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.
Chronic hepatitis B is considered a major public health problem, and its treatment entails increasing health budget expenses with high-cost drugs covered by Unified NationalHealth System. The objective of this study was to compare the efficacy of interferon (conventional; IntroduçãoA hepatite crônica B constitui um grave problema de saúde pública, pois afeta mais de 400 milhões de pessoas no mundo, sendo contabilizado mais de um milhão de mortes anualmente 1 . Esses pacientes apresentam risco aumentado de desenvolvimento de cirrose, hepatite descompensada e carcinoma hepatocelular 2 . O objetivo do tratamento é alcançar a supressão contínua da replicação do vírus da hepatite B (HBV) e remissão da doença do fígado 3 .O tratamento para hepatite B depende de vá-rios fatores, como o estágio da doença, a presença ou ausência do antígeno "e", o potencial de resistência ao medicamento e a subseqüente incapacidade de utilização de um medicamento, em particular nos estágios finais da doença crônica do fígado. Esses e outros fatores são importantes para avaliar o momento de início de tratamento, o tipo de tratamento indicado e sua duração 4 .Entre as alternativas medicamentosas preconizadas nos protocolos clínicos e diretrizes terapêuticas para medicamentos excepcionais do Ministério da Saúde 5 , o interferon alfa 2a e interferon alfa 2b (IFN 2a e 2b) tem sido utilizados, por muitos anos, como primeira escolha de tratamento com baixos níveis de HBV do DNA, altos níveis de alanina amino transferase (ALT) e com biópsia hepática ativa. A meta do tratamento é ativar resposta imunológica em termos de soroconversão HBeAg, queda ou negativação REVISÃO REVIEW
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