F Fiorentino

Custo‐efetividade dos novos anticoagulantes orais na fibrilhação auricular em Portugal

INTRODUCTION AND OBJECTIVES Recently, three novel non-vitamin K antagonist oral anticoagulants received approval for reimbursement in Portugal for patients with non-valvular atrial fibrillation (AF). It is therefore important to evaluate the relative cost-effectiveness of these new oral anticoagulants in Portuguese AF patients. METHODS A Markov model was used to analyze disease progression over a lifetime horizon. Relative efficacy data for stroke (ischemic and hemorrhagic), bleeding (intracranial, other major bleeding and clinically relevant non-major bleeding), myocardial infarction and treatment discontinuation were obtained by pairwise indirect comparisons between apixaban, dabigatran and rivaroxaban using warfarin as a common comparator. Data on resource use were obtained from the database of diagnosis-related groups and an expert panel. Model outputs included life years gained, quality-adjusted life years (QALYs), direct healthcare costs and incremental cost-effectiveness ratios (ICERs). RESULTS Apixaban provided the most life years gained and QALYs. The ICERs of apixaban compared to warfarin and dabigatran were €5529/QALY and €9163/QALY, respectively. Apixaban was dominant over rivaroxaban (greater health gains and lower costs). The results were robust over a wide range of inputs in sensitivity analyses. Apixaban had a 70% probability of being cost-effective (at a threshold of €20 000/QALY) compared to all the other therapeutic options. CONCLUSIONS Apixaban is a cost-effective alternative to warfarin and dabigatran and is dominant over rivaroxaban in AF patients from the perspective of the Portuguese national healthcare system. These conclusions are based on indirect comparisons, but despite this limitation, the information is useful for healthcare decision-makers.

Cost-Effectiveness Of Idelalisib In Combination With Rituximab For The Treatment Of Relapsed/Refractory Chronic Lymphocytic Leukemia (Cll) In Portugal.

TREATMENT OF RELAPSED/REFRACTORY CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) IN PORTUGAL Gouveia M1, Silva MG2, Alarcao J3, Fiorentino F 3, Carda J 4, Costa R 5, Mariz JM 6, Raposo J 7, Costa J 7, Borges M 8 1Catolica Lisbon School of Business and Economics, Lisbon, Portugal, 2Instituto Portugues Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal, 3Center for Evidence Based Medicine, Faculty of Medicine, University of Lisbon, Lisbon, Portugal, 4Centro Hospitalar Universitario de Coimbra, Coimbra, Portugal, 5Hospital Garcia de Orta, Almada, Portugal, 6Instituto Portugues de Oncologia do Porto Francisco Gentil, Oporto, Portugal, 7Centro Hospitalar Lisboa Norte, Lisbon, Portugal, 8Institute of Molecular Medicine, Lisbon, Portugal

Does acute myocardial infarction kill more people on weekends? Analysis of in-hospital mortality rates for weekend admissions in Portugal

Objectives To investigate a possible weekend effect in the in-hospital mortality rate for acute myocardial infarction in Portugal, and whether the delay in invasive intervention contributes to this effect. Methods Data from the National 2011–2015 Diagnostic-Related-Group databases were analysed. The focus was on adult patients admitted via the emergency department and with the primary diagnosis of acute myocardial infarction. Patients were grouped according to ST-elevation myocardial infarction and non-ST-elevation myocardial infarction episodes. We employed multivariable logistic regressions to determine the association between weekend admission and in-hospital mortality, controlling for episode complexity (through a severity index and acute comorbidities), demographic characteristics and hospital identifications. The association between the probability of a prompt surgery (within one day) and the day of admission was investigated to explore the possible delay of care delivery for patients admitted during weekends. Results Our results indicate that in-hospital mortality rates were not significantly higher for weekend admissions than for weekday admissions in both ST-elevation myocardial infarction (STEMI) and non-STEMI episodes. This result is robust to the inclusion of a number of potential confounding mechanisms. Patients admitted on weekends had lower probabilities of undergoing invasive cardiac surgery within the day after admission, but delay in care delivery during the weekend was not associated with worse outcomes in terms of in-hospital mortality. Conclusions There is no evidence for the existence of a weekend effect due to admission for acute myocardial infarction in Portugal, in both STEMI and non-STEMI episodes.

The cost and burden of schizophrenia in Portugal in 2015

Católica Lisbon School of Business and Economics, Universidade Católica Portuguesa, Lisbon, Portugal Centro de Estudos de Medicina Baseada na Evidência, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal Centro Hospitalar de Lisboa Central, EPE, Lisbon, Portugal Laboratório de Farmacologia Clínica e Terapêutica, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal

Cost-effectiveness of the 13-valent Pneumococcal Conjugate Vaccine in Children in Portugal

Background: Pneumococcal infections are the leading cause of vaccine-preventable death in children. In June 2015, the 13-valent pneumococcal conjugate vaccine (PCV13) was introduced in the Portuguese Immunization Program. We evaluated the cost-effectiveness of children vaccinated with PCV13 versus no vaccination for preventing pneumococcal diseases. Methods: A cohort simulation model for 2014 Portuguese newborns was used, considering a lifetime horizon and existence of herd effect on adults. Model outcomes measured life years gained, direct and indirect healthcare costs and net benefits considering &OV0556;20,000 per life years gained. PCV13 clinical effectiveness rate by serotype covered was assumed similar to PCV7. Patients’ resource use was based on 2014 diagnostic-related group database and experts’ opinion, while national legislation and official drug cost database were the main sources for unitary costs. Univariate sensitivity analyses were conducted to assess results’ effectiveness. Results: In base case scenario, PCV13 was a dominant strategy, being associated with better health outcomes and lower costs. In a lifetime, a total of 6238 infections (excluding acute otitis media) and 130 deaths were averted, with a total saving of &OV0556;397,217 (

Cost-Effectiveness Of The Non-Vitamin K Antagonist Oral Anticoagulants For Atrial Fibrillation In Portugal

432,966). Net benefits were estimated above &OV0556;28 million (

Hospitalized Patients with Schizophrenia In Portugal: Clinical Characterization and Costs

30 million). Results were robust in all sensitivity analyses, with positive net benefits, except when herd effect was excluded. Conclusions: Vaccination of children with PCV13 starting in their first year of life is a cost-effective intervention with the potential to save costs to the Portuguese health system and to provide health gains by reducing the burden of pneumococcal disease in the vaccines and through the herd effect of this vaccine.

Economic Evaluation of The Portuguese Needle Exchange Programme In Community Pharmacies (NEP-CP)

Costa J1. Fiorentino F2. Caldeira D1. Inês M3. Pereira C2. Pinheiro L4. Vaz Carneiro A2. Gouveia M5. Borges M1 1Institute of Molecular Medicine. Lisbon. Portugal. 2Center for Evidence Based Medicine. Faculty of Medicine. University of Lisbon. Lisbon. Portugal. 3Laboratórios Pfizer Lda.. Lisbon. Portugal. 4Centro Hospitalar Lisboa Norte. Lisbon. Portugal. 5Católica Lisbon School of Business and Economics. Lisbon. Portugal