A879from 90.1% (1L) and 87.5% (2L) APACs could be decoded. Most used drug combinations reported for 1L-treatment were cyclophosphamide monotherapy (8.6%), cycl ophosphamide+dexamethasone+thalidomide (7.7%) and melphalane+prednisone (4.9%); for 2L-treatment, cyclophosphamide monotherapy (9.7%), bortezomibe (6.3%) cyclophosphamide+dexamethasone+thalidomide (5.2%) were the most frequent. ConClusions: The most reported drug was a monotherapy not included in the PCDT recommendations, all other frequent combinations were coherent with the current PCDT. The results found are limited by the uncertainty in data input in the database.
A935possible. Results: 159 case reports were included. In descending order, the numbers of case reports found for each drug were: etanercept = 57; infliximab = 46; adalimumab = 31; tocilizumab = 12; rituximab = 5; anakinra = 3; golimumab = 2; abatacept = 2; and certolizumab= 1. The mean age of all patients was 55 (12.3) years, 80% were female and disease duration was between 8 months and 48 years. 137 treatment withdrawals ocurred in patients using anti-TNF. Considering all adverse reactions, 21% were related to serious infections, 16% to skin diseases, 13% to autoimmune reactions, 9% to hematological disorders, 7% to allergies, 5% to hepatitis while neoplasias, infusion reactions and reactions in the cardiovascular system presented 4% each. ConClusions: The most commonly reported adverse event leading to treatment discontinuation presented on the case reports appraised in this systematic review was serious infections. Case reports are important in the detection of rare adverse events and should be considered in the choice of appropriate therapy for each patient.
A551 the Decision Resources Group's 'Global Market Access Solution' database were reviewed. Results: The healthcare systems in Brazil, Argentina and Mexico are decentralised, while that of Colombia is centrally managed. All countries have a national health service for all residents, but the proportion of the population that relies solely on this varies greatly between countries. In Brazil, 25% of the population has private health insurance, while only a small proportion of the population relies on private insurance in the other countries. In Mexico and Argentina, residents in formal employment are obliged to enrol in one of the social security sponsored schemes. In Brazil, Argentina and Colombia, national formularies include the mandatory minimum healthcare provision. In Mexico, the national formulary is not binding and the different social security schemes decide which treatments to cover. The role of health technology assessment (HTA) in the reimbursement process varies in different countries. In Brazil, Mexico and Colombia, HTA is critical in the reimbursement decision process, while in Argentina it has been mostly used to assess treatments for catastrophic illnesses; although there is a drive to include HTA in the decision process. Opportunities include a growing demand for pharmaceuticals, and challenges include decentralised healthcare systems and high use of generics. ConClusions: Most countries have a decentralised system where reimbursement decision making occurs at the regional level or at the social security funds level. HTA is critical in decision making in Brazil, Mexico and Colombia, but not yet in Argentina. We have identified current opportunities and challenges for the different countries.
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