J.F. Mould-Quevedo

Prevalence of Pain Reporting and Associated Health Outcomes Across Emerging Markets and Developed Countries

OBJECTIVE The current study represents the first broad, multi-country, population-based survey of pain, assessing the association between pain and health outcomes, plus comparing the burden of pain across emerging and developed countries. DESIGN Data from the 2011/2012 National Health and Wellness Surveys were used. Respondents reporting pain (neuropathic pain, fibromyalgia, back pain, surgery pain, and/or arthritis pain) vs no pain in emerging (Brazil, China, Russia) vs developed (European Union, Japan, United States) countries were compared on sociodemographic characteristics and measures of quality of life (SF-12v2 and SF-36v2), work productivity and activity impairment, and health care resource use. SUBJECTS Respondents included 128,821 without pain and 29,848 with pain in developed countries, and 37,244 without pain and 4,789 with pain in emerging countries. RESULTS Pain reporting and treatment rates were lower in China (6.2% and 28.3%, respectively) and Japan (4.4% and 26.3%, respectively) than in other countries (≥ 14.3% and 35.8%, respectively). Significant impairments in quality of life, productivity, and resource use were associated with pain across all health outcomes in both developed and emerging countries, with some productivity and physical health status impairments greater with pain in developed countries, whereas mental health status impairment and resource use were greater with pain in emerging countries. CONCLUSIONS Pain was associated with burden across all study outcomes in all regions. Yet, differences emerged in the degree of impairment, pain reporting, diagnosis, treatment rates, and characteristics of patients between emerging and developed nations, thus helping guide a broader understanding of this highly prevalent condition globally.

Prevalence, Awareness, Treatment, and Burden of Major Depressive Disorder: Estimates from the National Health and Wellness Survey in Brazil

OBJECTIVE Major depressive disorder (MDD) is often underdiagnosed, undertreated, and associated with negative health outcomes. The current study examined the prevalence of MDD signs and symptoms in Brazil, including awareness, diagnosis, treatment, and the association of MDD with health outcomes. METHODS Data were collected from the 2011 National Health and Wellness Survey in Brazil (N = 12,000). Excluding those with bipolar disorder, respondents who met Patient Health Questionnaire-9 criteria for MDD (n = 1105) were compared with those not qualifying as having MDD or any depressive symptoms (n = 8684), analyzing separately those currently taking (n = 184) or not taking (n = 155) prescription medication for depression. Sociodemographics and health status, symptoms, experience of depression, diagnosis, MDD severity, pharmacotherapy, productivity impairment (Work Productivity and Activity Impairment questionnaire), health status (Short-Form 12, version 2), and health care resource use were measured. Results were weighted and projected to the Brazil adult population. Differences were measured with column proportion and mean tests for categorical and continuous outcomes, respectively. RESULTS MDD prevalence was 10.2%, with only 28.1% of the individuals with MDD diagnosed and 15.6% currently using prescription medication for depression. Males were especially likely to be unaware of MDD. Compared with non-MDD controls, patients with MDD (treated or untreated) reported significantly greater overall work impairment, worse mental and physical health status, and greater health care resource utilization (all P<0.05). There was a trend for worsening health outcomes with increasing MDD severity. CONCLUSIONS These findings suggest that Brazilians may be underdiagnosed and undertreated for MDD. Individuals with MDD reported substantially poorer health outcomes, suggesting the need to increase MDD awareness, especially among males, and provide better access to treatment.

Prevalência da percepção e do tratamento da dor e de seus resultados de saúde em diferentes condições do Brasil

JUSTIFICATIVA E OBJETIVOS: A dor e uma condicao clinica prevalente que gera um fardo humanistico e economico tremendo em todo o mundo. Tendo em vista os poucos estudos sobre o impacto da dor em resultados de saude no Brasil, este estudo avaliou a prevalencia de condicoes dolorosas, a taxa de diagnostico e tratamento, e o possivel impacto nos resultados de saude entre adultos brasileiros. METODO: Os dados foram coletados de uma amostra estratificada e aleatoria de adultos (n = 12.000) da pesquisa transversal National Health and Wellness Survey de 2011 feita no Brasil. Os entrevistados deram informacoes sociodemograficas, sobre qualidade de vida relacionada a saude (SF-12v2), produtividade no trabalho e prejuizo de suas atividades (WPAI), condicoes comorbidas e uso de recursos de assistencia a saude. As comparacoes entre os individuos com e sem dor (isto e, dor neuropatica, fibromialgia, dor relacionada a procedimentos cirurgicos/medicos, ou lombalgia, versus os controles sem a respectiva condicao; ou artrite, com versus sem dor) foram realizadas pelos testes Qui-quadrado e t para variaveis categoricas e continuas, respectivamente. RESULTADOS: Lombalgia foi a condicao dolorosa mais comum (12%), seguida de fibromialgia. Entre os incluidos nessa condicao, a dor neuropatica foi a mais comumente diagnosticada e tratada, e a lombalgia foi a menos diagnosticada e tratada. Nas diferentes condicoes, em graus variaveis, dor versus sem dor foi associada a maior fardo comorbido, maior utilizacao de recursos, e maiores prejuizos ao estado de saude e a produtividade no trabalho, com poucas diferencas nos fatores sociodemograficos. CONCLUSAO: As condicoes dolorosas foram associadas a diferentes percepcoes e taxas de tratamento entre adultos brasileiros. Corroborando estudos anteriores norte-americanos e europeus, a dor foi associada a varios resultados negativos para a saude. Esses achados destacam o subtratamento e uma gama de fontes potenciais de fardo da dor no Brasil.

Cost-Effectiveness Analysis of Atorvastatin versus Rosuvastatin in Primary and Secondary Cardiovascular Prevention Populations in Brazil and Columbia

BACKGROUND Latin America has witnessed a marked increase in cardiovascular (CV) disease, the leading cause of death in many countries. The benefits of lipid-lowering therapy to reduce CV-related events are widely accepted. Clinical evidence suggests that rosuvastatin is associated with slightly greater reductions in low-density lipoprotein cholesterol levels than is atorvastatin at comparable doses. Rosuvastatin, however, is often priced at a premium. OBJECTIVE Our objective was to examine the cost-effectiveness of using atorvastatin versus rosuvastatin in reducing CV events in Brazil and Colombia using real-world prices. METHODS A global Markov cohort model of primary and secondary CV prevention was developed and adapted to Brazilian and Colombian settings. The risks and costs of major CV events and efficacy, adherence, and costs of statins were considered. Total gains in life-years, quality-adjusted life-years, major CV events avoided, and costs over the lifetime horizon were estimated. Several dose comparisons were considered. RESULTS In the Colombian analyses, differences in drug costs between therapies were considerable while outcomes were similar. The incremental cost per quality-adjusted life-year gained for rosuvastatin versus atorvastatin was more than

Análisis de coste-efectividad del tratamiento empírico antimicrobiano de pacientes con neumonía asociada a la ventilación mecánica en unidades de cuidados intensivos del Instituto Mexicano del Seguro Social

700,000 and

Análisis económico de acontecimientos adversos producidos por sunitinib, bevacizumab + interferón alfa e interferón alfa en pacientes con carcinoma de células renales metastásico en México

200,000 in primary and secondary prevention, respectively. Brazilian analyses found lower incremental cost-effectiveness ratios for rosuvastatin at some dose comparisons due to similar pricing between statins. Sensitivity analyses revealed that changes in treatment efficacy and adherence had the largest impact on results. CONCLUSIONS In primary and secondary CV prevention, the efficacy advantage of rosuvastatin was minimal, while its acquisition cost was higher, particularly in Colombia. The incremental cost-effectiveness ratios were, therefore, generally in favor of atorvastatin being the cost-effective option.

Evaluación económica para el tratamiento hormonal adyuvante en mujeres postmenopáusicas con receptores hormonales positivos en estadios tempranos del cáncer de mama

ResumenObjetivo: Identificar el antibiótico más coste-efectivo (vancomicina frente a imipenem, teicoplanina y linezolid) en el tratamiento de la neumonía asociada a la ventilación mecánica (NAVM) en pacientes internados en unidades de cuidados intensivos (UCI) en el Instituto Mexicano del Seguro Social (IMSS). Métodos: Diseño: análisis de coste efectividad. Ámbito: UCI de una unidad de tercer nivel de atención del IMSS. Intervenciones: se elaboró un modelo tipo árbol de decisiones y se llevó a cabo un análisis de sensibilidad probabilístico. Variables de interés principal: los medicamentos evaluados fueron vancomicina, linezolid, imipenem y teicoplanina. La medida de efectividad fue el porcentaje de pacientes en remisión completa. Dado que el tratamiento estándar para el tratamiento de las NAVM es la vancomicina, se la consideró el tratamiento comparador. Para el cálculo de las probabilidades se llevó a cabo una revisión sistemática. La perspectiva de la investigación fue la del proveedor de servicios. La temporalidad fue de doce semanas. Resultados: La efectividad más alta se reportó con linezolid, con un 57,4%, y le siguió vancomicina con un 37,2%. Los costes con linezolid fueron de 23.976,3€ y con vancomicina de 24.078,4€. La razón coste-efectividad tuvo una diferencia de 22,9€ entre linezolid y vancomicina (41,8€/paciente frente a 64,7€/paciente, respectivamente). El medicamento que tuvo mayor probabilidad de ser elegido como la opción más coste-efectiva por el IMSS fue linezolid. Conclusión: En el ámbito de una UCI del IMSS, el medicamento que fue más coste-efectivo fue linezolid en el tratamiento empírico de las NAVM.AbstractObjective: Identify the most cost-effective antibiotic therapy (vancomycin vs imipenem, teicoplanin and linezolid) for the treatment of mechanic ventilatorassociated pneumonia (MVAP) in hospitalized patients in an intensive care unit (ICU) within the Mexican Institute of the Social Security (IMSS). Methods: Design: Cost-effectiveness analysis. Setting: An ICU in a third level hospital at IMSS. Interventions: A decision tree model was constructed and probabilistic sensitivity analyses were performed. Main interest variables: Assessed drugs were: vancomycin, linezolid, imipenem, and teicoplanin. The effectiveness measure was the percentage of patients with complete remission. Taking into account that the gold standard for the treatment of MVAP is vancomycin, this drug was selected as the comparator. Transition probabilities were found through a systematic review. This research used the healthcare provider perspective with a twelve-week time horizon. Results: The highest effectiveness was reported for linezolid with 57.4% followed by vancomycin with 37.2%. Total costs for linezolid were €23,976.3 vs €24,078.4 with vancomycin. The average cost-effectiveness ratio showed a difference of €22.9 between linezolid and vancomycin (€41.8/patient vs €64.7/ patient, respectively). The medication which showed the highest probability to be the most cost-effective option at IMSS was linezolid. Conclusions: In an ICU setting at IMSS, the most cost-effective drug for the empiric treatment of MVAP was linezolid.

PSY28 COST-EFFECTIVENESS ANALYSIS OF CELECOXIB FOR THE MANAGEMENT OF LOW BACK PAIN AT THE SOCIAL SECURITY MEXICAN INSTITUTE

ResumenObjetivo: Al considerar tratamientos para el cáncer de células renales metastásico (CCRm), el coste de manejo de acontecimientos adversos (AA) asociados a estos tratamientos adquiere relevancia. El coste de manejo de AA con sunitinib, interferón-α (IFN-α) y bevacizumab+IFN-α en pacientes con CCRm se estimó desde la perspectiva de los proveedores de servicios de salud en México. Métodos: Se realizó una revisión de historias clínicas de pacientes con CCRm (n=214) para estimar incidencia de AA y el consumo de recursos para su manejo. Los AA fueron estratificados por severidad. El coste medio de asistencia de los AA se estimó a partir de costes unitarios del Instituto Mexicano del Seguro Social. La incidencia y costes de AA se introdujeron en un árbol de decisiones para estimar el coste de manejo de AA por esquema farmacológico (

PCV78 A PHARMACOECONOMICS ASSESSMENT OF SILDENAFIL IN THE MANAGEMENT OF PULMONARY ARTERIAL HYPERTENSION IN PEDIATRICS: THE MEXICAN CASE

US). Resultados: El promedio de presentación de AA (grados 3 y 4) en pacientes tratados con sunitinib, IFN-α y bevacizumab+IFN-α fue de 0,207, 0,234 y 0,923 por paciente, respectivamente. Los costes por paciente para AA de grados 1 y 2 asociados a sunitinib, IFN-α y bevacizumab+IFN-α fueron de US

Coste-efectividad de dalteparina en la profilaxis y manejo de la enfermedad tromboembólica venosa (ETV) asociada al paciente adulto médico y quirúrgico en México

14,97, US