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The model used to develop the STRONGkids tool incorporated clinical evaluation to a greater extent than the assessment of nutritional status. The tool, however, had a low sensitivity and a high percentage of false positives. Therefore, it should be considered as a preliminary evaluation tool and its use should be complemented with clinical data.

ment in chronic HCV infected patients with thrombocytopenia to enable INF-based treatment regimens from the Spanish Health System perspective. Methods: A two-phase individual-level model was developed to evaluate the cost-effectiveness of eltrombopag treatment in thrombocytopenic HCV-patients over a lifetime horizon. Individual-level models are more flexible and provide more accurate estimations than Markov approaches. One million patients were simulated using data from trials ENABLE 1 and 2 and local studies. In the first phase, a discrete event simulation was used to recreate patient events during INF-treatment. When eltrombopag was considered, patients underwent an initial pre-INF treatment with eltrombopag. Those that failed to reach INF-label platelet count did not receive INF-based regimens. In the second phase, a microsimulation was used to emulate each patient from treatment discontinuation to death. Health states included fibrosis (F0, F1/2, F3, F4), liver decompensation, hepatocelullar carcinoma, liver transplant and death. Transition probabilities for each 1-month cycle, utilities and direct health care costs (€ 2014) were obtained from literature and national databases. A 3% annual discount was applied to costs and health outcomes. Sensitivity analysis with 0% and 5% discount rates were performed. Results: Eltrombopag was associated with an average increment of 0.58 quality-adjusted life years (QALY) and an additional cost of € 17,084.47/patient. The average incremental cost effectiveness ratio (ICER) was 29,808.26 € /QALY. Considering a € 30,000 threshold, eltrombopag was cost-effective in 59.12% of cases. This proportion remained similar with 5% (56.7%) and 0% (63.25%) discount rates. ConClusions: With the premises considered in this study, eltrombopag in HCV patients could be considered cost-effective from the Spanish Health System perspective.objeCtives: Thrombocytopenia limits the use of interferon (INF) based regimens in chronic hepatitis C virus (HCV) patients. Eltrombopag, a thrombopoietin-receptor agonist, effectively elevates platelet count allowing optimal INF-treatment. The objective of the present study was to assess the cost-effectiveness as support treat-

ResumoOs distúrbios de crescimento e nutrição são problemas de saúde frequentes em crianças com paralisia cerebral (PC). Esses distúrbios nutricionais podem acarretar comprometimento no desenvolvimento motor e cognitivo, na socialização, e na maior necessidade do uso de serviços de saúde e de internação hospitalar. Mesmo sob condições aparentemente adequadas (ambiente apropriado e atendimento médico regular), as crianças com PC crescem mais lentamente do que as sem condições crônicas de saúde e possuem padrões de crescimento únicos. Em geral, as equipes de saúde utilizam como medida de referência as curvas de crescimento para populações sem déficit neurológico, as quais não são adequadas para crianças com PC, já que essa população possui um crescimento distinto. Nas últimas décadas, pesquisadores vem construindo curvas de crescimento específicas para a PC. Até o momento, existem cinco padrões de referência publicados. A escolha do melhor padrão de referência dessa população é uma tarefa difícil. No entanto, as curvas de crescimento elaborada por Brooks et al. parece ser mais confiáveis e são as mais utilizadas nos centros especializados em cuidados dessas e adolescentes. Elas são simples, metodologicamente mais seguras, baseadas em uma amostra grande e representativa de todos os grupos de desenvolvimento motor que os indivíduos com PC possam apresentar e estão relacionadas a desfechos clínicos. Contudo, carece de mais estudos que comprovem a sua qualidade, principalmente em contextos diferentes. No entanto, pela importância de se avaliar cada criança/adolescente com sua curva de crescimento específica para sua enfermidade, sugere-se que ela deva ser integrada na avalição antropométrica junto com outros parâmetros nutricionais na prática clínica.

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