RESUMEN
The demonstration of the link between certain genetic variations and drug response has allowed the emergence of pharmacogenetics, which offers many opportunities to improve patient care. Type-2 diabetes mellitus is a disease for which several gene polymorphisms have been reported to be associated with drug response. Sulfonylureas are commonly used for the management of this disease. Genetic polymorphisms of CYP2C9, the main enzyme involved in the metabolism of sulfonylureas, have been associated with the risk of severe hypoglycaemia, particularly in poor metabolizers carrying CYP2C9 *3/*3 genotype, and especially in the case of patients treated with glimepiride. The objectives of the present study were to evaluate the potential clinical and economic outcomes of using CYP2C9 genotype data to guide the management of SU regimen in patients initiating glimepiride therapy, and to identify factors affecting the cost-effectiveness of this treatment scheme. The analysis was conducted using a decision tree, considering a 1-year time horizon, and taking as perspective that of the French national health insurance system. With pharmacogenetic-guided therapy, the cost to avoid an episode of severe hypoglycaemia event per 100 000 patients treated was 421 834. Genotyping cost was the most influential factor on the incremental cost-effectiveness ratio. In conclusion, the potential cost of CYP2C9 genotype-guided dosing for glimepiride therapy is relatively high, and associated with modest improvements with respect to the number of hypoglycaemia avoided, as compared with standard dosing. Additional economic studies are required to better specify the usefulness of CYP2C9 genotyping prior to glimepiride regimen initiation.
Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Hipoglucemiantes/uso terapéutico , Compuestos de Sulfonilurea/uso terapéutico , Análisis Costo-Beneficio , Citocromo P-450 CYP2C9/genética , Diabetes Mellitus Tipo 2/economía , Diabetes Mellitus Tipo 2/genética , Técnicas de Genotipaje/economía , Técnicas de Genotipaje/métodos , Costos de la Atención en Salud , Humanos , Hipoglucemiantes/economía , Polimorfismo Genético , Compuestos de Sulfonilurea/economía , Resultado del TratamientoAsunto(s)
Insuficiencia Suprarrenal/inducido químicamente , Betula , Suplementos Dietéticos/efectos adversos , Preparaciones de Plantas/efectos adversos , Etiquetado de Medicamentos , Femenino , Humanos , Hiponatremia/sangre , Hiponatremia/inducido químicamente , Persona de Mediana Edad , Intoxicación por Agua/etiologíaRESUMEN
Vaccination has been identified many decades ago as an effective means to prevent several diseases. However, in France, there is an emergence of vaccine hesitancy, that has caused a reduction of vaccination coverage rates. This issue reduces the effectiveness of the immunization process, and represents a real threat to public health that should be urgently addressed. The purpose of this review is to present actions that have been taken to fight against vaccine hesitancy and thus enhance vaccine uptake. The results indicate that different strategies have been proposed to reach this goal, mainly by vaccination campaigns. These findings highlight the strong implication of national health authorities and the medical staff of hospitals and health-care centers. However, actions implemented should be part of a long-term approach, and further studies are required to identify the most effective strategies to address vaccine hesitancy.
