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Rubulotta F, Hemmerling T. Does biological sex matter in solid organ transplantation? Eur J Intern Med 2023; 112:115-116. [PMID: 37029051 DOI: 10.1016/j.ejim.2023.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 04/09/2023]
Affiliation(s)
- Francesca Rubulotta
- Chair of the Department of Critical Care Medicine, Montreal Canada Chair of iWIN (International Women in Intensive and Critical Care Medicine Network), McGill University, Canada.
| | - Thomas Hemmerling
- Department of Anesthesiology and Division of Experimental Surgery, McGill University, 1400 Rue des Pins, Montreal H3G 1B1, Canada
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Tejada S, Martinez-Reviejo R, Nogueira TA, Gómez A, Pont T, Liao X, Zhang Z, Manuel O, Rello J. The effect of sex inequality on solid organ transplantation: A systematic review and meta-analysis. Eur J Intern Med 2023; 109:58-67. [PMID: 36585321 DOI: 10.1016/j.ejim.2022.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/14/2022] [Accepted: 12/19/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Sex disparities are related to biological differences, which may have significant impact on patient and allograft outcomes. The aim was to investigate the impact of sex on clinical and safety outcomes after solid organ transplantation (SOT). METHODS A systematic review and meta-analysis was performed. Observational studies comparing females vs. males after SOT were considered for inclusion after a systematic search of the Pubmed, Cochrane Library, and Web of Science databases conducted from 2016 to 2021. Primary outcome was mortality. PROSPERO register number: CRD42021282615. RESULTS After retrieving 1103 studies, 22 observational studies (1,045,380 subjects) were finally deemed eligible for inclusion. Females accounted 36.3% of SOT recipients, but presented significantly lower mortality (odds ratio (OR): 0.87, 95% confidence interval (CI): 0.83-0.92, I2=78%). In subgroup analyses, mortality was significantly lower in females undergoing liver (OR: 0.89 95%CI: 0.86-0.92, I2=0%) or kidney transplantation (OR: 0.82 95%CI: 0.76-0.89, I2=72%). Male sex was consistently reported as a protective factor against hospital readmission. Among the outcomes, allograft dysfunction was influenced by a combination of donor-recipient sex and age. Data on overall infections were inconclusive. Several reports suggest a higher risk of malignancy among males. CONCLUSIONS Females represent one-third of SOT recipients but have higher survival rates than males after liver and kidney transplantation. The impact on graft dysfunction was heterogeneous. While further research is warranted, our findings should encourage clinicians and researchers to consider sex as a factor when taking decisions regarding SOT management.
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Affiliation(s)
- Sofia Tejada
- Centro de Investigación Biomédica En Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Clinical Research/Epidemiology in Pneumonia & Sepsis (CRIPS), Vall d'Hebron Institut of Research (VHIR), Barcelona, Spain
| | - Raquel Martinez-Reviejo
- Centro de Investigación Biomédica En Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Clinical Research/Epidemiology in Pneumonia & Sepsis (CRIPS), Vall d'Hebron Institut of Research (VHIR), Barcelona, Spain
| | | | - Aroa Gómez
- Department of Donor & Transplant Coordination, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Teresa Pont
- Department of Donor & Transplant Coordination, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Xuelian Liao
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China; West China Tianfu Hospital, Sichuan University, Chengdu, China
| | - Zheng Zhang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Oriol Manuel
- Service of Infectious Diseases, Lausanne University Hospital, Lausanne, Switzerland; Transplantation Center, Lausanne University Hospital, Lausanne, Switzerland
| | - Jordi Rello
- Clinical Research/Epidemiology in Pneumonia & Sepsis (CRIPS), Vall d'Hebron Institut of Research (VHIR), Barcelona, Spain; Clinical Research CHU Nîmes, Université de Nîmes-Montpellier, France; Medicine Department, Universitat Internacional de Catalunya (UIC), Sant Cugat, Spain.
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Nascimento GF, Gomes RM, Alvares-Teodoro J, Ribeiro NG, Cherchiglia ML, Simão-Filho C, Acurcio FA, Sarmento TTR, Gargano LP, Guerra AA. Sixteen-Year Cohort of Liver Transplantation in the National Health System in Brazil: Analysis of Immunosuppression Maintenance Therapies. Front Pharmacol 2020; 11:572043. [PMID: 33123009 PMCID: PMC7573511 DOI: 10.3389/fphar.2020.572043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/10/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate factors related to liver graft survival with a focus on immunosuppressive schemes based on calcineurin inhibitors (tacrolimus or cyclosporine). METHODOLOGY This study was carried out through an open cohort constructed by deterministic and probabilistic matching through three databases of the SUS with assessment of liver graft survival from 2000 to 2015 in Brazil. From this first cohort, a second cohort was constructed by pairing 1: 1 to more precisely assess the effect of the immunosuppressive scheme on graft survival. The Kaplan-Meier method and was used to estimate the probability of survival. Cox's model of proportional risks was used to assess factors related to graft loss. RESULT We found 12,687 patients in the Full cohort and 470 patients in the Matched cohort. The overall graft survival rates at 1, 5, 10, and 16 years were 72.6, 63.3, 52.8, and 45.3%, respectively. Patients younger had a longer graft survival than older ones. In the Full cohort, male patients had a higher survival rate than female ones. Therapeutic schemes based on tacrolimus were more prevalent and had a better survival rate when compared to schemes that used cyclosporine. Tacrolimus without association with antiproliferative agents or rapamycin inhibitors was the therapeutic scheme associated with greater survival rate in both cohorts (HR = 0.81, 95% CI = 0.72-0.91), (HR = 0.50, 95% CI = 0.30-0.85). In addition, white-skinned patients had longer survival rate in both cohorts (HR = 0.55, 95% CI = 0.50-0.61 and HR = 0.50, 95% CI = 0.34-0.75). On the other hand, patients who a greater time ratio without using an immunosuppressant had lower graft survival rate (HR = 6.46, 95% CI = 5.05-8.27 and HR = 6.57, 95% CI = 2.66-16.22). CONCLUSION This 16-year cohort showed that the older age and the greater time ratio without using an immunosuppressant are risk factors for liver graft loss. White-skinned patients and tacrolimus-based regimens, especially tacrolimus without other immunosuppressants, are factors of better prognosis to the graft.
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Affiliation(s)
| | - Rosângela Maria Gomes
- Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Juliana Alvares-Teodoro
- Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
- SUS Collaborating Centre–Technology Assessment & Excellence in Health, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Nélio Gomes Ribeiro
- SUS Collaborating Centre–Technology Assessment & Excellence in Health, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Mariângela Leal Cherchiglia
- Department of Preventive and Social Medicine, College of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Charles Simão-Filho
- Department of Surgery, College of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Francisco Assis Acurcio
- Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
- SUS Collaborating Centre–Technology Assessment & Excellence in Health, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Tulio Tadeu Rocha Sarmento
- SUS Collaborating Centre–Technology Assessment & Excellence in Health, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Ludmila Peres Gargano
- SUS Collaborating Centre–Technology Assessment & Excellence in Health, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Augusto Afonso Guerra
- Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
- SUS Collaborating Centre–Technology Assessment & Excellence in Health, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Gomes RM, Barbosa WB, Godman B, Costa JDO, Ribeiro Junior NG, Simão Filho C, Cherchiglia ML, Acurcio FDA, Guerra Júnior AA. Effectiveness of Maintenance Immunosuppression Therapies in a Matched-Pair Analysis Cohort of 16 Years of Renal Transplant in the Brazilian National Health System. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1974. [PMID: 32192172 PMCID: PMC7142921 DOI: 10.3390/ijerph17061974] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 03/09/2020] [Accepted: 03/11/2020] [Indexed: 12/11/2022]
Abstract
The maintenance of patients with renal transplant typically involves two or more drugs to prevent rejection and prolong graft survival. The calcineurin inhibitors (CNI) are the most commonly recommended medicines in combinations with others. While immunosuppressive treatment regimens are well established, there is insufficient long-term effectiveness data to help guide future management decisions. The study analyzes the effectiveness of treatment regimens containing CNI after renal transplantation during 16 years of follow-up with real-world data from the Brazilian National Health System (SUS). This was a retrospective study of 2318 SUS patients after renal transplantion. Patients were propensity score-matched (1:1) by sex, age, type and year of transplantation. Kaplan-Meier analysis was used to estimate the cumulative probabilities of survival. A Cox proportional hazard model was used to evaluate factors associated with progression to graft loss. Multivariable analysis, adjusted for diabetes mellitus and race/color, showed a greater risk of graft loss for patients using tacrolimus plus mycophenolate compared to patients treated with cyclosporine plus azathioprine. In conclusion, this Brazilian real-world study, with a long follow-up period using matched analysis for relevant clinical features and the representativeness of the sample, demonstrated improved long-term effectiveness for therapeutic regimens containing cyclosporine plus azathioprine. Consequently, we recommend that protocols and clinical guidelines for renal transplantation should consider the cyclosporine plus azathioprine regimen as a potential first line option, along with others.
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Affiliation(s)
- Rosângela Maria Gomes
- Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
- SUS Collaborating Centre—Technology Assessment & Excellence in Health, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
- Programa de Pós-graduação em Medicamentos e Assistência Farmacêutica, Departamento de Farmácia Social, Faculdade de Farmácia, Universidade Federal de Minas Gerais—UFMG. Av. Presidente Antônio Carlos, 6627 Campus Pampulha, Belo Horizonte, MG 31270-901 Brazil
| | - Wallace Breno Barbosa
- Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
- SUS Collaborating Centre—Technology Assessment & Excellence in Health, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow G4 ORE, UK
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden
- Health Economics Centre, Liverpool University Management School, Chatham Street, Liverpool L69 7ZH, UK
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - Juliana de Oliveira Costa
- SUS Collaborating Centre—Technology Assessment & Excellence in Health, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
- Department of Preventive and Social Medicine, College of Medicine, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
| | - Nélio Gomes Ribeiro Junior
- SUS Collaborating Centre—Technology Assessment & Excellence in Health, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
| | - Charles Simão Filho
- Department of Surgery, College of Medicine, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
| | - Mariângela Leal Cherchiglia
- Department of Preventive and Social Medicine, College of Medicine, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
| | - Francisco de Assis Acurcio
- Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
- SUS Collaborating Centre—Technology Assessment & Excellence in Health, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
| | - Augusto Afonso Guerra Júnior
- Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
- SUS Collaborating Centre—Technology Assessment & Excellence in Health, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil
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Gomes RM, Guerra Júnior AA, Lemos LLPD, Costa JDO, Almeida AM, Alvares J, Filho CS, Cherchiglia ML, Andrade EIG, Godman B, Acurcio FA. Ten-year kidney transplant survival of cyclosporine- or tacrolimus-treated patients in Brazil. Expert Rev Clin Pharmacol 2016; 9:991-9. [DOI: 10.1080/17512433.2016.1190270] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Rosângela Maria Gomes
- Post-Graduation Program in Medicines and Pharmaceutical Assistance, Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Minas Gerais, Brazil
- SUS Collaborating Centre – Technology Assessment & Excellence in Health, College of Pharmacy, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Augusto Afonso Guerra Júnior
- Post-Graduation Program in Medicines and Pharmaceutical Assistance, Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Minas Gerais, Brazil
- SUS Collaborating Centre – Technology Assessment & Excellence in Health, College of Pharmacy, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Lívia Lovato Pires de Lemos
- SUS Collaborating Centre – Technology Assessment & Excellence in Health, College of Pharmacy, Federal University of Minas Gerais, Minas Gerais, Brazil
- Post-Graduation Program in Public Health, Department of Preventive and Social Medicine, College of Medicine, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Juliana de Oliveira Costa
- Post-Graduation Program in Public Health, Department of Preventive and Social Medicine, College of Medicine, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Alessandra Maciel Almeida
- Post-Graduation Program in Medicines and Pharmaceutical Assistance, Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Minas Gerais, Brazil
- SUS Collaborating Centre – Technology Assessment & Excellence in Health, College of Pharmacy, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Juliana Alvares
- Post-Graduation Program in Medicines and Pharmaceutical Assistance, Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Minas Gerais, Brazil
- SUS Collaborating Centre – Technology Assessment & Excellence in Health, College of Pharmacy, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Charles Simão Filho
- Department of Surgery, College of Medicine, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Mariângela Leal Cherchiglia
- Post-Graduation Program in Public Health, Department of Preventive and Social Medicine, College of Medicine, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Eli Iola Gurgel Andrade
- Post-Graduation Program in Public Health, Department of Preventive and Social Medicine, College of Medicine, Federal University of Minas Gerais, Minas Gerais, Brazil
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Division of Clinical Pharmacology, Karolinska Institute, Stockholm, Sweden
| | - Francisco Assis Acurcio
- Post-Graduation Program in Medicines and Pharmaceutical Assistance, Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Minas Gerais, Brazil
- SUS Collaborating Centre – Technology Assessment & Excellence in Health, College of Pharmacy, Federal University of Minas Gerais, Minas Gerais, Brazil
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Godman B, Malmström RE, Diogene E, Gray A, Jayathissa S, Timoney A, Acurcio F, Alkan A, Brzezinska A, Bucsics A, Campbell SM, Czeczot J, de Bruyn W, Eriksson I, Yusof FAM, Finlayson AE, Fürst J, Garuoliene K, Guerra Júnior A, Gulbinovič J, Jan S, Joppi R, Kalaba M, Magnisson E, McCullagh L, Miikkulainen K, Ofierska-Sujkowska G, Pedersen HB, Selke G, Sermet C, Spillane S, Supian A, Truter I, Vlahović-Palčevski V, Vien LE, Vural EH, Wale J, Władysiuk M, Zeng W, Gustafsson LL. Are new models needed to optimize the utilization of new medicines to sustain healthcare systems? Expert Rev Clin Pharmacol 2015; 8:77-94. [PMID: 25487078 DOI: 10.1586/17512433.2015.990380] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Medicines have made an appreciable contribution to improving health. However, even high-income countries are struggling to fund new premium-priced medicines. This will grow necessitating the development of new models to optimize their use. The objective is to review case histories among health authorities to improve the utilization and expenditure on new medicines. Subsequently, use these to develop exemplar models and outline their implications. A number of issues and challenges were identified from the case histories. These included the low number of new medicines seen as innovative alongside increasing requested prices for their reimbursement, especially for oncology, orphan diseases, diabetes and HCV. Proposed models center on the three pillars of pre-, peri- and post-launch including critical drug evaluation, as well as multi-criteria models for valuing medicines for orphan diseases alongside potentially capping pharmaceutical expenditure. In conclusion, the proposed models involving all key stakeholder groups are critical for the sustainability of healthcare systems or enhancing universal access. The models should help stimulate debate as well as restore trust between key stakeholder groups.
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Affiliation(s)
- Brian Godman
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
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Target of rapamycin inhibitors (TORi) as maintenance immunosuppression for kidney transplant recipients. Hippokratia 2015. [DOI: 10.1002/14651858.cd009637.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Guerra AA, Silva GD, Andrade EIG, Cherchiglia ML, Costa JDO, Almeida AM, Acurcio FDA. Cyclosporine versus tacrolimus: cost-effectiveness analysis for renal transplantation in Brazil. Rev Saude Publica 2015; 49:13. [PMID: 25741648 PMCID: PMC4386555 DOI: 10.1590/s0034-8910.2015049005430] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 11/09/2014] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To analyze the cost-effectiveness of treatment regimens with cyclosporine or tacrolimus, five years after renal transplantation. METHODS This cost-effectiveness analysis was based on historical cohort data obtained between 2000 and 2004 and involved 2,022 patients treated with cyclosporine or tacrolimus, matched 1:1 for gender, age, and type and year of transplantation. Graft survival and the direct costs of medical care obtained from the National Health System (SUS) databases were used as outcome results. RESULTS Most of the patients were women, with a mean age of 36.6 years. The most frequent diagnosis of chronic renal failure was glomerulonephritis/nephritis (27.7%). In five years, the tacrolimus group had an average life expectancy gain of 3.96 years at an annual cost of R$78,360.57 compared with the cyclosporine group with a gain of 4.05 years and an annual cost of R$61,350.44. CONCLUSIONS After matching, the study indicated better survival of patients treated with regimens using tacrolimus. Moreover, regimens containing cyclosporine were more cost-effective [corrected].
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Affiliation(s)
- Augusto Afonso Guerra
- Departamento de Medicina Preventiva e Social. Faculdade de Medicina. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
- Departamento de Farmácia Social. Faculdade de Farmácia. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
| | - Grazielle Dias Silva
- Superintendência de Assistência Farmacêutica. Secretaria de Estado de Saúde de Minas Gerais. Belo Horizonte, MG, Brasil
| | - Eli Iola Gurgel Andrade
- Departamento de Medicina Preventiva e Social. Faculdade de Medicina. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
| | - Mariângela Leal Cherchiglia
- Departamento de Medicina Preventiva e Social. Faculdade de Medicina. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
| | - Juliana de Oliveira Costa
- Departamento de Farmácia Social. Faculdade de Farmácia. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
| | - Alessandra Maciel Almeida
- Departamento de Medicina Preventiva e Social. Faculdade de Medicina. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
| | - Francisco de Assis Acurcio
- Departamento de Medicina Preventiva e Social. Faculdade de Medicina. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
- Departamento de Farmácia Social. Faculdade de Farmácia. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
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Acurcio FDA, Saturnino LTM, Silva ALD, Oliveira GLAD, Andrade EIG, Cherchiglia ML, Ceccato MDGB. Análise de custo-efetividade dos imunossupressores utilizados no tratamento de manutenção do transplante renal em pacientes adultos no Brasil. CAD SAUDE PUBLICA 2013; 29 Suppl 1:S92-109. [DOI: 10.1590/0102-311x00006913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 07/24/2013] [Indexed: 11/22/2022] Open
Abstract
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%.
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Szuster DAC, Caiaffa WT, Andrade EIG, Acurcio FDA, Cherchiglia ML. Sobrevida de pacientes em diálise no SUS no Brasil. CAD SAUDE PUBLICA 2012; 28:415-24. [PMID: 22415174 DOI: 10.1590/s0102-311x2012000300002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 09/15/2011] [Indexed: 11/22/2022] Open
Abstract
O objetivo deste estudo foi analisar a sobrevida dos que iniciaram tratamento renal substitutivo em hemodiálise e diálise peritoneal no SUS, entre 2002 a 2004. Estudo observacional, prospectivo não concorrente. Utilizou-se a Base Nacional em Terapias Renais Substitutivas resultante de pareamento probabilístico dos sistemas Autorização de Procedimentos de Alta Complexidade/Sistema de Informações Ambulatoriais e Sistema de Informações sobre Mortalidade do SUS. Incluíram-se os admitidos em 2002 e 2003, com 3 meses de tratamento e maiores de 18 anos. Dos 31.298 pacientes, a maioria iniciou em hemodiálise, era do sexo masculino, com média de 54 anos e residentes na Região Sudeste, e em municípios com IDH médio foi de 0,78. Associou-se a maior risco óbito: sexo feminino, idade superior a 55 anos, diagnóstico de diabete mellitus, em diálise peritoneal, não residir na Região Sudeste. Residir em cidades com melhor IDH proporcionou menor risco. Risco ajustado de HR = 1,17 em favor da hemodiálise. Os resultados sugerem menor sobrevida para os de diálise peritoneal e mais velhos. Portanto, torna-se necessário subsidiar políticas que avaliem melhor a escolha da modalidade, com estudos que aprofundem os achados encontrados.
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Malaekeh-Nikouei B, Banaee T, Aghamohammadian J, Mosallaei N, Mohajeri SA. Quantitative LC Analysis of Cyclosporine A in Ocular Samples. Chromatographia 2011. [DOI: 10.1007/s10337-011-1963-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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