Suchergebnisse

Omar Maoujoud,1,2 Samir Ahid,1 Yahia Cherrah1 1Research Team of Pharmacoepidemiology and Pharmacoeconomics, Medical and Pharmacy School, Mohammed V University, Rabat, 2Department of Nephrology and Dialysis, Military Hospital, Agadir, Morocco Objective: The purpose of this study was to determine the cost-utility of treating anemic dialysis patients with continuous erythropoietin receptor activator (CERA) once monthly or Epoetin Beta (EpoB) thrice weekly compared with a reference strategy of managing anemia with red blood cell transfusion (RBCT).Methods: Cost-utility analysis study design. Decision analysis model, National health care payer, over 1 year with the publicly funded health care system. Chronic hemodialysis patients with renal anemia were included. The outcome marker of this study was the incremental cost per quality-adjusted life-year (QALY) gained (incremental cost-utility ratio [ICUR]) of CERA or EpoB relative to RBCT.Results: The total cost per patient (in US$) was estimated at $2,176.37, $4,107.01, and $4,356.69 for RBCT, CERA, and EpoB, respectively. The cost-utility ratio was calculated at 4,423.52, 6,955.50, and 7,406.38 $/QALY for RBCT, CERA, and EpoB, with an ICUR of CERA and EpoB in relation to RBCT at 19,606.40 and 22,466.09 $/QALY, respectively. In sensitivity analysis, the model was most sensitive to hospitalization costs, hospital stay, and annual number of RBCT units. Also, assuming utility and survival improvement with erythropoiesis stimulating agents use resulted in a decrease in ICUR at 13,429 $/QALY for CERA and 15,331 $/QALY for EpoB. In probabilistic sensitivity analysis, the main results of our model were unchanged; CERA and EpoB were more costly and more effective than RBCT below a threshold of 19,500 $/QALY. CERA was the best option for a willingness to pay over 19,500 $/QALY.Limitations: Some model parameters were obtained from observational data, the comparator RBCT is not the standard of care.Conclusion: Our study suggests that managing anemia in dialysis patient with CERA or EpoB may results in better outcomes with higher overall costs. Considering different assumptions, we found substantial variability in the estimates of the cost-utility and incremental of using CERA or EpoB. Keywords: cost-utility, cost-effectiveness, anemia, dialysis, erythropoiesis stimulating agents, continuous erythropoietin receptor activator, epoetin

International audience ; One hundred samples of dried fruits (20 dried raisins, 20 walnuts, 20 peanuts, 20 dried figs and 20 pistachios) and twenty samples of rice purchased from retail shops of Rabat and Salé area in Morocco were analyzed for ochratoxin A (OTA) by immunoaffinity (IAC) clean-up and LC with fluorimetric detection. The limit of quantification (LOQ) (S/N, 10:1) of OTA was 0.021 ng/g in rice, 0.027 ng/g in pistachio, peanut and walnut and 0.030 ng/g in dried raisins and dried figs. The incidence of OTA in dried raisins, walnuts, peanuts, dried figs and rice were 30, 35, 25, 65 and 90 % respectively. Analytical results showed that pistachio samples were with no detectable levels. OTA concentrations ranged from 0.02±0.01 to 32.4±2.10 ng/g in rice, from 0.10±0.05 to 2.36±0.75 in peanut, from 0.03±0.01 to 1.42±0.45 in dried figs, from 0.05±0.02 to 4.95±0.02 in dried raisins and from 0.04±0.01 to 0.23±0.05 in walnut. Results showed also that 15% of total analyzed samples of rice exceeded the maximum residue level (MRL) set by European Union regulations for OTA in cereals (European Commission 2002). This is the first report on the occurrence of OTA in dried fruits and rice available in Morocco.