Budget impact analysis of venetoclax for the management of acute myeloid leukemia from the perspective of the social security and the private sector in Argentina.

OBJECTIVE: This study aimed to estimate the budget impact of the incorporation of venetoclax for the treatment of patients with Acute Myeloid Leukemia (AML) over 75 years of age or those with comorbidities and contraindications for the use of intensive chemotherapy, from the perspective of the social security and the private third-party payers in Argentina. METHODS: A budget impact model was adapted to estimate the cost difference between the current scenario (azacitidine, decitabine and low doses of cytarabine) and the new scenario (incorporation of venetoclax) for a third-party payer over a time horizon of three years. Input parameters were obtained from a literature review, validated or complemented by expert opinion using a modified Panel Delphi approach. All direct medical costs were estimated by the micro-costing approach and were expressed in US dollars (USD) as of September 2020 (1 USD = 76.18 Argentine pesos). RESULTS: For a third-party payer with a cohort of 1,000,000 individuals covered, incorporating venetoclax was associated with an average budget impact per-member per-month (PMPM) of $0.11 USD for the social security sector and $0.07 USD for the private sector. The duration of treatment with venetoclax was the most influential parameter in the budget impact results. CONCLUSION: The introduction of venetoclax was associated with a positive and slight budget impact. These findings are informative to support policy decisions aimed to expand the current treatment landscape of AML.

Impacto presupuestario de upadacitinib en pacientes con artritis reumatoide moderada a severa en Argentina / Budget impact of upadacitinib in patients with moderate to severe rheumatoid arthritis in Argentina

OBJETIVOS. Analizar el impacto presupuestario de upadacitinib (UPA) 15 mg + metotrexato (MTX) para el tratamiento de la artritis reumatoide (AR) moderada a grave en pacientes con respuesta inadecuada a los fármacos antirreumáticos modificadores de la enfermedad convencionales (RI-DMARc) desde la perspectiva de la seguridad social y los sectores de salud privados en Argentina. MATERIALES Y METODOS. Se desarrolló un modelo de análisis de impacto presupuestario para una cohorte hipotética de 100,000 adultos con cobertura de seguro de salud que fueron diagnosticados con AR en un horizonte de tiempo de 5 años. Los parámetros del modelo se obtuvieron a través de una revisión de la literatura y se validaron con expertos locales. Los costos se expresan en dólares estadounidenses (USD) para el 2024. RESULTADOS. La introducción de UPA 15 mg + MTX para el tratamiento de AR moderada a grave y RI-DMARc resultó en un costo incremental mínimo, con un costo acumulado total a cinco años de USD 1.855 para la seguridad social y USD 1.812 para el sector privado de salud, lo que representa aproximadamente el 2% del presupuesto total. El costo de adquisición de UPA fue la variable más influyente en el análisis de sensibilidad. CONCLUSIONES.La introducción de UPA 15 mg + MTX para el tratamiento de AR genera un incremento de costos marginal para el sistema de salud en Argentina, lo cual es especialmente importante en contextos de presupuestos limitados. Proporcionar estimaciones basadas en la evidencia es una herramienta valiosa para ayudar a tomar decisiones informadas sobre la asignación eficiente de recursos en salud.

A multifactorial study on nutritional status, binge eating and physical activity as main factors directly influencing body weight in Parkinson's disease.

Weight lossisa multifactorial disorder commonly affecting Parkinson's disease patients. The aim of this study was to investigate the relationship between body weight, nutritional status, physical activity, and Parkinson's disease-related factors. A total of 114 consecutive Parkinson's disease patients without dietary restrictions were evaluated prospectively with respect to: nutritional status (Mini Nutritional Assessment), physical activity level (Yale Physical Activity Survey), MDS-UPDRS score, olfactory function, depression, cognitive functionand impulse-control disorders, among other variables. Structural equation modeling was used to build multivariate models and to calculate standardized regression weights (srw) for pairs of variables, which are homologous to correlation coefficients, taking into account the effects of all other variables in the model. Sixty (53%) patients were males. Mean age was 66.1 ± 9.8 years and mean disease duration was 8.3 ± 5.6 years. Longer disease duration was negatively related to nutritional status (srw = -0.25; p = 0.01). UPDRS II + III score was associated with reduced cognitive function (srw = -0.39; p = 0.01), which was positivelyrelated to nutritional status (srw = 0.23; p = 0.01). Finally, nutritional status was positively related to body weight (srw = 0.22, p < 0.01). Binge eating and physical activity were also directly and positively related to body weight (srw = 0.32; p = 0.001 and srw = 0.23; p = 0.001). Nutritional status, binge eating and physical activity were directly and independently related to body weight in our sample of Parkinson's disease patients. Therefore, physicians should actively explore nutritional status and binge eating in Parkinson's disease patients to avoid alterations in body weight regulation. Effects of physical activity should be further explored.