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1.
Yonsei Med J ; 61(4): 301-309, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32233172

RESUMO

PURPOSE: Few studies have been investigated the in vivo efficacy of generic vancomycin products available outside of the United States. In this study, we aimed to compare the in vivo pharmacokinetics (PK) and pharmacodynamics (PD) of five generic vancomycin products available in Korea with those of the innovator. MATERIALS AND METHODS: The in vitro vancomycin purity of each product was examined using high-pressure liquid chromatography. Single-dose PK analyses were performed using neutropenic mice. The in vivo efficacy of vancomycin products was compared with that of the innovator in dose-effect experiments (25 to 400 mg/kg per day) using a thigh-infection model with neutropenic mice. RESULTS: Generic products had a lower proportion of vancomycin B (range: 90.3-93.8%) and a higher proportion of impurities (range: 6.2-9.7%) than the innovator (94.5% and 5.5%, respectively). In an in vivo single-dose PK study, the maximum concentration (Cmax) values of each generic were lower than that of the innovator, and the geographic mean area under the curve ratios of four generics were significantly lower than that of the innovator (all p<0.1). In the thigh-infection model, the maximum efficacies of generic products reflected in maximal effect (Emax) values were not significantly different from the innovator. However, the PD profile curves of some generic products differed significantly from that of the innovator in mice injected with a high level of Mu3 (all p≤0.05). CONCLUSION: Some generic vancomycin products available in Korea showed inferior PK and PD profiles, especially in mice infected with hetero-vancomycin-resistant Staphylococcus aureus.


Assuntos
Medicamentos Genéricos/farmacocinética , Medicamentos Genéricos/uso terapêutico , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Infecções Estafilocócicas/tratamento farmacológico , Vancomicina/farmacocinética , Vancomicina/uso terapêutico , Animais , Antibacterianos/farmacocinética , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Modelos Animais de Doenças , Medicamentos Genéricos/farmacologia , Camundongos , Testes de Sensibilidade Microbiana , República da Coreia , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/efeitos dos fármacos , Coxa da Perna/microbiologia , Falha de Tratamento , Vancomicina/farmacologia
2.
Zhonghua Er Ke Za Zhi ; 58(4): 301-307, 2020 Apr 02.
Artigo em Chinês | MEDLINE | ID: mdl-32234137

RESUMO

Objective: To investigate the availability, prices and affordability of essential medicines in pediatric population across China, in the hope of improving rational use of medicines. Methods: A multicenter cross-sectional survey of medicine prices, availability and affordability was conducted in 17 provinces, municipalities and autonomous region across east, south-central part, west and north of China. Data on 42 medicines used in pediatric population, both original and generic, were collected in 55 public hospitals from May 26 to June 2, 2017. Availability was expressed as the percentage of hospitals with stock of the target medicine on the day of data collection,and median price ratio (MPR) was the ratio of price upon investigation to international reference. Based on national minimum daily wage, affordability represents the number of working days needed to earn the expense which covers a standard course using the target medicine. Statistical software SPSS 13.0 was applied for descriptive analysis of availability, MPR and affordability. Results: Mean Availability of original and generic medicine was 33% and 32%, with median MPR being 5.43 and 1.55. Among the 19 medicines with price information for both original and generic product, the median MPR was 7.73 and 2.04 respectively. Regarding the five medicines used to treat four common pediatric diseases (pneumonia,peptic ulcer, congenital hypothyroidism, refractory nephrotic syndrome), the affordability was 0.63 (0.16-6.17) d for generic medicine, and 1.03 (0.16-11.53) d for its original counterpart. Conclusions: The availability to both original and generic products of the 42 medicines used in pediatric population was low in China. The prices of generic medicines seem to be lower and affordability higher than those of original medicines. There is an urgent need to improve the availability and affordability of pediatric medicines.


Assuntos
Preparações Farmacêuticas/economia , Preparações Farmacêuticas/provisão & distribução , Criança , China , Estudos Transversais , Custos de Medicamentos , Medicamentos Genéricos/economia , Medicamentos Genéricos/provisão & distribução , Humanos , Pediatria
3.
Dermatol Online J ; 26(1)2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-32155036

RESUMO

Online coupon retailers and pharmacies are popular sites that patients can access discounted medications when compared to cash prices. These sources are especially important for those patients without insurance. In our study, we analyzed commonly prescribed topical and oral medications and compared the cash prices to the discounted medications based on a typical month of usage. We found savings in every one of the medications that we analyzed, some with savings up to hundreds of dollars. Savings were present in all the sources analyzed, with the coupon-based programs often having the lowest price. We suggest certain alternative prescribing guidelines when considering patients who may not be able to afford cash prices of medications. Our hopes with this study are to quantify savings for discounted medications as well as to help physicians target more affordable medications for their patients.


Assuntos
Redução de Custos , Medicamentos Genéricos/economia , Farmácias , Honorários por Prescrição de Medicamentos , Custos de Medicamentos , Disponibilidade de Medicamentos Via Internet/economia , Farmácias/economia , Estados Unidos
4.
Drug Discov Ther ; 14(1): 14-20, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32147626

RESUMO

We compared the pharmaceutical properties, such as surface tension, drop volume, nozzle inner diameter, and force to push the drug product out of the container (squeeze force), of purified sodium hyaluronate eye drops preparations of one brand-name (Hyalein) and 11 generic drugs used for treatment of keratoconjunctiva epithelial disorders, and examined product selection based on the needs of the patient. The surface tension of Nissin (51.0 dyn/cm) and Nitten (52.3 dyn/cm) was significantly lower than that of Hyalein (62.8 dyn/cm), whereas Nitten PF (69.5 dyn/cm) was significantly higher than Hyalein. The drop volume of Tearbalance (42.4 mg), Nissin (43.7 mg), and Nitten (42.7 mg) was significantly lower than that of Hyalein (50.4 mg). We compared the squeeze force using a wearable touch sensor (Haptic Skill Logger: HapLog®) and digital force gauge (DF). The squeeze force of HapLog® showed values of about 1.7- to 3.5-fold higher than that of DF. Moreover, the squeeze force of Eyecare (34.0 N), Kyorin (35.4 N), and Nitten PF (44.3 N) by HapLog® was significantly higher than that of Hyalein (10.5 N). In contrast, the squeeze force of Kyorin (20.8 N) and Nitten PF (25.0 N) by DF was significantly higher than that of Hyalein (12.2 N). Two questionnaire surveys on the feeling of instillation of eye drops revealed a strong negative correlation between feeling of use and squeeze force.


Assuntos
Avaliação de Medicamentos , Soluções Oftálmicas , Avaliação de Medicamentos/normas , Medicamentos Genéricos/normas , Humanos , Soluções Oftálmicas/normas , Satisfação do Paciente , Dispositivos Eletrônicos Vestíveis
6.
Medwave ; 20(2): e7825, 2020 Feb 25.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-32119654

RESUMO

Medicines are an economic good and a fundamental component of public and private spending and health decision-making. Assurance of their quality, efficiency and safety is essential. However, the variety of products on the Chilean market, including innovative and generic productsthe latter accounted for by many products that are certified as bioequivalent while others are notresults in a potentially confusing scenario for consumers and health providers. In this review, we intend to shed light on the concepts of bioequivalency (applicable to compounds of small molecular size) and biosimilarity (applicable to biological compounds of greater molecular complexity). In both cases, how the active substance interacts with the host organism must be demonstrated by studies carried out for this purpose. A direct application of the concept of bioequivalence is interchangeability, defined as the possibility of using a product of the same active principle, as long as the pharmaceutical form and dosage scheme are the same. Regulations related to bioequivalence and biosimilarity must not only guarantee safety and efficacy when products are interchanged, but also facilitate cost savings and access to medicines. Likewise, the implementation of evidence-based guidelines that standardize concepts of interchangeability should be encouraged, as this could lead to a more educated usage and a reduction in the information asymmetry between patients (users) and the industry. The importance of interchangeability of medicines is particularly relevant in two governmental health initiatives in Chile: the Explicit Health Guarantees Plan (GES) and the Financial Protection for Diagnoses and Treatments of High Cost, known as the Ricarte Soto Act. Nonetheless, it is not possible to guarantee that all alternative products to an innovative drug on the Chilean market are bioequivalent. The synthesis of knowledge available on this subject may impact and contribute to decision-making by stakeholders. It could also help to develop better health policies regarding bioequivalent and biosimilar pharmaceutical products in our country.


Assuntos
Medicamentos Biossimilares , Medicamentos Genéricos , Equivalência Terapêutica , Chile , Humanos , Legislação de Medicamentos
7.
Medicine (Baltimore) ; 99(9): e19271, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32118735

RESUMO

The objective of this study was to examine the association between county-level socioeconomic factors and brand-name drug prescription drug patterns among medical specialties with overall high brand-name outpatient prescription use.This cross-sectional study used data from 2 publicly available datasets. The 2015 Medicare Part D PUF data quantifies the prescription rates at the county-level and data from the US Census Bureau provides information on socioeconomic status at the county-level.We analyzed 3,821,523 brand-name claims and 14,088,613 generic claims reported by health providers from 40 specialties as provided by the 2015 Medicare Part D dataset. Internal Medicine, Family Practice, General Practice, Cardiology, and Ophthalmology accounted for 71% of the total amount of brand-name drugs filled under Medicare Part D in 2015. As the presence of individuals with an income ≥$100,000 increased in a given county, the likelihood of receiving a brand-name prescription claim increased.A county-level association exists involving socioeconomic factors and outpatient brand-name drug prescription patterns. Future interventions should consider these factors in order to reduce percentage of brand-name drugs filled and decrease health care expenditures.


Assuntos
Medicare Part D/estatística & dados numéricos , Padrões de Prática Médica , Medicamentos sob Prescrição/economia , Adolescente , Adulto , Idoso , Criança , Estudos Transversais , Custos de Medicamentos , Medicamentos Genéricos , Feminino , Humanos , Revisão da Utilização de Seguros , Masculino , Pessoa de Meia-Idade , Rhode Island , Fatores Socioeconômicos , Estados Unidos , Adulto Jovem
8.
Bull World Health Organ ; 98(3): 188-197K, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-32132753

RESUMO

Objective: To compare the efficacy of generic direct-acting agents and brand-name medicines for treating hepatitis C virus (HCV) infection by conducting a systematic review and meta-analysis. Methods: We searched online databases for studies that reported sustained virological responses 12 weeks after the end of HCV treatment with generic direct-acting agents. We derived pooled proportions of treated patients with a sustained virological response from intention-to-treat and per-protocol analyses. In addition, we calculated the pooled relative risk (RR) of a sustained virological response brand-name versus generic direct-acting agents using a random-effects model (DerSimonian-Laird) from the data available. Between-study heterogeneity was assessed using the I2 statistic. Findings: We identified 19 studies involving a total of 57 433 individuals from eight territories or regions. The pooled overall proportions of patients with a sustained virological response were 98% (95% confidence interval, CI: 97-99; 18 studies; I2 = 94.1%) in per-protocol analyses and 96% (95% CI: 93-98; 8 studies; I2 = 68.1%) in intention-to-treat analyses. The likelihood of a sustained virological response with brand-name medicines was similar to that with generic direct-acting agents (RR: 1.00; 95% CI: 0.98-1.02; I2 = 0.0%). The likelihood of a sustained virological response was significantly higher in patients without than with cirrhosis (RR:1.03; 95% CI: 1.01-1.06; 7 studies) but was not significantly affected by either previous treatment (3 studies) or human immunodeficiency virus coinfection (3 studies). Conclusion: Generic direct-acting agents are highly effective for treating hepatitis C. Generic agents should be considered in resource-constrained settings for decreasing the burden of liver disease in HCV-infected patients.


Assuntos
Antivirais/uso terapêutico , Hepatite C/tratamento farmacológico , Medicamentos Genéricos , Humanos , Resultado do Tratamento
9.
BMC Health Serv Res ; 20(1): 82, 2020 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-32013951

RESUMO

BACKGROUND: Generic substitution (GS) was introduced in Finland in 2003 and supplemented with a reference price system (RPS) in 2009. Patients play a vital role in the acceptance of GS and the use of less expensive generic medicines. The objective of this study was to explore Finnish pharmacy customers' experience with allowing and refusing GS. Specific aims were to investigate the reasons for (1) allowing and (2) refusing GS and (3) to determine the prescription medicine-related factors influencing the customer's choice of an interchangeable prescription medicine. METHODS: A questionnaire survey was conducted in February 2018. Questionnaires were handed out from 18 community pharmacies across Finland to customers ≥18 years who purchased for themselves a prescription medicine included in the RPS. A descriptive approach was used in the analysis using frequencies, the Chi-square test and Fisher's exact test. RESULTS: The final study material consisted of 1043 questionnaires (response rate 40.0%). Of the customers, 47.9% had both allowed and refused GS, 41.2% had only allowed GS and 6.0% had only refused GS. Customers had allowed GS because they wanted to lower their medicine expenses (75.5%), or because the prescribed medicine (30.8%) or medicine they had used before (27.4%) was unavailable at the pharmacy. The main reasons for refusing GS were an insignificant price difference between interchangeable medicines (63.3%) and satisfaction with the medicine used before (60.2%). The main factors influencing customers' choice of an interchangeable prescription medicine were price (81.1%), familiarity (38.4%) and availability (32.8%). Customers who had allowed GS chose the medicine based on price. Customers who had only refused GS appreciated familiarity more than the price of the medicine. CONCLUSIONS: GS is a common practice in Finnish community pharmacies. The price of the medicine was the most important factor affecting customers' decision to allow or refuse GS and the choice of an interchangeable prescription medicine. Thus, customers should receive information about medicine prices at the pharmacy in order to help them make their decision. However, individual needs should also be taken into account in counselling because customers regard several factors as important in their choice of an interchangeable medicine.


Assuntos
Comportamento do Consumidor/estatística & dados numéricos , Substituição de Medicamentos , Medicamentos sob Prescrição , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Comércio , Comportamento do Consumidor/economia , Substituição de Medicamentos/economia , Medicamentos Genéricos/economia , Feminino , Finlândia , Humanos , Masculino , Pessoa de Meia-Idade , Farmácias , Medicamentos sob Prescrição/economia , Inquéritos e Questionários , Adulto Jovem
14.
Int J Clin Pharmacol Ther ; 58(2): 112-120, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31829925

RESUMO

OBJECTIVE: The purpose of this study was to evaluate the bioequivalence of two formulations of atorvastatin using the reference-scaled average bioequivalence (RSABE) method and to study the pharmacokinetics of atorvastatin in healthy Chinese subjects under fed conditions. MATERIALS AND METHODS: A single-dose, randomized, open-label, four-way crossover study was conducted in healthy Chinese subjects after informed consent was obtained. Healthy subjects were randomly assigned to receive 20 mg of either the test or reference formulation, following a 7-day washout period. The formulations were considered bioequivalent if 90% confidence intervals (CIs) for the ln-transformed ratios and ratio of geometric means (GMR) of AUC and Cmax of atorvastatin were within the bioequivalence range (80 - 125%). Plasma atorvastatin, ortho-hydroxy atorvastatin and para-hydroxy atorvastatin concentrations were analyzed by liquid chromatography-tandem mass spectrometry. Tolerability was assessed during the entire study period. RESULTS: ANOVA indicated that the period, sequence, and formulation had no significant effect on the pharmacokinetic parameters (p < 0.05). The test formulation was bioequivalent to the marketed formulation as the 90% CIs for natural log-transformed ratios of atorvastatin of Cmax (88.45 - 103.57%), AUC0-t (98.08 - 104.89%) and AUC0-∞ (98.15 - 104.87%) were within equivalence limits (80 - 125%). No serious adverse events were found among the subjects. CONCLUSION: The RSABE approach was successful in evaluating the bioequivalence of these two formulations. This study confirmed that test and reference atorvastatin calcium tablets were bioequivalent under fed condition.


Assuntos
Atorvastatina/farmacocinética , Medicamentos Genéricos/farmacocinética , Administração Oral , Área Sob a Curva , Disponibilidade Biológica , Estudos Cross-Over , Humanos , Comprimidos , Equivalência Terapêutica
15.
J Oncol Pharm Pract ; 26(1): 124-132, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31106664

RESUMO

INTRODUCTION: Biosimilar drugs have significantly shaken the global pharmaceutical market through a better access to the health care services. The aim of this study is to establish a state of play in Tunisia based on the knowledge and perceptions of doctors on biosimilars in order to identify the problems related to these drugs and to propose solutions for improvement. MATERIALS AND METHODS: In our study, we conducted a prospective, descriptive survey using a questionnaire, destinated to oncologists and hematologists with different grades, from both public and private sectors and from several regions. The questions focused on physicians' general knowledge of biosimilars and their comparison with reference on safety, quality, efficacy, and indication. Finally, we explored the proportion of physicians who are favorable to the policy encouraging biosimilar use. RESULTS: One hundred and seven doctors among 150 answered the questionnaire; 57% were oncologists and 43% were hematologists. About one over five physicians defines biosimilar as a chemical drug. About 29% do not differentiate between a biosimilar and a generic one. A percentage of 68 believe that a biosimilar can have all the indications of its reference following complementary clinical studies. On the other side, 68.2% support the policy encouraging these drugs. Last, only 3.7% of the practitioners believe that they are well informed about biosimilars. DISCUSSION: Our results are comparable to other surveys described in the literature. However, this is the first study that targets oncologists and hematologists specifically. CONCLUSION: Our study showed a lack of information from oncologists and hematologists about biosimilars in Tunisia. Thus, health authorities should carry out training programs on biosimilars and introduce clear and effective legislation in order to allow better access to health care services.


Assuntos
Atitude do Pessoal de Saúde , Medicamentos Biossimilares/uso terapêutico , Hematologia/normas , Oncologistas/normas , Inquéritos e Questionários , Medicamentos Genéricos/uso terapêutico , Humanos , Oncologistas/psicologia , Estudos Prospectivos , Tunísia/epidemiologia
16.
Int J Clin Pharmacol Ther ; 58(3): 183-193, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31841106

RESUMO

OBJECTIVE: The present study compared the pharmacokinetics of two (1 mg) tacrolimus formulations (test (generic from Panacea) and reference (innovator from Astellas)) after a single-dose administration as per the European Medicine Agency (EMA) guidelines to grant marketing authorization. MATERIALS AND METHODS: This study was a randomized, open-label, balanced, two-treatment, two-period, two-sequences, single-dose, truncated-area, crossover design with a washout period of 19 days between the phases. Healthy subjects aged 18 - 45 years (both inclusive) were included. Eligible subjects received a single oral dose of 5 × 1-mg capsule of tacrolimus either test or reference formulation. Blood samples were collected until 72.00 hours postdose, and peak concentration (Cmax) and area under the curve (AUC0-72) were evaluated in whole blood using validated LC-MS/MS. Safety was also assessed in each period. RESULTS: Of 56 subjects enrolled, 52 completed both study periods. The arithmetic mean (SD) Cmax for the reference and test formulations was 40.62 (11.30) and 46.20 (10.73) ng/mL, and AUC0-72 was 348.34 (156.41) and 361.04 (158.71) ng×h/mL, respectively. The geometric least square mean ratio (90% confidence interval (CI)) was 115.07% (90% CI: 109.81, 120.59) for Cmax and 103.78 (90% CI: 97.40, 110.58) for AUC0-72, which fell within the acceptance range as per EMA guidelines for narrow therapeutic index drugs (Cmax: 80.00 - 125.00%; AUC: 90.00 - 111.11%). No serious adverse event was observed. CONCLUSION: The generic tacrolimus was bioequivalent to the reference formulation, was well tolerated, and provides a well-acceptable alternative to the reference drug. Switching treatment to generic tacrolimus medication may reduce the cost and economic burden of treating transplanted patients.


Assuntos
Jejum , Tacrolimo/administração & dosagem , Tacrolimo/farmacocinética , Adulto , Área Sob a Curva , Disponibilidade Biológica , Cromatografia Líquida , Estudos Cross-Over , Medicamentos Genéricos/administração & dosagem , Medicamentos Genéricos/farmacocinética , Humanos , Masculino , Pessoa de Meia-Idade , Comprimidos , Espectrometria de Massas em Tandem , Equivalência Terapêutica , Adulto Jovem
17.
J Assoc Physicians India ; 67(11): 66-67, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31793272

RESUMO

Millions of people across the globe go without essential medicines resulting in many avoidable deaths each year. It's no secret that the cost of prescription drugs, including the life-saving ones has been rising far faster than inflation over the last few years. If we take the example of diabetes and as India has the largest number of patients with the condition in the world; it has been shown that patients belonging to the low income group in urban India were spending. 27% of their annual income and those in rural India 34% of their annual income on diabetes care; most of which was spent on purchase of medicines. This raises the question of whether current pricing of drugs is based on reasonable expectation of return on investment or whether it is based on what prices the market can bear. The price of pharmaceuticals has become an issue of great concern for people and governments around the world. Thus governments across the globe must make efforts to correct the present distortions around the concept of generic drugs.


Assuntos
Medicamentos Biossimilares , Medicamentos Genéricos , Humanos , Índia
20.
PLoS One ; 14(12): e0226552, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31869360

RESUMO

BACKGROUND: Imatinib mesylate (IM) is a first-line treatment option for patients with chronic myeloid leukemia (CML). Patients who fail or are intolerant to IM therapy are treated with more expensive second and third-generation tyrosine kinase inhibitors. Patients show wide variation in trough concentrations in response to standard dosing. Thus, many patients receive subtherapeutic or supratherapeutic doses. Therapeutic drug monitoring (TDM) may improve dose management that, in turn, may reduce costs and improve outcomes. However, TDM also adds to the cost of patient care. The objective of this study was to determine the cost-effectiveness of TDM for generic IM therapy. METHODS: We developed a microsimulation model for the trough plasma concentration of IM which is related to a cytogenetic or molecular response. We compared two cohorts: one with TDM and one without TDM (NTDM). The lifetime incremental cost-effectiveness ratio (ICER) was calculated using quality-adjusted life years (QALYs) as the effectiveness measure. One-way and probabilistic sensitivity analyses were performed. RESULTS: The lifetime cost and QALY of treatment with TDM were $2,137K [95% Ci: 2,079K; 2,174K] and 12.37 [95% CI: 12.07; 12.55], respectively. The cost and QALY of NTDM were $2,132K [95% CI: 2,091K; 2,197K] and 12.23 [95% CI: 11.96; 12.50], respectively. The incremental cost and QALY for TDM relative to NTDM was $4,417 [95% CI: -52,582; 32,097]) and 0.15 [95% CI: -0.13; 0.28]. The ICER for TDM relative to NTDM was $30,450/QALY. Probabilistic sensitivity analysis showed that TDM was cost-effective relative to NTDM in 90% of the tested scenarios at a willingness-to-pay threshold of $100,000/QALY. CONCLUSIONS: Although the impact of TDM is modest, the cost-effectiveness over a lifetime horizon (societal perspective, ($30,450/QALY) falls within the acceptable range (< $100k/QALY).


Assuntos
Monitoramento de Medicamentos/economia , Mesilato de Imatinib/uso terapêutico , Leucemia Mielogênica Crônica BCR-ABL Positiva/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/economia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Simulação por Computador , Análise Custo-Benefício , Análise Citogenética , Monitoramento de Medicamentos/métodos , Resistencia a Medicamentos Antineoplásicos/genética , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/economia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/genética , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/terapia , Medicamentos Genéricos/economia , Medicamentos Genéricos/uso terapêutico , Transplante de Células-Tronco Hematopoéticas/economia , Transplante de Células-Tronco Hematopoéticas/estatística & dados numéricos , Humanos , Mesilato de Imatinib/economia , Leucemia Mielogênica Crônica BCR-ABL Positiva/economia , Leucemia Mielogênica Crônica BCR-ABL Positiva/epidemiologia , Leucemia Mielogênica Crônica BCR-ABL Positiva/genética , Adesão à Medicação/estatística & dados numéricos , Testes Farmacogenômicos , Anos de Vida Ajustados por Qualidade de Vida , Análise de Sobrevida
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