Avaliação econômica de Vildagliptina para o tratamento de pessoas vivendo com Diabetes Mellitus Tipo 2: perspectiva do Sistema Público de Saúde Brasileiro
Notice bibliographique
Résumé
In Brazil, health is a citizens right. To ensure it, Brazil has adopted a universal system - the Unified Health System (SUS), which has to perform integrated therapeutic care actions, including pharmaceutical services. One of the steps in pharmaceutical services is the selection of medicines. To support a choice between treatments has gained importance the set of concepts and methods called Health Technology Assessment. This approach uses scientific and economic evidence to support the health decisions. In Brazil, about 6% of all deaths are attributed to diabetes mellitus and 41% of them occur before the age of seventy. Among people living with this disease, type 2 diabetes mellitus (T2DM) is the type diagnosed in 85% to 95% of them. In Brazil, the drugs considered essential by SUS for people living with T2DM are metformin, glibenclamide, gliclazide, regular insulin and NPH insulin. Patients with a medical prescription of other drugs go to court to force the SUS to provide them. In Minas Gerais, vildagliptin was the most frequently acquired oral hypoglycemic agent to meet legal demands. The aim of this study is to define the cost-effectiveness of vildagliptin for the treatment of people living with T2DM. A cross-sectional study was conducted to identify the average price recorded for purchases of oral hypoglycemic agents by SUS. These prices were compared to federal subsidies in the "Aqui Tem Farmácia Popular" co-pay program and to reimbursements from other countries with universal health systems - Portugal, Spain, Canada and the United Kingdom. A systematic review of the literature was conducted to obtain data on the efficacy and effectiveness of vildagliptin-containing treatments and its comparators. Markov models were built to establish the cost-effectiveness of vildagliptin-containing treatments. Probabilistic sensitivity analysis was performed to evaluate the uncertainties of models and a GDP per capita was considered as the willingness to pay threshold. The amount subsidized by the federal government for each essential drug tablet for T2DM may reach 1023% of the average value of the SUS acquisitions. Overall, the average price in the SUS is lower than that reimbursed in other countries. On the other hand, the copayment with public funds in Brazil is higher than other studied countries. The incremental cost-effectiveness ratio (ICER) of vildagliptin monotherapy compared to metformin alone was approximately $ 20,000, considered above the willingness to pay in Brazil. For the comparison between associations with metformin, vildagliptin presented ICER of around $ 4,700. Evaluating data from observational studies, the ICER of dual vildagliptin-containing treatment was approximately $ 8,600. Although these two ICER are below established willingness to pay threshold, sensitivity analyzes have shown that these values are likely to be above a GDP per capita. Thus, according to the conditions of this study, it is not recommended to include vildagliptin- containing treatments in the SUS care line for the treatment of people living with T2DM.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,006 | 0,012 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,002 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».