Avaliação econômica das anticitocinas adalimumabe, etanercepte e infliximabe no tratamento da artrite reumatoide no Estado do Paraná

Este estudo objetivou realizar uma avaliação econômica das anticitocinas adalimumabe (ADA), etanercepte (ETA) e infliximabe (IFX) para o tratamento da artrite reumatoide no Estado do Paraná, sob a perspectiva do SUS. Os dados de eficácia e segurança dos tratamentos foram buscados na literatura, e os custos foram calculados com valores gastos pelo SUS para cada um dos tratamentos. Foi elaborado o modelo de Markov para obter a relação custo-efetividade de cada tratamento. A relação custo-efetividade incremental (ICER) comparado ao tratamento padrão também foi calculada para cada anticitocina. Análises de sensibilidade e taxas de desconto foram aplicadas. Na avaliação custo-efetividade, encontraram-se custos por QALY de R$511.633,00, R$ 437.486,00 e R$657.593,00 para ADA, ETA e IFX, respectivamente. O ICER por QALY foi R$ 628.124,00, R$509.974,00 e R$ 965.927,00 para ADA, ETA e IFX, respectivamente. Nas análises de sensibilidade, o ETA e o ADA apresentaram valores próximos. Cabe aos gestores públicos e aos médicos prescritores a escolha adequada para cada paciente, entre os tratamentos disponibilizados.This study aimed to perform an economic evaluation of anticytokines adalimumab (ADA), etanercept (ETA) and infliximab (IFX) for the treatment of rheumatoid arthritis in the State of Parana, in Brazil, in the perspective of the Brazilian Unified Health System. Data on efficacy and safety of treatment were collected in literature, and costs were calculated on the amounts spent by the Government for each treatment. A Markov model was performed to get the cost-effectiveness of each treatment. The incremental cost-effectiveness relationship (ICER) compared to a standard treatment was also calculated for each anticytokine. Sensitivity analysis and discount rates were applied. In assessing cost-effectiveness we found the following values (cost at R$per QALY): 511,633.00, 437,486.00 and 657,593.00 (respectively for ADA, ETA and IFX). The ICER (R$ per QALY) was 628,124.00, 509,974.00 and 965,927.00 (for ADA, ETA and IFX). In the sensitivity analysis, ETA and ADA showed similar values. It is for public managers and physicians the choice for each patient, among the treatments available

Histopathology from liver of tuvira (Gymnotus spp.) parasitized by larvae of nematodes.

Abstract: The aim of this study was to evaluate the histological changes in the liver of thirty-five Gymnotus spp. parasitized by endohelminths collected between April 2012 to October 2013 in commercial bait fish farming of Pantanal basin. Histological cuts of 7 micrometers were stained with hematoxylin-eosin for parasites research and liver changes and have also been submitted to the Perls histochemical method for evaluation of hemosiderosis (Fe+++) based on the incidence degree and severity of change (Grade I, II and III) and tests for the presence of central melanomacrophages. Parasites identified were: Brevimulticaecum sp. with a prevalence of 22,9%, Eustrongylides sp 17,1%, Contracaecum type I 68,7%, Contracaecum type II 5,7%, Contracaecum type III 5,7% and larvae of Anisakidae 11,4%. Histological analysis showed intense disorganization of hepatic parenchyma with degenerate hepatocytes due to high parasitic infection, changes that can be deleterious and compromise the organism functioning, being harmful to the health of evaluated animals. Also evidencing normal tissue interleaved with different stages of Fe+++ deposit in grades II and III, injuring or destroing the cell. Histopathological changes in the tuvira?s liver suggested a chronic response and the development of a balance relation between tuvira and parasitism by endohelminth identified in this study. There are also a testimony to the health condition of commercial bait fish farming on current ecosystem conditions.201