Economic evaluation of the levonorgestrel-releasing intrauterine system for the treatment of dysfunctional uterine bleeding in Spain.

OBJECTIVE: To compare the cost and effectiveness of the levonorgestrel-releasing intrauterine system (LNG-IUS) versus combined oral contraception (COC) and progestogens (PROG) in first-line treatment of dysfunctional uterine bleeding (DUB) in Spain. STUDY DESIGN: A cost-effectiveness and cost-utility analysis of LNG-IUS, COC and PROG was carried out using a Markov model based on clinical data from the literature and expert opinion. The population studied were women with a previous diagnosis of idiopathic heavy menstrual bleeding. The analysis was performed from the National Health System perspective, discounting both costs and future effects at 3%. In addition, a sensitivity analysis (univariate and probabilistic) was conducted. RESULTS: The results show that the greater efficacy of LNG-IUS translates into a gain of 1.92 and 3.89 symptom-free months (SFM) after six months of treatment versus COC and PROG, respectively (which represents an increase of 33% and 60% of symptom-free time). Regarding costs, LNG-IUS produces savings of € 174.2-309.95 and € 230.54-577.61 versus COC and PROG, respectively, after 6 months-5 years. Apart from cost savings and gains in SFM, quality-adjusted life months (QALM) are also favourable to LNG-IUS in all scenarios, with a range of gains between 1 and 2 QALM compared to COC and PROG. CONCLUSIONS: The results indicate that first-line use of the LNG-IUS is the dominant therapeutic option (less costly and more effective) in comparison with first-line use of COC or PROG for the treatment of DUB in Spain. LNG-IUS as first line is also the option that provides greatest health-related quality of life to patients.

[Retrospective comparative analysis of antidementia medication persistence patterns in Spanish Alzheimer's disease patients treated with donepezil, rivastigmine, galantamine and memantine]. / Analisis comparativo de los patrones de persistencia de medicaciones antidemencia en una cohorte retrospectiva de pacientes con demencia de tipo Alzheimer tratados con donepecilo, rivastigmina, galantamina y memantina en Espana.

INTRODUCTION AND AIM: Dementia of Alzheimer type has become the most frequent type of dementia in our environment. Treatment persistence is a crucial factor to delay patient functional and cognitive impairment. The aim of the present study was to determine treatment persistence in usual care settings with four different antidementia drugs: donepezil, rivastigmine, galantamine and memantine in a cohort of patients with Alzheimer's dementia in Spain. PATIENTS AND METHODS: An Alzheimer type dementia retrospective cohort study was performed in 13 Primary Care Health Centers in Spain. The study included patients treated between January 2000 and March 2005. RESULTS: A total of 299 patients (44.8% female), mean age 77.9 years, were included: 101 donepezil (33.8.%), 105 rivastigmine (35.1%), 51 galantamine (17.1%) and 42 memantine (14.0%). Mean treatment duration was significantly different depending on therapy type, showing higher values for donepezil patients (mean: 83.3 weeks; 95% CI: 72.7-93.9) than for the other cholinesterase inhibitors: rivastigmine (mean: 76.6 weeks; 95% CI: 66.0-87.3), galantamine (mean: 65.8 weeks; 95% CI: 55.3-76.3) and memantine (60.9 weeks; 95% CI: 48.8-73.1), p = 0.049. Overall treatment persistence was significantly different between drugs, with again donepezil showing higher persistence (median time: 70.3 weeks; 95% CI: 49.8-90.7) than with the others drugs: rivastigmine (median time: 56.1 weeks; 95% CI: 36.1-76.2), galantamine (median time: 56.7 weeks; 95% CI: 41.1-72.3) and memantine (median time: 52.1 weeks; 95% CI: 35.2-69.1), log-rank = 10.16; p = 0.017. CONCLUSION: This study showed significative differences in the global treatment persistence among the considered drug-cholinesterase inhibitors, showing higher persistence resulting in patients treated with donepezil compared to those who received rivastigmine, galantamine or memantine.

Análisis comparativo de los patrones de persistencia de medicaciones antidemencia en una cohorte retrospectiva de pacientes con demencia de tipo Alzheimer tratados con donepecilo, rivastigmina, galantamina y memantina en España / Retrospective comparative analysis of antidementia medication persistence patterns in spanish alzheimer’s disease patients treated with donepezil, rivastigmine, galantamine and memantine

Introducción y objetivos. La demencia de tipo Alzheimeres la causa más frecuente de demencia en nuestro entorno. La persistenciadel tratamiento es un factor crucial para demorar el deteriorofuncional y cognitivo del paciente. El objetivo de este estudioha sido determinar la persistencia del tratamiento con cuatro medicacionesantidemencia (donepecilo, rivastigmina, galantamina ymemantina) en una cohorte de pacientes con enfermedad de Alzheimeren España. Pacientes y métodos. Se realizó un estudio retrospectivoen 13 centros de atención primaria en España. Los pacientesincluidos fueron tratados entre enero de 2000 y marzo de2005. Resultados. Se incluyeron un total de 299 pacientes (44,8%mujeres) con una edad media de 77,9 años: 101 se trataron condonepecilo (33,8%), 105 con rivastigmina (35,1%), 51 con galantamina(17,1%) y 42 con memantina (14,0%). La duración media deltratamiento fue significativamente diferente entre los anticolinesterásicos(p = 0,049), siendo superior en los pacientes tratados condonepecilo (media: 83,3 semanas; IC 95%: 72,7-93,9), que con elresto de agentes terapéuticos: rivastigmina (media: 76,6 semanas;IC 95%: 66,0-87,3), galantamina (media: 65,8 semanas; IC 95%:55,3-76,3) y memantina (media: 60,9 semanas; IC 95%: 48,8-73,1).La persistencia global del tratamiento fue significativamente diferenteentre los tratamientos (log-rank = 10,16; p = 0,017), siendosuperior con donepecilo (mediana: 70,3 semanas; IC 95%: 49,8-90,7) que con el resto de terapias: rivastigmina (mediana: 56,1 semanas;IC 95%: 36,1-76,2), galantamina (mediana: 56,7 semanas;IC 95%: 41,1-72,3) y memantina (mediana: 52,1 semanas; IC 95%:35,2-69,1). Conclusiones. El estudio ha mostrado diferencias significativasen la persistencia global de los distintos tratamientos antidemenciaconsiderados, siendo superior en aquellos pacientes tratadoscon donepecilo respecto a los tratados con rivastigmina,galantamina o memantina

Introduction and aim. Dementia of Alzheimer type has become the most frequent type of dementia in our environment.Treatment persistence is a crucial factor to delay patient functional and cognitive impairment. The aim of the present studywas to determine treatment persistence in usual care settings with four different antidementia drugs: donepezil, rivastigmine,galantamine and memantine in a cohort of patients with Alzheimer’s dementia in Spain. Patients and methods. An Alzheimertype dementia retrospective cohort study was performed in 13 Primary Care Health Centers in Spain. The study includedpatients treated between January 2000 and March 2005. Results. A total of 299 patients (44.8% female), mean age 77.9 years,were included: 101 donepezil (33.8.%), 105 rivastigmine (35.1%), 51 galantamine (17.1%) and 42 memantine (14.0%). Meantreatment duration was significantly different depending on therapy type, showing higher values for donepezil patients (mean:83.3 weeks; 95% CI: 72.7-93.9) than for the other cholinesterase inhibitors: rivastigmine (mean: 76.6 weeks; 95% CI: 66.0-87.3),galantamine (mean: 65.8 weeks; 95% CI: 55.3-76.3) and memantine (60.9 weeks; 95% CI: 48.8-73.1), p = 0.049. Overalltreatment persistence was significantly different between drugs, with again donepezil showing higher persistence (mediantime: 70.3 weeks; 95% CI: 49.8-90.7) than with the others drugs: rivastigmine (median time: 56.1 weeks; 95% CI: 36.1-76.2),galantamine (median time: 56.7 weeks; 95% CI: 41.1-72.3) and memantine (median time: 52.1 weeks; 95% CI: 35.2-69.1),log-rank = 10.16; p = 0.017. Conclusion. This study showed significative differences in the global treatment persistenceamong the considered drug-cholinesterase inhibitors, showing higher persistence resulting in patients treated with donepezilcompared to those who received rivastigmine, galantamine or memantine