RESUMO
OBJECTIVE: To carry out a budget impact analysis (BIA) of olmesartan/amlodipine (20/5, 40/5 and 40/10mg) marketed as a fixed combination (FC) in its approved indication for the National Health System (NHS). DESIG: We developed a decision tree model in order to estimate usual hypertension treatment algorithm in Spanish clinical practice. SETTINGS: The BIA has been developed from the perspective of the NHS for a period of 3 years (years 2010-2012). PARTICIPANTS: Spanish hypertensive population ≥ 35 years old. INTERVENTIONS: Introduction into the market of a fixed combination (FC) olmesartan/amlodipine in Spain. PRIMARY MEASURES: Expected costs to be assumed by the Spanish NHS (RRP-VAT) for hypertensive population able to be treated with the FC versus currently assumed costs by the NHS with free combination olmesartan and amlodipine. RESULTS: Estimated pharmaceutical costs in hypertensive population treated with olmesartan and amlodipine (2 pills) would be 25.2M (1(st) year), 26.4M (2011), 27.6M (2012), with a total 3-year period of 79.2M. According to patient tree model, the population able to be treated with FC would be 71,283 patients (2010), with a growth rate of 4.8% in the successive years, which supposes an annual cost of 21.2M (2010), 21.8M (2011) and 22.4M (2012), with a total 3-year period of 65.4M. The BIA shows savings of 13.8M in a total 3-year period. CONCLUSION: The BIA of FC olmesartan/amlodipine could generate net savings of 13.8M for the NHS in the period ranging from years 2010 to 2012.
Assuntos
Anlodipino/administração & dosagem , Anlodipino/economia , Bloqueadores do Receptor Tipo 1 de Angiotensina II/administração & dosagem , Bloqueadores do Receptor Tipo 1 de Angiotensina II/economia , Anti-Hipertensivos/administração & dosagem , Anti-Hipertensivos/economia , Hipertensão/tratamento farmacológico , Imidazóis/administração & dosagem , Imidazóis/economia , Tetrazóis/administração & dosagem , Tetrazóis/economia , Idoso , Custos e Análise de Custo , Árvores de Decisões , Combinação de Medicamentos , Humanos , Pessoa de Meia-Idade , Programas Nacionais de Saúde , EspanhaRESUMO
BACKGROUND AND OBJECTIVES: Analyze evolution Renal Chronic Failure stage 4-5 (ACRF) patients and influence information they receive (educational process, EP) in modality Renal Replacement Therapy (RRT) or conservative treatment (CT) in multidisciplinar ACRF Office. MATERIAL AND METHODS: Prospective, multicenter study (3 centers). Inclusion: from June-01-2014 to October-01-2015; observation: 12 months or until start RRT or death if they occur before 12 months; ends October-01-2016. RESULTS: 336 patients were included (60% males), median and intercuartile rank 71.5 (17), 55% ≥ 70 years; Follow up initiation eGFR CKD-EPI: 21 (9) ml / min / 1.73m2; Charlson Index (ChI) with / without age 8 (3) / 4 (2); Diabetic patients: 52,4%. The EP was carried out in 168, eGFR 15 (10) ml / min / 1.73m2. The initial treatment election: 26% peritoneal dialysis (PD), 45% hemodyalisis (HD), 26% CT, kidney trasplant 3%; 60 patients started RRT: 3.3% kidney traspant; 30% PD, 66% HD; 104 admissions in 73 patients, the most frequent cause: cardiovascular disease (42%). Fallecimiento: 23 patients (6.8%). Age was higher (78.4 (6) vs. 67.8 (13.4), P<.001), higher ChI 9.8 (2.1) vs. 7.4 (2.5), P<.001). All deceased who received EP had chosen CT; 61% of deceased had at least one hospital admission vs. 39% alive (P<0.001). Cox regression: age and Charlson index were the predictive mortality variables. CONCLUSIONS: The population of ACRF patients is elder, comorbid, with high rate hospitalizations rate. The PD election is higher than usual. The EP has been very useful tool and has favored the PD choice.
Assuntos
Tratamento Conservador , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/terapia , Diálise Renal , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisões , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Estudos Prospectivos , Índice de Gravidade de Doença , Fatores de TempoRESUMO
ANTECEDENTES Y OBJETIVOS: Conocer evolución de pacientes ERC estadios 4 y 5 (ERCA) e influencia de la información (proceso educativo [PE]) que reciben para elección de la modalidad de tratamiento renal sustitutivo (TRS) o tratamiento conservador (TC) en consulta multidisciplinar de ERCA. MATERIAL Y MÉTODOS: Estudio prospectivo, multicéntrico (3 centros españoles). Pacientes incidentes: consulta ERCA desde el 1 de junio del 2014 al 1 de octubre del 015; observación: 12 meses o inicio del TRS o fallecimiento si antes de los 12 meses; finaliza el 1 de octubre del 2016. RESULTADOS: Trescientos treinta y tres pacientes (60% varones), mediana y rango intercuartil: edad 71,5 (17) años (55% ≥ 70 años), FGe CKD-EPI inicio 21 (9) ml/min/1,73 m2, índice de Charlson (ICh) con/sin edad 8 (3)/4 (2). Pacientes diabéticos: 52,4%. Recibieron PE 168 pacientes, FGe al inicio 15 (10) ml/min/1,73 m2. Tratamiento inicial elegido: 26% diálisis peritoneal (DP), 45% hemodiálisis (HD), 26% TC, trasplante renal 3%; 60 pacientes iniciaron TRS: 3,3% trasplante renal, 30% DP, 66% HD. Ingresos: 104 en 73 pacientes, la causa más frecuente fue por enfermedad cardiovascular (42%). Fallecimiento: 23 pacientes (6,8%), de mayor edad (78,4 [6] vs. 67,8 [13,4], p < 0,001), ICh más elevado 9,8 [2,1] vs. 7,4 [2,5], p < 0,001). Todos los fallecidos con PE habían decidido TC; el 61% de los fallecidos tenían al menos un ingreso hospitalario vs. 39%vivos (p < 0,001). Regresión Cox: variables predictivas mortalidad: edad e ICh. CONCLUSIONES:La población de ERCA es añosa, comórbida y con elevado índice de ingresos hospitalarios. La incidencia de DP es mayor a la habitual. El PE ha sido una herramienta de gran utilidad y favorece la elección de DP
BACKGROUND AND OBJECTIVES: Analyze evolution Renal Chronic Failure stage 4-5 (ACRF) patients and influence information they receive (educational process, EP) in modality Renal Replacement Therapy (RRT) or conservative treatment (CT) in multidisciplinar ACRF Office. MATERIAL AND METHODS: Prospective, multicenter study (3 centers). Inclusion: from June-01-2014 to October-01-2015; observation: 12 months or until start RRT or death if they occur before 12 months; ends October-01-2016. RESULTS: 336 patients were included (60% males), median and intercuartile rank 71.5 (17), 55% ≥ 70 years; Follow up initiation eGFR CKD-EPI: 21 (9) ml / min / 1.73m2; Charlson Index (ChI) with / without age 8 (3) / 4 (2); Diabetic patients: 52,4%. The EP was carried out in 168, eGFR 15 (10) ml / min / 1.73 m2. The initial treatment election: 26% peritoneal dialysis (PD), 45% hemodyalisis (HD), 26% CT, kidney trasplant 3%; 60 patients started RRT: 3.3% kidney traspant; 30% PD, 66% HD; 104 admissions in 73 patients, the most frequent cause: cardiovascular disease (42%). Fallecimiento: 23 patients (6.8%). Age was higher (78.4 (6) vs. 67.8 (13.4), P < .001), higher ChI 9.8 (2.1) vs. 7.4 (2.5), P < .001). All deceased who received EP had chosen CT; 61% of deceased had at least one hospital admission vs. 39% alive (P < 0.001). Cox regression: age and Charlson index were the predictive mortality variables. CONCLUSIONS: The population of ACRF patients is elder, comorbid, with high rate hospitalizations rate. The PD election is higher than usual. The EP has been very useful tool and has favored the PD choice
Assuntos
Humanos , Masculino , Feminino , Idoso , Insuficiência Renal Crônica/terapia , Terapia de Substituição Renal/métodos , Estudos Prospectivos , Utilização de Instalações e Serviços , Insuficiência Renal Crônica/fisiopatologia , Rim/fisiopatologia , Comunicação Interdisciplinar , Hemodiálise no Domicílio/métodos , Hemodiálise no Domicílio/tendênciasRESUMO
ObjetivoRealizar un análisis de impacto presupuestario (AIP) de la introducción en el Sistema Nacional de Salud (SNS) de la combinación fija (CF) de olmesartan/amlodipino (20/5, 40/5 y 40/10mg) en la indicación aprobada.DiseñoModelo de árbol de decisión que refleja el algoritmo de tratamiento más habitual en la práctica clínica de la hipertensión junto con sus probabilidades de ocurrencia.EmplazamientoPerspectiva del SNS para un período de 3 años (2010-2012).ParticipantesPoblación española hipertensa mayor de 35 años.IntervencionesIntroducción de la CF olmesartan/amlodipino en el mercado español.Mediciones principalesCostes financiados por el SNS (a PVP-IVA) para la población de pacientes susceptibles de ser tratados con la CF frente a los asumidos con la combinación libre (CL) olmesartan y amlodipino.ResultadosLa estimación del gasto farmacéutico con olmesartan y amlodipino en CL era de 25,2 M (primer año), 26,4 M el segundo año y 27,6 M el tercero, totalizando 79,2 M. Según el modelo, la población susceptible de ser tratada con la CF es de 71.283 pacientes (primer año), con una tasa de crecimiento cercana al 4,8% en los sucesivos años, lo que supone un coste anual de 21,2 M (2010), 21,8 M (2011) y 22,4 M (2012), totalizando 65,4 M. El AIP muestra un ahorro de 13,8 M, siendo unos resultados robustos confirmados por los análisis de sensibilidad univariantes de tipo umbral.ConclusiónEl AIP de la CF de olmesartan/amlodipino podría generar unos ahorros netos para el SNS en 3 años de 13,8 M(AU)
ObjectiveTo carry out a budget impact analysis (BIA) of olmesartan/amlodipine (20/5, 40/5 and 40/10mg) marketed as a fixed combination (FC) in its approved indication for the National Health System (NHS).DesigWe developed a decision tree model in order to estimate usual hypertension treatment algorithm in Spanish clinical practice.SettingsThe BIA has been developed from the perspective of the NHS for a period of 3 years (years 2010-2012).ParticipantsSpanish hypertensive population ≥ 35 years old.InterventionsIntroduction into the market of a fixed combination (FC) olmesartan/amlodipine in Spain.Primary measuresExpected costs to be assumed by the Spanish NHS (RRP-VAT) for hypertensive population able to be treated with the FC versus currently assumed costs by the NHS with free combination olmesartan and amlodipine.ResultsEstimated pharmaceutical costs in hypertensive population treated with olmesartan and amlodipine (2 pills) would be 25.2M (1st year), 26.4M (2011), 27.6M (2012), with a total 3-year period of 79.2M. According to patient tree model, the population able to be treated with FC would be 71,283 patients (2010), with a growth rate of 4.8% in the successive years, which supposes an annual cost of 21.2M (2010), 21.8M (2011) and 22.4M (2012), with a total 3-year period of 65.4M. The BIA shows savings of 13.8M in a total 3-year period.ConclusionThe BIA of FC olmesartan/amlodipine could generate net savings of 13.8M for the NHS in the period ranging from years 2010 to 2012(AU)