Time filter

Source Type

Costa J.,University of Lisbon | Costa J.,Institute Medicina Molecular | Fiorentino F.,University of Lisbon | Caldeira D.,University of Lisbon | And 9 more authors.
Revista Portuguesa de Cardiologia | Year: 2015

Introduction and Objectives Recently, three novel non-vitamin K antagonist oral anticoagulants received approval for reimbursement in Portugal for patients with non-valvular atrial fibrillation (AF). It is therefore important to evaluate the relative cost-effectiveness of these new oral anticoagulants in Portuguese AF patients. Methods A Markov model was used to analyze disease progression over a lifetime horizon. Relative efficacy data for stroke (ischemic and hemorrhagic), bleeding (intracranial, other major bleeding and clinically relevant non-major bleeding), myocardial infarction and treatment discontinuation were obtained by pairwise indirect comparisons between apixaban, dabigatran and rivaroxaban using warfarin as a common comparator. Data on resource use were obtained from the database of diagnosis-related groups and an expert panel. Model outputs included life years gained, quality-adjusted life years (QALYs), direct healthcare costs and incremental cost-effectiveness ratios (ICERs). Results Apixaban provided the most life years gained and QALYs. The ICERs of apixaban compared to warfarin and dabigatran were €5529/QALY and €9163/QALY, respectively. Apixaban was dominant over rivaroxaban (greater health gains and lower costs). The results were robust over a wide range of inputs in sensitivity analyses. Apixaban had a 70% probability of being cost-effective (at a threshold of €20 000/QALY) compared to all the other therapeutic options. Conclusions Apixaban is a cost-effective alternative to warfarin and dabigatran and is dominant over rivaroxaban in AF patients from the perspective of the Portuguese national healthcare system. These conclusions are based on indirect comparisons, but despite this limitation, the information is useful for healthcare decision-makers. © 2015 Sociedade Portuguesa de Cardiologia.


PubMed | Pfizer, Catholic University of Portugal, University of Lisbon and Centro Hospitalar Lisbon Norte EPE
Type: Journal Article | Journal: Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology | Year: 2015

Recently, three novel non-vitamin K antagonist oral anticoagulants received approval for reimbursement in Portugal for patients with non-valvular atrial fibrillation (AF). It is therefore important to evaluate the relative cost-effectiveness of these new oral anticoagulants in Portuguese AF patients.A Markov model was used to analyze disease progression over a lifetime horizon. Relative efficacy data for stroke (ischemic and hemorrhagic), bleeding (intracranial, other major bleeding and clinically relevant non-major bleeding), myocardial infarction and treatment discontinuation were obtained by pairwise indirect comparisons between apixaban, dabigatran and rivaroxaban using warfarin as a common comparator. Data on resource use were obtained from the database of diagnosis-related groups and an expert panel. Model outputs included life years gained, quality-adjusted life years (QALYs), direct healthcare costs and incremental cost-effectiveness ratios (ICERs).Apixaban provided the most life years gained and QALYs. The ICERs of apixaban compared to warfarin and dabigatran were 5529/QALY and 9163/QALY, respectively. Apixaban was dominant over rivaroxaban (greater health gains and lower costs). The results were robust over a wide range of inputs in sensitivity analyses. Apixaban had a 70% probability of being cost-effective (at a threshold of 20 000/QALY) compared to all the other therapeutic options.Apixaban is a cost-effective alternative to warfarin and dabigatran and is dominant over rivaroxaban in AF patients from the perspective of the Portuguese national healthcare system. These conclusions are based on indirect comparisons, but despite this limitation, the information is useful for healthcare decision-makers.


Shapovalova O.,Centro Hospitalar Lisbon Norte EPE | Sacadura-Leite E.,Centro Hospitalar Lisbon Norte EPE | Sacadura-Leite E.,New University of Lisbon | Mendonca Galaio L.,Centro Hospitalar Lisbon Norte EPE | And 3 more authors.
Revista Portuguesa de Saude Publica | Year: 2016

The diagnosis of latent tuberculosis infection (LTBI), namely in healthcare workers, has been done by tuberculin skin test (TST). Recently, Interferon-λ Release Assays (IGRA tests) have been introduced. Unlike TST, they do not turn positive after BCG vaccine or after most of non-tuberculous mycobacteria infections. In the absence of a gold standard for the diagnosis of LTB, the aim of this study was to analyze the correlation between the two LTB diagnostic techniques, by determining Kappa coefficient and concordance rate between TST and IGRA test, in healthcare workers of a Portuguese university hospital. We carried out a cross-sectional and retrospective study, and we analysed TST and IGRA tests records, that are performed simultaneously (up to 15 days apart) in Occupational Health Department, in 2010 and 2011 (n 137). Most of the sample did BCG and 44.5% did two or more inoculations. The average diameter of PT was 17.5 mm (SD 4.3). Only two subjects reported TST < 10 mm, both showing a negative IGRA test. Only 53 (39.3%) of the 135 participants with positive PT had a positive IGRA test too. The level of agreement between TST and the IGRA test was determined by Kappa coefficient. Respectively to a cut off for PT of 10 mm, 15 mm and 20 mm, the degree of agreement was 0.019 (p = 0.26), 0,19 (p = 0.001) and 0.26 (p = 0.003). Concordance rates were respectively 40%, 54% and 65%. It was found that the concordance between the two methods increased as the cut off for TST also increased. Nevertheless, a higher concordance rate would be expected with cut off of 15 mm, and particularly of 20 mm, since BCG vaccine administered in childhood usually induce smaller reactions. The existence of more than one BCG inoculation in the sample, especially after childhood, can be partly responsible for the low concordance between the two methods. Nevertheless, we cannot also exclude IGRA test's false negatives. In the decision to treat LTB, it is necessary to take into account the limitations of both tests, their level of agreement and weighting individual, occupational and epidemiological factors. © 2015 The Authors.


Serra S.,University of Coimbra | Joao Saavedra M.,Centro Hospitalar Lisbon Norte EPE | Joao Salvador M.,University of Coimbra | Pedro Reis J.,University of Coimbra | Malcata A.,University of Coimbra
Acta Reumatologica Portuguesa | Year: 2010

The authors present a clinical case of a 30 year old male patient admitted to the hospital for recurrent cyanosis and feet pain lasting for one year. In addition he presented bilateral purpuric lesions in the lateral maleolar region, one of which with ulceration. The finding of anticardiolipin antibodies associated with intraluminal thrombosis in the dermal vessels, allowed to conclude for Antiphospholipid syndrome. The cutaneous changes identified are named livedoid vasculitis.

Loading Centro Hospitalar Lisbon Norte EPE collaborators
Loading Centro Hospitalar Lisbon Norte EPE collaborators