Cost-Utility of Gastric Bypass Surgery Compared to Clinical Treatment for Severely Obese With and Without Diabetes in the Perspective of the Brazilian Public Health System.

PURPOSE: Obesity is associated with increased morbidity and mortality. Weight loss due to gastric bypass (GBP) surgery improves clinical outcomes and may be a cost-effective intervention. To estimate the cost-effectiveness of GBP compared to clinical treatment in severely obese individuals with and without diabetes in the perspective of the Brazilian public health system. MATERIALS AND METHODS: A Markov model was developed to compare costs and outcomes of gastric bypass in an open approach to clinical treatment. Health states were living with diabetes, remission of diabetes, non-fatal and fatal myocardial infarction, and death. We also included the occurrence of complications related to surgery and plastic surgery after the gastric bypass surgery. The direct costs were obtained from primary data collection performed in three public reference centers for obesity treatment. Utility values also derived from this cohort, while transition probabilities came from the international literature. A sensitivity analysis was performed to evaluate uncertainties. The model considered a 10-year time horizon and a 5% discount rate. RESULTS: Over 10 years, GBP increased quality-adjusted life years (QALY) and costs compared to clinical treatment, resulting in an incremental cost-effectiveness ratio (ICER) of Int$1820.17/QALY and Int$1937.73/QALY in individuals with and without diabetes, respectively. Sensitivity analysis showed that utility values and direct costs of treatments were the parameters that affected the most the ICERs. CONCLUSION: The study demonstrated that GBP is a cost-effective intervention for severely obese individuals in the Brazilian public health system perspective, with a better result in individuals with diabetes.

Estudo prospectivo não-randomizado e multicêntrico comparando stents farmacológicos com stents convencionais em pacientes multiarteriais / Prospective non-randomized multicenter study comparing pharmacological stents with conventional stents in multi-arterial patients

Fundamentos: A angioplastia em multiarteriais é segura no tratamento das coronariopatias. Objetivo: Comparar stents farmacológicos (SF) e convencionais (SC) em pacientes multiarteriais. Método: Avaliação prospectiva: 109 pacientes, outubro/2002 a setembro/2005: 72 do grupo SF e 37 do grupo SC. Desfechos: óbito, reestenose clínica e a combinação de ambos. Resultados: Seguimento: 24,6 maior ou menor que 9,5 meses. Havia 52 (72,2 por cento) homens no SF e 24 (64,9 por cento) no SC. Idade média: 66,2 maior ou menor que 10,5 (42 a 90) anos.Comorbidades foram mais presentes no SF...

Estudo prospectivo da angioplastia percutânea com stents farmacológicos em pacientes diabéticos / Prospective study of percutaneous angioplasty with pharmacological stents in diabetic patients

Objetivo: Avaliar os resultados tardios da angioplastia com os stents farmacológicos (SF) Paclitaxel (Taxus) e Rapamicina (Cypher) em pacientes diabéticos. Métodos: Estudo prospectivo de amostra não-selecionada de pacientes consecutivos, compreendendo 107 indivíduos tratados eletivamente por angioplastia com SF, no período de maio de 2003 a dezembro de 2005. Em 74 pacientes (70,5 por cento) foi utilizado stent Taxus, e em 31 (29,5 por cento), Cypher. Os desfechos no período foram: óbito, restenose, revascularização da lesão-alvo (RLA) e do vaso-alvo (RVA). Resultados: A idade média dos pacientes foi de 65,3 mais ou menos 9,5 amos (46-86 anos), sendo 63,8 por cento homens (IC 95 por cento igual 53,8 por cento a 72,8 por cento). O seguimento foi de 24,9 mais ou menos 9,0 meses (12,-54,6 meses). Os fatores de risco...