Avaliação econômica dos novos anticoagulantes para a prevenção de eventos tromboembólicos: análise de custo-minimização

CONTEXT AND OBJECTIVE: Randomized clinical trials have shown that the new oral anticoagulants have at least similar impact regarding reduction of thromboembolic events, compared with warfarin, with similar or improved safety profiles. There is little data on real costs within clinical practice. Our aim here was to perform economic analysis on these strategies from the perspective of Brazilian society and the public healthcare system. DESIGN AND SETTING: Cost-minimization analysis; anticoagulation clinic of Hospital Municipal Odilon Behrens, Belo Horizonte, MG, Brazil. METHODS: Patients at the anticoagulation clinic were recruited between August and October 2011, with minimum follow-up of four weeks. Operational and non-operational costs were calculated and corrected to 2015. RESULTS: This study included 633 patients (59% women) of median age 62 years (interquartile range 49- 73). The mean length of follow-up was 64 ± 28 days. The average cost per patient per month was $54.26 (US dollars). Direct costs accounted for 32.5$ 49.87, $51.40 and$ 52.16 per patient per month, respectively, which was lower than the costs relating to warfarin treatment. CONCLUSION: In the Brazilian context, from the perspective of society and the public healthcare system, the cumulative costs per patient using warfarin with follow-up in anticoagulation clinics is currently higher than the strategy of prescribing the new oral anticoagulants.CONTEXTO E OBJETIVO: Estudos clínicos randomizados demonstraram que novos anticoagulantes orais têm pelo menos impacto semelhante em reduzir eventos tromboembólicos quando comparados à varfarina, com perfil de segurança similar ou superior. Há pouca evidência acerca de custos reais na prática clínica. Nosso objetivo é realizar análise econômica dessas estratégias, na perspectiva do sistema de saúde pública e da sociedade brasileiros. TIPO DE ESTUDO E LOCAL: Análise de custo-minimização; Clínica de Anticoagulação do Hospital Municipal Odilon Behrens, Belo Horizonte, MG, Brasil. MÉTODOS: Os pacientes da clínica de anticoagulação foram recrutados de agosto a outubro de 2011, com tempo mínimo de acompanhamento de quatro semanas. Custos operacionais e não operacionais foram computados e corrigidos para 2015. RESULTADOS: Este estudo incluiu 633 pacientes, com idade mediana de 62 (intervalo interquartil 49-73) anos, sendo 59% mulheres. O tempo médio de acompanhamento foi de 64 ± 28 dias. O custo médio por paciente por mês foi de $54.26 (dólares). Custos diretos foram responsáveis por 32,5$ 49.87, $51.40 e$ 52.26 por paciente por mês, valores inferiores aos custos relacionados ao tratamento com varfarina. CONCLUSÃO: No contexto brasileiro, na perspectiva do sistema de saúde pública e da sociedade, os custos cumulativos por paciente em uso de varfarina acompanhados em clínica de anticoagulação são atualmente superiores à estratégia de prescrever novos anticoagulantes orais

Heart Rate influence on myocardial deformation evaluated by echocardiography

Introdução: A aplicabilidade diagnóstica e prognóstica da técnica de speckle tracking é inquestionável no cenário clínico atual. Contudo, pouco se conhece sobre a possível influência de variáveis hemodinâmicas sobre os achados por ela fornecidos. Objetivo: Avaliar a influência isolada da frequência cardíaca sobre a deformação miocárdica analisada pela ecocardiografia. Métodos: Estudo transversal em um centro de referência em cardiologia que envolveu portadores de marcapasso cardíaco por doença do nó sinusal com condução atrioventricular preservada e função cardíaca normal. Os pacientes foram submetidos ao ecocardiograma bidimensional com frequências cardíacas programadas de 70, 90, 110 e 130 batimentos por minuto; com cálculo dos índices de deformidade miocárdica a cada etapa e posterior aplicação do teste ANOVA considerando-se significativo o valor de p <0,05. Resultados: Catorze pacientes participaram do protocolo. Metade da amostra era do gênero masculino e a idade média foi de 63,3 ± 12,6 anos. Não houve diferença significativa nos valores de pressão arterial sistólica, diastólica e média dos pacientes. Os valores globais de strain longitudinal, radial e circunferencial, o twist e a torção não mostraram diferença estatisticamente relevante nas diferentes frequências cardíacas estudadas. Conclusão: A frequência cardíaca como parâmetro isolado não exerce influência significativa sob os índices globais de deformidade miocárdica avaliados pela ecocardiografia bidimensional.Introduction: Speckle tracking imaging has a broad applicability for diagnosis and prognosis evaluation in current clinic scenario. However, little is known about the possible influence of hemodynamic variables on its findings. Objective: To evaluate the influence of heart rate as an isolated parameter on myocardial deformation using echocardiography. Methods: This is a cross-sectional study conceived in a reference cardiology center involving pacemaker carries for sick sinus syndrome with preserved atrioventricular conduction and normal cardiac function. Two-dimensional echocardiography was performed in the patients and myocardial deformation indices were calculated at pacing rates of 70, 90, 110 and 130 bpm. Afterwards, ANOVA test was used and a p value <0,05 was considered significant. Results: Fourteen patients were allocated for the protocol. Half of them were male and their mean age was 63,3 ± 12,6 years. There was no significant difference in systolic, diastolic and mean blood pressure values among the stages. Global values of longitudinal, radial e circunferencial strain, twist and torsion were not significantly different between pacing rates. Conclusion: Heart rate as an isolated variable does not significantly influence global indices of myocardial deformation using two-dimensional echocardiograph

Economic evaluation of the new oral anticoagulants for the prevention of thromboembolic events: a cost-minimization analysis

ABSTRACT CONTEXT AND OBJECTIVE: Randomized clinical trials have shown that the new oral anticoagulants have at least similar impact regarding reduction of thromboembolic events, compared with warfarin, with similar or improved safety profiles. There is little data on real costs within clinical practice. Our aim here was to perform economic analysis on these strategies from the perspective of Brazilian society and the public healthcare system. DESIGN AND SETTING: Cost-minimization analysis; anticoagulation clinic of Hospital Municipal Odilon Behrens, Belo Horizonte, MG, Brazil. METHODS: Patients at the anticoagulation clinic were recruited between August and October 2011, with minimum follow-up of four weeks. Operational and non-operational costs were calculated and corrected to 2015. RESULTS: This study included 633 patients (59% women) of median age 62 years (interquartile range 49-73). The mean length of follow-up was 64 ± 28 days. The average cost per patient per month was $54.26 (US dollars). Direct costs accounted for 32.5$ 49.87, $51.40 and$ 52.16 per patient per month, respectively, which was lower than the costs relating to warfarin treatment. CONCLUSION: In the Brazilian context, from the perspective of society and the public healthcare system, the cumulative costs per patient using warfarin with follow-up in anticoagulation clinics is currently higher than the strategy of prescribing the new oral anticoagulants