. Conclusiones. Entre las alternativas de tratamiento para el SFM, pregabalina alcanza el mejor control del dolor y es coste-efectiva hasta en el 80% de los pacientes del sistema de salud público en México (AU)

Objective. To identify, from the Mexican Public Health System perspective, which would be the most cost-effective treatment for patients with Fibromyalgia (FM). Material and methods. A Markov model including three health states, divided by pain intensity (absence or presence of mild, moderate or severe pain) and considering three-month cycles; costs and effectiveness were estimated for amitriptyline (50mg/day), fluoxetine (80mg/day), duloxetine (120mg/day), gabapentin (900mg/day), pregabalin (450mg/day), tramadol/acetaminophen (150mg/1300mg/día) and amitriptyline/fluoxetine (50mg/80mg/día) for the treatment of FM. The clinical outcome considered was the annual rate of pain control. Probabilities assigned to the model were collected from published literature. Direct medical costs for FM treatment were retrieved from the 2006 data of the Mexican Institute of Social Security (IMSS) databases and were expressed in 2010 Mexican Pesos. Probabilistic Sensitivity Analyses were conducted. Results. The best pain control rate was obtained with pregabalin (44.8%), followed by gabapentin (38.1%) and duloxetine (34.2%). The lowest treatment costs was for amitriptyline ($ 9047.01), followed by fluoxetine ($ 10,183.89) and amitriptyline/fluoxetine ($ 10,866.01). By comparing pregabalin vs amitriptyline, additional annual cost per patient for pain control would be around $ 50.000 and $ 75.000 and would result cost-effective in 70% and 80% of all cases. Conclusions. Among all treatment options for FM, pregabalin achieved the highest pain control and was cost-effective in 80% of patients of the Mexican Public Health System (AU)

Cost-effectiveness analysis of pharmacologic treatment of fibromyalgia in Mexico.

OBJECTIVE: To identify, from the Mexican Public Health System perspective, which would be the most cost-effective treatment for patients with Fibromyalgia (FM). MATERIAL AND METHODS: A Markov model including three health states, divided by pain intensity (absence or presence of mild, moderate or severe pain) and considering three-month cycles; costs and effectiveness were estimated for amitriptyline (50mg/day), fluoxetine (80 mg/day), duloxetine (120 mg/day), gabapentin (900 mg/day), pregabalin (450 mg/day), tramadol/acetaminophen (150 mg/1300 mg/día) and amitriptyline/fluoxetine (50mg/80 mg/día) for the treatment of FM. The clinical outcome considered was the annual rate of pain control. Probabilities assigned to the model were collected from published literature. Direct medical costs for FM treatment were retrieved from the 2006 data of the Mexican Institute of Social Security (IMSS) databases and were expressed in 2010 Mexican Pesos. Probabilistic Sensitivity Analyses were conducted. RESULTS: The best pain control rate was obtained with pregabalin (44.8%), followed by gabapentin (38.1%) and duloxetine (34.2%). The lowest treatment costs was for amitriptyline ($ 9047.01), followed by fluoxetine ($ 10,183.89) and amitriptyline/fluoxetine ($ 10,866.01). By comparing pregabalin vs amitriptyline, additional annual cost per patient for pain control would be around $ 50.000 and $ 75.000 and would result cost-effective in 70% and 80% of all cases. CONCLUSIONS: Among all treatment options for FM, pregabalin achieved the highest pain control and was cost-effective in 80% of patients of the Mexican Public Health System.

[Economic analysis of dalteparin use in knee surgery at Instituto Mexicano del Seguro Social]. / Análisis económico de dalteparina en la indicacióncirugía de rodilla en el Instituto Mexicano del Seguro Social.

BACKGROUND: Knee surgery is a risk factor for thromboembolic disease. Prophylaxis reduces the risk of this condition. METHODS: Economic and health consequences of drugs preventing and treating thromboembolic disease in patients undergoing knee surgery from the institutional perspective (time horizon: 1 year) were estimated. The measures of effectiveness were: reduction in the number of cases (per 1,000 patients) of deep vein thrombosis, pulmonary embolism, hospital admissions and deaths. Transition probabilities were estimated by meta-analysis. The alternatives were: warfarin (reference), dalteparin, enoxaparin, nadroparin, unfractionated heparin + warfarin, and non-prophylaxis. Data on resources use and costs corresponds to the Instituto Mexicano del Seguro Social (IMSS). Acceptability curves were constructed. RESULTS: No prophylaxis implied three times higher cost ($18,835.10 versus $5,967.10) and less effectiveness in comparison with warfarin. The incremental cost-effectiveness ratios for enoxaparin were $3, $13, $17 and $3 per each additional case of deep vein thrombosis, pulmonary embolism, death and hospital admission avoided. Results of nadroparin and unfractionated heparin were inferior to warfarin (59.1% and 72.9% more costly and less effective in three measures of effectiveness, respectively). Dalteparin showed higher health outcomes and lower cost compared with warfarin (-20.6%). Dalteparin had a higher probability of being cost-effective than enoxaparin. DISCUSSION: thromboprophylaxis is a clinically and economically favorable alternative. The identification of a pharmacoeconomic profile of alternatives to perform it becomes relevant given the increasing pressure on institutional budgets. CONCLUSIONS: Dalteparin would be a cost-saving alternative in thromboprophylaxis of patients undergoing knee surgery at IMSS.

Artesia tricuspidea: curso clínico en 120 niños / Tricuspid atresia: clinical course in 120 children

De 120 niños con Atresia tricuspídea (AT) atendidos en el Hospital de Cardiología y Neumología "Dr. Luis Méndes" del Centro Médico Nacional fueron 61 masculinos y 59 femeninos. La edad al diagnóstico fue 79 recién nacidos, diecisiete de uno a seis meses, 20 de seis a 24 meses y cuatro mayores de dos años. La presentación clínica en 89% fue mediante crisis de hipoxia, fundamentalmente los de menor edad y resto con unsuficiencia cardiaca. El estudio radiológico mostró cardiomegalia en el 85%, con flujo pulmonar disminuido en 48%, aumentado en 27.5% y normal en 9%. El electrocardiograma con eje eléctrico desviado a la extrema izquierda en 94%, con crecimiento de aurícula derecha en 58%, de aurícula izquierda en 47.5% y de ventrículo izquierdo en 96%. El tipo I se observó en 103 niños, de la variedad Ic en 70, Ib en 27 y Ia en seis. El tipo II se presentó en diecisiete niños, con ocho IIc, seis IIb ytres IIa. El manejo fue médico en 44, mientras que se efectuó fístula sistémico-pulmonar en 63, con anastomosis de Blalock-Taussig en 37. Se practicó operación de Fontan en trece niños. Hubo 21 fallecimientos. Se compara la casuística con la de la literatura y se hacen recomendaciones de manejo

Taquicardia ventricular helicoidal inducida por amitriptilina: presentación de un caso / Helicoid ventricular tachycardia induced by amytriptilini: report of a case

Se presenta el caso de una paciente atendida en el Servicio de psiquiatría por melancolía involutiva que fué tratada con amitriptilina a dosis terapeúticas, y quien manifestó clínicamente crisis de Stokes-Adams y electrocardiográficamente síndrome de QT prolongado y taquicardia ventricular helicoidad (TVH). Se consideró como factor desencadenante de ésta arritmia la asociación de antidepresivos tricíclicos así como hipokalemia. Considerada la probable dispersión del período refractario como la causa fundamental de la arritmia, la paciente fue tratada con isoproterenol intravenoso, lográndose reversión inmediata de dicha arritmia ventricular (torsade de pointes) y temprana de la prolongación del QT