[Estimating demand for anti-Chagas drugs: a contribution for access in Latin America]. / Estimación de la demanda de medicamentos antichagásicos: una contribución para el acceso en América Latina.

OBJECTIVE: Describe a tool to estimate demand for benznidazole and nifurtimox to treat Chagas disease, and report on its implementation in a group of Latin American countries. METHODS: The project was carried out in the following stages: 1) development of a tool to estimate demand, and definition of the evaluation and decision variables to estimate demand 2) data collection via a questionnaire completed by representatives of control programs, complemented with data from the literature; 3) presentation of the tool, followed by validation, and adaptation by representatives of the control programs in order to plan drug procurement for 2012 and 2013; and 4) further analysis of the obtained data, especially regarding benznidazole, and comparison of country estimates. RESULTS: Fourteen endemic countries of Latin America took part in the third stage, and a consolidated estimate was made. The number of estimated treatments, based on the number of tablets per treatment established in the regimen of reference was: 867 in the group under 1 year of age; 2 042 835 in the group from 1 to 15 years old; 2 028 in the group from 15 to 20 years old; and 10 248 in adults over 20. This means that it is possible to provide benznidazole to less than 1% of people for whom treatment is indicated. CONCLUSIONS: The development and systematic use of demand management tools can play a key role in helping to provide access to the anti-Chagas drugs. There is a significant gap between the projected demand for drugs and current estimates of prevalence rates.

Estimación de la demanda de medicamentos antichagásicos: una contribución para el acceso en América Latina / Estimating demand for anti-Chagas drugs: a contribution for access in Latin America / Estimativa da demanda de medicamentos antichagásicos: uma contribuição para o acesso na América Latina

Objetivo. Describir una herramienta de estimación de la demanda de benznidazol y nifurtimox para la enfermedad de Chagas y relatar su aplicación en un conjunto de países de América Latina. Métodos. El proyecto se desarrolló en las siguientes etapas: 1) elaboración de una herramienta y definición de las variables de evaluación y decisión para estimación de la demanda, 2) recolección de datos a partir de un cuestionario a representantes de programas de control, complementado con datos de la literatura, 3) presentación, validación y adaptación de la herramienta por representantes de los programas de control, con la intención de planificar la adquisición de medicamentos para los años de 2012 y 2013, y 4) análisis complementar de los datos obtenidos, en especial benznidazol, y comparación de las estimaciones de los países. Resultados. Catorce países endémicos de América Latina participaron de la tercera etapa, con definición de una estimación consolidada. El número de tratamientos estimados a partir del número de comprimidos por tratamiento establecido en el esquema de referencia resultó ser de 867 en menores de un año, 2 042 835 en el grupo de 1 a 15 años, 2 028 en el grupo de 15 a 20 años y de 10 248 en adultos mayores de 20 años. Este cuantitativo representa la posibilidad de tratar menos de 1% de las personas con indicación para tratamiento con benznidazol. Conclusiones. El desarrollo y el uso sistemático de herramientas de gestión de la demanda pueden jugar un papel clave en el apoyo al acceso a los medicamentos en la enfermedad de Chagas. Existe una brecha significativa entre las previsiones de demanda de medicamentos y estimaciones actuales de las tasas de prevalencia.

Objective. Describe a tool to estimate demand for benznidazole and nifurtimox to treat Chagas disease, and report on its implementation in a group of Latin American countries. Methods. The project was carried out in the following stages: 1) development of a tool to estimate demand, and definition of the evaluation and decision variables to estimate demand 2) data collection via a questionnaire completed by representatives of control programs, complemented with data from the literature; 3) presentation of the tool, followed by validation, and adaptation by representatives of the control programs in order to plan drug procurement for 2012 and 2013; and 4) further analysis of the obtained data, especially regarding benznidazole, and comparison of country estimates. Results. Fourteen endemic countries of Latin America took part in the third stage, and a consolidated estimate was made. The number of estimated treatments, based on the number of tablets per treatment established in the regimen of reference was: 867 in the group under 1 year of age; 2 042 835 in the group from 1 to 15 years old; 2 028 in the group from 15 to 20 years old; and 10 248 in adults over 20. This means that it is possible to provide benznidazole to less than 1% of people for whom treatment is indicated. Conclusions. The development and systematic use of demand management tools can play a key role in helping to provide access to the anti-Chagas drugs. There is a significant gap between the projected demand for drugs and current estimates of prevalence rates.

Objetivo. Descrever uma ferramenta de estimativa da demanda de benznidazol e nifurtimox para a doença de Chagas e descrever a sua aplicação em um conjunto de países da América Latina. Métodos. O projeto foi desenvolvido nas seguintes etapas: 1) elaboração de uma ferramenta e definição das variáveis de avaliação e decisão para a estimativa da demanda, 2) compilação de dados a partir de um questionário apresentado a representantes de programas de controle, complementado com dados da literatura, 3) apresentação, validação e adaptação da ferramenta por representantes dos programas de controle, com a intenção de planejar a aquisição de medicamentos para os anos de 2012 e 2013 e 4) análise complementar dos dados obtidos, especialmente sobre o benznidazol, e comparação das estimativas nos países. Resultados. Quatorze países endêmicos da América Latina participaram da terceira etapa, sendo definida uma estimativa consolidada. O número de tratamentos estimados a partir do número de comprimidos por tratamento estabelecido no regime de referência foi de 867 em pacientes menores de um ano, 2.042.835 no grupo com idade entre 1 e 15 anos, 2.028 no grupo entre 15 e 20 anos e 10.248 em adultos maiores de 20 anos. Esta quantidade representa a possibilidade de tratar menos de 1% das pessoas com indicação para tratamento com benznidazol. Conclusões. O desenvolvimento e o uso sistemático de ferramentas de gestão da demanda podem ser fundamentais para apoiar o acesso aos medicamentos para a doença de Chagas. Existe uma disparidade significativa entre as previsões de demanda de medicamentos e as estimativas atuais das taxas de prevalência.

Efficacy and tolerability of salmeterol/fluticasone propionate versus montelukast in childhood asthma: A prospective, randomized, double-blind, double-dummy, parallel-group study.

BACKGROUND: Asthma control remains suboptimal in adults and children worldwide. Inhaled salmeterol/fluticasone propionate combination (SFC) and oral montelukast (MON) are 2 treatments available for childhood asthma. OBJECTIVE: This study, the PEdiatric Asthma Control Evaluation (PEACE), investigated the efficacy and tolerability of SFC compared with MON for the control of persistent asthma in children. METHODS: Children with asthma (forced expiratory volume in 1 second [FEV(1)] 55%-80% predicted; reversibility >or=12%) aged 6 to 14 years who were receiving only short-acting beta(2)-agonists entered a 2-week run-in period. Symptomatic patients (rescue use or symptoms during 4 of the last 7 days) were randomized to double-blind, double-dummy treatment with SFC 50/100 microg BID via multidose dry powder inhaler or MON 5-mg tablet QD for 12 weeks. The primary end point was change from baseline in morning peak expiratory flow (PEF). Efficacy assessments included lung function, asthma symptoms, rescue medication use, and asthma control. Tolerability was assessed by recording the number and type of adverse events (AEs) and the number of asthma exacerbations. RESULTS: Of 607 patients screened, 548 were randomized to treatment. The SFC group contained 281 patients and the MON group included 267. Demographic characteristics and baseline data were similar for both groups (mean age, 9.3 years for both groups; mean [SD] FEV(1), 1.49 [0.43] L in the SFC group and 1.48 [0.43] L in the MON group). There were more males in the MON group (179 [67%]) than in the SFC group (156 [56%]). The adjusted mean (SE) changes from baseline in morning PEF were 45.88 (2.82) L/min with SFC and 28.7 (2.86) L/min with MON (treatment difference, 17.16 L/min; 95% CI, 9.23-25.08; P < 0.001). Compared with MON, the SFC group had significantly more asthma symptom-free days (odds ratio [OR], 1.74; 95% CI, 1.07-2.82; P = 0.025), more rescue-free days (OR, 3.24; 95% CI, 2.09-5.02; P < 0.001), and more asthma-controlled weeks (difference in treatment medians over weeks 1-12, 16.77%; 95% CI, 8.3-16.77; P < 0.001). Both treatments were well tolerated, with a similar number of patients reporting AEs (SFC group, 155/281 [55%]; MON group, 153/267 [57%]); the most common AE in both groups was headache (SFC group, 66 [23%]; MON group, 72 [27%]). The mean exacerbation rates over 12 weeks (post hoc analysis) were 0.12 in the SFC group and 0.30 in the MON group (SFC/MON ratio, 0.40; 95% CI, 0.29-0.57; P < 0.001). CONCLUSIONS: In these children with uncontrolled asthma previously on short-acting beta(2)-agonist monotherapy (% predicted FEV(1) <80%, frequent asthma symptoms and rescue medication use), treatment with SFC was significantly more effective in improving morning PEF and other measures of asthma control and in decreasing exacerbation rates (in a post hoc analysis) than treatment with MON. The 2 drugs were both well tolerated, with similar numbers and types of AEs reported.

Asthma control in Latin America: the Asthma Insights and Reality in Latin America (AIRLA) survey.

OBJECTIVES: The aims of this survey were (1) to assess the quality of asthma treatment and control in Latin America, (2) to determine how closely asthma management guidelines are being followed, and (3) to assess perception, knowledge and attitudes related to asthma in Latin America. METHODS: We surveyed a household sample of 2,184 adults or parents of children with asthma in 2003 in 11 countries in Latin America. Respondents were asked about healthcare utilization, symptom severity, activity limitations and medication use. RESULTS: Daytime asthma symptoms were reported by 56% of the respondents, and 51% reported being awakened by their asthma at night. More than half of those surveyed had been hospitalized, attended a hospital emergency service or made unscheduled emergency visits to other healthcare facilities for asthma during the previous year. Patient perception of asthma control did not match symptom severity, even in patients with severe persistent asthma, 44.7% of whom regarded their disease as being well or completely controlled. Only 2.4% (2.3% adults and 2.6% children) met all criteria for asthma control. Although 37% reported treatment with prescription medications, only 6% were using inhaled corticosteroids. Most adults (79%) and children (68%) in this survey reported that asthma symptoms limited their activities. Absence from school and work was reported by 58% of the children and 31% of adults, respectively. CONCLUSIONS: Asthma control in Latin America falls short of goals in international guidelines, and in many aspects asthma care and control in Latin America suffer from the same shortcomings as in other areas of the world.