Impacto presupuestario de XEN®63 en el tratamiento del glaucoma primario de ángulo abierto en España / Budget impact analysis of the XEN®63 for the treatment of primary open angle glaucoma in Spain

Antecedentes y objetivo Evaluar el impacto económico en España derivado de la introducción del implante XEN®63 como alternativa quirúrgica en el manejo del glaucoma primario de ángulo abierto (GPAA) con o sin cataratas en pacientes refractarios. Materiales y métodos Se diseñó un análisis de impacto presupuestario para estimar los costes del tratamiento quirúrgico del GPAA desde la perspectiva del Sistema Nacional de Salud (SNS) español, en un horizonte temporal de1 año. Los comparadores considerados (trabeculectomía, esclerectomía profunda no perforante, válvula de Ahmed, iStent inject®, Preserflo® microshunt y XEN®45) se corresponden a los empleados en la práctica clínica pública española. Para el cálculo de la población diana, cuotas de mercado y uso de recursos en términos de visitas de seguimiento, procedimientos adicionales y complicaciones poscirugía, se emplearon datos de la literatura y se validaron con un panel de cuatro expertos. Los costes unitarios (€de2021) se obtuvieron de la base de datos ESALUD Resultados la inclusión de XEN®63 podría generar un ahorro de 2.569.737€ tras un año desde su introducción, derivado del ahorro en el coste del implante y del procedimiento (−423.120; −0,7%), de las visitas de seguimiento (−777.407€; −4,5%), de los procedimientos adicionales (−1.048.145€, −20,6%) y de las complicaciones poscirugía (−321.065€, −14,2%). Conclusiones La incorporación de XEN®63 en el arsenal quirúrgico para el tratamiento del GPAA refractario con y sin cataratas podría generar ahorros para el SNS (AU)

Background and objective To evaluate the economic impact in Spain derived from the introduction of the XEN®63 implant as a surgical alternative in the management of primary open angle glaucoma (POAG) with or without cataract in refractory patients. Materials and methods A budget impact analysis was designed to estimate the costs of surgical treatment of POAG from the perspective of the Spanish National Health System (NHS), over a time horizon of 1year. The comparators considered (trabeculectomy, deep non-perforating sclerectomy, Ahmed valve, iStent inject®, Preserflo® microshunt and XEN®45) correspond to those used in Spanish public clinical practice. For the calculation of the target population, market shares and resource use in terms of follow-up visits, additional procedures and post-surgery complications, data from the literature were used and validated with a panel of 4 experts. Unit costs (€2021) were obtained from the ESALUD database. Result The inclusion of XEN®63 could generate savings of €2,569,737 after one year since its introduction, derived from savings in the cost of the implant and procedure (−€423,120; −0.7%), follow-up visits (−€777,407; −4.5%), additional procedures (−1,048,145; −20.6%) and post-surgery complications (−€321,065; −14.2%). Conclusion The incorporation of XEN®63 in the surgical arsenal for the treatment of refractory POAG with and without cataracts could generate savings for the NHS (AU)

Budget impact analysis of the XEN®63 for the treatment of primary openangle glaucoma in Spain.

BACKGROUND AND OBJECTIVE: To evaluate the economic impact in Spain derived from the introduction of the XEN®63 implant as a surgical alternative in the management of primary open angle glaucoma (POAG) with or without cataract in refractory patients. MATERIALS AND METHODS: A budget impact analysis was designed to estimate the costs of surgical treatment of POAG from the perspective of the Spanish National Health System (NHS), over a time horizon of 1 year. The comparators considered (trabeculectomy, deep non-penetrating sclerectomy, Ahmed valve, iStent inject, Preserflo® microshunt and XEN®45) correspond to those used in Spanish public clinical practice. For the calculation of the target population, market shares and resource use in terms of follow-up visits, additional procedures and post-surgery complications, data from the literature were used and validated with a panel of 4 experts. Unit costs (€ 2021) were obtained from the ESALUD database. RESULTS: The inclusion of XEN®63 could generate savings of €2,569,737 after one year since its introduction, derived from savings in the cost of the implant and procedure (-€423,120; -0.7%), follow-up visits (-€777,407; -4.5%), additional procedures (-€1,048,145; -20.6%) and post-surgery complications (-€321,065; -14.2%). CONCLUSIONS: The incorporation of XEN63®in the surgical arsenal for the treatment of refractory POAG with and without cataracts could generate savings for the NHS.

Análise do Impacto Orçamentário da Prevenção de Lesão por Pressão em Idosos Acamados / Analysis of the Budgetary Impact of Pressure Injury Prevention in Bedridden Elderly / Análisis del Impacto Presupuestario de la Prevención de Lesiones por Presión em Ancianos Encamados

Objetivo: Analisar o impacto orçamentário e o incremento de custos da incorporação de superfícies especiais para o manejo da pressão para prevenção de lesão por pressão em pacientes idosos acamados. Método: Análise de impacto orçamentário, seguindo as recomendações da diretriz metodológica análise de impacto orçamentário. Delinearam-se dois possíveis cenários (referência e alternativo 1, 2 e 3). Resultados: O custo em cinco anos no cenário de referência, adotando apenas a estratégia de mudança de decúbito, foi estimado em R$ 253.86,2542,81. Os custos nos cenários alternativos 1, 2 e 3 foram respectivamente, no mesmo período e com os ajustes econômicos, R$ 250.422.191,73, R$ 249.223.263,19 e R$ 248.029.130,37. Conclusão: A utilização de altas tecnologias nem sempre será o diferencial para o melhor desfecho clínico do paciente e poderá acarretar mais custo ao sistema.

Objective:To analyze the budgetary impact and the increase in costs of the incorporation of special surfaces for pressure management to prevent pressure injuries in bedridden elderly patients. Method: Budget impact analysis, following the recommendations of the budget impact analysis methodological guideline. Two possible scenarios were out lined. In the first (alternative) scenario, the elderly receives a prevention strategy that includes the use of a viscoelastic mattress as a pressure distribution surface and a change in position with a minimum interval of 2 hours. In the second scenario (reference), the elderly receives a prevention strategy that only includes a change in position with a minimum interval of 2 hours. All costs were estimated using the macro costing technique. Results: The results of the analysis of the budget impact speak in disfavor, therefore, contrary to the eventual incorporation of the viscoelastic mattress as a complementary strategy to the systematic change of decubitus, of at least every 2 hours as a measure to prevent pressure injuries. Conclusion: The use of high technologies will not always be the differential for the best clinical outcome of the patient and it can result in more cost to the system.

Objetivo:Analizar el impacto presupuestario y el incremento de costes de la incorporación de superfícies especiales para el manejo de la presión para la prevención de lesiones por presión em pacientes ancianos encamados. Método:Análisis de Impacto Presupuestario (AIO), siguiendo las recomendaciones de la Guía Metodológica de Análisis de Impacto Presupuestario. Se esbozaron dos escenarios posibles. Em el primer escenario (alternativo), las personas mayores recibe ecnologiategia de prevención que incluye el uso de um colchón viscoelástico ecnologiaficie de distribución de presiem y un cambio de poemión con un intervalo mínimo de 2 horas. Enel segundo escenario (referencia), los adultos mayore ecnologiana estrategia de prevención que solo incluye el cambio de posición conun intervalo mínimo de 2 horas. Todos los costos se estimaron utilizando la técnica de macro costos. Resultados: Los resultados del análisis de impacto presupuestario hablan desfavorablemente, por tanto, en contra de la eventual incorporación del colchón viscoe ecnologiamo estrategia complementaria al cambio sistemático de decúbito, de al menos cada 2 horas como medida de prevención de lesiones por presión. Conclusión: Se concluye que el ecnologiass tecnologías no siempre será el diferencial para el mejor desenlace clínico del paciente y que puede resultar em mayor costo para el sistema.

Budgetarry impact of the incorporation of claritromycin in the treatment of infection by new coronavirus / Impacto presupuestario de la incorporación de claritromicina en el tratamiento de la infección por nuevos coronavirus / Impacto orçamentário da incorporação da claritromicina no tratamento da infecção pelo novo coronavírus

Introduction: In Brazil, the use of third generation cephalosporins associated with a macrolide (azithromycin or clarithromycin), has been recommended at admission. Objective: To estimate the budgetary impact of the use of clarithromycin as a supporting macrolide in the empirical treatment scheme for patients with Severe Acute Respiratory Syndrome. Method: Budgetary Impact Analysis. Unified Health System perspective, local level. 5-year time horizon. Used the Brazilian Budget Impact Analysis Worksheet. Three alternative scenarios and one reference were analyzed. Results: The five-year cost in the reference scenario was R$ 2,504,887.92. Conclusion: The incorporation of clarithromycin in alternative scenarios may represent an average incremental cost of more than 22% of the budget available for the acquisition of azithromycin in 5 years, which may be economically unfeasible to offer to all patients in hospitals, without having loss in meeting other demands.

Introducción: en Brasil, se recomienda el uso de cefalosporinas de tercera generación asociadas con un macrólido (azitromicina o claritromicina) al ingreso. Objetivo: estimar el impacto presupuestario del uso de claritromicina como un macrólido de apoyo en el esquema de tratamiento empírico para pacientes con síndrome respiratorio agudo severo. Método: Análisis de impacto presupuestario. Perspectiva del Sistema Único de Salud, nivel local. Horizonte temporal de 5 años. Se utilizó la hoja de trabajo de análisis de impacto presupuestario brasileño Se analizaron tres escenarios alternativos y una referencia. Resultados: El costo a cinco años en el escenario de referencia fue de R $ 2.504.887,92. Conclusión: La incorporación de claritromicina en escenarios alternativos puede representar un costo incremental promedio de más del 22% del presupuesto disponible para la adquisición de azitromicina en 5 años, lo que puede ser económicamente inviable para ofrecer a todos los pacientes en hospitales, sin tener pérdida en el cumplimiento de otras demandas.

Introdução: No Brasil, o uso de cefalosporinas de terceira geração associadas a um macrolídeo (azitromicina ou claritromicina), tem sido recomendada na internação. Objetivo: Estimar o impacto orçamentário do uso da claritromicina como macrolídeo coadjuvante no esquema de tratamento empírico de pacientes com Síndrome Respiratória Aguda Grave. Método: Análise de Impacto Orçamentário. Perspectiva do Sistema Único de Saúde, nível local. Horizonte temporal de 5 anos.  Utilizou a Planilha Brasileira de Análise de Impacto Orçamentário. Analisados três cenários alternativos e um de referência. Resultados: O custo em cinco anos no cenário de referência foi de R$2.504.887,92. Conclusão: A incorporação da claritromicina nos cenários alternativos pode representar um custo incremental médio superior a 22% do orçamento disponível para a aquisição de azitromicina em  5 anos, o que podendo ser economicamente inviável a sua oferta para todos os pacientes nos hospital, sem que houvesse prejuízo no atendimento de outras demandas.

Nimotuzumab (CIMAher®) en pacientes cubanos con cáncer de cabeza y cuello estadios III/IV: Análisis de impacto presupuestario / Nimotuzumab (CIMAher®) in Cuban patients with head and neck cancer stage III/IV: Budget impact analysis

En Cuba, el cáncer es la segunda causa de muerte con 24.902 defunciones en el 2018; de ellas, 795 fueron por tumores de laringe y 826 por tumores de labio, cavidad bucal y faringe. El anticuerpo monoclonal nimotuzumab (CIMAher®) está registrado como tratamiento combinado con radioterapia o quimioterapia para el cáncer de células escamosas de cabeza y cuello estadios avanzados. Del mismo se conoce su efectividad y perfil de seguridad, no así el impacto económico que acarrearía la incorporación del mismo al Sistema Nacional de Salud (SNS) cubano; de forma tal de asignar y reajustar presupuestos en la esfera de medicamentos. Por tanto, se hizo necesario realizar un análisis de impacto presupuestario, con el objetivo de estimar el impacto financiero de la incorporación del nimotuzumab (CIMAher®) al paquete de beneficios del SNS cubano. Se tomaron los datos de prevalencia e incidencia de la enfermedad en los estadios III/IV. Se estableció un escenario actual con la terapia radio/quimioterapia secuencial y una tasa de penetración de 100%. El escenario futuro fue radio/quimioterapia secuencial + nimotuzumab (CIMAher®) con tasa anual de penetración 20, 40, 60, 80 y 100 por ciento. La perspectiva fue desde el SNS y un horizonte temporal de 5 años (2019-2023). El análisis de impacto presupuestal mostró que, desde perspectiva, horizonte y tasa de penetración establecidos, el SNS debe invertir aproximadamente de 10 a 65 millones de pesos cubanos (CUP); cifras menores al presupuesto destinado a salud pública(AU)

In Cuba, cancer is the second cause of death with 24,902 deaths in 2018; 795 were due to laryngeal tumors and 826 due to tumors of the lip, oral cavity and pharynx. The monoclonal antibody nimotuzumab (CIMAher®) is registered as a combined treatment with radiotherapy or chemotherapy for advanced squamous cell carcinoma of the head and neck. Its effectiveness and safety profile are known, but not their economic impact into the Cuban National Health System (NHS); in order to allocate and readjust budgets in the field of medicines. Therefore, it was necessary to perform a budget impact analysis in order to estimate the financial impact of the incorporation of nimotuzumab (CIMAher®) into the benefits package of the Cuban NHS. Data on prevalence and incidence of the disease in stages III / IV were taken into account. The current scenario was with the therapy radio/sequential chemotherapy and penetration rate of 100 percent. The future scenario was radio/sequential chemotherapy + nimotuzumab (CIMAher®) and annual penetration rate of 20, 40, 60, 80 and 100 percent. The perspective was from the NHS and a time horizon of five years (2019-2023). The budget impact analysis showed that from an established perspective, horizon and penetration rate, the NHS must invest 10-65 million Cuban pesos (CUP) approximately; lower values than the budget allocated to Public Health(AU)

Análisis de Minimización de Costo e Impacto Presupuestario del Tratamiento ARV con Abacavir/Lamivudina para el VIH/SIDA en México.

OBJECTIVE: In Mexico, health authorities have raised reach the total of people living with HIV/ AIDS who need treatment have access to it, with the proper use of the best ARV therapies. Evaluate health spending would mean the management of patients with HIV/AIDS with the first-line therapy of abacavir/lamivudine with respect to tenofovir/emtricitabine and lamivudine-zidovudine. METHODS: A literature review was conducted to seek evidence from clinical studies that demonstrated similar efficacy of ARV treatment between abacavir-lamivudine medications compared with other options. To calculate the incremental cost between these treatments, there was a Budget Impact Analysis and a pharmacoeconomic model was constructed to estimate the economic benefits by increasing its market share. RESULTS: Increased market penetration of abacavir/lamivudine represent a save of $ 44.8 million for the National Health System in Mexico during the years 2012-2017, without compromising the quality and effectiveness of treatment. Furthermore, this increase in market share with abacavir-lamivudine, the National Health System could get an additional benefit to deal on average 5.197 with HIV patients by 5 years with ARV therapies in Mexico. CONCLUSIONS: The use of abacavir/lamivudine in ARV treatment of patients with HIV/AIDS is a cost saving for the Mexican health System, which leads to a potential reduction in resources of US$44.8 million in treatment costs in the five projected years.