RESUMO
Objetivo: Estimar el impacto económico del emicizumab en pacientes con hemofilia A (HA) e inhibidor en un hospital de tercer nivel, comparándolo con las alternativas terapéuticas. Métodos: Se estimó el coste anual del tratamiento de la HA e inhibidor con complejo protrombínico activado (aPCC), factor VII recombinante (rFVIIa) y emicizumab, y varias estrategias terapéuticas: profiláctica, a demanda e inmunotolerancia (ITI). Las dosis utilizadas, localización, frecuencia y gravedad de los sangrados se obtuvieron de la literatura. Resultados: El coste medio anual de la estrategia a demanda con aPCC/rFVIIa y de la estrategia profiláctica fueron 309.523 y 354.866 , en un paciente pediátrico y 808.928 y 926.574 en un adulto, respectivamente. El coste de la ITI fue 619.644 y 1.029.399 en el paciente pediátrico y adulto, respectivamente. Respecto a la estrategia profiláctica, el coste del tratamiento con emicizumab fue un 27,7% menor en el paciente pediátrico (240.255 ) y un 50,8% menor en el adulto (427.266 ).Conclusiones: Emicizumab, además de aportar mejoras clínicas y de calidad de vida a los pacientes con HA, ofrece ventajas económicas frente a los agentes bypass. (AU)
Purpose: Estimate the economic impact of the use of emicizumab in patients with hemophilia A (HA) and inhibitor in a third level hospital, comparing it with the different therapeutic alternatives.Methods: HA and inhibitor annual cost treatment with activated prothrombin complex (aPCC), recombinant factor VII (rFVIIa) and emicizumab was estimated. The patients were stratified in pediatrics (<14 years) and adults (>14 years). Several strategies were considered: prophylactic, on demand and immune tolerance induced (ITI). The dose used and the bleeding location, frequency and severity were obtained from the literature.Results: The average annual cost of on demand strategy with aPCC and rFVIIa and prophylactic strategy in a pediatric patient was 309,523 and 354,866 respectively, and 808,928 and 926,574 in an adult patient, respectively. ITI cost was 619,644 and 1,029,399 in pediatric and adult patient respectively. Regard prophylactic strategy, the treatment cost with emicizumab was 27.7% lower in pediatric patients (240,255 ) and 50.8% lower in adult patients (427,266 ). (AU)
Assuntos
Humanos , Custos de Medicamentos , Custos e Análise de Custo , Hemofilia A/tratamento farmacológico , Protrombina , Fator VIIRESUMO
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Assuntos
Humanos , Serviço de Farmácia Hospitalar , Serviços Terceirizados , Serviço de Farmácia Hospitalar/legislação & jurisprudência , Atenção à Saúde , Preparações Farmacêuticas , Inquéritos e QuestionáriosRESUMO
Pediatric patients present changing physiological features. Because of the lack of land suitable for commercial management, pediatric specialties very often need to prepare extemporaneous formulations to improve the dosage and administration of drugs for children. Oral liquid formulations are the most suitable for pediatric patients. Clonidine is widely used in the pediatric population for opioid withdrawal, hypertensive crisis, attention deficit disorders and hyperactivity syndrome, and as an analgesic in neuropathic cancer pain. The objective was to study the physicochemical and microbiological stability and determine the shelf life of an oral solution containing 20 µg/mL clonidine hydrochloride in different storage conditions (5 ± 3 °C, 25 ± 3 °C, and 40 ± 2 °C). Using raw material with excipients safe for all pediatric age groups, two oral liquid formulations of clonidine hydrochloride were designed (with and without preservatives). Solutions stored at 5 ± 3 °C (with and without preservatives) were physically and microbiologically stable for at least 90 days in closed containers and for 42 days after opening. Two oral solutions of clonidine hydrochloride 20 µg/mL were developed for pediatric use from raw materials that are readily available and easy to process, containing safe excipients that are stable over a long period of time.
Assuntos
Analgésicos/administração & dosagem , Analgésicos/química , Clonidina/administração & dosagem , Clonidina/química , Administração Oral , Fenômenos Químicos , Criança , Composição de Medicamentos/métodos , Estabilidade de Medicamentos , Escherichia coli , Humanos , Soluções Farmacêuticas/administração & dosagem , Soluções Farmacêuticas/química , Pseudomonas aeruginosa/isolamento & purificaçãoRESUMO
OBJECTIVE: To analyse carboplatin dosage in cancer patients in order to establish whether they are over- or underdosed in comparison to the theoretical dose calculations during the first cycle of chemotherapy and to find a relationship between the dosage in the first cycle and dose reduction in subsequent cycles, as a result of adverse effects related to the same. METHOD: Retrospective analysis over a one year period of prescriptions of chemotherapy with carboplatin. Patients were stratified into 4 groups according to body mass index and serum creatinine values. The mean percent error (MPE) was used to determine the relationship between the dose received and the theoretical dose calculation during the first cycle. The Mann-Whitney U test was used to study the possible relationship between patients dosage during the first cycle and dose reduction in subsequent cycles. RESULTS: A total of 86 patients were selected. Only the cohort of patients who were overweight/obese showed significant differences between the theoretical dose calculation and the dose actually received. The mean MPE value with the standard error for this group was 7.963 +- 2.610%. No links were found with the dose reduction in subsequent cycles for this cohort of patients. CONCLUSIONS: Not using adjusted weight or serum creatinine values in the Cockcroft-Gault equation may lead to incorrect doses of carboplatin in obese patients. Studies including a larger number of patients are required to confirm the relationship between overdosing during the first cycle and dose reduction in subsequent cycles, as a result of carboplatin toxicity.
Assuntos
Antineoplásicos/administração & dosagem , Antineoplásicos/toxicidade , Carboplatina/administração & dosagem , Carboplatina/toxicidade , Neoplasias/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Objetivo: Realizar un análisis de la dosificación de carboplatinoen pacientes oncológicos para conocer si están sobre- o infradosificadoscon respecto a la dosis teórica calculada en el primerciclo de quimioterapia. Relacionar esta dosificación en primerciclo y la reducción de dosis en ciclos sucesivos por aparición deefectos adversos relacionados con la misma.Método: Análisis retrospectivo de un año de duración de lasprescripciones de quimioterapia con carboplatino. Los pacientes seestratificaron en 4 grupos en función de los valores de índice demasa corporal y creatinina sérica. Para determinar la relación entrela dosis recibida y la dosis teórica calculada en primer ciclo se utilizóel porcentaje medio de error (MPE). La posible relación de la dosificaciónde pacientes en primer ciclo y la reducción de dosis en ciclossucesivos se estudió mediante el test de Mann-Whitney.Resultados: Se seleccionaron 86 pacientes. Únicamente lacohorte de pacientes con sobrepeso/obesidad mostró diferenciassignificativas entre la dosis teórica calculada y la dosis real recibida.El valor medio de MPE con su error estándar para este grupofue de 7,963 ± 2,610%. No se encontró relación con la reducciónde dosis en ciclos sucesivos en esta cohorte de pacientes.Conclusiones: La no utilización del peso ajustado o de la creatininasérica ajustada en la ecuación de Cockcroft-Gault puede llevara dosificaciones inapropiadas de carboplatino en pacientes obesos.Son necesarios estudios con mayor número de pacientes parademostrar la relación entre sobredosificación en primer ciclo yreducción de dosis en ciclos sucesivos por toxicidad a carboplatino
Objective: To analyse carboplatin dosage in cancer patientsin order to establish whether they are over or underdosed in comparisonto the theoretical dose calculations during the first cycle ofchemotherapy and to find a relationship between the dosage inthe first cycle and dose reduction in subsequent cycles, as a resultof adverse effects related to the same.Method: Retrospective analysis over a one year period of prescriptionsof chemotherapy with carboplatin. Patients were stratifiedinto 4 groups according to body mass index and serum creatininevalues. The mean percent error (MPE) was used to determine therelationship between the dose received and the theoretical dose calculationduring the first cycle. The Mann-Whitney U test was used tostudy the possible relationship between patients dosage during thefirst cycle and dose reduction in subsequent cycles.Results: A total of 86 patients were selected. Only the cohortof patients who were overweight/obese showed significant differencesbetween the theoretical dose calculation and the dose actuallyreceived. The mean MPE value with the standard error for thisgroup was 7.963 ± 2.610%. No links were found with the dosereduction in subsequent cycles for this cohort of patients.Conclusions: Not using adjusted weight or serum creatininevalues in the Cockcroft-Gault equation may lead to incorrect dosesof carboplatin in obese patients. Studies including a larger numberof patients are required to confirm the relationship between overdosingduring the first cycle and dose reduction in subsequentcycles, as a result of carboplatin toxicity
