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[PMID]:29431341
[Au] Autor:Sakiev KZ; Ibraeva LK; Dyusembaeva NK; Rybalkina DK; Drobchenko EA
[Ti] Título:[Qualitative index of population health losses in the aral sea region].
[So] Source:Gig Sanit;95(10):950-4, 2016.
[Is] ISSN:0016-9900
[Cp] País de publicação:Russia (Federation)
[La] Idioma:eng; rus
[Ab] Resumo:The article is devoted to the approbation of the modification of the method of the presentation of indices of medical and social losses of the population on an example of environmentally unfavorable Aral Sea region in Kazakhstan. The first step in improvement of the system ofpublic health care is the identification of the most important problems related with the assessment of the disease burden and the adjustment of data of such type in accordance national aims on the decline of medical and social losses in this problem area. So far according to the criteria for the determination of the boundary of ecological catastrophe area one of the indices is the steady gain in the mortality rate. Using the index "Years of Life Lost" (YLL) in medical statistics as a relatively new approach that continues to be improved and its development supposes the improvement in the quality of health statistics. We modified this method consisting in the determination of the coefficient of loss of years. In the given work after comprehensive analysis of the loss of years due to morbidity and mortality on the base of life tables the potential of lost years for the population was determined with bearing in mind of module tables and compared with the loss in years due to the health loss. So far there was declined the dimension of the comprehensive index, there was elevated its comparability with other indices, and the data interpretation has been optimized. Suggested modification can be used for a comprehensive assessment of health state in the execution of epidemiological studies and monitoring of medical and social situation in ecologically unfavorable regions.
[Mh] Termos MeSH primário: Exposição Ambiental
Expectativa de Vida
Saúde Pública
Anos de Vida Ajustados por Qualidade de Vida
[Mh] Termos MeSH secundário: Exposição Ambiental/efeitos adversos
Exposição Ambiental/análise
Exposição Ambiental/prevenção & controle
Saúde Ambiental/métodos
Saúde Ambiental/normas
Indicadores Básicos de Saúde
Seres Humanos
Cazaquistão/epidemiologia
Saúde Pública/métodos
Saúde Pública/normas
Saúde Pública/estatística & dados numéricos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180213
[St] Status:MEDLINE


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[PMID]:28456529
[Au] Autor:Shankar MB; Staples JE; Meltzer MI; Fischer M
[Ad] Endereço:Division for Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS C-18, Atlanta, GA 30329, USA. Electronic address: kiu8@cdc.gov.
[Ti] Título:Cost effectiveness of a targeted age-based West Nile virus vaccination program.
[So] Source:Vaccine;35(23):3143-3151, 2017 05 25.
[Is] ISSN:1873-2518
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: West Nile virus (WNV) is the leading cause of domestically-acquired arboviral disease in the United States. Several WNV vaccines are in various stages of development. We estimate the cost-effectiveness of WNV vaccination programs targeting groups at increased risk for severe WNV disease. METHODS: We used a mathematical model to estimate costs and health outcomes of vaccination with WNV vaccine compared to no vaccination among seven cohorts, spaced at 10year intervals from ages 10 to 70years, each followed until 90-years-old. U.S. surveillance data were used to estimate WNV neuroinvasive disease incidence. Data for WNV seroprevalence, acute and long-term care costs of WNV disease patients, quality-adjusted life-years (QALYs), and vaccine characteristics were obtained from published reports. We assumed vaccine efficacy to either last lifelong or for 10years with booster doses given every 10years. RESULTS: There was a statistically significant difference in cost-effectiveness ratios across cohorts in both models and all outcomes assessed (Kruskal-Wallis test p<0.0001). The 60-year-cohort had a mean cost per neuroinvasive disease case prevented of $664,000 and disability averted of $1,421,000 in lifelong model and $882,000 and $1,887,000, respectively in 10-year immunity model; these costs were statistically significantly lower than costs for other cohorts (p<0.0001). Vaccinating 70-year-olds had the lowest cost per death averted in both models at around $4.7 million (95%CI $2-$8 million). Cost per disease case averted was lowest among 40- and 50-year-old cohorts and cost per QALY saved lowest among 60-year cohorts in lifelong immunity model. The models were most sensitive to disease incidence, vaccine cost, and proportion of persons developing disease among infected. CONCLUSIONS: Age-based WNV vaccination program targeting those at higher risk for severe disease is more cost-effective than universal vaccination. Annual variation in WNV disease incidence, QALY weights, and vaccine costs impact the cost effectiveness ratios.
[Mh] Termos MeSH primário: Programas de Imunização/economia
Vacinas contra o Vírus do Nilo Ocidental/economia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Fatores Etários
Idoso
Idoso de 80 Anos ou mais
Criança
Análise Custo-Benefício
Feminino
Seres Humanos
Imunização Secundária/economia
Masculino
Cadeias de Markov
Meia-Idade
Método de Monte Carlo
Anos de Vida Ajustados por Qualidade de Vida
Fatores de Risco
Estudos Soroepidemiológicos
Estados Unidos/epidemiologia
Vacinação/economia
Febre do Nilo Ocidental/epidemiologia
Febre do Nilo Ocidental/prevenção & controle
Vacinas contra o Vírus do Nilo Ocidental/administração & dosagem
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (West Nile Virus Vaccines)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170501
[St] Status:MEDLINE


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Polanczyk, Carisi Anne
Bocchi, Edimar Alcides
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[PMID]:29390308
[Au] Autor:Brandão SMG; Hueb W; Ju YT; Lima ACP; Polanczyk CA; Cruz LN; Garcia RMR; Takiuti ME; Bocchi EA
[Ad] Endereço:Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, SP, BR.
[Ti] Título:Utility and quality-adjusted life-years in coronary artery disease: Five-year follow-up of the MASS II trial.
[So] Source:Medicine (Baltimore);96(50):e9113, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: This study evaluated the utility and quality-of-life year measurements for patients with coronary artery disease who underwent any of 3 therapeutic strategies with a 5-year follow-up. METHODS: Quality-of-life data were obtained from the Medicine, Angioplasty, or Surgery Study II trial. To obtain utilities, the 36-Item Short-Form questionnaire was converted to a 6-Dimensional Health State Classification System. RESULTS: Of the 611 initial patients, 579 completed the questionnaire. In all, 188 patients received the surgical treatment-194 the percutaneous, and the remaining 197 the medical. The median utility scores for the 5 years analyzed were 0.809 (95% confidence interval [CI] 0.794-0.842) for patients assigned to percutaneous coronary intervention, 0.755 (95% CI 0.723-0.774) for medical treatment, and 0.780 (95% CI 0.761-0.809) for coronary artery bypass graft surgery. The difference between percutaneous coronary intervention and medical treatment was statistically significant (P < .05, Dunn test). The median cumulative quality-of-life years across the 5 years were 3.802 (95% CI 3.668-3.936) for percutaneous, 3.540 (95% CI 3.399-3.681) for medical, and 3.764 (95% CI 3.638-3.890) for surgery. Additionally, the median quality-of-life years between percutaneous and medical treatment was 0.262 (95% CI 0.068-0.456), between surgery and medical treatment it was 0.224 (95% CI 0.036-0.413), and between surgery and percutaneous coronary intervention it was -0.038 (95% CI -0.221 to -0.146). CONCLUSION: Coronary artery bypass surgery and percutaneous coronary intervention were similar regarding cumulative quality-of-life years; however, they were both superior to that of medical treatment. The results presented are valuable data for further cost-utility studies.
[Mh] Termos MeSH primário: Doença da Artéria Coronariana/terapia
Anos de Vida Ajustados por Qualidade de Vida
[Mh] Termos MeSH secundário: Feminino
Seguimentos
Seres Humanos
Masculino
Meia-Idade
Estudos Prospectivos
Inquéritos e Questionários
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009113


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[PMID]:29360841
[Au] Autor:Uthman RT; Sutton AJ; Jackson LJ; Uthman OA
[Ad] Endereço:Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom.
[Ti] Título:Does directly administered antiretroviral therapy represent good value for money in sub-Saharan Africa? A cost-utility and value of information analysis.
[So] Source:PLoS One;13(1):e0191465, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Successful antiretroviral therapy (ART) relies on the optimal level of ART adherence to achieve reliable viral suppression, avert HIV drug resistance, and prevent avoidable deaths. It has been shown that there are various groups of people living with HIV at high-risk of non-adherence to ART in sub-Saharan Africa. The objective of this study was to examine the cost effectiveness and value-of-information of directly administered antiretroviral therapy (DAART) versus self-administered ART among people living with HIV, at high risk of non-adherence to ART in sub-Saharan Africa. METHODS AND FINDINGS: A Markov model was developed that describes the transition between HIV stages based on the CD4 count, along with direct costs, quality of life and the mortality rate associated with DAART in comparison with self-administered ART. Data used in the model were derived from the published literature. A health system perspective was employed using a life-time time horizon. Probabilistic sensitivity analysis was performed to determine the impact of parameter uncertainty. Value of information analysis was also conducted. The expected cost of self-administered ART and DAART were $5,200 and $15,500 and the expected QALYs gained were 8.52 and 9.75 respectively, giving an incremental cost effectiveness ratio of $8,400 per QALY gained. The analysis demonstrated that the annual cost DAART needs to be priced below $200 per patient to be cost-effective. The probability that DAART was cost-effective was 1% for a willingness to pay threshold of $5,096 for sub-Saharan Africa. The value of information associated with the cost of DAART and its effectiveness was substantial. CONCLUSIONS: From the perspective of the health care payer in sub-Saharan Africa, DAART cannot be regarded as cost-effective based on current information. The value of information analysis showed that further research will be worthwhile and potentially cost-effective in resolving the uncertainty about whether or not to adopt DAART.
[Mh] Termos MeSH primário: Fármacos Anti-HIV/administração & dosagem
Fármacos Anti-HIV/economia
Terapia Diretamente Observada/economia
Infecções por HIV/tratamento farmacológico
Infecções por HIV/economia
[Mh] Termos MeSH secundário: África ao Sul do Saara
Análise Custo-Benefício
Seres Humanos
Cadeias de Markov
Adesão à Medicação
Modelos Econômicos
Anos de Vida Ajustados por Qualidade de Vida
Autoadministração/economia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Anti-HIV Agents)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180227
[Lr] Data última revisão:
180227
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180124
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191465


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[PMID]:29384848
[Au] Autor:Tierrablanca LE; Ochalek J; Ford D; Babiker A; Gibb D; Butler K; Turkova A; Griffin S; Revill P; BREATHER (PENTA 16) Trial Group
[Ad] Endereço:Tecnología e Información para la Salud, Mexico City, Mexico.
[Ti] Título:Economic evaluation of weekends-off antiretroviral therapy for young people in 11 countries.
[So] Source:Medicine (Baltimore);97(5):e9698, 2018 Feb.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: To analyze the cost effectiveness of short-cycle therapy (SCT), where patients take antiretroviral (ARV) drugs 5 consecutive days a week and have 2 days off, as an alternative to continuous ARV therapy for young people infected with human immunodeficiency virus (HIV) and taking efavirenz-based first-line ARV drugs. METHODS: We conduct a hierarchical cost-effectiveness analysis based on data on clinical outcomes and resource use from the BREATHER trial. BREATHER is a randomized trial investigating the effectiveness of SCT and continuous therapy in 199 participants aged 8 to 24 years and taking efavirenz-based first-line ARV drugs in 11 countries worldwide. Alongside nationally representative unit costs/prices, these data were used to estimate costs and quality adjusted life years (QALYs). An incremental cost-effectiveness comparison was performed using a multilevel bivariate regression approach for total costs and QALYs. Further analyses explored cost-effectiveness in low- and middle-income countries with access to low-cost generic ARV drugs and high-income countries purchasing branded ARV drugs, respectively. RESULTS: At 48 weeks, SCT offered significant total cost savings over continuous therapy of US dollar (USD) 41 per patient in countries using generic drugs and USD 4346 per patient in countries using branded ARV drugs, while accruing nonsignificant total health benefits of 0.008 and 0.009 QALYs, respectively. Cost-effectiveness estimates were similar across settings with access to generic ARV drugs but showed significant variation among high-income countries where branded ARV drugs are purchased. CONCLUSION: SCT is a cost-effective treatment alternative to continuous therapy for young people infected with HIV in countries where viral load monitoring is available.
[Mh] Termos MeSH primário: Fármacos Anti-HIV/administração & dosagem
Fármacos Anti-HIV/economia
Análise Custo-Benefício
Infecções por HIV/tratamento farmacológico
Infecções por HIV/economia
[Mh] Termos MeSH secundário: Adolescente
Benzoxazinas/administração & dosagem
Benzoxazinas/economia
Criança
Esquema de Medicação
Medicamentos Genéricos/administração & dosagem
Medicamentos Genéricos/economia
Seguimentos
Custos de Cuidados de Saúde
Seres Humanos
Internacionalidade
Anos de Vida Ajustados por Qualidade de Vida
Análise de Regressão
Resultado do Tratamento
Carga Viral
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Anti-HIV Agents); 0 (Benzoxazines); 0 (Drugs, Generic); JE6H2O27P8 (efavirenz)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180221
[Lr] Data última revisão:
180221
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009698


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[PMID]:29324759
[Au] Autor:Lackner J; Weiss M; Müller-Graf C; Greiner M
[Ad] Endereço:Department of Exposure, Federal Institute for Risk Assessment, Berlin, Germany.
[Ti] Título:Disease burden of methylmercury in the German birth cohort 2014.
[So] Source:PLoS One;13(1):e0190409, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:This study aimed to estimate the disease burden of methylmercury for children born in Germany in the year 2014. Humans are mainly exposed to methylmercury when they eat fish or seafood. Prenatal methylmercury exposure is associated with IQ loss. To quantify this disease burden, we used Monte Carlo simulation to estimate the incidence of mild and severe mental retardation in children born to mothers who consume fish based on empirical data. Subsequently, we calculated the disease burden with the disability-adjusted life years (DALY)-method. DALYs combine mortality and morbidity in one measure and quantify the gap between an ideal situation, where the entire population experiences the standard life expectancy without disease and disability, and the actual situation. Thus, one DALY corresponds to the loss of one year of life in good health. The methylmercury-induced burden of disease for the German birth cohort 2014 was an average of 14,186 DALY (95% CI 12,915-15,440 DALY). A large majority of the DALYs was attributed to morbidity as compared to mortality. Of the total disease burden, 98% were attributed to mild mental retardation, which only leads to morbidity. The remaining disease burden was a result of severe mental retardation with equal proportions of premature death and morbidity.
[Mh] Termos MeSH primário: Compostos de Metilmercúrio/toxicidade
[Mh] Termos MeSH secundário: Carga Corporal (Radioterapia)
Pré-Escolar
Estudos de Coortes
Pessoas com Deficiência
Exposição Ambiental
Feminino
Alemanha
História do Século XXI
Seres Humanos
Deficiência Intelectual/induzido quimicamente
Masculino
Compostos de Metilmercúrio/farmacocinética
Método de Monte Carlo
Anos de Vida Ajustados por Qualidade de Vida
Alimentos Marinhos/análise
[Pt] Tipo de publicação:HISTORICAL ARTICLE; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Methylmercury Compounds)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180215
[Lr] Data última revisão:
180215
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180112
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0190409


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Texto completo SciELO Colômbia
Texto completo SciELO Saúde Pública
[PMID]:28453035
[Au] Autor:Martínez-Betancur O; Quintero-Cusguen P; Mayor-Agredo L
[Ad] Endereço:Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia, omartinez@unal.edu.co.
[Ti] Título:[Estimating disability-adjusted life-years for subtypes of acute ischemic stroke].
[Ti] Título:Estimación de años de vida ajustados por discapacidad según subtipo de ataque cerebrovascular isquémico agudo..
[So] Source:Rev Salud Publica (Bogota);18(2):226-237, 2016 Apr.
[Is] ISSN:0124-0064
[Cp] País de publicação:Colombia
[La] Idioma:spa
[Ab] Resumo:Objective To test the hypothesis that DALYs, estimated individually for each patient with acute ischemic stroke upon hospital discharge, without reperfusion therapy, are not different between the different subtypes of ischemic stroke. Patients and Methods In the Hospital Universitario de la Samaritana in Bogotá, the health records of patients diagnosed with their first acute ischemic stroke event from admission and monitoring to discharge were selected. The subtype of acute ischemic stroke was classified according to the criteria established by the Trial of Org 10172 in Acute Stroke Treatment (TOAST). DALYs were estimated for each patient with acute ischemic stroke at hospital discharge. To establish differences of DALYs among the five acute ischemic stroke subtypes (TOAST), the Kruskal Wallis test was used. Results Of the 39 cases of acute ischemic stroke, 17 (43.6 %) were classified as artherosclerosis, 10 (25.6 %) as lacunar events, 6 (15.4 %) as cardioembolic attacks, and another 6 (15.4 %) cases with unclear etiology. At hospital discharge, the estimated total DALYs provided by patients with acute ischemic stroke was 316.9 years, without statistically significant differences between the subtypes of ischemic stroke. At hospital discharge, the average of optimal years free of disability lost by a patient surviving an acute ischemic stroke was 8.12. Conclusion Non conclusive results are attributed to the concurrence of dissimilar acute clinical care processes and to the risk factors distributions, comorbidities and patient complications.
[Mh] Termos MeSH primário: Isquemia Encefálica/classificação
Isquemia Encefálica/etiologia
Anos de Vida Ajustados por Qualidade de Vida
Acidente Vascular Cerebral/classificação
Acidente Vascular Cerebral/etiologia
[Mh] Termos MeSH secundário: Doença Aguda
Idoso
Idoso de 80 Anos ou mais
Estudos de Coortes
Feminino
Hospitais Universitários
Seres Humanos
Masculino
Meia-Idade
Alta do Paciente
Fatores de Risco
Estatísticas não Paramétricas
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180215
[Lr] Data última revisão:
180215
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE


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[PMID]:29253489
[Au] Autor:Papadimitriou N; Tsilidis KK; Orfanos P; Benetou V; Ntzani EE; Soerjomataram I; Künn-Nelen A; Pettersson-Kymmer U; Eriksson S; Brenner H; Schöttker B; Saum KU; Holleczek B; Grodstein FD; Feskanich D; Orsini N; Wolk A; Bellavia A; Wilsgaard T; Jørgensen L; Boffetta P; Trichopoulos D; Trichopoulou A
[Ad] Endereço:Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece.
[Ti] Título:Burden of hip fracture using disability-adjusted life-years: a pooled analysis of prospective cohorts in the CHANCES consortium.
[So] Source:Lancet Public Health;2(5):e239-e246, 2017 May.
[Is] ISSN:2468-2667
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: No studies have estimated disability-adjusted life-years (DALYs) lost due to hip fractures using real-life follow-up cohort data. We aimed to quantify the burden of disease due to incident hip fracture using DALYs in prospective cohorts in the CHANCES consortium, and to calculate population attributable fractions based on DALYs for specific risk factors. METHODS: We used data from six cohorts of participants aged 50 years or older at recruitment to calculate DALYs. We applied disability weights proposed by the National Osteoporosis Foundation and did a series of sensitivity analyses to examine the robustness of DALY estimates. We calculated population attributable fractions for smoking, body-mass index (BMI), physical activity, alcohol intake, type 2 diabetes and parity, use of hormone replacement therapy, and oral contraceptives in women. We calculated summary risk estimates across cohorts with pooled analysis and random-effects meta-analysis methods. FINDINGS: 223 880 men and women were followed up for a mean of 13 years (SD 6). 7724 (3·5%) participants developed an incident hip fracture, of whom 413 (5·3%) died as a result. 5964 DALYs (27 per 1000 individuals) were lost due to hip fractures, 1230 (20·6%) of which were in the group aged 75-79 years. 4150 (69·6%) DALYs were attributed to disability. Current smoking was the risk factor responsible for the greatest hip fracture burden (7·5%, 95% CI 5·2-9·7) followed by physical inactivity (5·5%, 2·1-8·5), history of diabetes (2·8%, 2·1-4·0), and low to average BMI (2·0%, 1·4-2·7), whereas low alcohol consumption (0·01-2·5 g per day) and high BMI had a protective effect. INTERPRETATION: Hip fracture can lead to a substantial loss of healthy life-years in elderly people. National public health policies should be strengthened to reduce hip fracture incidence and mortality. Primary prevention measures should be strengthened to prevent falls, and reduce smoking and a sedentary lifestyle. FUNDING: European Community's Seventh Framework Programme.
[Mh] Termos MeSH primário: Efeitos Psicossociais da Doença
Pessoas com Deficiência/estatística & dados numéricos
Fraturas do Quadril/epidemiologia
Anos de Vida Ajustados por Qualidade de Vida
[Mh] Termos MeSH secundário: Idoso
Europa (Continente)/epidemiologia
Feminino
Seres Humanos
Masculino
Meia-Idade
Estudos Prospectivos
Fatores de Risco
Estados Unidos/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180214
[Lr] Data última revisão:
180214
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171219
[St] Status:MEDLINE


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[PMID]:29183961
[Au] Autor:López-López JA; Sterne JAC; Thom HHZ; Higgins JPT; Hingorani AD; Okoli GN; Davies PA; Bodalia PN; Bryden PA; Welton NJ; Hollingworth W; Caldwell DM; Savovic J; Dias S; Salisbury C; Eaton D; Stephens-Boal A; Sofat R
[Ad] Endereço:Department of Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK.
[Ti] Título:Oral anticoagulants for prevention of stroke in atrial fibrillation: systematic review, network meta-analysis, and cost effectiveness analysis.
[So] Source:BMJ;359:j5058, 2017 Nov 28.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo: To compare the efficacy, safety, and cost effectiveness of direct acting oral anticoagulants (DOACs) for patients with atrial fibrillation. Systematic review, network meta-analysis, and cost effectiveness analysis.  Medline, PreMedline, Embase, and The Cochrane Library. Published randomised trials evaluating the use of a DOAC, vitamin K antagonist, or antiplatelet drug for prevention of stroke in patients with atrial fibrillation. 23 randomised trials involving 94 656 patients were analysed: 13 compared a DOAC with warfarin dosed to achieve a target INR of 2.0-3.0. Apixaban 5 mg twice daily (odds ratio 0.79, 95% confidence interval 0.66 to 0.94), dabigatran 150 mg twice daily (0.65, 0.52 to 0.81), edoxaban 60 mg once daily (0.86, 0.74 to 1.01), and rivaroxaban 20 mg once daily (0.88, 0.74 to 1.03) reduced the risk of stroke or systemic embolism compared with warfarin. The risk of stroke or systemic embolism was higher with edoxaban 60 mg once daily (1.33, 1.02 to 1.75) and rivaroxaban 20 mg once daily (1.35, 1.03 to 1.78) than with dabigatran 150 mg twice daily. The risk of all-cause mortality was lower with all DOACs than with warfarin. Apixaban 5 mg twice daily (0.71, 0.61 to 0.81), dabigatran 110 mg twice daily (0.80, 0.69 to 0.93), edoxaban 30 mg once daily (0.46, 0.40 to 0.54), and edoxaban 60 mg once daily (0.78, 0.69 to 0.90) reduced the risk of major bleeding compared with warfarin. The risk of major bleeding was higher with dabigatran 150 mg twice daily than apixaban 5 mg twice daily (1.33, 1.09 to 1.62), rivaroxaban 20 mg twice daily than apixaban 5 mg twice daily (1.45, 1.19 to 1.78), and rivaroxaban 20 mg twice daily than edoxaban 60 mg once daily (1.31, 1.07 to 1.59). The risk of intracranial bleeding was substantially lower for most DOACs compared with warfarin, whereas the risk of gastrointestinal bleeding was higher with some DOACs than warfarin. Apixaban 5 mg twice daily was ranked the highest for most outcomes, and was cost effective compared with warfarin. The network meta-analysis informs the choice of DOACs for prevention of stroke in patients with atrial fibrillation. Several DOACs are of net benefit compared with warfarin. A trial directly comparing DOACs would overcome the need for indirect comparisons to be made through network meta-analysis. PROSPERO CRD 42013005324.
[Mh] Termos MeSH primário: Anticoagulantes/uso terapêutico
Fibrilação Atrial/complicações
Fibrilação Atrial/tratamento farmacológico
Acidente Vascular Cerebral/prevenção & controle
[Mh] Termos MeSH secundário: Administração Oral
Anticoagulantes/administração & dosagem
Anticoagulantes/efeitos adversos
Anticoagulantes/economia
Fibrilação Atrial/economia
Análise Custo-Benefício
Custos de Medicamentos/estatística & dados numéricos
Hemorragia/induzido quimicamente
Seres Humanos
Anos de Vida Ajustados por Qualidade de Vida
Ensaios Clínicos Controlados Aleatórios como Assunto
Acidente Vascular Cerebral/economia
Acidente Vascular Cerebral/etiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Anticoagulants)
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180210
[Lr] Data última revisão:
180210
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171130
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.j5058


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[PMID]:29298315
[Au] Autor:Kromer C; Celis D; Sonntag D; Peitsch WK
[Ad] Endereço:Department of Dermatology, University Medical Center Göttingen, Göttingen University, Göttingen, Germany.
[Ti] Título:Biologicals and small molecules in psoriasis: A systematic review of economic evaluations.
[So] Source:PLoS One;13(1):e0189765, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Biological therapy for moderate-to-severe psoriasis is highly effective but cost-intensive. This systematic review aimed at analyzing evidence on the cost-effectiveness of biological treatment of moderate-to-severe psoriasis. A literature search was conducted until 30/06/2017 in PubMed, Cochrane Library, LILACS, and EconLit. The quality of identified studies was assessed with the checklist by the Centre for Reviews and Dissemination guidance. Out of 482 records, 53 publications were eligible for inclusion. Half of the studies met between 20 and 25 of the quality checklist items, displaying moderate quality. Due to heterogeneity of studies, a qualitative synthesis was conducted. Cost ranges per outcome were enormous across different studies due to diversity in assumptions and model design. Pairwise comparisons of biologicals revealed conflicting results. Overall, adalimumab appeared to be most cost-effective (100% of all aggregated pairwise comparisons), followed by ustekinumab (66.7%), and infliximab (60%). However, in study conclusions most recent publications favored secukinumab and apremilast (75% and 60% of the studies investigating these medications). Accepted willingness-to-pay thresholds varied between 30,000 and 50,000 USD/Quality-Adjusted Life Year (QALY). Three-quarters of studies were financially supported, and in 90% of those, results were consistent with the funder's interest. Economic evaluation of biologicals is crucial for responsible allocation of health care resources. In addition to summarizing the actual evidence this review highlights gaps and needs for future research.
[Mh] Termos MeSH primário: Anticorpos Monoclonais Humanizados/uso terapêutico
Psoríase/tratamento farmacológico
[Mh] Termos MeSH secundário: Anticorpos Monoclonais Humanizados/economia
Análise Custo-Benefício
Seres Humanos
Anos de Vida Ajustados por Qualidade de Vida
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Antibodies, Monoclonal, Humanized)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180206
[Lr] Data última revisão:
180206
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180104
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0189765



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