RESUMEN
BACKGROUND: Hyperkalemia is an electrolyte abnormality with potentially life-threatening consequences. Published data have shown that potassium-binding polymer patiromer (Veltassa) is associated with reduced rates of severe edema and hospitalization for heart failure compared with sodium zirconium cyclosilicate (SZC, Lokelma) when treating hyperkalemia. The aim of this study was to evaluate the possible costs associated with these interventions in the Spanish and UK settings. METHODS: A cost-analysis model was developed in Microsoft Excel to compare the costs associated with patiromer and SZC for the management of hyperkalemia. Clinical event rates were taken from a published real-world comparative study, with the base case capturing the statistically significant reduction in severe edema with patiromer vs SZC and a sensitivity analysis also including the non-statistically significant reduction in hospitalization for heart failure. Country-specific costs, expressed in 2022 Euros (EUR) and British pounds sterling (GBP), were evaluated from a healthcare payer perspective and included pharmacy costs and costs of clinical events. RESULTS: Patiromer may be associated with cost savings of EUR 107 and GBP 630 per patient-year of treatment vs SZC in Spain and the UK, respectively. The majority of cost savings were due to the possible lower daily cost of patiromer compared with SZC. Including the difference in heart failure hospitalization rates in a sensitivity analysis led to greater cost savings with patiromer over SZC, increasing to EUR 460 and GBP 902 in Spain and the UK, respectively. Extrapolation of patient-level economic outcomes to a population level found that patiromer was associated with annual cost savings of EUR 30.6 million in Spain, and GBP 801.7 million in the UK vs SZC. CONCLUSIONS: Patiromer has the potential to be cost saving vs SZC for the treatment of hyperkalemia in Spain and the UK based on the results of a real-world evidence analysis.
Asunto(s)
Hiperpotasemia , Polímeros , Silicatos , Hiperpotasemia/tratamiento farmacológico , Hiperpotasemia/economía , Humanos , España , Reino Unido , Polímeros/uso terapéutico , Silicatos/uso terapéutico , Silicatos/economía , Insuficiencia Cardíaca/tratamiento farmacológico , Insuficiencia Cardíaca/economía , Análisis Costo-Beneficio , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Costos y Análisis de Costo , Modelos EconométricosRESUMEN
INTRODUCTION: Recent evidence finds mineral trioxide aggregate (MTA) more effective than calcium hydroxide (CH) for direct pulp capping (DPC). The present study assessed the cost-effectiveness of MTA versus CH for DPC using a model-based simulation approach. METHODS: A mixed public/private payer perspective in the context of German health care was adopted. We modeled a permanent molar with a vital asymptomatic, exposed pulp treated via DPC with either MTA or CH. The tooth was followed over the lifetime of a 20-year-old patient using Markov models. Transition probabilities were obtained from systematically and nonsystematically collected data. The primary health outcome was tooth retention time. Costs for DPC were estimated via microcosting. Required personnel time for application was estimated using a survey among German specialized and general dentists. Material expenses were calculated based on market prices in 2015. All other costs were derived from public and private item fee catalogues. Uncertainty was introduced via probabilistic and univariate sensitivity analyses. RESULTS: DPC using MTA was both more effective and less costly (52 years retention, lifetime costs = 1368 Euro) than CH (49 years, 1527 Euro). Regardless of a payer's willingness to pay, DPC with MTA had the higher probability of being cost-effective. The identified ranking was not affected by parameter or structural uncertainty or heterogeneity. CONCLUSIONS: MTA was more cost-effective than CH for DPC despite higher initial treatment costs because expensive retreatments were avoided. Our estimates apply only on the basis of current evidence and within the chosen health care setting. From a payer's perspective, MTA should be used for DPC.
Asunto(s)
Compuestos de Aluminio/economía , Compuestos de Calcio/economía , Hidróxido de Calcio/economía , Recubrimiento de la Pulpa Dental/métodos , Óxidos/economía , Materiales de Recubrimiento Pulpar y Pulpectomía/economía , Silicatos/economía , Análisis Costo-Beneficio , Combinación de Medicamentos , Humanos , Masculino , Cadenas de Markov , Adulto JovenRESUMEN
OBJECTIVES: This study aimed to investigate treatment protocols and opinions towards direct pulp capping (DPC) amongst New Zealand (NZ) general dental practitioners (GDP) through a Practice Based Research Network (PBRN) study. DESIGN: Mixed-methods approach using qualitative thematic and quantitative analysis. METHODS: An on-line survey containing Likert scale items and open-ended questions was distributed to GDPs on the Dental Council of New Zealand (DCNZ) register (2012) to collect information on practitioner demographics, treatment protocols, continuing professional development (CPD) and philosophies towards DPC. RESULTs: Two hundred and ten GDPs from North and South Islands providing care in main centres and rural areas engaged with the PBRN and participated in the study. Almost all performed DPC treatment although it was not a common procedure. DPC was perceived as 'successful' or 'very successful' by 95% of respondents, mostly for cases of reversible pulpitis. Most provided DPC for patients of all ages but younger patients were perceived to have the best clinical outcomes. Calcium hydroxide and MTA were the most commonly used materials for DPC. MTA was believed to have the best outcome but cost and handling properties were barriers to its use. The majority of respondents had participated in CPD related to vital pulp therapy and regarded this treatment as conservative and providing time and financial benefits compared with more invasive treatment. Clinicians' timeframes for assessing healing were variable, and combined clinical and radiographic findings were considered most useful. CONCLUSION: New Zealand dentists perceive DPC as a successful and conservative treatment in selected cases. The findings have provided insights into engagement of NZ dentists in using research to inform everyday clinical practice through a PBRN study.
Asunto(s)
Recubrimiento de la Pulpa Dental/estadística & datos numéricos , Adolescente , Adulto , Factores de Edad , Anciano , Compuestos de Aluminio/economía , Compuestos de Aluminio/uso terapéutico , Actitud del Personal de Salud , Compuestos de Calcio/economía , Compuestos de Calcio/uso terapéutico , Hidróxido de Calcio/uso terapéutico , Investigación Participativa Basada en la Comunidad , Toma de Decisiones , Recubrimiento de la Pulpa Dental/economía , Exposición de la Pulpa Dental/terapia , Combinación de Medicamentos , Costos de los Medicamentos , Educación Continua en Odontología , Femenino , Odontología General , Humanos , Masculino , Persona de Mediana Edad , Nueva Zelanda , Óxidos/economía , Óxidos/uso terapéutico , Pautas de la Práctica en Odontología , Materiales de Recubrimiento Pulpar y Pulpectomía/uso terapéutico , Pulpitis/terapia , Investigación Cualitativa , Silicatos/economía , Silicatos/uso terapéutico , Resultado del Tratamiento , Adulto JovenRESUMEN
All postgraduate trainees in Restorative Dentistry within the United Kingdom were contacted by e-mail and invited toparticipate in a structured on-line questionnaire regarding MTA usage. Responses were received from 46/65 (70.8%) postgraduate trainees. MTA was used by 15/46 (32.6%) trainees in the primary dentition and 46/46 (100%) in the permanent dentition. Barriers to the use of MTA in the permanent dentition related to material cost and in the primary dentition, the lack of an evidence base. Overall, 32/46 (69.6%) had received tuition during their postgraduate programme and 21/46 (45.7%) indicated an interest in further educational opportunities in material use.
Asunto(s)
Compuestos de Aluminio/uso terapéutico , Compuestos de Calcio/uso terapéutico , Materiales Dentales/uso terapéutico , Operatoria Dental/educación , Educación de Posgrado en Odontología , Óxidos/uso terapéutico , Pautas de la Práctica en Odontología , Silicatos/uso terapéutico , Adulto , Compuestos de Aluminio/economía , Actitud del Personal de Salud , Compuestos de Calcio/economía , Cementos Dentales/uso terapéutico , Materiales Dentales/economía , Combinación de Medicamentos , Costos de los Medicamentos , Femenino , Humanos , Masculino , Óxidos/economía , Materiales de Recubrimiento Pulpar y Pulpectomía/uso terapéutico , Materiales de Obturación del Conducto Radicular/uso terapéutico , Silicatos/economía , Encuestas y Cuestionarios , Diente Primario/patología , Diente no Vital/terapia , Reino UnidoRESUMEN
The purpose of the study was to assess the current opinions and usage of mineral trioxide aggregate (MTA) for apical barrier formation of non-vital immature permanent teeth by consultants in paediatric dentistry in the UK. A semi-structured postal questionnaire was sent to all known consultants in paediatric dentistry in the UK. The response rate was 78.6% (44 of 56). Thity-eight consultants (86.3%) agreed that the use of this material was a good idea with 68.2% having used or arranged for its use in apical barrier formation. Forty-two consultants (95.5%) agreed that reduced number of visits was an advantage to the technique, with only 34.1% agreeing that this procedure was less likely to weaken the tooth and 63.6% agreed that material and equipment costs were a drawback and 50% agreed that lack of available evidence was a disadvantage to its use. The results from this study give an indication of the extent of MTA use by consultant-led services in paediatric dentistry in the UK and highlights the need for a multi-centre randomised controlled clinical trial.
Asunto(s)
Compuestos de Aluminio/uso terapéutico , Actitud del Personal de Salud , Compuestos de Calcio/uso terapéutico , Odontólogos , Incisivo/efectos de los fármacos , Óxidos/uso terapéutico , Odontología Pediátrica , Pautas de la Práctica en Odontología , Materiales de Obturación del Conducto Radicular/uso terapéutico , Tratamiento del Conducto Radicular/métodos , Silicatos/uso terapéutico , Ápice del Diente/efectos de los fármacos , Diente no Vital/terapia , Compuestos de Aluminio/economía , Fenómenos Biomecánicos , Compuestos de Calcio/economía , Dentina Secundaria/inducido químicamente , Combinación de Medicamentos , Humanos , Incisivo/patología , Óxidos/economía , Materiales de Obturación del Conducto Radicular/economía , Tratamiento del Conducto Radicular/economía , Silicatos/economía , Estrés Mecánico , Encuestas y Cuestionarios , Ápice del Diente/patología , Reino UnidoRESUMEN
Portland cement has been analyzed and compared to mineral trioxide aggregate (MTA) because of their chemical similarity. The possibility of using this material as a less expensive alternative to MTA in dental practice should be considered. In view of this, the present study compared the components of a Portland cement (Votoran) to two commercial brands of MTA (Pro-Root and MTA-Angelus). Twelve specimens of each material were fabricated and examined by scanning electron microscopy (SEM) with energy dispersive spectroscopy (EDS) to obtain their percentage of chemical elements. The means of the chemical elements found in each material was compared by descriptive statistics. Bismuth was present only in MTA cements to provide radiopacity. In conclusion, the tested cements have similar components, which supports, as far as composition is concerned, the possible clinical use of Portland as an option to MTA.
Asunto(s)
Compuestos de Aluminio/química , Compuestos de Calcio/química , Cementos Dentales/química , Óxidos/química , Materiales de Obturación del Conducto Radicular/química , Silicatos/química , Compuestos de Aluminio/economía , Bismuto/análisis , Bismuto/química , Bismuto/economía , Compuestos de Calcio/economía , Cementos Dentales/economía , Combinación de Medicamentos , Microscopía Electrónica de Rastreo/métodos , Óxidos/economía , Materiales de Obturación del Conducto Radicular/economía , Silicatos/economía , Espectroscopía de Pérdida de Energía de Electrones/métodosRESUMEN
Portland cement has been analyzed and compared to mineral trioxide aggregate (MTA) because of their chemical similarity. The possibility of using this material as a less expensive alternative to MTA in dental practice should be considered. In view of this, the present study compared the components of a Portland cement (Votoran®) to two commercial brands of MTA (Pro-Root and MTA-Angelus®). Twelve specimens of each material were fabricated and examined by scanning electron microscopy (SEM) with energy dispersive spectroscopy (EDS) to obtain their percentage of chemical elements. The means of the chemical elements found in each material was compared by descriptive statistics. Bismuth was present only in MTA cements to provide radiopacity. In conclusion, the tested cements have similar components, which supports, as far as composition is concerned, the possible clinical use of Portland as an option to MTA.
O cimento Portland tem sido analisado e comparado com o agregado trióxido mineral (MTA) devido a sua similaridade química. Dada à possibilidade de uso na Odontologia como uma alternativa menos onerosa ao MTA, realizou-se uma análise comparativa dos componentes do cimento Portland (Votoran®) com os constituintes de dois cimentos MTA (Pro-Root-MTA e Angelus®-MTA). Para tanto, foram confeccionados 12 corpos-de-prova de cada um dos materiais (n=36), e estes foram analisados em microscopia eletrônica de varredura (MEV) pela técnica de espectroscopia por dispersão de energia (EDS), que fornece o percentual dos componentes químicos encontrados nos corpos-de-prova. As médias dos elementos químicos encontrados nos três cimentos foram comparadas por meio de análise estatística descritiva. O bismuto estava presente somente nos cimentos MTA. Concluiu-se que os cimentos testados apresentaram similaridade em seus constituintes, o que indica, considerando-se a composição, a possibilidade de futura utilização clínica do cimento Portland como alternativa ao MTA.
Asunto(s)
Compuestos de Aluminio/química , Compuestos de Calcio/química , Cementos Dentales/química , Óxidos/química , Materiales de Obturación del Conducto Radicular/química , Silicatos/química , Compuestos de Aluminio/economía , Bismuto/análisis , Bismuto/química , Bismuto/economía , Compuestos de Calcio/economía , Combinación de Medicamentos , Cementos Dentales/economía , Microscopía Electrónica de Rastreo/métodos , Óxidos/economía , Materiales de Obturación del Conducto Radicular/economía , Silicatos/economía , Espectroscopía de Pérdida de Energía de Electrones/métodosRESUMEN
The unextracted residue obtained after a countercurrent two-step extractive process of silica from pumice lapillus, at 100 degrees C and room pressure, has been found mainly crystallized to the pseudo-cubic form typical of zeolite P. This residue could be active as a low-cost agent for the removal of heavy metals from wastewater. In this paper the removal capacity of six metallic cations (i.e. Cu(2+), Ni(2+), Zn(2+), Cd(2+), Pb(2+) and Cr(3+)) was studied in a stirred batch reactor. Results obtained showed that the removal of metal ions (100-500mgg(-1)) from wastewater is achieved in a short time and the concentration lowered under the legal limits. The adsorption mechanism mainly involves an ionic exchange between sodium ions from the solid phase and heavy metals in solution. However, if wastewater was accompanied by free acidity, it first should be neutralized to pH 4-5 to prevent zeolite destruction.
Asunto(s)
Metales Pesados/química , Metales Pesados/aislamiento & purificación , Silicatos/química , Silicatos/economía , Eliminación de Residuos Líquidos/economía , Eliminación de Residuos Líquidos/métodos , Contaminantes del Agua/aislamiento & purificación , Zeolitas/química , Adsorción , Iones/química , Microscopía Electrónica de Rastreo , Contaminantes del Agua/economía , Difracción de Rayos XRESUMEN
A mesoporous carbon molecular sieve with a hexagonal framework structure (denoted C-MSU-H) has been prepared using a MSU-H silica template that can be assembled from a low cost soluble silicate precursor at near-neutral pH conditions.