RESUMO
BACKGROUND: The RENAAL (Reduction of Endpoints in Type 2 Diabetes with the Angiotensin II Antagonist Losartan) study demonstrated that treatment with losartan reduced the risk of ESRD by 29% among hypertensive patients with type 2 diabetes and diabetic nephropathy. The objective of this study was to project the effect of losartan compared to placebo on the lifetime incidence of ESRD and associated costs from a third-party payer perspective in Mexico. METHODS: A competing risks method was used to estimate lifetime incidence of ESRD, while accounting for the risk of death without ESRD. The cost associated with ESRD was estimated by combining the cumulative incidence of ESRD with the lifetime cost associated with ESRD. Total cost was estimated as the sum of the cost associated with ESRD from the three main public institutions in Mexico, the lifetime cost of losartan therapy, and other costs (non-ESRD/non-losartan) expected for patients with type 2 diabetes. Survival was estimated by weighting the life expectancies with and without ESRD by the cumulative risk of ESRD. RESULTS: The projected lifetime incidence of ESRD for losartan patients was lower (66%) compared with placebo patients (83%). This reduction in ESRD resulted in a decrease in ESRD-related cost of M dollar 49,737 per patient and a discounted gain of 0.697 life years per patient. After accounting for the cost of losartan and the additional cost associated with greater survival, we projected that treatment with losartan would result in a net savings of M dollar 24,073 per patient. CONCLUSION: Treatment with losartan in patients with type 2 diabetes and nephropathy not only reduced the within-trial incidence of ESRD but is projected to result in lifetime reductions in ESRD, increased survival, and overall cost savings to public institutions in Mexico.
Assuntos
Bloqueadores do Receptor Tipo 1 de Angiotensina II/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Nefropatias Diabéticas/complicações , Hipertensão/tratamento farmacológico , Falência Renal Crônica/prevenção & controle , Losartan/uso terapêutico , Adulto , Idoso , Bloqueadores do Receptor Tipo 1 de Angiotensina II/economia , Anti-Hipertensivos/economia , Efeitos Psicossociais da Doença , Análise Custo-Benefício , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/economia , Nefropatias Diabéticas/economia , Nefropatias Diabéticas/epidemiologia , Intervalo Livre de Doença , Método Duplo-Cego , Feminino , Seguimentos , Hospitais Públicos/estatística & dados numéricos , Humanos , Hipertensão/complicações , Incidência , Reembolso de Seguro de Saúde/estatística & dados numéricos , Falência Renal Crônica/economia , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/etiologia , Expectativa de Vida , Losartan/economia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Terapia de Substituição Renal/economia , Risco , Análise de SobrevidaRESUMO
Background. The RENAAL (Reduction of Endpoints in Type 2 Diabetes with the Angiotensin II Antagonist Losartan) study demonstrated that treatment with losartan reduced the risk of ESRD by 29% among hypertensive patients with type 2 diabetes and diabetic nephropathy. The objective of this study was to project the effect of losartan compared to placebo on the lifetime incidence of ESRD and associated costs from a third-party payer perspective in Mexico. Methods. A competing risks method was used to estimate lifetime incidence of ESRD, while accounting for the risk of death without ESRD. The cost associated with ESRD was estimated by combining the cumulative incidence of ESRD with the lifetime cost associated with ESRD. Total cost was estimated as the sum of the cost associated with ESRD from the three main public institutions in Mexico, the lifetime cost of losartan therapy, and other costs (non-ESRD/non-losartan) expected for patients with type 2 diabetes. Survival was estimated by weighting the life expectancies with and without ESRD by the cumulative risk of ESRD. Results. The projected lifetime incidence of ESRD for losartan patients was lower (66%) compared with placebo patients (83%). This reduction in ESRD resulted in a decrease in ESRD-related cost of M$49,737 per patient and a discounted gain of 0.697 life years per patient. After accounting for the cost of losartan and the additional cost associated with greater survival, we projected that treatment with losartan would result in a net savings of M$24,073 per patient. Conclusion. Treatment with losartan in patients with type 2 diabetes and nephropathy not only reduced the within-trial incidence of ESRD but is projected to result in lifetime reductions in ESRD, increased survival, and overall cost savings to public institutions in Mexico.
Antecedentes. El estudio RENAAL (Reducción de los grados o puntos terminales en la diabetes tipo 2 con losartan, el antagonista de la anglotenslna II) demostró que el tratamiento con losartan redujo el riesgo de la ESRD (enfermedad renal de la etapa terminal) en 29% entre pacientes hipertensos con diabetes tipo 2 y neuropatía diabética. El propósito estudiado fue hacer una proyección del efecto del losartan comparándolo con el placebo en la incidencia de por vida de la ESRD y con los costos asociados de un tercer pagador en perspectiva en México. Métodos. Se utilizó un método de riesgos muy competitivo para calcular la incidencia de por vida de la ESRD, al mismo tiempo que se calculaba el riesgo de muerte sin la ESRD. El costo asociado con la ESRD se calculó confirmando la incidencia acumulativa de la ESRD en relación con el costo de por vida de la terapia con losar-tan y otros costos (sin ESRD o sin losartan) con los que se contaba para pacientes con diabetes tipo 2. La supervivencia se calculó esperando las expectativas de vida con y sin ESRD por el riesgo acumulativo de ESRD. Resultados. La proyectada incidencia de por vida de la ESRD en cuanto a los pacientes con losartan fue más baja (66%) comparada con los pacientes que tomaron placebo (83%). Esta reducción de la ESRD tuvo por resultado una disminución en el costo relacionado con la ESRD de $49,737 por paciente y una ganancia descartada de 0.697 años de vida por paciente. Luego de contabilizar el costo del losartan y el costo añadido asociado con una mayor supervivencia, llegamos a la conclusión de que el tratamiento con losartan daría por resultado un ahorro neto de $24,073 por paciente. Conclusión. El tratamiento mediante losartan en pacientes aquejados de diabetes tipo 2 y neuropatía no sólo redujo la incidencia intraexperimental de la ESRD, sino que además nos ha servido para proyectar que resulte en reducciones de por vida en la ESRD, en una supervivencia incrementada y en un ahorro total de costos en cuanto a las instituciones públicas en nuestro país.
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Bloqueadores do Receptor Tipo 1 de Angiotensina II/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Nefropatias Diabéticas/complicações , Hipertensão/tratamento farmacológico , Falência Renal Crônica/prevenção & controle , Losartan/uso terapêutico , Bloqueadores do Receptor Tipo 1 de Angiotensina II/economia , Anti-Hipertensivos/economia , Efeitos Psicossociais da Doença , Análise Custo-Benefício , Intervalo Livre de Doença , Método Duplo-Cego , /complicações , /economia , Nefropatias Diabéticas/economia , Nefropatias Diabéticas/epidemiologia , Seguimentos , Hospitais Públicos/estatística & dados numéricos , Hipertensão/complicações , Incidência , Reembolso de Seguro de Saúde/estatística & dados numéricos , Falência Renal Crônica/economia , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/etiologia , Expectativa de Vida , Losartan/economia , México/epidemiologia , Estudos Multicêntricos como Assunto/estatística & dados numéricos , Risco , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Terapia de Substituição Renal/economia , Análise de SobrevidaRESUMO
An open-label study was undertaken at multiple centers in Mexico to assess the impact of treatment with etoricoxib - a selective cyclo-oxygenase-2 (COX-2) inhibitor - on quality of life (QoL) and pain relief among patients with osteoarthritis (OA), rheumatoid arthritis (RA) or chronic low-back pain (CLBP). The study involved 191 adult patients (aged > 18 years old) who had used non-selective non-steroidal antiinflammatory drugs (NSAIDs) for the treatment of OA, RA or CLBP during the month prior to study enrolment. After discontinuation of prior therapy, patients were treated with etoricoxib 60 mg for OA and CLBP,or 90 mg for RA once daily for 2 weeks. Patient and physician questionnaires were used to collect information about drug treatments, patients' QoL (Short Form-8 Health Survey [SF8] and EQ-5D VAS), patients' pain assessment, and physicians' and patients' satisfaction with treatment at baseline and at follow-up visits. Relative to prior NSAID use, etoricoxib use was associated with improvements in all SF-8 QoL domains and component scores as well as in measures of pain and physical functioning. Current pain was reduced from 59.1 mm (0-100mm VAS) at baseline to 27.1mm at follow-up and the physical component score of the SF-8 improved from 33.3 to 46.3 (on a scale from 0 to100). At follow-up, 91% of patients were satisfied with the pain control provided by etoricoxib compared with 34% who were satisfied with the pain control provided by previous NSAIDs. Among physicians, 93% reported satisfaction with the analgesic effect, 95% with the anti-inflammatory profile, and 82% with the side-effect profile of etoricoxib relative to pre-study NSAID treatment. During etoricoxib therapy, use of concomitant medications was reduced. The results of this study are limited due to the lack of a control group, the un-blinded design, and the small number of patients. Large naturalistic trials are needed to confirm the results.
Assuntos
Artrite Reumatoide/tratamento farmacológico , Inibidores de Ciclo-Oxigenase/uso terapêutico , Dor Lombar/tratamento farmacológico , Osteoartrite/tratamento farmacológico , Piridinas/uso terapêutico , Qualidade de Vida , Sulfonas/uso terapêutico , Administração Oral , Adulto , Etoricoxib , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Medição da Dor , Satisfação do Paciente , Projetos PilotoRESUMO
El presente libro recomienda una propuesta llamada Estrategia Nacional por la Calidad y la Eficiencia, como uno de los elementos de la reforma en materia de salud para mejorar la calidad de atención al público usuario, mediante la explicación de los siguientes puntos: I. Introducción II. Organizaciones de servicio a humanos como organizaciones complejas III. La esencia del desempeño: calidad y eficiencia. Conceptos y relaciones IV. Lo que se sabe de la calidad de la atención en México V. Dirección, diseño y desarrollo organizacionales: factores inductores de alto desempeño VI. Estrategia Nacional por la Calidad y la Eficiencia VII. Estrategias de articulación VIII. Estrategias de implantación y reforzamiento