4.89; I 2 =0%; 2 studies), complications (RR=0.37; 95%CI: 0.21, 0.65; I 2 = 0%; 2 studies), blood loss (mean difference= -1634.9ml; 95% CI: -2242.2ml, -1027.5ml; I 2 = 0%; 3 studies), and visual analogue scale (mean difference= -0.78; 95% CI: -1.50, -0.03; I 2 = 0%; 3 studies). Infection risk (RR=0.40; 95%CI: 0.09, 1.69; I 2 =0%; 2 studies), favorable change in cobb angle (mean difference= -0.38; 95% CI: -3.19, 2.43; I 2 =90.6%; 3 studies), and Oswestry Disability Index (mean difference= -3.45; 95% CI: -8.35, 1.45; I 2 =0%; 3 studies) were not significantly different between surgery types. Conclusions: Following a comprehensive pooling of the literature, this meta-analysis demonstrated that MIS was associated with better health and safety outcomes in adult patients with adult degenerative scoliosis compared to OS. Further studies are needed to allow for subgroup analyses and identification of specific patient populations who may benefit the most from MIS vs OS.

0 1 7 ) A 8 5 3 -A 9 4 3 A867 generated a tornado diagram, and a two-way deterministic one considering the two key parameters that differentiate CRRT from IRRT: the daily implementation cost difference and the cumulative risk of dialysis dependence. We used the threshold of 3 times per capita GDP, that is, R $ 84,741 (3 X R $ 28,247) as the threshold for cost-effectiveness. Results: CRRT is dominant vs. IRRT from 18 months of treatment. Based our assumptions, the cohort of patients initially treated with CRRT had better clinical outcomes QALY´s and lower total costs of treatment. Patients treated with CRRT are more likely to recover renal function. ConClusions: CRRT when compared to IRRT can be considered a dominant therapy, that is, it offers better outcomes and lower total treatment costs, under the perspective of the private healthcare system in Brazil.

OBJECTIVES: Ticagrelor, co-administered with acetylsalicylic acid, is a new antiplatelet therapy for patients with acute coronary syndrome (ACS) aimed at preventing thrombotic events [i.e., cardiovascular mortality, myocardial infarction (MI) and stroke]. The goal was to determine the cost per life year gained (LYG) for ticagrelor compared to current standard therapy (clopidogrel) using a cost-effectiveness analysis framework based on the published results from the Platelet Inhibition and Patient Outcomes (PLATO). METHODS: A Markov model framework was developed in order to evaluate the costs and benefits of ticagrelor over a lifetime time horizon. The clinical outcomes consisted of four health states: "MI", "Stroke", "All Cause Mortality" and "Recovered", with frequencies derived from the pivotal PLATO study at one year. These health states were extrapolated into the future via "Live" and "Die" scenarios. Resources and costs (2010 Canadian $) were obtained from the literature or public domain. A 5% discount rate was applied to all the cost and clinical inputs after the first year. RESULTS: An incremental cost effectiveness ratio (ICER) of $1125/LYG was determined. Probabilistic sensitivity analysis presented greater than 99% of all iterations resulting in an ICER less than $50,000/LYG. The economic model was most sensitive to the probability of death within one year of ticagrelor or clopidogrel treatment. CONCLUSIONS: Based on outcomes in the PLATO trial, the use of ticagrelor instead of clopidogrel for treatment of ACS in Canada is associated with an ICER of $1,125/LYG. OBJECTIVES:Diabetic nephropathy significantly increases the risk of cardiovascular disease (CVD) and end-stage renal disease (ESRD) in hypertensive patients. According to the AVOID study, the direct renin-inhibitor aliskiren, when added to losartan and optimal antihypertensive therapy in patients with hypertension, type 2 diabetes (T2DM) and diabetic nephropathy, significantly (pϭ0.001) reduced albuminuria by 20% over 6 months, as assessed by urinary albumin-creatinine ratio (UACR). This simulation examines the potential long-term clinical benefits and costs of add-on therapy with aliskiren in hypertensive patients with T2DM and diabetic nephropathy in Germany. METHODS: We developed a micro-simulation model to depict the progression to ESRD, measured by UACR levels over time.Patients at model entry were on maximal recommended doses of losartan and optimal antihypertensive therapy, and either continued this regimen or received aliskiren as an add-on therapy. In scenario analyses, different assumptions on the maintenance of the 20% UACR-reduction were made. Expected costs of pharmacotherapy and medical care were calculated based on German-specific sources over 10 years applying an annual discount rate of five percent. Sensitivity analyses were conducted to analyze the impact of different input parameters. RESULTS: Add-on therapy with aliskiren was projected to reduce the risk of ESRD by 1.8% and delay the onset of ESRD by 0.15 years assuming that t...

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Objectives: The decision of antiplatelet therapy after a percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) patients is complicated. Clopidogrel requires activation by cytochrome P450 (CYP), primarily CYP2C19. Patients with CYP2C19 loss-of-function alleles are at increased risk of major adverse cardiovascular events. Ticagrelor is a more effective and expensive alternative antiplatelet agent that is unaffected by the CYP2C19 polymorphism. Genotype-guided therapy is used to determine the CYP2C19 mutation carrier's status so that the more expensive ticagrelor can be selectively prescribed to patients with loss-of-function alleles. The study aimed to evaluate the cost-effectiveness of CYP2C19*2/*3 genotype-guided antiplatelet therapy compared to the universal use of ticagrelor or clopidogrel in ACS patients who undergo PCI. Methods: A two-parts model, including a one-year decision-analytic model and a 20-years follow-up Markov model, was created from the Qatar health-care provider's perspective, to follow the use of (i) universal clopidogrel, (ii) universal ticagrelor, and (iii) genotypeguided antiplatelet therapy. Outcome measures were the incremental cost-utility ratio (ICUR) and incremental cost-effectiveness ratio (ICER) of genotype-guided therapy. Therapy success was defined as survival without myocardial infarction, stroke, stent thrombosis, cardiovascular death, or the no therapy discontinuation due to adverse events. The base-case modeling was based on a multivariate analysis of uncertainty in probabilistic and utility input data. Results: Base-case 1-year results illustrated that CYP2C19 genotype-guided therapy was cost-effective compared to the universal use of clopidogrel and ticagrelor (ICER of US$ 3,836 and 4,964, respectively, per one case of success without ADR). While the universal use of clopidogrel was dominant over the universal use of ticagrelor. Over the long-term Markov model, genotype-guided therapy was dominant compared to both universal ticagrelor and clopidogrel. Conclusions: The CYP2C19 genotype-guided antiplatelet therapy appears to be the preferred antiplatelet strategy over the universal use of ticagrelor or clopidogrel for ACS patients undergoing PCI in Qatar.