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1.
Recenti Prog Med ; 112(3): 173-181, 2021 03.
Artigo em Italiano | MEDLINE | ID: mdl-33687354

RESUMO

When a pandemic occurs, scientific research moves fast in order to achieve readily results, such as effective therapies to fight the SARS-CoV-2 and vaccines. But this high-speed science, engaged by the emergency and characterized by the explosion of online publications in preprint form not subject to scrutiny by peer reviewers, carries some risks. And it represents a challenge to maintain research integrity and to comply with those globally recognized standard principles of fairness. Competition and the pressure to publish immediately - a way of encouraging rapid data sharing - can favor the dissemination of incomplete if not erroneous results obtained from partial studies, which feed false news, such as the benefits of a drug, and illusory hopes. It is commonly through press releases that "speed science" disseminates information to an audience that wants to be informed and reassured. Financial and political interests often mix with the urgency to find solutions. Covid-19 has highlighted in particular the risk of a politicization of science at the expense of transparency.


Assuntos
Pandemias , Editoração/normas , Pesquisa/normas , Monofosfato de Adenosina/análogos & derivados , Monofosfato de Adenosina/economia , Monofosfato de Adenosina/provisão & distribução , Monofosfato de Adenosina/uso terapêutico , Alanina/análogos & derivados , Alanina/economia , Alanina/provisão & distribução , Alanina/uso terapêutico , Antivirais/economia , Antivirais/provisão & distribução , Antivirais/uso terapêutico , Surtos de Doenças , Aprovação de Drogas , União Europeia , Humanos , Influenza Humana/tratamento farmacológico , Influenza Humana/economia , Influenza Humana/epidemiologia , Influenza Humana/prevenção & controle , Disseminação de Informação , Consentimento Livre e Esclarecido , Oseltamivir/economia , Oseltamivir/provisão & distribução , Oseltamivir/uso terapêutico , Revisão da Pesquisa por Pares , Publicações Periódicas como Assunto , Política , Risco , Fatores de Tempo , Estados Unidos
2.
Public Health ; 190: 116-122, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33450632

RESUMO

OBJECTIVES: We develop a patient prioritization scheme for treating patients infected with hepatitis C virus (HCV) and study under which scenarios it outperforms the current practices in Spain and Chile. STUDY DESIGN: We use simulation to evaluate the performance of prioritization rules under two HCV patient cohorts, constructed using secondary data of public records from Chile and Spain, during 2015-2016. METHODS: We use the results of a mathematical model, which determines individual optimal HCV treatment policies as an input for constructing a patient prioritization rule, when limited resources are present. The prioritization is based on marginal analysis on cost increases and health-outcome gains. We construct the Chilean and Spanish case studies and used Monte Carlo simulation to evaluate the performance of our methodology in these two scenarios. RESULTS: The resulting prioritizations for the Chilean and Spanish patients are similar, despite the significant differences of both countries, in terms of epidemiological profiles and cost structures. Furthermore, when resources are scarce compared with the number of patients in need of the new drug, our prioritization significantly outperforms current practices of treating sicker patients first, both in terms of cost and healthcare indicators: for the Chilean case, we have an increase in the quality-adjusted life years (QALYs) of 0.83 with a cost reduction of 8176 euros per patient, with a budget covering 2.5% of the patients in the cohort. This difference slowly decreases when increasing the available resources, converging to the performance indicators obtained when all patients are treated immediately: for the Spanish case, we have a decrease in the QALYs of 0.17 with a cost reduction of 1134 euros per patient, with a budget covering 20% of the patients in the cohort. CONCLUSION: Decision science can provide useful analytical tools for designing efficient public policies that can excel in terms of quantitative health performance indicators.


Assuntos
Antivirais/uso terapêutico , Hepacivirus/isolamento & purificação , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/tratamento farmacológico , Antivirais/economia , Orçamentos , Chile/epidemiologia , Estudos de Coortes , Análise Custo-Benefício , Feminino , Custos de Cuidados de Saúde , Hepacivirus/efeitos dos fármacos , Hepatite C Crônica/economia , Humanos , Programas de Rastreamento/economia , Modelos Teóricos , Método de Monte Carlo , Anos de Vida Ajustados por Qualidade de Vida , Espanha/epidemiologia , Resultado do Tratamento
4.
Salud Colect ; 16: e2897, 2020 10 17.
Artigo em Espanhol | MEDLINE | ID: mdl-33147400

RESUMO

Taking into account the latent threat of future pandemics, the objective of this study is to analyze - particularly with respect to medications - the sustainability of the health system, healthcare coverage, budgetary efficiency, and connections with the pharmaceutical patent system. In this context, the pharmaceutical patent system acts as a determining factor, given that promoting its existence stimulates the production of research, but in turn its existence stands in the way of rapid advancements, primarily due to the development of protective legislation concerning patents, which has largely accommodated the industry. Given that the pharmaceutical industry has managed to extend the duration of patents and avoid the incorporation of generics, our analysis focuses on the influence of pharmaceutical patents; this influence has led to reflection on the possibility of combining efforts by forging alliances between numerous companies and the public sector in order to face the challenges posed by new diseases caused by viruses that give rise to epidemics and pandemics.


Assuntos
Antivirais , Custos de Medicamentos , Indústria Farmacêutica/organização & administração , Política de Saúde , Acesso aos Serviços de Saúde/organização & administração , Patentes como Assunto , Viroses/tratamento farmacológico , Antivirais/economia , Antivirais/uso terapêutico , Medicamentos Genéricos , Saúde Global , Humanos , Pandemias , Avaliação de Programas e Projetos de Saúde , Viroses/economia , Viroses/epidemiologia , Viroses/prevenção & controle
5.
PLoS One ; 15(10): e0236543, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33006987

RESUMO

OBJECTIVES: Recently, the results of two economic evaluations were published both of which seemingly demonstrate the cost-effectiveness of sofosbuvir-based regimens for the treatment of chronic hepatitis C genotype 1 infection in Germany. Both analyses were sponsored by the manufacturer of sofosbuvir and use a different methodology: Whereas one evaluation is based on a conventional cost-utility analysis, the other rests upon the efficiency-frontier method used by the German Institute for Quality and Efficiency in Health Care (IQWiG). The purpose of this study is to reanalysis the results of both economic evaluations in combination. DESIGN: Reanalysis of published decision modelling results. SETTING: Primary care in Germany. PARTICIPANTS: Patients with chronic hepatitis C genotype 1 infection (treatment-naïve and -experienced, cirrhotic and non-cirrhotic). INTERVENTIONS: Sofosbuvir, other anti-hepatitis C virus drugs, and no treatment. PRIMARY AND SECONDARY OUTCOME MEASURES: Cost per unit of health benefit and cost per quality-adjusted life year. RESULTS: Reanalysis of the results of both economic evaluations in combination reveals an unclear rationale for choosing the selected cost-effectiveness methods as well as a potential publication bias, favoring the product of the manufacturer. Based on the reanalysis, sofosbuvir is not cost-effective in treatment-experienced non-cirrhotic patients, potentially lacks cost-effectiveness in treatment-experienced cirrhotic patients, and is only partially cost-effective in treatment-naïve non-cirrhotic patients. Taken together, these results indicate a lack of cost-effectiveness in three quarters of the German patient population. CONCLUSIONS: Two economic evaluations on sofosbuvir suggest, in combination, that sofosbuvir cannot be considered a cost-effective treatment in three quarters of the German patient population.


Assuntos
Antivirais/economia , Hepacivirus/genética , Hepatite C Crônica/economia , Sofosbuvir/economia , Antivirais/uso terapêutico , Quimioterapia Combinada , Genótipo , Alemanha/epidemiologia , Hepacivirus/efeitos dos fármacos , Hepatite C Crônica/epidemiologia , Hepatite C Crônica/virologia , Humanos , Interferon-alfa/economia , Interferon-alfa/uso terapêutico , Anos de Vida Ajustados por Qualidade de Vida , Ribavirina/economia , Ribavirina/uso terapêutico , Sofosbuvir/uso terapêutico
6.
Value Health ; 23(11): 1409-1422, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33127010

RESUMO

OBJECTIVE: To review published economic evaluations of antiviral treatment for pandemics and outbreaks of respiratory illnesses. METHODS: We conducted a systematic review to identify economic evaluations of antiviral treatment for pandemics and outbreaks of respiratory illnesses, including coronavirus disease 2019 (COVID-19). We searched Medline (EBSCOhost), EMBASE (Ovid), EconLit (Ovid), National Health Service Economic Evaluation Database (Ovid), and Health Technology Assessment (Ovid). The search was last rerun on July 5, 2020. Citation tracking and reference checking were used. Only full economic evaluations published as peer-reviewed articles in the last 10 years were included. Studies were quality assessed using the National Institute for Health and Care Excellence economic evaluation checklist. RESULTS: Overall, 782 records were identified, of which 14 studies met the inclusion criteria. The studies were mostly conducted in high-income countries. All were model-based. Seven (50%) were cost-utility analyses, 4 (28.6%) were cost-effectiveness analyses, 2 (14.3%) were cost-consequences analyses, and 1 (7.1%) was a cost-benefit analysis. Strategies including antiviral treatment were found to be either cost-saving or cost-effective, at the study-specific willingness-to-pay thresholds. Empirical treatment was more cost-effective than test-guided treatment for young adults but less so for older adults. CONCLUSIONS: Antiviral treatment for managing pandemics and outbreaks of respiratory illnesses that have very high case fatality rate, similar to COVID-19 pandemic, are likely to be cost-effective either as a standalone intervention or part of a multifaceted strategy. Investing in the development of such curative treatments and promptly evaluating their cost-effectiveness, relative to other strategies in use at the time of their introduction should be the focus going forward to inform resource allocation decisions particularly in low- and middle-income countries.


Assuntos
Antivirais/economia , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Análise Custo-Benefício , Surtos de Doenças , Pandemias , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/epidemiologia , Insuficiência Respiratória/tratamento farmacológico , Insuficiência Respiratória/epidemiologia , Betacoronavirus/efeitos dos fármacos , Humanos , Avaliação da Tecnologia Biomédica
7.
Value Health ; 23(9): 1137-1141, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32940230

RESUMO

OBJECTIVES: Hepatitis C virus (HCV) antivirals have been shown to be highly effective with minimal adverse effects, but they are costly. Little is known about the national spending on this drug class in either Canada or the United States, 2 countries with different drug pricing regulations. Thus the objective of this study was to compare drug expenditure on HCV medications in the United States and Canada. METHODS: This was a retrospective cross-sectional study using the IQVIA National Sales Perspectives (United States) and Geographic Prescription Monitor (Canada) databases, which contains prescription transactions from American and Canadian pharmacies. All prescription claims for the period between January 1, 2014, and June 30, 2018, were used to describe HCV antiviral expenditure in both countries. RESULTS: The United States and Canada spent $59.7 billion and $2.8 billion on HCV medications, respectively. Population-adjusted HCV medication costs were higher in the United States ($1 million per 100 000 population) compared with Canada ($0.4 million per 100 000 population). CONCLUSIONS: Although the rates of HCV infection are similar in the 2 countries, these findings highlight the differences in both the reimbursement utilization policy for HCV treatments in the countries and the major differences in drug pricing policies. As policies to reduce drug spending in the United States are explored, this article highlights the potential cost implications of implementing Canadian index pricing.


Assuntos
Antivirais/economia , Custos de Medicamentos/estatística & dados numéricos , Hepatite C/tratamento farmacológico , Canadá , Estudos Transversais , Política de Saúde , Humanos , Estudos Retrospectivos , Estados Unidos
8.
Value Health ; 23(9): 1180-1190, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32940236

RESUMO

OBJECTIVE: Very few cost-utility analyses have either evaluated direct-acting antivirals (DAAs) on hepatitis C virus (HCV) genotype 6 patients or undertaken societal perspective. Recently, DAAs have been introduced into the Vietnamese health insurance drug list for chronic hepatitis C (CHC) treatment without empirical cost-effectiveness evidence. This study was conducted to generate these data on DAAs among CHC patients with genotypes 1 and 6 in Vietnam. METHODS: A hybrid decision-tree and Markov model was employed to compare costs and quality-adjusted life-years (QALYs) of available DAAs, including (1) sofosbuvir/ledipasvir, (2) sofosbuvir/velpatasvir, and (3) sofosbuvir plus daclatasvir, with pegylated-interferon plus ribavirin (PR). Primary data collection was conducted in Vietnam to identify costs and utility values. Incremental cost-effectiveness ratios were estimated from societal and payer perspectives. Uncertainty and scenario analyses and value of information analyses were performed. RESULTS: All DAAs were cost-saving as compared with PR in CHC patients with genotypes 1 and 6 in Vietnam, and sofosbuvir/velpatasvir was the most cost-saving regimen, from both societal and payer perspectives. From the societal perspective, DAAs were associated with the increment of quality-adjusted life-years by 1.33 to 1.35 and decrement of costs by $6519 to $7246. Uncertainty and scenario analyses confirmed the robustness of base-case results, whereas the value of information analyses suggested the need for further research on relative treatment efficacies among DAA regimens. CONCLUSIONS: Allocating resources for DAA treatment for HCV genotype 1 and 6 is surely a rewarding public health investment in Vietnam. It is recommended that the government rapidly scale up treatment and enable financial accessibility for HCV patients.


Assuntos
Antivirais/economia , Hepatite C Crônica/tratamento farmacológico , Antivirais/uso terapêutico , Análise Custo-Benefício , Quimioterapia Combinada , Feminino , Hepatite C Crônica/economia , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde/economia , Anos de Vida Ajustados por Qualidade de Vida , Vietnã
11.
Pharmazie ; 75(8): 407-410, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32758342

RESUMO

New drugs against the in COVID-19 pandemic are urgently needed. Gilead Science's remdesivir has been introduced to China through special approval procedures, and was directly conducting the Phase III clinical trial. As expected, the marketing authorization process was completed soon. The drug brought hope to patients as well as business opportunities to companies. However, we must pay attention to the patent competition, generic drug competition and other unfair competition that remdesivir may face in China. China also needs to strengthen the innovation ability and international cooperation ability of local pharmaceutical companies by taking advantages of the opportunity to introduce remdesivir.


Assuntos
Monofosfato de Adenosina/análogos & derivados , Alanina/análogos & derivados , Antivirais/administração & dosagem , Infecções por Coronavirus/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Monofosfato de Adenosina/administração & dosagem , Monofosfato de Adenosina/economia , Alanina/administração & dosagem , Alanina/economia , Antivirais/economia , China , Ensaios Clínicos como Assunto , Infecções por Coronavirus/epidemiologia , Aprovação de Drogas , Indústria Farmacêutica/economia , Medicamentos Genéricos/administração & dosagem , Medicamentos Genéricos/economia , Competição Econômica , Humanos , Pandemias , Pneumonia Viral/epidemiologia
12.
JAMA Netw Open ; 3(6): e208081, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32602909

RESUMO

Importance: Direct-acting antiviral (DAA) therapy for hepatitis C is highly effective but expensive. Evidence is scarce on whether DAA therapy reduces downstream medical costs. Objective: To examine the association of DAA therapy with posttreatment medical costs among Medicare beneficiaries. Design, Setting, and Participants: This retrospective cohort study obtained data from various Medicare claims files for 2013 to 2017. The study population comprised patients with a hepatitis C diagnosis in 2014 who were enrolled in fee-for-service Medicare and Part D. Multivariate regression models were used to compare changes in medical costs over a 30-month posttreatment follow-up period between patients who used DAA therapy (treatment group) and a propensity score-matched cohort of patients who did not use DAA (control group). The model was estimated separately for patients with and those without cirrhosis. Data were analyzed between September 1, 2019, and March 31, 2020. Exposures: Completion of DAA therapy. Main Outcomes and Measures: Two outcomes were established: hepatitis C or liver disease-related costs and total medical costs. Costs were measured by Medicare-allowed payments, which included Medicare reimbursements, patient responsibilities, and third-party payments. Results: A propensity score-matched cohort of 15 198 patients (9038 men [59.5%]; mean [SD] age, 60.2 [10.8] years) was analyzed. During the first 6 months after DAA therapy, hepatitis C or liver disease-related costs decreased by $2498 (95% CI, -$3356 to -$1640) in patients with cirrhosis and by $486 (95% CI, -$603 to -$369) in patients without cirrhosis compared with control or untreated patients. Cumulative reductions in hepatitis C or liver disease-related costs during 30 months after DAA treatment were $15 808 (95% CI, -$22 530 to -$9085) in patients with cirrhosis and $5372 (95% CI, -$6384 to -$4360) in patients without cirrhosis. Among those who used DAA therapy compared with control patients, total medical costs decreased by $2905 (95% CI, -$4832 to -$979) in patients with cirrhosis and by $1287 (95% CI, -$2393 to -$283) in patients without cirrhosis during the first 6 months after DAA therapy. No statistically significant association was found between DAA therapy and total medical cost reductions after 12 months of follow-up. Cumulative reductions in total costs during 30 months after DAA therapy were $7074 (95% CI, -$18 448 to $4298) in patients with cirrhosis and $7497 (95% CI, -$14 287 to -$709) in patients without cirrhosis. Conclusions and Relevance: This study reported that DAA therapy appeared to be associated with a decrease in hepatitis C or liver disease-related costs for 30 months after treatment and with reduction in total medical costs for only 12 months after treatment in patients with or without cirrhosis. Longer-term follow-up studies with diverse outcomes are necessary to assess the value of DAA therapy.


Assuntos
Antivirais , Custos de Cuidados de Saúde/estatística & dados numéricos , Hepatite C , Idoso , Antivirais/economia , Antivirais/uso terapêutico , Feminino , Hepatite C/tratamento farmacológico , Hepatite C/economia , Hepatite C/epidemiologia , Humanos , Masculino , Medicare/economia , Medicare/estatística & dados numéricos , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Retrospectivos , Estados Unidos
13.
Rev Soc Bras Med Trop ; 53: e20190594, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32578707

RESUMO

INTRODUCTION: We conducted a cost-utility analysis of available interferon-free treatments for patients with early-stage genotype 1 chronic hepatitis C based on a Brazilian public health system perspective. METHODS: A Markov model was derived using a cohort of stage F0-F2 patients treated as recommended by the Brazilian national guidelines. RESULTS: Glecaprevir plus pibrentasvir was superior to all other treatments, followed by sofosbuvir plus velpatasvir. Sofosbuvir plus daclatasvir was identified as the least cost-effective option. CONCLUSIONS: The above findings were confirmed via probabilistic sensitivity analysis and the tested scenarios.


Assuntos
Antivirais/economia , Quimioterapia Combinada/economia , Hepacivirus/genética , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/economia , Antivirais/administração & dosagem , Análise Custo-Benefício , Quimioterapia Combinada/métodos , Genótipo , Humanos
15.
Drug Res (Stuttg) ; 70(8): 337-340, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32559771

RESUMO

The world is faced with the dire challenge of finding an effective treatment against the rampaging COVID 19 pandemic. Amidst the crisis, reports of in vitro inhibitory activity of ivermectin, an approved anthelmintic, against the causative SARSCoV2 virus, have generated lot of optimism. In this article, we have fished and compiled the needed information on the drug, that will help readers and prospective investigators in having a quick overview. Though the primordial biological action of the drug is allosteric modulation of helminthic ion channel receptor, its in vitro activity against both RNA and DNA viruses is known for almost a decade. In the past two years, efficacy study in animal models of pseudorabies and zika virus was found to be favourable and unfavourable respectively. Only one clinical study evaluated the drug in dengue virus infection without any clinical efficacy. However, the proposed mechanism of drug action, by inhibiting the importin family of nucleus-cytoplasmic transporters along with favourable pharmacokinetics, warrants exploration of its role in COVID 19 through safely conducted clinical trials. Being an available and affordable drug, enlisted in WHO List of Essential Medicine, and a long track record of clinical safety, the drug is already in clinical trials the world over. As the pandemic continues to ravage human civilisation with unabated intensity, the world eagerly waits for a ray of hope emanating from the outcome of the ongoing trials with ivermectin as well as other drugs.


Assuntos
Antivirais/uso terapêutico , Betacoronavirus/efeitos dos fármacos , Infecções por Coronavirus/tratamento farmacológico , Ivermectina/uso terapêutico , Pneumonia Viral/tratamento farmacológico , Animais , Antivirais/química , Antivirais/economia , Antivirais/farmacologia , Betacoronavirus/genética , Modelos Animais de Doenças , Humanos , Ivermectina/química , Ivermectina/economia , Ivermectina/farmacologia , Pandemias
16.
JAAPA ; 33(6): 12-17, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32384293

RESUMO

HIV preexposure prophylaxis (PrEP) is an opportunity for clinicians to curb the 40,000 HIV infections occurring annually in the United States. PrEP is medication used by HIV-negative patients to reduce their risk of acquiring the virus. This article provides a baseline understanding of PrEP indications, prescribing, and monitoring, including a review of previously approved medication and an update on newly approved drugs, including emtricitabine/tenofovir alafenamide (F/TAF). Sexual and gender minorities are often underrepresented in the literature about PrEP, but clinicians should address risk focused on specific behaviors rather than population-level characteristics. As one of few professions with prescriptive authority, PAs have an obligation to understand and manage PrEP.


Assuntos
Adenina/análogos & derivados , Antivirais/administração & dosagem , Emtricitabina/administração & dosagem , Infecções por HIV/prevenção & controle , Assistentes Médicos , Profilaxia Pré-Exposição/métodos , Atenção Primária à Saúde , Tenofovir/administração & dosagem , Adenina/administração & dosagem , Adenina/efeitos adversos , Adenina/economia , Antivirais/efeitos adversos , Antivirais/economia , Emtricitabina/efeitos adversos , Emtricitabina/economia , Feminino , Infecções por HIV/transmissão , Humanos , Masculino , Profilaxia Pré-Exposição/economia , Tenofovir/efeitos adversos , Tenofovir/economia , Resultado do Tratamento
17.
AAPS PharmSciTech ; 21(5): 153, 2020 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-32449007

RESUMO

The supply of affordable, high-quality pharmaceuticals to US patients has been on a critical path for decades. In and beyond the COVID-19 pandemic, this critical path has become tortuous. To regain reliability, reshoring of the pharmaceutical supply chain to the USA is now a vital national security need. Reshoring the pharmaceutical supply with old know-how and outdated technologies that cause inherent unpredictability and adverse environmental impact will neither provide the security we seek nor will it be competitive and affordable. The challenge at hand is complex akin to redesigning systems, including corporate and public research and development, manufacturing, regulatory, and education ones. The US academic community must be engaged in progressing solutions needed to counter emergencies in the COVID-19 pandemic and in building new methods to reshore the pharmaceutical supply chain beyond the pandemic.


Assuntos
Antivirais/provisão & distribução , Betacoronavirus/efeitos dos fármacos , Defesa Civil/organização & administração , Infecções por Coronavirus/terapia , Necessidades e Demandas de Serviços de Saúde/organização & administração , Determinação de Necessidades de Cuidados de Saúde/organização & administração , Pandemias , Pneumonia Viral/terapia , Vacinas Virais/provisão & distribução , Antivirais/economia , Betacoronavirus/patogenicidade , Defesa Civil/economia , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/economia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/virologia , Custos de Medicamentos , Necessidades e Demandas de Serviços de Saúde/economia , Humanos , Determinação de Necessidades de Cuidados de Saúde/economia , Pandemias/economia , Pneumonia Viral/economia , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Estados Unidos , Vacinas Virais/economia
18.
Gastroenterol Clin North Am ; 49(2): 253-277, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32389362

RESUMO

The World Health Organization has called for the elimination of hepatitis C virus (HCV) as a public health threat by 2030. Highly effective direct-acting antiviral agents provide the therapeutic tools required for elimination. In the absence of a vaccine, HCV elimination will require enhanced primary prevention and an increase in the proportions of people diagnosed and treated. Given that globally only 20% of people with chronic HCV are diagnosed, and around 5% have initiated HCV treatment, the task ahead is enormous. But, global public health needs optimism, and countries currently on track for HCV elimination provide a pathway forward.


Assuntos
Antivirais/administração & dosagem , Hepatite C Crônica/tratamento farmacológico , Hepatite C Crônica/prevenção & controle , Anilidas/administração & dosagem , Antivirais/economia , Benzofuranos/administração & dosagem , Carbamatos/administração & dosagem , Quimioterapia Combinada , Saúde Global , Custos de Cuidados de Saúde , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/economia , Humanos , Imidazóis/administração & dosagem , Sofosbuvir/administração & dosagem , Sulfonamidas/administração & dosagem , Uracila/administração & dosagem , Uracila/análogos & derivados , Organização Mundial da Saúde
19.
PLoS One ; 15(4): e0232186, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32343727

RESUMO

BACKGROUND AND AIMS: Hepatitis C virus (HCV) and its sequelae present a significant source of economic and societal burden. Introduction of highly effective curative therapies has made HCV elimination attainable. The study used a predictive model to assess the clinical and economic impact of implementing national screening and treatment policies toward HCV elimination in Korea. METHODS: A previously validated Markov disease progression model of HCV infection was employed to analyze the clinical and economic impact of various strategies for HCV diagnosis and treatment in Korea. In this analysis, the model compared the clinical and economic outcomes of current HCV-related interventions in Korea (7,000 patients treated and 4,200 patients newly diagnosed annually, starting in 2017) to four elimination scenarios: 1) initiating sufficient diagnosis and treatment interventions to meet the World Health Organization's GHSS elimination targets by 2030, 2) delaying initiation of interventions by one year, 3) delaying initiation of interventions by two years and 4) accelerating initiation of interventions to meet elimination targets by 2025. Modelled historical incidence of HCV was calibrated to match a viremic HCV prevalence of 0.44% in 2009. Elimination scenarios required 24,000 treatments and 34,000 newly diagnosed patients annually, starting in 2018, to reach the 2030 targets. RESULTS: Compared to current "status quo" interventions, elimination (or accelerated elimination by 2025) would avert 23,700 (27,000) incident cases of HCV, 1,300 (1,400) liver-related deaths (LRDs) and 2,900 (3,100) cases of end-stage liver disease (ESLD) over the 2017-2030 time period. Postponing interventions by one (or two) years would avert 21,100 (18,600) new HCV infections, 920 (660) LRDs and 2,000 (1,400) cases of ESLD by 2030. Following elimination or accelerated elimination strategies would save 860 million USD or 1.1 billion USD by 2030, respectively, compared to the status quo, requiring an up-front investment in prevention that decreases spending on liver-related complications and death. CONCLUSIONS: By projecting the impact of interventions and tracking progress toward GHSS elimination targets using modelling, we demonstrate that Korea can prevent significant morbidity, mortality and spending on HCV. Results should serve as the backbone for policy and decision-making, demonstrating how aggressive prevention measures are designed to reduce future costs and increase the health of the public.


Assuntos
Hepatite C/epidemiologia , Adulto , Antivirais/economia , Antivirais/uso terapêutico , Análise Custo-Benefício , Doença Hepática Terminal/epidemiologia , Doença Hepática Terminal/mortalidade , Doença Hepática Terminal/prevenção & controle , Feminino , Custos de Cuidados de Saúde , Hepatite C/tratamento farmacológico , Hepatite C/economia , Humanos , Incidência , Masculino , Cadeias de Markov , Programas de Rastreamento/economia , Modelos Econômicos , Prevalência , República da Coreia/epidemiologia
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