RESUMO
OBJECTIVE: To compare quality of life, in patients living with HIV infection with pharmaceutical care according to the CMO methodology: capacity, motivation and opportunity versus conventional follow-up. METHODS: Longitudinal, prospective, multicenter, health intervention study, conducted between October 2019 and November 2021 in 14 centers throughout Spain. Patients over 18 years of age, receiving antiretroviral treatment and attending the consultations of the participating Pharmacy Services for 1 year were included. Patients who did not have the autonomy to complete the planned questionnaires were excluded. At baseline, participating centers were randomized to continue using the same systematics of work (traditional follow-up) or to implement the CMO model using patient stratification models, goal setting in relation to pharmacotherapy, use of motivational interviewing, as well as longitudinal follow-up enabled by new technologies. The main variable was the difference in the number of dimensions positively affected in each follow-up arm at 24 weeks of follow-up according to the MOS-HIV questionnaire. In the CMO group, the interventions performed the most frequently were recorded. RESULTS: 151 patients were included. The median age was 51.35 years. A significant improvement in quality of life was found at the end of follow-up in the CMO group, reducing the number of patients with negatively affected dimensions (2/11 vs 8/11). The most frequent interventions carried out in the CMO group, according to the taxonomy, were Motivation (51,7%) and review and validation (49,4%). CONCLUSIONS: The quality of life of patients is higher in those centers that develop Pharmaceutical Care based on the CMO methodology compared to traditional follow-up.
Assuntos
Infecções por HIV , Assistência Farmacêutica , Humanos , Adolescente , Adulto , Pessoa de Meia-Idade , Infecções por HIV/tratamento farmacológico , Seguimentos , Qualidade de Vida , Estudos ProspectivosRESUMO
OBJECTIVE: To assess the cost-effectiveness relationship of Ticagrelor versus Clopidogrel for the management of acute coronary syndrome in Spain. METHODS: The data from the PLATO study were used for the calculation of the events rate and health-related quality of life for Ticagrelor and Clopidogrel for the first 12 months, whereas the costs were obtained from Spanish sources. Quality of life-adjusted survival and costs were estimated according to the fact that the patients did not suffer any thrombotic event (myocardial infarction or ictus) or this one was not fatal. The lifetime cots, life years gained, and the quality of life-adjusted survival were estimated for both treatment arms. Incremental cost-effectiveness ratios were assessed through the perspective of the Spanish healthcare system for 2013, by using a macro-costs strategy based on published literature and the survival tables for the Spanish population. RESULTS: Treatment with Ticagrelor was associated to an incremental cost of 1,228 Euros per year, an increase in 0.1652 life years gained, and 0.1365 years adjusted by quality of life, as compared to Clopidogrel. The cost for one quality of life-adjusted life year was 8,997 Euros and the cost per one gained life year of 7,435 ï. The sensitivity analysis showed consistent results. CONCLUSIONS: Treatment of acute coronary syndrome for 12 months with Ticagrelor was associated with a cost per 1 life year of quality of life-adjusted cost below the cost-effectiveness limits generally accepted in Spain.
OBJETIVO: Evaluar la relación coste-efectividad de ticagrelor frente a clopidogrel en el tratamiento del síndrome coronario agudo en España. MÉTODOS: Para el cálculo de la tasa de eventos y la calidad de vida relacionada con la salud para ticagrelor y clopidogrel durante los doce primeros meses se utilizaron los datos del estudio PLATO, mientras que los costes se obtuvieron de fuentes españolas. La supervivencia ajustada por calidad de vida y los costes se estimaron en función de que los pacientes no sufrieran ningún evento trombótico (infarto de miocardio o ictus) o éste fuese no mortal. El coste a lo largo de toda la vida, los años de vida ganados y la supervivencia por calidad de vida se estimaron para ambos brazos de tratamiento. Los ratios de coste-efectividad incremental se presentaron desde la perspectiva del sistema sanitario español en 2013, empleando una estrategia de macrocostes basada en la bibliografía publicada y utilizando las tablas de supervivencia de la población española. RESULTADOS: El tratamiento con ticagrelor se asoció con un coste incremental de 1.228 ïï anuales, un aumento de 0,1652 años de vida ganados y 0,1365 años de vida ajustados por calidad comparado con clopidogrel. Se obtuvo un coste por año de vida ajustado por calidad de 8.997ïï y un coste por año de vida ganado de 7.435 ï. El análisis de sensibilidad mostró resultados consistentes. CONCLUSIONES: El tratamiento durante 12 meses del síndrome coronario agudo con ticagrelor se asoció a un coste por año de vida ajustado por calidad por debajo de los límites de costeefectividad generalmente aceptados en España.