Lege Artis Medicinae

[Population-level QALY gain estimates with the use of cariprazine for patients with negative symptoms of schizophrenia in Hungary]

BENDES Rita1, NÉMETH Bertalan1, PITTER János György1, KÓCZIÁN Kristóf2, GÖTZE Árpád2, KALÓ Zoltán1,3

OCTOBER 20, 2019

Lege Artis Medicinae - 2019;29(10)

DOI: https://doi.org/10.33616/lam.29.045

[INTRODUCTION - The loss in quality of life caused by mental illnesses has been growing in developed countries. This study aims to quantify the possible gains in quality of life by advantages of cariprazine therapy while treating patients with negative symptoms of schizophrenia in Hungary. Comparator therapy was defined as the currently available second-generation oral antipsychotic drugs. METHODS - In order to estimate the reachable gain in quality of life with cariprazine, an 8-state deterministic Markov cohort model was developed. Data was gathered from relevant scientific literature and public databases. The main assumptions regarding patient pathways have been validated by clinical experts, based on their real-life experience. The number of patients with negative symptoms of schizophrenia was estimated by the same methods as well. Sensitivity analyses were conducted on the input parameters. RESULTS - When compared with currently available second-generation oral antipsychotics, cariprazine generated an estimated increase of 0.05 quality-adjusted life years per patient in 2 years run. The deterministic sensitivity analysis confirmed the robustness of the results. Based on data of the National Health Insurance Fund and the scientific literature, a total gain of 450 quality-adjusted life years is expected at national level over a time horizon of 2 years. Even higher gains of QALY can be expected for longer time horizons. CONCLUSION - Based on conservative estimates significant health gain can be ge­ne­rated, if all patients with negative symp­toms of schizophrenia would receive the adequate cariprazine therapy in Hungary in­stead of the currently used se­cond-ge­ne­ration oral antipsychotic drugs. ]

AFFILIATIONS

  1. Syreon Kutató Intézet
  2. Richter Gedeon Nyrt.
  3. Semmelweis Egyetem Egészségügyi Technológiaértékelő és Elemzési Központ

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[Thiazide- or thiazide-like diuretics should be used in the treatment of patients with hypertension? Particularities of the situation in Hungary]

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[Diuretics have remained the cornerstone of the antihypertensive treatment since their widespreading in the 1960s. According to the 2018 ESC/ESH Guidelines for the management of arterial hypertension, in the absence of evidence from direct comparator trials and recognizing that many of the approved single-pill combinations are based on hydrochlorothiazide, this drug and thiazide-like indapamide can be considered suitable antihypertensive agents. In the 2018 Hungarian guidelines indapamide is named as the most efficacious diuretic in the treatment of patients with hypertension. The aim of the publication is redefining thiazide- and thiazide-like diuretic use in the treatment of hypertensive patients, with particular attention to presently available hydrochlorothia­zide and indapamide, and their combination drugs in Hungary.]

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[Medical therapy of peripherial artery disease]

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[Care of PAD (peripherial arterial disease) is one of the most negligent area of cardiovascular diseases: on one hand patients suffering from PAD are the most uncared, less educated and health-minded population (it’s enough to keep in mind the high rate of smoking and alcohol-abuse among them) in addition the number of angiologists is insufficient for the treatment of PAD. Although detection of PAD would be easy as a widely applicable, cheap screening method, the ankle-brachial index is available which is an obligatory screening investigation in general care. Therapeutic options are better and better since cilostazol was launched we have an evidence-based treatment which can solve the symptoms, slower the progression which is strongly recommended (IA recommendation) in both American and Hungarian guidelines. Cilostazol, a PDE3-inhibitor has complex pharmacological effect but contraindicated in several clinical conditions as pentoxiphylline is not totally excluded from the therapeutic arsenal of PAD. The place of antiplatelet agents is well-defined in the most recent European guidelines in the treatment of PAD. The jumping development of interventional radiology beyond medical therapy contributed a lot to prevent limb amputations in the case of early detection of PAD. ]

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