Adherence to immunosuppressive therapy after kidney transplantation is crucial to avoid graft rejection and optimise long term patient and graft survival. However, patient's adherence is not always optimal. Our aim was to identify reasons for non-adherence and health-related quality of life (HRQoL) dimensions affected by immunosuppressant therapy (IT) after kidney transplantation (KT) including patient preference of once daily over twice daily immunosuppressive regimen. MethOds: A literature review on adherence to immunosuppressant therapy (IT) and impact of IT on HRQoL through the EMBASE database was performed. Interviews were conducted with 2 clinical experts to determine key concepts related to KT and immunosuppressants. Thirty-six patients in four focus groups were asked to cite important concepts related to adherence and impact of IT on HRQoL and rate them. Qualitative analysis was conducted to code patient's responses. Results: The results showed that non-adherence was mostly unintentional among the participants. The reason for non-adherence included forgetfulness, interference with lifestyle, being asleep at the time the medication should be taken, change in routine and impact of side effects. The twice daily regimen was more problematic in relation to adherence. Overall, participants were of the opinion that a once daily IT regimen would help them be more adherent. Also, IT impacts on the HRQoL of the patient in a number of ways including: restricting the patients' lifestyle, causing anxiety or impairing the patient's ability to work. Although the patients happily oblige to the necessity of taking IT medication, patients preferred to reduce the burden associated with medication. cOnclusiOns: This study suggested that patients strongly valued adherence to IT medication and saw a change in the regimen from twice daily to once daily as one way to improve their adherence to IT. Results also suggested that a once daily regimen could improve patient's HRQoL.
Brazil ministry of health guidance for diabetes management allows for an insulin needle to be reused 8 times. Reuse has been associated with lipohypertrophy. Additionally, diabetes patients with lipohypertrophy require higher doses of insulin. This analysis demonstrates potential cost savings from syringe reuse reduction in Brazil. MethOds: A budget impact model was created to demonstrate the relationship between lower syringe reuse and lipohypertrophy rates. It was assumed 90% of patients use syringes in Brazil. An international survey suggests the lipohypertrophy rate is 48%. Another study showed increasing reuse correlates to a higher ratio of lipohypertrophy presence. With estimates including additional insulin requirements for lipohypertrophy, cost of insulin, and annual cost and volume of syringes, the difference between insulin wasted from lipohypertrophy and the cost associated with reducing reuse rate was calculated. Results: The estimated insulin injecting population with lipohypertrophy using syringes in Brazil is 691,200. If these patients require 15 units more insulin/day and the cost/ unit is $0.03, then the cost of excess insulin is $113.5 million/yr. The difference in rate of lipohypertrophy between reusing 8x (rate of 5.5) and reusing 4x (rate of 2.2) is a factor of 2.5. Based on estimated cost, volume, and currently allowed reuse rate, Brazil spends approximately $22.8 million on insulin syringes. If a reuse rate of 4x was implemented ($45.6 million), Brazil could anticipate a lipohypertrophy reduction of 28.8%, and a $68.1 million decrease in excess insulin. The savings on excess insulin and the incremental investment in syringes ($22.8 million) Resultsin a total savings of $45.3 million/yr. cOnclusiOns: The current acceptable reuse rate in Brazil, 8x, may be driving increased diabetes management costs. Best practice advocates single use. However, if Brazil cuts their reuse guidance in half, they can save $45.3 million/yr from reduced insulin waste. PMD6 BuDget iMPact analysis of DRug coateD Balloon vs. PeRcutaneous tRansluMinal Balloon angioPlasty in tHe tReatMent of PeRiPHeRal aRteRial Disease in loweR liMBs in BRazil
A807los pacientes con resultado positivo de un estudio electrofisiológico. En el análisis para los pacientes no isquémicos la costo efectividad depende del escenario escogido, superando algunas veces el umbral y otras no. En general, los resultados son sensibles a cambios en variables como el horizonte temporal, las probabilidades de muerte y el precio del CDI.
Extended psychometric analysis was done using the factor analysis (Horn´s Parallel Analysis, Exploratory Factor Analysis) and Rasch analysis (RA, Rating Scale model) (Scale diagnostic, Validity, Reliability, Dimensionality and Local independence, Differential item functioning (DIF)). Results: Horn´s Parallel Analysis revealed one factor (loading factor > 0.40). RA showed a correct functioning of the rating categories of the scale. As for the item fit, only one item 'It is easy to put on my device' slightly underfitted the model (Outfit MSQ = 0.720, Infit MSQ = 0.650) and item 'durability' overfitted the model (Outfit MSQ = 1.378, Infit MSQ = 1.291). The study showed a few similar allocations of items along the logit scale, weight and fit was easy to endorse, whereas the look and comfort of the orthosis were difficult to agree with. No local dependency was detected. The targeting of item difficulty to the patient ability was good. Omega reliability value of CSD-Sk was 0.9 (polychoric Cronbach's alpha level 0.9). No DIF was detected. ConClusions: Despite some limitations in terms of fit, psychometric properties of CSD-Sk are in line with previous analyses on the English, Swedish and Italian version of the tool.
zada en Colombia. METODOLOGÍAS: Mediante un modelo de Markov se estimaron desenlaces clínicos y uso de recursos asociados al manejo de TNE. El modelo consta de 3 estadios: enfermedad estable, enfermedad progresiva y muerte. Las probabilidades de transición entre estadios fueron calculadas a partir de la literatura. Las variables de costos y su frecuencia de uso fueron validadas con expertos clinicos. Los costos de los recursos asociados a la enfermedad se extrajeron de instituciones públicas y privadas en Colombia. El horizonte temporal fue de 10 años con una tasa de descuento del 3% anual. RESULTADOS: El modelo nos permitió estimar que en grupo de pacientes con TNE, la progresión de la enfermedad estaría presente en un 69,3% de los pacientes y un 24,2% adicional, fallecería al cabo de diez años de seguimiento. En promedio, cada paciente acumularía 3,4 años libres de progresión. Los costos médicos directos asociados al manejo de la enfermedad estable es de aproximadamente US$3,738, mientras el costo anual asciende a US$51,333 para la enfermedad progresiva. Después de diez años, el costo promedio acumulado por paciente alcanzaría US$254,690. Según los estimados de incidencia, en Colombia, se presentarían 176 nuevos casos por año, y según la distribución de los pacientes y el nivel de progresión, los costos médicos directos asociados a esta patología podrían superar US$ 1,400,000 al año. CONCLUSIONES: El impacto financiero de los TNE en el sistema de salud en Colombia es sustancial. Alternativas de tratamiento que extiendan el tiempo libre de progresión de la enfermedad y reduzcan la mortalidad pueden tener un efecto favorable para el sistema de salud colombiano.
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