• JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
  • JoomlaWorks Simple Image Rotator
 
  Bookmark and Share
 
 
Master's Dissertation
DOI
https://doi.org/10.11606/D.5.2021.tde-23072021-182807
Document
Author
Full name
Luciana Marcondes Ferreira
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2021
Supervisor
Committee
Haddad, Luciana Bertocco de Paiva (President)
Ataide, Elaine Cristina de
Cassenote, Alex Jones Flores
Farias, Alberto Queiroz
Title in Portuguese
Custo-efetividade do uso da terlipressina no tratamento da síndrome hepatorrenal
Keywords in Portuguese
Avaliação de custo-efetividade
Custos de cuidados em saúde
Gastroenterologia
Norepinefrina
Síndrome hepatorrenal
Terlipressina
Abstract in Portuguese
Introdução: A Síndrome Hepatorrenal (SHR) é a forma mais grave de lesão renal aguda em pacientes com cirrose avançada, estando diretamente associada à altas taxas de mortalidade. Normalmente é diagnosticada seguindo critérios definidos pela International Ascites Club (IAC). Atualmente, as terapias farmacológicas mais indicadas no tratamento da SHR são a combinação de vasoconstritores esplâncnicos (terlipressina ou norepinefrina) associados à albumina. Com o aumento progressivo dos gastos em saúde, torna-se relevante realizar uma análise de custo-efetividade do tratamento farmacológico em pacientes com diagnóstico de SHR. Objetivo: Realizar avaliação de custo-efetividade do uso da terlipressina associada à albumina no tratamento da Síndrome Hepatorrenal em pacientes com cirrose. Metodologia: Avaliação econômica de custo-efetividade, com base em dados secundários de estudos publicados com resultado da eficácia da terapia com terlipressina, em comparação com norepinefrina combinada com albumina ou apenas albumina. A análise de custo-efetividade foi calculada usando a razão de custo-efetividade incremental (RCEI) e uma análise de sensibilidade foi desenvolvida variando os valores das terapias e probabilidades. Resultados: Após a seleção, elegibilidade e avaliação da qualidade das publicações, os resultados demonstraram que a administração da associação de terlipressina ou norepinefrina com albumina em pacientes diagnosticados com SHR tipo 1 possui eficácia comprovada. Os custos do tratamento com a terapia combinada de terlipressina com albumina foram de R$8.993,00, administração de somente albumina R$4.988,74 e norepinefrina mais albumina R$12.640,44. Considerando as terapias combinadas com efetividade terapêutica comprovada, isto é, terlipressina e norepinefrina associada a albumina, o custo incremental foi de R$ -3.647,00 e efetividade de 0,570 para o grupo da terlipressina associada a albumina e de 0,200 para o grupo da norepinefrina associada a albumina. A efetividade incremental foi de 0,370 e o valor da RCEI foi de R$ -9.856,76. Assim, os fatores de incremento do custo por terapia e razão de custo-efetividade incremental definem que a terapia combinada de terlipressina mais albumina é custo efetiva quando comparada a administração de somente albumina ou norepinefrina no cenário do sistema único de saúde. Conclusão: O estudo demonstrou por meio de uma análise de custo-efetividade que a terlipressina associada à albumina quando administrada concomitantemente a pacientes com diagnóstico de SHR tipo 1 é custo-efetiva quando comparada à albumina sozinha e com norepinefrina associada à albumina administrada em um ambiente controlado.
Title in English
Cost effectiveness of use of terlipressin in the treatment of hepatorenal syndrome
Keywords in English
Cost-effectiveness evaluation
Gastroenterology.
Health care costs
Hepatorenal syndrome
Norepinephrine
Terlipressin
Abstract in English
Introduction: Hepatorenal syndrome (HRS) is the most severe form of acute kidney injury in patients with advanced cirrhosis, associated with high mortality. It is usually diagnosed following the criteria defined by the International Ascites Club (IAC). Currently, the most indicated pharmacological therapies for the treatment of SHR are a combination of splanchnic vasoconstrictors (terlipressin or norepinephrine) associated with albumin. With the progressive increase in health spending, it becomes relevant to conduct a cost-effectiveness analysis of pharmacological treatment in patients diagnosed with HRS. Objective: To perform the cost-effectiveness assessment of the use of terlipressin associated with albumin in the treatment of Hepatorenal Syndrome in patients with cirrhosis. Methodology: Economic evaluation of cost-effectiveness, based on secondary data from studies produced with the result of the efficacy of terlipressin therapy, in comparison with norepinephrine combined with albumin or just albumin. The cost-effectiveness analysis was calculated using the incremental cost-effectiveness ratio (ICER) and a sensitivity analysis was developed varying the values of therapies and probabilities. Results: After selection, eligibility and evaluation of the quality of publications, the results demonstrated that the administration of the combination of terlipressin or norepinephrine with albumin in patients diagnosed with HRS type 1 has proven efficacy. The cost of treatment with the combined therapy of terlipressin with albumin was R$ 8,993.00, administration of only albumin R $ 4,988.74 and norepinephrine plus albumin R $ 12,640.44. Considering therapies combined with proven therapeutic effectiveness, that is, terlipressin and norepinephrine associated with albumin, the incremental cost was R $ -3,647.00 and effectiveness of 0.570 for the group of terlipressin associated with albumin and 0.200 for the group of norepinephrine associated with albumin. The incremental effectiveness was 0.370 and the ICER was R $ -9,856.76. Thus, the factors of increasing cost per therapy and incremental cost-effectiveness ratio define that the combined therapy of terlipressin plus albumin is cost effective when compared to the administration of only albumin or norepinephrine in the scenario of the single health system. Conclusion: The study demonstrated by means of a costeffectiveness analysis that terlipressin associated with albumin when administered concomitantly to patients diagnosed with type 1 SHR is cost-effective when compared to albumin alone and with norepinephrine associated with albumin administered in an environment controlled.
 
WARNING - Viewing this document is conditioned on your acceptance of the following terms of use:
This document is only for private use for research and teaching activities. Reproduction for commercial use is forbidden. This rights cover the whole data about this document as well as its contents. Any uses or copies of this document in whole or in part must include the author's name.
Publishing Date
2021-07-23
 
WARNING: Learn what derived works are clicking here.
All rights of the thesis/dissertation are from the authors
CeTI-SC/STI
Digital Library of Theses and Dissertations of USP. Copyright © 2001-2021. All rights reserved.