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Background: The clinical frailty scale (CFS) was used as a triage tool for medical decision making during the COVID-19 pandemic. The CFS has been posed as a suitable risk marker for in-hospital mortality in COVID-19 patients. We evaluated whether the CFS is associated with mortality 24 months after hospitalisation for COVID-19. Methods: The COvid MEdicaTion (COMET) study is an international, multicentre, observational cohort study, including adult patients hospitalised for COVID-19 between March 2020–July 2020. Patients’ characteristics, prescribed medication, clinical characteristics, and CFS were collected at admission, survival data were collected 24 months after hospitalisation. Multivariable cox proportional hazard models stratified by age (

Abstract Coronavirus disease 2019 (COVID-19) is a pandemic infection caused by the newly discovered severe acute respiratory syndrome coronavirus 2. Remdesivir (RDV) and corticosteroids are used mainly in COVID-19 patients with acute respiratory failure. The main objective of the study was to assess the effectiveness of remdesivir with and without corticosteroids in the treatment of COVID-19 patients. We conducted a prospective observational study, including adult patients consecutively hospitalized with confirmed COVID-19 and acute respiratory failure. Patients were divided according to treatment strategy: RDV alone versus RDV with corticosteroids. The primary outcome was the time to recovery in both treatment groups. We included 374 COVID-19 adult patients, 184 were treated with RDV, and 190 were treated with RDV and corticosteroid. Patients in the RDV group had a shorter time to recovery in comparison with patients in the RDV plus corticosteroids group at 28 days after admission [11 vs. 16 days (95% confidence Interval 9.7–12.8; 14.9–17.1; p = .016)]. Patients treated with RDV alone had a shorter length of hospital stay. The use of corticosteroids as adjunctive therapy of RDV was not associated with improvement in mortality of COVID-19 patients.

Introduction: In late 2014, Portugal implemented a national program for the treatment of patients with chronic hepatitis C with directacting antiviral agents. This program has made Portugal one of the first European countries to implement a structured measure of treatment to eliminate this serious public health problem. The aim of this study was to assess the effectiveness of direct-acting antiviral therapy in the treatment of patients with chronic hepatitis C virus infection. Material and Methods: A retrospective observational study was conducted at Centro Hospitalar de Lisboa Ocidental on the national online platform from December 2014 until February 2017 and included patients with hepatitis C virus infection who underwent treatment. The primary endpoint was sustained virologic response at least 12 weeks post treatment. Data was analyzed with the SPSS 17.0 program. Results: During the study period, 820 patients completed therapy and achieved sufficient follow-up time to assess sustained virologic response with an overall response rate of 97.2% (n = 797) and a response rate of 98.0%, 99.5%, 90.9%, 95.1% and 94.2% for genotypes 1a, 1b, 2, 3 and 4, respectively. Data suggested that advanced fibrosis (F3/F4), human immunodeficiency virus co-infection and treatment failure with interferon and ribavirin were not negatively related with sustained virologic response in our population. Most patients (80.1%) completed treatment with ledipasvir/sofosbuvir ± ribavirin. The most common adverse events were fatigue and insomnia followed by headache and weight loss. Discussion: Patients predominantly had genotype 1 infection which correlates with HCV distribution in Europe, but we found a major proportion in genotype 4 which can be explained by immigration from African countries. Our patients’ ages ranging from 22 to 90 years, reflected a new approach with no upper age limit. Direct-acting antivirals regimens resulted in remarkably high SVR rates compared to interferon-based regimens, which were consistent with clinical trials data. Conclusion: Our data showed that direct-acting antiviral-based regimens are safe and have a high success rate in the treatment of patients with hepatitis C virus infection in a real-world setting.

Objectives: To determine the cost associated with the preparation and administration of intravenous (IV) trastuzumab and to estimate the difference versus subcutaneous (SC) administration considering only the consumption of material resources (MR) and the cost associated with the time spent by the health professionals (HP) involved. Study Design: Cross-sectional study of resource consumption evaluation by interview. Location: Hospitals distributed nationally. Population: Health care professionals. Methods: Data were collected by interview to the HP involved intrastuzumab preparation and administration in the hospitals. The cost of time spent by HP was calculated by multiplying the time value of each HP by the average time of each procedure; the costs of MR were determined based on the values contained in the Health Public Supply Catalog, in Infomed or in table value provided by the manufacturer. Results: Seven Mainland Portugal hospitals were included, five public and two private, that use trastuzumab in the treatment of an average of 12 patients with HER2 + breast cancer, per week. The trastuzumab IV preparation and administration average total cost, per treatment cycle, was estimated at €35.63 (HP – €18.42; MR – €17.21) and €3.18 (PS – €3.13; RM – €0.05) for SC administration. Considering 18 treatment cycles (1 year of treatment), the cost per patient treated with trastuzumab via IV is estimated at €641.32 versus €57.20 with SC administration. Conclusions: The substitution of trastuzumab IV for the SC formulation would allow a saving of about €584 per patient per year of treatment. This study is limited by the subjectivity associated with the fact that the determination of costs was based on answers given by HP. On the other hand, the results may be undervalued due to lack of information on other costs, including costs spent by the patient.

A Reunião de Reflexão sobre Financiamento da Inovação Disruptiva teve como objetivo debater possíveis formas de avaliação e de financiamento dos medicamentos de grau de inovação disruptiva que assegurem o seu rápido e efetivo acesso ao mercado e aos doentes. De facto, novas opções terapêuticas em determinadas áreas podem constituir uma verdadeira quebra com práticas do passado. Esquemas de tratamento, progressão das doenças e características epidemiológicas podem ser absolutamente revolucionados quando surja uma opção terapêutica que mude radicalmente o curso natural da evolução da doença. São estes casos que entendemos que justificam repensar todo o sistema de avaliação, e também de financiamento, de modo a otimizar todo o benefício potencial que o SNS e os cidadãos podem extrair de determinado fármaco que apresente as características atrás descritas. No decorrer da reunião foram debatidos alguns aspetos relativos aos constrangimentos e estrangulamentos no atual sistema de avaliação e financiamento, tendo sido sugeridas diversas melhorias ao funcionamento do sistema. A reunião contou com a participação ativa e a opinião de todos os intervenientes. Este documento foi objeto de revisão e aprovação por parte dos participantes na reunião, tendo sido a sua redação final o resultado da discussão presencial e de um processo de consulta posterior realizado com o objetivo de elaborar um documento consensual.

Objetivos: Determinar o custo associado à preparação e administração de trastuzumab por via intravenosa (IV) e estimar a diferença versus a administração por via subcutânea (SC), considerando apenas o consumo de recursos materiais (RM) e o custo associado ao tempo despendido pelos profissionais de saúde (PS) envolvidos. Tipo de Estudo: Estudo transversal de avaliação de consumo de recursos por entrevista. Local: Hospitais distribuídos a nível nacional. População: Profissionais de saúde. Métodos: Os dados foram recolhidos por entrevista a PS envolvidos na preparação e administração de trastuzumab nos hospitais. O custo do tempo despendido pelos PS foi calculado multiplicando o valor/hora de cada PS pelo tempo médio de cada procedimento; os custos dos RM determinaram-se com base nos valores constantes do Catálogo de Aprovisionamento Público de Saúde, no Infomed ou no valor de tabela fornecido pelo fabricante. Resultados: Incluíram-se sete hospitais de Portugal Continental, cinco públicos e dois privados, que utilizam trastuzumab no tratamento de, em média, 12 doentes com cancro da mama HER2+ por semana. O custo total médio (CTM) da preparação e administração de trastuzumab por via IV por ciclo de tratamento foi estimado em € 35,63 (PS – € 18,42; RM – € 17,21) e em € 3,18 (PS – € 3,13; RM – € 0,05) para a administração SC. Considerando 18 ciclos de tratamento (ou seja, um ano de tratamento), o custo por doente tratado com trastuzumab por via IV é estimado em € 641,32 versus € 57,20 com a administração SC. Conclusões: A substituição de trastuzumab IV pela formulação SC permitiria uma poupança de cerca de € 584 por doente, por ano de tratamento. Este estudo tem como limitação a subjetividade associada ao facto da determinação dos custos se ter baseado em respostas dadas por PS. Por outro lado, os resultados poderão estar subvalorizados por inexistência de informação relativa a outros custos, nomeadamente os gastos incorridos pelo doente.