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        "resumen" => "<span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El ensayo cl&#237;nico PROWESS ha demostrado que el tratamiento con drotrecogina alfa &#40;activada&#41; en pacientes con sepsis grave se asocia a una reducci&#243;n del riesgo absoluto de muerte en comparaci&#243;n con el tratamiento est&#225;ndar&#46; El objetivo del estudio fue evaluar el coste-efectividad de drotrecogina alfa &#40;activada&#41;&#44; frente a tratamiento est&#225;ndar&#44; en el tratamiento de la sepsis grave en Espa&#241;a&#46;</p> <span class="elsevierStyleSectionTitle">Pacientes y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se elabor&#243; un modelo de an&#225;lisis de decisi&#243;n en el que se compararon los costes hasta el alta hospitalaria y la eficacia a largo plazo de drotrecogina alfa &#40;activada&#41; frente a tratamiento est&#225;ndar de pacientes con sepsis grave en Espa&#241;a&#44; desde la perspectiva del financiador de los servicios sanitarios&#46; La mayor&#237;a de la informaci&#243;n para realizar el modelo se obtuvo del ensayo cl&#237;nico PROWESS&#46; El an&#225;lisis basal fue doble&#58; a&#41; para todos los pacientes incluidos en el ensayo cl&#237;nico PROWESS&#44; y b&#41; para los pacientes con 2 o m&#225;s fallos org&#225;nicos&#46; Las variables principales de valoraci&#243;n cl&#237;nica fueron la reducci&#243;n de la mortalidad hospitalaria y los a&#241;os de vida ganados &#40;AVG&#41;&#46; El coste-efectividad se expres&#243; como coste por AVG&#46; Se realiz&#243; un an&#225;lisis de sensibilidad utilizando tasas de descuento del 3 y el 5&#37; para los AVG y modificando los patrones de atenci&#243;n sanitaria&#44; los costes de la unidad de cuidados intensivos&#44; la esperanza de vida seg&#250;n la comorbilidad inicial y la eficacia terap&#233;utica de drotrecogina alfa &#40;activada&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">El tratamiento con drotrecogina alfa &#40;activada&#41; se asoci&#243; a un descenso del riesgo absoluto de mortalidad hospitalaria del 6&#44;0&#37; &#40;p &#61; 0&#44;005&#41; cuando se incluyeron todos los pacientes del estudio PROWESS&#44; y una reducci&#243;n del 7&#44;3&#37; &#40;p &#61; 0&#44;005&#41; cuando s&#243;lo se incluyeron los pacientes con 2 o m&#225;s fracasos org&#225;nicos&#46; El coste-efectividad de drotrecogina alfa &#40;activada&#41; fue de 13&#46;550 euros por AVG respecto a placebo cuando se analiz&#243; el total de pacientes&#44; y de 9&#46;800 euros por AVG en el grupo de pacientes con 2 o m&#225;s fallos org&#225;nicos&#46; En el an&#225;lisis de sensibilidad&#44; los resultados oscilaron desde 7&#46;322 a 16&#46;493 euros por AVG&#46; Los factores que m&#225;s influyeron en los resultados fueron la modificaci&#243;n de la eficacia de drotrecogina alfa &#40;activada&#41;&#44; el ajuste de la supervivencia seg&#250;n la comorbilidad inicial y la aplicaci&#243;n de descuento a los AVG&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">El tratamiento con drotrecogina alfa &#40;activada&#41; presenta una relaci&#243;n coste-efectividad favorable en comparaci&#243;n con otras intervenciones sanitarias com&#250;nmente utilizadas en Espa&#241;a&#46;</p>"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The PROWESS clinical trial has shown that treatment with drotrecogin alpha &#40;activated&#41; in patients with severe sepsis is associated with a reduction in the absolute risk of death compared with standard treatment&#46; The aim of the present study was to assess the cost-effectiveness of drotrecogin alpha &#40;activated&#41; versus that of standard care in the treatment of severe sepsis in Spain&#46;</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A decision analysis model was drawn up to compare costs to hospital discharge and the long-term efficacy of drotrecogin alpha &#40;activated&#41; versus those of standard care in the treatment of severe sepsis in Spain from the perspective of the health care payer&#46; Most of the information for creating the model was obtained from the PROWESS clinical trial&#46; A two-fold baseline analysis was performed&#58; a&#41; for all patients included in the PROWESS clinical trial and b&#41; for the patients with two or more organ failures&#46; The major variables for clinical assessment were the reduction in mortality and years of life gained &#40;YLG&#41;&#46; Cost-effectiveness was expressed as cost per YLG&#46; A sensitivity analysis was applied using 3&#37; and 5&#37; discount rates for YLG and by modifying the patterns of health care&#44; intensive care unit costs&#44; and life expectancy by initial co-morbidity and therapeutic efficacy of drotrecogin alpha &#40;activated&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Treatment with drotrecogin alfa &#40;activated&#41; was associated with a 6&#46;0&#37; drop in the absolute risk of death &#40;p &#61; 0&#46;005&#41; when all of the patients from the PROWESS trial were included and with a 7&#46;3&#37; reduction &#40;p &#61; 0&#46;005&#41; when the analysis was restricted to patients with two or more organ failures&#46; The cost-effectiveness of drotrecogin alfa &#40;activated&#41; was euros 13&#44;550 per YLG with respect to standard care after analysing all of the patients and euros 9&#44;800 per YLG in the group of patients with two or more organ failures&#46; In the sensitivity analysis&#44; the results ranged from 7&#44;322 to euros 16&#44;493 per YLG&#46; The factors with the greatest impact on the results were the change in the efficacy of drotrecogin alfa &#40;activated&#41;&#44; adjustment of survival by initial co-morbidity and the application of discount rates to YLG&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Treatment with drotrecogin alfa &#40;activated&#41; presents a favorable cost-effectiveness ratio compared with other health care interventions commonly used in Spain&#46;</p>"
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