[Cost-effectiveness of the clinical treatment of Grave's disease in a public University Hospital: a retrospective analysis and prospective projection for a therapeutic approach].
The aim of the present study was to evaluate a new proposal for increasing compliance to the clinical management of patients with Graves' disease (GD) in a large and public University Hospital. The patients were carefully selected (no previous GD treatment, goiter volume less than 6 mL must be living in the metro area of São Paulo), received medication at no cost, were contacted frequently by the social worker and alerted for the date of consultation and only referred to a single endocrinologist during all phases of treatment. We recruited 229 patients with GD that were initially treated with methimazole (MMI--60 mg q.d) in a single daily dose followed by a combination of MMI (20 mg) plus L-T4 (100 microg) daily for 24 months. Only 83 patients (36.2%) completed the protocol and were subdivided in: Group 1 (n= 34) that were in remission for 3 years after discontinuation of the MMI and Group 2 (n= 49) that presented recurrence of GD between 2 and 36 months without MMI. Predictive factors associated with remission were: decrease of the glandular volume, serum TG< 40 ng/mL and normal TRAb values. We concluded that in spite of a careful protocol planned to increase compliance, more than 60% of patients with GD did not complete the therapeutic trial and were referred for radioiodine treatment. The solution for this low therapeutic success for GD should be the possible identification of factors that would indicate patients that are not inclined to follow a long period of clinical therapy.
Lima
Nicolau
N
Unidade de Tiróide, Faculdade de Medicina, Universidade de São Paulo, SP. nineto@bol.com.br
Knobel
Meyer
M
Camargo
Rosalinda Y
RY
Tomimori
Eduardo
E
Medeiros-Neto
Geraldo
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D013956:Antithyroid Agents / Q000008:administration & dosage* / Q000191:economics; D002985:Clinical Protocols; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006111:Graves Disease / Q000097:blood / Q000188:drug therapy* / Q000191:economics; D017048:Health Care Costs; D006779:Hospitals, Public; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008713:Methimazole / Q000008:administration & dosage* / Q000191:economics; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data; D010352:Patient Dropouts / Q000706:statistics & numerical data; D012008:Recurrence; D012189:Retrospective Studies; D014505:Urban Population
D013956:Antithyroid Agents; D008713:Methimazole