Coste-efectividad de drotrecogina alfa (activada) en el tratamiento de la sepsis grave en España
Cost-effectiveness of drotrecogin alpha [activated] in the treatment of severe sepsis in Spain
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Sacristán, Luis Prieto, Teresa Huete, Antonio Artigas, Xavier Badia, Christopher Chinn, Peter Hudson" "autores" => array:7 [ 0 => array:4 [ "nombre" => "José A." "apellidos" => "Sacristán" "email" => array:1 [ 0 => "Sacristan_jose@lilly.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Luis" "apellidos" => "Prieto" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Teresa" "apellidos" => "Huete" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Antonio" "apellidos" => "Artigas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "Xavier" "apellidos" => "Badia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 5 => array:3 [ "nombre" => "Christopher" "apellidos" => "Chinn" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 6 => array:3 [ "nombre" => "Peter" "apellidos" => "Hudson" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Departamento de Investigación Clínica, Lilly España" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Hospital Parc Taulí. Sabadell (Barcelona)" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Health Outcomes Research Europe. Barcelona. España" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Health Outcomes Research. Lilly Europa" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Consultor independiente. Reino Unido" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "*" "correspondencia" => "Correspondencia:ee Departamento de Investigación Clínica, Lilly S.A. Avda. de la Industria, 30. 28108 Alcobendas. Madrid. España." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Cost-effectiveness of drotrecogin alpha [activated] in the treatment of severe sepsis in Spain" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2003-04-07" "fechaAceptado" => "2003-10-07" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec268673" "palabras" => array:3 [ 0 => "Sepsis grave" 1 => "Drotrecogina alfa (activada)" 2 => "Coste-efectividad" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec268674" "palabras" => array:3 [ 0 => "Severe sepsis" 1 => "Drotrecogin alfa (activated)" 2 => "Cost effectiveness" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Introducción</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El ensayo clínico PROWESS ha demostrado que el tratamiento con drotrecogina alfa (activada) en pacientes con sepsis grave se asocia a una reducción del riesgo absoluto de muerte en comparación con el tratamiento estándar. El objetivo del estudio fue evaluar el coste-efectividad de drotrecogina alfa (activada), frente a tratamiento estándar, en el tratamiento de la sepsis grave en España.</p> <span class="elsevierStyleSectionTitle">Pacientes y métodos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se elaboró un modelo de análisis de decisión en el que se compararon los costes hasta el alta hospitalaria y la eficacia a largo plazo de drotrecogina alfa (activada) frente a tratamiento estándar de pacientes con sepsis grave en España, desde la perspectiva del financiador de los servicios sanitarios. La mayoría de la información para realizar el modelo se obtuvo del ensayo clínico PROWESS. El análisis basal fue doble: a) para todos los pacientes incluidos en el ensayo clínico PROWESS, y b) para los pacientes con 2 o más fallos orgánicos. Las variables principales de valoración clínica fueron la reducción de la mortalidad hospitalaria y los años de vida ganados (AVG). El coste-efectividad se expresó como coste por AVG. Se realizó un análisis de sensibilidad utilizando tasas de descuento del 3 y el 5% para los AVG y modificando los patrones de atención sanitaria, los costes de la unidad de cuidados intensivos, la esperanza de vida según la comorbilidad inicial y la eficacia terapéutica de drotrecogina alfa (activada).</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">El tratamiento con drotrecogina alfa (activada) se asoció a un descenso del riesgo absoluto de mortalidad hospitalaria del 6,0% (p = 0,005) cuando se incluyeron todos los pacientes del estudio PROWESS, y una reducción del 7,3% (p = 0,005) cuando sólo se incluyeron los pacientes con 2 o más fracasos orgánicos. El coste-efectividad de drotrecogina alfa (activada) fue de 13.550 euros por AVG respecto a placebo cuando se analizó el total de pacientes, y de 9.800 euros por AVG en el grupo de pacientes con 2 o más fallos orgánicos. En el análisis de sensibilidad, los resultados oscilaron desde 7.322 a 16.493 euros por AVG. Los factores que más influyeron en los resultados fueron la modificación de la eficacia de drotrecogina alfa (activada), el ajuste de la supervivencia según la comorbilidad inicial y la aplicación de descuento a los AVG.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">El tratamiento con drotrecogina alfa (activada) presenta una relación coste-efectividad favorable en comparación con otras intervenciones sanitarias comúnmente utilizadas en España.</p>" ] "en" => array:2 [ "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 (activated) in patients with severe sepsis is associated with a reduction in the absolute risk of death compared with standard treatment. The aim of the present study was to assess the cost-effectiveness of drotrecogin alpha (activated) versus that of standard care in the treatment of severe sepsis in Spain.</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 (activated) versus those of standard care in the treatment of severe sepsis in Spain from the perspective of the health care payer. Most of the information for creating the model was obtained from the PROWESS clinical trial. A two-fold baseline analysis was performed: a) for all patients included in the PROWESS clinical trial and b) for the patients with two or more organ failures. The major variables for clinical assessment were the reduction in mortality and years of life gained (YLG). Cost-effectiveness was expressed as cost per YLG. A sensitivity analysis was applied using 3% and 5% discount rates for YLG and by modifying the patterns of health care, intensive care unit costs, and life expectancy by initial co-morbidity and therapeutic efficacy of drotrecogin alpha (activated).</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Treatment with drotrecogin alfa (activated) was associated with a 6.0% drop in the absolute risk of death (p = 0.005) when all of the patients from the PROWESS trial were included and with a 7.3% reduction (p = 0.005) when the analysis was restricted to patients with two or more organ failures. The cost-effectiveness of drotrecogin alfa (activated) was euros 13,550 per YLG with respect to standard care after analysing all of the patients and euros 9,800 per YLG in the group of patients with two or more organ failures. In the sensitivity analysis, the results ranged from 7,322 to euros 16,493 per YLG. The factors with the greatest impact on the results were the change in the efficacy of drotrecogin alfa (activated), adjustment of survival by initial co-morbidity and the application of discount rates to YLG.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Treatment with drotrecogin alfa (activated) presents a favorable cost-effectiveness ratio compared with other health care interventions commonly used in Spain.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:38 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." 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| año/Mes | Html | Total | |
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| 2021 Diciembre | 19 | 29 | 48 |
| 2021 Noviembre | 24 | 38 | 62 |
| 2021 Octubre | 29 | 39 | 68 |
| 2021 Septiembre | 31 | 47 | 78 |
| 2021 Agosto | 15 | 29 | 44 |
| 2021 Julio | 21 | 27 | 48 |
| 2021 Junio | 16 | 22 | 38 |
| 2021 Mayo | 18 | 27 | 45 |
| 2021 Abril | 46 | 38 | 84 |
| 2021 Marzo | 43 | 38 | 81 |
| 2021 Febrero | 20 | 10 | 30 |
| 2021 Enero | 16 | 18 | 34 |
| 2020 Diciembre | 20 | 14 | 34 |
| 2020 Noviembre | 15 | 16 | 31 |
| 2020 Octubre | 19 | 20 | 39 |
| 2020 Septiembre | 18 | 11 | 29 |
| 2020 Agosto | 19 | 11 | 30 |
| 2020 Julio | 17 | 12 | 29 |
| 2020 Junio | 21 | 7 | 28 |
| 2020 Mayo | 17 | 7 | 24 |
| 2020 Abril | 35 | 16 | 51 |
| 2020 Marzo | 21 | 9 | 30 |
| 2020 Febrero | 37 | 13 | 50 |
| 2020 Enero | 28 | 12 | 40 |
| 2019 Diciembre | 22 | 18 | 40 |
| 2019 Noviembre | 14 | 4 | 18 |
| 2019 Octubre | 35 | 12 | 47 |
| 2019 Septiembre | 10 | 6 | 16 |
| 2019 Agosto | 19 | 9 | 28 |
| 2019 Julio | 12 | 4 | 16 |
| 2019 Junio | 11 | 7 | 18 |
| 2019 Mayo | 10 | 6 | 16 |
| 2019 Abril | 7 | 8 | 15 |
| 2019 Marzo | 8 | 7 | 15 |
| 2019 Febrero | 6 | 10 | 16 |
| 2019 Enero | 3 | 5 | 8 |
| 2018 Diciembre | 5 | 9 | 14 |
| 2018 Noviembre | 29 | 14 | 43 |
| 2018 Octubre | 53 | 26 | 79 |
| 2018 Septiembre | 25 | 11 | 36 |
| 2018 Agosto | 28 | 13 | 41 |
| 2018 Julio | 36 | 10 | 46 |
| 2018 Junio | 29 | 13 | 42 |
| 2018 Mayo | 37 | 13 | 50 |
| 2018 Abril | 31 | 12 | 43 |
| 2018 Marzo | 10 | 13 | 23 |
| 2018 Febrero | 17 | 7 | 24 |
| 2018 Enero | 8 | 7 | 15 |
| 2017 Diciembre | 19 | 7 | 26 |
| 2017 Noviembre | 10 | 10 | 20 |
| 2017 Octubre | 12 | 8 | 20 |
| 2017 Septiembre | 14 | 8 | 22 |
| 2017 Agosto | 11 | 7 | 18 |
| 2017 Julio | 13 | 7 | 20 |
| 2017 Junio | 30 | 9 | 39 |
| 2017 Mayo | 23 | 10 | 33 |
| 2017 Abril | 18 | 9 | 27 |
| 2017 Marzo | 17 | 8 | 25 |
| 2017 Febrero | 14 | 5 | 19 |
| 2017 Enero | 8 | 3 | 11 |
| 2016 Diciembre | 23 | 3 | 26 |
| 2016 Noviembre | 19 | 9 | 28 |
| 2016 Octubre | 16 | 10 | 26 |
| 2016 Septiembre | 30 | 10 | 40 |
| 2016 Agosto | 32 | 12 | 44 |
| 2016 Julio | 18 | 10 | 28 |
| 2016 Enero | 1 | 0 | 1 |
| 2015 Diciembre | 3 | 0 | 3 |
| 2015 Noviembre | 1 | 0 | 1 |
| 2015 Octubre | 6 | 0 | 6 |
| 2015 Septiembre | 2 | 0 | 2 |
| 2015 Julio | 4 | 4 | 8 |
| 2015 Junio | 1 | 0 | 1 |
| 2015 Mayo | 2 | 3 | 5 |
| 2015 Marzo | 3 | 2 | 5 |
| 2015 Febrero | 3 | 0 | 3 |
| 2015 Enero | 0 | 3 | 3 |
| 2014 Diciembre | 5 | 3 | 8 |
| 2014 Noviembre | 6 | 2 | 8 |
| 2014 Octubre | 5 | 4 | 9 |
| 2014 Septiembre | 5 | 4 | 9 |
| 2014 Agosto | 6 | 3 | 9 |
| 2014 Julio | 7 | 1 | 8 |
| 2014 Junio | 4 | 3 | 7 |
| 2014 Mayo | 5 | 1 | 6 |
| 2014 Abril | 10 | 1 | 11 |
| 2014 Marzo | 6 | 2 | 8 |
| 2014 Febrero | 8 | 1 | 9 |
| 2014 Enero | 16 | 1 | 17 |
| 2013 Diciembre | 22 | 1 | 23 |
| 2013 Noviembre | 17 | 2 | 19 |
| 2013 Octubre | 30 | 2 | 32 |
| 2013 Septiembre | 7 | 4 | 11 |
| 2013 Agosto | 44 | 4 | 48 |
| 2013 Julio | 20 | 0 | 20 |
| 2004 Enero | 1158 | 0 | 1158 |
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