Objective:Sodium-glucose cotransporter 2 inhibitors(SGLT2i)are approved for heart failure with reduced ejection fraction(HFrEF).However,their cost-effectiveness remains unknown.We aimed to compare the cost-effectivene...Objective:Sodium-glucose cotransporter 2 inhibitors(SGLT2i)are approved for heart failure with reduced ejection fraction(HFrEF).However,their cost-effectiveness remains unknown.We aimed to compare the cost-effectiveness of SGLT2i versus mineralocorticoid antagonists(MRAs).Methods:Data from the RALES,EPHESUS,EMPHASIS,DAPA-HF,and EMPEROR-Reduced trials were includ-ed.We calculated the risk-ratio(RR)for a composite of cardiovascular death or heart failure hospitalization(CV death-HHF),all-cause mortality,and heart failure hospitalization(HHF)between MRAs and SGLT2i.A Markov model was developed to simulate the progression of HFrEF over 5 years.The primary outcome was incremental cost-effectiveness ratio(ICER),measured by cost per quality-adjusted life-year(QALY)gained.Results:We observed a similar benefit in CV death-HHF(RR 1.04;95%CI 0.82–1.31),all-cause mortality(RR 0.91;95%CI 0.78–1.06),and HHF(RR 1.05;95%CI 0.84–1.31)between MRAs and SGLT2i.In a 5-year model,no difference in survival was observed between treatments.MRAs were associated with lower cost($63,135.52 vs.$80,365.31)and more QALYs gained per patient(2.53 versus 2.49)than SGLT2i.The ICER for SGLT2i versus MRAs was$-172,014.25/QALY,in favor of MRAs.Conclusion:MRAs and SGLT2i provided similar benefits;however,MRAs were a more cost-effective treatment than SGLT2i.展开更多
Eosinophilic esophagitis is an immune-allergic pathology of multifactorial etiology(genetic and environmental)that affects both pediatric and adult patients.Its symptoms,which include heartburn,regurgitation,and esoph...Eosinophilic esophagitis is an immune-allergic pathology of multifactorial etiology(genetic and environmental)that affects both pediatric and adult patients.Its symptoms,which include heartburn,regurgitation,and esophageal stenosis(with dysphagia being more frequent in eosinophilic esophagitis in young adults and children),are similar to those of gastroesophageal reflux disease,causing delays in diagnosis and treatment.Although endoscopic findings such as furrows,esophageal mucosa trachealization,and whitish exudates may suggest its presence,this diagnosis should be confirmed histologically based on the presence of more than 15 eosinophils per high-power field and the exclusion of other causes of eosinophilia(parasitic infections,hypereosinophilic syndrome,inflammatory bowel disease,among others)for which treatment could be initiated.Currently,the 3“D”s(“Drugs,Diet,and Dilation”)are considered the fundamental components of treatment.The first 2 components,which involve the use of proton pump inhibitors,corticosteroids,immunosuppressants and empirical diets or guided food elimination based on allergy tests,are more useful in the initial phases,whereas endoscopic dilation is reserved for esophageal strictures.Herein,the most important aspects of eosinophilic esophagitis pathophysiology will be reviewed,in addition to evidence for the various treatments.展开更多
文摘Objective:Sodium-glucose cotransporter 2 inhibitors(SGLT2i)are approved for heart failure with reduced ejection fraction(HFrEF).However,their cost-effectiveness remains unknown.We aimed to compare the cost-effectiveness of SGLT2i versus mineralocorticoid antagonists(MRAs).Methods:Data from the RALES,EPHESUS,EMPHASIS,DAPA-HF,and EMPEROR-Reduced trials were includ-ed.We calculated the risk-ratio(RR)for a composite of cardiovascular death or heart failure hospitalization(CV death-HHF),all-cause mortality,and heart failure hospitalization(HHF)between MRAs and SGLT2i.A Markov model was developed to simulate the progression of HFrEF over 5 years.The primary outcome was incremental cost-effectiveness ratio(ICER),measured by cost per quality-adjusted life-year(QALY)gained.Results:We observed a similar benefit in CV death-HHF(RR 1.04;95%CI 0.82–1.31),all-cause mortality(RR 0.91;95%CI 0.78–1.06),and HHF(RR 1.05;95%CI 0.84–1.31)between MRAs and SGLT2i.In a 5-year model,no difference in survival was observed between treatments.MRAs were associated with lower cost($63,135.52 vs.$80,365.31)and more QALYs gained per patient(2.53 versus 2.49)than SGLT2i.The ICER for SGLT2i versus MRAs was$-172,014.25/QALY,in favor of MRAs.Conclusion:MRAs and SGLT2i provided similar benefits;however,MRAs were a more cost-effective treatment than SGLT2i.
文摘Eosinophilic esophagitis is an immune-allergic pathology of multifactorial etiology(genetic and environmental)that affects both pediatric and adult patients.Its symptoms,which include heartburn,regurgitation,and esophageal stenosis(with dysphagia being more frequent in eosinophilic esophagitis in young adults and children),are similar to those of gastroesophageal reflux disease,causing delays in diagnosis and treatment.Although endoscopic findings such as furrows,esophageal mucosa trachealization,and whitish exudates may suggest its presence,this diagnosis should be confirmed histologically based on the presence of more than 15 eosinophils per high-power field and the exclusion of other causes of eosinophilia(parasitic infections,hypereosinophilic syndrome,inflammatory bowel disease,among others)for which treatment could be initiated.Currently,the 3“D”s(“Drugs,Diet,and Dilation”)are considered the fundamental components of treatment.The first 2 components,which involve the use of proton pump inhibitors,corticosteroids,immunosuppressants and empirical diets or guided food elimination based on allergy tests,are more useful in the initial phases,whereas endoscopic dilation is reserved for esophageal strictures.Herein,the most important aspects of eosinophilic esophagitis pathophysiology will be reviewed,in addition to evidence for the various treatments.
