Avaliação farmacoeconômica dos tratamentos para leishmaniose visceral no Estado de Sergipe
Autor(a) principal: | |
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Data de Publicação: | 2015 |
Tipo de documento: | Dissertação |
Idioma: | por |
Título da fonte: | Repositório Institucional da UFS |
Texto Completo: | https://ri.ufs.br/handle/riufs/3911 |
Resumo: | Search for new therapeutic alternatives for leishmaniasis is considered essential by the World Health Organization, due to the high toxicity of the drugs currently used, its high cost and the risk of resistance. In Brazil, it is used three drugs to treat leishmaniasis: meglumine antimoniate and two formulations of amphotericin B (deoxycholate and liposomal). This study is a piggy-back evaluation linked to a multicentric clinical trial with the objective to perform a decision analysis between the treatment regimens for visceral leishmaniasis, for both adults and children. For this end, it was performed analysis of the data obtained in the state of Sergipe from 62 patients randomized to treatment with meglumine antimoniate (group A), considered the first line treatment in Brazil, amphotericin B deoxycholate (group B), liposomal amphotericin B (group C) and the combined regimen of meglumine antimoniate with liposomal amphotericin B (group D), in order to conduct a decision analysis from among these therapeutic regimens for both adults and children. To this end, two scenarios were considered: scenario 1 is the currently prevailing in Brazil, where patients are always treated as possible on an outpatient basis with meglumine antimoniate, although with a smaller monitoring on its potentially lethal side effects and a possible lower adherence to treatment. In the scenario 2, patients are hospitalized during the treatment period, with a better monitoring of clinical and laboratory parameters of the patient, although with a higher risk of nosocomial infections and increasing treatment costs. In terms of security, there is an emphasis on amphotericin B deoxycholate as the one that presents a greater amount of serious and potentially lethal adverse reactions, with an average of 2 severe reactions per patient. From the viewpoint of cost-efficacy, for scenario 1 the meglumine antimoniate remains the treatment of choice for both adults and children. However, in scenario 2, the combination of drugs (group D) presented itself as the most costeffective for both adults and children. From this study it became clear, from a safety point of view for the patient, the need to evaluate both therapeutic regimens, particularly amphotericin B deoxycholate, such as the treatment scenarios for visceral leishmaniasis. |
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Santos, João Luiz Alves doshttp://lattes.cnpq.br/9639889172454540Almeida, Roque Pacheco dehttp://lattes.cnpq.br/85276339183915712017-09-26T12:18:58Z2017-09-26T12:18:58Z2015-08-31SANTOS, João Luiz Alves dos. Avaliação farmacoeconômica dos tratamentos para leishmaniose visceral no Estado de Sergipe. 2015. 71 f. Dissertação (Mestrado em Ciências da Saúde) - Universidade Federal de Sergipe, São Cristóvão, 2015.https://ri.ufs.br/handle/riufs/3911Search for new therapeutic alternatives for leishmaniasis is considered essential by the World Health Organization, due to the high toxicity of the drugs currently used, its high cost and the risk of resistance. In Brazil, it is used three drugs to treat leishmaniasis: meglumine antimoniate and two formulations of amphotericin B (deoxycholate and liposomal). This study is a piggy-back evaluation linked to a multicentric clinical trial with the objective to perform a decision analysis between the treatment regimens for visceral leishmaniasis, for both adults and children. For this end, it was performed analysis of the data obtained in the state of Sergipe from 62 patients randomized to treatment with meglumine antimoniate (group A), considered the first line treatment in Brazil, amphotericin B deoxycholate (group B), liposomal amphotericin B (group C) and the combined regimen of meglumine antimoniate with liposomal amphotericin B (group D), in order to conduct a decision analysis from among these therapeutic regimens for both adults and children. To this end, two scenarios were considered: scenario 1 is the currently prevailing in Brazil, where patients are always treated as possible on an outpatient basis with meglumine antimoniate, although with a smaller monitoring on its potentially lethal side effects and a possible lower adherence to treatment. In the scenario 2, patients are hospitalized during the treatment period, with a better monitoring of clinical and laboratory parameters of the patient, although with a higher risk of nosocomial infections and increasing treatment costs. In terms of security, there is an emphasis on amphotericin B deoxycholate as the one that presents a greater amount of serious and potentially lethal adverse reactions, with an average of 2 severe reactions per patient. From the viewpoint of cost-efficacy, for scenario 1 the meglumine antimoniate remains the treatment of choice for both adults and children. However, in scenario 2, the combination of drugs (group D) presented itself as the most costeffective for both adults and children. From this study it became clear, from a safety point of view for the patient, the need to evaluate both therapeutic regimens, particularly amphotericin B deoxycholate, such as the treatment scenarios for visceral leishmaniasis.A busca por novas alternativas terapêuticas para as leishmanioses é considerada essencial pela Organização Mundial da Saúde, em virtude da elevada toxicidade dos medicamentos atualmente utilizados, seu alto custo e o risco de resistência. No Brasil, utilizam-se três drogas para o tratamento da leishmaniose: o antimoniato de meglumina e as formulações de anfotericina B (desoxicolato e lipossomal). Este estudo é uma análise econômica atrelada a um ensaio clínico multicêntrico, com o objetivo de se realizar uma análise de decisão entre os esquemas terapêuticos para a leishmaniose visceral, tanto para adultos como para crianças. Para tal, foram utilizados os dados obtidos do estado de Sergipe, onde foram acompanhados 62 pacientes, randomizados para tratamento com antimoniato de meglumina (grupo A), considerado o esquema de primeira escolha no Brasil, anfotericina B desoxicolato (grupo B), anfotericina B lipossomal (grupo C) e o esquema terapêutico combinado de antimoniato de meglumina com anfotericina B lipossomal (grupo D). Na análise de decisão, foram considerados dois cenários: o cenário 1, atualmente existente no Brasil, no qual os pacientes são tratados sempre que possível ambulatorialmente com o antimoniato de meglumina, porém com um menor acompanhamento de suas reações adversas potencialmente letais e uma possível menor adesão ao tratamento. Já no cenário 2, os pacientes são internados durante todo o período do tratamento, com um melhor monitoramento dos parâmetros clínicos e laboratoriais do paciente, porém com um risco maior de infecções hospitalares e aumento de custos do tratamento. No quesito segurança, há um destaque para a anfotericina B desoxicolato como sendo a que apresenta uma maior quantidade de reações adversas graves e potencialmente letais, com uma média de 2 reações graves/paciente. Já no ponto de vista de custo-eficácia, para o cenário 1 o antimoniato de meglumina continua sendo o tratamento de primeira escolha, tanto para adultos como para crianças. Porém, no cenário 2, a combinação de medicamentos (grupo D) se apresentou como o mais custo-eficaz tanto para adultos como para crianças. Deste estudo evidenciou-se, do ponto de vista de segurança ao paciente, a necessidade de reavaliação tanto dos esquemas terapêuticos, particularmente a anfotericina B desoxicolato, como dos cenários de tratamento para a leishmaniose visceral.Coordenação de Aperfeiçoamento de Pessoal de Nível Superiorapplication/pdfporUniversidade Federal de SergipePós-Graduação em Ciências da SaúdeUFSBRFarmacoeconomiaLeishmaniose visceralPolítica de SaúdeCombinação de medicamentosPharmacoeconomicsVisceral leishmaniasisHealth policyDrug combinationsCNPQ::CIENCIAS DA SAUDEAvaliação farmacoeconômica dos tratamentos para leishmaniose visceral no Estado de Sergipeinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFSinstname:Universidade Federal de Sergipe (UFS)instacron:UFSORIGINALJOAO_LUIZ_ALVES_SANTOS.pdfapplication/pdf2150404https://ri.ufs.br/jspui/bitstream/riufs/3911/1/JOAO_LUIZ_ALVES_SANTOS.pdf0996eb07a512d4726e62a9aaf9ab95b9MD51TEXTJOAO_LUIZ_ALVES_SANTOS.pdf.txtJOAO_LUIZ_ALVES_SANTOS.pdf.txtExtracted texttext/plain120798https://ri.ufs.br/jspui/bitstream/riufs/3911/2/JOAO_LUIZ_ALVES_SANTOS.pdf.txtbfa743546856e04d9726451b477d8983MD52THUMBNAILJOAO_LUIZ_ALVES_SANTOS.pdf.jpgJOAO_LUIZ_ALVES_SANTOS.pdf.jpgGenerated Thumbnailimage/jpeg1377https://ri.ufs.br/jspui/bitstream/riufs/3911/3/JOAO_LUIZ_ALVES_SANTOS.pdf.jpg3e70c0b943f16e669d91ed7af4f92433MD53riufs/39112017-11-28 16:19:47.876oai:ufs.br:riufs/3911Repositório InstitucionalPUBhttps://ri.ufs.br/oai/requestrepositorio@academico.ufs.bropendoar:2017-11-28T19:19:47Repositório Institucional da UFS - Universidade Federal de Sergipe (UFS)false |
dc.title.por.fl_str_mv |
Avaliação farmacoeconômica dos tratamentos para leishmaniose visceral no Estado de Sergipe |
title |
Avaliação farmacoeconômica dos tratamentos para leishmaniose visceral no Estado de Sergipe |
spellingShingle |
Avaliação farmacoeconômica dos tratamentos para leishmaniose visceral no Estado de Sergipe Santos, João Luiz Alves dos Farmacoeconomia Leishmaniose visceral Política de Saúde Combinação de medicamentos Pharmacoeconomics Visceral leishmaniasis Health policy Drug combinations CNPQ::CIENCIAS DA SAUDE |
title_short |
Avaliação farmacoeconômica dos tratamentos para leishmaniose visceral no Estado de Sergipe |
title_full |
Avaliação farmacoeconômica dos tratamentos para leishmaniose visceral no Estado de Sergipe |
title_fullStr |
Avaliação farmacoeconômica dos tratamentos para leishmaniose visceral no Estado de Sergipe |
title_full_unstemmed |
Avaliação farmacoeconômica dos tratamentos para leishmaniose visceral no Estado de Sergipe |
title_sort |
Avaliação farmacoeconômica dos tratamentos para leishmaniose visceral no Estado de Sergipe |
author |
Santos, João Luiz Alves dos |
author_facet |
Santos, João Luiz Alves dos |
author_role |
author |
dc.contributor.author.fl_str_mv |
Santos, João Luiz Alves dos |
dc.contributor.advisor1Lattes.fl_str_mv |
http://lattes.cnpq.br/9639889172454540 |
dc.contributor.advisor1.fl_str_mv |
Almeida, Roque Pacheco de |
dc.contributor.authorLattes.fl_str_mv |
http://lattes.cnpq.br/8527633918391571 |
contributor_str_mv |
Almeida, Roque Pacheco de |
dc.subject.por.fl_str_mv |
Farmacoeconomia Leishmaniose visceral Política de Saúde Combinação de medicamentos |
topic |
Farmacoeconomia Leishmaniose visceral Política de Saúde Combinação de medicamentos Pharmacoeconomics Visceral leishmaniasis Health policy Drug combinations CNPQ::CIENCIAS DA SAUDE |
dc.subject.eng.fl_str_mv |
Pharmacoeconomics Visceral leishmaniasis Health policy Drug combinations |
dc.subject.cnpq.fl_str_mv |
CNPQ::CIENCIAS DA SAUDE |
description |
Search for new therapeutic alternatives for leishmaniasis is considered essential by the World Health Organization, due to the high toxicity of the drugs currently used, its high cost and the risk of resistance. In Brazil, it is used three drugs to treat leishmaniasis: meglumine antimoniate and two formulations of amphotericin B (deoxycholate and liposomal). This study is a piggy-back evaluation linked to a multicentric clinical trial with the objective to perform a decision analysis between the treatment regimens for visceral leishmaniasis, for both adults and children. For this end, it was performed analysis of the data obtained in the state of Sergipe from 62 patients randomized to treatment with meglumine antimoniate (group A), considered the first line treatment in Brazil, amphotericin B deoxycholate (group B), liposomal amphotericin B (group C) and the combined regimen of meglumine antimoniate with liposomal amphotericin B (group D), in order to conduct a decision analysis from among these therapeutic regimens for both adults and children. To this end, two scenarios were considered: scenario 1 is the currently prevailing in Brazil, where patients are always treated as possible on an outpatient basis with meglumine antimoniate, although with a smaller monitoring on its potentially lethal side effects and a possible lower adherence to treatment. In the scenario 2, patients are hospitalized during the treatment period, with a better monitoring of clinical and laboratory parameters of the patient, although with a higher risk of nosocomial infections and increasing treatment costs. In terms of security, there is an emphasis on amphotericin B deoxycholate as the one that presents a greater amount of serious and potentially lethal adverse reactions, with an average of 2 severe reactions per patient. From the viewpoint of cost-efficacy, for scenario 1 the meglumine antimoniate remains the treatment of choice for both adults and children. However, in scenario 2, the combination of drugs (group D) presented itself as the most costeffective for both adults and children. From this study it became clear, from a safety point of view for the patient, the need to evaluate both therapeutic regimens, particularly amphotericin B deoxycholate, such as the treatment scenarios for visceral leishmaniasis. |
publishDate |
2015 |
dc.date.issued.fl_str_mv |
2015-08-31 |
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2017-09-26T12:18:58Z |
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2017-09-26T12:18:58Z |
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info:eu-repo/semantics/masterThesis |
format |
masterThesis |
status_str |
publishedVersion |
dc.identifier.citation.fl_str_mv |
SANTOS, João Luiz Alves dos. Avaliação farmacoeconômica dos tratamentos para leishmaniose visceral no Estado de Sergipe. 2015. 71 f. Dissertação (Mestrado em Ciências da Saúde) - Universidade Federal de Sergipe, São Cristóvão, 2015. |
dc.identifier.uri.fl_str_mv |
https://ri.ufs.br/handle/riufs/3911 |
identifier_str_mv |
SANTOS, João Luiz Alves dos. Avaliação farmacoeconômica dos tratamentos para leishmaniose visceral no Estado de Sergipe. 2015. 71 f. Dissertação (Mestrado em Ciências da Saúde) - Universidade Federal de Sergipe, São Cristóvão, 2015. |
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