Effectiveness and safety of vedolizumab for treatment of Crohn's disease : a systematic review and meta-analysis

Introduction: The aim of this systematic review (SR) and meta-analysis was to assess the efficacy and safety of vedolizumab in the treatment of Crohn’s disease (CD). Material and methods: A systematic literature search was conducted in Medline/PubMed, Embase and Cochrane Library until 25 January, 2015. Included studies were critically appraised according to the PRISMA protocol. Assessment in specified subgroups of CD patients and meta-analysis with Revman software were performed. Results: Two randomized controlled trial (RCTs) were included in a meta-analysis for the induction phase of therapy: GEMINI II and GEMINI III. The clinical response was significantly higher for patients who received vedolizumab compared to placebo in the general population (risk benefit (RB) = 1.48; p = 0.0006) and in both analyzed subgroups: patients with previous failure of anti-TNFs treatment (RB = 1.51; p = 0.006) and patients naive to earlier anti-TNFs (RB = 1.41; p = 0.001). The clinical remission in the general population and subpopulation of TNF-antagonist naive patients was significantly higher for patients who received vedolizumab compared to placebo (RB = 1.77; p = 0.003; RB = 2.29; p = 0.0004; respectively). Meta-analysis for adverse events, serious adverse events (SAEs) and serious infections, revealed that vedolizumab was as safe as placebo in the induction phase of therapy. Conclusions: The clinical response was significantly higher for patients who received vedolizumab in the general population and in both analyzed subgroups of patients. The clinical remission in the general population and subpopulation of TNF-antagonist naive patients was significantly higher for vedolizumab, but no significant differences were revealed in the subgroup of patients with previous TNF antagonist failure

Analysis of expenditure on health care in OECD countries in the period of 2000 – 2009

Celem przedstawianej pracy magisterskiej jest dokonanie porównania i ocena nakładów finansowych przeznaczanych na opiekę zdrowotną w krajach członkowskich OECD w latach 2000-2009. Kolejnym celem jest sprawdzenie czy i w jakim stopniu poziom i struktura źródeł finansowania wydatków na zdrowie zależy od zamożności krajów mierzonej produktem krajowym brutto per capita. Analizie poddane zostały udziały w PKB wydatków na ochronę zdrowia w PKB, struktura tych nakładów według źródeł pochodzenia środków oraz poziomy wydatków per capita (USD PPP) według źródeł finansowania. W wyniku przeprowadzonej analizy zaobserwowano dominującą rolę publicznych środków w finansowaniu opieki zdrowotnej w krajach członkowskich oraz rosnący poziom nakładów sektora publicznego jak i prywatnego. Dokonana analiza potwierdziła założenie, że poziom wydatków na zdrowie jest ściśle związany z zamożnością krajów, im państwa bogatsze tym nakłady są wyższe. Jednak kraje z grupy najbiedniejszej wykazują najwyższą dynamikę wzrostu wydatków publicznych, choć ta w dużej mierze dyktowana jest przez niskie wartości wyjściowe. W krajach najbogatszych i najbiedniejszych zauważono także wysoki poziom prywatnych nakładów na zdrowie. O ile jednak w grupie krajów bogatych środki prywatne pochodzą głównie z prywatnych ubezpieczeń zdrowotnych to w grupie krajów biedniejszych dominują bezpośrednie wydatki gospodarstw domowych.The MA Thesis presented here aims at comparing and assessing financial means allocated to health care in the OECD member countries in the period of 2000 - 2009. Another aim is to determine, whether, and on what level, the structure of sources of financial means spent on health depends on richness of a country, measured by its gross domestic product per capita. The health care's expenditure share in GDP was analyzed, as well as the structure of this spending according to the source of resources and level of spending per capita (USD PPP) by financing sources.As a result of the analysis provided, the dominant role of public financing sources on health care in the member countries and the rising level of outlays in the public sector, as well as in the private one, were observed. The mentioned analysis confirmed the assumption, that the level of spending on health is strictly connected to the richness of a country: the richer the country, the bigger the spending. Still, the poorest countries are the ones presenting the greatest dynamics in the growth of public spending, but it is dictated by low output value. In both the poorest and the richest countries, high level of private spending on health was observed. But while in the group of rich countries private sources come mainly from the private health insurances, in the poor countries out of pocket payments dominate