Background Etanercept (ETA) and adalimumab (ADA) are some of the biological agents available for treating severe psoriasis and a variety of inflammatory diseases in patients who have an inadequate response to standard treatment. Purpose To analyse and evaluate current costs to the regional health system of the treatment of the following inflammatory diseases: Rheumatoid Arthritis (RA), Ankylosing Spondylitis (AS) and Psoriatic Arthritis (PsA) with the main (self-injectable) anti-TNF drugs in Almería public hospitals (Spain). Materials and methods Retrospective multicentre study including all patients treated with etanercept or adalimumab during the period January-December 2010 in all Almería public hospitals. Results During the study period a total of 300 patients with AS, PsA or RA were treated; 112 (37.3%) received adalimumab and 188 (62.7%), etanercept; distribution of pathologies was: 51.6% RA, AS 29.7% and 18.7% PsA. The distribution per treatment indication was: RA (ADA 32.2%, 67.8% ETA), AS (39.3% ADA, ETA 60.7%) and PsA (48.2% ADA, ETA 51.8%). Average annual cost per patient for each therapeutic alternative was: RA (ADA 9931.6€, ETA 7363.5 €), AS (ADA 10162.5€, ETA 8146.2€) and PsA (ADA 6577.8€, ETA 8585.9€). In the light of these results and taking into account that the two drugs have similar efficacy, ETA appears to be the most favourable option in the treatment of RA and AS; PsA data with ETA could be influenced by double doses in dermatology-derived patients. Conclusions For higher prevalence and incidence pathologies, etanercept is the most economical option, therefore it is proposed as first-line treatment, leaving adalimumab as a second line in case of lack of response. It is necessary to perform longer-term studies and include the rest of the anti-TNF drugs currently used to position each one in its maximum efficiency indication.

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INTRODUCCIÓN: Durante la ultima década los tratamientos con metadona han sufrido un gran desarrollo hasta consolidarse como uno de los recurso terapéuticos más útiles y eficaces. En el presente trabajo se presenta la retención como criterio de valoración de la eficacia del tratamiento de mantenimiento con metadona realizado en una Unidad de Conductas Adictivas. PACIENTES Y MÉTODO: Se han seguido durante dos años 136 pacientes que se han incorporado a tratamiento de mantenimiento con metadona durante el periodo 1998-1999. Se ha realizado para la valoración de la retención la curva de Kaplan y Meier. Se ha analizado la relación entre la dosis y la retención, mediante ANOVA de un factor. RESULTADOS: La dosis media durante 1998 fue de 45,6 mg y en 1999 fue de 50,9 mg. La retención fue del 92% a los 20 meses de seguimiento. No se obtuvo relación entre la dosis y la permanencia o abandono del tratamiento. DISCUSIÓN: Las dosis de metadona utilizadas se consideran bajas. Sin embargo, los pacientes siguen vinculados de modo mayoritario al tratamiento. La retención no solo se debe a la dosis administrada si no también a otros factores relacionadas con la organización y estrategia del tratamiento. AbstractINTRODUCTION: Methadone treatment has undergone great development, to the point of becoming one of the most useful and efficient therapeutic resources. This work presents retention as evaluation criteria of the efficiency of the methadone treatment. PATIENTS AND METHOD: Monitoring was carried out for a period of two years on 136 methadone treated patients during the 1998-1999 period. Kaplan and Meier curve was used to evaluate retention. The relationship between dosage and retention has been analysed via ANOVA. RESULTS: The 1998 average dosage was 45.6 mg, and the average dosage was 50.9 mg. Retention was 92% registered following 20 months of monitoring. No relation was discovered between dosage and permanence within or out of treatment. DISCUSSION: The methadone dosage employed was considered to be low. Nevertheless, the majority of the patients remained at treatment. Retention is not only based on the dosage administered, but also in other factors related with organisation and strategy of treatment.