Análise de preços praticados nas aquisições de medicamentos pelos consórcios de saúde em comparação com as instituições municipais para o período de 2017 a 2018 / Analysis of practical prices in the acquisition of medicines by the health consortia compared to municipal institutions in the period from 2017 to 2018

Objetivo: Identificar se as aquisições de medicamentos realizadas pelos Consórcios de Saúde foram mais eficientes, em termos econômicos, que as compras realizadas individualmente pelas Instituições Municipais, para os anos de 2017 e 2018. Métodos: Análise descritiva da amostra, empregando as medidas de tendência central, análise econômica e cálculo do percentual econômico. Resultados: Os valores obtidos mostraram eficiência nas compras dos consórcios, refletidos na maior quantidade adquirida e no menor preço praticado, para a maioria dos itens analisados no período de referência. Conclusão: As compras pelos Consórcios de Saúde proporcionaram mais economia em comparação com as compras realizadas pelas Instituições Municipais, mostrando-se como uma opção para obter economicidade dos recursos destinados à saúde.

Objective: To identify whether the drug purchases made by the Health Consortia were more efficient, in economic terms, than the purchases made individually by the Municipal Institutions, for the years 2017 and 2018. Methods: Descriptive analysis of the sample, using the trend measures central, economic analysis and calculation of the economic percentage. Results: The values obtained showed efficiency in consortium purchases, reflected in the greater quantity acquired and the lower price practiced, for most of the items analyzed in the reference period. Conclusion: Purchases by Health Consortia provided more savings compared to purchases made by Municipal Institutions, proving to be an option to obtain economic resources for health.

El copago farmacéutico en España tras la reforma del año 2012 desde la perspectiva del usuario. ¿Evidencias de inequidad? / Pharmaceutical copayment in Spain after the 2012 reform from the user's perspective. Evidence of inequity?

Objetivo: Identificar cuáles son las características que se asocian con aquella parte de la población que manifiesta no poder comprar todos los medicamentos recetados por un médico de la sanidad pública, relacionándolas con los criterios que definen el sistema de copago farmacéutico fijado por el Real Decreto 16/2012, con la finalidad de orientar cambios que eliminen posibles inequidades. Método: Estudio de asociación y relación causal entre la dificultad para comprar medicamentos recetados por la sanidad publica que manifiestan los usuarios a través de la encuesta Barómetro Sanitario y un conjunto de variables que reflejan la capacidad económica, el nivel de necesidad de servicios de salud y que, a su vez, forman parte de los criterios de copago, mediante técnicas de análisis de correspondencias múltiples y de regresión. Resultados: Tras el análisis de las oleadas correspondientes a los años 2013-2017 se ha encontrado evidencia a favor de la hipótesis de que los usuarios más pobres, los activos y los de peor salud manifiestan mayores dificultades para acceder a los medicamentos que les han sido recetados por un médico de la sanidad pública. Conclusiones: Los resultados son compatibles con la hipótesis de que el copago actual es percibido como una barrera de acceso a medicamentos necesarios por parte de algunos sectores de la población. Aunque del trabajo pueden derivarse ciertas acciones dirigidas a reducir dicha barrera, es necesario realizar más investigación que tenga en cuenta la opinión de los usuarios. (AU)

Objective: Identify what are the characteristics of the part of the population that says they cannot buy all the medicines prescribed by a public health doctor, relating them to the criteria that define the pharmaceutical co-payment system established by Royal Decree 16/2012, with the purpose of guiding changes that eliminate possible inequities. Method: Association study and causal relationship between the difficulty to buy prescription drugs that users expressed through the survey called Health Barometer and a set of variables that reflect the degree of need for health services and the economic capacity, that is also part of the co-payment criteria, using multiple correspondence and regression analysis techniques. Results: After the analysis of the data corresponding to the years 2013-2017, evidence has been found in favour of the hypothesis that the poorest users, as well as the working ones and those with worst health show greater difficulties in accessing the medicines which have been prescribed by a public health doctor and, consequently, changes are proposed in the copayment system aimed at eliminating or, at least, reducing such differences. Conclusions: The results obtained are compatible with the hypothesis that the current copayment is perceived as a barrier to access necessary medicines by some sectors of the population. Although certain actions aimed at reducing this barrier can be derived from the work, more research that considers the opinion of the users is needed. (AU)

[Pharmaceutical copayment in Spain after the 2012 reform from the user's perspective. Evidence of inequity?] / El copago farmacéutico en España tras la reforma del año 2012 desde la perspectiva del usuario. ¿Evidencias de inequidad?

OBJECTIVE: Identify what are the characteristics of the part of the population that says they cannot buy all the medicines prescribed by a public health doctor, relating them to the criteria that define the pharmaceutical co-payment system established by Royal Decree 16/2012, with the purpose of guiding changes that eliminate possible inequities. METHOD: Association study and causal relationship between the difficulty to buy prescription drugs that users expressed through the survey called Health Barometer and a set of variables that reflect the degree of need for health services and the economic capacity, that is also part of the co-payment criteria, using multiple correspondence and regression analysis techniques. RESULTS: After the analysis of the data corresponding to the years 2013-2017, evidence has been found in favour of the hypothesis that the poorest users, as well as the working ones and those with worst health show greater difficulties in accessing the medicines which have been prescribed by a public health doctor and, consequently, changes are proposed in the copayment system aimed at eliminating or, at least, reducing such differences. CONCLUSIONS: The results obtained are compatible with the hypothesis that the current copayment is perceived as a barrier to access necessary medicines by some sectors of the population. Although certain actions aimed at reducing this barrier can be derived from the work, more research that considers the opinion of the users is needed.

Pharmaceutical procurement among public sector procurers in CARICOM / Compras farmacéuticas por parte de organismos del sector público de CARICOM / Aquisição de produtos farmacêuticos por compradores do setor público da CARICOM

ABSTRACT Objective. To examine multiple aspects of the medicines in CARICOM procurement markets, including manufacturer headquarters location, regulatory history, and type (innovator versus generic); the proportion of World Health Organization (WHO) essential medicines; and the most expensive medicines procured. Methods. An analysis of procurement information from selected CARICOM procurers. Four public sector procurement lists were obtained based on public availability or sharing of data from public sector procurers. Analyses were based on parameters available or deduced from these data. Results. The majority of products come from manufacturers headquartered in North America and Europe (63%-67%). The percentage of medicines procured from generic companies is 60%-87%; and 25%-50% of medicines procured are on the WHO Essential Medicines List. Wide price variations exist in the most expensive medicines purchased. Conclusions. The analysis identifies vulnerabilities and opportunities in the procurement situation of CARICOM states, particularly related to quality and rational use of medicines. This analysis represents a baseline that governments and other stakeholders can use in the future.

RESUMEN Objetivo. Revisar los múltiples aspectos de los medicamentos en los mercados de compras y los proveedores de CARICOM, como la ubicación de la sede del fabricante, el historial de regulación, el tipo (patentado versus genérico); la proporción de medicamentos esenciales de la Organización Mundial de la Salud (OMS); y los medicamentos comprados más caros. Métodos. Se analizó información sobre la compra por parte de determinados organismos de CARICOM. La información procedía de cuatro listas de organismos del sector público que realizan las compras, que se consiguieron en función de su disponibilidad pública o de los datos distribuidos por los organismos del sector público que realizan las compras. Los análisis estaban basados en los parámetros disponibles o derivados de estos datos. Resultados. La mayoría de los productos proviene de fabricantes radicados en América del Norte y Europa (entre 63% y 67%). El porcentaje de medicamentos que se compra de empresas genéricas oscila entre 60% y 87%; y de 25% a 50% de los medicamentos que se compran están en la Lista de Medicamentos Esenciales de la OMS. Hay una gran divergencia de precios entre los medicamentos comprados más caros. Conclusiones. En el análisis se han encontrado vulnerabilidades y oportunidades con respecto a la situación de las compras de medicamentos de los Estados de CARICOM, especialmente en cuanto a la calidad y al uso racional de los medicamentos. Este análisis representa una línea de base que los gobiernos u otros interesados directos pueden utilizar en el futuro.

RESUMO Objetivo. Examinar vários aspectos relacionados aos mercados e fornecedores de produtos farmacêuticos da CARICOM, incluindo a localização da sede do laboratório fabricante, histórico regulatório e tipo de produtos (inovadores versus genéricos); proporção de medicamentos adquiridos que constam da relação de medicamentos essenciais da Organização Mundial da Saúde (OMS); e medicamentos mais caros comprados. Métodos. Foi realizada uma análise de informação sobre compras feitas por compradores selecionados da CARICOM. Quatro listas de compras do setor público foram obtidas com informação de acesso público ou compartilhada pelos compradores. As análises foram feitas com base em parâmetros disponíveis ou inferidos a partir dos dados. Resultados. A maioria dos produtos farmacêuticos é proveniente de laboratórios com sedes na América do Norte e Europa (63%-67%). Do total, 60%-87% dos medicamentos adquiridos são de laboratórios de produtos genéricos e 25%-50% constam da relação de medicamentos essenciais da OMS. Existe uma ampla variação nos preços dos medicamentos mais caros comprados. Conclusões. Foram identificadas fragilidades e oportunidades na situação de compras dos países da CARICOM, em particular relacionadas à qualidade dos produtos e ao uso racional dos medicamentos. Esta análise serve de referência a ser usada futuramente pelos governos e outras partes interessadas.

Cobertura de medicamentos de alto costo para enfermedades huérfanas en Argentina. Aspectos conceptuales, metodológicos y de aplicabilidad para informar la toma de decisiones / Coverage of high-cost drugs for orphan diseases in Argentina. Conceptual, methodological and applicability aspects to inform decision making

INTRODUCCIÓN El tratamiento de las enfermedades poco frecuentes (EPOF) involucra en parte medicamentos caracterizados por tener un costo de adquisición muy elevado, por lo que suelen representar un impacto económico elevado para los sistemas sanitarios y muchas veces para los mismos pacientes. Este estudio propone herramientas con el fin de asistir a priorizar y justificar políticas que puedan hacer frente a estos dilemas. METODOS se llevaron a cabo diferentes componentes de análisis específicos con el fin de describir el estado de situación local e internacional en relación a la cobertura de estos medicamentos; desarrollar una metodología de impacto presupuestario en salud que sea de utilidad para los financiadores en estos medicamentos, junto con el análisis de un caso; y proponer una serie de criterios que deberían ser considerados a nivel local en la toma de decisión sobre la cobertura de estos medicamentos. RESULTADOS La fragmentación del sistema de salud argentino dificulta el acceso oportuno a los tratamientos de las EPOF. Por otro lado, es notorio el avance en esta temática en países de altos ingresos, que demostraron presentar sólidos criterios al momento de definir la financiación, cobertura y/o reembolso de estos medicamentos. Los hallazgos obtenidos de análisis locales demuestran que la incorporación de medicamentos para el tratamiento de enfermedades huérfanas avanza sobre los presupuestos de salud en los últimos años. Se recomiendan entonces criterios específicos con relación al proceso de favorecer el acceso de la población a estas tecnologías, consideradas de alto valor social. DISCUSIÓN Los hallazgos de este estudio contribuyen a avanzar en el análisis y posibles soluciones de los problemas que surgen en lagestión de las EPOF en el marco de un sistema de salud fragmentado

La guía farmacoeconómica una herramienta útil en salud pública / The pharmacoeconomic guide a useful tool in public health

Resumen Introducción: Los medicamentos son insumos que generan gastos en salud y las guías de evaluación económica son muy útiles, porque permiten valorar la relación costo y efecto que producen los medicamentos en las personas; pero también, en los sistemas de salud y la sociedad. Objetivo: Realizar una revisión descriptiva del tema de las guías farmacoeconómicas. Método: Se seleccionaron documentos de interés, en texto completo, desde las bases de datos y sitios en Internet, entre 1998-2018 mediante las palabras clave. Se realizó una lectura crítica de cada documento y se desarrolló una síntesis en cada sección en que se organizó este documento. Resultados: Los medicamentos son tecnologías en salud que requieren de evaluaciones económicas y la aplicación de las guías farmacoeconómicas, generan resultados de utilidad para el proceso de toma de decisión en el sector salud. Las guías, se desarrollaron hace más de treinta años; en algunos países son de carácter obligatorio, en otros no son de uso obligatorio o solo de recomendación, cuentan con ventajas y desventajas, objetivos, alcances, diferentes denominaciones o nombres, justificaciones, audiencias específicas y procesos particulares para su elaboración que dependen de un conjunto de factores; existen agencias evaluadoras en algunos países en el ámbito internacional. El contenido de una guía es general y cumple con los criterios estándares establecidos; su existencia es un aporte a la mejora de la calidad en diferentes áreas. Conclusión: Los hallazgos evidencian que una guía farmacoeconómica es un recurso útil para la evaluación económica de medicamentos, que genera resultados conducentes a acciones de interés en salud pública.

Abstract Introduction: Medications are inputs that generate health expenditures and economic evaluation guides are very useful because they allow us to assess the cost and effect of medicines on people, besides health systems and society. Objective: To conduct a descriptive review relative to the topic of pharmacoeconomic guidelines. Method: Full text material was selected from the databases and Internet sites, between 1998-2018, for which keywords were used. After a critical reading of every document, summaries were made for each section in which this document was organized. Results: Medications are health technologies that must have economic evaluations, and pharmacoeconomic guidelines generate useful results for the decision-making process that affects the health sector. Guidelines were made more than thirty years ago; in some countries they are mandatory and in others not mandatory or only a recommendation, they have advantages and disadvantages, objectives, scope, denominates names, justifications, specific audiences and a particular process for its development that depends on a set of factors; there are evaluation agencies in some countries in the international arena. The content of a guide is general and meets the criteria of established standards, its existence contributes to the improvement of quality in different areas. Conclusion: The results evidence that application of a pharmacoeconomic guide is useful to medicines economic evaluation, which generates results that lead to actions that are of interest in public health.

Impacto económico institucional del programa Receta Resurtible con pacientes diabéticos / Institutional economic impact of the Receta Resurtible (Resupply Prescription) program in diabetic patients

Objetivo: determinar el impacto económico institucional del programa Receta Resurtible con pacientes diabéticos. Material y métodos: estudio de costos antes y después del programa Receta Resurtible con pacientes diabéticos. El costo promedio incluyó perfil de uso y costo unitario. El perfil de uso se determinó para Consulta externa, Farmacia y medicamentos. En el análisis se plantearon escenarios y se adoptaron supuestos. Resultados: el promedio de consultas antes y después se ubica en 6.45 y 4.73, respectivamente. La dotación de medicamentos fue 55.8% y 99%. El impacto del programa para una unidad de medicina familiar con 6400 pacientes diabéticos, de los cuales 18% se encuentra en el programa Receta Resurtible, permite un ahorro de $ 490 366 en la consulta de Medicina familiar y atención en Farmacia, sin embargo existe un incremento de $112 100 por consumo de medicamentos, el ahorro total en este escenario es de $378 266. Conclusión: el impacto económico del programa Receta Resurtible es benéfico para la institución.

Objective: To determine the institutional economic impact of the Resupply Prescription program in diabetic patients. Material and methods: Study of costs before and after the Resupply Prescription program with diabetic patients. The average cost included usage profile and unit cost. The profile of use was determined for External consultation, Pharmacy and medication. In the analysis, scenarios were raised and assumptions were adopted. Results: The average of before and after consultations is located at 6.45 and 4.73, respectively. The medication provision was 55.8 and 99%. The impact of the program for a Family Medicine Unit with 6400 diabetic patients, of which 18% is in the Resupply Prescription program, allows a saving of $ 490 366 in the consultation of Family Medicine and Pharmacy, however there is a increase of $ 112 100 for drug consumption, the total saving in this scenario is $ 378 266. Conclusion: The economic impact of the Resupply Prescription program is beneficial for the institution.

Uso y gasto en medicamentos antihipertensivos en el subsector público de salud de la provincia del Neuquén en 2012-2014 / Use of and spending on antihypertensive drugs in the public health subsector of Neuquén province in 2012-2014

INTRODUCCIÓN: la hipertensión arterial es un factorde riesgo con alto impacto en la morbi-mortalidad cardiovascular. Laprescripción de antihipertensivos no siempre sigue las recomendacionesvigentes, lo que representa un uso ineficiente de los recursos.OBJETIVOS: Evaluar el uso de medicamentos antihipertensivos, costosasociados y grado de adecuación a las recomendaciones provinciales.MÉTODOS: Se analizaron las compras de medicamentosantihipertensivos de la Subsecretaría de Salud provincial y entregasdel Plan Remediar para 2012-2014. Los consumos se expresaron endosis diaria definida (DDD)/1000 habitantes. RESULTADOS: El gastoen medicamentos antihipertensivos representó un 1,14% del total delgasto anual en medicamentos. Las DDD/1000 habitantes provistasen los años sucesivos fueron 75,5; 86,7 y 73,8. El sistema público deSalud provincial financió dos terceras partes, y el Plan Remediar elresto. El costo de adquisición por compra directa fue, en promedio,un 79% mayor que el de licitación pública. Más de dos tercios de lasDDD correspondieron a enalapril e hidroclorotiazida. CONCLUSIONES:La erogación en antihipertensivos representa una mínima partedel gasto provincial en medicamentos. El patrón de prescripción nose adecua completamente a la Guía de Práctica Clínica provincial, conuna relación hidroclorotiacida-enalapril inversa a la recomendada.Pese a esto, el 80% de las DDD dispensadas corresponden a estosdos medicamentos, lo que se considera una forma de uso racional.

INTRODUCTION: hypertension is a risk factor withhigh impact on cardiovascular morbidity and mortality. The prescriptionof antihypertensive drugs does not always follow currentrecommendations, which represents an inefficient use of resources.OBJECTIVES: To assess the use of antihypertensive medications,costs and adequacy to provincial recommendations. METHODS:Information on antihypertensive medications purchase was obtainedfrom provincial Health Undersecretariat, and deliveries ofPlan Remediar for 2012-2014. Drug use was expressed as defineddaily doses (DDD) per 1000 inhabitants. RESULTS: Spending onantihypertensive medications accounted for 1.14% of total annualdrug spending. The DDD/1000 inhabitants provided were 75.5 in2012, 86.7 in 2013 and 73.8 in 2014. The provincial public healthsystem funded two thirds, and Plan Remediar the remaining third.The average cost of direct purchase was 79% higher than with publicauction purchase. More than two thirds of DDD corresponded toenalapril (EN) and hydrochlorothiazide (HCT). CONCLUSIONS:Spending on antihypertensive drugs represents a minimum fractionof total provincial drug spending. The prescription pattern doesnot fully adhere to the clinical practice guidelines, with a HCT-ENrelationship that is inverse compared to the recommended one.In spite of this, 80% of the dispensed DDD correspond to thesetwo drugs, which is considered a rational use.

Estructura del consumidor, la frontera de producción y el marco de bienestar creado por la interacción del consumidor, productor y el mercado vinculado a la oferta y demanda de medicamentos / Structure of Consumer, the Frontier of Production and Part of Welfare Created by the Interaction of Consumer, Producer and the Market Linked to the Supply and Demand for Drugs / Estrutura do consumidor, a fronteira de produção e parte do bem-estar criado pela interação do consumidor, o produtor e o mercado ligado à oferta e a procura de medicação

Introducción: La sustentación del sector farmacéutico desde la economía representa un reto para su consideración, respecto al papel que desempeñan los actores inmiscuidos en el mercado de los medicamentos. Objetivo: Caracterizar la fundamentación económica del sector, la estructura del consumidor, la frontera de producción y el marco de bienestar creado por la interacción del consumidor, el productor y el mercado vinculado a la oferta y demanda de medicamentos. Metodología: El análisis institucional funge como herramienta metodológica para allanar la composición de cada uno de los actores relacionados desde la combinación económica, jurídica y social, cuya máxima se encuentra en el acceso, disposición y oferta general de medicamentos. Desarrollo: La diversificación de agentes económicos, particularmente empresariales, financieros e industriales en el sector farmacéutico, ha dejado por fuera de la discusión a los consumidores, pacientes o usuarios. Conclusiones: El sector farmacéutico internacional está en mora de reorientar el perfil económico que lo ha caracterizado, en un campo en el que los medicamentos hacen las veces de bienes meritorios.

Introduction: The bearing capacity of the pharmaceutical sector from the economy presents a challenge for its consideration, with regard to the role played by the actors involved in the drugs market. Aim: To characterize the economic foundation of the sector, the structure of the consumer, production frontier and the framework of welfare created by the interaction of the consumer, the producer and the market linked to the supply and demand of drugs. Methodology: Institutional analysis serves as a methodological tool to smooth out the composition of each of the actors since the economic, legal and social combination whose maximum is found in access, provision and general supply of drugs. Development: The diversification of economic, particularly business, financial and industrial agents in the pharmaceutical sector has left out of the discussion to consumers, patients and users. Conclusions: The international pharmaceutical industry is in arrears of reorienting the economic profile that has characterized, in a field in which drugs make meritorious goods as.

Introdução: A capacidade de rolamento do sector farmacêutico da economia é um desafio para a sua consideração, no que se refere o papel desempenhado pelos atores envolvidos no mercado de drogas. Objetivo: Caracterizar a base económica do sector, a estrutura do consumidor, fronteira de produção e a estrutura de bem-estar criado pela interação do consumidor e produtor o mercado ligado à oferta e a procura de drogas. Metodologia: Análise institucional serve como uma ferramenta metodológica para suavizar a composição de cada um dos atores, desde a combinação econômica, jurídica e social, cujo máximo é encontrada no acesso, disponibilização e fornecimento geral de drogas. Desenvolvimento: A diversificação dos agentes económicos, particularmente negócios, financeiros e industriais do setor farmacêutico, deixou fora da discussão para os consumidores, pacientes e usuários. Conclusões: A indústria farmacêutica internacional está em atraso de reorientar o perfil econômico que caracterizou, em um campo em que drogas fazem bens meritórios como.

Evaluación de costo/efectividad de tres combinaciones fijas de acetaminofén y opiáceos para el manejo del dolor agudo en Colombia / Cost/effectiveness evaluation of three fixed combinations of acetaminophen and opioids in the management of acute pain in Colombia

Objective: To compare the cost-effectiveness of three different formulations indicated for moderate and severe acute pain, commercialized in Colombia [acetaminophen 500 mg + codeine 30 mg (AC), acetaminophen 500 mg + hydrocodone 5 mg (AH) and acetaminophen 325 mg+ tramadol 37.5 mg (AT)]. Materials and methods:Cost-effectiveness analysis using the NNT as the health outcome indicator. The costs were evaluated in two specific settings: Institutional Channel (IC), representing the cost for the Colombian Ministry of Health (SISMED 2011); Retail Channel (RC), representing consumer prices, obtained from the IMS annual average for 2011, plus an adjustment to include the average profit margin for pharmacies (10%). The incremental cost effectiveness ratios (ICER) were calculated for the three formulations and the two settings (IC and RC). The intervention values are expressed in Colombian pesos (COP). Results: The prices/NNT for each formulation were $1816 COP/2.2 for AC, $4772 COP/2.3 for AH and $5342/2.6 for AT. Using these data and taking AC as the comparator, the ICER for the other formulations shows the following results: in the RC, $5065 COP for AT and $19,600 COP for AH; in the IC setting, $8790 COP for AT and $29,460 COP for AH. The probabilistic sensitivity analysis demonstrated that the majority of simulation results fell between the 1st and 4th quadrants of the cost-effectiveness matrix, using AC as a reference. Conclusion: The analysis, from the payer and patient perspectives, demonstrates that the AC formulation has a lower cost and is more effective inreducingpain within the first 4-6 h after administration, compared with the AH and AT formulations in their specific indications.

Objetivo: Comparar diferencias en costo-efectividad de 3 formulaciones comercializadas en Colombia (acetaminofén 500 mg + codeína 30 mg [AC], acetaminofén 500 mg + hidrocodona5 mg [AH] y acetaminofén 325 mg + tramadol 37,5 mg [AT]) indicadas para el tratamiento del dolor agudo moderado-severo. Materiales y métodos: Análisis de costo-efectividad, usando el NNT como medida de desenlace. Los costos fueron evaluados en 2 canales específicos: canal institucional (CI), representado por los costos relacionados con el medicamento consignados en SISMED 2011,y canal al por menor (CM), que representa los precios al consumidor tomados de IMS promedio anual 2011 más margen de farmacia (10%). Se calcularon las razones de costo-efectividad incremental (RCEI) para las 3 formulaciones en cada canal (CI y CM). Los valores de las intervenciones fueron expresados en pesos colombianos. Resultados: Los precios/NNT para cada formulación fueron $1.816 COP/2,2 para AC, $4.772COP/2,3 para AH y $5.342/2,6 para AT. Con base en estos datos y tomando AC como el comparador, las RCEI para las otras formulaciones fueron: en el CM, $5.065 COP para la formulación AT y $19.600 COP para la formulación AH; en el CI, $8.790 COP para la formulación AT y$29.460 COP para la formulación AH. El análisis de sensibilidad probabilístico evidencia que las observaciones simuladas se ubican entre el primer y el cuarto cuadrante del plano de costo-efectividad, tomando como referente AC. Conclusión: El análisis, desde la perspectiva del tercer pagador y el paciente, permite concluir que la formulación AC tiene un menor costo y mayor efectividad para reducir el dolor en las primeras 4-6 h, comparada con AH y AT es sus indicadores específicos.

Desempeño predictivo y clínico de un dispositivo target-controlled infusion para sevofluorano en una estación de trabajo convencional: correlación farmacocinética del modelo empleado / Predictive and clinical performance of a target-controlled infusion device for sevoflurane at a conventional workstation: Pharmacokinetic correlation of the model used

Introducción: La racionalización de recursos y el calentamiento global han despertado el interés en la anestesia inhalatoria con flujos mínimos (0,3-0,5 l/min). Objetivos: Conocer el desempeño predictivo, clínico y la correlación farmacocinética de un dispositivo target-controlled infusion (TCI) para sevofluorano. Metodología: Estudio prospectivo, longitudinal y analítico en 25 pacientes adultos. Flujo de gas fresco empleado 0,5 l/min. Concentración objetivo de sevofluorano 1,2% v/v. Infusión continua y variable en el circuito de la estación de anestesia. Controlador desarrollado con LABVIEW 6.1. Datos hemodinámicos, respiratorios y profundidad anestésica capturados cada 5 s con software de la estación de anestesia. Se determinó en la primera hora: sesgo (Mediana del Error Predictivo, MDPE%), inexactitud (Mediana del valor absoluto del Error Predictivo, MDAPE%), oscilación y divergencia del TCI; análisis del área bajo la curva de las concentraciones objetivo y espirada con pkcollapse STATA-12. Resultados expresados en media (IC 95%) y mediana [IQR]*. Resultados: Concentración objetivo empleada 1,22 [1,14-1,37]%*, alcanzada en 04:07 [03:1506:15]* min:s (en rama espiratoria). Duración anestésica 1:10:50 (0:56:57-1:24:43) h:min:s. Consumo de sevofluorano 6,9 (5,7-8,0) ml. MDPE% -12,8 (-17,6 a -8,1)%; MDAPE% 15,9 (11,919,8) %; oscilación 6,9 (5,0-8,7) % y divergencia 0,89 (-5,96-7,7)%h-1. Interacciones por hora sobre el TCI de 3 (2-4). Correlación del área bajo la curva, Spermann rho = 0,8577; p < 0,00001. La inexactitud ≥ 15% se asoció con edad > 65 años y obesidad. Conclusiones: El TCI sevoflurane© ó buen desempeño, la concentración objetivo se alcanzó rápidamente y se mantuvo estable, siendo necesarias pocas interacciones sobre el dispositivo durante la primera hora. No hubo sobredosificación ni alteraciones clínicas significativas.

Introduction: Good governance of resources and global warming has attracted interest on minimal flow (0.3-0.5 l/min) inhalation anesthesia. Objectives: To evaluate the predictive and clinical performance of a TCI (Target-controlled infusion) device, and its pharmacokinetic correlation for sevoflurane. Methods: Prospective, longitudinal, and analytical study on 25 adult patients. Fresh gas flow used 0.5 l/min. Target concentration of 1.2% (v/v). Continuous and variable infusion into the circuit of the anesthesia workstation. Controller developed with LABVIEW 6.1. Hemodynamic, respiratory and anesthetic depth data collected every 5 s using the anesthesia workstation software. Bias (MDPE%), inaccuracy (MDAPE%), wobble, and divergence of the TCI device were determined in the first hour. STATA-12 pk collapse was used to analyze the area under the curve of the target and expired concentrations. The results are expressed as Mean (CI 95%) and Median [IQR]*. Results: Target concentration used 1.22 [1.14-1.37] %*, reached in 04:07 [03:15-06:15]* min:s (expiratory branch). Anesthetic duration 1:10:50 (00:56:57-1:24: 43) h:min:s. Sevoflurane consumption 6.9 (5.7-8.0) ml. MDPE% -12.8 (-17.6 to -8.1) %;MDAPE% 15.9 (11.9-19.8) %;wobble 6.9 (5.0-8.7)% and divergence 0.89% (-5.96 to 7.7)%h-1. Interactions per hour on the TCI of 3 (2-4). Correlation of the area under the curve, Spearman's rho = 0.8577, p < 0.00001. =15% inaccuracy was associated with age >65 years and obesity. Conclusions: The TCI sevoflurane© showed good performance, and the target concentration was rapidly reached and remained stable, with few interactions with the device needed during the first hour. There were neither overdosing nor clinically significant alterations.

Acceso a medicamentos y situación del mercado farmacéutico en Ecuador / Access to drugs and the situation of the pharmaceutical market in Ecuador

Resulta fundamental, en el área de la salud pública, conocer la estructura y dinámica del mercado farmacéutico ecuatoriano, su segmentación entre el sector público y privado, así como su relación con la demanda y oferta de medicamentos tanto genéricos como de marca. Para esto, se realizó un estudio descriptivo observacional con la información obtenida de las bases de datos científicos, institucionales, técnico-administrativas y económicas disponibles. Además, se revisó la información científica referente al mercado farmacéutico ecuatoriano y regional a través de los buscadores PubMed y Ovid. Los medicamentos de marca dispensados en el país corresponden 69,6% a marcas y los genéricos a 30,4%. En Ecuador, del total de medicamentos registrados, 1 829 (13,6%) son considerados de venta libre y 11 622 (86,4%) son de venta bajo prescripción médica. De las ventas, 93,15% corresponden a medicamentos de marca y solo 6,85% a genéricos. El 90% de las farmacias se hallan en la zona urbana y solo 10% a nivel rural. El incremento de precios en los últimos cinco años fue de 12,5% para los medicamentos de marca y de 0,86% para genéricos. La dispensación y consumo de medicamentos de marca es 2,3 veces mayor que la de genéricos. La mayoría de las farmacias se localizan en la zona urbana, demostrando que existe una relación entre el poder adquisitivo y el acceso a los medicamentos. A pesar de que la autoridad reguladora estipula que 13% de medicamentos son de venta libre, aproximadamente 60% de la población accede a medicamentos sin prescripción médica.

In the area of public health, it is fundamental to understand the structure and dynamics of the Ecuadorian pharmaceutical market, its segmentation between the public and private sectors, and its relationship with supply and demand, both for generic and brand-name drugs. To achieve this, an observational descriptive study was conducted with information obtained from the available scientific, institutional, technical-administrative, and economic databases. Furthermore, the scientific information concerning the Ecuadorian and regional pharmaceutical market was reviewed through the PubMed and Ovid search engines. In Ecuador, 69.6% of dispensed drugs are brand-name and 30.4% are generics. Of all registered drugs in the country, 1 829 (13.6%) are considered over-the-counter and 11 622 (86.4%) are for sale under medical prescription. In terms of sales, 93.15% correspond to brand-name drugs and only 6.85% to generics. Ninety percent of the pharmacies are located in urban areas and only 10% in rural areas. In the last five years, prices have increased by 12.5% for brand-name drugs and 0.86% for generics. Brand-name drugs are dispensed and consumed 2.3 times more than generics. The majority of pharmacies are located in urban areas, showing that there is a relationship between purchasing power and access to drugs. Although the regulatory authority stipulates that 13% of drugs should be over-the-counter, approximately 60% of the population acquires drugs without a medical prescription. .

Há irracionalidades no consumo de inibidores de apetite no Brasil? Uma análise farmacoeconométrica de dados em painel / Are there irrationalities in the consumption of anti-obesity drugsin Brazil? A pharmaco-econometric analysis of panel datasets

Este estudo busca analisar os determinantes do consumo de inibidores de apetite (anfepramona, femproporex, mazindol e sibutramina) por meio da estimação de um modelo dinâmico de dados em painel para as capitais brasileiras e do Distrito Federal (DF) no período de 2009 a 2011. Os resultados revelam que o consumo de inibidores de apetite não acompanhou a distribuição geográfica dos indivíduos com excesso de peso e com obesidade nas unidades estudadas. Do consumo recorrente de inibidores, 79% são explicados pelo ocorrido no passado. Dentre as variáveis que explicam o consumo de inibidores, destacam-se os percentuais de adultos com obesidade e que dos que consomem frutas e hortaliças e a taxa de cobertura de planos de saúde. A análise farmacoeconométrica sugere que há problemas no uso racional dos inibidores de apetite nas capitais brasileiras e no DF, seja no que tange ao consumo desses medicamentos com outros fármacos - considerados ilegais pelo Conselho Federal de Medicina e pela Anvisa - e, também, na indicação terapêutica de uso desses produtos.

The scope of this study is to analyze the determinants of the use of appetite suppressants (amfepramone, femproporex, mazindol and sibutramine) through the estimation of a dynamic panel dataset model for the Brazilian state capitals and the Federal District (DF) in the period from 2009 to 2011. The results show that consumption of appetite suppressants did not follow the geographic distribution of overweight and obese individuals across the capitals and DF. There is a recurrent consumption of appetite inhibitors, in which 79% of the current consumption of these drugs is explained by past consumption. Among the variables that explain the use of inhibitors, the percentage of obese adults, the percentage of adults who habitually consume fruit and vegetables, and the coverage rate of health plans stand out. The pharmaco-econometric analysis suggests that there are problems in the rational use of appetite suppressants in the Brazilian state capitals and the Federal District with respect to both the combined consumption of these drugs with other medicines - deemed illegal by the Federal Council of Medicine and ANVISA - and in the therapeutic prescription of these products.

[Cost-effectiveness analysis of etanercept compared with other biologic therapies in the treatment of rheumatoid arthritis]. / Etanercept y otras terapias biológicas en artritis reumatoide. Un análisis de costo-efectividad.

OBJECTIVE: to conduct cost-effectiveness analysis of etanercept compared with other biologic therapies in the treatment of moderate or severe rheumatoid arthritis in patients with previous unresponse to immune selective anti-inflammatory derivatives failure. METHODS: a pharmacoeconomic model based on decision analysis to assess the clinical outcome after giving etanercept, infliximab, adalimumab or tocilizumab to treat moderate or severe rheumatoid arthritis was employed. Effectiveness of medications was assessed with improvement rates of 20 % or 70 % of the parameters established by the American College of Rheumatology (ACR 20 and ACR 70). RESULTS: the model showed that etanercept had the most effective therapeutic response rate: 79.7 % for ACR 20 and 31.4 % for ACR 70, compared with the response to other treatments. Also, etanercept had the lowest cost ($149,629.10 per patient) and had the most cost-effective average ($187,740.40 for clinical success for ACR 20 and $476,525.80 for clinical success for ACR 70) than the other biologic therapies. CONCLUSIONS: we demonstrated that treatment with etanercept is more effective and less expensive compared to the other drugs, thus making it more efficient therapeutic option both in terms of means and incremental cost-effectiveness ratios for the treatment of rheumatoid arthritis.

Objetivo: analizar la relación costo-efectividad del etanercept en comparación con otras terapias biológicas para tratar la artritis reumatoide moderada o severa en pacientes con falla previa a fármacos antirreumáticos modificadores de la enfermedad. Métodos: se empleó un modelo farmacoeconómico basado en el análisis de decisiones para valorar la evolución clínica con etanercept, infliximab, adalimumab o tocilizumab para tratar artritis reumatoide moderada o severa. Los parámetros de efectividad fueron las tasas de mejoría igual o superior a 20 % (ACR 20) y de mejoría igual o superior a 70 % (ACR 70). Resultados: etanercept tuvo la mayor efectividad terapéutica: en 79.7 % de los pacientes se observó una ACR 20 y en 31.4 %, una ACR 70. También tuvo el menor costo asociado ($149 629.1 por paciente) y fue más costo-efectiva ($187 740.4 por éxito clínico para obtener ACR 20 y $476 525.8 por éxito clínico para obtener ACR 70) que las demás terapias biológicas. Conclusiones: el etanercept fue el fármaco más efectivo y menos costoso, por lo que resulta la opción terapéutica más eficiente, desde el punto de vista de la relación costo-efectividad media y en términos incrementales para el tratamiento de la artritis reumatoide.

Impact of group purchasing in cooperative of hospital in Colombia, using a price index from 1999 to 2012 / Impacto del grupo de compra en la cooperativa de hospital en Colombia, con un índice de precios de 1999 a 2012

The application of price indices is useful to analyze the behavior of prices as an important component in patients´ access to essential medications over a period of time. The present work analyzed the variation in the prices of 303 medications sold by a cooperative of hospitals in central Colombia between 1999 and 2010 by applying inflation-adjusted price indices and Laspeyres-Paasche quantities by ABC groups and principal therapeuticals in the first and second ATC (anatomic, therapeutical, chemical) level, taking 1999 as the starting year. The medications of type A and B, as well as those belonging to the first four therapeutical groups in the first ATC level in cost and for seven groups in the second ATC level, registered a drop between 40 and 53% (P < 0.05) in the applied price indices. In addition, all the ABC and ATC groups showed increases between 9 and 12 times (P < 0.01) when applying the indices on units sold. The estimated net saving in 2010 at prices of 1999, went above $ 16.9 billion COP. This impact on prices has helped to expand the coverage in essential medications supplied to the public hospitals which are afterwards administered to the patients of this region of Colombia.

La aplicación de los índices de precios es útil para analizar el comportamiento de los precios como un componente importante en el acceso de los pacientes a los medicamentos esenciales en un determinado período de tiempo. El presente trabajo analiza la variación de los precios de 303 medicamentos comercializados por una cooperativa de hospitales en el centro de Colombia entre 1999 y 2010 mediante la aplicación de los índices de precios ajustados a la inflación, según las expresiones de Laspeyres y Paasche por grupos ABC y de principales agentes terapéuticos en el primer y segundo nivel ATC (anatómico, terapéutico, químico), tomando 1999 como año de partida. Los medicamentos de tipo A y B, así como los que pertenecen a los cuatro primeros grupos terapéuticos en el primer nivel de ATC en el costo, y considerando siete grupos en el segundo nivel de ATC, registraron una caída entre 40% y 53% (P < 0,05) en los índices de precios aplicados. Además, todos los grupos ABC y ATC mostraron aumentos entre 9 y 12 veces (P < 0,01) al aplicar los índices en las unidades vendidas. El ahorro neto estimado en 2010 a precios de 1999, pasó por encima de 16,9 mil millones de pesos colombianos. Este impacto en los precios ha contribuido a ampliar la cobertura en los medicamentos esenciales suministrados a los hospitales públicos, y que luego son administrados a los pacientes de esta región de Colombia.

Evolución del consumo de medicamentos de alto costo en Colombia / Evolution of consumption of high-cost drugs in Colombia

Objective. Determine the patterns of consumption of high-cost drugs (HCD) during the 2005–2010 period in a population of Colombian patients enrolled in the General System of Social Security in Health. Methods. An observational descriptive study was conducted. The prescription dataof formulas of any drug considered to be high-cost dispensed to all users (1 674 517) in 20 cities of Colombia between 2005 and 2010 were analyzed. The anatomical therapeutic classification was considered, and the number of patients as well as monthly invoicing for each drug, the daily dose defined, and the cost per 1 000 inhabitants/day were defined. Results. Over the entire study period, the amount invoiced for HCDs increased by 847.4%. Antineoplastic and immunomodulator drugs accounted for 46.3% of the totalinvoicing. The other drugs were anti-infectives (15.2%), systemic hormonal preparations (9.5%), and drugs for the nervous system (9.1%). Most of these drugs were prescribed at the daily doses defined as recommended by the World Health Organization, but with high costs per 1 000 inhabitants/day. Conclusions. In Colombia a crisis has occurred in recent years due to the high spending generated by the most expensive drugs. The progressive growth of pharmaceutical spending is greater than the increased coverage by the country’s health system. The Colombian health system should evaluate how much it is willing to pay for the most expensive drugs for some diseases and what strategies should be implemented to cover these expenses and thus guarantee access to the insured.

Objetivo. Determinar el comportamiento del consumo de medicamentos de alto costo (MAC) durante 2005–2010 en una población de pacientes colombianos afiliados al Sistema General de Seguridad Social en Salud. Métodos. Estudio descriptivo observacional; se analizaron datos de prescripción de fórmulas dispensadas desde 2005 a 2010 a todos los usuarios (1 674 517) de algún medicamento considerado de alto costo en 20 ciudades de Colombia. Se consideró la clasificación anatómicaterapéutica y el número de pacientes, así como la facturación mensual por cada medicamento, la dosis diaria definida y el costo por 1 000 habitantes/día. Resultados. En todo el período de estudio, el valor facturado por MAC creció 847,4%. Losantineoplásicos e inmunomoduladores constituyeron 46,3% del total facturado, antinfecciosos 15,2%, preparaciones hormonales sistémicas 9,5% y fármacos para el sistema nervioso 9,1%. La mayoría de estos medicamentos fueron prescritos a las dosis diarias definidas recomendadaspor la Organización Mundial de Salud, pero con altos costos por 1 000 habitantes y día. Conclusiones. En Colombia durante los últimos años se ha presentado una crisis debida al elevado gasto generado por los medicamentos más costosos. El crecimiento progresivo del gasto farmacéutico es mayor que el aumento de la cobertura del sistema sanitario del país. El sistema sanitario colombiano debe evaluar cuánto está dispuesto a pagar por los medicamentosmás costosos para algunas morbilidades y qué estrategias debe implementar para sufragar estos gastos y así garantizar el acceso a los asegurados.

Capacidade aquisitiva e disponibilidade de medicamentos para doenças crônicas no setor público / Affordability and availability of drugs for treatment of chronic diseases in the public health care system

OBJETIVO: Avaliar a capacidade aquisitiva do trabalhador para pagar medicamentos utilizados no tratamento de doenças crônicas e a disponibilidade desses medicamentos na forma de referência, similar ou genérica para fornecimento gratuito no setor público. MÉTODOS: Utilizou-se metodologia preconizada pela Organização Mundial da Saúde (OMS) e Health Action International (HAI) para coleta padronizada de informações sobre preços de venda no setor privado e disponibilidade no setor público de medicamentos em seis cidades do Rio Grande do Sul, Brasil. A coleta de dados ocorreu de novembro de 2008 a janeiro de 2009. A capacidade aquisitiva foi estimada como o número de dias do salário que um trabalhador com rendimento de 1 salário mínimo nacional necessita trabalhar para adquirir, em uma farmácia privada, a quantidade necessária de medicamento para 1 mês de tratamento. A disponibilidade foi avaliada verificando-se a presença dos medicamentos nas farmácias do setor público. RESULTADOS: A pesquisa incluiu 22 estabelecimentos públicos e 30 farmácias privadas. Dos 21 medicamentos utilizados no tratamento de sete doenças crônicas, apenas nove eram disponibilizados gratuitamente nos seis municípios pesquisados. O percentual médio da disponibilidade variou de 83,3 por cento (São Leopoldo) a 97,6 por cento (Caxias do Sul). A capacidade aquisitiva variou de 0,4 a 10,5 dias de salário para medicamentos de referência; de 0,2 a 8,4 dias de salário para medicamentos similares; e de 0,3 a 3,8 dias de salário para medicamentos genéricos. CONCLUSÕES: A disponibilidade geral dos medicamentos pesquisados foi superior aos 80 por cento recomendados pela OMS; porém, alguns tratamentos não estavam disponíveis, ou apresentaram uma disponibilidade limitada no setor público. A capacidade aquisitiva dos trabalhadores nos municípios estudados indicou um comprometimento de dias do salário que pode afetar a continuidade dos tratamentos com medicamentos para doenças crônicas.

OBJECTIVE: To assess the affordability by workers of drugs used for treatment of chronic diseases, as well as the availability of the reference, similar, or generic forms of these drugs in the public health care system. METHODS: We employed the methodology recommended by the World Health Organization (WHO) and Health Action International (HAI) for the standardized collection of information on selling prices in the private sector and availability in the public health care system of drugs in six cities in the state of Rio Grande do Sul, Brazil. Data were collected from November 2008 to January 2009. Affordability was estimated as the number of salary days required for a worker receiving the national minimum wage to buy, in a private pharmacy, the amount of medication required for one month of treatment. Availability was assessed by the presence of these drugs in public health care system facilities. RESULTS: Twenty-two public facilities and 30 private pharmacies were studied. Of 21 drugs used for the treatment of seven chronic disorders, only nine were available free of charge in the six cities. Mean availability ranged from 83.3 percent (São Leopoldo) to 97.6 percent (Caxias do Sul). Affordability ranged from 0.4 to 10.5 salary days for reference drugs, 0.2 to 8.4 salary days for similar drugs, and 0.3 to 3.8 salary days for generic drugs. CONCLUSIONS: The overall availability of the drugs surveyed was higher than the 80 percent recommended by WHO. However, some treatments were not available, or had limited availability in the public system. Concerning affordability, the number of salary days required to buy these drugs may affect the continuation of drug treatments for chronic diseases.

Evidências advindas do consumo de medicamentos moduladores do apetite no Brasil: um estudo farmacoeconométrico / Evidence for the use of appetite suppressant drugs in Brazil: a pharmacoeconometric study

OBJETIVO: Analisar o consumo de moduladores do apetite (CMA) no Brasil em 2009, condicionado às características dos usuários, do sistema de saúde e de outros medicamentos. MÉTODOS: Estudo farmacoeconométrico com dados em corte transversal para analisar as relações entre o CMA (mg/per capita) e as variáveis independentes selecionadas (gênero, raça/cor, faixa etária, escolaridade, renda, cobertura de planos de saúde e consumo de fluoxetina e clordiazepóxido), mediante análise de regressão linear múltipla. Este estudo utilizou-se dessas variáveis em nível de agregação por estados para 2009. As análises foram realizadas no software Gretl. RESULTADOS: Destacamos que São Paulo registrou o maior CMA, com 97,3 mg/per capita, seguido de Goiás, com 94,8 mg/per capita. O menor consumo foi verificado no Ceará (3,8 mg/per capita). Os maiores consumidores de fluoxetina foram o Rio Grande do Sul, com 58,0 mg/per capita, e Goiás, com 51,5 mg/per capita. O Ceará (2,3 mg/per capita) registrou o menor con-sumo. Para o clordiazepóxido, os maiores valores foram verificados em Minas Gerais (7,5 mg/per capita) e Rio de Janeiro (4,8 mg/per capita), enquanto que o Amazonas (0,08 mg/per capita) obteve o menor consumo. Da análise de regressão destacamos: 1) o CMA está relacionado com renda, escolaridade e consumo de fluoxetina; e 2) raça/cor, gênero, idade, cobertura de plano de saúde e consumo de clordiazepóxido, porém revelaram-se não relacionados com CMA. CONCLUSÃO: Essas evidências podem contribuir para o aprimoramento das ações de regulação, vigilância sanitária e de conduta ética, principalmente, no que tange o consumo "casado" de moduladores do apetite com fluoxetina, o qual é vedado pelo Conselho Federal de Medicina, e, também, pela Anvisa.

OBJECTIVE: Analyze the use of appetite suppressants in Brazil in 2009, according to the characteristics of users, healthcare system, and other drugs. METHODS: Pharmaconeconometric study of cross-sectional data to analyze the relationship between the use of appetite suppressants (mg/per capita) and the independent variables selected (gender, race/color, age, schooling, income, health insurance coverage, and use of fluoxetine and chlordiazepoxide) using multiple linear regression analysis. This study used these variables in level of aggregation by states for 2009. The analyses were performed using the Gretl software. RESULTS: We highlight that São Paulo showed the highest use of appetite suppressants with 97.3 mg/per capita, followed by Goiás with 94.8 mg/per capita. The lowest use of appetite suppressants was seen in Ceará (3.8 mg/per capita). The biggest fluoxetine users were in Rio Grande do Sul, with 58.0 mg/per capita, and in Goiás, with 51.5 mg/per capita. Ceará showed the lowest fluoxetine use (2.3 mg/per capita). For chlordiazepoxide, the highest values were seen in Minas Gerais (7.5 mg/per capita) and in Rio de Janeiro (4.8 mg/per capita), while Amazonas (0.08 mg/per capita) showed the lowest use. Based on regression analysis, we can highlight: 1) the use of appetite suppressants is related to income, education, and fluoxetine use; and 2) race/color, gender, age, health insurance coverage, and use of chlordiazepoxide showed no relation to the use of appetite suppressants. CONCLUSION: These evidences may contribute to the improvement of regulatory actions, sanitary surveillance, and ethical conduct, particularly with regard to the concomitant use of appetite suppressants and fluoxetine, which is prohibited by the Federal Council of Medicine (Conselho Federal de Medicina) and also by Anvisa (Agência Nacional de Vigilância Sanitária - National Health Surveillance Agency).

Oxybutynin and tolterodine for treatment of neurogenic detrusor overactivity: a pharmacoeconomic evaluation in the Brazilian context

Antimuscarinic agents are the first-line choice for the treatment of neurogenic detrusor overactivity (NDO). The currently available antimuscarinic drugs have been widely studied in patients presenting idiopathic detrusor overactivity; however, investigations evaluating the effects of these drugs on NDO are scant, particularly with regard to cost-effectiveness analyses. A pharmacoeconomic evaluation was performed to compare the costs and effectiveness of oxybutynin and tolterodine in two different formulations, extended (ER) and immediate-release (IR), for the treatment of NDO (based on Brazilian maximal consumer price index). A systematic review of literature was conducted in order to obtain significant clinical and urodynamic data (based on expert opinion), concerning the effects of these drugs in the neurogenic population. Furthermore, a pharmacoeconomic evaluation was performed and costs involved were calculated based on percentage effectiveness obtained for the timeframes of one month and of one year. The best cost-effectiveness ratio (CER) was observed with oxybutynin IR for the urodynamic parameters. In terms of clinical parameters, oxybutynin IR and ER showed the best CER. Based on the key urological parameters analyzed, oxybutynin IR was considered the most cost-effective antimuscarinic agent.

A terapia antimuscarínica é vista como primeira escolha para o tratamento da hiperatividade detrusora de origem neurológica (HDON). No entanto, a maioria dos antimuscarínicos existentes é amplamente estudada em pacientes portadores de hiperatividade detrusora idiopática. Assim, existe escassez de pesquisas que avaliam esses fármacos na problemática da HDON, principalmente em termos de estudos de custo-efetividade. Diante isso, um estudo farmacoeconômico foi realizado (baseado no índice de preço máximo ao consumidor) para comparar os custos e a efetividade da oxibutinina e da tolterodina, em duas diferentes formulações, cápsulas de liberação imediata (LI) e controlada (LC), para o tratamento da HDON. Uma revisão sistemática da literatura foi conduzida para obtenção de dados urodinâmicos e clínicos relevantes (baseado em opinião de especialistas), quanto aos efeitos desses fármacos em pacientes com distúrbios urológicos de origem neurológica. Após essa etapa, um estudo farmacoeconômico foi conduzido e os custos envolvidos foram calculados sobre cada percentual de efetividade obtido, num horizonte temporal de 1 mês e 1 ano. A melhor razão de custo-efetividade (RCE) quanto aos parâmetros urodinâmicos foi obtida com uso de oxibutinina LI. Quantos aos parâmetros clínicos, oxibutinina LI e LC tiveram as melhores RCE. Baseando-se nos principais parâmetros urológicos analisados, oxibutinina LI foi considerada o antimuscarínico mais custo-efetivo.

El análisis de impacto presupuestario en salud: puesta al día con un modelo de abordaje genérico / Budgetary impact analysis in health: update with a model using a generic approach

El Análisis de Impacto Presupuestario (AIP) en el campo de la salud puede ser definido como la estimación de los costos financieros netos que le representarían a una institución dar cobertura a una determinada intervención. En la práctica, los AIP se utilizan frecuentemente para decidir la inclusión o exclusión de medicamentos en formularios terapéuticos y notoriamente han obligado a reconocer que las Evaluaciones Económicas representan una mirada parcial en el análisis de las consecuencias de la incorporación de tecnologías sanitarias. Este trabajo procura identificar los determinantes y componentes de los análisis de impacto presupuestario, y a partir de ello describir el desarrollo de un modelo creado en una planilla de cálculo que permite considerar cualquier tecnología sanitaria y obtener estimaciones con diferentes grados de complejidad. Su diseño incorpora de forma explícita las habilidades del usuario y las deficiencias de información, buscando a su vez promover el desarrollo de estas herramientas en los ámbitos de gestión de nuestros países.

Budgetary Impact Analysis (BIA) applied to health care can be defined as the estimate of the net financial costs that a given intervention would represent for a health care institution given the case it was covered. Routinely, BIAs are used to decide the inclusion or exclusion of drugs in therapeutic schemes; actually, the increased use of BIAs have raised awareness about the fact that health economic evaluations represent a partial view in the analysis of the consequences of incorporating health technologies. This paper seeks to identify the determinants and components of BIA, and to describe the development of a spreadsheet model that enables us to assess the Budget impact of any health technology and perform estimations with differing degrees of complexity. Its design explicitly adapts to the user skills and gaps in information, thus seeking to promote the development of these tools in the management fields in our countries.