: estructuración del manuscrito, aportes a resultados y discusión María de los Ángeles Carrasquilla: discusión sobre la metodología y análisis de la información Verónica Jhajaira Gómez y Jaime Robledo: redacción del manuscrito y discusión de los resultados Todos los autores participaron en la selección de los estudios publicados.
Objectives: No drugs have yet been FDA-approved to treat non-alcoholic fatty liver disease (NAFLD). Several clinical trials have demonstrated beneficial effects of antidiabetic drugs (i.e., pioglitazone, liraglutide, and exenatide) in treating NAFLD. However, whether diagnosis of NAFLD influences clinicians' choice of antidiabetic agents is unknown. This study assessed the initiation timing of glucagon-like peptide-1 receptor agonists (GLP-1RAs), dipeptidyl peptidase-4 inhibitors (DPP-4is), and thiazolidinediones (TZDs) relative to a NAFLD diagnosis. Methods: We conducted a retrospective cohort study from 2012-2019 using MarketScan® Explorys® Claims-EMR Data Set. Adult patients with diagnosis of NAFLD who newly initiated GLP-1RAs, DPP-4is, or TZDs were selected from the database. The index date was defined as the initiation date of an antidiabetic agent. NAFLD was identified using the earliest date of diagnosis 365 days before and after the index date. We described the raw frequency distribution of antidiabetic drugs initiation relative to a NAFLD diagnosis. Results: Overall, 4,640 patients with diagnosis of NAFLD contributed 5,180 initiation episodes (n GLP-1RAs = 2,243, n DPP-4is = 2,587, n TZDs = 350). Approximately 60% of the initiations were subsequent to the diagnosis of NAFLD. Among GLP1-RAs, DPP-4is, and TZDs, the distribution of dispensed products was similar before and after the NAFLD diagnosis, with a slight decline in sitagliptin (40.3% prior to NAFLD vs 36.9% after NAFLD) and increase in dulaglutide (10.2% prior to NAFLD vs 12.5% after NAFLD) and linagliptin (7.0% prior to NAFLD vs 8.3% after NAFLD). Conclusions: The preliminary findings from this study suggest that patients are more likely to initiate these GLP-1RAs, DPP-4is, and TZDs after a NAFLD diagnosis. Further analysis will aim to establish the direct effect of a NAFLD diagnosis on the initiation of these drugs.
Objectives: Rheumatoid arthritis (RA) autoimmune disorder is characterized by joint pain, stiffness, and impaired functionality. The disease is characterized for its variability in terms of the cost therapy, especially the biological one, compared to other treatment alternatives. We aimed to examine the costs in patients with RA receiving biological therapy and to describe global change in Disease Activity Score 28 (DAS28). MethOds: Under a T2T model, we followed patients with RA receiving biological therapy during 12 months; each patient had a minimum of 6 follow-up visits. Clinical follow-up was defined according to DAS28 as follows: every 3-5 weeks (DAS28> 5.1), every 7-9 weeks (DAS28≥ 3.1 and ≤ 5.1), and every 11-13 weeks (DAS28< 3.1). Tender joint count, swollen joint count and DAS28 were measured on each visit. We stratified patients in four groups: remission, low disease activity (LDA), moderate disease activity (MDA) and severe disease activity (SDA). Means and standard deviations were estimated for continuous variables and categorical variables were presented as percentages. We assessed the overall drug expenses; costs were presented in US dollars at the official rate of exchange for December 2017. Results: 606 were included, 83% were female, mean age was 60 years ±11. We achieved remission in 29.63 % of patients, and 22.56% in LDA (at overall 52.2% of response rate). Regarding therapy, 27% received Certolizumab, followed by Etanercept 17%, Abatacept 13%, Rituximab 9% Tocilizumab 9%, Golimumab and Tofacitinib 7%, adalimumab 6% and infliximab 4%. The cost therapy for 12 months was 5.039.840 Million/Dollars for all patients. cOnclusiOns: Our study showed an evident global improvement of DAS28 in a cohort of RA patients receiving biological therapy. Although the therapy is effective, ratios of cost-effectiveness should be considered by stakeholders; further research is needed using a greater sample to verify our results.
for UK. The utility values for the one-time use catheters were associated with the attributes of steps/time needed for catheterization, pain during catheterization and frequency of urinary tract infections (UTIs). ConClusions: The investigated attributes of compact catheter design, phthalates, steps/time needed, pain related to catheterization and frequency of UTIs have a significant impact on health utilities, which highlight the value of catheter innovations in these areas. No cut-off limit was applied to exclude extreme values and it would be relevant to explore the impact of outlier responses in future research.
in both sexes. In our analysis we used descriptive statistics, independent samples t-test. Results: In 1990, standardized mortality in men 45-59 was the highest in fSU (n=15) 358.69/100,000, the lowest rate was found in WE (n=17) 143.67/100,000. It significantly decreased to 244.99/100,000 (-31.70%, n=11) and 50.29/100,000 (-65.00%, n=15) by 2014 respectively (p,0.05). In 1990, standardized mortality in women 45-59 was the highest in fSU (n=15) 99.78/100,000, the lowest rate was found in WE (n=17) 29.06/100,000. It significantly decreased to 56.26/100,000 (-43.61%, n=11) and 9.89/100,000 (-65.97%, n=15) by 2014 respectively (p,0.05). Mortality also decreased significantly (p,0.001) among men (-49.41%) and women (-50.57%) in EE between 1990 and 2014. Conclusions: A significant decline was detected in standardized mortality of IHD in both sexes aged 45-59 between the assessed time period. The highest improvement was observed in Western-European countries.
Objectives: We aimed to estimate the cost of treating patients with rheumatoid arthritis (RA) in a Center of Excellence (CoE) for rheumatic diseases located in Bogotá, Colombia. Methods: We performed a cost analysis from the standard cost estimation of a CoE program for RA care. We estimated costs of consultations, laboratory and imaging tests, and pharmacological treatment from the measurement of the health care resource utilization of the CoE standard protocol according to the activity level of the disease (DAS28). Costing process was done following the recommendation of the Colombian Institute of Health Technology Assessment (IETS, in Spanish). Mean, minimum and maximum costs were reported annually for a type case depending on severity and classified as Remission, low disease activity (LDA), moderate disease activity (MDA) and severe disease activity -SDA-(with and without bDMARD). All costs were reported in American dollars, using the average exchange rate from January to December of 2018, reported by Banco de la República de Colombia: US$1 = $2,951.3 Colombian pesos. Results: Mean total direct medical cost to treat a patient in remission is US$235.7 (213.0-336.4), in LDA is
show that DCV+ASV, SOF+PR, OBV/PTV/r+DSV and EBR/ GZR had a probability of 80.70%, 77.50%, 84.80%, 86.60% probability of being cost-effective at WTP of one time GDP per capita when compared with PR, respectively. Conclusions: DAA regimens are more cost-effective than PR, so traditional interferon therapy no longer has any advantage of price and efficacy. AS for the four DAA regimens considered in our research, EBR/ GZR was the most cost-effective. DAA regimens could be included in drug insurance list and case payment or value based payment for chronic hepatitis C treatment could be explored in the future.
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