Farmacia Hospitalaria (English Edition)最新文献_第10页

Factors associated with adherence in HIV patients HIV患者依从性的相关因素

Farmacia Hospitalaria (English Edition)

Pub Date : 2009-01-01 Epub Date: 2012-02-20 DOI: 10.1016/S2173-5085(09)70063-2

A. Arrondo Velasco , M.L. Sainz Suberviola , E.M. Andrés Esteban , A.I. Iruin Sanz , V. Napal Lecumberri

Objective

To establish the relationship between the adherence to ARVT and the clinical situation and detect those factors which relate to the lack of adherence.

Method

Observational study on HIV patients who had attended the Pharmacy Service in Hospital de Navarra between February and May 2005. The SMAQ questionnaire and pharmacy dispensing records were used to assess adherence to treatment. Socio-demographic variables and other factors which could influence adherence were recorded. Statistical analysis was carried out using the SPSS programme, version 14.0.

Results

No concordance was noted between the 2 measurements of adherence, although there was an association between the viral load and compliance, irrespective of the method used. The questionnaire recorded a higher percentage of non-adhering female patients, substance users and psychiatric patients. Non-adhering patients indicated more frequently factors which made taking the medication difficult. The multivariate analysis showed that the lack of a suitable social-familial environment negatively influenced the adherence level, according to the SMAQ questionnaire, and that the high number of tablets per dose was related to the lack of adherence according to the pharmacy dispensing records.

Conclusions

Patients who adhere to ARVT have a lesser risk of virological failure. An unsuitable social-familial environment and the complexity of treatment are associated with a lack of adherence. The method of using dispensing records should be combined with a patient interview to define the factors which reduce adherence and to propose intervention strategies.

目的探讨ARVT治疗依从性与临床情况的关系，并找出导致ARVT治疗依从性不足的相关因素。方法对2005年2 - 5月在纳瓦拉医院药房就诊的HIV患者进行观察研究。使用SMAQ问卷和药房调剂记录来评估治疗依从性。记录可能影响依从性的社会人口变量和其他因素。采用SPSS软件14.0进行统计分析。结果:尽管病毒载量和依从性之间存在关联，但无论使用何种方法，两种依从性测量结果之间没有一致性。调查问卷显示，不坚持服药的女性患者、药物使用者和精神病患者的比例较高。非依从性患者更频繁地指出使服药困难的因素。多因素分析显示，SMAQ问卷显示，缺乏合适的社会家庭环境对依从性水平有负向影响，药房调剂记录显示，单剂量片数高与依从性缺乏有关。结论坚持ARVT治疗的患者病毒学失败的风险较低。不适宜的社会家庭环境和治疗的复杂性与缺乏依从性有关。使用配药记录的方法应与患者访谈相结合，以确定降低依从性的因素并提出干预策略。

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引用次数: 1

Quality of interaction database management systems 交互数据库管理系统的质量

Farmacia Hospitalaria (English Edition)

Pub Date : 2009-01-01 Epub Date: 2012-02-20 DOI: 10.1016/S2173-5085(09)70079-6

A. Rodríguez-Terol , M.O. Caraballo , D. Palma , B. Santos-Ramos , T. Molina , T. Desongles , A. Aguilar

Objective

To identify drug interaction databases (DID) and assess the quality of their structures.

Method

A search was made of the literature for DID and a series of exclusion and structural quality criteria were defined (at least 4 quality criteria: classification according to severity, classification according to level of evidence, bibliographical reference data, description of clinical management, and 11 criteria used for weighting). The level of compliance of every DID with the criteria defined was analysed, together with the level of compliance of each criteria in each DID.

Results

A total of 54 DID were identified, 30 of which complied with exclusion criteria and 15 of which did not meet the minimum criteria. The rest of the criteria were evaluated in 9 DID: Botplus and Medinteract (100%), SEFH Guide, Lexi-interact and Medscape (89%), Hansten (83%), Micromedex and Stockley (78%), Drug Interactions Facts (68%). Ninety-two percent of the DID describe the mechanism of action, 87% classify the information according to the active ingredient, 75% do not state they have any conflict of interest, classify according to level of severity, have electronic format, and are easy to search. A total of 67% are specific DID, 62% are classified according to level of evidence, contain bibliographical references, and describe clinical management.

Conclusions

A third of the DID comply with the minimum criteria. Differences were observed in the level and compliance criteria among Spanish and foreign DID. Some of the main DID used as references in the bibliography have significant structural defects: no web presentation, no multi-check function and others.

目的鉴定药物相互作用数据库(DID)并评价其结构质量。方法对DID文献进行检索，定义一系列排除性和结构性质量标准(至少4个质量标准:按严重程度分类、按证据水平分类、参考文献资料分类、临床管理描述和11个标准加权)。分析了每个DID对所定义标准的遵守程度，以及每个DID中每个标准的遵守程度。结果共检出54例，其中符合排除标准的30例，不符合最低标准的15例。其余标准在9个DID中进行评估:Botplus和Medinteract (100%)， SEFH Guide, lexex -interact和Medscape (89%)， Hansten (83%)， Micromedex和Stockley(78%)，药物相互作用事实(68%)。92%的DID描述了作用机制，87%的DID根据有效成分对信息进行分类，75%的DID没有说明它们有任何利益冲突，根据严重程度进行分类，具有电子格式，并且易于搜索。共有67%是特定的DID, 62%根据证据水平分类，包含参考书目，并描述临床管理。结论三分之一的患者符合最低标准。在西班牙和外国DID的水平和依从性标准上观察到差异。参考书目中作为参考文献使用的一些主要DID存在明显的结构缺陷:没有网页显示，没有多重检查功能等。

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引用次数: 24

Biologic therapies for systemic autoimmune diseases. Are expectations met? 系统性自身免疫性疾病的生物疗法。是否达到了预期?

Farmacia Hospitalaria (English Edition)

Pub Date : 2009-01-01 Epub Date: 2012-02-20 DOI: 10.1016/S2173-5085(09)70070-X

L. Pallarés Ferreres , M. Ramos-Casals

引用次数: 0

Therapeutic use and profile of toxicity of the FOLFOX4 regimen FOLFOX4方案的治疗用途和毒性概况

Farmacia Hospitalaria (English Edition)

Pub Date : 2009-01-01 Epub Date: 2012-02-20 DOI: 10.1016/S2173-5085(09)70074-7

B. Fernández-Lobato , M.S. Díaz-Carrasco , A. Pareja , M. Marín , N. Vila , A. de la Rubia

Introduction

Since the publication of the MOSAIC test results in 2004, the FOLFOX4 regimen has been established as an adjuvant treatment which is recommended in stage III colorectal cancer. The aim of this study is to assess the use of this regimen in our field and to describe its toxicity.

Methods

Descriptive study of treatments with FOLFOX4 prescribed between April 2005 and March 2007. The data was obtained from the Farhos Oncología® programme and clinical records. The following data was collected: age, gender, diagnosis, stage of the illness (TNM classification), and adverse reactions, expressing severity according to Common Toxicity Criteria 2.0.

Results

The FOLFOX4 regimen was prescribed for 39 patients (24 men and 15 women) with an average age of 59. The diagnoses were: 28 colon cancer (4 stage II, 17 stage III, and 7 stage IV), 10 rectal cancer (1 stage II, 4 stage III, and 5 stage IV), and 1 stage IV gastric cancer. The most frequent adverse reactions were peripheral neuropathy (82%), neutropaenia (56.4%), and diarrhoea (53.9%). When the study was completed, 9 patients continued active treatment with the regimen (average, 6.8 cycles). Of the 30 remaining patients only 16 people completed the 12 planned cycles. Forteen patients stopped their treatment (average, 8.1 cycles) due to toxicity in 10 cases, clinical progression in 3 cases, and 1 patient died. Of the total 368 cycles administered, 68 suffered administration delays and 22 had the dosage reduced.

Conclusion

The use of the FOLFOX4 regimen has been adjusted to uses with some solid scientific evidence, but its toxicity has limited its use and has made administering the planned dosage levels difficult.

自2004年MOSAIC试验结果发表以来，FOLFOX4方案已被确立为推荐用于III期结直肠癌的辅助治疗。本研究的目的是评估该方案在我们领域的使用，并描述其毒性。方法对2005年4月至2007年3月间使用FOLFOX4治疗的病例进行描述性研究。数据来自Farhos Oncología®项目和临床记录。收集以下资料:年龄、性别、诊断、疾病分期(TNM分类)、不良反应，按照通用毒性标准2.0表达严重程度。结果39例患者采用FOLFOX4方案治疗，其中男性24例，女性15例，平均年龄59岁。诊断为:28例结肠癌(4例II期，17例III期，7例IV期)，10例直肠癌(1例II期，4例III期，5例IV期)，1例IV期胃癌。最常见的不良反应是周围神经病变(82%)、中性粒细胞减少(56.4%)和腹泻(53.9%)。当研究完成时，9名患者继续积极治疗该方案(平均，6.8周期)。在剩下的30名患者中，只有16人完成了计划的12个周期。14例患者因毒副作用停药10例(平均8.1周期)，3例临床进展，1例死亡。在总共368个疗程中，68个疗程出现给药延迟，22个疗程剂量减少。结论FOLFOX4方案的使用已经有了一些可靠的科学依据，但其毒性限制了其使用，并使其难以达到计划剂量水平。

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引用次数: 4

Negative results related to drugs required in hospitalisation 与住院期间所需药物相关的阴性结果

Farmacia Hospitalaria (English Edition)

Pub Date : 2009-01-01 Epub Date: 2012-02-20 DOI: 10.1016/S2173-5085(09)70064-4

A. Santamaría-Pablos , C. Redondo-Figuero , M.I. Baena , M.J. Faus , R. Tejido , O. Acha , F.J. Novo

Objective

To assess the prevalence of negative clinical outcomes associated with medication as a cause of hospital admission and to determine their characteristics (types, categories, avoidability, severity, and the drug groups involved). To determine possible risk factors related to the appearance of this problem.

Method

An observational study carried out over a 3 month period in a department of the university hospital, 163 patients were selected at random. The information obtained from the patient interview, the revision of clinical records and clinical sessions were used to then identify negative clinical outcomes using the Dader method.

Results

In 27 cases (16.6%; 95% confidence interval [CI], 1.6–23.0), negative clinical outcomes associated with medication were considered to be the main cause of hospital admission. The most frequent negative clinical outcomes associated with medication were untreated health problems, non-quantitative ineffectiveness, and quantitative safety problems respectively. The overall prevalence of preventable admissions due to negative clinical outcomes associated with medication was 88.9%; (95% CI, 71.9–96.1). With regards to severity, 74.1% (95% CI, 55.3–86.1) of the total admissions were moderate. The most common drugs implicated in hospital admissions were: antibacterial for systemic use, cardiovascular, and non steroidal anti-inflammatory agents. Apart from age, no other factors were found for hospital admissions due to negative results associated with medication.

Conclusions

Negative clinical outcomes associated with medication as cause of hospital admission are a prevalent problem and most of them are avoidable with pharmacotherapeutic follow-up.

目的评估与药物治疗相关的不良临床结果的发生率，并确定其特征(类型、类别、可避免性、严重程度和涉及的药物组)。确定与该问题出现相关的可能风险因素。方法在大学附属医院某科室进行为期3个月的观察性研究，随机抽取163例患者。从患者访谈、临床记录的修订和临床会话中获得的信息，然后使用Dader方法确定阴性临床结果。结果27例(16.6%);95%可信区间[CI]， 1.6-23.0)，与药物相关的临床不良结果被认为是住院的主要原因。与药物相关的最常见的负面临床结果分别是未经治疗的健康问题、非定量的无效和定量的安全性问题。由于与药物相关的负面临床结果导致的可预防入院的总体患病率为88.9%;(95% ci, 71.9-96.1)。在严重程度方面，74.1% (95% CI, 55.3-86.1)的患者为中度。与住院有关的最常见药物是:全身使用的抗菌药物、心血管药物和非甾体抗炎药。除年龄外，没有发现其他因素与药物相关的负面结果有关。结论以药物治疗为住院原因的临床不良反应是一个普遍存在的问题，其中大部分通过药物治疗随访是可以避免的。

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引用次数: 4

Establishment of a quality indicator for pharmaceutical care 建立药学服务质量指标

Farmacia Hospitalaria (English Edition)

Pub Date : 2009-01-01 Epub Date: 2012-02-20 DOI: 10.1016/S2173-5085(09)70093-0

M. Gaspar , M. Caja , I. Romero , L. Moreno Royo , A. García-Vivó , V. Tudela , M. Piquer

Objective

To establish a quality indicator for pharmaceutical care in an integral system for personalised medication dispensing (ISPMD) with electronic prescription.

Methods

Descriptive transversal study. Period: 2007. On a daily basis, we revised the pharmaceutical treatment of patients admitted to hospital units with ISPMD. Study variables: a) suitability of pharmaceutical interventions: important or very important; b) acceptance of those interventions. The LASER® method was used to identify patients with improvement opportunities.

Results

In absolute terms (mean [SD]): important pharmaceutical interventions, 26.6 (14.8); very important, 31.5 (24.6); acceptance, 57.5 (25.9). Percentages (95% CI): pharmaceutical interventions: important, 33.7 (9.3–58.0); very important, 39.80 (17.7–62.2); acceptance, 72.6 (64.7–80.5).

Conclusions

Implementation of the quality indicator for pharmaceutical care allowed us to evaluate the clinical significance and the acceptance rate of the pharmaceutical care being provided.

目的建立电子处方个性化配药集成系统中药学服务质量指标。方法描述性横向研究。期:2007。我们每天都在修改医院收治的ISPMD患者的药物治疗方案。研究变量:a)药物干预的适宜性:重要或非常重要;B)接受这些干预措施。使用LASER®方法识别有改善机会的患者。结果绝对项(mean [SD]):重要药物干预措施26.6 (14.8);非常重要，31.5 (24.6);验收，57.5(25.9)。百分比(95% CI):药物干预:重要，33.7 (9.3-58.0);非常重要，39.80 (17.7-62.2);验收，72.6(64.7-80.5)。结论实施药学服务质量指标，可以对所提供的药学服务的临床意义和接受程度进行评价。

{"title":"Establishment of a quality indicator for pharmaceutical care","authors":"M. Gaspar , M. Caja , I. Romero , L. Moreno Royo , A. García-Vivó , V. Tudela , M. Piquer","doi":"10.1016/S2173-5085(09)70093-0","DOIUrl":"10.1016/S2173-5085(09)70093-0","url":null,"abstract":"<div><h3>Objective</h3><p>To establish a quality indicator for pharmaceutical care in an integral system for personalised medication dispensing (ISPMD) with electronic prescription.</p></div><div><h3>Methods</h3><p>Descriptive transversal study. Period: 2007. On a daily basis, we revised the pharmaceutical treatment of patients admitted to hospital units with ISPMD. Study variables: a) suitability of pharmaceutical interventions: important or very important; b) acceptance of those interventions. The LASER® method was used to identify patients with improvement opportunities.</p></div><div><h3>Results</h3><p>In absolute terms (mean [SD]): important pharmaceutical interventions, 26.6 (14.8); very important, 31.5 (24.6); acceptance, 57.5 (25.9). Percentages (95% CI): pharmaceutical interventions: important, 33.7 (9.3–58.0); very important, 39.80 (17.7–62.2); acceptance, 72.6 (64.7–80.5).</p></div><div><h3>Conclusions</h3><p>Implementation of the quality indicator for pharmaceutical care allowed us to evaluate the clinical significance and the acceptance rate of the pharmaceutical care being provided.</p></div>","PeriodicalId":100521,"journal":{"name":"Farmacia Hospitalaria (English Edition)","volume":"33 6","pages":"Pages 296-304"},"PeriodicalIF":0.0,"publicationDate":"2009-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S2173-5085(09)70093-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73758100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Study of rituximab efficacy, cost, safety, and compliance of its package leaflet in a tertiary hospital 某三级医院利妥昔单抗疗效、成本、安全性及包装说明书依从性的研究

Farmacia Hospitalaria (English Edition)

Pub Date : 2009-01-01 Epub Date: 2012-02-20 DOI: 10.1016/S2173-5085(09)70094-2

M.C. Conde García , M.A. Fernández Feijoo , M.A. Calleja Hernández

Introduction

The appearance of monoclonal antibodies, and specifically, rituximab, has provided a new approach to treating non-Hodgkin's lymphomas and rheumatoid arthritis. The purpose of this study is to analyse whether this drug is used according to its package leaflet in clinical practice, evaluate the treatment's efficacy, and determine its cost.

Methods

Ambispective, observational single-centre study of medication use set up as a prescription evaluation for the indication of rituximab in a tertiary hospital between March 2003 and December 31, 2007.

Results

Eighty-two of the 221 patients who were treated (37.1%) received the drug for a condition that does not appear in the package leaflet. Fifty-one point one percent and 27.5% of response and progression were registered for approved diagnoses and 34.9% and 47% for nonapproved diagnoses; the death rate was 25.3% and 41.5% respectively. The mean cost per treatment episode was the highest for idiopathic thrombocytopaenic purpura (#euro11 683), whilst the highest treatment cost per patient was associated with follicular lymphoma (€15 940).

Discussion

We found that the main cause of the high rate of non-compliance with the package leaflet is patient lack of response to standard treatments, together with clinical practice guides that support the use of rituximab for conditions other than those for which it is indicated. Nevertheless, most of the clinical trials evaluating the efficacy of rituximab for these unauthorised diagnostic profiles have poor methodology, are in phase II, are open studies, have low patient numbers, or in some cases, are not comparative.

单克隆抗体的出现，特别是利妥昔单抗的出现，为治疗非霍奇金淋巴瘤和类风湿性关节炎提供了新的途径。本研究的目的是分析该药物在临床实践中是否按照其包装说明书使用，评估治疗效果，确定其成本。方法对2003年3月至2007年12月31日某三级医院利妥昔单抗适应症处方用药情况进行双视角、单中心观察性研究。结果221例患者中，有82例(37.1%)的用药情况未在药品说明书中注明。批准诊断的缓解率和进展率分别为51.1%和27.5%，未批准诊断的缓解率和进展率分别为34.9%和47%;死亡率分别为25.3%和41.5%。特发性血小板减少性紫癜每次治疗的平均费用最高(11 683欧元)，而每位患者的最高治疗费用与滤泡性淋巴瘤相关(15 940欧元)。我们发现，不遵守包装说明书的高发生率的主要原因是患者对标准治疗缺乏反应，以及临床实践指南支持使用利妥昔单抗治疗非指征性疾病。然而，大多数评估利妥昔单抗对这些未经授权的诊断特征的疗效的临床试验方法不佳，处于II期，是开放研究，患者人数少，或者在某些情况下，不具有可比性。

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引用次数: 3

The influence of alternative medicine in highly active antiretroviral treatment 替代药物对高活性抗逆转录病毒治疗的影响

Farmacia Hospitalaria (English Edition)

Pub Date : 2009-01-01 Epub Date: 2012-02-20 DOI: 10.1016/S2173-5085(09)70066-8

M. Vázquez Hernández , M.F. Hurtado Gómez , J.R. Blanco

Objective

Over the last few years, there has been a notable increase in the use of alternative medicine by the general population. The aim of this study is 2-fold. Firstly we will analyse the incidence of the use of medicinal plants in patients with HIV undergoing Highly Active Anti-Retroviral Therapy (HAART). Secondly, with the help of existing bibliographic information, we want to study the existence of possible interactions.

Material and method

We carried out a prospective study with a targeted interview (October to December 2007) on consenting patients with HIV undergoing HAART treatment.

Results

Of the 193 patients that agreed to take part in the survey, 16.6% confirmed they used alternative medicinal therapies. In 46% of the cases there was a potential interaction with the effectiveness of HAART. Forty-six percent of the potential interactions were in the case of the patients who used grapefruit as an alternative medicine, 21% in the case of patients using thistle and Echinacea respectively, 4% for those using omega-3, Chinese herbs, and ginseng.

Conclusion

There is a significant use of natural products by these groups of patients, of which a significant percentage interact with HAART. A better understanding of the possible interactions with HAART and improved information offered to patients with HIV is needed.

目的在过去的几年里，普通人群中替代医学的使用有了显著的增加。这项研究的目的是双重的。首先，我们将分析在接受高效抗逆转录病毒治疗(HAART)的艾滋病毒患者中使用药用植物的发生率。其次，借助已有的书目信息，研究可能存在的交互作用。材料与方法我们在2007年10月至12月对接受HAART治疗的HIV患者进行了一项前瞻性研究。结果在同意参加调查的193名患者中，16.6%的人确认他们使用了替代药物疗法。在46%的病例中，与HAART的有效性存在潜在的相互作用。46%的潜在相互作用发生在使用葡萄柚作为替代药物的患者中，21%的患者分别使用蓟和紫锥菊，4%的患者使用omega-3，中草药和人参。结论这类患者大量使用天然药物，其中与HAART相互作用的比例较高。需要更好地了解与HAART的可能相互作用，并改进向艾滋病毒患者提供的信息。

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引用次数: 9

Work of a multidisciplinary team in the control of the prescription of ertapenem 多学科团队在厄他培南处方控制中的工作

Farmacia Hospitalaria (English Edition)

Pub Date : 2009-01-01 Epub Date: 2012-02-20 DOI: 10.1016/S2173-5085(09)70069-3

M.V. Gil-Navarro , R. Muñoz-Corte , M. Herrero Romero , M.D. Santos Rubio , E. Cordero Matía , J. Bautista Paloma

Objective

To determine the effectiveness of the intervention of a multidiscipline antimicrobial control group in the correct prescription of Ertapenem.

Method

A 4-month long, prospective study into prescriptions for ertapenem was carried out in a third-level hospital. Assessment into the degree of suitability of each prescription according to the infections commission usage criteria. In the situation where prescriptions were not suitable, recommendations were given and acceptance of this was recorded. The effectiveness of the antimicrobial treatment used was assessed and treatment was considered effective when there was remission of the signs and symptoms of the infection when the treatment was completed. The treatment was considered to have failed when the signs and symptoms of infection persisted or progressed, requiring the addition of another antimicrobial agent, changing antibiotics or the prolongation of the treatment for longer than 2 weeks. Lastly, the differences in the average length of stay and the duration of the antibiotic treatment between groups were analysed.

Results

Forty-eight prescriptions were assessed. The usage criterion was adequate in 48% of cases, with 78% effectiveness in this group. In the cases where the prescription was not adequate, but a change in prescription was accepted, the effectiveness was 92%, with 55.5% of those cases not accepting recommendation for change. The average stay was higher in this last group (P=.07). The duration of the antibiotic treatment in the patients who accepted the change in prescription was significantly less than in those who did not accept it (2 vs 7.4 days, P<.0001).

Conclusions

The control of ertapenem prescriptions by a multidisciplinary group was effective.

目的探讨多学科抗菌对照组对厄他培南正确处方的干预效果。方法在某三级医院对厄他培南的处方进行为期4个月的前瞻性研究。根据感染委员会的使用标准对各处方的适宜程度进行评估。在处方不合适的情况下，提出建议并记录接受情况。评估所使用的抗菌素治疗的有效性，当治疗完成后感染的体征和症状缓解时，认为治疗有效。当感染的体征和症状持续或进展，需要添加另一种抗菌剂，更换抗生素或延长治疗时间超过2周时，则认为治疗失败。最后，分析了组间平均住院时间和抗生素治疗持续时间的差异。结果共评价处方48张。使用标准在48%的病例中是适当的，在该组中有78%的有效性。在处方不充分但接受改变处方的情况下，有效性为92%，其中55.5%的病例不接受改变建议。最后一组的平均住院时间更长(P=.07)。接受处方改变的患者的抗生素治疗持续时间明显少于未接受处方改变的患者(2天vs 7.4天，p < 0.01)。结论多学科组对厄他培南处方的控制是有效的。

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引用次数: 1

Budget impact of a set-dose combination of efavirenz-emtricitabine-tenofovir in the treatment of patients infected with HIV-1 依非韦伦-恩曲他滨-替诺福韦固定剂量联合治疗HIV-1感染患者的预算影响

Farmacia Hospitalaria (English Edition)

Pub Date : 2009-01-01 Epub Date: 2012-02-20 DOI: 10.1016/S2173-5085(09)70090-5

Itziar Oyagüez , Miguel A. Casado , Manuel Cotarelo , Antonio Ramírez-Arellano , Josep Mallolas

Objective

Estimate the budgetary impact of using a set-dose combination of efavirenz-emtricitabine-tenofovir for the Spanish health care system's treatment of patients infected with HIV-1, while evaluating repercussions for each autonomous community in 2008.

Methods

We developed a budgetary impact model with pharmacological costs for the different currently available treatment options, based on GeSida's recommended guidelines for treating HIV-positive patients. The model defines 5 possible scenarios in which various possibilities for substituting different drug cocktails with the efavirenz-emtricitabine-enofovir combination are contemplated.

Results

The investment per patient on a national level amounts to €7989 in the base scenario (without considering the availability of the efavirenz-emtricitabine-tenofovir combination) and to €7997, €8424, €7830, €8375, and €8527 for scenario 1 (substitution of recommended drugs with efavirenz, emtricitabine, and tenofovir or efavirenz, lamivudine, and tenofovir); scenario 2 (substitution of recommended drugs with efavirenz); scenario 3 (substitution of recommended drugs with tenofovir); scenario 4 (substitution of recommended drugs with tenoforvir or zidovudine); and scenario 5 (total substitution), respectively. Compared with the base scenario this means increments of 0.11%, 5.45%, −1.99%, 4.83%, and 6.73% for scenarios 1, 2, 3, 4, and 5.

Conclusion

Use of a set combination of efavirenz, emtricitabine and tenofovir to treat adult patients with the HIV-1 virus would lead to slight surpluses or even budgetary savings by decreasing the number of daily doses, which could increase patients’ quality of life and help them stay on the treatment properly.

目的评估2008年西班牙卫生保健系统对HIV-1感染患者使用固定剂量的依非韦伦-恩曲他滨-替诺福韦组合治疗的预算影响，同时评估对每个自治区的影响。方法:基于GeSida推荐的hiv阳性患者治疗指南，我们针对不同的现有治疗方案开发了药理学成本预算影响模型。该模型定义了5种可能的情况，其中考虑了用依非韦伦-恩曲他滨-依诺福韦组合替代不同药物鸡尾酒的各种可能性。结果在国家层面上，基本方案(不考虑依非韦伦-恩曲他滨-替诺福韦联合用药的可获得性)的人均投资为7989欧元，方案1(以依非韦伦、恩曲他滨和替诺福韦替代推荐药物)的人均投资为7997欧元、8424欧元、7830欧元、8375欧元和8527欧元;情景2(用依非韦伦替代推荐药物);情景3(替诺福韦替代推荐药物);情景4(用替诺福韦或齐多夫定替代推荐药物);和场景5(完全替代)。与基本场景相比，这意味着场景1、2、3、4和5的增量分别为0.11%、5.45%、−1.99%、4.83%和6.73%。结论采用依非韦伦、恩曲他滨和替诺福韦联合治疗成人HIV-1病毒患者，可减少日用药剂量，使治疗费用略有盈余甚至节省预算，提高患者的生活质量，有利于患者正确坚持治疗。

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引用次数: 5