To evaluate clinical and economic value of ipilimumab in the treatment of advanced melanoma compared with drugs available for the treatment of advanced cancer. MethOds: An analysis was performed comparing ipilimumab and other drugs for advanced cancer regarding overall survival (OS) and costs associated with improvement in survival. Parameters analyzed were: improvement in median/mean OS, improvement on survival rate at 1 year and the number needed to treat (NNT) to avoid one death. Monthly costs for improvement in mean OS were evaluated. Efficacy data were obtained from clinical trials. Medications costs were obtained from official price lists, such as Banco de Dados de Preços do Sistema de Saúde do Ministério da Saúde Brasileiro and Lista da Câmara de Regulação do Mercado de Medicamentos da Agência Nacional de Vigilância Sanitária (CMED). Results: Improvement in median OS ranged from +2.8 (sorafenib) to +4.8 (transtuzumab), and improvements in mean OS ranged from +1.6 (sorafenib) to +6.1 (ipilimumab). Only ipilimumab showed better mean OS compared with the median OS (6.1 vs. 3.7). This demonstrates the effect of ipilimumab in prolonging OS in long term, which is observed in a considerable proportion of patients treated with this drug. Major improvement in the survival rate in 1 year occurred with ipilimumab (20%). The NNT to prevent 1 death ranged from 7 (ipilimumab) to 61 (bevacizumab for lung cancer). Costs per month of mean OS improvement ranged from BRL 34,906 (sorafenib) to BRL 64,410 (bevacizumab for lung cancer). cOnclusiOns: This comparative analysis of drugs used for treatment of advanced cancer used key parameters for decision making in health sciences. The results suggest that ipilimumab delivers superior clinical and economic benefits when compared with other drugs available in Brazil for the treatment of advanced cancer.
In the Survival of Myocardial Infarction Long-term Evaluation 4 Study (SMILE-4) zofenopril (Z) associated with acetylsalicylic acid (ASA) was superior to ramipril (R) plus ASA in reducing the occurrence of major cardiovascular events, in patients with left ventricular dysfunction (LVD) following acute myocardial infarction (AMI). The present post-hoc analysis was performed to evaluate cost-effectiveness of Z compared to R. METHODS: A total of 771 patients with LVD and AMI were randomized, double-blind to Z 60 mg/day (n=389) or R 10 mg/day (n=382) plus ASA 100 mg/day and followed-up for 1 year. The primary study end-point was 1-year combined occurrence of death or hospitalization for cardiovascular causes. The economic analysis was based on the evaluation of cost of medications and hospitalizations and was applied to the intention-to-treat population (n=716). Cost data were drawn from the database of the Italian National Health Service. The incremental cost-effectiveness ratio (ICER) was used to quantify the cost per event prevented with Z versus R. RESULTS: Z significantly (p=0.028) reduced the risk of the primary study endpoint by 30% as compared to ramipril (95% confidence interval: 49%, 4%). The number needed to treat to prevent a major cardiovascular event with Z was 13 less than with R. The cost of drug therapies was higher with Z (€313.90 per patient per year, n=365) than with R (€160.60 per patient per year, n=351). The cost related to the occurrence of major cardiovascular events requiring hospitalization, averaged €3195.47 for Z and €3071.37 for R. The ICER of Z versus R was €1990.88 per event prevented. CONCLUSIONS: Z is a viable and costeffective treatment for managing patients with LVD after AMI.
A547treatment option as compared with escitalopram,sertraline, and venlafaxine in a matrix comparator, with regard to side effects especially sexual dysfunction, agomelatine should be considered as the most cost-effective option for treatment of depression.
In the Survival of Myocardial Infarction Long-term Evaluation 4 Study (SMILE-4) zofenopril (Z) associated with acetylsalicylic acid (ASA) was superior to ramipril (R) plus ASA in reducing the occurrence of major cardiovascular events, in patients with left ventricular dysfunction (LVD) following acute myocardial infarction (AMI). The present post-hoc analysis was performed to evaluate cost-effectiveness of Z compared to R. METHODS: A total of 771 patients with LVD and AMI were randomized, double-blind to Z 60 mg/day (n=389) or R 10 mg/day (n=382) plus ASA 100 mg/day and followed-up for 1 year. The primary study end-point was 1-year combined occurrence of death or hospitalization for cardiovascular causes. The economic analysis was based on the evaluation of cost of medications and hospitalizations and was applied to the intention-to-treat population (n=716). Cost data were drawn from the database of the Italian National Health Service. The incremental cost-effectiveness ratio (ICER) was used to quantify the cost per event prevented with Z versus R. RESULTS: Z significantly (p=0.028) reduced the risk of the primary study endpoint by 30% as compared to ramipril (95% confidence interval: 49%, 4%). The number needed to treat to prevent a major cardiovascular event with Z was 13 less than with R. The cost of drug therapies was higher with Z (€313.90 per patient per year, n=365) than with R (€160.60 per patient per year, n=351). The cost related to the occurrence of major cardiovascular events requiring hospitalization, averaged €3195.47 for Z and €3071.37 for R. The ICER of Z versus R was €1990.88 per event prevented. CONCLUSIONS: Z is a viable and costeffective treatment for managing patients with LVD after AMI.
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