En Colombia la Diabetes Mellitus es un problema de salud pública por lo que deben generarse e implementarse estrategias de prevención, diagnóstico, tratamiento y seguimiento, aplicables en todos los niveles de atención con miras a establecer el control de la diabetes en forma temprana y sostenida. Se elaboró una guía de práctica clínica siguiendo los lineamientos de la guía metodológica del Ministerio de Salud y Protección Social para recolectar de forma sistemática la evidencia científica y formular las recomendaciones utilizando la metodología GRADE. El presente documento muestra, de forma resumida, el resultado de ese proceso, incluyendo las recomendaciones y las consideraciones tenidas en cuenta para llegar a ellas. En términos generales, se propone un proceso de tamización mediante el cuestionario FINDRISC adaptado a población Colombiana que permite llegar a un diagnóstico temprano de la enfermedad y un algoritmo para el manejo inicial que es generalizable a la gran mayoría de los pacientes con DMT2 y que es sencillo de aplicar en atención primaria. También se hacen unas recomendaciones para escalar el tratamiento farmacológico de los pacientes que no alcanzan la meta o la pierden con el manejo inicial, teniendo en cuenta principalmente la evolución del peso y la individualización de la meta de control glucémico en poblaciones especiales. Finalmente se proponen algunas recomendaciones para la detección oportuna de las complicaciones micro y macrovasculares de la diabetes.
Objectives: To estimate the clinical and economic trade-offs involved in using the molecular assay EPICUP to aid in identifying the primary site in Cancer of Unknown Primary (CUP). MethOds: A decision-analytic model was developed to estimate the lifetime clinical and economic outcomes of incorporating the EPICUP assay compared with other molecular assays (CancerTYPE ID, Cancer Origin Test and ResponseDX: Tissue of Origin Test). The analysis was limited to 6 primary cancer sites (breast, colon, pancreas, lung, liver and prostate) for adenocarcinoma histological subtype. Results are presented as incremental cost-effectiveness ratio (ICER, cost per quality-adjusted life-years [QALY] gained) from the USA Health Payers perspective. Model inputs were based on a case-control study of EPICUP, published literature, Surveillance Epidemiology and End Results database and a clinical expert panel. Results: Based on a price of USD3,500 for EPICUP and for a willingness to pay USD100,000, EPICUP is cost-effective (vs. CancerTYPE ID, Cancer Origin Test and ResponseDX: Tissue of Origin Test) in all tumors analyzed, ranging between 80% and 100% of the simulations. EPICUP increased the proportion of patients treated correctly, decreased the proportion of patients treated with an empiric approach, and increased the quality-adjusted overall survival. For a willingness to pay USD50,000 EPICUP is cost-effective in breast, colon, pancreas, lung (NSCLC) and prostate cancer, again ranging between 80% and 100% of the simulations. These findings were robust across deterministic and probabilistic sensitivity analyses. cOnclusiOns: EPICUP assay for diagnosing the primary tumor in CUP patients is a cost-effective approach in breast, colon, pancreas, lung (NSCLC), hepatocellular and prostate cancer in comparison with other alternatives available, while improving patient care. PMD70 EconoMic EvAluAtion of orAl AnticoAgulAtion thErAPiEs (oAt) in chinA
Objectives: Despite relevant treatments, only 29% of type 2 diabetes (T2DM) patients in Greece achieve their pre-defined glycemic targets. When treatment with metformin (MF) fails to control T2DM patients, add-on therapies are needed. Sitagliptin is indicated as second-line therapy in Greece, after treatment with MF has failed and is a valid option in the proposed national therapeutic protocols. The present study aimed to assess the cost-effectiveness of adding Sitagliptin to MF vs adding sulphonylurea (SU) to MF for the treatment of T2DM patients with inadequate glycemic control. MethOds: A published individual-level simulation model was developed to simulate the lifetime medical cost, diabetic complications, drug-related adverse events, life expectancy and quality adjusted life years (QALYs) associated with Sitagliptin add-on therapy versus SU add-on therapy. The model is developed based upon the UKPDS 68 risk equations to project long-term complications and mortalities. Efficacy and safety profiles of drugs were obtained from a head-to-head trial. Costs (€ 2014 prices) and effects were discounted at 3.5% annually. Greek data retrieved by an expert input forum of specialists. Sensitivity analyses performed on 17 parameters. Analysis based on Greek payer perspective. Results: Sitagliptin strategy is projected to cost 359 EUR more than SU strategy per patient over lifetime. Sitagliptin showed reductions in diabetes-related complications and adverse events. The incremental QALY for Sitagliptin strategy is 0.042, primarily driven by the improved outcomes associated with hypoglycemia, body weight change, and MI. The incremental cost effectiveness ratio (ICER) is 8,582 € /QALY gained. Sensitivity analysis conducted varied multiple parameters. ICER ranges from 4,873 to 12,173 € /QALY gained. The results are robust and never exceeded the 30,000€ /QALY threshold. cOnclusiOns: Sitagliptin add-on strategy could be costeffective, compared to SU, for the Greek healthcare setting. Furthermore, it remains cost-effective in all types of sensitivity analysis.
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