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Análisis coste-efectividad del tratamiento de la hiperplasia prostática benigna de grado moderado
Cost-effectiveness analysis of the treatment of moderate benign prostatic hyperplasia
C.M. Meseguer Barrosa, M.L. Fidalgo Garcíab,b, S. Rubio Cebriánc
a Servicio de Epidemiología. Sección Enfermedades no Transmisibles. Consejería de Sanidad de la Comunidad de Madrid.
b Farmacéutica Atención Primaria. Servicio de Farmacia Atención Primaria del Área 8. INSALUD. Madrid.
c Profesor del Departamento de Planificación y Economía de la Salud. Escuela Nacional de Sanidad. Madrid.
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Determinar la alternativa m&#225;s coste-efectiva del tratamiento de la hiperplasia prost&#225;tica benigna de grado moderado &#40;HPB-GM&#41; y conocer si las conclusiones pueden modificarse al variar el coste o efectividad de las estrategias de tratamiento&#46;</p> <span class="elsevierStyleSectionTitle">Dise&#241;o</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El estudio se modeliza mediante un &#225;rbol de decisi&#243;n para examinar el ratio costeefectividad de 3 estrategias de tratamiento&#58; <span class="elsevierStyleItalic">a</span>&#41; espera vigilada&#44; y si no hay respuesta se administra un f&#225;rmaco&#59; si tampoco hay respuesta&#44; se procede a resecci&#243;n transuretral de pr&#243;stata &#40;RUTP&#41;&#59; <span class="elsevierStyleItalic">b</span>&#41; tratamiento farmacol&#243;gico&#44; y si no hay respuesta se realiza RTUP&#44; o <span class="elsevierStyleItalic">c</span>&#41; aplicar inicialmente RTUP&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se simula el tratamiento de 1&#46;000 pacientes con HPB-GM y su trayectoria de episodios y probabilidades a lo largo de 2 a&#241;os de tratamiento y desde el punto de vista del sistema sanitario como financiador de servicios&#46;</p> <span class="elsevierStyleSectionTitle">Mediciones y resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Los datos de efectividad se obtienen a partir de un consenso americano de expertos&#46; Se consideran &#250;nicamente los costes tangibles directos derivados del tratamiento&#44; en pesetas constantes de 1998&#46; Se realiza un an&#225;lisis de sensibilidad simple univariante considerando las variables de costes de la RTUP y de los f&#225;rmacos en un rango aceptable de &#177; 20&#37;&#44; y la eficacia de la espera vigilada y del tratamiento farmacol&#243;gico seg&#250;n los valores incluidos en su intervalo de confianza del 90&#37;&#46; La alternativa con un menor coste por paciente mejorado &#40;PM&#41; es la espera vigilada &#40;77&#46;069 pts&#46;&#47;PM&#41; seguido del tratamiento con f&#225;rmacos &#40;118&#46;656 pts&#46;&#47;PM&#41; y&#44; por &#250;ltimo&#44; de la RTUP &#40;456&#46;642 pts&#46;&#47;PM&#41;&#46; Variaciones en los valores de las variables no hacen modificar las posiciones relativas de las estrategias de tratamiento evaluadas&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Desde el punto de vista farmacoecon&#243;mico&#44; el tratamiento de la HPB-GM debe iniciarse con espera vigilada&#44; procediendo a administrar f&#225;rmacos s&#243;lo si no hay respuesta positiva y recurrir a RTUP cuando los procedimientos farmacol&#243;gicos no hayan resultado efectivos&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">To estimate the most cost-effective alternative of treatment of moderate benign prostatic hyperplasia and to learn whether the outcome can be varied by changing the cost or effectiveness of the alternatives&#46;</p> <span class="elsevierStyleSectionTitle">Design</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The study is made by a decision tree in order to test the cost-effectiveness &#40;CE&#41; rate of three treatment strategies&#58; <span class="elsevierStyleItalic">a</span>&#41; watchful waiting&#59; if there is no response a drug is administered and if there is no response transurethral resection of the prostate &#40;TURP&#41; is done&#44; <span class="elsevierStyleItalic">b</span>&#41; pharmacological treatment&#44; and if there is no response TURP is done&#44; and <span class="elsevierStyleItalic">c</span>&#41; to apply TURP initially&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The treatment is simulated taking 1000 patients with MBPH and testing the outcome of events and probabilities in a two-year treatment and from the point of view of the health system as services supplier&#46;</p> <span class="elsevierStyleSectionTitle">Measurements and results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Effectiveness is obtained from an american experts&#39; consensus&#46; Only the direct tangible costs are taken into account&#44; in constant 1998 pts&#46; An univariant simple sensitivity analysis is made considering the cost variables of TURP and from the drugs in an acceptable range of &#177; 20&#37;&#44; and the effectiveness of the watchful waiting and the pharmacological treatment&#46; The lower cost alternative per improved patient &#40;IP&#41; is the watchful waiting &#40;77069 pts&#46;&#47;IP&#41; followed by the drug treatment &#40;118656 pts&#46;&#47;IP&#41; and lastly the TURP &#40;456642 pts&#46;&#47;IP&#41;&#46; Variations in the variable values make no difference in the relative positions of the tested alternatives&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">From the pharmacoeconomics&#39; point of view the MBPH treatment must be iniciated by watchful waiting&#44; proceeding to drug administration only if there is a positive response and to make use of TURP when the pharmacological procedures have not been effective&#46;</p>"
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Información del artículo
ISSN: 02126567
Idioma original: Español
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2020 Noviembre 7 12 19
2020 Octubre 9 6 15
2020 Septiembre 21 17 38
2020 Agosto 8 13 21
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2020 Junio 5 5 10
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2020 Abril 6 8 14
2020 Marzo 12 20 32
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2020 Enero 20 39 59
2019 Diciembre 28 31 59
2019 Noviembre 2 11 13
2019 Octubre 2 2 4
2019 Septiembre 5 7 12
2019 Agosto 1 2 3
2019 Julio 4 12 16
2019 Junio 47 50 97
2019 Mayo 84 74 158
2019 Abril 5 2 7
2019 Marzo 3 4 7
2019 Febrero 8 6 14
2019 Enero 2 3 5
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2018 Octubre 4 9 13
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2018 Agosto 2 1 3
2018 Julio 1 3 4
2018 Junio 0 0 0
2018 Mayo 1 3 4
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2018 Marzo 0 2 2
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2017 Diciembre 1 0 1
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2017 Octubre 2 2 4
2017 Septiembre 0 1 1
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2017 Mayo 12 2 14
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2017 Marzo 13 27 40
2017 Febrero 5 1 6
2017 Enero 4 3 7
2016 Diciembre 12 0 12
2016 Noviembre 14 0 14
2016 Octubre 12 0 12
2016 Septiembre 8 2 10
2016 Agosto 13 0 13
2016 Julio 9 2 11
2016 Junio 22 0 22
2016 Mayo 20 2 22
2016 Abril 11 0 11
2016 Marzo 10 2 12
2016 Febrero 11 1 12
2016 Enero 11 0 11
2015 Diciembre 18 0 18
2015 Noviembre 26 0 26
2015 Octubre 18 0 18
2015 Septiembre 14 0 14
2015 Agosto 10 0 10
2015 Julio 9 0 9
2015 Junio 4 0 4
2015 Mayo 7 0 7
2015 Abril 11 0 11
2015 Marzo 9 0 9
2015 Febrero 5 0 5
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2014 Noviembre 5 0 5
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2014 Mayo 8 0 8
2014 Abril 6 0 6
2014 Marzo 4 0 4
2014 Febrero 4 0 4
2014 Enero 5 0 5
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