RESUMO
INTRODUCTION: Triple therapy with telaprevir or boceprevir has proven to be effective in the treatment of chronic hepatitis C with response rates of up to 88%. However, the treatment may be associated with important adverse effects and a high economic impact. OBJECTIVE: To assess the cost-effectiveness and safety of triple therapy with telaprevir or boceprevir for the treatment of chronic hepatitis C. METHODS: Retrospective observational study. We included all patients who had started treatment with protease inhibitors before July 31(st), 2013. We evaluated sustained virological response, the cost per patient achieving sustained virological response, and the cost of the supportive treatment for adverse events associated with triple therapy. RESULTS: Fifty-nine patients were included; 35 had been treated with telaprevir (59.3%) and 24 with boceprevir (40.7%). Sustained virological response was achieved by 38 (64.4%) patients: 24 (68.6%) patients in the telaprevir treatment arm and 14 (58.3%) patients in the boceprevir treatment arm. The cost per patient with sustained virological response was 43,555 (95% CI 35,389-51,722 ). There were no statistically significant differences between the overall costs of therapy with telaprevir, 43,494 (95% CI 34,795 -55,092 ) versus boceprevir, 42,005 (95% CI 32,122-64,243). The mean cost of supportive care per patient was 1,500 , while the maximum cost was 11,374 . Due to adverse events, 8 (13.6%) patients required hospital admission, 22 (37.3%) patients attended the accident and emergency department, and 26 (44.1%) patients needed additional medical consultations. CONCLUSIONS: The treatment of triple therapy with telaprevir or boceprevir resulted in high cost per patient with sustained virological response. Due to adverse events, a high number of patients required supportive care, whose costs should be added to those of triple therapy.
Assuntos
Antivirais/uso terapêutico , Hepatite C Crônica/tratamento farmacológico , Oligopeptídeos/uso terapêutico , Prolina/análogos & derivados , Inibidores de Proteases/uso terapêutico , Antivirais/administração & dosagem , Antivirais/efeitos adversos , Antivirais/economia , Análise Custo-Benefício , Custos de Medicamentos , Quimioterapia Combinada , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Doenças Hematológicas/induzido quimicamente , Doenças Hematológicas/economia , Hepatite C Crônica/economia , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Interferons/administração & dosagem , Interferons/economia , Interferons/uso terapêutico , Masculino , Pessoa de Meia-Idade , Oligopeptídeos/administração & dosagem , Oligopeptídeos/efeitos adversos , Oligopeptídeos/economia , Prolina/administração & dosagem , Prolina/efeitos adversos , Prolina/economia , Prolina/uso terapêutico , Inibidores de Proteases/efeitos adversos , Inibidores de Proteases/economia , Indução de Remissão , Estudos Retrospectivos , Ribavirina/administração & dosagem , Ribavirina/economia , Ribavirina/uso terapêutico , EspanhaRESUMO
Wilson's disease is a hereditary autosomal recessive disorder of copper metabolism,characterized by copper accumulation in the liver and brain. This rare entity, which has a broad clinical spectrum, is often difficult to diagnose and should therefore always be suspected in patients with liver disease of unclear cause. We describe two types of manifestation of liver disease in two patients; the first developed fulminant hepatic failure requiring urgent liver transplantation and the second showed advanced chronic liver disease and received standard medical treatment. The objective of this clinical observation is to analyze the diagnosis of Wilson's disease in two patients with distinct onset, illustrating the broad clinical spectrum of the disease, and its treatment.
Assuntos
Degeneração Hepatolenticular/diagnóstico , Adulto , Cobre , Feminino , Humanos , Hepatopatias/diagnóstico , Pessoa de Meia-IdadeAssuntos
Quelantes/efeitos adversos , Degeneração Hepatolenticular/complicações , Penicilamina/efeitos adversos , Pseudoxantoma Elástico/induzido quimicamente , Pseudoxantoma Elástico/complicações , Adulto , Quelantes/uso terapêutico , Feminino , Degeneração Hepatolenticular/tratamento farmacológico , Humanos , Penicilamina/uso terapêuticoAssuntos
Duodenopatias/patologia , Melanose/patologia , Gastropatias/patologia , Idoso , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
INTRODUCCIÓN: La triple terapia con telaprevir o boceprevir ha resultado efectiva en el tratamiento de la hepatitis C crónica, con porcentajes de respuesta de hasta el 88%. Se asocia a importantes efectos adversos y supone un alto impacto económico. OBJETIVO: Valorar el coste-efectividad y la seguridad de telaprevir y boceprevir. MÉTODOS: Estudio observacional retrospectivo. Se incluyó a pacientes que iniciaron tratamiento con inhibidores de proteasa antes del 31 de julio del 2013. Se valoraron la respuesta virológica sostenida, el coste por paciente curado y el coste de las medidas para el manejo de los efectos adversos. RESULTADOS: Se incluyó a 59 pacientes, 35 con telaprevir (59,3%) y 24 con boceprevir (40,7%). Obtuvieron respuesta virológica sostenida 38 (64,4%) pacientes, 24 (68,6%) con telaprevir y 14 (58,3%) con boceprevir. El coste por paciente curado fue 43.555 Euros (IC del 95%, 35.389-51.722 Euros), sin diferencias significativas entre telaprevir, 43.494 Euros (IC del 95%, 34.795 Euros-55.092 Euros), y boceprevir, 42.005 Euros (IC del 95%, 32.122-64.243 Euros). El coste medio por paciente del manejo de los efectos adversos supuso 1.500 Euros, con un máximo 11.374 Euros. Para el tratamiento de los efectos adversos requirieron ingreso hospitalario 8 (13,6%) pacientes, visitas a Urgencias 22 (37,3%) pacientes y visitas médicas adicionales 26 (44,1%) pacientes. CONCLUSIONES: El tratamiento con triple terapia basada en telaprevir o boceprevir ha supuesto un alto coste por paciente curado. Los efectos adversos desarrollados han requerido que un alto número de pacientes necesiten medidas de soporte, cuyo coste hay que añadir al del tratamiento con triple terapia
INTRODUCTION: Triple therapy with telaprevir or boceprevir has proven to be effective in the treatment of chronic hepatitis C with response rates of up to 88%. However, the treatment may be associated with important adverse effects and a high economic impact. OBJECTIVE: To assess the cost-effectiveness and safety of triple therapy with telaprevir or boceprevir for the treatment of chronic hepatitis C. METHODS: Retrospective observational study. We included all patients who had started treatment with protease inhibitors before July 31st, 2013. We evaluated sustained virological response, the cost per patient achieving sustained virological response, and the cost of the supportive treatment for adverse events associated with triple therapy. RESULTS: Fifty-nine patients were included; 35 had been treated with telaprevir (59.3%) and 24 with boceprevir (40.7%). Sustained virological response was achieved by 38 (64.4%) patients: 24 (68.6%) patients in the telaprevir treatment arm and 14 (58.3%) patients in the boceprevir treatment arm. The cost per patient with sustained virological response was 43,555 Euros (95% CI 35,389-51,722 Euros). There were no statistically significant differences between the overall costs of therapy with telaprevir, 43,494 Euros (95% CI 34,795 Euros-55,092 Euros) versus boceprevir, 42,005 Euros (95% CI 32,122-64,243 Euros). The mean cost of supportive care per patient was 1,500 Euros, while the maximum cost was 11,374 Euros. Due to adverse events, 8 (13.6%) patients required hospital admission, 22 (37.3%) patients attended the accident and emergency department, and 26 (44.1%) patients needed additional medical consultations. CONCLUSIONS: The treatment of triple therapy with telaprevir or boceprevir resulted in high cost per patient with sustained virological response. Due to adverse events, a high number of patients required supportive care, whose costs should be added to those of triple therapy
Assuntos
Humanos , Hepatite C Crônica/tratamento farmacológico , Antivirais/uso terapêutico , Inibidores de Proteases/uso terapêutico , 50303 , Interferon-alfa/uso terapêutico , Ribavirina/uso terapêutico , Segurança do Paciente , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Esquema de MedicaçãoRESUMO
No disponible
Assuntos
Humanos , Feminino , Adulto , Degeneração Hepatolenticular/complicações , Pseudoxantoma Elástico/induzido quimicamente , D-Penicilina (2,5)-Encefalina/efeitos adversos , Acetato de Zinco/uso terapêuticoRESUMO
No disponible
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Sarda Melanótica de Hutchinson/complicações , Sarda Melanótica de Hutchinson/diagnóstico , Sarda Melanótica de Hutchinson/patologia , Melanose/diagnóstico , Melanose/patologia , Mucosa Gástrica/citologia , Mucosa Gástrica/patologia , Mucosa Intestinal/patologia , Endoscopia do Sistema Digestório/métodos , Macrófagos/citologia , Macrófagos/patologia , Anti-Hipertensivos/efeitos adversos , Hipertensão/complicações , Ferro/efeitos adversos , Insuficiência Renal/complicações , Hemorragia Gastrointestinal/complicações , Complicações do Diabetes , Insuficiência Cardíaca/complicações , Diagnóstico DiferencialRESUMO
La enfermedad de Wilson es un trastorno hereditario autosómico recesivo del metabolismo del cobre (gen ATP7B), que se caracteriza por la acumulación del mismo en diferentes órganos, principalmente el hígado y el cerebro. Es una enfermedad poco frecuente, difícil de diagnosticar en muchas ocasiones y con un espectro clínico muy amplio y, por lo tanto, debemos sospecharla siempre en un paciente con hepatopatía de causa no clara. En el siguiente artículo presentamos 2 pacientes con diferentes formas de manifestación de la enfermedad hepática, uno de ellos requirió trasplante hepático urgente por fallo hepático fulminante y el otro recibió tratamiento médico. El objetivo de esta observación clínica es analizar el diagnóstico de la enfermedad de Wilson en 2 pacientes en los que se inició de forma diferente y, por tanto, el amplio espectro clínico de la enfermedad y su tratamiento (AU)
Wilsons disease is a hereditary autosomal recessive disorder of copper metabolism, characterized by copper accumulation in the liver and brain. This rare entity, which has abroad clinical spectrum, is often difficult to diagnose and should therefore always be suspected in patients with liver disease of unclear cause. We describe two types of manifestation of liver disease in two patients; the first developed fulminant hepatic failure requiring urgent liver transplantation and the second showed advanced chronic liver disease and received standard medical treatment. The objective of this clinical observation is to analyze the diagnosis of Wilsons disease in two patients with distinct onset, illustrating the broad clinical spectrum of the disease, and its treatment (AU)