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        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">The constant increase in health care costs&#44; in a context of limited resources and the appearance of more costly though more effective drugs&#44; justifies an assessment of the pharmacoeconomics of these drugs&#46; The objective of this study was to evaluate the cost-effectiveness of one of the newest drugs for the treatment of chronic obstructive pulmonary disease &#40;COPD&#41;-tiotropium&#46;</p> <span class="elsevierStyleSectionTitle">Material and method</span><p class="elsevierStyleSimplePara elsevierViewall">A cost-effectiveness analysis &#40;costs and outcomes&#41; within the framework of the Spanish National Health System was done&#46; The alternatives to tiotropium analyzed were ipratropium and salmeterol Direct health care costs associated with hospital treatment were calculated&#46; Forced expiratory volume in 1 second&#44; quality of life &#40;with the Saint George&#39;s Respiratory Questionnaire&#41;&#44; dyspnea transitional index&#44; mean stay in hospital&#44; and exacerbations were the variables used to measure effectiveness&#46; Values for these variables were taken from the main reviews and randomized clinical trials published for tiotropium&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">For COPD patients&#44; treatment with tiotropium leads to a greater reduction in exacerbations &#40;37&#37; compared to ipratropium and 25&#37; compared to salmeterol 25&#37;&#41;&#44; and a reduction in the number of days in hospital &#40;33&#37; compared to ipratropium and 14&#37; compared to salmeterol&#41;&#46; Therefore&#44; use of tiotropium could save &#8364;100&#8200;000 for the current rates of admission and lengths of hospital stay in Spain&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">Tiotropium was more effective than ipratropium and salmeterol as measured by objective clinical variables &#40;forced expiratory volume in 1 second&#41; and subjective ones &#40;the Saint George&#39;s Respiratory Questionnaire and dyspnea transitional index&#41;&#46; Hospital stays were shorter and exacerbations fewer with tiotropium&#46; In all cases&#44; tiotropium was more cost-effective than the alternatives&#44; thus use of tiotropium could help hospitals to save money&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">El incesante incremento de los costes en un marco en el que los recursos son limitados&#44; as&#237; como la apa-rici&#243;n de nuevos medicamentos m&#225;s costosos y a la vez m&#225;s eficaces&#44; justifica la evaluaci&#243;n econ&#243;mica de los medicamentos&#46; El objetivo de este trabajo es evaluar el coste-eficacia de uno de los f&#225;rmacos m&#225;s novedosos para el tratamien-to de la enfermedad pulmonar obstructiva cr&#243;nica &#40;EPOC&#41;&#44; el tiotropio&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todo</span><p class="elsevierStyleSimplePara elsevierViewall">Se ha realizado un an&#225;lisis de coste-eficacia &#40;costes y consecuencias&#41; desde la perspectiva del Sistema Nacional de Salud&#46; Las alternativas analizadas han sido ipratropio y salmeterol&#46; Se han considerado s&#243;lo costes sanitarios directos en el &#225;mbito hospitalario&#46; Los par&#225;me-tros de eficacia analizados han sido&#58; volumen espiratorio forzado en el primer segundo&#44; calidad de vida &#40;mediante el Saint George&#39;s Respiratory Questionnaire&#41;&#44; &#237;ndice transicio-nal de disnea&#44; estancias medias y exacerbaciones&#46; Dichos pa-r&#225;metros se han obtenido de las principales revisiones y en-sayos cl&#237;nicos aleatorizados publicados sobre el tiotropio&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">Teniendo en cuenta la reducci&#243;n del n&#250;mero de exacerbaciones conseguida con el tiotropio frente al ipratropio y salmeterol &#40;el 37 y el 25&#37;&#44; respectivamente&#41; y del n&#250;mero de d&#237;as de estancia hospitalaria &#40;el 33 y el 14&#37;&#44; respectivamente&#41;&#44; su utilizaci&#243;n puede suponer un ahorro superior a los 100&#46;000 &#8364; para las cifras actuales de tasa de ingresos y d&#237;as de estancia hospitalaria de los pacientes con EPOC en Espa&#241;a&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">El tiotropio ha sido m&#225;s efectivo que el ipratropio y salmeterol tanto en par&#225;metros cl&#237;nicos &#40;objetivos&#44; como el volumen espiratorio forzado en el primer segundo&#44; y subjetivos&#44; como el Saint George&#39;s Respiratory Questionnaire y el &#237;ndice transicional de disnea&#41; como en disminuci&#243;n de estancias hospitalarias y exacerbaciones&#46; En todos los casos re-sulta m&#225;s coste-efectivo que sus alternativas&#44; lo que supone im-portantes ahorros en el &#225;mbito hospitalario&#46;</p>"
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Vol. 41. Issue 5.
Pages 242-248 (May 2005)
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Vol. 41. Issue 5.
Pages 242-248 (May 2005)
Original Articles
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Cost-Effectiveness Analysis of Tiotropium Compared to Ipratropium and Salmeterol
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A.J. García Ruiza,
Corresponding author
ajgr@uma.es

Correspondence: Prof. A.J. García Ruiz Unidad de Farmacoeconomía e IRS. Departamento de Farmacología. Facultad de Medicina. Campus deTeatinos UMA. 29071 Málaga. España
, F. Leiva Fernándezb, F. Martos Crespoa
a Unidad de Farmacoeconomía e IRS, Departamento de Farmacología y Terapéutica Clínica, Universidad de Málaga, Málaga, Spain
b Unidad Docente de Medicina de Familia y Comunitaria de Málaga, Málaga, Spain
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Objective

The constant increase in health care costs, in a context of limited resources and the appearance of more costly though more effective drugs, justifies an assessment of the pharmacoeconomics of these drugs. The objective of this study was to evaluate the cost-effectiveness of one of the newest drugs for the treatment of chronic obstructive pulmonary disease (COPD)-tiotropium.

Material and method

A cost-effectiveness analysis (costs and outcomes) within the framework of the Spanish National Health System was done. The alternatives to tiotropium analyzed were ipratropium and salmeterol Direct health care costs associated with hospital treatment were calculated. Forced expiratory volume in 1 second, quality of life (with the Saint George's Respiratory Questionnaire), dyspnea transitional index, mean stay in hospital, and exacerbations were the variables used to measure effectiveness. Values for these variables were taken from the main reviews and randomized clinical trials published for tiotropium.

Results

For COPD patients, treatment with tiotropium leads to a greater reduction in exacerbations (37% compared to ipratropium and 25% compared to salmeterol 25%), and a reduction in the number of days in hospital (33% compared to ipratropium and 14% compared to salmeterol). Therefore, use of tiotropium could save €100 000 for the current rates of admission and lengths of hospital stay in Spain.

Conclusions

Tiotropium was more effective than ipratropium and salmeterol as measured by objective clinical variables (forced expiratory volume in 1 second) and subjective ones (the Saint George's Respiratory Questionnaire and dyspnea transitional index). Hospital stays were shorter and exacerbations fewer with tiotropium. In all cases, tiotropium was more cost-effective than the alternatives, thus use of tiotropium could help hospitals to save money.

Key Words:
Cost-effectiveness analysis
Tiotropium
Pharmacoeconomics
Effectiveness
Objetivo

El incesante incremento de los costes en un marco en el que los recursos son limitados, así como la apa-rición de nuevos medicamentos más costosos y a la vez más eficaces, justifica la evaluación económica de los medicamentos. El objetivo de este trabajo es evaluar el coste-eficacia de uno de los fármacos más novedosos para el tratamien-to de la enfermedad pulmonar obstructiva crónica (EPOC), el tiotropio.

Material y método

Se ha realizado un análisis de coste-eficacia (costes y consecuencias) desde la perspectiva del Sistema Nacional de Salud. Las alternativas analizadas han sido ipratropio y salmeterol. Se han considerado sólo costes sanitarios directos en el ámbito hospitalario. Los paráme-tros de eficacia analizados han sido: volumen espiratorio forzado en el primer segundo, calidad de vida (mediante el Saint George's Respiratory Questionnaire), índice transicio-nal de disnea, estancias medias y exacerbaciones. Dichos pa-rámetros se han obtenido de las principales revisiones y en-sayos clínicos aleatorizados publicados sobre el tiotropio.

Resultados

Teniendo en cuenta la reducción del número de exacerbaciones conseguida con el tiotropio frente al ipratropio y salmeterol (el 37 y el 25%, respectivamente) y del número de días de estancia hospitalaria (el 33 y el 14%, respectivamente), su utilización puede suponer un ahorro superior a los 100.000 € para las cifras actuales de tasa de ingresos y días de estancia hospitalaria de los pacientes con EPOC en España.

Conclusiones

El tiotropio ha sido más efectivo que el ipratropio y salmeterol tanto en parámetros clínicos (objetivos, como el volumen espiratorio forzado en el primer segundo, y subjetivos, como el Saint George's Respiratory Questionnaire y el índice transicional de disnea) como en disminución de estancias hospitalarias y exacerbaciones. En todos los casos re-sulta más coste-efectivo que sus alternativas, lo que supone im-portantes ahorros en el ámbito hospitalario.

Palabras clave:
Análisis coste-eficacia
Tiotropio
Farmacoeconomía
Efectividad
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