Utilización de fármacos específicos para la enfermedad de Alzheimer / Use of specific drugs for Alzheimer's disease

Objetivo. Analizar la evolución y repercusiones económicas del consumo de fármacos específicos para la enfermedad de Alzheimer (EA) en Aragón, conocer su patrón de utilización y estimar la proporción de pacientes en tratamiento específico. Métodos. Estudio descriptivo del consumo extrahospitalario de inhibidores de colinesterasa y memantina (1996-2004) a través de los envases facturados por oficinas de farmacia al Sistema Nacional de Salud. A partir de las dosis diarias definidas (DDD) e importe se calcularon: DDD por cada 1.000 habitantes (DHD), DDD por cada 1.000 habitantes mayores de 64 años (DHD65), incremento primer-último año (%), consumo proporcional por fármaco, coste por habitante y año y coste-tratamiento- día (CTD). Para la estimar la proporción de pacientes tratados se compararon las DHD65 con la prevalencia de EA. Resultados. Las DHD del conjunto han evolucionado de 0,026 (1996) a 3,235 (2004). El donepezilo se consolida como el más prescrito, aunque su peso disminuye ante la rápida penetración de nuevas alternativas. Las DHD consumidas en 2004 supusieron un coste cercano a 6 millones de euros. El CTD disminuyó un 30% en el período estudiado, mientras que el coste total se multiplicó por 90 (por 60 cuando se utilizaron euros constantes de 2004). Se estima que en 2004 el 34% de pacientes con EA recibió tratamiento específico. Conclusiones. Se observa un importante ascenso en el uso y la carga económica que suponen estos fármacos, cuyo coste-efectividad ha sido discutido en algunos estudios. Son necesarios trabajos con datos más específicos por paciente que permitan identificar sus características y valorar la adecuación de los tratamientos

Objetive. To evaluate the consumption evolution and financial impact of specific treatments for Alzheimer's disease (AD) in Aragon (Spain), analyzing consumption patterns and trends, and to estimate the proportion of AD patients treated with these drugs. Methods. Descriptive study of outpatient utilization of cholinesterase inhibitors and memantine (1996-2004), obtained from the drug packages dispensed by community pharmacists through prescriptions charged to the National Health Service. According to the defined daily doses (DDD) and expenditure data available, data were expressed in DDD per 1,000 inhabitants per day (DHD), DDD per 1,000 inhabitants older than 64 (DHD65), firstlast year increase (%), drug consumption pattern, annual cost per inhabitant and daily treatment cost (DTC). To estimate the proportion of treated patients we compared the DHD65 data with the estimated AD prevalence. Results. Overall consumption of these drugs has increased from 0.026 DHD (1996) to 3.235 DHD (2004). Donepezil remains as the most prescribed, though it is proportionally decreasing as a result of the quick introduction of newer alternatives. Overall cost of the DHD dispensed in 2004 reached nearly 6 million euros. DTC decreased about 30% over the study period, but the total cost increased ninety-fold (sixty-fold when non-variable euros from 2004 were considered). According to our estimates, 34 % of people with AD were receiving specific treatment. Conclusions. There is a significant increase in the consumption and economical burden of these drugs, whose cost-effectiveness has been questioned in some studies. More studies including specific patient data are needed in order to identify individual characteristics and evaluate treatment appropriateness

[Use of specific drugs for Alzheimer's disease]. / Utilización de fármacos específicos para la enfermedad de Alzheimer.

OBJECTIVE: To evaluate the consumption evolution and financial impact of specific treatments for Alzheimer's disease (AD) in Aragon (Spain), analyzing consumption patterns and trends, and to estimate the proportion of AD patients treated with these drugs. METHODS: Descriptive study of outpatient utilization of cholinesterase inhibitors and memantine (1996-2004), obtained from the drug packages dispensed by community pharmacists through prescriptions charged to the National Health Service. According to the defined daily doses (DDD) and expenditure data available, data were expressed in DDD per 1,000 inhabitants per day (DHD), DDD per 1,000 inhabitants older than 64 (DHD65), first-last year increase (%), drug consumption pattern, annual cost per inhabitant and daily treatment cost (DTC). To estimate the proportion of treated patients we compared the DHD65 data with the estimated AD prevalence. RESULTS: Overall consumption of these drugs has increased from 0.026 DHD (1996) to 3.235 DHD (2004). Donepezil remains as the most prescribed, though it is proportionally decreasing as a result of the quick introduction of newer alternatives. Overall cost of the DHD dispensed in 2004 reached nearly 6 million euros. DTC decreased about 30% over the study period, but the total cost increased ninety-fold (sixty-fold when non-variable euros from 2004 were considered). According to our estimates, 34% of people with AD were receiving specific treatment. CONCLUSIONS: There is a significant increase in the consumption and economical burden of these drugs, whose cost-effectiveness has been questioned in some studies. More studies including specific patient data are needed in order to identify individual characteristics and evaluate treatment appropriateness.

Estudio de la efectividad, supervivencia y seguridad de las terapias antirretrovirales de inicio en pacientes VIH+ / A study of initial antiretroviral therapy effectiveness, survival and safety in HIV+ patients

Objetivo: Estudiar los tratamientos antirretrovirales de inicioindicados en pacientes VIH durante el periodo 2001-2003, suefectividad, supervivencia y seguridad.Método: Estudio descriptivo retrospectivo de las variables clínicasy farmacológicas de los pacientes VIH naïve a través de lahistoria farmacoterapéutica.Resultados: La media de linfocitos CD4+ ha sido 209,6 células/mm3. La neumonía por Pneumocystis carinii ha sido la principalenfermedad presente al iniciar tratamiento antirretroviral.Las terapias más utilizadas han sido las basadas en la utilización deun inhibidor de la transcriptasa inversa no análogo de los nucleósidos(ITINN) combinado con dos inhibidores análogos (ITIAN). Lascombinaciones de tres inhibidores de la transcriptasa inversa análogosde los nucleósidos presentaron la mayor supervivenciamedia. El principal motivo de suspensión de terapia inicial hansido los efectos adversos, siendo la estavudina el peor tolerado.Conclusiones: Las terapias basadas en inhibidores de la transcriptasainversa no análogos de los nucleósidos e inhibidores de laproteasa (IPs) han demostrado una efectividad similar en el incrementode células CD4+. En la disminución de los niveles de cargaviral los inhibidores de la proteasa han resultado más efectivos. Lasterapias con tres inhibidores de la transcriptasa inversa análogos delos nucleósidos han presentado la mayor supervivencia

Objective: To study initial antiretroviral therapies indicatedfor HIV-infected patients during the 2001-2003 period regardingeffectiveness, survival and safety.Method: A descriptive, retrospective study of clinical anddrug-related variables of naïve HIV-infected patients throughpharmacotherapeutic history.Results: Mean CD4+ lymphocytes counts were 209.6cells/mm3. Pneumonia by Pneumocystis carinii was the mostcommonly found condition at antiretroviral treatment onset. Mostcommonly used therapies included those based on a non-nucleosidereverse transcriptase inhibitor (NNRTI) combined with twonucleoside reverse transcriptase inhibitors (NRTIs). The longestmean survival was achieved by using combinations of three nucleosidereverse transcriptase inhibitors. The primary reason for initialantiretroviral therapy discontinuation were adverse effects,with stavudine exhibiting the poorest tolerability.Conclusions: Therapies based on non-nucleoside reversetranscriptase inhibitors and protease inhibitors (PIs) have shownsimilar effectiveness to increase CD4+ cell counts. Regarding viralload decreases, protease inhibitors were most effective. Therapiesusing three nucleoside reverse transcriptase inhibitors resulted inpeak survival