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    "titulo" => "Análisis de la Relación Coste-efectividad de la Acarbosa en el Tratamiento de pacientes con Intolerancia a la Glucosa"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Realizar un an&#225;lisis de la relaci&#243;n coste-efectividad del tratamiento farmacol&#243;gico con acarbosa en pacientes con diagn&#243;stico de intolerancia a la glucosa &#40;ITG&#41; y compararlo con la pr&#225;ctica habitual &#40;medidas higi&#233;nico-diet&#233;ticas y sin tratamiento farmacol&#243;gico&#41; desde la perspectiva del financiador p&#250;blico&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A partir de los datos de eficacia provenientes del ensayo cl&#237;nico STOP-NIDDM respecto a la incidencia de la diabetes mellitus tipo 2 &#40;DM2&#41; y los eventos cardiovasculares &#40;ECV&#41; en los 2 grupos del ensayo &#40;acarbosa y placebo&#41;&#46; Se modelizan las consecuencias sanitarias y econ&#243;micas de los 2 tratamientos en poblaciones de 1&#46;000 individuos&#44; durante un per&#237;odo de 40 meses&#44; mediante un &#225;rbol de decisi&#243;n&#46; Los datos sobre el coste de los recursos se refieren al sistema sanitario espa&#241;ol&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">En el caso base del estudio&#44; el tratamiento con acarbosa resulta ligeramente dominante respecto de la pr&#225;ctica habitual&#44; ya que presenta mejores resultados con un coste incluso algo inferior&#46; El an&#225;lisis de sensibilidad pone de relieve que el tratamiento con acarbosa deja de ser dominante para pasar a presentar&#44; en algunos casos&#44; una relaci&#243;n de coste por transici&#243;n a DM2 evitada moderadamente positiva&#59; la relaci&#243;n coste-efectividad es especialmente sensible al coste de los tratamientos cardiovasculares&#44; al riesgo de transici&#243;n a DM2&#44; a la dosis diaria de acarbosa y a la proporci&#243;n del coste del medicamento a cargo del financiador p&#250;blico&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">El tratamiento con acarbosa en pacientes con diagn&#243;stico de intolerancia a la glucosa resulta dominante en comparaci&#243;n con la pr&#225;ctica habitual&#46; El coste por transici&#243;n a DM2 evitada y por individuo adicional libre de ECV es moderadamente positivo en algunos de los supuestos introducidos en el an&#225;lisis de sensibilidad&#46; Para evaluar de una forma m&#225;s completa el posible tratamiento a pacientes con ITG&#44; ser&#237;a necesario ampliar las alternativas que se han comparado y el horizonte temporal del estudio y utilizar alguna medida deresultados en salud que tenga en cuenta los efectos del tratamiento&#46;</p>"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To perform a cost-effectiveness analysis of treatment with acarbose in patients with impaired glucose tolerance &#40;IGT&#41; in comparison with conventional treatment &#40;based on medical counseling on diet and health and without drug treatment&#41; from the perspective of the public payer&#46;</p> <span class="elsevierStyleSectionTitle">Material and method</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A cost-effectiveness analysis was performed using data on efficacy&#44; the incidence of diabetes mellitus type 2 &#40;DM2&#41; and cardiovascular events from the STOPNIDDM clinical trial of acarbose treatment vs&#46; placebo&#46; The study used a decision tree analysis to estimate the health and economic impact of the two alternative treatments in a population of 1&#44;000 patients over a period of 40 months&#46; Resource use and cost data refer to the Spanish health care system&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">In the base case&#44; acarbose treatment was slightly dominant over conventional treatment since it achieved improved outcomes at an even lower cost&#46; Sensitivity analysis revealed that acarbose treatment lost dominance due to a moderately positive cost-effectiveness ratio for avoided progression to DM2 in some scenarios&#46; The cost-effectiveness ratio was particularly sensitive to the cost of cardiovascular treatments&#44; the risk of progression to DM2&#44; the daily doses of acarbose&#44; and the publicly funded share of the cost of this drug&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Acarbose treatment in patients diagnosed with IGT appeared to be the dominant alternative compared with conventional treatment&#46; The cost per avoided progression to DM2 and per additional individual free of a cardiovascular event was moderately low in some of the scenarios included in the sensitivity analysis&#46; For a more comprehensive evaluation of the possible treatment of patients with IGT&#44; the alternatives under comparison and the time horizon of the study would need to be increased and more refined health outcome measures&#44; comprising all the treatment&#39;s health effects&#44; would need to be introduced&#46;</p>"
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                          0 => array:2 [
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                            4 => "M&#46; Karasik"
                            5 => "M&#46; Laakso"
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                        "volumen" => "359"
                        "paginaInicial" => "2072"
                        "paginaFinal" => "2077"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12086760"
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                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An&#225;lisis coste-efectividad del tratamiento con ramipril de pacientes con alto riesgo de padecer eventos cardiovasculares en Espa&#241;a"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "W&#46;M&#46; Hart"
                            1 => "C&#46; Rubio-Terr&#233;s"
                            2 => "I&#46; Margalet"
                            3 => "J&#46;R&#46; G&#243;nzalez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "An Med Interna"
                        "fecha" => "2002"
                        "volumen" => "19"
                        "paginaInicial" => "515"
                        "paginaFinal" => "520"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12481494"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cost-effectiveness of cardiovascular prevention in Spain"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "P&#46; Plans-Rubio"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Technology Assessment Health Care"
                        "fecha" => "1998"
                        "volumen" => "14"
                        "paginaInicial" => "320"
                        "paginaFinal" => "330"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Increase hospital expenditures in diabetic patients hospitalized for cardiovascular diseases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "F&#46; Carral"
                            1 => "M&#46; Aguilar"
                            2 => "G&#46; Olveira"
                            3 => "A&#46; Mangas"
                            4 => "I&#46; Dom&#233;nech"
                            5 => "I&#46; Torres"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Diab Complications"
                        "fecha" => "2002"
                        "volumen" => "17"
                        "paginaInicial" => "331"
                        "paginaFinal" => "336"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The cost-effectiveness of primary prevention for non-insulin dependent diabetes mellitus&#44; CHPE Research Report Series"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46; Segal"
                            1 => "A&#46; Dalton"
                            2 => "J&#46; Richardson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:1 [
                        "serieFecha" => "1997"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Economic evaluation of therapeutic interventions to prevent type 2 diabetes in Canada"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;J&#46; Caro"
                            1 => "D&#46; Getsios"
                            2 => "I&#46; Caro"
                            3 => "W&#46;S&#46; Klittich"
                            4 => "J&#46;A&#46; O&#39;Brien"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Diab Med"
                        "fecha" => "2004"
                        "volumen" => "21"
                        "paginaInicial" => "1229"
                        "paginaFinal" => "1236"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intensive lifestyle changes or metformin in patients with impaired glucose tolerance&#58; modeling the long-term health economic implications of the Diabetes Prevention Program in Australia&#44; France&#44; Germany&#44; Switzerland&#44; and the United Kingdom"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Andrew"
                            1 => "A&#46;J&#46; Palmer"
                            2 => "S&#46; Roze"
                            3 => "W&#46;J&#46; Valentine"
                            4 => "G&#46;A&#46; Spinas"
                            5 => "J&#46;E&#46; Shaw"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Ther"
                        "fecha" => "2004"
                        "volumen" => "26"
                        "paginaInicial" => "304"
                        "paginaFinal" => "321"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15038953"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
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Vol. 18. Núm. 6.
Páginas 431-439 (noviembre - diciembre 2004)
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Vol. 18. Núm. 6.
Páginas 431-439 (noviembre - diciembre 2004)
Open Access
Análisis de la Relación Coste-efectividad de la Acarbosa en el Tratamiento de pacientes con Intolerancia a la Glucosa
Cost-effectiveness analysis of acarbose in the treatment of patients with impaired glucose tolerance
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8044
Ramón Sabés
Autor para correspondencia
ramon.sabes@salud.madrid.org

Correspondencia: Gran Vía, 27. 28013 Madrid. España.
Centro de Investigación en Economía y Salud (CRES). Departamento de Economía y Empresa. Universitat Pompeu Fabra. Barcelona. España
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Resumen
Objetivo

Realizar un análisis de la relación coste-efectividad del tratamiento farmacológico con acarbosa en pacientes con diagnóstico de intolerancia a la glucosa (ITG) y compararlo con la práctica habitual (medidas higiénico-dietéticas y sin tratamiento farmacológico) desde la perspectiva del financiador público.

Material y método

A partir de los datos de eficacia provenientes del ensayo clínico STOP-NIDDM respecto a la incidencia de la diabetes mellitus tipo 2 (DM2) y los eventos cardiovasculares (ECV) en los 2 grupos del ensayo (acarbosa y placebo). Se modelizan las consecuencias sanitarias y económicas de los 2 tratamientos en poblaciones de 1.000 individuos, durante un período de 40 meses, mediante un árbol de decisión. Los datos sobre el coste de los recursos se refieren al sistema sanitario español.

Resultados

En el caso base del estudio, el tratamiento con acarbosa resulta ligeramente dominante respecto de la práctica habitual, ya que presenta mejores resultados con un coste incluso algo inferior. El análisis de sensibilidad pone de relieve que el tratamiento con acarbosa deja de ser dominante para pasar a presentar, en algunos casos, una relación de coste por transición a DM2 evitada moderadamente positiva; la relación coste-efectividad es especialmente sensible al coste de los tratamientos cardiovasculares, al riesgo de transición a DM2, a la dosis diaria de acarbosa y a la proporción del coste del medicamento a cargo del financiador público.

Conclusiones

El tratamiento con acarbosa en pacientes con diagnóstico de intolerancia a la glucosa resulta dominante en comparación con la práctica habitual. El coste por transición a DM2 evitada y por individuo adicional libre de ECV es moderadamente positivo en algunos de los supuestos introducidos en el análisis de sensibilidad. Para evaluar de una forma más completa el posible tratamiento a pacientes con ITG, sería necesario ampliar las alternativas que se han comparado y el horizonte temporal del estudio y utilizar alguna medida deresultados en salud que tenga en cuenta los efectos del tratamiento.

Palabras clave:
Evaluación económica
Coste-efectividad
Acarbosa
Prevención de diabetes
Eventos cardiovasculares
Abstract
Objective

To perform a cost-effectiveness analysis of treatment with acarbose in patients with impaired glucose tolerance (IGT) in comparison with conventional treatment (based on medical counseling on diet and health and without drug treatment) from the perspective of the public payer.

Material and method

A cost-effectiveness analysis was performed using data on efficacy, the incidence of diabetes mellitus type 2 (DM2) and cardiovascular events from the STOPNIDDM clinical trial of acarbose treatment vs. placebo. The study used a decision tree analysis to estimate the health and economic impact of the two alternative treatments in a population of 1,000 patients over a period of 40 months. Resource use and cost data refer to the Spanish health care system.

Results

In the base case, acarbose treatment was slightly dominant over conventional treatment since it achieved improved outcomes at an even lower cost. Sensitivity analysis revealed that acarbose treatment lost dominance due to a moderately positive cost-effectiveness ratio for avoided progression to DM2 in some scenarios. The cost-effectiveness ratio was particularly sensitive to the cost of cardiovascular treatments, the risk of progression to DM2, the daily doses of acarbose, and the publicly funded share of the cost of this drug.

Conclusions

Acarbose treatment in patients diagnosed with IGT appeared to be the dominant alternative compared with conventional treatment. The cost per avoided progression to DM2 and per additional individual free of a cardiovascular event was moderately low in some of the scenarios included in the sensitivity analysis. For a more comprehensive evaluation of the possible treatment of patients with IGT, the alternatives under comparison and the time horizon of the study would need to be increased and more refined health outcome measures, comprising all the treatment's health effects, would need to be introduced.

Key words:
Economic evaluation
Cost-effectiveness
Acarbose
Diabetes prevention
Cardiovascular events
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Bibliografía
[1.]
A. Goday, E. Delgado, F. Díaz, P. De Pablos, J.A. Vázquez, E. Soto.
Epidemiología de la diabetes tipo 2 en España.
Endocrinol Nutr, 49 (2002), pp. 113-126
[2.]
M. Mata, F. Antoñanzas, M. Tafalla, P. Sanz.
El coste de la diabetes tipo 2 en España. El estudio CODE-2.
Gac Sanit, 16 (2002), pp. 511-512
[3.]
J. Tuomilehto, J. Lindstrom, J.G. Eriksson, T.T. Valle, H. Hamalainen, P. Ilanne-Parikka, et al.
Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance.
N Engl J Med, 344 (2001), pp. 1343-1350
[4.]
Diabetes prevention program research group.
Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin [editorial].
N Engl J Med, 346 (2002), pp. 393-403
[5.]
H.W. Breuer.
Review of acarbose therapeutic strategies in the long-term treatment and in the prevention of type 2 diabetes.
Int J Clin Pharmacol Ther, 41 (2003), pp. 421-440
[6.]
J.L. Chiasson, R.G. Josse, R. Gomis, H. Hanefeld, M. Karasik, M. Laakso.
Acarbose for prevention of type 2 diabetes mellitus: the Stop-NIDDM randomised trial.
Lancet, 359 (2002), pp. 2072-2077
[7.]
J.L. Chiasson, R.G. Josse, R. Gomis, H. Hanefeld, M. Karasik, M. Laakso.
Acarbose treatment reduces the risk of cardiovascular disease and hypertension in subjects with impaired glucose tolerance: The STOP-NIDDM Trial.
JAMA, 290 (2003), pp. 486-489
[8.]
W.M. Hart, C. Rubio-Terrés, I. Margalet, J.R. Gónzalez.
Análisis coste-efectividad del tratamiento con ramipril de pacientes con alto riesgo de padecer eventos cardiovasculares en España.
An Med Interna, 19 (2002), pp. 515-520
[9.]
P. Plans-Rubio.
Cost-effectiveness of cardiovascular prevention in Spain.
Int J Technology Assessment Health Care, 14 (1998), pp. 320-330
[10.]
F. Carral, M. Aguilar, G. Olveira, A. Mangas, I. Doménech, I. Torres.
Increase hospital expenditures in diabetic patients hospitalized for cardiovascular diseases.
J Diab Complications, 17 (2002), pp. 331-336
[11.]
L. Segal, A. Dalton, J. Richardson.
The cost-effectiveness of primary prevention for non-insulin dependent diabetes mellitus, CHPE Research Report Series.
[12.]
J.J. Caro, D. Getsios, I. Caro, W.S. Klittich, J.A. O'Brien.
Economic evaluation of therapeutic interventions to prevent type 2 diabetes in Canada.
Diab Med, 21 (2004), pp. 1229-1236
[13.]
J. Andrew, A.J. Palmer, S. Roze, W.J. Valentine, G.A. Spinas, J.E. Shaw, et al.
Intensive lifestyle changes or metformin in patients with impaired glucose tolerance: modeling the long-term health economic implications of the Diabetes Prevention Program in Australia, France, Germany, Switzerland, and the United Kingdom.
Clin Ther, 26 (2004), pp. 304-321

Este estudio ha sido financiado mediante un contrato no condicionado entre Química Farmacéutica Bayer S.A. y la Universitat Pompeu Fabra.

Copyright © 2004. Sociedad Española de Salud Pública y Administración Sanitaria
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