Avaliação da custo-efetividade da dabigatrana na fibrilação atrial
Avaliação da custo-efetividade da dabigatrana na fibrilação atrial
Data
2015
Autores
Chevrand, Waldylene Pagoto
Journal Title
Journal ISSN
Volume Title
Publisher
Instituto Nacional de Cardiologia
Resumo
A Fibrilação Atrial (FA) acomete 0,4% a 1% da população geral e sua
prevalência aumenta com idade, podendo chegar a 8% em pacientes com mais de
80 anos. Com a inversão da pirâmide etária já em curso no Brasil, a análise
econômica de medicamentos utilizados nesta população é importante para sustentar
decisões de direcionamento de recursos da saúde.
Este estudo analisa através do desenho de uma árvore de decisão a custo
efetividade da Dabigatrana 150mg no tratamento da FA, tendo a Varfarina Sódica
5mg como comparador. Foi realizada uma busca na literatura científica a fim de
identificar ensaios clínicos randomizados (ECR) e revisões sistemáticas de ECR
publicados nas base de dados eletrônica MEDLINE via PUBMED, com dados de
probabilidade capazes de popular a árvore de decisão. Os dados de custos foram
extraídos das bases públicas Comprasnet, SIGTAP e DATASUS.
A construção da árvore de decisão identificou que as variáveis custo do
sangramento e probabilidade de embolizar dado que utilizou Varfarina, são as
variáveis que influenciam o modelo e para sua melhor avaliação foi realizada análise
de sensibilidade. Após as análises estatísticas foi possível identificar, que apesar de
não haver dominância a Varfarina 5mg é mais custo efetiva que a Dabigatrana
150mg no tratamento da FA. A razão incremental de custo efetividade (ICER) foi de
R$ 376.975,96 por morte evitada, sendo 5,2 vezes maior que a disposição a pagar
(WTP) de 3 vezes o PIB per capta.
Estudos apurados de segurança da Dabigatrana devem ser realizados afim
de se entender de forma mais acurada o motivo de interrupção de segmento do
tratamento, bem como a necessidade de ajustes de dose. Enquanto não houver
benefício econômico e tão pouco dados robustos sobre a segurança deste novo
anticoagulante oral, a Varfarina Sódica deve continuar a ser a opção de escolha no
Sistema Único de Saúde (SUS). Esta escolha que está embasada em resultados
favoráveis de custo efetividade, ainda pode ser potencializada com programas que
colaborem para o adequado uso deste medicamento, à exemplo da atenção
farmacêutica especializada.
Atrial Fibrillation (AF) affects 0.4% to 1% of the population and its prevalence increases with age, reaching 8% in patients over 80 years. With the inversion of the age pyramid already underway in Brazil, the economic analysis of drugs used in this population is important to sustain the health system of targeting decisions. This study analyzes through a decision tree drawing the cost effectiveness of Dabigatran 150mg to treat AF, taking Warfarin Sodium 5mg as comparator. A search was conducted in the scientific literature in order to identify randomized controlled trials (RCTs) and systematic reviews of RCTs published in electronic databases MEDLINE via PubMed, with probability data that could be applied in a decision tree. Cost data were collected in public databases Comprasnet, SIGTAP and DATASUS. The construction of the decision tree identified that the variable cost of bleeding and likely to embolize as used Warfarin are the variables that influence the model and a sensitivity analysis was performed. After statistical analysis it was possible to identify that although there is no dominance Warfarin 5mg is more cost effective that Dabigatran 150 mg in the treatment of AF. The incremental cost effectiveness ratio (ICER) was R$ 376,975.96, being 5.2 times greater than the willingness to pay (WTP) of 3 times GDP per capita. Calculated safety of Dabigatran studies should be performed in order to more accurately understand the reason for discontinuation of the treatment segment, as well as the need for dosage adjustments. Whilst there is no economic benefit and so little robust data on the safety of this new oral anticoagulant Warfarin Sodium should remain the option of choice in Brazilian Public Health System. This choice is based on favorable results of cost effectiveness that can be further boosted with programs that contribute to the proper use of this drug, as example the implementation of specialized pharmaceutical care.
Atrial Fibrillation (AF) affects 0.4% to 1% of the population and its prevalence increases with age, reaching 8% in patients over 80 years. With the inversion of the age pyramid already underway in Brazil, the economic analysis of drugs used in this population is important to sustain the health system of targeting decisions. This study analyzes through a decision tree drawing the cost effectiveness of Dabigatran 150mg to treat AF, taking Warfarin Sodium 5mg as comparator. A search was conducted in the scientific literature in order to identify randomized controlled trials (RCTs) and systematic reviews of RCTs published in electronic databases MEDLINE via PubMed, with probability data that could be applied in a decision tree. Cost data were collected in public databases Comprasnet, SIGTAP and DATASUS. The construction of the decision tree identified that the variable cost of bleeding and likely to embolize as used Warfarin are the variables that influence the model and a sensitivity analysis was performed. After statistical analysis it was possible to identify that although there is no dominance Warfarin 5mg is more cost effective that Dabigatran 150 mg in the treatment of AF. The incremental cost effectiveness ratio (ICER) was R$ 376,975.96, being 5.2 times greater than the willingness to pay (WTP) of 3 times GDP per capita. Calculated safety of Dabigatran studies should be performed in order to more accurately understand the reason for discontinuation of the treatment segment, as well as the need for dosage adjustments. Whilst there is no economic benefit and so little robust data on the safety of this new oral anticoagulant Warfarin Sodium should remain the option of choice in Brazilian Public Health System. This choice is based on favorable results of cost effectiveness that can be further boosted with programs that contribute to the proper use of this drug, as example the implementation of specialized pharmaceutical care.
Description
Palavras-chave
Custo-efetividade, Fibrilação atrial, Dabigatrana, Cost effectiveness, Atrial fibrillation, Dabigatran
Citação
Chevrand WP. Avaliação da custo-efetividade da dabigatrana na fibrilação atrial. Rio de Janeiro. Dissertação [Mestrado Profissional em Avaliação de Tecnologias em Saúde] Instituto Nacional de Cardiologia - INC; 2015.