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Tôrres LL, Azevedo PS, Rocha Sarmento TT, Ramalho-de-Oliveira D, Reis EA, Dias Godói IP, Guerra Júnior AA, Ruas CM. Acceptability and consumers' willingness to pay for comprehensive medication management services in Brazil. J Comp Eff Res 2024; 13:e230127. [PMID: 38329429 PMCID: PMC11044949 DOI: 10.57264/cer-2023-0127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 01/18/2024] [Indexed: 02/09/2024] Open
Abstract
Aim: Comprehensive medication management (CMM) is a clinical service that aims to optimize the therapeutic results of patients at the individual level. Studies carried out in Brazil and in several parts of the world have found a positive impact of the service, mainly in the resolution of drug therapy problems and in improving clinical outcomes and patients' quality of life. This service is not widespread and its acceptability and willingness to pay were not defined by the population yet. Objective: This work aims to conduct a study with users of private health services to determine the acceptability and willingness to pay for CMM services. Methods: This is a cross-sectional survey conducted through face-to-face interviews, among residents over 18 years of age of the metropolitan region of Belo Horizonte, capital of Minas Gerais State, Brazil. Results: For this study, 563 individuals were interviewed. Most respondents were female (55.1%), had completed high school (46.8%) and were employed (62.5%). The acceptability for the service was 93,25%, and among all respondents, 37 would not accept the service even if it was free. The amount of consumers' willingness to pay for the CMM service was estimated at $17.75 (40.00 BRL). Conclusion: The research results show that most people are willing to pay for the CMM service. This study can contribute to the decision-making regarding the implementation and pricing of the service in Brazil.
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Affiliation(s)
- Lucas Lima Tôrres
- Faculty of Pharmacy – Federal University of Minas Gerais, 6627 Moacir Gomes de Freitas St., Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Pâmela Santos Azevedo
- Postgraduate Program in Medicines & Pharmaceutical Assistance, School of Pharmacy, Federal University of Minas Gerais, 6627 Moacir Gomes de Freitas St., Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Túlio Tadeu Rocha Sarmento
- Faculty of Pharmacy – Federal University of Minas Gerais, 6627 Moacir Gomes de Freitas St., Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Djenane Ramalho-de-Oliveira
- Faculty of Pharmacy – Federal University of Minas Gerais, 6627 Moacir Gomes de Freitas St., Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Edna Afonso Reis
- Statistics Department – Federal University of Minas Gerais, 308 Reitor Pires Albuquerque St., Pampulha, Belo Horizonte, Minas Gerais, 31270-010, Brazil
| | - Isabella Piassi Dias Godói
- Institute of Pharmaceutical Sciences, Federal University of Rio de Janeiro, Avenida Aluízio da Silva Gomes 50, Granja dos Cavaleiros, Macaé, Rio de Janeiro, 27930-560, Brazil
- Health Technology Assessment Center - Management, Economics, Education and Pharmaceutical Services, Federal University of Rio de Janeiro, Avenida Aluízio da Silva Gomes 50, Granja dos Cavaleiros, Macaé, Rio de Janeiro, 27930-560, Brazil
| | - Augusto Afonso Guerra Júnior
- Faculty of Pharmacy – Federal University of Minas Gerais, 6627 Moacir Gomes de Freitas St., Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
- Collaborating Center of the SUS for Technology Assessment & Excellence in Health, School of Pharmacy, Federal University of Minas Gerais, 6627 Moacir Gomes de Freitas St., Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
| | - Cristina Mariano Ruas
- Faculty of Pharmacy – Federal University of Minas Gerais, 6627 Moacir Gomes de Freitas St., Pampulha, Belo Horizonte, Minas Gerais, 31270-901, Brazil
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Camelo RM, Barbosa MM, Henriques LCM, Martin AP, Godman B, Guerra Júnior AA, Acurcio FDA, Alvares-Teodoro J. Emicizumab prophylaxis for people with hemophilia A: Waste estimation and the Brazilian perspective. Saudi Pharm J 2023; 31:101867. [PMID: 38028212 PMCID: PMC10661532 DOI: 10.1016/j.jsps.2023.101867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/05/2023] [Indexed: 12/01/2023] Open
Abstract
Costs of hemophilia A treatment are increasing. Waste of clotting products should be avoided. To estimate the first-year waste of emicizumab prophylaxis for people with hemophilia A and inhibitors (PwHAi) who failed immune tolerance induction (ITI), in Brazil. We evaluated the manufacturer and the Brazilian Ministry of Health (MoH) protocol-recommended regimens in a budget impact model. The loading dose consisted of 3.0 mg/kg/Q1W for 4 weeks, for both recommendations. The manufacturer maintenance regimens comprised 1.5 mg/kg/Q1W, 3.0 mg/kg/Q2W, and 6.0 mg/kg/Q4W. The MoH protocol maintenance regimen encompassed a hybrid Q1W/Q2W administration, depending on the body weight. The Q4W regimen was not recommended by the MoH protocol. Analyses were performed to estimate waste given its expense based on the World Health Organization body weight range (percentiles [P] 15, 50, and 85). The first-year emicizumab waste was estimated individually and for the disclosed PwHAi who failed ITI (n = 114). The highest emicizumab waste was estimated for the lowest body weights and the Q1W regimen. The Q4W regimen resulted in the lowest emicizumab waste, followed by the MoH protocol regimen. The total reconstituted costs estimated for the PwHAi who failed ITI according to the hybrid MoH protocol ranged from US$32,858,777 (P15) to US$47,186,858 (P85), with emicizumab waste ranging from 7.9 % (US$2,594,515) to 3.7 % (US$1,738,750), respectively. Lost resources due to current protocols for emicizumab prophylaxis for PwHAi who failed ITI in Brazil are considerable. Waste was more pronounced due to lower body weight and shorter administration intervals.
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Affiliation(s)
| | | | | | - Antony Paul Martin
- QC Medica, Liverpool, United Kingdom
- Faculty of Health and Life Science, University of Liverpool, Liverpool, United Kindgom
| | - Brian Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
- Strathclyde Institute of Pharmacy and Biomedical Science, University of Strathclyde, Glasgow, United Kingdom
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Melo APS, Dippenaar IN, Johnson SC, Weaver ND, de Assis Acurcio F, Malta DC, Ribeiro ALP, Júnior AAG, Wool EE, Naghavi M, Cherchiglia ML. All-cause and cause-specific mortality among people with severe mental illness in Brazil's public health system, 2000-15: a retrospective study. Lancet Psychiatry 2022; 9:771-781. [PMID: 35964638 PMCID: PMC9477749 DOI: 10.1016/s2215-0366(22)00237-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/19/2022] [Accepted: 06/24/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND People with severe mental illness have a mortality rate higher than the general population, living an average of 10-20 years less. Most studies of mortality among people with severe mental illness have occurred in high-income countries (HICs). We aimed to estimate all-cause and cause-specific relative risk (RR) and excess mortality rate (EMR) in a nationwide cohort of inpatients with severe mental illness compared with inpatients without severe mental illness in a middle income country, Brazil. METHODS This national retrospective cohort study included all patients hospitalised through the Brazilian Public Health System (Sistema Único de Saúde [SUS]-Brazil) between Jan 1, 2000, and April 21, 2015. Probabilistic and deterministic record linkages integrated data from the Hospital Information System (Sistema de informações Hospitalares) and the National Mortality System (Sistema de Informação sobre Mortalidade). Follow-up duration was measured from the date of the patients' first hospitalisation until their death, or until April 21, 2015. Severe mental illness was defined as schizophrenia, bipolar disorder, or depressive disorder by ICD-10 codes used for the admission. RR and EMR were calculated with 95% CIs, comparing mortality among patients with severe mental illness with those with other diagnoses for patients aged 15 years and older. We redistributed deaths using the Global Burden of Diseases, Injuries, and Risk Factors Study methodology if ill-defined causes of death were stated as an underlying cause. FINDINGS From Jan 1, 2000, to April 21, 2015, 72 021 918 patients (31 510 035 [43·8%] recorded as male and 40 974 426 [56·9%] recorded as female; mean age 41·1 (SD 23·8) years) were admitted to hospital, with 749 720 patients (372 458 [49·7%] recorded as male and 378 670 [50·5%] as female) with severe mental illness. 5 102 055 patient deaths (2 862 383 [56·1%] recorded as male and 2 314 781 [45·4%] as female) and 67 485 deaths in patients with severe mental illness (39 099 [57·9%] recorded as male and 28 534 [42·3%] as female) were registered. The RR for all-cause mortality in patients with severe mental illness was 1·27 (95% CI 1·27-1·28) and the EMR was 2·52 (2·44-2·61) compared with non-psychiatric inpatients during the follow-up period. The all-cause RR was higher for females and for younger age groups; however, EMR was higher in those aged 30-59 years. The RR and EMR varied across the leading causes of death, sex, and age groups. We identified injuries (suicide, interpersonal violence, and road injuries) and cardiovascular disease (ischaemic heart disease) as having the highest EMR among those with severe mental illness. Data on ethnicity were not available. INTERPRETATION In contrast to studies from HICs, inpatients with severe mental illness in Brazil had high RR for idiopathic epilepsy, tuberculosis, HIV, and acute hepatitis, and no significant difference in mortality from cancer compared with inpatients without severe mental illness. These identified causes should be addressed as a priority to maximise mortality prevention among people with severe mental illness, especially in a middle-income country like Brazil that has low investment in mental health. FUNDING Bill and Melinda Gates Foundation, Fundação de Amparo a Pesquisa do Estado de Minas Gerais, FAPEMIG, and the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior-Brasil.
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Affiliation(s)
- Ana Paula Souto Melo
- Universidade Federal de São João Del Rei, São João del-Rei, Brazil; Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ilse N Dippenaar
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Nicole Davis Weaver
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Francisco de Assis Acurcio
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Centro Colaborador do SUS para Avaliação de Tecnologias e Excelência em Saúde, Belo Horizonte, Brazil
| | | | - Antônio Luiz P Ribeiro
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Telehealth Center and Cardiology Service, Hospital das Clínicas, and Department of Internal Medicine, Faculdade de Medicina, Belo Horizonte, Brazil
| | - Augusto Afonso Guerra Júnior
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Centro Colaborador do SUS para Avaliação de Tecnologias e Excelência em Saúde, Belo Horizonte, Brazil
| | - Eve E Wool
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA.
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Faria RJ, Cordeiro FJR, dos Santos JBR, Alvares-Teodoro J, Guerra Júnior AA, Acurcio FDA, da Silva MRR. Conventional Synthetic Disease-Modifying Anti-rheumatic Drugs for Psoriatic Arthritis: Findings and Implications From a Patient Centered Longitudinal Study in Brazil. Front Pharmacol 2022; 13:878972. [PMID: 35559237 PMCID: PMC9086188 DOI: 10.3389/fphar.2022.878972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/24/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Conventional synthetic disease-modifying antirheumatic drugs are the first-line treatment to inhibit the progression of psoriatic arthritis. Despite their widespread clinical use, few studies have been conducted to compare these drugs for psoriatic arthritis. Methods: a longitudinal study was carried out based on a centered patient national database in Brazil. Market share of drugs, medication persistence, drug costs, and cost per response were evaluated. Results: a total of 1,999 individuals with psoriatic arthritis were included. Methotrexate was the most used drug (44.4%), followed by leflunomide (40.6%), ciclosporin (8.2%), and sulfasalazine (6.8%). Methotrexate and leflunomide had a greater market share than ciclosporin and sulfasalazine over years. Medication persistence was higher for leflunomide (58.9 and 28.2%), followed by methotrexate (51.6 and 25.4%) at six and 12 months, respectively. Leflunomide was deemed the most expensive drug, with an average annual cost of $317.25, followed by sulfasalazine ($106.47), ciclosporin ($97.64), and methotrexate ($40.23). Methotrexate was the drug being the lowest cost per response. Conclusion: Methotrexate had the best cost per response ratio, owing to its lower cost and a slightly lower proportion of persistent patients when compared to leflunomide. Leflunomide had a slightly higher medication persistence than methotrexate, but it was the most expensive drug.
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Affiliation(s)
- Ronaldo José Faria
- Pharmaceutical Services Graduate Program, Federal University of Espírito Santo, Alegre, Brazil
- Health Assessment, Technology, and Economy Group, Federal University of Espírito Santo, Alegre, Brazil
| | | | - Jéssica Barreto Ribeiro dos Santos
- Pharmaceutical Services Graduate Program, Federal University of Espírito Santo, Alegre, Brazil
- Health Assessment, Technology, and Economy Group, Federal University of Espírito Santo, Alegre, Brazil
| | | | | | | | - Michael Ruberson Ribeiro da Silva
- Pharmaceutical Services Graduate Program, Federal University of Espírito Santo, Alegre, Brazil
- Health Assessment, Technology, and Economy Group, Federal University of Espírito Santo, Alegre, Brazil
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Torres NPB, Alvares-Teodoro J, Júnior AAG, Horizonte PDB, Acurcio FDA. Social and economic factors associated with antidepressant use: results of a national survey in primary care. Journal of Affective Disorders Reports 2022. [DOI: 10.1016/j.jadr.2021.100307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Dias-Godói IP, Tadeu Rocha Sarmento T, Afonso Reis E, Peres Gargano L, Godman B, de Assis Acurcio F, Alvares-Teodoro J, Guerra Júnior AA, Mariano Ruas C. Acceptability and willingness to pay for a hypothetical vaccine against SARS CoV-2 by the Brazilian consumer: a cross-sectional study and the implications. Expert Rev Pharmacoecon Outcomes Res 2021; 22:119-129. [PMID: 33993823 DOI: 10.1080/14737167.2021.1931128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The new coronavirus pandemic has appreciably impacted morbidity and mortality, as well as having an economic impact worldwide. New vaccines are a potential way forward to reduce transmission rates and subsequent infection. In Brazil, vaccines are being distributed via the public sector; however, in the future, they will be available in the private market. Information about consumers' willingness to pay (WTP) for a hypothetical vaccine against SARS CoV-2 can help future price setting discussions. METHODS A cross-sectional study was conducted with consumers in the five regions of Brazil regarding the WTP for a hypothetical vaccine against SARS CoV-2 with a 50% efficacy. RESULTS A total of 1402 individuals over 18 years of age who declared not having COVID-19 at the time of the survey were interviewed. The acceptability for this hypothetical vaccine was 80.7%. In addition, the amount of WTP by Brazilian consumers for a hypothetical SARS CoV-2 vaccine was estimated at US$ 22.18(120.00 BRL). CONCLUSION This study can contribute to decision-making to inform potential pricing for a hypothetical SARS CoV-2 vaccine.
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Affiliation(s)
- Isabella Piassi Dias-Godói
- College of Public Health, Institute of Health and Biological Studies, Universidade Federal do Sul e Sudeste do Pará, Marabá, Pará, Brazil.,Researcher of the Group (Cnpq) for Epidemiological, Economic and Pharmacological Studies of Arboviruses (EEPIFARBO) - Universidade Federal Do Sul E Sudeste Do Pará; Avenida Dos Ipês, Marabá, Pará, Brazil
| | - Túlio Tadeu Rocha Sarmento
- SUS Collaborating Centre for Technology Assessment and Excellence in Health, Sala 1042, Faculdade De Farmácia, Universidade Federal De Minas Gerais, Av. Presidente Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte, Minas Gerais, Brazil
| | - Edna Afonso Reis
- Researcher of the Group (Cnpq) for Epidemiological, Economic and Pharmacological Studies of Arboviruses (EEPIFARBO) - Universidade Federal Do Sul E Sudeste Do Pará; Avenida Dos Ipês, Marabá, Pará, Brazil.,Department of Statistics, Exact Sciences Institute, Universidade Federal De Minas Gerais, Belo Horizonte, Brazil
| | - Ludmila Peres Gargano
- SUS Collaborating Centre for Technology Assessment and Excellence in Health, Sala 1042, Faculdade De Farmácia, Universidade Federal De Minas Gerais, Av. Presidente Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte, Minas Gerais, Brazil.,Programa De Pós-Graduação Em Medicamentos E Assistência Farmacêutica, School of Pharmacy, Universidade Federal De Minas Gerais, Belo Horizonte, Brazil
| | - Brian Godman
- Department of Pharmacoepidemiology, Institute of Pharmacy and Biomedical Sciences, Glasgow, UK.,Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.,Health Economics Centre, Liverpool University Management School, Liverpool, UK.,School of Pharmacy, Department of Public Health and Pharmacy Management, Sefako Health Sciences University, Pretoria, South Africa
| | - Francisco de Assis Acurcio
- SUS Collaborating Centre for Technology Assessment and Excellence in Health, Sala 1042, Faculdade De Farmácia, Universidade Federal De Minas Gerais, Av. Presidente Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte, Minas Gerais, Brazil.,Programa De Pós-Graduação Em Medicamentos E Assistência Farmacêutica, School of Pharmacy, Universidade Federal De Minas Gerais, Belo Horizonte, Brazil
| | - Juliana Alvares-Teodoro
- SUS Collaborating Centre for Technology Assessment and Excellence in Health, Sala 1042, Faculdade De Farmácia, Universidade Federal De Minas Gerais, Av. Presidente Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte, Minas Gerais, Brazil.,Programa De Pós-Graduação Em Medicamentos E Assistência Farmacêutica, School of Pharmacy, Universidade Federal De Minas Gerais, Belo Horizonte, Brazil
| | - Augusto Afonso Guerra Júnior
- SUS Collaborating Centre for Technology Assessment and Excellence in Health, Sala 1042, Faculdade De Farmácia, Universidade Federal De Minas Gerais, Av. Presidente Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte, Minas Gerais, Brazil.,Programa De Pós-Graduação Em Medicamentos E Assistência Farmacêutica, School of Pharmacy, Universidade Federal De Minas Gerais, Belo Horizonte, Brazil
| | - Cristina Mariano Ruas
- Programa De Pós-Graduação Em Medicamentos E Assistência Farmacêutica, School of Pharmacy, Universidade Federal De Minas Gerais, Belo Horizonte, Brazil
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Barbosa WB, Gomes RM, Godman B, Acurcio FDA, Guerra Júnior AA. Real-world effectiveness of olanzapine and risperidone in the treatment of schizophrenia in Brazil over a 16-year follow-up period; findings and implications. Expert Rev Clin Pharmacol 2020; 14:269-279. [PMID: 33331189 DOI: 10.1080/17512433.2021.1865799] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Introduction: Antipsychotics are widely prescribed for patients with schizophrenia. The Brazilian public health system provides these patients free of charge to patients and it is pertinent to evaluate their benefits.Objective: To evaluate the effectiveness of olanzapine and risperidone in the treatment of patients with schizophrenia in the real-world and assessing risk factors for their discontinuation through a national non-concurrent cohort with 16 years of follow-up.Methods: Three SUS administrative databases were integrated by deterministic-probabilistic linkage. After patients were matched (1:1) for psychiatric hospitalization, year of receiving the antipsychotic, sex, and age, considering either olanzapine or risperidone at study entry. Kaplan-Meier was used to estimate the cumulative probabilities of discontinuation of treatment and associated factors were identified. Sensitivity analyses were performed.Results: 3416 pairs of patients were included. Olanzapine had a longer time until discontinuation of treatment (p = 0.021), and risperidone had a higher risk of discontinuation (p = 0.021). Among patients persistent for at least 24 months, there was no statistically significant difference.Conclusion: Olanzapine demonstrated superior real-world effectiveness over risperidone, in terms of survival and psychiatric hospitalization. This superiority was not sustained in all analyses.
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Affiliation(s)
- Wallace Breno Barbosa
- Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil.,, SUS Collaborating Centre‑Technology Assessment and Excellence in Health (CCATES/UFMG), Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Rosângela Maria Gomes
- Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil.,, SUS Collaborating Centre‑Technology Assessment and Excellence in Health (CCATES/UFMG), Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.,Division of Clinical Pharmacology, Karolinska, Karolinska Institute, Stockholm, Sweden.,School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, South Africa
| | - Francisco de Assis Acurcio
- Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil.,, SUS Collaborating Centre‑Technology Assessment and Excellence in Health (CCATES/UFMG), Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Augusto Afonso Guerra Júnior
- Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil.,, SUS Collaborating Centre‑Technology Assessment and Excellence in Health (CCATES/UFMG), Federal University of Minas Gerais, Belo Horizonte, Brazil
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Souza KM, Diniz IM, de Lemos LLP, Junior NGR, Zuppo IDF, Teodoro JA, Acurcio FDA, Atallah ÁN, Júnior AAG. Effectiveness of first-line treatment for relapsing-remitting multiple sclerosis in Brazil: A 16-year non-concurrent cohort study. PLoS One 2020; 15:e0238476. [PMID: 32877451 PMCID: PMC7467258 DOI: 10.1371/journal.pone.0238476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/17/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Relapsing-remitting multiple sclerosis (RRMM) is a chronic, progressive, inflammatory and immune-mediated disease that affects the central nervous system and is characterized by episodes of neurological dysfunction followed by a period of remission. The pharmacological strategy aims to delay the progression of the disease and prevent relapse. Interferon beta and glatiramer are commonly used in the Brazilian public health system and are available to patients who meet the guideline criteria. The scenario of multiple treatments available and in development brings the need for discussion and evaluation of the technologies already available before the incorporation of new drugs. This study analyses the effectiveness of first-line treatment of RRMS measured by real-world evidence data, from the Brazilian National Health System (SUS). METHODS AND FINDINGS We conducted a non-concurrent national cohort between 2000 and 2015. The study population consisted of 22,722 patients with RRMS using one of the following first-line drugs of interest: glatiramer or one of three presentations of interferon beta. Kaplan-Meier analysis was used to estimate the time to treatment failure. A univariate and multivariate Cox proportional hazard model was used to evaluate factors associated with treatment failure. In addition, patients were propensity score-matched (1:1) in six groups of comparative first-line treatments to evaluate the effectiveness among them. The analysis indicated a higher risk of treatment failure in female patients (HR = 1.08; P = 0,01), those with comorbidities at baseline (HR = 1.20; P<0,0001), in patients who developed comorbidities after starting treatment (i.e., rheumatoid arthritis-HR = 1.65; P<0,0001), those exclusive SUS patients (HR = 1.31; P<0,0001) and among patients using intramuscular interferon beta (IM βINF-1a) (28% to 60% compared to the other three treatments; P<0,0001). Lower risk of treatment failure was found among patients treated with glatiramer. CONCLUSIONS This retrospective cohort suggests that glatiramer is associated with greater effectiveness compared to the three presentations of interferon beta. When evaluating beta interferons, the results suggest that the intramuscular presentation is not effective in the treatment of multiple sclerosis.
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Affiliation(s)
- Kathiaja Miranda Souza
- Programa de Pós-Graduação em Saúde Baseada em Evidências, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Isabela Maia Diniz
- SUS Collaborating Centre for Technology Assessment & Excellence in Health, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Programa de Pós-Graduação em Medicamentos e Assistência Farmacêutica, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Lívia Lovato Pires de Lemos
- SUS Collaborating Centre for Technology Assessment & Excellence in Health, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Nélio Gomes Ribeiro Junior
- SUS Collaborating Centre for Technology Assessment & Excellence in Health, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Isabella de Figueiredo Zuppo
- SUS Collaborating Centre for Technology Assessment & Excellence in Health, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Juliana Alvares Teodoro
- SUS Collaborating Centre for Technology Assessment & Excellence in Health, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Programa de Pós-Graduação em Medicamentos e Assistência Farmacêutica, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Francisco de Assis Acurcio
- SUS Collaborating Centre for Technology Assessment & Excellence in Health, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Programa de Pós-Graduação em Medicamentos e Assistência Farmacêutica, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Álvaro Nagib Atallah
- Programa de Pós-Graduação em Saúde Baseada em Evidências, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
- Cochrane Brazil, Centro de Estudos de Saúde Baseada em Evidências e Avaliação Tecnológica em Saúde, São Paulo, São Paulo, Brazil
| | - Augusto Afonso Guerra Júnior
- SUS Collaborating Centre for Technology Assessment & Excellence in Health, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Programa de Pós-Graduação em Medicamentos e Assistência Farmacêutica, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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9
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Silveira VF, Teodoro JA, Acúrcio FA, Júnior AAG, Nascimento RCRM. Drug interactions in the elderly of the Unified Health System (SUS) in Brazil. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Elderly people with chronic non-communicable diseases generally use a large amount of medicines, increasing the risk of adverse events that can compromise the quality of pharmacotherapy.
Objective
To analyze the prevalence of drug interactions in the elderly assisted by primary care of the Unified Health System (SUS), who use polypharmacy.
Methods
This is a cross-sectional study, part of the National Survey on Access, Use and Promotion of Rational Use of Medicines (PNAUM) - Services, 2015, which used a representative sample of the Brazilian population. Elderly were considered people with 65 years or older and polypharmacy was defined as the concomitant use of five or more medicines. Drug interactions were classified using Micromedex®. The variables were presented as absolute and relative frequences, mean and standard deviation, using the software Stata® 13.
Results
Of the 1,157 elderly people interviewed, 19.01% (n = 220) were in polypharmacy. The average of chronic diseases was 3.84 ± 1.73 per elderly person, being hypertension (91.82%, n = 202) and arthritis (55.91%, n = 123) he most frequent. There were found 1,076 interactions, ranging from 0 to 23 per person, with an average of 3.87 ± 3.41. In the polypharmacy group, the prevalence of drug interaction was 88.99% (n = 194). Among the interactions, 66.83% (n = 679) were classified as moderate, 31.10% (n = 316) major and 2.07% (n = 21) minor; 84.83% (n = 861) were pharmacodynamic and 15.17% (n = 154) pharmacokinetic. The most prevalent interactions were: Hydrochlorothiazide and Acetylsalicylic Acid (5.31%, n = 54); Captopril and Hydrochlorothiazide (5.31%, n = 54) and Losartan and Acetylsalicylic Acid (3.74%, n = 38).
Conclusions
The most prevalent interactions have synergistic or antagonistic effects, which need monitoring to ensure the safety and effectiveness of treatment, especially due to the physiological changes resulting from aging.
Key messages
Analyze the prevalence of drug interactions in elderly people using polypharmacy. Cross-sectional, evaluative study.
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Affiliation(s)
- V F Silveira
- Pharmaceutical Sciences Postgraduate Program, Federal University of Ouro Preto, Ouro Preto, Brazil
| | - J A Teodoro
- Postgraduate Program in Medicines and Pharmaceutical Service, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - F A Acúrcio
- Postgraduate Program in Medicines and Pharmaceutical Service, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - A A G Júnior
- Postgraduate Program in Medicines and Pharmaceutical Service, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - R C R M Nascimento
- Pharmaceutical Sciences Postgraduate Program, Federal University of Ouro Preto, Ouro Preto, Brazil
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10
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Moreira TDA, Alvares-Teodoro J, Barbosa MM, Guerra Júnior AA, Acurcio FDA. Use of medicines by adults in primary care: Survey on health services in Minas Gerais, Brazil. Rev Bras Epidemiol 2020; 23:e200025. [PMID: 32401914 DOI: 10.1590/1980-549720200025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 01/09/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Inappropriate use and increase of health care spending reinforce the need to extend our knowledge about the quality of medication use. OBJECTIVES To describe and evaluate the profile of medication use in a representative sample of adult users of primary care services in the Unified Health System (SUS) of Minas Gerais. METHOD Cross-sectional study, with 1,159 interviewees in 104 municipalities and 253 health care services. Data on sociodemographic characteristics, health conditions and use of medicines were collected, and these variables were stratified by age group. Univariate and multivariate analyses, using logistic regression, were conducted to identify predictors of self-medication. We set a significance level of 5% for all tests. RESULTS The prevalence of medication use was 81.8%, with an average of 2.67 medicines per user, which increased with age. The most used drugs were losartan, hydrochlorothiazide and simvastatin, which differed between age groups. Significant self-medication was observed not only in young adults but also in the elderly. The predictors of self-medication were: being a young adult, having a higher level of education, not having chronic diseases, having worse self-perception of health and not adhering to prescription drugs. Young and elderly adults showed characteristics that made them more vulnerable in relation to the rational use of medicines. CONCLUSION This study can contribute to improving primary care, where it identified problems related to the extent of medication use, especially among young adults and the elderly in Minas Gerais.
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Affiliation(s)
- Thais de Abreu Moreira
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Juliana Alvares-Teodoro
- Departamento de Farmácia Social, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Mariana Michel Barbosa
- Programa de Pós-Graduação em Medicamentos e Assistência Farmacêutica, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Augusto Afonso Guerra Júnior
- Departamento de Farmácia Social, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Francisco de Assis Acurcio
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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11
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Gomes RM, Barbosa WB, Godman B, Costa JDO, Ribeiro Junior NG, Simão Filho C, Cherchiglia ML, Acurcio FDA, Guerra Júnior AA. Effectiveness of Maintenance Immunosuppression Therapies in a Matched-Pair Analysis Cohort of 16 Years of Renal Transplant in the Brazilian National Health System. Int J Environ Res Public Health 2020; 17:E1974. [PMID: 32192172 PMCID: PMC7142921 DOI: 10.3390/ijerph17061974] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 03/09/2020] [Accepted: 03/11/2020] [Indexed: 12/11/2022]
Abstract
The maintenance of patients with renal transplant typically involves two or more drugs to prevent rejection and prolong graft survival. The calcineurin inhibitors (CNI) are the most commonly recommended medicines in combinations with others. While immunosuppressive treatment regimens are well established, there is insufficient long-term effectiveness data to help guide future management decisions. The study analyzes the effectiveness of treatment regimens containing CNI after renal transplantation during 16 years of follow-up with real-world data from the Brazilian National Health System (SUS). This was a retrospective study of 2318 SUS patients after renal transplantion. Patients were propensity score-matched (1:1) by sex, age, type and year of transplantation. Kaplan-Meier analysis was used to estimate the cumulative probabilities of survival. A Cox proportional hazard model was used to evaluate factors associated with progression to graft loss. Multivariable analysis, adjusted for diabetes mellitus and race/color, showed a greater risk of graft loss for patients using tacrolimus plus mycophenolate compared to patients treated with cyclosporine plus azathioprine. In conclusion, this Brazilian real-world study, with a long follow-up period using matched analysis for relevant clinical features and the representativeness of the sample, demonstrated improved long-term effectiveness for therapeutic regimens containing cyclosporine plus azathioprine. Consequently, we recommend that protocols and clinical guidelines for renal transplantation should consider the cyclosporine plus azathioprine regimen as a potential first line option, along with others.
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Affiliation(s)
- Rosângela Maria Gomes
- Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
- SUS Collaborating Centre—Technology Assessment & Excellence in Health, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
- Programa de Pós-graduação em Medicamentos e Assistência Farmacêutica, Departamento de Farmácia Social, Faculdade de Farmácia, Universidade Federal de Minas Gerais—UFMG. Av. Presidente Antônio Carlos, 6627 Campus Pampulha, Belo Horizonte, MG 31270-901 Brazil
| | - Wallace Breno Barbosa
- Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
- SUS Collaborating Centre—Technology Assessment & Excellence in Health, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow G4 ORE, UK
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden
- Health Economics Centre, Liverpool University Management School, Chatham Street, Liverpool L69 7ZH, UK
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - Juliana de Oliveira Costa
- SUS Collaborating Centre—Technology Assessment & Excellence in Health, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
- Department of Preventive and Social Medicine, College of Medicine, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
| | - Nélio Gomes Ribeiro Junior
- SUS Collaborating Centre—Technology Assessment & Excellence in Health, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
| | - Charles Simão Filho
- Department of Surgery, College of Medicine, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
| | - Mariângela Leal Cherchiglia
- Department of Preventive and Social Medicine, College of Medicine, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
| | - Francisco de Assis Acurcio
- Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
- SUS Collaborating Centre—Technology Assessment & Excellence in Health, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
| | - Augusto Afonso Guerra Júnior
- Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
- SUS Collaborating Centre—Technology Assessment & Excellence in Health, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
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12
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da Silva MRR, Dos Santos JBR, Almeida AM, Guerra Júnior AA, Alvares Teodoro J, Acurcio FDA. Biological therapy in the treatment of psoriatic arthritis: economic and epidemiological considerations. Expert Rev Clin Immunol 2019; 15:879-887. [PMID: 31192746 DOI: 10.1080/1744666x.2019.1631798] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background: Biological therapies have a significant economic and clinical burden but, in general, lose their effectiveness over time. This study evaluated the medication persistence and costs associated to use of anti-TNF agents for psoriatic arthritis (PsA) treatment. Methods: A historical cohort composed of individuals in Brazil with PsA diagnosis was developed during the period between 2010 and 2015. The difference among the anti-TNF agents was verified by the log-rank test. The predictors of medication non-persistence were identified by Cox regression. The costs were compared by variance analysis with Bonferroni correction. Results: 11,008 patients were analyzed. Adalimumab (51%) was the most used anti-TNF agent. Individuals using adalimumab presented higher medication persistence as compared to etanercept and infliximab. The costs with anti-TNF agents corresponded to 90% of the total costs and were similar among anti-TNF agents. The non-persistence predictors were female sex, younger patients, to live in the Northeastern and Northern regions of Brazil, to use infliximab and etanercept, and have more comorbidities. Conclusion: The direct costs with anti-TNF agents were the main component of total costs. Outpatient and inpatient costs increase when medication persistence decreases. A considerable price reduction of anti-TNF agents has been observed over the years.
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Affiliation(s)
- Michael Ruberson Ribeiro da Silva
- a Postgraduate Program in Medicines & Pharmaceutical Services, College of Pharmacy, Federal University of Minas Gerais , Minas Gerais , Brazil
| | - Jéssica Barreto Ribeiro Dos Santos
- a Postgraduate Program in Medicines & Pharmaceutical Services, College of Pharmacy, Federal University of Minas Gerais , Minas Gerais , Brazil
| | - Alessandra Maciel Almeida
- b College of Pharmacy, Federal University of Minas Gerais , Minas Gerais , Brazil.,c Institute of Research and Postgraduate in Medical Sciences, Faculty of Medical Sciences of Minas Gerais , Minas Gerais , Brasil
| | | | | | - Francisco de Assis Acurcio
- b College of Pharmacy, Federal University of Minas Gerais , Minas Gerais , Brazil.,d Department of Social and Preventive Medicine, School of Medicine, Federal University of Minas Gerais , Minas Gerais , Brazil
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13
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Silva GDD, Andrade EIG, Cherchiglia ML, Almeida AM, Guerra Júnior AA, Acurcio FDA. Perfil de gastos com o tratamento da Artrite Reumatoide para pacientes do Sistema Único de Saúde em Minas Gerais, Brasil, de 2008 a 2013. Ciênc saúde coletiva 2018; 23:1241-1253. [DOI: 10.1590/1413-81232018234.16352016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 07/03/2016] [Indexed: 11/22/2022] Open
Abstract
Resumo A artrite reumatoide (AR) é uma doença crônica que afeta cerca de 1% da população adulta. No estudo de coorte histórica de pacientes de Minas Gerais, registrados no Sistema de Informações Ambulatoriais (SIA), em 2008-2013, foram identificados 11.573 indivíduos. A perspectiva foi a do financiador público e os valores observados como gastos do Sistema Único de Saúde (SUS) foram ajustados pelo Índice Nacional de Preços ao Consumidor Amplo (IPCA), de dezembro de 2015. O Etanercept foi o tratamento mais caro. A análise múltipla mostrou uma relação negativa entre o aumento das despesas e idade, sexo feminino e diagnóstico de entrada na coorte, e relação positiva para as variáveis Índice de Desenvolvimento Humano Municipal (IDH-M) e o uso de medicamentos bloqueadores do fator de necrose tumoral (ANTI-TNF). Este estudo identificou os fatores que têm impacto sobre o gasto com o tratamento medicamentoso da AR. Também apontou que métodos que permitem extrair dados demográficos e de gastos de sistemas de informação administrativos podem ser ferramentas importantes na construção de estudos econômicos capazes de subsidiar as avaliações econômicas de saúde, especialmente do ponto de vista da gestão.
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Lemos LLPD, Guerra Júnior AA, Santos M, Magliano C, Diniz I, Souza K, Pereira RG, Alvares J, Godman B, Bennie M, Zimmermann IR, dos Santos VCC, Pretramale CA, Acurcio FDA. The Assessment for Disinvestment of Intramuscular Interferon Beta for Relapsing-Remitting Multiple Sclerosis in Brazil. Pharmacoeconomics 2018; 36:161-173. [PMID: 29139001 PMCID: PMC5805817 DOI: 10.1007/s40273-017-0579-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In Brazil, inclusion and exclusion of health technologies within the Unified Health System (SUS) is the responsibility of the National Committee for Health Technology Incorporation (CONITEC). A recent Cochrane systematic review demonstrated that intramuscular interferon beta 1a (IFN-β-1a-IM) was inferior to the other beta interferons (IFN-βs) for multiple sclerosis (MS). As a result, CONITEC commissioned an analysis to review possible disinvestment within SUS. The objective of this paper is to describe the disinvestment process for IFN-β-1a-IM in Brazil. The first assessment comprised a literature review and mixed treatment comparison meta-analysis. The outcome of interest was the proportion of relapse-free patients in 2 years. This analysis confirmed the inferiority of IFN-β-1a-IM. Following this, CONITEC recommended disinvestment, with the decision sent for public consultation. More than 3000 contributions were made on CONITEC's webpage, most of them against the preliminary decision. As a result, CONITEC commissioned a study to assess the effectiveness of IFN-β-1a-IM among Brazilian patients in routine clinical care. The second assessment involved an 11-year follow-up of a non-concurrent cohort of 12,154 MS patients developed by deterministic-probabilistic linkage of SUS administrative databases. The real-world assessment further demonstrated that IFN-β-1a-IM users had a statistically higher risk of treatment failure, defined as treatment switching or relapse treatment or death, with the assessment showing that IFN-β-1a-IM was inferior to the other IFN-βs and to glatiramer acetate in both direct and indirect analysis. In the drug ranking with 40,000 simulations, IFN-β-1a-IM was the worst option, with a success rate of only 152/40,000. Following this, CONITEC decided to exclude the intramuscular presentation of IFN-β from the current MS treatment guidelines, giving patients who are currently on this treatment the option of continuing until treatment failure. In conclusion, we believe this is the first example of this new disinvestment process in action, providing an exemplar for other treatments in Brazil as well as other countries.
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Affiliation(s)
- Livia Lovato Pires de Lemos
- SUS Collaborating Centre for Technology Assessment and Excellence in Health, sala 1042, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte, Minas Gerais CEP 31270-901 Brazil
- Programa de Pós-Graduação em Saúde Pública, sala 533, Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Porf. Alfredo Balena, 190 , Campus Saúde, Belo Horizonte, Minas Gerais CEP 30130-100 Brazil
| | - Augusto Afonso Guerra Júnior
- SUS Collaborating Centre for Technology Assessment and Excellence in Health, sala 1042, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte, Minas Gerais CEP 31270-901 Brazil
- Programa de Pós-Graduação em Medicamentos e Assistência Farmacêutica, sala 1023, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte, Minas Gerais CEP 31270-901 Brazil
| | - Marisa Santos
- Núcleo de Avaliação de Tecnologias em Saúde, Instituto Nacional de Cardiologia, R. das Laranjeiras, 374, Bairro Laranjeiras, Rio de Janeiro, Rio de Janeiro CEP 22240-006 Brazil
| | - Carlos Magliano
- Núcleo de Avaliação de Tecnologias em Saúde, Instituto Nacional de Cardiologia, R. das Laranjeiras, 374, Bairro Laranjeiras, Rio de Janeiro, Rio de Janeiro CEP 22240-006 Brazil
| | - Isabela Diniz
- SUS Collaborating Centre for Technology Assessment and Excellence in Health, sala 1042, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte, Minas Gerais CEP 31270-901 Brazil
- Programa de Pós-Graduação em Medicamentos e Assistência Farmacêutica, sala 1023, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte, Minas Gerais CEP 31270-901 Brazil
| | - Kathiaja Souza
- Departamento de Gestão e Incorporação de Tecnologias em Saúde, Secretaria de Ciência, Tecnologia e Insumos Estratégicos, Ministério da Saúde, Esplanada dos Ministérios Bloco G, Brasília, Distrito Federal CEP 70058-900 Brazil
- Programa de Pós-Graduação em Saúde Baseada em Evidências, Universidade Federal de São Paulo, Rua Botucatu, 740, 3 andar, Vila Clementino, São Paulo, São Paulo CEP 04023-900 Brazil
| | - Ramon Gonçalves Pereira
- SUS Collaborating Centre for Technology Assessment and Excellence in Health, sala 1042, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte, Minas Gerais CEP 31270-901 Brazil
| | - Juliana Alvares
- SUS Collaborating Centre for Technology Assessment and Excellence in Health, sala 1042, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte, Minas Gerais CEP 31270-901 Brazil
- Programa de Pós-Graduação em Medicamentos e Assistência Farmacêutica, sala 1023, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte, Minas Gerais CEP 31270-901 Brazil
| | - Brian Godman
- Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, 141 86, Stockholm, Sweden
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, 161 Cathedral Street, Glasgow, G4 0RE UK
- Health Economics Centre, University of Liverpool Management School, Liverpool, UK
| | - Marion Bennie
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, 161 Cathedral Street, Glasgow, G4 0RE UK
| | - Ivan Ricardo Zimmermann
- Departamento de Gestão e Incorporação de Tecnologias em Saúde, Secretaria de Ciência, Tecnologia e Insumos Estratégicos, Ministério da Saúde, Esplanada dos Ministérios Bloco G, Brasília, Distrito Federal CEP 70058-900 Brazil
| | - Vânia Crisitna Canuto dos Santos
- Departamento de Gestão e Incorporação de Tecnologias em Saúde, Secretaria de Ciência, Tecnologia e Insumos Estratégicos, Ministério da Saúde, Esplanada dos Ministérios Bloco G, Brasília, Distrito Federal CEP 70058-900 Brazil
| | - Clarice Alegre Pretramale
- Departamento de Gestão e Incorporação de Tecnologias em Saúde, Secretaria de Ciência, Tecnologia e Insumos Estratégicos, Ministério da Saúde, Esplanada dos Ministérios Bloco G, Brasília, Distrito Federal CEP 70058-900 Brazil
| | - Francisco de Assis Acurcio
- SUS Collaborating Centre for Technology Assessment and Excellence in Health, sala 1042, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte, Minas Gerais CEP 31270-901 Brazil
- Programa de Pós-Graduação em Saúde Pública, sala 533, Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Porf. Alfredo Balena, 190 , Campus Saúde, Belo Horizonte, Minas Gerais CEP 30130-100 Brazil
- Programa de Pós-Graduação em Medicamentos e Assistência Farmacêutica, sala 1023, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte, Minas Gerais CEP 31270-901 Brazil
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De Oliveira GLA, Guerra Júnior AA, Godman B, Acurcio FDA. Cost-effectiveness of vildagliptin for people with type 2 diabetes mellitus in Brazil; findings and implications. Expert Rev Pharmacoecon Outcomes Res 2017; 17:109-119. [PMID: 28403729 DOI: 10.1080/14737167.2017.1292852] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Vildagliptin is an inhibitor of the enzyme dipeptidyl peptidase 4, indicated for the treatment of type 2 diabetes mellitus, combined or not with metformin. This study aims to evaluate the cost-effectiveness of vildagliptin in the Brazilian context. Areas covered: Using MEDLINE, Cochrane Library, Lilacs and CRD, six studies were selected for the economic models. This study utilised cost data in the Brazilian health system to provide the context. Expert commentary: Type 2 diabetes mellitus is an epidemic disease and represents a challenge for all health care systems. Although guidelines clearly define first-line treatment, there are several other promising treatments. Vildagliptin is one of them, resulting in a mean lifetime increase of 0.31 years compared to metformin alone and 1.19 more life years compared to other metformin combinations. Considering observational data, life years with dual vildagliptin-containing treatments were 0.37 more compared to other dual treatments. However, its high cost versus generic metformin and its unclear safety profile weakens its subsequent cost-effectiveness. Consequently, the incorporation of vildagliptin or its combination with metformin is currently not recommended for the Brazilian Health Care System. This may change as more data becomes available.
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Affiliation(s)
- Gustavo Laine Araujo De Oliveira
- a Department of Social Pharmacy, School of Pharmacy , Federal University of Minas Gerais , Belo Horizonte , Brazil.,b Department of Management and Incorporation of Health Technology , Ministry of Health , Brasilia , Brazil
| | - Augusto Afonso Guerra Júnior
- a Department of Social Pharmacy, School of Pharmacy , Federal University of Minas Gerais , Belo Horizonte , Brazil.,c SUS Collaborating Centre - Technology Assessment & Excellence in Health, School of Pharmacy , Federal University of Minas Gerais , Minas Gerais , Brazil
| | - Brian Godman
- d Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , UK.,e Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet , Karolinska University Hospital Huddinge , Stockholm , Sweden
| | - Francisco de Assis Acurcio
- a Department of Social Pharmacy, School of Pharmacy , Federal University of Minas Gerais , Belo Horizonte , Brazil.,c SUS Collaborating Centre - Technology Assessment & Excellence in Health, School of Pharmacy , Federal University of Minas Gerais , Minas Gerais , Brazil.,f School of Medicine , Federal University of Minas Gerais , Belo Horizonte , Brazil
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16
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Godói IP, Lemos LLP, de Araújo VE, Bonoto BC, Godman B, Guerra Júnior AA. CYD-TDV dengue vaccine: systematic review and meta-analysis of efficacy, immunogenicity and safety. J Comp Eff Res 2017; 6:165-180. [PMID: 28084784 DOI: 10.2217/cer-2016-0045] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Dengue virus (DENV) is a serious global health problem. CYD-TDC (Dengvaxia®) was the first vaccine to gain regulatory approval to try and address this problem. AIM Summarize all available evidence on the immunogenicity, efficacy and safety of the CYD-TDV dengue vaccine. METHOD Meta-analysis and systematic review. RESULTS The best and worst immunogenicity results were for DENV4 and DENV1, respectively. Vaccine efficacy of 60% was derived from studies with participants aged 2-16 years old, with DENV4 and DENV2 presenting the best and worst results, respectively. Erythema and swelling were more frequent with CYD-TDV. No differences were detected for systemic adverse events. CONCLUSION CYD-TDV showed moderate efficacy in children and adolescents. From the immunogenicity results in adults, we can expect satisfactory efficacy from vaccination in this population.
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Affiliation(s)
- Isabella Piassi Godói
- Programa de Pós-graduação em Medicamentos e Assistência Farmacêutica, sala 1023, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte, Minas Gerais, CEP 31270-901, Brazil.,SUS Collaborating Centre for Technology Assessment & Excellence in Health, sala 1042, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte, Minas Gerais, CEP 31270-901, Brazil
| | - Livia Lovato Pires Lemos
- SUS Collaborating Centre for Technology Assessment & Excellence in Health, sala 1042, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte, Minas Gerais, CEP 31270-901, Brazil
| | - Vânia Eloisa de Araújo
- Faculdade de Odontologia, Instituto de Ciências Biológicas e da Saúde, Pontifícia Universidade Católica de Minas Gerais, Av. Dom José Gaspar, 500 Coração Eucaristíco, Belo Horizonte, Minas Gerais, CEP 30535-901, Brazil
| | - Braúlio Cesar Bonoto
- Programa de Pós-graduação em Medicamentos e Assistência Farmacêutica, sala 1023, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte, Minas Gerais, CEP 31270-901, Brazil
| | - Brian Godman
- University of Strathclyde Glasgow, Institute of Pharmacy & Biomedical Sciences, Pharmacoepidemiology, 161 Cathedral Street, Glasgow G4 0RE, UK.,Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital, SE-141 86, Stockholm, Sweden
| | - Augusto Afonso Guerra Júnior
- Programa de Pós-graduação em Medicamentos e Assistência Farmacêutica, sala 1023, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte, Minas Gerais, CEP 31270-901, Brazil.,SUS Collaborating Centre for Technology Assessment & Excellence in Health, sala 1042, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, 6627, Campus Pampulha, Belo Horizonte, Minas Gerais, CEP 31270-901, Brazil
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Gomes RM, Guerra Júnior AA, Lemos LLPD, Costa JDO, Almeida AM, Alvares J, Filho CS, Cherchiglia ML, Andrade EIG, Godman B, Acurcio FA. Ten-year kidney transplant survival of cyclosporine- or tacrolimus-treated patients in Brazil. Expert Rev Clin Pharmacol 2016; 9:991-9. [DOI: 10.1080/17512433.2016.1190270] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Rosângela Maria Gomes
- Post-Graduation Program in Medicines and Pharmaceutical Assistance, Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Minas Gerais, Brazil
- SUS Collaborating Centre – Technology Assessment & Excellence in Health, College of Pharmacy, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Augusto Afonso Guerra Júnior
- Post-Graduation Program in Medicines and Pharmaceutical Assistance, Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Minas Gerais, Brazil
- SUS Collaborating Centre – Technology Assessment & Excellence in Health, College of Pharmacy, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Lívia Lovato Pires de Lemos
- SUS Collaborating Centre – Technology Assessment & Excellence in Health, College of Pharmacy, Federal University of Minas Gerais, Minas Gerais, Brazil
- Post-Graduation Program in Public Health, Department of Preventive and Social Medicine, College of Medicine, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Juliana de Oliveira Costa
- Post-Graduation Program in Public Health, Department of Preventive and Social Medicine, College of Medicine, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Alessandra Maciel Almeida
- Post-Graduation Program in Medicines and Pharmaceutical Assistance, Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Minas Gerais, Brazil
- SUS Collaborating Centre – Technology Assessment & Excellence in Health, College of Pharmacy, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Juliana Alvares
- Post-Graduation Program in Medicines and Pharmaceutical Assistance, Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Minas Gerais, Brazil
- SUS Collaborating Centre – Technology Assessment & Excellence in Health, College of Pharmacy, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Charles Simão Filho
- Department of Surgery, College of Medicine, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Mariângela Leal Cherchiglia
- Post-Graduation Program in Public Health, Department of Preventive and Social Medicine, College of Medicine, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Eli Iola Gurgel Andrade
- Post-Graduation Program in Public Health, Department of Preventive and Social Medicine, College of Medicine, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Division of Clinical Pharmacology, Karolinska Institute, Stockholm, Sweden
| | - Francisco Assis Acurcio
- Post-Graduation Program in Medicines and Pharmaceutical Assistance, Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Minas Gerais, Brazil
- SUS Collaborating Centre – Technology Assessment & Excellence in Health, College of Pharmacy, Federal University of Minas Gerais, Minas Gerais, Brazil
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Mata ARD, Álvares J, Diniz LM, Ruberson Ribeiro da Silva M, Alvernaz dos Santos BR, Guerra Júnior AA, Cherchiglia ML, Andrade EIG, Godman B, Acurcio FDA. Quality of life of patients with Diabetes Mellitus Types 1 and 2 from a referal health centre in Minas Gerais, Brazil. Expert Rev Clin Pharmacol 2016; 9:739-46. [DOI: 10.1586/17512433.2016.1152180] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Almeida-Brasil CC, Costa JDO, Aguiar VCFDS, Moreira DP, Moraes END, Acurcio FDA, Guerra Júnior AA, Álvares J. Acesso aos medicamentos para tratamento da doença de Alzheimer fornecidos pelo Sistema Único de Saúde em Minas Gerais, Brasil. CAD SAUDE PUBLICA 2016; 32:e00060615. [DOI: 10.1590/0102-311x00060615] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 02/18/2016] [Indexed: 01/22/2023] Open
Abstract
Resumo: Avaliou-se as barreiras de acesso ao tratamento da doença de Alzheimer com base nos processos administrativos de medicamentos inibidores da colinesterase (IChE), enviados à Secretaria de Estado de Saúde de Minas Gerais, Brasil, entre 2012 e 2013. Utilizando-se informações de 165 processos selecionados aleatoriamente, abordaram-se as dimensões de acesso: acessibilidade geográfica, acomodação, aceitabilidade, disponibilidade e capacidade aquisitiva. O trâmite administrativo para o fornecimento dos IChE levou em média 39 dias e foi influenciado por características do trajeto percorrido pelo usuário. A maioria dos prescritores cumpriu menos de 80% dos critérios exigidos pelo Protocolo Clínico e Diretrizes Terapêuticas (PCDT) da doença de Alzheimer. Como resultado, 38% dos processos não foram deferidos. A capacidade aquisitiva para o tratamento privado mensal com IChE foi de cerca de 21 dias de salário mínimo. Conclui-se que a burocracia do trâmite administrativo e a dificuldade de seguimento do PCDT pelos prescritores prejudicam o acesso ao tratamento da doença de Alzheimer e constituem uma grande carga para o orçamento dos pacientes.
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Guerra Júnior AA, Silva GD, Andrade EIG, Cherchiglia ML, Costa JDO, Almeida AM, Acurcio FDA. Cyclosporine versus tacrolimus: cost-effectiveness analysis for renal transplantation in Brazil. Rev Saude Publica 2015; 49:13. [PMID: 25741648 PMCID: PMC4386555 DOI: 10.1590/s0034-8910.2015049005430] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 11/09/2014] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To analyze the cost-effectiveness of treatment regimens with cyclosporine or tacrolimus, five years after renal transplantation. METHODS This cost-effectiveness analysis was based on historical cohort data obtained between 2000 and 2004 and involved 2,022 patients treated with cyclosporine or tacrolimus, matched 1:1 for gender, age, and type and year of transplantation. Graft survival and the direct costs of medical care obtained from the National Health System (SUS) databases were used as outcome results. RESULTS Most of the patients were women, with a mean age of 36.6 years. The most frequent diagnosis of chronic renal failure was glomerulonephritis/nephritis (27.7%). In five years, the tacrolimus group had an average life expectancy gain of 3.96 years at an annual cost of R$78,360.57 compared with the cyclosporine group with a gain of 4.05 years and an annual cost of R$61,350.44. CONCLUSIONS After matching, the study indicated better survival of patients treated with regimens using tacrolimus. However, regimens containing cyclosporine were more cost-effective.
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de Souza ALC, Acurcio FDA, Guerra Júnior AA, do Nascimento RCRM, Godman B, Diniz LM. Authors' reply to Dr. Malerbi: "Insulin glargine in a Brazilian state: should the government disinvest?". Appl Health Econ Health Policy 2014; 12:561-563. [PMID: 25119850 DOI: 10.1007/s40258-014-0113-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Ana Luísa Caires de Souza
- Medical College, Federal University of Minas Gerais (UFMG), Av. Antônio Carlos, 6627, Bloco 02, sl 1048, Belo Horizonte, MG, CEP 31270-901, Brazil,
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Lemos LLPD, Costa JDO, Machado MADÁ, Almeida AM, Barbosa MM, Kakehasi AM, Araújo VED, Júnior AAG, Acurcio FDA. Rituximabe para o tratamento da artrite reumatoide: Revisão sistemática. Revista Brasileira de Reumatologia 2014. [DOI: 10.1016/j.rbr.2013.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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de Lemos LLP, Costa JDO, Machado MADÁ, Almeida AM, Barbosa MM, Kakehasi AM, de Araújo VE, Guerra Júnior AA, Acurcio FDA. Rituximab for rheumatoid arthrits treatment: a systematic review. Rev Bras Reumatol 2014; 54:220-230. [PMID: 25054600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 08/23/2013] [Indexed: 06/03/2023] Open
Abstract
INTRODUCTION Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by systemic joint inflammation that often leads to significant disability. Several effective anti-TNF agents have been used, but some patients have shown an inadequate response. Rituximab is a therapeutic monoclonal antibody indicated in such cases. METHODS We conducted a systematic review to access efficacy and safety of rituximab in patients with active RA which have or have not been treated with anti-TNF agents before, and to relate outcome with RF and anti-CCP serology. We searched major electronics databases, grey literature and searched for references manually. We used Review Manager(r)5.1 for meta-analysis. RESULTS We included six RCTs comparing rituximab 1000 mg with placebo. Methotrexate was used by both groups. Treatment with rituximab was more effective in naïve and in anti-TNF treatment failure patients - ACR20/50/70 and EULAR response. We observed lower changes in Total Genant-modified Sharp score, erosion score and joint narrowing scores in the rituximab group, and SF-36, FACIT-T and HAQ-DI scores were also better in this group. There were no differences between groups regarding safety outcomes, with exception of acute injection reactions, which were more common on rituximab group. More RF/anti-CCP seropositive patients achieved ACR20 than RF/anti-CP negative patients in rituximab group. CONCLUSION Available data support the use of rituximab for the treatment of RA, as it is an effective and safe option for naïve and anti-TNF treatment failure patients. RF and anti-CCP seam to influence treatment results, but this inference needs further research.
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Affiliation(s)
- Lívia Lovato Pires de Lemos
- Departamento de Farmácia Social, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - Juliana de Oliveira Costa
- Departamento de Medicina Preventiva e Social, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - Marina Amaral de Ávila Machado
- Departamento de Medicina Preventiva e Social, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - Alessandra Maciel Almeida
- Departamento de Medicina Preventiva e Social, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | | | - Adriana Maria Kakehasi
- Departamento do Aparelho Locomotor, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - Vânia Eloísa de Araújo
- Departamento de Farmácia Social, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - Augusto Afonso Guerra Júnior
- Departamento de Farmácia Social, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - Francisco de Assis Acurcio
- Departamento de Farmácia Social, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
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Caires de Souza AL, de Assis Acurcio F, Guerra Júnior AA, Rezende Macedo do Nascimento RC, Godman B, Diniz LM. Insulin glargine in a Brazilian state: should the government disinvest? An assessment based on a systematic review. Appl Health Econ Health Policy 2014; 12:19-32. [PMID: 24385261 DOI: 10.1007/s40258-013-0073-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION AND OBJECTIVE The costs of the insulin analogue (insulin glargine) have been growing appreciably in the State of Minas Gerais in Brazil, averaging 291% per year in recent years. This growth has been driven by an increasing number of successful law suits and a 536% price difference between insulin glargine and neutral protamine Hagedorn (NPH) insulin. One potential way to address this is to undertake a systematic review assessing the efficacy and safety of insulin glargine analogue compared with NPH insulin in patients with type 1 diabetes mellitus (T1DM), and, as a result, provide published data to support future recommended activities by the State of Minas Gerais. These could include maintaining it on the list of the Public Health System (SUS) provided there is a price reduction. Alternatively, the review could provide potential arguments to defend against future law suits should the authorities decide to delist insulin glargine. METHODS A systematic review of published studies researching the effectiveness of insulin glargine in patients with T1DM between January 1970 and July 2009 in MEDLINE (PubMed), the Latin American and Caribbean Centre on Health Sciences Information, the Cochrane Controlled Trials Databases and the National Health Service Centre for Reviews and Dissemination. Inclusion criteria included insulin glargine on its own or combined with other insulin formulations. Only randomised controlled clinical trials were included. Initially, the titles of all studies were assessed by two independent reviewers before being potentially discarded, with the quality of papers assessed using a modified Jadad scale. The outcome measures included blood levels of glycated haemoglobin, episodes of hypoglycaemia, adverse effects and the reduction of microvascular and macrovascular end-organ complications of T1DM. RESULTS Out of 803 studies found in the selected databases, only eight trials met the inclusion criteria. Most of the studies were of poor methodological quality or had a high risk of bias, with a mean score of 2.125 on the Jadad scale. No study could be classified as double-blind, and only one study documented the increased efficacy of insulin glargine in relation to both glycaemic control and hypoglycaemic episodes. Typically, there was no significant difference between insulin glargine and NPH insulins. CONCLUSIONS This systematic review showed no therapeutic benefit of insulin glargine over other insulin formulations studied when analysing together glycaemic control and the frequency and severity of hypoglycaemia. We therefore recommend to the State Authority to delist insulin glargine or renegotiate a price reduction with the manufacturer. This systematic review provides support for this decision as well as documentation to combat potential law suits if discussions are unsatisfactory.
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Affiliation(s)
- Ana Luísa Caires de Souza
- Medical College, Federal University of Minas Gerais (UFMG), Av. Antônio Carlos, 6627, Bloco 02, sl 1048, CEP 31270-901, Belo Horizonte, MG, Brazil,
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Almeida DEDS, Ceccato MDGB, Guerra Júnior AA, Acurcio FDA. Avaliação normativa do processo de prescrição e dispensação de imunossupressores para pacientes transplantados renais no estado de Minas Gerais, Brasil, 2008. Epidemiol Serv Saúde 2013. [DOI: 10.5123/s1679-49742013000400011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Pereira VODM, Acurcio FDA, Guerra Júnior AA, Silva GDD, Cherchiglia ML. [Use of medicines by individuals with hypertension and diabetes in municipalities covered by the Pharmacy Network in Minas Gerais State, Brazil]. CAD SAUDE PUBLICA 2013; 28:1546-58. [PMID: 22892974 DOI: 10.1590/s0102-311x2012000800013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 04/17/2012] [Indexed: 11/22/2022] Open
Abstract
This article analyzes the use of medicines by individuals with hypertension and/or diabetes mellitus who received their medication through a public network of pharmacies, with a particular emphasis on gender differences. During the first two months of 2010, individuals with hypertension and/or diabetes were interviewed in half of the 64 municipalities (counties) participating in the Minas Gerais Pharmacy Network. Mean age of the 4,777 interviewees was 60.9 years, which may have contributed to the high mean number of medicines used (4.0 among women and 3.5 among men). The most frequently used drugs were those acting on the cardiovascular system (56.3%), alimentary tract and metabolism (14.9%), and nervous system (13.8%), consistent with the sample's epidemiological profile. Women and more elderly individuals tended to use more medicines. The findings show high expenditures on medicines by the interviewees and suggest the design of educational activities targeting rational use of medication.
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Silva GDD, Acúrcio FDA, Cherchiglia ML, Guerra Júnior AA, Andrade EIG. Medicamentos excepcionais para doença renal crônica: gastos e perfil de utilização em Minas Gerais, Brasil. CAD SAUDE PUBLICA 2011; 27:357-68. [DOI: 10.1590/s0102-311x2011000200017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Accepted: 10/26/2010] [Indexed: 11/21/2022] Open
Abstract
No Brasil, os medicamentos para o tratamento da doença renal crônica são disponibilizados gratuitamente pelo Sistema Único de Saúde (SUS). Este estudo teve como objetivos descrever os gastos públicos com esses medicamentos em Minas Gerais, Brasil, e o perfil dos usuários; objetivou, também, analisar os fatores associados ao gasto médio mensal individual. Observou-se que o gasto total com os medicamentos estudados (R$ 41,6 milhões) representa uma parcela significativa do gasto total com procedimentos ambulatoriais no SUS (9,6%). A maioria dos usuários é do sexo masculino, adultos jovens e teve como causa principal de doença renal crônica a hipertensão arterial. A análise multivariada indicou tendência de menor gasto entre indivíduos que eram mais idosos, que tinham como causa principal da doença o diabetes, que fizeram uso de hidróxido de ferro e que residiam em municípios de menor IDH-M (p < 0,05). Finalmente, o estudo indicou a importância de ferramentas gerenciais que permitam visualizar a trajetória dos pacientes no sistema de saúde, as quais sejam capazes de subsidiar o processo de formulação de políticas de saúde.
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Acurcio FDA, Brandão CMR, Guerra Júnior AA, Cherchiglia ML, Andrade IG, Almeida AM, Silva GDD, Queiroz OVD, Faleiros DR. Perfil demográfico e epidemiológico dos usuários de medicamentos de alto custo no Sistema Único de Saúde. Rev bras estud popul 2009. [DOI: 10.1590/s0102-30982009000200007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Queiroz OVD, Guerra Júnior AA, Machado CJ, Andrade ELG, Meira Júnior W, Acúrcio FDA, Santos Filho WD, Cherchiglia ML. A construção da Base Nacional de Dados em Terapia Renal Substitutiva (TRS) centrada no indivíduo: relacionamento dos registros de óbitos pelo subsistema de Autorização de Procedimentos de Alta Complexidade (Apac/SIA/SUS) e pelo Sistema de Informações sobre Mortalidade (SIM) - Brasil, 2000-2004. Epidemiol Serv Saúde 2009. [DOI: 10.5123/s1679-49742009000200002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Cherchiglia ML, Guerra Júnior AA, Andrade EIG, Machado CJ, Acúrcio FDA, Meira Júnior W, Paula BDD, Queiroz OVD. A construção da base de dados nacional em Terapia Renal Substitutiva (TRS) centrada no indivíduo: aplicação do método de linkage determinístico-probabilístico. Rev bras estud popul 2007. [DOI: 10.1590/s0102-30982007000100010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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