This study suggests that DUL provides overall savings and better health outcomes compared with branded-GBP and PGB. Administering DUL rather than generic-GBP is a cost-effective intervention to manage PDPN in Mexico.

Low bone density entails substantial epidemiological and financial burden in Mexico, and their impact will grow considerably during the next years.

with pharmacist-managed ESA clinics (nϭ314) and at six sites with usual care only (nϭ167); outpatients were followed for 6 months in 2009. We took a VA perspective with projections over a five-year time horizon; costs and effectiveness values were discounted at 3%/yr. Strategy-specific likelihoods of target range hemoglobin values (10-12 g/dl) were based on study results. Utilities for ND-CKD and ESA-related adverse events and their likelihood were obtained from the literature. ESA costs were based on average monthly epoetin and darbepoetin doses per patient during the study and VA ESA cost data. RESULTS: In the base case analysis, cost and effectiveness were $12,500 and 2.096 quality-adjusted life-years (QALYs) in the pharmacistmanaged ESA clinics and $15,500 and 2.093 QALYs in usual care; ESA clinics dominated usual care. In one-way sensitivity analyses, ESA clinics no longer dominated if their patients' probability of being in the target range fell to 0.54 (base case 0.71) or if the mean cost/month of epoetin or darbepoetin in ESA clinics increased to approximately $360 (base case $211) or $460 (base case $250), respectively. When all parameters were varied simultaneously in a probabilistic sensitivity analysis, ESA clinics were favored Ն80% of the time regardless of willingness-to-pay threshold. CONCLUSIONS: Pharmacist-managed ESA clinics were less costly and more effective than usual care in patients receiving ESAs for anemia and ND-CKD. Results were robust to variation and support the use of pharmacist-managed ESA clinics.

No abstract

OBJECTIVES: Hemophilia B is a rare and expensive to treat disease. The aim of this study was to develop an economic evaluation of prophylactic vs on-demand supply of recombinant factor IX (rFIX) in the treatment of patients with severe hemophilia B, from the Social Security Mexican Institute (IMSS) perspective. METHODS: A three-state Markov model (two-week cycles) following male patients from birth up to 75 years was developed to estimate the cost and outcomes of prophylactic (30 IU/kg body weight/week) and on-demand (40 IU/kg body weight/joint bleed) approaches to manage haemophilia B. On-demand was considered the usual practice. Effectiveness measure was the QALY. A literature review was performed to extract Mexican demographic and general epidemiologic data needed to populate the model. Treatment cost data (inpatient, outpatient, emergency services, medicines, laboratory and image studies) were extracted from Mexican published databases (the acquisition cost of rFIX was provided by the manufacturer). Health and economic consequences were assessed in different age groups. Both costs and outcomes were discounted at 5% annual rate Probabilistic sensitivity analyses and acceptability curves were constructed. RESULTS: Cost of rFIX in prophylaxis represented 60.3% and 90.4% of the total annual cost in the Յ4 years and Ͼ19 years groups, respectively. In on-demand approach, the cost of the therapy represented 45.3% and 83.9% in the Յ4 years and Ͼ19 years group, respectively. The incremental effectiveness for rFIX is close to one QALY in all age groups. ,291/QALY gained, respectively. Acceptability curves showed an inverse relationship between age and cost-effective proportion. CONCLUSIONS: At IMSS setting, the prophylaxis with rFIX for the management of patients suffering severe hemophilia B appears to be a highly costeffective and a cost-effective intervention in children and teenagers, respectively.