ABSTRACT
Las directrices sobre el tratamiento de la hipercolesterolemia identifican la reducción del colesterol unido a lipoproteínas de baja densidad (colesterol LDL) como el principal objetivo terapéutico y han puesto de manifiesto la necesidad de utilizar estatinas para conseguirlo. Existen seis estatinas con cuatro dosis distintas y con diferentes potencias reductoras de colesterol LDL. Al añadir ezetimiba, existen 48 posibilidades terapéuticas. Esta extensa oferta farmacéutica facilita el tratamiento, pero dificulta elegir la estatina más coste-efectiva porque es muy difícil recordar todas las potencias y costes de las opciones terapéuticas. En este artículo se ofrece un método para priorizar la mejor opción hipolipidemiante coste-efectiva, y selecciona la estatina más económica que consigue el objetivo terapéutico deseado de colesterol LDL (AU)
Current guidelines for the management of hypercholesterolemia identify LDL cholesterol (LDL-c) reduction as the primary therapeutic target and have highlighted the need to use statins to achieve it. There are six statins with four different doses and with different power-reducing LDL-c. By adding ezetimibe, there are 48 therapeutic possibilities. This extensive offer provides pharmaceutical treatment, but it is difficult to choose the most cost-effective statin because it is very difficult to remember all the powers and costs of treatment options. This paper offers a method to prioritize the best cost-effective lipid lowering, and chooses the cheapest statin that achieves the desired therapeutic goal of LDL-c (AU)
Subject(s)
Humans , Economics, Pharmaceutical/trends , Hypercholesterolemia/drug therapy , Hydroxymethylglutaryl-CoA Reductase Inhibitors/pharmacokinetics , Biomedical Enhancement/methods , Anticholesteremic Agents/pharmacokinetics , 50303ABSTRACT
Current guidelines for the management of hypercholesterolemia identify LDL cholesterol (LDL-c) reduction as the primary therapeutic target and have highlighted the need to use statins to achieve it. There are six statins with four different doses and with different power-reducing LDL-c. By adding ezetimibe, there are 48 therapeutic possibilities. This extensive offer provides pharmaceutical treatment, but it is difficult to choose the most cost-effective statin because it is very difficult to remember all the powers and costs of treatment options. This paper offers a method to prioritize the best cost-effective lipid lowering, and chooses the cheapest statin that achieves the desired therapeutic goal of LDL-c.
Subject(s)
Hydroxymethylglutaryl-CoA Reductase Inhibitors/economics , Hypercholesterolemia/economics , Atorvastatin , Cholesterol, LDL/blood , Cost-Benefit Analysis , Fatty Acids, Monounsaturated/economics , Fatty Acids, Monounsaturated/therapeutic use , Fluorobenzenes/economics , Fluorobenzenes/therapeutic use , Fluvastatin , Goals , Heptanoic Acids/economics , Heptanoic Acids/therapeutic use , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Hypercholesterolemia/blood , Hypercholesterolemia/drug therapy , Indoles/economics , Indoles/therapeutic use , Lovastatin/economics , Lovastatin/therapeutic use , Practice Guidelines as Topic , Pravastatin/economics , Pravastatin/therapeutic use , Pyrimidines/economics , Pyrimidines/therapeutic use , Pyrroles/economics , Pyrroles/therapeutic use , Rosuvastatin Calcium , Simvastatin/economics , Simvastatin/therapeutic use , Spain , Sulfonamides/economics , Sulfonamides/therapeutic useABSTRACT
BACKGROUND AND OBJECTIVE: The Helicobacter pylori eradication in patients with functional dyspepsia has been the subject of controversy because trials come to contradictory conclusions. The objective of this trial was to evaluate the effect, compared with placebo, of the eradication treatment in patients with functional dyspepsia. PATIENTS AND METHOD: Randomized double blind placebo controlled trial. We included 158 patients attended by family physicians (Area 10 Primary Care, Health Institute of Madrid) with functional dyspepsia and Helicobacter pylori infection detected by the ureasa test in endoscopy. An OCA (ameprazole clarithromycin and amoxicillin group (n = 79) and a placebo group (n = 79) were randomized. During 7 days, patients at the OCA group received omeprazole (20 mg bid), clarithromycin (500 mg bid) and amoxicillin (1000 mg bid) daily, and patients at the control group received the placebo agent twice daily. Dyspepsia improvement according to a Likert scale (5 steps), and eradication of H. pylori by 13C-urea breath test were evaluated during one year. RESULTS: Both groups were homogeneous in relation to age, sex and dyspepsia degree. The average age (standard deviation) of studied patients was 41.99 (13.93) years. At one year of follow up, H. pylori was eradicated in 81.01% (64/79) of the OCA group and 5.06% (4/79) of the placebo group. The difference of dyspepsia improvement (22.78%; 95% confidence interval [CI], 7.62-37.79) between the OCA group (41.77%; 95% CI, 30.77-53.41), and the placebo group (18.99%; 95% CI 11.03-29.38) was significant (p = 0.0018). CONCLUSION: Eradication of Helicobacter pylori in patients with functional dyspepsia is more effective improving symptoms than placebo.
Subject(s)
Dyspepsia/drug therapy , Helicobacter Infections/drug therapy , Helicobacter pylori/isolation & purification , Adult , Amoxicillin/administration & dosage , Anti-Bacterial Agents/administration & dosage , Anti-Ulcer Agents/administration & dosage , Clarithromycin/administration & dosage , Confidence Intervals , Double-Blind Method , Drug Therapy, Combination , Dyspepsia/microbiology , Female , Gastroscopy , Helicobacter Infections/diagnosis , Helicobacter pylori/drug effects , Humans , Male , Odds Ratio , Omeprazole/administration & dosage , Treatment OutcomeABSTRACT
Fundamento y objetivo: El tratamiento erradicador en pacientes con dispepsia funcional ha sido frecuentemente objeto de discusión porque los ensayos llegan a conclusiones contradictorias, por lo que son necesarios más estudios para aclarar este tema. El objetivo de este ensayo es valorar el efecto del tratamiento erradicador en pacientes con dispepsia funcional comparándolo con placebo. Pacientes y método: Se trata de un ensayo clínico aleatorizado, doble ciego y controlado con placebo. Se seleccionó a 158 pacientes atendidos por médicos de familia (Área 10 IMSALUD), con dispepsia funcional e infección por Helicobacter pylori detectado por test de ureasa en la endoscopia. Se asignaron aleatoriamente a un grupo de tratamiento activo con omeprazol, claritromicina y amoxicilina (OCA) (n = 79) y a un grupo que recibió placebo (n = 79). Durante 7 días, el grupo OCA recibió omeprazol (20 mg/12 h), claritromicina (500 mg/12 h) y amoxicilina (1000 mg/12 h), mientras que el grupo control recibió placebo 2 veces al día. Se evaluaron durante un año las variaciones de mejoría de dispepsia según una escala Likert (5 grados), y la erradicación de Helicobacter pylori mediante prueba del aliento con urea-13C. Resultados: Ambos grupos eran homogéneos con respecto a la edad, el sexo y el grado de dispepsia. La edad media (desviación estándar) de los pacientes estudiados fue de 41,99 (13,93) años. Al año de seguimiento, H. Pylori se erradicó en el 81,01% (64/79) del grupo OCA y en el 5,06% (4/79) del grupo placebo. La diferencia de mejora de dispepsia (22,78%; intervalo de confianza [IC del 95%, 7,62-37,79]) entre el grupo OCA (41,77%, [IC del 95%, 30,77-53,41]) y el grupo placebo (18,99%; [IC del 95%, 11,03-29,38]) fue significativa (p = 0,0018). Conclusión: El tratamiento erradicador de H. pylori en pacientes con dispepsia funcional es más efectivo que el placebo, tanto para la erradicación del germen como en la mejoría de la dispepsia
Background and objective: The Helicobacter pylori eradication in patients with functional dyspepsia has been the subject of controversy because trials come to contradictory conclusions. The objective of this trial was to evaluate the effect, compared with placebo, of the eradication treatment in patients with functional dyspepsia. Patients and method: Randomized double blind placebo controlled trial. We included 158 patients attended by family physicians (Área 10 Primary Care, Health Institute of Madrid) with functional dyspepsia and Helicobacter pylori infection detected by the ureasa test in endoscopy. An OCA (ameprazole clarithromycin and amoxicillin group (n = 79) and a placebo group (n = 79) were randomized. During 7 days, patients at the OCA group received omeprazole (20 mg bid), clarithromycin (500 mg bid) and amoxicillin (1000 mg bid) daily, and patients at the control group received the placebo agent twice daily. Dyspepsia improvement according to a Likert scale (5 steps), and eradication of H. pylori by 13C-urea breath test were evaluated during one year. Results: Both groups were homogeneous in relation to age, sex and dyspepsia degree. The average age (standard deviation) of studied patients was 41.99 (13.93) years. At one year of follow up, H. pylori was eradicated in 81.01% (64/79) of the OCA group and 5.06% (4/79) of the placebo group. The difference of dyspepsia improvement (22.78%; 95% confidence interval [CI], 7.62-37.79) between the OCA group (41.77%; 95% CI, 30.77-53.41), and the placebo group (18.99%; 95% CI 11.03-29.38) was significant (p = 0.0018). Conclusion: Eradication of Helicobacter pylori in patients with functional dyspepsia is more effective improving symptoms than placebo