Objective: This study aims to describe the eligibility for biologic therapies for severe asthma (SA) in a cohort of patients attending the Program for Control of Asthma (ProAR) in Bahia, Brazil. Methods: Data from SA patients (!18 years old) attending the ProAR, that were included in a case-control study conducted from 2013 to 2015, were used to reassess patients according to a modified ERS/ATS 2014 SA criteria. Patients were then classified according to the eligibility for SA biological therapy based on current prescription labels. Results: From 544 patients in the cohort, 531 (97.6%) were included and 172 (32.4%) were identified as SA patients according to the ERS/ATS 2014 modified criteria. Of these 172 patients, 69 (40.1%) were ineligible for any of the biologicals approved for asthma (omalizumab, mepolizumab, reslizumab and benralizumab), 60 (34.9%) patients were eligible for one of the biological therapies, and 10 (5.8%) patients were eligible for all biological therapies. Conclusions: More than half of patients with SA were eligible for biologic therapy in our study, but none of them received this form of treatment. Almost half of them were not eligible to any of the approved biologics, however. The variability and overlap in patients' eligibility highlight the importance of evaluating each patient individually for a more personalized treatment approach. While there is a need to increase access for some of those eligible that may really need a biologic treatment, continuous efforts are required to develop alternatives to those who are not eligible.
O objetivo do estudo foi realizar análise custoefetividade de imunossupressores utilizados na terapia de manutenção pós-transplante renal. Coorte hipotética de adultos transplantados foi acompanhada por 20 anos, empregando-se modelo de Markov. Os 10 esquemas terapêuticos avaliados continham prednisona (P). O custo médio dos medicamentos foi obtido na Câmara de Regulação do Mercado de Medicamentos. Outros custos assistenciais compuseram cada estágio da doença. O custo foi expresso em reais, a efetividade em anos de vida ganhos e adotou-se a perspectiva do sistema público de saúde. Ao fim do acompanhamento, a análise com desconto mostrou que todos os esquemas foram dominados por ciclosporina(CSA)+azatioprina(AZA) +P. Nas demais análises, tacrolimo+AZA+P não foi dominado, mas a relação custo-efetividade incremental entre estes dois esquemas foi de R$ 156.732,07/ anos de vida ganhos, na análise sem desconto, valor que ultrapassa o limiar de três vezes o PIB per capita brasileiro. Nenhuma alteração qualitativa foi demonstrada pela análise de sensibilidade e a probabilidade do esquema CSA+AZA+P ser o mais custo-efetivo é superior a 85%.
Objectives: To determine the trend of self-reported asthma diagnosed prevalence and to describe the factors associated with asthma in Brazilian adults. Method: Epidemiological cross-sectional study based on databases analysis from three national household surveys: Pesquisa Nacional por Amostra de Domicílios (PNAD) 2003, PNAD 2008 and Pesquisa Nacional de Saúde (PNS) 2013. Participants between 18-45 years old were included. Trend analysis of asthma diagnosed prevalence was conducted using a logistic general linear model. A hierarchical logistic regression model was used to select factors significantly associated with asthma prevalence. Results: Asthma diagnosed prevalence was 3.6% (2003), 3.7% (2008) and 4.5% (2013), showing a statistically significant increased trend. Asthma diagnosed prevalence also increased when analysed by gender (annual change for men: 2.47%, p < 0.003; women: 2.16%, p < 0.001), urban area (annual change for urban: 2.15%, p < 0.001; rural: 2.69%, p = 0.072), healthcare insurance status (annual change without healthcare insurance: 2.18%, p < 0.001; with healthcare insurance: 1.84%, p = 0.014), and geographic regions (annual change North: 4.68%, p < 0.001; Northeast: 4.14%, p < 0.001; and Southeast: 1.84%, p = 0.025). Female gender, obesity, living in urban areas and depression were associated with asthma diagnosed prevalence. Discussion: PNAD and PNS surveys allow for a very large, representative community-based sample of the Brazilian adults to investigate the asthma prevalence. From 2003 to 2013, the prevalence of self-reported physician diagnosis of asthma increased, especially in the North and Northeast regions. Gender, region of residence, household location (urban/rural), obesity, and depression diagnosis seem to play significant roles in the epidemiology of asthma in Brazil.
O Internato Rural na formação do profissional farmacêutico para a atuação no Sistema Único de SaúdeRural Internship in the professional training of pharmacists to serve in the Brazilian Unified Health System
The 2002 Brazilian Curricular Lines established a new curriculum for Pharmacy Programs, including amplified information about the Unified Health System (SUS). Following this, some Colleges have implemented a Rural Internship (RI) discipline, as a way to promote: a) adequate information on the SUS, and b) students' interaction with pharmaceutical assistance. In this study we analyzed the perceptions of students enrolled in the Rural Internship program of the undergraduate Pharmacy Program at the Federal University of Minas Gerais. Eight students participated in this study and their perceptions and ideas were obtained by focus groups, both before and after the RI. This information was analyzed by content analysis. The students had a fragmented, distorted view on assistance, before as well as after taking the RI. Nevertheless, the RI provided students with a view of the professional realities and difficulties routinely faced by pharmacists in the public health system. The RI course of the Pharmacy Programs was viewed as an opportunity to improve the professional work within the SUS.Uniterms: Pharmaceutical assistance. Pharmacy/education. Unified Health System. Rural Internship.As Diretrizes Curriculares de 2002 implantaram um novo currículo para o Curso de Farmácia, trazendo como propósito a aprendizagem para o Sistema Único de Saúde (SUS). Para atender a esta demanda, algumas Faculdades têm implantado a disciplina de Internato Rural (IR) como forma de viabilizar o ensino para o SUS e a interação do aluno com a assistência farmacêutica. Este trabalho analisa a concepção de alunos do IR do Curso de Farmácia da Universidade Federal de Minas Gerais sobre a assistência farmacêutica e sobre a atividade do profissional farmacêutico no SUS. A coleta das informações foi realizada por meio da técnica do grupo focal antes e após o IR. Para a análise dos discursos foi utilizada a técnica da análise de conteúdo. Participaram do estudo oito estudantes. Observou-se que os alunos apresentavam uma visão fragmentada sobre a assistência, tanto antes como após o internato. O IR proporcionou aos estudantes uma visão da realidade e o reconhecimento das dificuldades que o profissional ainda enfrenta nos serviços. Além disso, notou-se que a disciplina de internato no curso de farmácia pode ser uma alternativa que contribui para a atuação e a formação do farmacêutico para o SUS.Unitermos: Assistência farmacêutica. Farmácia/ensino. Sistema Único de Saúde. Internato Rural. INTRODUCTIONDespite the countless challenges that the Unified Health System (Sistema Único de Saúde -SUS) has faced since its institution in 1988, its creation has enabled a number of advances in the Brazilian public health domain (Marin, 2003). One improvement was the National Policy of Medications, 1998, which redefined pharmaceutical assistance and considers it as a cycle of activities dedicated to individual and collective health promotion, prevention and recuperation, centered on medication and destined to support community health (Brasil, 1998). At this time, some a...
To perform a treatment cost comparison of pirfenidone versus nintedanib on the treatment of idiopathic pulmonary fibrosis (IPF) under the Brazilian private healthcare system perspective. MethOds: Both treatment's ex-factory prices were obtained from official published lists, by the Brazilian Ministry of Health, considering the incidence of taxes (ICMS 18%). Annual treatment cost was calculated based on the dosage of pirfenidone (2.403 mg/day) and nintedanib (150 mg BID) obtained from their respective Brazilian labels. A year was assumed to be 12 months with 30 days each. Results were shown for 2 scenarios: first year (including initial dose ramp up for pirfenidone) and maintenance phases. Results: Pirfenidone and nintedanib unitary costs were BRL 9,144 (BRL 33.87 per 267 mg tablet) and BRL 14,916 (BRL 248.60 per 150 mg tablet), respectively, according to their list prices. Pirfenidone showed an annual treatment cost of BRL 107,591 and BRL 109,724 on the first year and subsequent years of treatment, respectively. Nintedanib incurred an annual cost of BRL 178,988 independent of year of treatment. Those results led to savings of approximately BRL 70,000 per year per patient treated with pirfenidone compared to those treated with nintedanib (a relative reduction of approximately 40%). Pirfenidone's dose ramp up, on the first year of treatment, did not decrease significantly the treatment cost, implying on a reduction of just 2% when compared to subsequent years. cOnclusiOns: Pirfenidone was lower than the cost of nintedanib.
El manejo de la artritis reumatoide (AR) implica grandes retos para los sistemas de salud, especialmente en países en vía de desarrollo, ya que exige la implementación de programas de atención integral para reducir el desgaste gradual, la complicación de síntomas y el impacto económico tanto a nivel familiar como del Estado. El objetivo del estudio fue construir una guía de intervención psicológica basada en la evidencia que facilite el ejercicio de psicólogos en la atención integral de pacientes diagnosticados con AR en Colombia. MetOdOlOgíAs: Se realizó una revisión sistemática de literatura y se formularon recomendaciones para el abordaje de factores psicológicos y sociales de la enfermedad a partir de la evidencia empírica hallada sobre la intervención psicológica para pacientes diagnosticados con AR. La inclusión de tales recomendaciones en la guía se logró a través de reuniones de consenso no estructurado con el grupo desarrollador; también fueron consideradas en el proceso las opiniones de expertos y de pacientes. Las recomendaciones fueron calificadas según los lineamientos de la Scottish Intercollegiate Guidelines Network (SIGN). ResultAdOs: Las prácticas recomendadas en esta guía se consolidaron en siete apartados: 1) psico-educación; 2) apoyo social; 3) estado de ánimo; 4) adherencia al tratamiento; 5) autoeficacia; 6) autocontrol -automanejo; y 7) manejo de dolor. La guía se encuentra lista para iniciar su validación e implementación en el ámbito clínico. cOnclusiOnes: Por primera vez, Colombia cuenta con una guía de intervención psicológica basada en la evidencia para la atención de pacientes con AR y el propósito final es que sea adoptada por el Sistema Nacional de Salud. El siguiente paso en el proceso de construcción de esta guía es su validación con expertos clínicos, pacientes, el Ministerio de Salud y otros actores del sistema de salud colombiano para hacer posible su diseminación y puesta en marcha.
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