Custo efetividade do uso do Peguinterferon alfa 2a combinado com Ribavirina no tratamento de respondedores virológicos lentos coinfectados com VHC/HIV
Autor(a) principal: | |
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Data de Publicação: | 2012 |
Tipo de documento: | Dissertação |
Idioma: | por |
Título da fonte: | Biblioteca Digital de Teses e Dissertações da UERJ |
Texto Completo: | http://www.bdtd.uerj.br/handle/1/4143 |
Resumo: | Worldwide, hepatitis caused by viral infections has been a major concern for public health because of its chronicity, asymptomatic course and its ability to determine the loss of liver function. With the widespread use of antiretroviral drugs, liver disease related to infection with hepatitis C virus (HCV) contributed to a radical change in the natural history of infection with human immunodeficiency virus (HIV). No one knows for sure the weight of coinfection HCV/HIV in Brazil, but evidence suggests that, regardless of geographic region, these individuals have greater difficulty in eliminating HCV compared to monoinfected. In the Brazilian Unified Health System (SUS), the standard antiviral treatment for patients infected with genotype 1 HCV and HIV is the association of pegylated interferon with ribavirin. Regarding the treatment period and which individuals should treat the two most recent protocols have disagreements. The most current protocol calls for treatment of early responders individuals added to slow responders. Since the guideline immediately preceding the 12th week excludes individuals who do not respond completely. Based on this difference, this study aimed to evaluate the costeffectiveness of HCV treatment in individuals with the genotype 1 coinfected with HIV, antiviral-naïve, non-cirrhotic and immunologically stable, undergoing antiviral treatment rules established by two most recent therapeutic guidelines directed to attend by SUS. To this evaluation, was developed a mathematical model of decision, based on Markov chains, simulating the progression of liver disease under treatment and no treatment. It was accompanied by a hypothetical cohort of thousand men individuals, more than 40 years. Was adopted the perspective of the Brazilian Unified Health System, time horizon of 30 years and a discount rate of 5% for the costs and for clinical consequences. The extension of treatment to slow responders provided an increase of 0.28 years of quality-adjusted life (QALY), 7% survival rate and an increase of 60% in the number of individuals who eliminated HCV. Besides the expected benefits in efficacy, the slow viral responders inclusion proved to be a costeffective strategy to achieve an incremental cost-effectiveness of BRL 44,171.00/QALY, value below of acceptability threshold proposed by the World Health Organization (BRL 63,756.00/QALY). Sensitivity analysis demonstrated that the potentials uncertainties in the model are unable to alter the final result, thus demonstrating the robustness of the analysis. The Inclusion of HCV/HIV co-infected individuals slow virologic responders to treatment protocol, is presented from the point of pharmacoeconomic view, as a strategy to cost-effectiveness favorable for the Brazilian Health System. Its adoption is perfectly compatible with the system perspective, returning better health outcomes with costs below an acceptable budget cap, and the society, to avoid a greater extent, complications and hospitalizations when compared to non-inclusion. |
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Vianna, Cid Manso de Mellohttp://lattes.cnpq.br/6812480293653692Peregrino, Antônio Augusto de Freitashttp://lattes.cnpq.br/5575333376636622Mosegui, Gabriela Bittencourt Gonzalezhttp://lattes.cnpq.br/2905858399806945Silva, Frances Valéria Costa ehttp://lattes.cnpq.br/7218336268944357Silva, Tania Cristina França dahttp://lattes.cnpq.br/4405544933008225http://lattes.cnpq.br/4238357413735081 RODRIGUES, M. P. S.Rodrigues, Marcus Paulo da Silva2020-07-05T16:04:32Z2013-04-102012-12-20RODRIGUES, Marcus Paulo da Silva. Custo efetividade do uso do Peguinterferon alfa 2a combinado com Ribavirina no tratamento de respondedores virológicos lentos coinfectados com VHC/HIV. 2012. 108 f. Dissertação (Mestrado em Saúde Coletiva) - Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 2012.http://www.bdtd.uerj.br/handle/1/4143Worldwide, hepatitis caused by viral infections has been a major concern for public health because of its chronicity, asymptomatic course and its ability to determine the loss of liver function. With the widespread use of antiretroviral drugs, liver disease related to infection with hepatitis C virus (HCV) contributed to a radical change in the natural history of infection with human immunodeficiency virus (HIV). No one knows for sure the weight of coinfection HCV/HIV in Brazil, but evidence suggests that, regardless of geographic region, these individuals have greater difficulty in eliminating HCV compared to monoinfected. In the Brazilian Unified Health System (SUS), the standard antiviral treatment for patients infected with genotype 1 HCV and HIV is the association of pegylated interferon with ribavirin. Regarding the treatment period and which individuals should treat the two most recent protocols have disagreements. The most current protocol calls for treatment of early responders individuals added to slow responders. Since the guideline immediately preceding the 12th week excludes individuals who do not respond completely. Based on this difference, this study aimed to evaluate the costeffectiveness of HCV treatment in individuals with the genotype 1 coinfected with HIV, antiviral-naïve, non-cirrhotic and immunologically stable, undergoing antiviral treatment rules established by two most recent therapeutic guidelines directed to attend by SUS. To this evaluation, was developed a mathematical model of decision, based on Markov chains, simulating the progression of liver disease under treatment and no treatment. It was accompanied by a hypothetical cohort of thousand men individuals, more than 40 years. Was adopted the perspective of the Brazilian Unified Health System, time horizon of 30 years and a discount rate of 5% for the costs and for clinical consequences. The extension of treatment to slow responders provided an increase of 0.28 years of quality-adjusted life (QALY), 7% survival rate and an increase of 60% in the number of individuals who eliminated HCV. Besides the expected benefits in efficacy, the slow viral responders inclusion proved to be a costeffective strategy to achieve an incremental cost-effectiveness of BRL 44,171.00/QALY, value below of acceptability threshold proposed by the World Health Organization (BRL 63,756.00/QALY). Sensitivity analysis demonstrated that the potentials uncertainties in the model are unable to alter the final result, thus demonstrating the robustness of the analysis. The Inclusion of HCV/HIV co-infected individuals slow virologic responders to treatment protocol, is presented from the point of pharmacoeconomic view, as a strategy to cost-effectiveness favorable for the Brazilian Health System. Its adoption is perfectly compatible with the system perspective, returning better health outcomes with costs below an acceptable budget cap, and the society, to avoid a greater extent, complications and hospitalizations when compared to non-inclusion.No mundo, as hepatites decorrentes de infecções virais têm sido uma das grandes preocupações em saúde pública devido a seu caráter crônico, curso assintomático e pela sua capacidade de determinar a perda da função hepática. Com o uso em larga escala de medicamentos antirretrovirais, a doença hepática relacionada à infecção pelo vírus da hepatite C (VHC) contribuiu para uma mudança radical na história natural da infecção pelo vírus da imunodeficiência humana (HIV). Não se sabe ao certo o peso da coinfecção VHC/HIV no Brasil, mas evidências apontam que independentemente da região geográfica, esses indivíduos apresentam maiores dificuldades em eliminar o VHC após o tratamento farmacológico, quando comparados a monoinfectados. No âmbito do SUS, o tratamento antiviral padrão para portadores do genótipo 1 do VHC e do HIV é a administração de peguinterferon associado à Ribavirina. Quanto ao período de tratamento e aos indivíduos que devem ser incluídos, os dois protocolos terapêuticos mais recentes possuem divergências. A diretriz mais atual preconiza o tratamento de indivíduos respondedores precoces somados a respondedores virológicos lentos, enquanto a diretriz imediatamente anterior exclui na 12ª semana indivíduos que não respondem completamente. Com base nessa divergência, esse estudo objetivou avaliar o custo-efetividade do tratamento contra o VHC em indivíduos portadores do genótipo 1, coinfectados com o HIV, virgens de tratamento antiviral, não cirróticos e imunologicamente estabilizados, submetidos às regras de tratamento antiviral estabelecidos pelas duas mais recentes diretrizes terapêuticas direcionadas ao atendimento pelo SUS. Para tal, foi elaborado um modelo matemático de decisão, baseado em cadeias de Markov, que simulou a progressão da doença hepática mediante o tratamento e não tratamento. Foi acompanhada uma coorte hipotética de mil indivíduos homens, maiores de 40 anos. Adotou-se a perspectiva do Sistema Único de Saúde, horizonte temporal de 30 anos e taxa de desconto de 5% para os custos e consequências clínicas. A extensão do tratamento para respondedores lentos proporcionou incremento de 0,28 anos de vida ajustados por qualidade (QALY), de 7% de sobrevida e aumento de 60% no número de indivíduos que eliminaram o VHC. Além dos esperados benefícios em eficácia, a inclusão de respondedores virológicos lentos mostrou-se uma estratégia custo-efetiva ao alcançar um incremental de custo efetividade de R$ 44.171/QALY, valor abaixo do limiar de aceitabilidade proposto pela Organização Mundial da Saúde OMS - (R$ 63.756,00/QALY). A análise de sensibilidade demonstrou que as possíveis incertezas contidas no modelo são incapazes de alterar o resultado final, evidenciando, assim, a robustez da análise. A inclusão de indivíduos coinfectados VHC/HIV respondedores virológicos lentos no protocolo de tratamento apresenta-se, do ponto de vista fármaco-econômico, como uma estratégia com relação de custoefetividade favorável para o Sistema Único de Saúde. Sua adoção é perfeitamente compatível com a perspectiva do sistema, ao retornar melhores resultados em saúdeassociados a custos abaixo de um teto orçamentário aceitável, e com o da sociedade, ao evitar em maior grau, complicações e internações quando comparado à não inclusão.Submitted by Boris Flegr (boris@uerj.br) on 2020-07-05T16:04:32Z No. of bitstreams: 2 Dissertacao parcial-Marcus Paulo da Silva Rodrigues.pdf: 538144 bytes, checksum: 1099097e7a0461e15e06fc9af530bb26 (MD5) Dissertacao-Marcus Paulo da Silva Rodrigues.pdf: 1400039 bytes, checksum: 48968988bc8e707c14b4df41c94a270d (MD5)Made available in DSpace on 2020-07-05T16:04:32Z (GMT). No. of bitstreams: 2 Dissertacao parcial-Marcus Paulo da Silva Rodrigues.pdf: 538144 bytes, checksum: 1099097e7a0461e15e06fc9af530bb26 (MD5) Dissertacao-Marcus Paulo da Silva Rodrigues.pdf: 1400039 bytes, checksum: 48968988bc8e707c14b4df41c94a270d (MD5) Previous issue date: 2012-12-20application/pdfporUniversidade do Estado do Rio de JaneiroPrograma de Pós-Graduação em Saúde ColetivaUERJBRCentro Biomédico::Instituto de Medicina SocialHepatitis CCoinfectionHIVCost-effectiveness analysisHepatite CCoinfecçãoHIVAvaliação de Custo-EfetividadeCNPQ::CIENCIAS DA SAUDE::SAUDE COLETIVACusto efetividade do uso do Peguinterferon alfa 2a combinado com Ribavirina no tratamento de respondedores virológicos lentos coinfectados com VHC/HIVCost-efectiveness of treatment with Peginterferon alfa 2A plus Rigavirin for slow virolocal responders coinfected with VHC/HIVinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/openAccessreponame:Biblioteca Digital de Teses e Dissertações da UERJinstname:Universidade do Estado do Rio de Janeiro (UERJ)instacron:UERJORIGINALDissertacao - Marcus Paulo da Silva Rodrigues - 2012 - Completa.pdfapplication/pdf1400039http://www.bdtd.uerj.br/bitstream/1/4143/2/Dissertacao+-+Marcus+Paulo+da+Silva+Rodrigues+-+2012+-+Completa.pdf48968988bc8e707c14b4df41c94a270dMD521/41432024-02-26 20:29:19.629oai:www.bdtd.uerj.br:1/4143Biblioteca Digital de Teses e Dissertaçõeshttp://www.bdtd.uerj.br/PUBhttps://www.bdtd.uerj.br:8443/oai/requestbdtd.suporte@uerj.bropendoar:29032024-02-26T23:29:19Biblioteca Digital de Teses e Dissertações da UERJ - Universidade do Estado do Rio de Janeiro (UERJ)false |
dc.title.por.fl_str_mv |
Custo efetividade do uso do Peguinterferon alfa 2a combinado com Ribavirina no tratamento de respondedores virológicos lentos coinfectados com VHC/HIV |
dc.title.alternative.eng.fl_str_mv |
Cost-efectiveness of treatment with Peginterferon alfa 2A plus Rigavirin for slow virolocal responders coinfected with VHC/HIV |
title |
Custo efetividade do uso do Peguinterferon alfa 2a combinado com Ribavirina no tratamento de respondedores virológicos lentos coinfectados com VHC/HIV |
spellingShingle |
Custo efetividade do uso do Peguinterferon alfa 2a combinado com Ribavirina no tratamento de respondedores virológicos lentos coinfectados com VHC/HIV Rodrigues, Marcus Paulo da Silva Hepatitis C Coinfection HIV Cost-effectiveness analysis Hepatite C Coinfecção HIV Avaliação de Custo-Efetividade CNPQ::CIENCIAS DA SAUDE::SAUDE COLETIVA |
title_short |
Custo efetividade do uso do Peguinterferon alfa 2a combinado com Ribavirina no tratamento de respondedores virológicos lentos coinfectados com VHC/HIV |
title_full |
Custo efetividade do uso do Peguinterferon alfa 2a combinado com Ribavirina no tratamento de respondedores virológicos lentos coinfectados com VHC/HIV |
title_fullStr |
Custo efetividade do uso do Peguinterferon alfa 2a combinado com Ribavirina no tratamento de respondedores virológicos lentos coinfectados com VHC/HIV |
title_full_unstemmed |
Custo efetividade do uso do Peguinterferon alfa 2a combinado com Ribavirina no tratamento de respondedores virológicos lentos coinfectados com VHC/HIV |
title_sort |
Custo efetividade do uso do Peguinterferon alfa 2a combinado com Ribavirina no tratamento de respondedores virológicos lentos coinfectados com VHC/HIV |
author |
Rodrigues, Marcus Paulo da Silva |
author_facet |
Rodrigues, Marcus Paulo da Silva |
author_role |
author |
dc.contributor.advisor1.fl_str_mv |
Vianna, Cid Manso de Mello |
dc.contributor.advisor1Lattes.fl_str_mv |
http://lattes.cnpq.br/6812480293653692 |
dc.contributor.referee1.fl_str_mv |
Peregrino, Antônio Augusto de Freitas |
dc.contributor.referee1Lattes.fl_str_mv |
http://lattes.cnpq.br/5575333376636622 |
dc.contributor.referee2.fl_str_mv |
Mosegui, Gabriela Bittencourt Gonzalez |
dc.contributor.referee2Lattes.fl_str_mv |
http://lattes.cnpq.br/2905858399806945 |
dc.contributor.referee3.fl_str_mv |
Silva, Frances Valéria Costa e |
dc.contributor.referee3Lattes.fl_str_mv |
http://lattes.cnpq.br/7218336268944357 |
dc.contributor.referee4.fl_str_mv |
Silva, Tania Cristina França da |
dc.contributor.referee4Lattes.fl_str_mv |
http://lattes.cnpq.br/4405544933008225 |
dc.contributor.authorLattes.fl_str_mv |
http://lattes.cnpq.br/4238357413735081 RODRIGUES, M. P. S. |
dc.contributor.author.fl_str_mv |
Rodrigues, Marcus Paulo da Silva |
contributor_str_mv |
Vianna, Cid Manso de Mello Peregrino, Antônio Augusto de Freitas Mosegui, Gabriela Bittencourt Gonzalez Silva, Frances Valéria Costa e Silva, Tania Cristina França da |
dc.subject.eng.fl_str_mv |
Hepatitis C Coinfection HIV Cost-effectiveness analysis |
topic |
Hepatitis C Coinfection HIV Cost-effectiveness analysis Hepatite C Coinfecção HIV Avaliação de Custo-Efetividade CNPQ::CIENCIAS DA SAUDE::SAUDE COLETIVA |
dc.subject.por.fl_str_mv |
Hepatite C Coinfecção HIV Avaliação de Custo-Efetividade |
dc.subject.cnpq.fl_str_mv |
CNPQ::CIENCIAS DA SAUDE::SAUDE COLETIVA |
description |
Worldwide, hepatitis caused by viral infections has been a major concern for public health because of its chronicity, asymptomatic course and its ability to determine the loss of liver function. With the widespread use of antiretroviral drugs, liver disease related to infection with hepatitis C virus (HCV) contributed to a radical change in the natural history of infection with human immunodeficiency virus (HIV). No one knows for sure the weight of coinfection HCV/HIV in Brazil, but evidence suggests that, regardless of geographic region, these individuals have greater difficulty in eliminating HCV compared to monoinfected. In the Brazilian Unified Health System (SUS), the standard antiviral treatment for patients infected with genotype 1 HCV and HIV is the association of pegylated interferon with ribavirin. Regarding the treatment period and which individuals should treat the two most recent protocols have disagreements. The most current protocol calls for treatment of early responders individuals added to slow responders. Since the guideline immediately preceding the 12th week excludes individuals who do not respond completely. Based on this difference, this study aimed to evaluate the costeffectiveness of HCV treatment in individuals with the genotype 1 coinfected with HIV, antiviral-naïve, non-cirrhotic and immunologically stable, undergoing antiviral treatment rules established by two most recent therapeutic guidelines directed to attend by SUS. To this evaluation, was developed a mathematical model of decision, based on Markov chains, simulating the progression of liver disease under treatment and no treatment. It was accompanied by a hypothetical cohort of thousand men individuals, more than 40 years. Was adopted the perspective of the Brazilian Unified Health System, time horizon of 30 years and a discount rate of 5% for the costs and for clinical consequences. The extension of treatment to slow responders provided an increase of 0.28 years of quality-adjusted life (QALY), 7% survival rate and an increase of 60% in the number of individuals who eliminated HCV. Besides the expected benefits in efficacy, the slow viral responders inclusion proved to be a costeffective strategy to achieve an incremental cost-effectiveness of BRL 44,171.00/QALY, value below of acceptability threshold proposed by the World Health Organization (BRL 63,756.00/QALY). Sensitivity analysis demonstrated that the potentials uncertainties in the model are unable to alter the final result, thus demonstrating the robustness of the analysis. The Inclusion of HCV/HIV co-infected individuals slow virologic responders to treatment protocol, is presented from the point of pharmacoeconomic view, as a strategy to cost-effectiveness favorable for the Brazilian Health System. Its adoption is perfectly compatible with the system perspective, returning better health outcomes with costs below an acceptable budget cap, and the society, to avoid a greater extent, complications and hospitalizations when compared to non-inclusion. |
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2012 |
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2012-12-20 |
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2013-04-10 |
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2020-07-05T16:04:32Z |
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RODRIGUES, Marcus Paulo da Silva. Custo efetividade do uso do Peguinterferon alfa 2a combinado com Ribavirina no tratamento de respondedores virológicos lentos coinfectados com VHC/HIV. 2012. 108 f. Dissertação (Mestrado em Saúde Coletiva) - Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 2012. |
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http://www.bdtd.uerj.br/handle/1/4143 |
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RODRIGUES, Marcus Paulo da Silva. Custo efetividade do uso do Peguinterferon alfa 2a combinado com Ribavirina no tratamento de respondedores virológicos lentos coinfectados com VHC/HIV. 2012. 108 f. Dissertação (Mestrado em Saúde Coletiva) - Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 2012. |
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