Methods: A transition state model based on disease severity was developed that compared the evolution of antiretroviral and non-antiretroviral-related direct costs of care in the target population over 3 years (2007-2009) under two scenarios: (1) darunavir enters the French market in year 1; (2) darunavir is not available to the target population during 2007-2009. Model inputs were derived from a targeted analysis of the French hospital database Q-VD-Oph in HIV, the darunavir POWER 1 and 2 trials and other relevant clinical studies.
Results: In the scenario where darunavir
was available from year 1, the proportion of patients in the lower, more costly CD4 cell count strata (<= 100 cells per mm(3)) was consistently lower than in the scenario without darunavir in each year of the model (17.0% vs 19.2%, 13.9% vs 18.3% and 10.8% vs 16.8% for years 1, 2 and 3, respectively). As a result, over the entire 3-year period, the net increase of antiretroviral drug costs
(+5.6 million Euros; (sic)), resulting from the substitution of older, cheaper PIs by darunavir, is expected to be fully compensated by savings in hospitalization costs ((sic)-9.7 million) and expenditures for other HIV-related (non-antiretroviral) medications ((sic)-7.3 million), leading to a net saving of (sic)11.4 million or 2.9% of the total budget in the scenario without darunavir. selleck chemical BMS202 chemical structure Various sensitivity analyses confirmed these projected savings.
Conclusion: The use of darunavir/ritonavir (DRV/r) 600/100 mg bid, in combination with other antiretroviral agents, in highly pre-treated, HIV-infected adults who have failed one or more PI-containing highly active antiretroviral therapy regimen is not expected to increase the budget of the French healthcare system, in comparison with a scenario without darunavir.
Further research is needed to estimate the budget impact of the use of DRV/r in less treatment-experienced, HIV-infected individuals in France.”
“Background: The course of dilated cardiomyopathy (DCM) leading to heart failure in children varies; survival with conventional treatment is 64% at 5 years. Heart transplantation (HTx) enables improved survival; however, outcomes from listing for transplant are not well described. This study reports survival of patients with DCM from listing with the availability of mechanical bridge to transplant.
Methods: Patients with a primary diagnosis of DCM (n = 1,098) were identified from a multi-institutional, prospective, registry of patients aged < 18 years listed for HTx from January 1, 1993, to December 31, 2006.
Results: Characteristics of DCM patients at listing included a mean age of 7.