A model was developed to assess the lifetime costs and outcomes associated with haemophilia in Mexico. A retrospective chart review of 182 type A haemophiliacs was conducted for patients aged 0-34 years receiving one of three treatments: (i) cryoprecipitate at clinic; (ii) concentrate at home; or (iii) concentrate at clinic. Patients treated at home experienced 30% less joint damage, used 13-54% less factor VIII, had four times fewer clinic visits, and utilized half as many hospital days than those treated at a clinic. For cryoprecipitate at clinic patients, the annual incidence rates of HCV and HIV were calculated to be 3.6% and 1.4% respectively. The life expectancy for patients receiving cryoprecipitate and those receiving concentrate was estimated to be 49 years and 69 years respectively, with 58% of cryoprecipitate patients predicted to die of AIDS before age 69. Across the lifespan, the average annual cost of care was US$11,677 (MN$110,464) for cryoprecipitate at clinic patients, US$10,104 (M$95,580) for concentrate at home patients and US$18,819 (MN$178,027) for concentrate at clinic patients. Using a 5% discount rate, the incremental lifetime cost per year of life added for treatment with concentrate at home compared with cryoprecipitate at a clinic was US$738 (MN$6981). Rank order stability analysis demonstrated that the model was most sensitive to the cost of fVIII. These results indicate that treatment with concentrate at home compared with cryoprecipitate at a clinic substantially improves clinical outcomes at reduced annual cost levels.
Twenty patients with severe aplastic anemia (SAA) were treated with low doses (1–5 mg/kg/day) of a high-potency antithymocyte globulin (ATC) produced in Mexico, shown to have at least a 10-fold potency as compared with other globulins of commercial sources. Patients received ATG within a 10-day period, every other day (5 doses) at a dose of 1 mg/kg/day (4 courses), 2 mg/kg/day (12 courses) or 5 mg/kg/day (8 courses). Four patients received 2 consecutive courses of different doses of ATG. A response rate of 42% was recorded in the group, assessed by means of increases in reticulocytes, granulocytes or platelets. One patient showed a complete remission. The 570-day survival of the group was 51 %. It is concluded that the domestically produced ATG is useful in the treatment of some patients with SAA in Mexico.
, mortality, duration of hospital stay, intensive care unit (ICU) admission, infected pancreatic necrosis (IPN) with positive culture after necrosectomy, and need for an interventional procedure against necrosis. AC was defined according to TG13 in all patients between admission and the first week post ANP onset. Results: A positive TG13 AC was found in 7(18.9%) patients, and was associated with POF (71.1% vs. 20%, p=0.016), PMOF (57.1% vs. 13.3%, p=0.027), ICU admission (57.1% vs. 13.3%, p=0.027), mechanical ventilation (57.1% vs 10%, p=0.015), and IPN (42.9% vs. 6.7%, p=0.037). No association was found regarding hospital stay, need for an interventional procedure and mortality. Conclusion: In our series, ANP with acute cholangitis defined by TG13 is associated with poor outcomes, including necrosis infection. Large series are needed to confirm these findings.
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