Análisis de minimización de costes de darbepoetina alfa frente a epoetina alfa en pacientes con insuficiencia renal crónica sometidos a hemodiálisis / Cost minimisation analysis for darbepoetin alpha vs. epoetin alpha in chronic kidney disease patients on haemodialysis

Introduction Multiple studies have shown that epoetin alpha (r-HuEpo) and darbepoetin alpha (NESP) are similarly effective and safe for maintaining haemoglobin levels in patients with chronic kidney disease (CKD). Nevertheless, there is some debate over their cost-effectiveness. The purpose of this study is to carry out a cost-minimisation analysis including a comparison of the costs to the hospital arising from treatment with r-HuEpo vs. NESP. Methods Prospective observational study. We included CRF patients on haemodialysis with no iron, vitamin B12 or folate deficiencies, treated with stable doses of IV r-HuEpo. Follow-up was performed over three periods: the first during six months, maintaining prior treatment with r-HuEpo; the second for eight months, after changing to NESP, and the third, during the final eight months, following resuming r-HuEpo treatment. For converting both treatments, the conversion factor established on technical sheet 1:200 was used.Results51 patients completed the study and were valid for analysis. Their mean age was 68.3 years, and 18 were women (35.3%). The mean weekly doses at the end of each period were 8,058.8 (SD 3,911.1)IU for the EPO1 period, 39.4 (SD 21.6)μg for NESP and 7,882.4 (SD 4,594.1)IU for EPO2. The weekly costs for each treatment showed significant differences between NESP and r-HuEpo: the cost of NESP was higher. Conclusion In our study, we found that r-HuEpo and NESP were similarly effective in patients with CRF on haemodialysis, but that there was a significant cost increase associated with NESP treatment (AU)

Introducción Diversos estudios han demostrado similar efectividad y seguridad de epoetina alfa (r-HuEpo) y darbepoetina alfa (NESP) en el mantenimiento de los niveles de hemoglobina, en pacientes con insuficiencia renal crónica (IRC). Sin embargo, existe controversia en cuanto a su eficiencia. El objetivo de este estudio es la realización de un análisis de minimización de costes (AMC), y como parte del mismo se comparan los costes que supone para el hospital el tratamiento con r-HuEpo frente a NESP. Métodos Estudio observacional prospectivo. Se incluyeron pacientes con IRC sometidos a hemodiálisis, sin déficit de hierro, vitamina B12 o folato, tratados con r-HuEpo IV a dosis estables. El seguimiento se realizó en 3 periodos: el primero durante 6 meses, manteniendo la terapia previa con r-HuEPO, el segundo, de 8 meses, tras cambiar a NESP y el tercero, los últimos 8 meses tras nuevo cambio a r-HuEPO. Para la conversión de ambos tratamientos se utilizó el factor de conversión establecido en ficha técnica 1:200.Resultados51 pacientes completaron el estudio y fueron válidos para el análisis, con una media de edad de 68,3 años, de los cuales 18 fueron mujeres (35,3%). Las dosis medias semanales al final de cada periodo fueron de 8.058,8 (SD 3.911,1) UI para el periodo EPO1, 39,4 (SD 21,6)μg para el NESP y 7.882,4 (SD 4.594,1)UI para el EPO2. Los costes semanales de cada tratamiento muestran diferencias significativas entre NESP y r-HuEpo, siendo el coste de NESP superior. Conclusión En nuestro estudio encontramos una eficacia similar de r-HuEpo y NESP en pacientes con IRC sometidos a hemodiálisis, y un incremento significativo de los costes asociado al tratamiento con NESP (AU)

[Cost minimisation analysis for darbepoetin alpha vs. epoetin alpha in chronic kidney disease patients on haemodialysis]. / Análisis de minimización de costes de darbepoetina alfa frente a epoetina alfa en pacientes con insuficiencia renal crónica sometidos a hemodiálisis.

INTRODUCTION: Multiple studies have shown that epoetin alpha (r-HuEpo) and darbepoetin alpha (NESP) are similarly effective and safe for maintaining haemoglobin levels in patients with chronic kidney disease (CKD). Nevertheless, there is some debate over their cost-effectiveness. The purpose of this study is to carry out a cost-minimisation analysis including a comparison of the costs to the hospital arising from treatment with r-HuEpo vs. NESP. METHODS: Prospective observational study. We included CRF patients on haemodialysis with no iron, vitamin B12 or folate deficiencies, treated with stable doses of IV r-HuEpo. Follow-up was performed over three periods: the first during six months, maintaining prior treatment with r-HuEpo; the second for eight months, after changing to NESP, and the third, during the final eight months, following resuming r-HuEpo treatment. For converting both treatments, the conversion factor established on technical sheet 1:200 was used. RESULTS: 51 patients completed the study and were valid for analysis. Their mean age was 68.3 years, and 18 were women (35.3%). The mean weekly doses at the end of each period were 8,058.8 (SD 3,911.1) IU for the EPO1 period, 39.4 (SD 21.6) microg for NESP and 7,882.4 (SD 4,594.1) IU for EPO2. The weekly costs for each treatment showed significant differences between NESP and r-HuEpo: the cost of NESP was higher. CONCLUSION: In our study, we found that r-HuEpo and NESP were similarly effective in patients with CRF on haemodialysis, but that there was a significant cost increase associated with NESP treatment.

[Cost-effectiveness analysis of the empirical antifungal strategy in oncohaematological patients]. / Estudio coste-efectividad de la estrategia empírica antifúngica en pacientes oncohematológicos.

OBJECTIVE: Observational study performing a cost-effectiveness analysis of the empirical antifungal strategy in high-risk oncohaematological patients, from the hospital perspective and with an average time horizon of 10.8 days of treatment. METHOD: Data gathered: effectiveness, purchase costs and other costs (diagnostic tests, hospitalisation, and second-line antifungal therapy). A total of 107 patients were analysed, 115 invasive fungal infection sub-episodes and 138 empirical treatments. RESULTS: The effectiveness and average cost/treatment were: voriconazole 88% and 20,108.8 euro, caspofungin 68% and 49,067.7 euro, Amphotericin B Lipid Complex (ABLC) 58% and 30,375.2 euro, and Amphotericin B Liposome (AB-L) 50% and 38,234.5 euro. The first tree designed shows voriconazole as the dominant option, although there are few case studies. The second tree selects ABLC in comparison to AB-L and caspofungin, with an average CE of 52,371 euro, the nearest figure to the established availability to pay (50,000 euro). The sensitivity analysis evaluates the most influential parameters. The variation in the cost of purchasing do not modify the sense of the analysis, and the modification of 25% in other costs for caspofungin reverses the ratio, making this the most cost-effective option. The ICE indicates that using voriconazole instead of caspofungin saves 144,794 euro. With regard to caspofungin, ABLC increases the cost by 186,925 euro, a deceptive figure influenced by a level of effectiveness that is not very different; and AB-L increases the cost by 60,184 euro. CONCLUSIONS: The analysis provides relevant information from the perspective of clinical practice in spite of the limitations of the unconsidered costs (nephrotoxicity). This type of analysis contributes to rationalising the use of antifungal agents in the hospital setting and in high-risk patients such as oncohaematological ones.

Estudio coste-efectividad de la estrategia empírica antifúngica en pacientes oncohematológicos / Cost-effectiveness analysis of the empirical antifungal strategy in oncohaematological patients

Objetivo: Estudio observacional que realiza un análisis coste-efectividadde la estrategia antifúngica empírica en pacientes oncohematológicosde alto riesgo, desde la perspectiva hospitalaria y con unhorizonte temporal de 10,8 días de media de tratamiento.Método: Se ha recogido: efectividad, costes de adquisición y otroscostes (pruebas de diagnóstico, hospitalización, terapia antifúngicade segunda línea). Se analizan 107 pacientes, 115 subepisodios deinfección fúngica invasiva y 139 tratamientos empíricos.Resultados: La efectividad y el coste medio/tratamiento fue: voriconazol,88% y 20.108,8 €; caspofungina, 68% y 49.067,7 €; anfotericinaB complejo lipídico (ABCL), 58% y 30.375,2 €, y anfotericina Bliposómica (AB-L), 50% y 38.234,5 €. El primer árbol diseñado señalavoriconazol como opción dominante, aunque su casuística resultaescasa. El segundo árbol selecciona ABCL frente a AB-L y caspofungina,con un CE medio de 52.371 €, el más próximo a ladisponibilidad a pagar establecida (50.000 €). El análisis de sensibilidadevalúa los parámetros más influyentes: la variación del costede adquisición no modifica el sentido del análisis; y la modificaciónde un 25% de otros costes para caspofungina invierte larelación, convirtiéndose ésta en la opción más coste/efectiva. El CEIindica que voriconazol en lugar de caspofungina ahorra 144.794 €.Respecto a caspofungina, ABCL incrementa el gasto en 186.925 €,cifra engañosa influenciada por una efectividad no muy distinta, yAB-L lo incrementa en 60.184 €.Conclusiones: El estudio aporta información relevante desde laperspectiva de la práctica clínica pese a las limitaciones de costes noconsiderados (nefrotoxicidad). Este tipo de estudios contribuye aracionalizar el uso de antifúngicos en el entorno hospitalario y enlos pacientes de alto riesgo como los oncohematológicos

Objective: Observational study performing a cost-effectivenessanalysis of the empirical antifungal strategy in high-risk oncohaematologicalpatients, from the hospital perspective and with an averagetime horizon of 10.8 days of treatment.Method: Data gathered: effectiveness, purchase costs and othercosts (diagnostic tests, hospitalisation, and second-line antifungaltherapy). A total of 107 patients were analysed, 115 invasive fungalinfection sub-episodes and 138 empirical treatments.Results: The effectiveness and average cost/treatment were: voriconazole88% and €20,108.8, caspofungin 68% and €49,067.7, AmphotericinB Lipid Complex (ABLC) 58% and €30,375.2, and AmphotericinB Liposome (AB-L) 50% and €38,234.5. The first treedesigned shows voriconazole as the dominant option, although thereare few case studies. The second tree selects ABLC in comparisonto AB-L and caspofungin, with an average CE of €52,371, the nearestfigure to the established availability to pay (50,000€). The sensitivityanalysis evaluates the most influential parameters. The variation inthe cost of purchasing do not modify the sense of the analysis, andthe modification of 25% in other costs for caspofungin reverses theratio, making this the most cost-effective option. The ICE indicatesthat using voriconazole instead of caspofungin saves €144,794. Withregard to caspofungin, ABLC increases the cost by €186,925, a deceptivefigure influenced by a level of effectiveness that is not very different;and AB-L increases the cost by €60,184.Conclusions: The analysis provides relevant information from theperspective of clinical practice in spite of the limitations of the unconsideredcosts (nephrotoxicity). This type of analysis contributes to rationalisingthe use of antifungal agents in the hospital setting and inhigh-risk patients such as oncohaematological ones

Agencias de evaluación de tecnologías sanitarias. Utilidad de sus informes de evaluación en un servicio de farmacia / Healthcare technologies assessment agencies. Utility of their assessment reports in a pharmacy department

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Guía del Hospital Universitario La Fe para la profilaxis y el tratamiento de las infecciones fúngicas en los enfermos inmunodeprimidos o que requieren cuidados especiales / No disponible

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