<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1130-6343</journal-id>
<journal-title><![CDATA[Farmacia Hospitalaria]]></journal-title>
<abbrev-journal-title><![CDATA[Farm Hosp.]]></abbrev-journal-title>
<issn>1130-6343</issn>
<publisher>
<publisher-name><![CDATA[Grupo Aula Médica]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1130-63432022000600003</article-id>
<article-id pub-id-type="doi">10.7399/fh.13038</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Análisis de los costes asociados al seguimiento de pacientes con VIH que discontinúan el tratamiento antirretroviral por falta de eficacia o toxicidad inaceptable en España]]></article-title>
<article-title xml:lang="en"><![CDATA[Analysis of the costs associated with the follow-up of HIV patients discontinuing antiretroviral treatment due to lack of effectiveness or unacceptable toxicity in Spain]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Castro]]></surname>
<given-names><![CDATA[Ángeles]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Díaz]]></surname>
<given-names><![CDATA[Pilar]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Domingo]]></surname>
<given-names><![CDATA[Pere]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[García-Yubero]]></surname>
<given-names><![CDATA[Cristina]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Losa-García]]></surname>
<given-names><![CDATA[Juan E]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Castro]]></surname>
<given-names><![CDATA[Antonio]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Vidal-Vilar]]></surname>
<given-names><![CDATA[Neus]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Aceituno]]></surname>
<given-names><![CDATA[Susana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Hospital Universitario A Coruña  ]]></institution>
<addr-line><![CDATA[A Coruña ]]></addr-line>
<country>España</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Hospital Universitario Nuestra Señora de La Candelaria  ]]></institution>
<addr-line><![CDATA[Santa Cruz de Tenerife Tenerife]]></addr-line>
<country>España</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Hospital de la Santa Creu i Sant Pau  ]]></institution>
<addr-line><![CDATA[Barcelona ]]></addr-line>
<country>España</country>
</aff>
<aff id="Af4">
<institution><![CDATA[,Hospital Infanta Sofía  ]]></institution>
<addr-line><![CDATA[Madrid ]]></addr-line>
<country>España</country>
</aff>
<aff id="Af5">
<institution><![CDATA[,Hospital Universitario Fundación Alcorcón  ]]></institution>
<addr-line><![CDATA[Alorcón Madrid]]></addr-line>
<country>España</country>
</aff>
<aff id="Af6">
<institution><![CDATA[,Gilead Sciences  ]]></institution>
<addr-line><![CDATA[Madrid ]]></addr-line>
<country>España</country>
</aff>
<aff id="Af7">
<institution><![CDATA[,Outcomes&#8217;10, S. L  ]]></institution>
<addr-line><![CDATA[Castellón de la Plana ]]></addr-line>
<country>España</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>12</month>
<year>2022</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>12</month>
<year>2022</year>
</pub-date>
<volume>46</volume>
<numero>6</numero>
<fpage>327</fpage>
<lpage>334</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_arttext&amp;pid=S1130-63432022000600003&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_abstract&amp;pid=S1130-63432022000600003&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.isciii.es/scielo.php?script=sci_pdf&amp;pid=S1130-63432022000600003&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen  Objetivo: Estimar el uso de recursos y costes asociados al seguimiento de pacientes con infección por el virus de la inmunodeficiencia humana tras discontinuación del tratamiento antirretroviral actual debido a falta de efectividad o toxicidad inaceptable y cambio a un nuevo tratamiento antirretroviral, comparado con el seguimiento habitual de los pacientes con tratamiento antirretroviral, desde la perspectiva del Sistema Nacional de salud español.  Método: Se identificó el uso de recursos (pruebas clínicas, visitas médicas, visitas a la farmacia hospitalaria) asociado al seguimiento de pacientes con infección por el virus de la inmunodeficiencia humana en tres perfiles de pacientes (estable, discontinuación y cambio por falta de efectividad, discontinuación y cambio por toxicidad inaceptable), a partir de las guías de práctica clínica y un panel de expertos multidisciplinar (. = 5). Los expertos consensuaron los principales eventos adversos que conducían a la discontinuación, agrupándolos en: alteraciones gastrointestinales, renales, óseas, musculoesqueléticas, dermatológicas, hepáticas y del perfil lipídico, trastornos neuropsiquiátricos y sexuales. Los costes unitarios se identificaron a partir de bases de datos oficiales costes sanitarios y de la literatura. Se estimó el coste (&#8364;, 2020) del seguimiento en cada perfil de paciente, sin incluir el coste derivado del tratamiento antirretroviral, en un horizonte temporal de dos años.  Resultados: El coste por paciente a dos años se estimó en 4.148 &#8364; (pruebas: 2.293 &#8364;; visitas: 1.855 &#8364;) para el seguimiento del paciente estable. El seguimiento del paciente tras discontinuación por falta de efectividad y cambio de tratamiento antirretroviral se estimó en 5.434 &#8364; (pruebas: 2.777 &#8364;; visitas: 2.657 &#8364;). El coste del seguimiento tras la discontinuación por toxicidad inaceptable y cambio de tratamiento antirretroviral varió en función del evento adverso que motivó el cambio, oscilando entre 4.690 &#8364; para las alteraciones del perfil lipídico, y 5.304 &#8364; para las alteraciones musculoesqueléticas. En este perfil de pacientes, las pruebas variaron entre 2.403 &#8364; y 3.017 &#8364; y las visitas entre 2.287 &#8364; y 2.842 &#8364;.  Conclusiones: El coste asociado al seguimiento del paciente con infección por el virus de la inmunodeficiencia humana tras discontinuación y cambio a un nuevo tratamiento antirretroviral es mayor comparado con el seguimiento habitual, sin tener en cuenta el coste farmacológico. La tasa de discontinuación del tratamiento antirretroviral es un factor relevante a la hora de seleccionar la terapia más adecuada para cada paciente.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Objective: To assess the use of resources and the costs associated with following up patients infected with the human immunodeficiency virus after discontinuation of an antiretroviral treatment and initiation of a new one due to a lack of effectiveness or unacceptable toxicity, as compared to the costs involved in the routine follow-up of patients on antiretroviral treatment, from the Spanish National Health System perspective.  Method: The use of resources (clinical tests, medical visits, and hospital pharmacy visits) associated with following three profiles of patients infected with the human immunodeficiency virus (stable ones, those discontinuing an existing antiretroviral treatment and being switched to a new one due to a lack of effectiveness, and those discontinuing an existing antiretroviral treatment and being switched to a new one due to unacceptable toxicity) was identified, based on clinical practice guidelines and the findings of a multidisciplinary expert panel (n = 5). The experts agreed on the main adverse events leading to discontinuation, classifying them into gastrointestinal, renal, osseous, musculoskeletal, dermatological, hepatic, lipid profile-related, neuropsychiatric and sexual alterations. Unit costs were identified from official healthcare costs databases. The cost (&#8364;, 2020) of following up each patient profile was estimated, excluding the cost of the antiretroviral treatment itself, with a time horizon of two years.  Results: The per-patient cost of following up stable patients over two years was estimated at &#8364;4,148 (tests: &#8364;2,293; visits: &#8364;1,855). Patient follow-up after discontinuation of an existing antiretroviral treatment and initiation of a different one due to a lack of effectiveness was estimated at &#8364;5,434 (tests: &#8364;2,777; visits: &#8364;2,657). The cost of follow-up after discontinuation of an existing regimen and initiation of a new one due to unacceptable toxicity varied according to the adverse event prompting the switch, ranging from &#8364;4,690 for lipid profile dysregulation, to &#8364;5,304, for musculoskeletal alterations. In this patient profile, the cost of tests ranged from &#8364;2,403 to &#8364;3,017, and that of visits from &#8364;2,287 to &#8364;2,842.  Conclusions: The cost associated with following up of patients infected with the human immunodeficiency virus after discontinuation of an existing antiretroviral regimen and initiation of a new one is higher tan that of routine follow-up, without taking the cost of drugs into account. The treatment discontinuation rate is a relevant factor when selecting the most appropriate therapy for each patient.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[VIH]]></kwd>
<kwd lng="es"><![CDATA[Tratamiento antirretroviral]]></kwd>
<kwd lng="es"><![CDATA[Seguimiento]]></kwd>
<kwd lng="es"><![CDATA[Servicio de Farmacia Hospital]]></kwd>
<kwd lng="es"><![CDATA[Toxicidad]]></kwd>
<kwd lng="es"><![CDATA[Coste sanitario]]></kwd>
<kwd lng="en"><![CDATA[HIV]]></kwd>
<kwd lng="en"><![CDATA[Antiretroviral therapy]]></kwd>
<kwd lng="en"><![CDATA[Follow-Up Studies]]></kwd>
<kwd lng="en"><![CDATA[Pharmacy Service, Hospital]]></kwd>
<kwd lng="en"><![CDATA[Toxicity]]></kwd>
<kwd lng="en"><![CDATA[Health Care Costs]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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