Breast cancer is one of the most frequent malignancies. The aim of the article is to analyse the cost-utility ratio and budgetary impact of talazoparib treatment for patients with locally advanced or metastatic gBRCA þ breast cancer from the perspective of the Spanish National Health System. Analyses were based on the EMBRACA clinical trial and the model was constructed according to "partitioned survival analysis". Two scenarios were considered in order to compare talazoparib with the alternatives of capecitabine, vinorelbine and eribulin: 1. Chemotherapy in patients pre-treated with anthracyclines/taxanes and, 2. A second-and subsequent-line treatment option. Treatment types following relapse were recorded in the mentioned clinical trial. The effectiveness measure used was quality-adjusted life years (QALY). The average health cost of patients treated at 43 months with talazoparib was 84,360.86V, whilst current treatment costs were 26,683.90V. The effectiveness of talazoparib was 1.93 years of survival (1.09 QALY) relative to 1.58 years (0.83 QALY) in the treatment group. The incremental cost-utility ratio was 252,420.04V/QALY. This represents the additional cost required to earn an additional QALY when changing from regular treatment to talazoparib. Regarding budgetary impact, the number of patients susceptible to receiving treatment with between 94 and 202 talazoparib was estimated, according to scenario and likelihood. The 3-year cost difference was between 6.9 and 9 million euros. The economic evaluation conducted shows an elevated incremental cost-utility ratio and budgetary impact. Taking these results into account, the price of talazoparib would have to be lower than that taken as a reference to reach the cost-utility thresholds.
The hospital pharmacist can actively cooperate with nutritional support units, given the need to assess the nutritional support administered and to manage potential complications and interactions between nutritional status, drugs and artificial nutrition. The pharmacist also plays a significant role in the prevention and identification of problems related to the administration of drugs via NGT.
The voriconazole 3 microg/mL eyewash preparation remained stable, sterile and with full antifungal activity for 21 days when stored both at room temperature and under refrigeration conditions.
BackgroundOptimization of Biological Therapy (BT) in patients with Rheumatoid Arthritis (RA) in remission, is a strategy employed in rheumatology practice in recent years consisting in dose reduction or enlargement dose interval (1,2) Some published studies (3-6) and recommendations of RA (7) management guidelines suggest that patients in sustained remission, could get the same benefit with a lower dose (8) Recently, there has been a consensus document from the Spanish Society of Rheumatology and hospital pharmacy about the unification of criteria for dose optimization with BT in order to minimizing the variability among professionals, striving for the minimum effective dose for each patient, limiting the occurrence of adverse effects and promoting economic savings.ObjectivesTo compare the clinical and laboratory characteristics that define the activity of RA patients in remission treated with BT at baseline and at one year after its optimization.MethodsObservational prospective study of 40 patients followed during 12 months, from a cohort of patients with RA (ACR 1987 criteria) in BT treatment (Anti TNF, Abatacept or Tocilizumab).After reaching sustained clinical remission according DAS28 (ESR) the patients were optimized using the following treatment regimen:etanercept: 50 mg/10 days (10%), 50 mg/14 days (17.5%), infliximab: 3 mg/9 weeks (10%),3 mg/10 weeks (5%), adalimumab: 40 mg/21 days (7.5%), 40 mg /30 days (7.5%),golimumab: 50 mg/ 5 weeks (5%), tocilizumab: 8 mg/kg/5 weeks (10%), 8 mg/kg/6 weeks (15%), abatacept: 750 mg/5 weeks (7.5%) and 750 mg /6 weeks (5%)We compared the clinical and laboratory features at the beginning of optimization and at 12 month of follow-up.ResultsOf the 40 patients with RA who were optimized, 80% were women with a mean age of 55.25±14.05 years, a DAS28 at baseline optimization 2.1±0.91 and a mean duration of disease of 16.3±15.3 years. The most widely used drug with spacing pattern was etanercept (27.5%), followed by tocilizumab (25%), both infliximab and adalimumab with 15%, abatacept 12.5% and golimumab 5%. No statistically significant differences were found when contrasting clinical and laboratory parameters of activity at baseline and at 12 months, maintaining remission rates close to 100% at one year of follow-up (DAS28 medium at 12 months 2.30±0.77)ConclusionsThe optimization of BT is a routine clinical practice in our hospital, employing more frequently enlargement dose interval rather than reducing it, managing to maintain remission status one year after the optimization. The adequacy to the published consensus recommendations regarding therapeutic target compliance and the rate of dose reduction was excellent, so we can conclude that optimization can be a useful performance in patients who are in sustained remission.ReferencesInciarte-Mundo J et al. Reumatol Clin 2014;10:10-6.Ramόn Albert A. Farmalia Comunicaciόn; 2010.Lee J et al. Clin Rheumatol 2010;29:1149-54.Cantini F et al. Biologics 2013;7:1-6.Navarro-Compan V et al. Clin Rheumatol. 2011;30:993-6.Cantini F et al. B...
Data suggest that in heart transplant patients it may be crucial to achieve tacrolimus levels of at least 8 ng/ml during the first days postsurgery to avoid rejection.
BackgroundTreat to Target (T2T)is an international initiative to define Rheumatoid Arthritis (RA) treatment targets and recommendations to measure disease severity and encourage earlier diagnosis and optimize treatment. The primary target for treatment of RA should be a state of clinical remission.After reaching remission there are different therapeutic approaches to consider. In recent years, optimization of Biological Therapy (BT)is a strategy employed in patients with RA in remission, consists in a dose reduction or an extended dose interval, searching a minimum effective dose for each patient, which limits the occurrence of adverse effects and promotes economic savingMethodsRA patients (ACR criteria 1987)of CREATE registry that November 1, 2013 had clinical remission (DAS28 value <2.6)of at least 6 months constituted the cohort of patients who were optimized. According to the consensus of the Spanish Society of Rheumatology and Hospital Pharmacy, dose optimization involved the reduction of between 20 and 50% of it.Decisions about treatment and dose reduction was performed by a multidisciplinary team of clinical rheumatologists and pharmacists in a tertiary hospital,which involved the application of protocols and patients revision at least every 2 monthsResultsWe performed a prospective observational cohort study in 70 RA optimized patients. (81.4% were women with a mean age at onset optimization of 56.9 ± 13.7 years. 68.8% were RF positive and 66.7% ACPA positive). Optimization occurred in 41.4% of patients in the first year and 58.8% in the second year (p=0.001).64 patients completed 24 month of follow-up, suffering 36 of these patients (56.3%) clinical relapse (mean DAS28 2.81 (0.88) at 1 year, reason why it was decided to return to the usual dose again reaching clinical remission in all patients after 2 years (DAS 28 2.59 (0.58).43.8% patients maintained optimization after 2 years of follow-up without suffering relapse (mean DAS28 2.19 (0.84)). Statistically significant differences were found when comparing the mean baseline DAS 28 between both groups, being lower in the subgroup of patients who maintains remission compared to the relapsing group (1.97 (0.85) vs 2.44 (0.66) (p=0.012)Conclusions-The use of an extended dose interval maintained remission status in patients with established RA who are in sustained clinical remission it is possible in 41.2% patients after 2 years of follow-up in clinical practice (CREATE registry)-This strategy is possible in patients with controlled disease persistently and in view of our results, we might consider that those patients who have a lower level of activity at onset optimization, are less likely to relapse and therefore maintain this strategy-After 2 years of follow up all patients maintained clinical remission (DAS28 <2.6),even the patients who relapsed at 12 months and returned to their usual doseReferencesRodríguez-Valverde et al Clin. 2006;2:S52-S59.Smolen JS et al 2013 update. Ann Rheum Dis 2014; 73:492–509.Hetland ML et al. Arthritis Rheum 62(1):22–32.Leffers ...
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