Publications (12) View all
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Article: [Antidiabetic Drugs and In-patient Admissions Attributable to Diabetes in Portugal].
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ABSTRACT: Introduction: The growth of oral antidiabetic drugs spending has led to concerns questioning the health gains and benefits for thehealth system generated by these drugs. This study contributes to answering these questions.Material and Methods: Initially we present estimates of the three variables central to the analysis: 1) the prevalence of treated diabetesper year and health region, based on the consumption of oral antidiabetic drugs, 2) the number of hospitalization episodes and theircosts attributable to diabetes, based on the relative risks and 3) a quantitative characterization of the consumption of oral antidiabeticsby calculating average vintages by year and region. Through the use of observations for 10 years and five regions, a total of 50 observations,it was possible to estimate an econometric model explaining statistically both hospitalizations and hospital costs attributable todiabetes by regional characteristics, treated prevalence and the average vintage of oral antidiabetic drugs.Results: The results of the multiple regression models show that hospital costs are proportional to the treated prevalence, all elseconstant, but that the more recent the oral antidiabetic drugs used, the lower are hospital costs. The effects on the number of hospitalizationsare similar.Discussion and Conclusions: For an average observation in the sample, if the average vintage of oral hypoglycemic agents had oneadditional year, then hospital costs would have a 5.3% reduction (about 11 million € in 2009) and the number of admissions would suffera 3.8% reduction (about 3965 less episodes in 2009). A counterfactual exercise allows us to estimate that for 2009 the introductionof the class of DPP IV inhibitors reduced the number of hospitalizations attributable to diabetes by 8480 and saved € 23.3 million inhospital costs.Acta medica portuguesa 09/2012; 25(5):323-31. · 0.09 Impact Factor -
Article: Clinical comparability of the new antiepileptic drugs in refractory partial epilepsy: a systematic review and meta-analysis.
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ABSTRACT: Evaluate the clinical comparability of new antiepileptic drugs (AEDs) in partial refractory epilepsy. Systematic review of randomized trials (RCTs) comparing a new AED (add-on treatment) with placebo or another AED. Primary outcomes: responder (≥50% seizure reduction) and withdrawal (tolerability) rates. Pooled estimates of odds ratios (ORs) and number needed treat/harm (NNT/NNH) taking into account baseline risk were derived by random-effects meta-analysis. Adjusted frequentist indirect comparisons between AEDs were estimated. Sixty-two placebo-controlled (12,902 patients) and eight head-to-head RCTs (1,370 patients) were included. Pooled ORs for responder and withdrawal rates (vs. placebo) were 3.00 [95% confidence interval (CI) 2.63-3.41] and 1.48 (1.30-1.68), respectively. Indirect comparisons of responder rate based on relative measurements of treatment effect (ORs) favored topiramate (1.52; 1.06-2.20) in comparison to all other AEDs, whereas gabapentin (0.67; 0.46-0.97) and lacosamide (0.66; 0.48-0.92) were less efficacious, without significant heterogeneity. When analyses were based on absolute estimates (NNTs), topiramate and levetiracetam were more efficacious, whereas gabapentin and tiagabine were less efficacious. Withdrawal rate was higher with oxcarbazepine (OR 1.60; 1.12-2.29) and topiramate (OR 1.68; 1.07-2.63), and lower with gabapentin (OR 0.65; 0.42-1.00) and levetiracetam (OR 0.62; 0.43-0.89). The differences found are of relatively small magnitude to allow a definitive conclusion about which new AED(s) has superior effectiveness. This uncertainty probably reflects the limitations of conclusions based on indirect evidence. The process of pharmacologic clinical decision making in partial refractory epilepsy probably depends more on other aspects, such as individual patient characteristics and pharmacoeconomics, than on available controlled randomized evidence.Epilepsia 07/2011; 52(7):1280-91. · 3.96 Impact Factor -
Article: [Clinical effectiveness and economical evaluation of preventive vaccination].
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ABSTRACT: The value of mass vaccination as a preventive measure for infectious diseases is one of the most important advances of modern Medicine. The impact on incidence of several infectious diseases, until recently responsible for significant morbidity and mortality at world level, is well proved in a series of high quality epidemiological studies. In this scientific review we aimed firstly to briefly resume the history of mass vaccination and its scientists, responsible for synthesis and marketing of these drugs. In second place we present a group of a few disease preventable by vaccines as well as the Portuguese National Vaccination Plan and its benefits. In third place we identified groups of subjects in which a well structured vaccination plan is particularly important, as well as the correspondent diseases to be covered by vaccination. Fourthly, we discussed the ethical considerations of vaccination, and its tensions between subject autonomy and society advantages in com pulsive programs. Fifthly, we analyzed clinical effectiveness of vaccines through the concept of herd immunity, clinical evaluation of immune response to vaccines and some examples of systematic reviews on three relevant diseases (influenza, meningococcal and pneumococcal infections). In sixth place we discussed vaccine safety presenting monitoring methods of vaccination risks, as well as discussing the public myths concerning vaccines. Finally we present a economic analysis of preventive vaccination with a review of some published literature on specific diseases. We conclude that mass vaccination is a efficacious preventive measure, as well as a economic rational choice, and that this public health intervention should be a pillar of a modern preventive system.Acta medica portuguesa 07/2011; 24(4):565-86. · 0.09 Impact Factor -
Article: The burden of disease and the cost of illness attributable to alcohol drinking--results of a national study.
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ABSTRACT: The World Health Organization estimated that 3.2% of the burden of disease around the world is attributable to the consumption of alcohol. The aim of this study is to estimate the burden of disease attributable to alcohol consumption in Portugal. Burden and costs of diseases attributable to alcohol drinking were estimated based on demographic and health statistics available for 2005, using the Disability-Adjusted Life Years (DALY) lost generated by death or disability. In Portugal, 3.8% of deaths are attributable to alcohol (4,059 of 107,839). After measuring the DALY generated by mortality data, the proportion of disease attributable to alcohol was 5.0%, with men having 5.6% of deaths and 6.2% of disease burden, while female figures were, respectively, 1.8 and 2.4%. Considering the sum of death and disability DALYs, liver diseases represented the main source of the burden attributable to alcohol with 31.5% of total DALYs, followed by traffic accidents (28.2%) and several types of cancer (19.2%). As for the cost of illness incurred by the health system, our results indicate that 95.1 millions euros are attributable to alcohol-related disease admissions (liver diseases, cancer, traffic accidents, and external causes) while the ambulatory costs of alcohol-related diseases were estimated in 95.9 million euros, totaling 191.0 million euros direct costs, representing 0.13% of Gross Domestic Product and 1.25% of total national health expenditures. An alternative analysis was carried out using higher consumption levels so as to replicate aggregate alcohol consumption statistics. In this case, DALYs lost increased by 11.7% and health costs by 23%. Our results confirm that alcohol is an important health risk factor in Portugal and a heavy economic burden for the health system, with hepatic diseases ranking first as a source of burden of disease attributable to alcohol.Alcoholism Clinical and Experimental Research 08/2010; 34(8):1442-9. · 3.34 Impact Factor -
Article: Efficacy of lipid lowering drug treatment for diabetic and non-diabetic patients: meta-analysis of randomised controlled trials.
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ABSTRACT: To evaluate the clinical benefit of lipid lowering drug treatment in patients with and without diabetes mellitus, for primary and secondary prevention. Systematic review and meta-analysis. Cochrane, Medline, Embase, and reference lists up to April 2004. Randomised, placebo controlled, double blind trials with a follow-up of at least three years that evaluated lipid lowering drug treatment in patients with and without diabetes mellitus. Two independent reviewers extracted data. The primary outcome was major coronary events defined as coronary heart disease death, non-fatal myocardial infarction, or myocardial revascularisation procedures. Twelve studies were included. Lipid lowering drug treatment was found to be at least as effective in diabetic patients as in non-diabetic patients. In primary prevention, the risk reduction for major coronary events was 21% (95% confidence interval 11% to 30%; P < 0.0001) in diabetic patients and 23% (12% to 33%; P = 0.0003) in non-diabetic patients. In secondary prevention, the corresponding risk reductions were 21% (10% to 31%; P = 0.0005) and 23% (19% to 26%; P < or = 0.00001). However, the absolute risk difference was three times higher in secondary prevention. When results were adjusted for baseline risk, diabetic patients benefited more in both primary and secondary prevention. Blood lipids were reduced to a similar degree in both groups. The evidence that lipid lowering drug treatment (especially statins) significantly reduce cardiovascular risk in diabetic and non-diabetic patients is strong and suggests that diabetic patients benefit more, in both primary and secondary prevention. Future research should define the threshold for treatment of these patients and the desired target lipid concentrations, especially for primary prevention.BMJ (Clinical research ed.). 06/2006; 332(7550):1115-24.
