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La primera l&#237;nea terap&#233;utica suelen ser los AINE y los glucocorticoides<a class="elsevierStyleCrossRef" href="#bib7"><span class="elsevierStyleSup">7</span></a>&#46; Estos f&#225;rmacos act&#250;an r&#225;pidamente mejorando el dolor y la tumefacci&#243;n causada por la AR&#46; Los f&#225;rmacos antirreum&#225;ticos modificadores de la enfermedad &#40;FAME&#41; son compuestos que act&#250;an de forma m&#225;s lenta mejorando no solo los s&#237;ntomas sino tambi&#233;n la progresi&#243;n cl&#237;nica y radiogr&#225;fica&#46; Debido a que su efecto puede tardar en observarse varias semanas o meses&#44; los FAME suelen prescribirse inicialmente junto con agentes que act&#250;an de forma m&#225;s r&#225;pida&#44; como los AINE y los glucocorticoides<a class="elsevierStyleCrossRef" href="#bib7"><span class="elsevierStyleSup">7</span></a>&#46; Los FAME han demostrado capacidad para enlentecer o detener la progresi&#243;n de la AR y entre ellos hay que destacar por su eficacia y rapidez de acci&#243;n al metotrexato que se puede administrar por v&#237;a oral o parenteral<a class="elsevierStyleCrossRef" href="#bib8"><span class="elsevierStyleSup">8</span></a>&#46; 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empeora o se mantiene en el mismo estado de salud&#46; Adem&#225;s seg&#250;n la recomendaci&#243;n de los expertos se ha pautado la secuencia de tratamiento tras el fallo de los mismos seg&#250;n la pr&#225;ctica cl&#237;nica espa&#241;ola&#44; siendo aumentar dosis de metotrexato&#44; cambio de v&#237;a de administraci&#243;n&#44; sustituir&#47;a&#241;adir otro FAME &#40;leflunomida&#44; hidroxicloroquina&#44; sulfasalazina y sales de oro&#41; o incluso a&#241;adir un tratamiento biol&#243;gico&#46; De tal forma&#44; que la cohorte hipot&#233;tica tiene las caracter&#237;sticas y la tasa de progresi&#243;n de la enfermedad para metotrexato en primera l&#237;nea de tratamiento equivalente a la del ensayo cl&#237;nico multic&#233;ntrico donde se comparaba metotrexato oral frente a subcut&#225;neo<a class="elsevierStyleCrossRef" href="#bib10"><span class="elsevierStyleSup">10</span></a>&#46; A partir de las 24 semanas del estudio Braun et al<a class="elsevierStyleCrossRef" href="#bib10"><span class="elsevierStyleSup">10</span></a>&#44; la efectividad incluida en el modelo es la misma para los comparadores &#40;metotrexatos&#41; y para los tratamientos administrados tras fallo &#40;otros FAME&#44; metotrexato&#43;biol&#243;gicos&#41; provenientes de los resultados a medio plazo &#40;12 meses&#41; del ensayo cl&#237;nico controlado ATTRACT de 54 semanas en pacientes con AR<a class="elsevierStyleCrossRef" href="#bib11"><span class="elsevierStyleSup">11</span></a>&#44; del an&#225;lisis coste-efectividad del estudio ATTRACT de Wong et al<a class="elsevierStyleCrossRef" href="#bib12"><span class="elsevierStyleSup">12</span></a> y de la revisi&#243;n Cochrane con infliximab<a class="elsevierStyleCrossRef" href="#bib13"><span class="elsevierStyleSup">13</span></a> y adalimumab<a class="elsevierStyleCrossRef" href="#bib14"><span class="elsevierStyleSup">14</span></a>&#46; Para los resultados a largo plazo &#40;segundo a&#241;o&#8211;resto de la vida&#41; se realiz&#243; un pron&#243;stico a largo plazo de los pacientes tomado del modelo farmacoecon&#243;mico del estudio de Wong et al<a class="elsevierStyleCrossRef" href="#bib12"><span class="elsevierStyleSup">12</span></a>&#44; de Brennan et al<a class="elsevierStyleCrossRefs" href="#bib15"><span class="elsevierStyleSup">15&#44;16</span></a> y de un estudio observacional holand&#233;s<a class="elsevierStyleCrossRef" href="#bib17"><span class="elsevierStyleSup">17</span></a>&#46;</p></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Sujetos del estudio</span><p class="elsevierStylePara elsevierViewall">El an&#225;lisis se ha desarrollado a partir de una cohorte hipot&#233;tica de pacientes con AR &#40;edad media 56 a&#241;os&#59; el 78&#44;9&#37; mujeres&#41; na&#239;ve a metotrexato&#44; a semejanza de los participantes del estudio de Braun et al<a class="elsevierStyleCrossRef" href="#bib10"><span class="elsevierStyleSup">10</span></a>&#46;</p></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Par&#225;metros</span><p class="elsevierStylePara elsevierViewall">La eficacia diferencial de las presentaciones de metotrexato existentes en Espa&#241;a&#44; seg&#250;n su v&#237;a de administraci&#243;n&#44; proviene del estudio de Braun et al<a class="elsevierStyleCrossRef" href="#bib10"><span class="elsevierStyleSup">10</span></a>&#46; En los ensayos cl&#237;nicos la medida de eficacia principal es la respuesta al &#237;ndice ACR aunque tambi&#233;n se mide como criterio de respuesta el &#237;ndice Disease Activity Store &#40;DAS28&#41;&#46; Los criterios de mejor&#237;a del ACR<a class="elsevierStyleCrossRef" href="#bib18"><span class="elsevierStyleSup">18</span></a>&#44; valoran la respuesta terap&#233;utica&#44; pero no miden valores absolutos de actividad&#44; sino sus cambios porcentuales&#46; Debido a la naturaleza del estudio y teniendo en cuenta que no siempre la eficacia se mide con DAS28&#44; se han presentado los an&#225;lisis en base al &#233;xito terap&#233;utico con ACR20&#44; ACR50 y ACR70&#46; En los casos en que la respuesta solo aparece con DAS28 se ha previsto que la respuesta ACR20 corresponde al DAS28 moderado&#44; la respuesta ACR50 al DAS28 leve y la respuesta ACR70 al DAS28 remisi&#243;n&#46;</p><p class="elsevierStylePara elsevierViewall">Por lo que respecta a las actitudes terap&#233;uticas en caso de progresi&#243;n de la enfermedad&#44; la distribuci&#243;n de cambios terap&#233;uticos en funci&#243;n del tratamiento inicial fueron tomados de Wong et al<a class="elsevierStyleCrossRef" href="#bib12"><span class="elsevierStyleSup">12</span></a> y validados y completados por la opini&#243;n del panel de expertos espa&#241;oles especialistas en reumatolog&#237;a&#46; De tal forma&#44; que cuando en un paciente la enfermedad progresa se eval&#250;a cuantos de ellos contin&#250;an el tratamiento y cuantos de ellos cambian a los tratamientos derivados de la pr&#225;ctica cl&#237;nica espa&#241;ola&#46; La validaci&#243;n y obtenci&#243;n de datos espa&#241;oles espec&#237;ficos fue obtenida del panel de expertos espa&#241;oles mediante un cuestionario creado adhoc&#46; El cuestionario para la obtenci&#243;n y validaci&#243;n de los datos fue elaborado previamente con el investigador principal antes de su env&#237;o al resto de los investigadores los cuales son coautores de este manuscrito&#46; En aquellos casos que se detectaron discrepancias en las respuestas se llev&#243; a cabo entrevistas en profundidad para detectar si eran pertinentes las modificaciones en un sentido u otro&#46;</p><p class="elsevierStylePara elsevierViewall">Con respecto a la calidad de vida&#44; se han utilizado datos de diferentes procedencias ya que no existen datos espa&#241;oles que pudiesen reflejar los valores para todos los estados de salud necesarios<a class="elsevierStyleCrossRefs" href="#bib12"><span class="elsevierStyleSup">12&#44;17</span></a>&#46;</p><p class="elsevierStylePara elsevierViewall">Se han considerado 3 grandes tipos de costes sanitarios&#58; el coste del tratamiento analizado&#44; el coste inicial del manejo de los distintos eventos &#40;ACR20&#44; ACR50&#44; ACR70&#44; muerte&#41; y el coste de seguimiento de los pacientes supervivientes a los distintos eventos&#46;</p><p class="elsevierStylePara elsevierViewall">El uso de recursos fue obtenido a partir de la opini&#243;n de expertos y los costes unitarios espa&#241;oles provienen de la base de datos del medicamento del consejo general de colegios oficiales de farmac&#233;uticos<a class="elsevierStyleCrossRef" href="#bib19"><span class="elsevierStyleSup">19</span></a> para los f&#225;rmacos y de la base de datos de costes sanitarios eSalud para el resto<a class="elsevierStyleCrossRef" href="#bib20"><span class="elsevierStyleSup">20</span></a>&#46; La estimaci&#243;n de los costes de las segundas l&#237;neas &#40;otros FAME&#44; anti-TNF&#41; y de la medicaci&#243;n concomitante proviene de estudios espec&#237;ficos espa&#241;oles<a class="elsevierStyleCrossRefs" href="#bib21"><span class="elsevierStyleSup">21&#44;22</span></a>&#46;</p></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Perspectiva&#44; horizonte temporal y descuento</span><p class="elsevierStylePara elsevierViewall">El an&#225;lisis est&#225; realizado desde la perspectiva del Sistema Nacional de Salud&#44; utilizando el horizonte temporal de 5 a&#241;os y de toda la vida&#46; Todos los costes se expresan en euros del a&#241;o 2009 y se ha utilizado una tasa de descuento del 3&#37; tanto para los costes como para los efectos&#46;</p></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">An&#225;lisis coste-efectividad</span><p class="elsevierStylePara elsevierViewall">Los resultados del modelo se expresan mediante la curva de aceptabilidad a pagar&#44; donde se muestra con qu&#233; probabilidad se debe escoger Metoject<span class="elsevierStyleSup">&#174;</span> en detrimento de metotrexato oral seg&#250;n diferentes disponibilidades a pagar te&#243;ricas asumibles por un decisor<a class="elsevierStyleCrossRef" href="#bib23"><span class="elsevierStyleSup">23</span></a>&#46; De tal forma que cuando se supera el umbral de equiprobabilidad &#40;50&#37;&#41; nos muestra que la alternativa estudiada es m&#225;s eficiente que la alternativa comparada&#46;</p><p class="elsevierStylePara elsevierViewall">Los datos de mortalidad y de utilidad introducidos en el modelo de Markov se estimaron a partir de estudios internacionales&#46; Debido a la incertidumbre de estos datos&#44; se realizaron varios escenarios que combinaban diferentes utilidades y datos de mortalidad por estado de salud&#46; El escenario base se refiere a valores seg&#250;n el estudio de Welsing et al<a class="elsevierStyleCrossRef" href="#bib17"><span class="elsevierStyleSup">17</span></a> para utilidad y valores del estudio de Kobelt et al<a class="elsevierStyleCrossRef" href="#bib24"><span class="elsevierStyleSup">24</span></a> para mortalidad&#46; La estimaci&#243;n de la calidad de vida para este caso base var&#237;a en funci&#243;n de la evoluci&#243;n de la enfermedad utilizando los valores 0&#44;75&#59; 0&#44;71&#59; 0&#44;64 y 0&#44;56 para estados de remisi&#243;n&#44; leve&#44; moderado y alto respectivamente&#46; Asimismo&#44; los datos de mortalidad tambi&#233;n son diferentes en funci&#243;n de estos estados y se considera que el riesgo relativo de 1&#44;00 equivale a la remisi&#243;n&#44; 1&#44;30 al estado leve&#44; 1&#44;65 al moderado y 2&#44;00 al estado alto<a class="elsevierStyleCrossRef" href="#bib24"><span class="elsevierStyleSup">24</span></a>&#46; Las utilidades y la mortalidad empleadas en el caso base corresponden al escenario m&#225;s conservador para Metoject<span class="elsevierStyleSup">&#174;</span> al estimarse la calidad de vida para diferentes estados de salud como la mayor observada de los estudios y con la menor mortalidad posible&#46; Por otro lado se construy&#243; el escenario m&#225;s favorable para Metoject<span class="elsevierStyleSup">&#174;</span> &#40;aunque el m&#225;s desfavorable para los pacientes&#41; con los pacientes que progresan en su gravedad y tienen la peor calidad de vida &#40;remisi&#243;n 0&#44;77&#59; leve 0&#44;68&#59; moderado 0&#44;62 y grave 0&#44;52&#41; posible adem&#225;s de una menor esperanza de vida &#40;riesgo relativo de 1&#44;00 para remisi&#243;n&#44; 1&#44;46 para leve&#44; 1&#44;92 para moderado y 2&#44;39 para grave&#41;<a class="elsevierStyleCrossRefs" href="#bib16"><span class="elsevierStyleSup">16&#44;24</span></a>&#46;</p></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">An&#225;lisis del impacto presupuestario</span><p class="elsevierStylePara elsevierViewall">Se ha desarrollado un an&#225;lisis del impacto presupuestario potencial de extender el uso de Metoject<span class="elsevierStyleSup">&#174;</span> sustituyendo en distintas proporciones al tratamiento farmacol&#243;gico por v&#46;o&#46; Estudiamos un escenario con el uso actual de Metoject<span class="elsevierStyleSup">&#174;</span> y el coste potencial de su mayor introducci&#243;n en esta poblaci&#243;n&#44; utilizando el coste por paciente para cada opci&#243;n&#44; durante los pr&#243;ximos 5 a&#241;os&#46; Para proyectar los pacientes susceptibles de ser tratados con metotrexato se ha llevado a cabo una regresi&#243;n lineal ajustando seg&#250;n los datos hist&#243;ricos<a class="elsevierStyleCrossRef" href="#bib25"><span class="elsevierStyleSup">25</span></a>&#46;</p></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">An&#225;lisis de sensibilidad</span><p class="elsevierStylePara elsevierViewall">Para valorar la influencia de la incertidumbre de los par&#225;metros &#40;eficacia&#44; tasa de abandono&#44; costes&#44; etc&#46;&#41; en los resultados del estudio y validar la solidez de los resultados obtenidos&#44; se realiz&#243; un an&#225;lisis de sensibilidad probabil&#237;stico mediante una simulaci&#243;n de Monte Carlo de segundo orden&#44; de tal forma que se simul&#243; 1&#46;000 veces el coste-efectividad de cada comparaci&#243;n&#46;</p><p class="elsevierStylePara elsevierViewall">Para llevar a cabo el an&#225;lisis de sensibilidad se han seleccionado unas distribuciones fijas y se han estimado los par&#225;metros de cada distribuci&#243;n en funci&#243;n de los datos primarios recopilados<a class="elsevierStyleCrossRef" href="#bib26"><span class="elsevierStyleSup">26</span></a>&#46;</p></span></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Resultados</span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Efectos sobre la salud y los costes</span><p class="elsevierStylePara elsevierViewall">En base a los resultados del estudio de Braun et al<a class="elsevierStyleCrossRef" href="#bib10"><span class="elsevierStyleSup">10</span></a> de 24 semanas de duraci&#243;n se ha concluido que Metoject<span class="elsevierStyleSup">&#174;</span> controla mejor el progreso de la enfermedad ya que el 41&#37; de los pacientes consiguen alcanzar la remisi&#243;n &#40;metotrexato oral 33&#37;&#41;&#44; el 21&#37; finalizan con un DAS28 leve &#40;metotrexato oral 26&#37;&#41;&#44; el 16&#37; con un DAS28 moderado &#40;metotrexato oral 11&#37;&#41; y solo el 22&#37; con un DAS28 alto &#40;metotrexato oral 30&#37;&#41;&#46; Se observa que el porcentaje de pacientes en remisi&#243;n es un 8&#37; mayor en el grupo Metoject<span class="elsevierStyleSup">&#174;</span> respecto a metotrexato oral y que el porcentaje de pacientes con DAS28 alto es inferior en el grupo Metoject<span class="elsevierStyleSup">&#174;</span>&#44; lo cual indica una mejora global del estado de salud de los pacientes&#46;</p><p class="elsevierStylePara elsevierViewall">Los datos del pron&#243;stico de los pacientes a largo plazo en cada opci&#243;n terap&#233;utica se han tomado de an&#225;lisis de coste-efectividad previos<a class="elsevierStyleCrossRefs" href="#bib12"><span class="elsevierStyleSup">12&#44;17</span></a> y denotan que la mayor&#237;a de los pacientes se mantienen en su estado de salud &#40;<a class="elsevierStyleCrossRef" href="#tbl1">tabla 1</a>&#41;&#46; Asimismo&#44; por lo que respecta a las actitudes terap&#233;uticas en caso de progreso de la enfermedad se observa que entre el 84&#8211;95&#37; de los pacientes mantienen el tratamiento&#46; As&#237; la mayor&#237;a de veces que se opta por el cambio de tratamiento se a&#241;ade otro FAME y en pocos casos &#40;entre el 10&#8211;20&#37;&#41; se elige a&#241;adir un anti-TNF&#46; Por otro lado&#44; en el caso de mejorar la progresi&#243;n de la enfermedad se observa que tanto en la pr&#225;ctica cl&#237;nica como en los estudios internacionales&#44; se realizan cambios de tratamiento aunque en baja frecuencia &#40;entre el 5&#8211;23&#37; para metotrexato&#44; entre el 9&#8211;35&#37; para FAME y entre el 16&#8211;41&#37; en la combinaci&#243;n de metotrexato m&#225;s FAME&#41;&#46; Cuando se lleva a cabo este cambio se puede observar que normalmente se basa en la sustituci&#243;n por metotrexato u otro FAME&#46;</p><elsevierMultimedia ident="tbl1"></elsevierMultimedia><p class="elsevierStylePara elsevierViewall">Con respecto a los costes principales&#44; se observ&#243; que el uso de recursos de Metoject<span class="elsevierStyleSup">&#174;</span> es similar al de metotrexato oral y&#44; por tanto&#44; los costes directos semestrales no farmacol&#243;gicos solo se incrementaban en 82<span class="elsevierStyleHsp" style=""></span>&#8364; para el grupo de Metoject<span class="elsevierStyleSup">&#174;</span> &#40;<a class="elsevierStyleCrossRefs" href="#tbl2">tablas 2 y 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl2"></elsevierMultimedia><elsevierMultimedia ident="tbl3"></elsevierMultimedia></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">An&#225;lisis coste-efectividad</span><p class="elsevierStylePara elsevierViewall">Metoject<span class="elsevierStyleSup">&#174;</span> aporta al paciente una ganancia de alrededor de 0&#44;103&#8211;0&#44;145 AVAC a los 5 a&#241;os&#44; llegando a suponer en toda la vida aproximadamente entre 0&#44;308&#8211;0&#44;396 AVAC&#46;</p><p class="elsevierStylePara elsevierViewall">La raz&#243;n de coste &#40;solo costes farmacol&#243;gicos&#41; por a&#241;os de vida ajustados por calidad &#40;AVAC&#41; ganado con Metoject<span class="elsevierStyleSup">&#174;</span> frente a metotrexato oral fue de entre 25&#46;173&#8211;35&#46;807<span class="elsevierStyleHsp" style=""></span>&#8364; a los 5 a&#241;os y de 19&#46;056&#8211;25&#46;351<span class="elsevierStyleHsp" style=""></span>&#8364; para el horizonte temporal de toda la vida&#44; valor por debajo del umbral asumido en Espa&#241;a &#40;<a class="elsevierStyleCrossRef" href="#tbl4">tabla 4</a>&#41;<a class="elsevierStyleCrossRef" href="#bib23"><span class="elsevierStyleSup">23</span></a>&#46; Al tener en cuenta todos los costes directos que intervienen en el tratamiento de la AR&#44; se observ&#243; que el coste-efectividad de Metoject<span class="elsevierStyleSup">&#174;</span> frente a metotrexato oral a los 5 a&#241;os fue de 29&#46;682&#8211;42&#46;175<span class="elsevierStyleHsp" style=""></span>&#8364;&#47;AVAC ganado y para toda la vida fue de 22&#46;514&#8211;29&#46;848<span class="elsevierStyleHsp" style=""></span>&#8364;&#47;AVAC ganado &#40;<a class="elsevierStyleCrossRef" href="#tbl4">tabla 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl4"></elsevierMultimedia><p class="elsevierStylePara elsevierViewall">El an&#225;lisis de sensibilidad mostr&#243; que el 68&#44; 77 y 87&#37; de los casos tratados con Metoject<span class="elsevierStyleSup">&#174;</span> est&#225;n por debajo de los umbrales de coste-efectividad de 30&#46;000&#44; 35&#46;000 y 45&#46;000<span class="elsevierStyleHsp" style=""></span>&#8364;&#47;AVAC ganado&#44; respectivamente&#46; As&#237;&#44; la <a class="elsevierStyleCrossRef" href="#fig2">figura 2</a> demuestra que Metoject<span class="elsevierStyleSup">&#174;</span> es un medicamento eficiente cuando se supera el umbral de equiprobabilidad de 24&#46;000<span class="elsevierStyleHsp" style=""></span>&#8364; por AVAC ganado&#46;</p><elsevierMultimedia ident="fig2"></elsevierMultimedia><p class="elsevierStylePara elsevierViewall">Asimismo&#44; la simulaci&#243;n mostr&#243; que el coste por AVAC mediano ronda los 23&#46;836<span class="elsevierStyleHsp" style=""></span>&#8364;&#47;AVAC&#44; con un rango intercuart&#237;lico de 14&#46;627<span class="elsevierStyleHsp" style=""></span>&#8364;&#47;AVAC&#44; valores que incluye tanto el escenario m&#225;s desfavorable &#40;caso base&#41; y favorable &#40;<a class="elsevierStyleCrossRef" href="#tbl4">tabla 4</a> y <a class="elsevierStyleCrossRef" href="#fig2">fig&#46; 2</a>&#41;&#46;</p></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">An&#225;lisis del impacto presupuestario</span><p class="elsevierStylePara elsevierViewall">En t&#233;rminos de impacto presupuestario la poblaci&#243;n tributaria de metotrexato es de entre 120&#46;000&#8211;160&#46;000 pacientes el primer y quinto a&#241;o&#44; respectivamente&#44; con un 20&#8211;24&#37; de pacientes en tratamiento con Metoject<span class="elsevierStyleSup">&#174;</span> &#40;<a class="elsevierStyleCrossRef" href="#tbl5">tabla 5</a>&#41;&#46; De tal forma que si se asume un incremento del uso de Metoject<span class="elsevierStyleSup">&#174;</span> del 10&#37; anual respecto al escenario actual entonces los costes directos asociados a la intervenci&#243;n ascienden a 2&#44;5&#8211;4 millones<span class="elsevierStyleHsp" style=""></span>&#8364;&#46; Como puede apreciarse en la <a class="elsevierStyleCrossRef" href="#fig3">figura 3</a>&#44; la repercusi&#243;n presupuestaria de incrementar la introducci&#243;n de Metoject<span class="elsevierStyleSup">&#174;</span> sobre el gasto sanitario de la poblaci&#243;n diana estimada supone un incremento del 1&#44;4&#37; del coste de la patolog&#237;a&#46;</p><elsevierMultimedia ident="tbl5"></elsevierMultimedia><elsevierMultimedia ident="fig3"></elsevierMultimedia><p class="elsevierStylePara elsevierViewall">El an&#225;lisis de sensibilidad del impacto presupuestario nos muestra que el incremento anual del uso de Metoject entre un 10&#8211;30&#37; provocar&#237;a como m&#225;ximo un coste directo neto del 4&#44;1&#37; del presupuesto &#40;<a class="elsevierStyleCrossRef" href="#tbl5">tabla 5</a>&#41;&#46; Asimismo&#44; cuando se estudia solo el impacto farmacol&#243;gico de la mayor introducci&#243;n de Metoject<span class="elsevierStyleSup">&#174;</span> se observa que el coste asciende al 2&#44;2&#8211;2&#44;5&#37; en el caso base y alcanza el 6&#44;6&#8211;7&#44;4&#37; al asumir un incremento del 30&#37; &#40;<a class="elsevierStyleCrossRef" href="#tbl5">tabla 5</a>&#41;&#46;</p></span></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discusi&#243;n</span><p class="elsevierStylePara elsevierViewall">Hasta la actualidad los datos existentes de eficacia comparativa no permit&#237;an concluir que el metotrexato por v&#237;a parenteral fuese mayor que el metotrexato por v&#46;o&#46;&#44; si bien la eficacia del f&#225;rmaco est&#225; m&#225;s que probada y es respaldada por las sociedades m&#233;dicas internacionales&#44; entre ellas la Sociedad Espa&#241;ola de Reumatolog&#237;a<a class="elsevierStyleCrossRef" href="#bib27"><span class="elsevierStyleSup">27</span></a>&#46; Con la aparici&#243;n del estudio de Braun et al<a class="elsevierStyleCrossRef" href="#bib10"><span class="elsevierStyleSup">10</span></a>&#44; se constata con un mayor grado de evidencia que la eficacia del metotrexato administrado por v&#237;a subcut&#225;nea&#44; como Metoject<span class="elsevierStyleSup">&#174;</span>&#44; es mayor que la eficacia del mismo f&#225;rmaco administrado por v&#46;o&#46; debido a la superior biodisponibilidad en la administraci&#243;n parenteral&#46; Esta mejora de la biodisponibilidad junto a la ya demostrada necesidad del tratamiento precoz de la AR con FAME<a class="elsevierStyleCrossRefs" href="#bib28"><span class="elsevierStyleSup">28&#44;29</span></a> ofrece&#44; tal como se muestra en nuestro estudio&#44; mayores posibilidades de modificar el curso de la enfermedad&#46; Asimismo&#44; se observa que el uso precoz de Metoject<span class="elsevierStyleSup">&#174;</span> aporta al paciente una ganancia de alrededor de 0&#44;103&#8211;0&#44;145 AVAC a los 5 a&#241;os&#44; llegando a suponer en toda la vida aproximadamente entre 0&#44;308&#8211;0&#44;396 AVAC&#46;</p><p class="elsevierStylePara elsevierViewall">Aparte de valorar en la pr&#225;ctica cl&#237;nica espa&#241;ola los efectos de la mayor eficacia de Metoject<span class="elsevierStyleSup">&#174;</span> a lo largo de la vida del paciente&#44; nuestro estudio sugiere que los costes adicionales de Metoject<span class="elsevierStyleSup">&#174;</span> respecto a metotrexato oral se ven compensados por su mejor efectividad&#44; expresada en t&#233;rminos de AVAC&#46; Hasta el momento&#44; la informaci&#243;n sobre el coste-efectividad del metotrexato en el tratamiento de la AR atendiendo a su v&#237;a de administraci&#243;n no hab&#237;a sido estudiada en profundidad debido a la carencia de ensayos cl&#237;nicos que comparasen la eficacia del f&#225;rmaco seg&#250;n su administraci&#243;n subcut&#225;nea u oral&#44; aunque hubiese sido posible llevar a cabo estudios de minimizaci&#243;n de costes&#46; Nuestra investigaci&#243;n es&#44; en definitiva&#44; un nuevo punto de partida para posibles estudios de evaluaci&#243;n econ&#243;mica que pueden permitir validar externamente que el uso de Metoject<span class="elsevierStyleSup">&#174;</span> en pacientes con AR es una terapia eficiente y por tanto&#44; de elecci&#243;n ante la disyuntiva de qu&#233; v&#237;a de administraci&#243;n utilizar&#46;</p><p class="elsevierStylePara elsevierViewall">El an&#225;lisis del impacto presupuestario es una t&#233;cnica utilizada para estimar cuantitativamente la alteraci&#243;n prevista en el gasto sanitario para la atenci&#243;n de una patolog&#237;a con la mayor introducci&#243;n de una nueva intervenci&#243;n sanitaria para su tratamiento<a class="elsevierStyleCrossRef" href="#bib30"><span class="elsevierStyleSup">30</span></a>&#46; En el caso de la mayor introducci&#243;n de Metoject<span class="elsevierStyleSup">&#174;</span> en el Sistema Nacional de Salud&#44; el impacto se deber&#225; esencialmente a la disminuci&#243;n del gasto por la progresi&#243;n de la enfermedad evitada y el coste diferencial del nuevo tratamiento&#46;</p><p class="elsevierStylePara elsevierViewall">Cabe destacar que la perspectiva adoptada en el estudio es la del Sistema Nacional de Salud y por tanto&#44; hemos excluido otros costes que ser&#237;an considerados importantes desde un punto vista social&#44; por ejemplo&#44; los costes asociados a la p&#233;rdida de horas laborales o el coste de la ayuda de los familiares&#46; Es conocido que la mayor&#237;a de los costes de la AR son indirectos&#44; ya que aproximadamente duplican a los costes directos<a class="elsevierStyleCrossRef" href="#bib31"><span class="elsevierStyleSup">31</span></a> y que el tratamiento eficaz de una persona a la que se le ha diagnosticado una AR tambi&#233;n puede reducir la carga que soporta la persona y la sociedad&#46;</p><p class="elsevierStylePara elsevierViewall">Una de las principales limitaciones del estudio deriva de la utilizaci&#243;n de datos de diferentes procedencias respecto a costes a corto y largo plazo&#44; pron&#243;stico a largo plazo&#44; par&#225;metros de eficacia&#44; calidad de vida&#44; mortalidad y utilidades ya que no existen datos espa&#241;oles que pudiesen reflejar los valores para todos los estados de salud necesarios&#46; Esta disparidad de estudios usados para establecer el modelo&#44; al no disponer de datos comparativos a medio&#47;largo plazo pueden estar influenciando los resultados debido a que la pr&#225;ctica cl&#237;nica de nuestro &#225;mbito puede no ser la misma pr&#225;ctica cl&#237;nica derivada de los estudios de los cuales hemos asumido los valores&#44; aunque en todo momento fue validada por el panel de expertos&#46; Asimismo&#44; cabe mencionar que la opci&#243;n de inicio de tratamiento con metrotexato oral en nuestro modelo puede no corresponderse con la pr&#225;ctica cl&#237;nica habitual&#44; en la que pacientes en que este tratamiento no es eficaz son cambiados a la forma SC&#46; Sin embargo&#44; dado que no existen evidencias de una mayor eficacia del tratamiento SC m&#225;s all&#225; del periodo inicial que se observ&#243; en el estudio de Braun&#44; la consideraci&#243;n de este cambio de oral a SC no se ha podido incluir en el modelo&#46;</p><p class="elsevierStylePara elsevierViewall">Adem&#225;s&#44; se tiene que tener en cuenta en la valoraci&#243;n de estos resultados la limitaci&#243;n por tratarse de un modelo te&#243;rico basado en resultados de ensayos cl&#237;nicos&#44; sobre todo del estudio de Braun et al<a class="elsevierStyleCrossRef" href="#bib10"><span class="elsevierStyleSup">10</span></a> que podr&#237;a estar sobreestimando los beneficios del metotrexato inyectable comparado con estudios de un solo brazo&#46; Hay que tener en cuenta que Braun et al<a class="elsevierStyleCrossRef" href="#bib10"><span class="elsevierStyleSup">10</span></a> demuestran que metotrexato subcut&#225;neo es posiblemente m&#225;s eficaz que metotrexato oral a dosis de 15<span class="elsevierStyleHsp" style=""></span>mg semanales&#46; Ello puede observarse en ACR20 y 70 pero no en ACR50&#46; Por lo tanto&#44; nuestro estudio te&#243;rico se basa en datos comparativos solo a corto plazo &#40;6 meses&#41; y l&#237;mite de dosis razonable &#44;sin embargo&#44; de 15<span class="elsevierStyleHsp" style=""></span>mg semanales&#46; Por otro lado&#44; en la misma l&#237;nea que el estudio de Braun&#44; 2 estudios recientes observacionales prospectivos llevados a cabo en Reino Unido han demostrado de nuevo que metotrexato subcut&#225;neo es m&#225;s eficaz que metotrexato oral y que se tolera bien en los pacientes con AR&#44; incluso en los casos en los que la enfermedad es m&#225;s cr&#243;nica<a class="elsevierStyleCrossRefs" href="#bib32"><span class="elsevierStyleSup">32&#44;33</span></a>&#46;</p><p class="elsevierStylePara elsevierViewall">Por &#250;ltimo&#44; aunque el coste por AVAC ganado del estudio cae dentro del l&#237;mite arbitrariamente aceptado en pa&#237;ses occidentales&#44; est&#225; bastante pr&#243;ximo al margen superior aceptado para el mismo&#46; Ser&#237;a pues deseable disponer de nuevos estudios comparativos directos en la pr&#225;ctica cl&#237;nica que permitiesen un mejor ajuste de las valoraciones tanto de la efectividad como de los costes&#46;</p><p class="elsevierStylePara elsevierViewall">De nuestra investigaci&#243;n se desprende que el estudio de la AR debe continuar intentando abordar aspectos no contemplados&#44; como el cumplimiento terap&#233;utico o la satisfacci&#243;n de los pacientes&#44; o sobre c&#243;mo reducir la incertidumbre respecto a la efectividad a largo plazo y a los costes &#40;directos&#47;indirectos&#41; asociados a la AR a nivel nacional&#46; Por otro lado&#44; aunque existen algunos estudios donde se ha evaluado la calidad de vida de los pacientes con AR en Espa&#241;a<a class="elsevierStyleCrossRef" href="#bib34"><span class="elsevierStyleSup">34</span></a> a&#250;n son necesarios estudios de calidad de vida con mayor n&#250;mero de pacientes que estudien en profundidad los estados de salud y con medidas equivalentes a las preferencias de los mismos como es el caso del EuroQol-5D&#46;</p><p class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; aunque se precisan m&#225;s datos a medio largo plazo para confirmar nuestros resultados&#44; nuestro estudio sugiere que los costes adicionales de Metoject<span class="elsevierStyleSup">&#174;</span> respecto a metotrexato oral se ver&#237;an compensados por su mejora en efectividad&#44; revelando que Metoject<span class="elsevierStyleSup">&#174;</span> podr&#237;a ser un tratamiento costeefectivo para el sistema sanitario espa&#241;ol seg&#250;n el umbral asumido&#44; con un impacto relativo al gasto generado actualmente por estos pacientes muy limitado&#46;</p></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Financiaci&#243;n</span><p class="elsevierStylePara elsevierViewall">El estudio fue financiado por Gebro Pharma&#44; pero la empresa no particip&#243; en la recogida de datos&#44; en la interpretaci&#243;n de ellos ni en la decisi&#243;n de publicar&#46;</p></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicto de intereses</span><p class="elsevierStylePara elsevierViewall">Jordi Galv&#225;n trabaja en Gebro Pharma que es la empresa promotora del estudio&#46; Max Brosa y Carlos Crespo trabajan para la consultora Oblikue Consulting que recibi&#243; honorarios de la empresa promotora del estudio en concepto de ayuda a la investigaci&#243;n&#46;</p></span></span>"
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          "titulo" => array:5 [
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          "titulo" => array:5 [
            0 => "Abstract"
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        4 => array:1 [
          "titulo" => "Introducci&#243;n"
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        5 => array:2 [
          "titulo" => "M&#233;todos"
          "secciones" => array:7 [
            0 => array:1 [
              "titulo" => "Modelizaci&#243;n"
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            1 => array:1 [
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            3 => array:1 [
              "titulo" => "Perspectiva&#44; horizonte temporal y descuento"
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            4 => array:1 [
              "titulo" => "An&#225;lisis coste-efectividad"
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            5 => array:1 [
              "titulo" => "An&#225;lisis del impacto presupuestario"
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            6 => array:1 [
              "titulo" => "An&#225;lisis de sensibilidad"
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        6 => array:2 [
          "titulo" => "Resultados"
          "secciones" => array:3 [
            0 => array:1 [
              "titulo" => "Efectos sobre la salud y los costes"
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            1 => array:1 [
              "titulo" => "An&#225;lisis coste-efectividad"
            ]
            2 => array:1 [
              "titulo" => "An&#225;lisis del impacto presupuestario"
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          ]
        ]
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          "titulo" => "Discusi&#243;n"
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        8 => array:1 [
          "titulo" => "Financiaci&#243;n"
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          "titulo" => "Conflicto de intereses"
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          "titulo" => "Bibliograf&#237;a"
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    "fechaRecibido" => "2009-05-06"
    "fechaAceptado" => "2009-11-05"
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec113142"
          "palabras" => array:3 [
            0 => "Metotrexato"
            1 => "Coste-efectividad"
            2 => "Calidad de vida"
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec113143"
          "palabras" => array:3 [
            0 => "Methotrexate"
            1 => "Cost-effectiveness"
            2 => "Quality of life"
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    "resumen" => array:2 [
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p class="elsevierStyleSimplePara elsevierViewall">El objetivo de este estudio ha sido comparar la eficiencia de utilizar el metotrexato subcut&#225;neo &#40;Metoject<span class="elsevierStyleSup">&#174;</span>&#41; con respecto al metotrexato oral en el manejo de pacientes con AR en Espa&#241;a&#46;</p> <span class="elsevierStyleSectionTitle">M&#233;todos</span><p class="elsevierStyleSimplePara elsevierViewall">Se ha realizado un an&#225;lisis coste-efectividad&#47;utilidad del tratamiento de la AR temprana utilizando un modelo de Markov&#46; El modelo ha permitido estimar la efectividad a largo plazo del tratamiento de la AR en funci&#243;n de los datos de la literatura y de la opini&#243;n de expertos y combinarlo con informaci&#243;n de los costes en Espa&#241;a&#46; El an&#225;lisis se ha realizado desde la perspectiva del Sistema Nacional de Salud&#44; utilizando un horizonte temporal de 5 a&#241;os y de toda la vida del paciente&#46; Todos los costes se expresaron en euros del a&#241;o 2009 y se ha utilizado una tasa de descuento del 3&#37;&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">La raz&#243;n de coste &#40;solo costes farmacol&#243;gicos&#41; por a&#241;o de vida ajustado por calidad &#40;AVAC&#41; ganado con Metoject<span class="elsevierStyleSup">&#174;</span> fue de 25&#46;173&#8211;35&#46;807<span class="elsevierStyleHsp" style=""></span>&#8364; a los 5 a&#241;os y de 19&#46;056&#8211;25&#46;351<span class="elsevierStyleHsp" style=""></span>&#8364; para toda la vida&#46; Al tener en cuenta los costes directos de la AR se observ&#243; que el coste-efectividad a los 5 a&#241;os fue de 29&#46;682&#8211;42&#46;175<span class="elsevierStyleHsp" style=""></span>&#8364;&#47;AVAC ganado y para toda la vida fue de 22&#46;514&#8211;29&#46;848<span class="elsevierStyleHsp" style=""></span>&#8364;&#47;AVAC ganado&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">Los costes adicionales de Metoject<span class="elsevierStyleSup">&#174;</span> respecto a metotrexato oral se ver&#237;an compensados por su mejora en efectividad&#44; expresada en t&#233;rminos de AVAC&#44; revelando que Metoject<span class="elsevierStyleSup">&#174;</span> podr&#237;a ser un tratamiento costeefectivo para la AR en el Sistema Nacional de Salud seg&#250;n el umbral asumido en Espa&#241;a&#46;</p>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><p class="elsevierStyleSimplePara elsevierViewall">The aim of this study was to compare the clinical and economic consequences of using subcutaneous methotrexate &#40;Metoject<span class="elsevierStyleSup">&#174;</span>&#41; with respect to oral methotrexate in the management of rheumatoid arthritis &#40;RA&#41; in Spain&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p class="elsevierStyleSimplePara elsevierViewall">A cost-effectiveness analysis was performed to compare early treatment of RA using a Markov model&#46; The model allowed us to estimate long term efficacy of RA treatment based on data from the literature and expert opinion&#44; and to combine this data with costs of managing RA in Spain&#46; The perspective of the study was from the National Health System point of view&#44; using a time horizon of 5 years and patient lifetime&#46; All costs were expressed in 2009 euros and a 3&#37; discount rate was applied&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">The cost &#40;only pharmacologic costs&#41; per quality-adjusted life year &#40;QALY&#41; gained with Metoject<span class="elsevierStyleSup">&#174;</span> went from 25&#44;173 to 35&#44;807<span class="elsevierStyleHsp" style=""></span>&#8364; at 5 years and from 19&#44;056 to 25&#44;351<span class="elsevierStyleHsp" style=""></span>&#8364; for patient lifetime&#46; When direct costs in RA treatment were considered&#44; it was observed that cost-effectiveness at 5 years went from 29&#44;682 to 42&#44;175<span class="elsevierStyleHsp" style=""></span>&#8364;&#47;QALY gained&#44; and for patient lifetime from 22&#44;514 to 29&#44;848<span class="elsevierStyleHsp" style=""></span>&#8364;&#47; QALY gained&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">Additional costs of Metoject<span class="elsevierStyleSup">&#174;</span> with respect to oral methotrexate would be offset by their improved effectiveness&#44; expressed in QALY&#44; showing that Metoject<span class="elsevierStyleSup">&#174;</span> could be a cost-effective treatment option for RA in the Spanish Health System assuming a spanish threshold&#46;</p>"
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          "leyenda" => "<p class="elsevierStyleSimplePara elsevierViewall">DAS 28&#58; disease Activity Score&#59; FAME&#58; f&#225;rmacos antirreum&#225;ticos modificadores de la enfermedad&#59; MTX&#58; metotrexato&#46;</p>"
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                  \t\t\t\t" style="border-bottom: 2px solid black">Anti-TNF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">METOJECT<span class="elsevierStyleSup">&#174;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">MTX Oral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">FAME&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">MET&#43;FAME&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Anti-TNF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">METOJECT<span class="elsevierStyleSup">&#174;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">MTX Oral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">FAME&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">MET&#43;FAME&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Anti-TNF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">METOJECT<span class="elsevierStyleSup">&#174;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">MTX Oral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">FAME&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">MET&#43;FAME&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Anti-TNF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="5" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Remisi&#243;n</span></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">METOJECT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&#44;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#44;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MTX oral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&#44;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#44;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FAME&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&#44;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#44;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
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                  <a target="_blank" href="main.stripin/si0001.gif"><span class="e-comp" style="background:PowderBlue;" title="Click here to view Table Image">Click&nbsp;Here&nbsp;To&nbsp;View&nbsp;Stripin</span></a><p style="margin-bottom:0em"></p><table border="0" frame="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">95&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Visitas traumat&#243;logo &#40;primera visita&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&#44;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Visitas traumat&#243;logo &#40;visitas de seguimiento&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#44;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Visitas rehabilitaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Visitas m&#233;dico atenci&#243;n primaria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#44;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Visitas urgencias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">108&#44;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Estancias hospitalarias &#40;reuma&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">374&#44;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hematolog&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">92&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bioqu&#237;mica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">92&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Orina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tomograf&#237;a computarizada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">228&#44;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Resonancia magn&#233;tica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">465&#44;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ecograf&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">131&#44;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Radiograf&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&#44;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Electromiograf&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">74&#44;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">3&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Administraci&#243;n tratamiento anual del paciente</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Visitas enfermer&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#44;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">97&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">91&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Visitas enfermer&#237;a domiciliarias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#44;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Visitas enfermer&#237;a atenci&#243;n primaria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Costes no farmacol&#243;gicos</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Anual</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;008&#44;23<span class="elsevierStyleHsp" style=""></span>&#8364;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">844&#44;13<span class="elsevierStyleHsp" style=""></span>&#8364;</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Semestral</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">504&#44;11<span class="elsevierStyleHsp" style=""></span>&#8364;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">422&#44;07<span class="elsevierStyleHsp" style=""></span>&#8364;</td></tr></tbody></table>
                  """
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">Coste farmacol&#243;gico semestral</span></td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " rowspan="2" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Costes directos semestrales &#40;no farmacol&#243;gicos&#41; &#40;<span class="elsevierStyleItalic">&#8364;&#41;</span></td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " rowspan="2" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Fuente</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">Primeros 6 meses &#40;&#8364;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Siguientes 6 meses &#40;<span class="elsevierStyleItalic">&#8364;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">METOJECT<span class="elsevierStyleSup">&#174;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">458&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">470&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">504&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#44; 20 y opini&#243;n de expertos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Metotrexato oral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">422&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#44; 20 y opini&#243;n de expertos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Otros FAME</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sustituci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">435&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">404&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">422&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#44; 20&#44; 22 y opini&#243;n de expertos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&#241;adido&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">312&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">312&#44;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">19&#44; 20&#44; 22 y opini&#243;n de expertos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Anti-TNF&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">19&#44; 20&#44; 21 y opini&#243;n de expertos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Medicaci&#243;n concomitante&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">19&#44; 20&#44; 22 y opini&#243;n de expertos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "leyenda" => "<p class="elsevierStyleSimplePara elsevierViewall">AVAC&#58; a&#241;os de vida ajustados por calidad&#59; &#916;&#58; incremento&#46;</p>"
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            0 => array:2 [
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                0 => """
                  <a target="_blank" href="main.stripin/si0002.gif"><span class="e-comp" style="background:PowderBlue;" title="Click here to view Table Image">Click&nbsp;Here&nbsp;To&nbsp;View&nbsp;Stripin</span></a><p style="margin-bottom:0em"></p><table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&#916; costes farmacol&#243;gicos&#44; &#8364;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&#916; Costes directos&#44; &#8364;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#916; AVAC&#44; &#8364;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Coste&#47;AVAC &#40;farmacol&#243;gicos&#41;&#44; &#8364;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Coste&#47;AVAC &#40;directos&#41;&#44; &#8364;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="6" align="" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">6 meses&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">37&#46;359&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">44&#46;037&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;410&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;840&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">43&#46;612&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t">4 a&#241;os&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">36&#46;481&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">42&#46;975&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">7&#44;5 a&#241;os&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">4&#46;957&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">5&#46;837&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;146&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">33&#46;840&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;206&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vida&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">7&#46;541&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">8&#46;910&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;396&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;056&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#46;514&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "si0002.jpeg"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p class="elsevierStyleSimplePara elsevierViewall">Coste adicional de METOJECT<span class="elsevierStyleSup">&#174;</span> por AVAC ganado en los diferentes escenarios en su comparaci&#243;n con metotrexato oral</p>"
        ]
      ]
      7 => array:7 [
        "identificador" => "tbl5"
        "etiqueta" => "Tabla 5"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Incremento anual esperado&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="6" align="" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">2&#46;489&#46;284 &#40;1&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">3&#46;630&#46;105 &#40;1&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">3&#46;977&#46;160 &#40;1&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t">1&#46;244&#46;642 &#40;0&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#46;362&#46;217 &#40;0&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">1&#46;604&#46;682 &#40;0&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">1&#46;815&#46;053 &#40;0&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#46;988&#46;580 &#40;0&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#46;733&#46;926 &#40;2&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#46;086&#46;651 &#40;2&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#46;814&#46;045 &#40;2&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#46;445&#46;158 &#40;2&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5&#46;965&#46;740 &#40;2&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">4&#46;978&#46;568 &#40;2&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6&#46;418&#46;726 &#40;2&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&#46;260&#46;211 &#40;2&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;954&#46;320 &#40;2&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">6&#46;223&#46;210 &#40;3&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">6&#46;811&#46;084 &#40;3&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;023&#46;408 &#40;3&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;075&#46;263 &#40;3&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;942&#46;900 &#40;3&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;467&#46;852 &#40;3&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;173&#46;301 &#40;4&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;628&#46;089 &#40;4&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;890&#46;316 &#40;4&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;931&#46;480 &#40;4&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Coste farmacol&#243;gico neto&#44;</span> &#37;</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Caso base &#40;10&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;145&#46;080 &#40;2&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;327&#46;343 &#40;2&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;741&#46;209 &#40;2&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;097&#46;748 &#40;2&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;391&#46;907 &#40;2&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;072&#46;540 &#40;1&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;163&#46;671 &#40;1&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;370&#46;605 &#40;1&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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          "es" => "<p class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis de sensibilidad del impacto presupuestario neto variando el n&#250;mero de paciente esperados con METOJECT&#174;</p>"
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                            3 => "P&#46; Mu&#241;oz"
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                      "doi" => "10.2146/ajhp050514"
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Análisis farmacoeconómico de Metoject® en el tratamiento de la artritis reumatoide en España
Pharmacoeconomic analysis of Metoject® in the treatment of rheumatoid arthritis in Spain
Carlos Crespoa,b,
Autor para correspondencia
carlos.crespo@oblikue.com

Autor para correspondencia.
, Max Brosaa, Jordi Galvánc, Jordi Carbonelld,e, Jordi Maymód,e, J.L.. José Luis Marencof, Javier del Pino-Montesg, Alberto Alonsoh, Carlos Rodríguezi
a Oblikue Consulting, Barcelona, España
b Departamento de Estadística, Universidad de Barcelona, Barcelona, España
c Departamento Médico, Laboratorios Gebro Pharma, Barcelona, España
d Hospital del Mar, Barcelona, España
e Hospital de la Esperanza, Barcelona, España
f Hospital Universitario de Valme, Sevilla, España
g Hospital Universitario de Salamanca, Salamanca, España
h Hospital de Cruces, Bilbao, España
i Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas, España
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La primera l&#237;nea terap&#233;utica suelen ser los AINE y los glucocorticoides<a class="elsevierStyleCrossRef" href="#bib7"><span class="elsevierStyleSup">7</span></a>&#46; Estos f&#225;rmacos act&#250;an r&#225;pidamente mejorando el dolor y la tumefacci&#243;n causada por la AR&#46; Los f&#225;rmacos antirreum&#225;ticos modificadores de la enfermedad &#40;FAME&#41; son compuestos que act&#250;an de forma m&#225;s lenta mejorando no solo los s&#237;ntomas sino tambi&#233;n la progresi&#243;n cl&#237;nica y radiogr&#225;fica&#46; Debido a que su efecto puede tardar en observarse varias semanas o meses&#44; los FAME suelen prescribirse inicialmente junto con agentes que act&#250;an de forma m&#225;s r&#225;pida&#44; como los AINE y los glucocorticoides<a class="elsevierStyleCrossRef" href="#bib7"><span class="elsevierStyleSup">7</span></a>&#46; Los FAME han demostrado capacidad para enlentecer o detener la progresi&#243;n de la AR y entre ellos hay que destacar por su eficacia y rapidez de acci&#243;n al metotrexato que se puede administrar por v&#237;a oral o parenteral<a class="elsevierStyleCrossRef" href="#bib8"><span class="elsevierStyleSup">8</span></a>&#46; Por otro lado&#44; los f&#225;rmacos modificadores de la respuesta biol&#243;gica &#40;agentes biol&#243;gicos&#41; act&#250;an contrarrestando el efecto de los mediadores inflamatorios en el tejido da&#241;ado por la AR&#46; El tratamiento inicial con anti-TNF m&#225;s metotrexato podr&#237;a estar justificado en pacientes con inicio reciente en los que se sospeche una evoluci&#243;n especialmente agresiva<a class="elsevierStyleCrossRef" href="#bib9"><span class="elsevierStyleSup">9</span></a>&#46;</p><p class="elsevierStylePara elsevierViewall">El objetivo del presente estudio ha sido comparar la eficiencia de metotrexato subcut&#225;neo &#40;Metoject<span class="elsevierStyleSup">&#174;</span>&#41; respecto a metotrexato oral en el manejo de los pacientes con AR en Espa&#241;a&#46;</p></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">M&#233;todos</span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Modelizaci&#243;n</span><p class="elsevierStylePara elsevierViewall">Se ha realizado un an&#225;lisis coste-efectividad del tratamiento con Metoject<span class="elsevierStyleSup">&#174;</span> frente a metotrexato oral utilizando un modelo de simulaci&#243;n basado en datos de la literatura y la opini&#243;n de un panel de expertos especialistas en reumatolog&#237;a para la asignaci&#243;n de consecuencias econ&#243;micas a cada opci&#243;n de comparaci&#243;n a 5 a&#241;os y durante toda la vida del paciente&#46; Para ello se ha adaptado al entorno espa&#241;ol un &#225;rbol de decisi&#243;n para las primeras 24 semanas y un modelo de Markov que simula la historia natural de la AR temprana &#40;<a class="elsevierStyleCrossRef" href="#fig1">fig&#46; 1</a>&#41; y la pr&#225;ctica cl&#237;nica habitual en el manejo de los pacientes que la sufren en Espa&#241;a&#46;</p><elsevierMultimedia ident="fig1"></elsevierMultimedia><p class="elsevierStylePara elsevierViewall">El modelo ha permitido estimar la efectividad a largo plazo del tratamiento de la AR&#44; combinando informaci&#243;n sobre los costes a corto y largo plazo del manejo de pacientes que sufren AR en Espa&#241;a con el pron&#243;stico&#46; Para ello&#44; se ha tomado como punto de partida el estudio de 24 semanas de Braun et al<a class="elsevierStyleCrossRef" href="#bib10"><span class="elsevierStyleSup">10</span></a> y se ha evaluado el cambio veros&#237;mil de tratamiento cada 6 meses dependiendo del f&#225;rmaco&#44; del estado inicial de la enfermedad y si el paciente mejora&#44; empeora o se mantiene en el mismo estado de salud&#46; Adem&#225;s seg&#250;n la recomendaci&#243;n de los expertos se ha pautado la secuencia de tratamiento tras el fallo de los mismos seg&#250;n la pr&#225;ctica cl&#237;nica espa&#241;ola&#44; siendo aumentar dosis de metotrexato&#44; cambio de v&#237;a de administraci&#243;n&#44; sustituir&#47;a&#241;adir otro FAME &#40;leflunomida&#44; hidroxicloroquina&#44; sulfasalazina y sales de oro&#41; o incluso a&#241;adir un tratamiento biol&#243;gico&#46; De tal forma&#44; que la cohorte hipot&#233;tica tiene las caracter&#237;sticas y la tasa de progresi&#243;n de la enfermedad para metotrexato en primera l&#237;nea de tratamiento equivalente a la del ensayo cl&#237;nico multic&#233;ntrico donde se comparaba metotrexato oral frente a subcut&#225;neo<a class="elsevierStyleCrossRef" href="#bib10"><span class="elsevierStyleSup">10</span></a>&#46; A partir de las 24 semanas del estudio Braun et al<a class="elsevierStyleCrossRef" href="#bib10"><span class="elsevierStyleSup">10</span></a>&#44; la efectividad incluida en el modelo es la misma para los comparadores &#40;metotrexatos&#41; y para los tratamientos administrados tras fallo &#40;otros FAME&#44; metotrexato&#43;biol&#243;gicos&#41; provenientes de los resultados a medio plazo &#40;12 meses&#41; del ensayo cl&#237;nico controlado ATTRACT de 54 semanas en pacientes con AR<a class="elsevierStyleCrossRef" href="#bib11"><span class="elsevierStyleSup">11</span></a>&#44; del an&#225;lisis coste-efectividad del estudio ATTRACT de Wong et al<a class="elsevierStyleCrossRef" href="#bib12"><span class="elsevierStyleSup">12</span></a> y de la revisi&#243;n Cochrane con infliximab<a class="elsevierStyleCrossRef" href="#bib13"><span class="elsevierStyleSup">13</span></a> y adalimumab<a class="elsevierStyleCrossRef" href="#bib14"><span class="elsevierStyleSup">14</span></a>&#46; Para los resultados a largo plazo &#40;segundo a&#241;o&#8211;resto de la vida&#41; se realiz&#243; un pron&#243;stico a largo plazo de los pacientes tomado del modelo farmacoecon&#243;mico del estudio de Wong et al<a class="elsevierStyleCrossRef" href="#bib12"><span class="elsevierStyleSup">12</span></a>&#44; de Brennan et al<a class="elsevierStyleCrossRefs" href="#bib15"><span class="elsevierStyleSup">15&#44;16</span></a> y de un estudio observacional holand&#233;s<a class="elsevierStyleCrossRef" href="#bib17"><span class="elsevierStyleSup">17</span></a>&#46;</p></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Sujetos del estudio</span><p class="elsevierStylePara elsevierViewall">El an&#225;lisis se ha desarrollado a partir de una cohorte hipot&#233;tica de pacientes con AR &#40;edad media 56 a&#241;os&#59; el 78&#44;9&#37; mujeres&#41; na&#239;ve a metotrexato&#44; a semejanza de los participantes del estudio de Braun et al<a class="elsevierStyleCrossRef" href="#bib10"><span class="elsevierStyleSup">10</span></a>&#46;</p></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Par&#225;metros</span><p class="elsevierStylePara elsevierViewall">La eficacia diferencial de las presentaciones de metotrexato existentes en Espa&#241;a&#44; seg&#250;n su v&#237;a de administraci&#243;n&#44; proviene del estudio de Braun et al<a class="elsevierStyleCrossRef" href="#bib10"><span class="elsevierStyleSup">10</span></a>&#46; En los ensayos cl&#237;nicos la medida de eficacia principal es la respuesta al &#237;ndice ACR aunque tambi&#233;n se mide como criterio de respuesta el &#237;ndice Disease Activity Store &#40;DAS28&#41;&#46; Los criterios de mejor&#237;a del ACR<a class="elsevierStyleCrossRef" href="#bib18"><span class="elsevierStyleSup">18</span></a>&#44; valoran la respuesta terap&#233;utica&#44; pero no miden valores absolutos de actividad&#44; sino sus cambios porcentuales&#46; Debido a la naturaleza del estudio y teniendo en cuenta que no siempre la eficacia se mide con DAS28&#44; se han presentado los an&#225;lisis en base al &#233;xito terap&#233;utico con ACR20&#44; ACR50 y ACR70&#46; En los casos en que la respuesta solo aparece con DAS28 se ha previsto que la respuesta ACR20 corresponde al DAS28 moderado&#44; la respuesta ACR50 al DAS28 leve y la respuesta ACR70 al DAS28 remisi&#243;n&#46;</p><p class="elsevierStylePara elsevierViewall">Por lo que respecta a las actitudes terap&#233;uticas en caso de progresi&#243;n de la enfermedad&#44; la distribuci&#243;n de cambios terap&#233;uticos en funci&#243;n del tratamiento inicial fueron tomados de Wong et al<a class="elsevierStyleCrossRef" href="#bib12"><span class="elsevierStyleSup">12</span></a> y validados y completados por la opini&#243;n del panel de expertos espa&#241;oles especialistas en reumatolog&#237;a&#46; De tal forma&#44; que cuando en un paciente la enfermedad progresa se eval&#250;a cuantos de ellos contin&#250;an el tratamiento y cuantos de ellos cambian a los tratamientos derivados de la pr&#225;ctica cl&#237;nica espa&#241;ola&#46; La validaci&#243;n y obtenci&#243;n de datos espa&#241;oles espec&#237;ficos fue obtenida del panel de expertos espa&#241;oles mediante un cuestionario creado adhoc&#46; El cuestionario para la obtenci&#243;n y validaci&#243;n de los datos fue elaborado previamente con el investigador principal antes de su env&#237;o al resto de los investigadores los cuales son coautores de este manuscrito&#46; En aquellos casos que se detectaron discrepancias en las respuestas se llev&#243; a cabo entrevistas en profundidad para detectar si eran pertinentes las modificaciones en un sentido u otro&#46;</p><p class="elsevierStylePara elsevierViewall">Con respecto a la calidad de vida&#44; se han utilizado datos de diferentes procedencias ya que no existen datos espa&#241;oles que pudiesen reflejar los valores para todos los estados de salud necesarios<a class="elsevierStyleCrossRefs" href="#bib12"><span class="elsevierStyleSup">12&#44;17</span></a>&#46;</p><p class="elsevierStylePara elsevierViewall">Se han considerado 3 grandes tipos de costes sanitarios&#58; el coste del tratamiento analizado&#44; el coste inicial del manejo de los distintos eventos &#40;ACR20&#44; ACR50&#44; ACR70&#44; muerte&#41; y el coste de seguimiento de los pacientes supervivientes a los distintos eventos&#46;</p><p class="elsevierStylePara elsevierViewall">El uso de recursos fue obtenido a partir de la opini&#243;n de expertos y los costes unitarios espa&#241;oles provienen de la base de datos del medicamento del consejo general de colegios oficiales de farmac&#233;uticos<a class="elsevierStyleCrossRef" href="#bib19"><span class="elsevierStyleSup">19</span></a> para los f&#225;rmacos y de la base de datos de costes sanitarios eSalud para el resto<a class="elsevierStyleCrossRef" href="#bib20"><span class="elsevierStyleSup">20</span></a>&#46; La estimaci&#243;n de los costes de las segundas l&#237;neas &#40;otros FAME&#44; anti-TNF&#41; y de la medicaci&#243;n concomitante proviene de estudios espec&#237;ficos espa&#241;oles<a class="elsevierStyleCrossRefs" href="#bib21"><span class="elsevierStyleSup">21&#44;22</span></a>&#46;</p></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Perspectiva&#44; horizonte temporal y descuento</span><p class="elsevierStylePara elsevierViewall">El an&#225;lisis est&#225; realizado desde la perspectiva del Sistema Nacional de Salud&#44; utilizando el horizonte temporal de 5 a&#241;os y de toda la vida&#46; Todos los costes se expresan en euros del a&#241;o 2009 y se ha utilizado una tasa de descuento del 3&#37; tanto para los costes como para los efectos&#46;</p></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">An&#225;lisis coste-efectividad</span><p class="elsevierStylePara elsevierViewall">Los resultados del modelo se expresan mediante la curva de aceptabilidad a pagar&#44; donde se muestra con qu&#233; probabilidad se debe escoger Metoject<span class="elsevierStyleSup">&#174;</span> en detrimento de metotrexato oral seg&#250;n diferentes disponibilidades a pagar te&#243;ricas asumibles por un decisor<a class="elsevierStyleCrossRef" href="#bib23"><span class="elsevierStyleSup">23</span></a>&#46; De tal forma que cuando se supera el umbral de equiprobabilidad &#40;50&#37;&#41; nos muestra que la alternativa estudiada es m&#225;s eficiente que la alternativa comparada&#46;</p><p class="elsevierStylePara elsevierViewall">Los datos de mortalidad y de utilidad introducidos en el modelo de Markov se estimaron a partir de estudios internacionales&#46; Debido a la incertidumbre de estos datos&#44; se realizaron varios escenarios que combinaban diferentes utilidades y datos de mortalidad por estado de salud&#46; El escenario base se refiere a valores seg&#250;n el estudio de Welsing et al<a class="elsevierStyleCrossRef" href="#bib17"><span class="elsevierStyleSup">17</span></a> para utilidad y valores del estudio de Kobelt et al<a class="elsevierStyleCrossRef" href="#bib24"><span class="elsevierStyleSup">24</span></a> para mortalidad&#46; La estimaci&#243;n de la calidad de vida para este caso base var&#237;a en funci&#243;n de la evoluci&#243;n de la enfermedad utilizando los valores 0&#44;75&#59; 0&#44;71&#59; 0&#44;64 y 0&#44;56 para estados de remisi&#243;n&#44; leve&#44; moderado y alto respectivamente&#46; Asimismo&#44; los datos de mortalidad tambi&#233;n son diferentes en funci&#243;n de estos estados y se considera que el riesgo relativo de 1&#44;00 equivale a la remisi&#243;n&#44; 1&#44;30 al estado leve&#44; 1&#44;65 al moderado y 2&#44;00 al estado alto<a class="elsevierStyleCrossRef" href="#bib24"><span class="elsevierStyleSup">24</span></a>&#46; Las utilidades y la mortalidad empleadas en el caso base corresponden al escenario m&#225;s conservador para Metoject<span class="elsevierStyleSup">&#174;</span> al estimarse la calidad de vida para diferentes estados de salud como la mayor observada de los estudios y con la menor mortalidad posible&#46; Por otro lado se construy&#243; el escenario m&#225;s favorable para Metoject<span class="elsevierStyleSup">&#174;</span> &#40;aunque el m&#225;s desfavorable para los pacientes&#41; con los pacientes que progresan en su gravedad y tienen la peor calidad de vida &#40;remisi&#243;n 0&#44;77&#59; leve 0&#44;68&#59; moderado 0&#44;62 y grave 0&#44;52&#41; posible adem&#225;s de una menor esperanza de vida &#40;riesgo relativo de 1&#44;00 para remisi&#243;n&#44; 1&#44;46 para leve&#44; 1&#44;92 para moderado y 2&#44;39 para grave&#41;<a class="elsevierStyleCrossRefs" href="#bib16"><span class="elsevierStyleSup">16&#44;24</span></a>&#46;</p></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">An&#225;lisis del impacto presupuestario</span><p class="elsevierStylePara elsevierViewall">Se ha desarrollado un an&#225;lisis del impacto presupuestario potencial de extender el uso de Metoject<span class="elsevierStyleSup">&#174;</span> sustituyendo en distintas proporciones al tratamiento farmacol&#243;gico por v&#46;o&#46; Estudiamos un escenario con el uso actual de Metoject<span class="elsevierStyleSup">&#174;</span> y el coste potencial de su mayor introducci&#243;n en esta poblaci&#243;n&#44; utilizando el coste por paciente para cada opci&#243;n&#44; durante los pr&#243;ximos 5 a&#241;os&#46; Para proyectar los pacientes susceptibles de ser tratados con metotrexato se ha llevado a cabo una regresi&#243;n lineal ajustando seg&#250;n los datos hist&#243;ricos<a class="elsevierStyleCrossRef" href="#bib25"><span class="elsevierStyleSup">25</span></a>&#46;</p></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">An&#225;lisis de sensibilidad</span><p class="elsevierStylePara elsevierViewall">Para valorar la influencia de la incertidumbre de los par&#225;metros &#40;eficacia&#44; tasa de abandono&#44; costes&#44; etc&#46;&#41; en los resultados del estudio y validar la solidez de los resultados obtenidos&#44; se realiz&#243; un an&#225;lisis de sensibilidad probabil&#237;stico mediante una simulaci&#243;n de Monte Carlo de segundo orden&#44; de tal forma que se simul&#243; 1&#46;000 veces el coste-efectividad de cada comparaci&#243;n&#46;</p><p class="elsevierStylePara elsevierViewall">Para llevar a cabo el an&#225;lisis de sensibilidad se han seleccionado unas distribuciones fijas y se han estimado los par&#225;metros de cada distribuci&#243;n en funci&#243;n de los datos primarios recopilados<a class="elsevierStyleCrossRef" href="#bib26"><span class="elsevierStyleSup">26</span></a>&#46;</p></span></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Resultados</span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Efectos sobre la salud y los costes</span><p class="elsevierStylePara elsevierViewall">En base a los resultados del estudio de Braun et al<a class="elsevierStyleCrossRef" href="#bib10"><span class="elsevierStyleSup">10</span></a> de 24 semanas de duraci&#243;n se ha concluido que Metoject<span class="elsevierStyleSup">&#174;</span> controla mejor el progreso de la enfermedad ya que el 41&#37; de los pacientes consiguen alcanzar la remisi&#243;n &#40;metotrexato oral 33&#37;&#41;&#44; el 21&#37; finalizan con un DAS28 leve &#40;metotrexato oral 26&#37;&#41;&#44; el 16&#37; con un DAS28 moderado &#40;metotrexato oral 11&#37;&#41; y solo el 22&#37; con un DAS28 alto &#40;metotrexato oral 30&#37;&#41;&#46; Se observa que el porcentaje de pacientes en remisi&#243;n es un 8&#37; mayor en el grupo Metoject<span class="elsevierStyleSup">&#174;</span> respecto a metotrexato oral y que el porcentaje de pacientes con DAS28 alto es inferior en el grupo Metoject<span class="elsevierStyleSup">&#174;</span>&#44; lo cual indica una mejora global del estado de salud de los pacientes&#46;</p><p class="elsevierStylePara elsevierViewall">Los datos del pron&#243;stico de los pacientes a largo plazo en cada opci&#243;n terap&#233;utica se han tomado de an&#225;lisis de coste-efectividad previos<a class="elsevierStyleCrossRefs" href="#bib12"><span class="elsevierStyleSup">12&#44;17</span></a> y denotan que la mayor&#237;a de los pacientes se mantienen en su estado de salud &#40;<a class="elsevierStyleCrossRef" href="#tbl1">tabla 1</a>&#41;&#46; Asimismo&#44; por lo que respecta a las actitudes terap&#233;uticas en caso de progreso de la enfermedad se observa que entre el 84&#8211;95&#37; de los pacientes mantienen el tratamiento&#46; As&#237; la mayor&#237;a de veces que se opta por el cambio de tratamiento se a&#241;ade otro FAME y en pocos casos &#40;entre el 10&#8211;20&#37;&#41; se elige a&#241;adir un anti-TNF&#46; Por otro lado&#44; en el caso de mejorar la progresi&#243;n de la enfermedad se observa que tanto en la pr&#225;ctica cl&#237;nica como en los estudios internacionales&#44; se realizan cambios de tratamiento aunque en baja frecuencia &#40;entre el 5&#8211;23&#37; para metotrexato&#44; entre el 9&#8211;35&#37; para FAME y entre el 16&#8211;41&#37; en la combinaci&#243;n de metotrexato m&#225;s FAME&#41;&#46; Cuando se lleva a cabo este cambio se puede observar que normalmente se basa en la sustituci&#243;n por metotrexato u otro FAME&#46;</p><elsevierMultimedia ident="tbl1"></elsevierMultimedia><p class="elsevierStylePara elsevierViewall">Con respecto a los costes principales&#44; se observ&#243; que el uso de recursos de Metoject<span class="elsevierStyleSup">&#174;</span> es similar al de metotrexato oral y&#44; por tanto&#44; los costes directos semestrales no farmacol&#243;gicos solo se incrementaban en 82<span class="elsevierStyleHsp" style=""></span>&#8364; para el grupo de Metoject<span class="elsevierStyleSup">&#174;</span> &#40;<a class="elsevierStyleCrossRefs" href="#tbl2">tablas 2 y 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl2"></elsevierMultimedia><elsevierMultimedia ident="tbl3"></elsevierMultimedia></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">An&#225;lisis coste-efectividad</span><p class="elsevierStylePara elsevierViewall">Metoject<span class="elsevierStyleSup">&#174;</span> aporta al paciente una ganancia de alrededor de 0&#44;103&#8211;0&#44;145 AVAC a los 5 a&#241;os&#44; llegando a suponer en toda la vida aproximadamente entre 0&#44;308&#8211;0&#44;396 AVAC&#46;</p><p class="elsevierStylePara elsevierViewall">La raz&#243;n de coste &#40;solo costes farmacol&#243;gicos&#41; por a&#241;os de vida ajustados por calidad &#40;AVAC&#41; ganado con Metoject<span class="elsevierStyleSup">&#174;</span> frente a metotrexato oral fue de entre 25&#46;173&#8211;35&#46;807<span class="elsevierStyleHsp" style=""></span>&#8364; a los 5 a&#241;os y de 19&#46;056&#8211;25&#46;351<span class="elsevierStyleHsp" style=""></span>&#8364; para el horizonte temporal de toda la vida&#44; valor por debajo del umbral asumido en Espa&#241;a &#40;<a class="elsevierStyleCrossRef" href="#tbl4">tabla 4</a>&#41;<a class="elsevierStyleCrossRef" href="#bib23"><span class="elsevierStyleSup">23</span></a>&#46; Al tener en cuenta todos los costes directos que intervienen en el tratamiento de la AR&#44; se observ&#243; que el coste-efectividad de Metoject<span class="elsevierStyleSup">&#174;</span> frente a metotrexato oral a los 5 a&#241;os fue de 29&#46;682&#8211;42&#46;175<span class="elsevierStyleHsp" style=""></span>&#8364;&#47;AVAC ganado y para toda la vida fue de 22&#46;514&#8211;29&#46;848<span class="elsevierStyleHsp" style=""></span>&#8364;&#47;AVAC ganado &#40;<a class="elsevierStyleCrossRef" href="#tbl4">tabla 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl4"></elsevierMultimedia><p class="elsevierStylePara elsevierViewall">El an&#225;lisis de sensibilidad mostr&#243; que el 68&#44; 77 y 87&#37; de los casos tratados con Metoject<span class="elsevierStyleSup">&#174;</span> est&#225;n por debajo de los umbrales de coste-efectividad de 30&#46;000&#44; 35&#46;000 y 45&#46;000<span class="elsevierStyleHsp" style=""></span>&#8364;&#47;AVAC ganado&#44; respectivamente&#46; As&#237;&#44; la <a class="elsevierStyleCrossRef" href="#fig2">figura 2</a> demuestra que Metoject<span class="elsevierStyleSup">&#174;</span> es un medicamento eficiente cuando se supera el umbral de equiprobabilidad de 24&#46;000<span class="elsevierStyleHsp" style=""></span>&#8364; por AVAC ganado&#46;</p><elsevierMultimedia ident="fig2"></elsevierMultimedia><p class="elsevierStylePara elsevierViewall">Asimismo&#44; la simulaci&#243;n mostr&#243; que el coste por AVAC mediano ronda los 23&#46;836<span class="elsevierStyleHsp" style=""></span>&#8364;&#47;AVAC&#44; con un rango intercuart&#237;lico de 14&#46;627<span class="elsevierStyleHsp" style=""></span>&#8364;&#47;AVAC&#44; valores que incluye tanto el escenario m&#225;s desfavorable &#40;caso base&#41; y favorable &#40;<a class="elsevierStyleCrossRef" href="#tbl4">tabla 4</a> y <a class="elsevierStyleCrossRef" href="#fig2">fig&#46; 2</a>&#41;&#46;</p></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">An&#225;lisis del impacto presupuestario</span><p class="elsevierStylePara elsevierViewall">En t&#233;rminos de impacto presupuestario la poblaci&#243;n tributaria de metotrexato es de entre 120&#46;000&#8211;160&#46;000 pacientes el primer y quinto a&#241;o&#44; respectivamente&#44; con un 20&#8211;24&#37; de pacientes en tratamiento con Metoject<span class="elsevierStyleSup">&#174;</span> &#40;<a class="elsevierStyleCrossRef" href="#tbl5">tabla 5</a>&#41;&#46; De tal forma que si se asume un incremento del uso de Metoject<span class="elsevierStyleSup">&#174;</span> del 10&#37; anual respecto al escenario actual entonces los costes directos asociados a la intervenci&#243;n ascienden a 2&#44;5&#8211;4 millones<span class="elsevierStyleHsp" style=""></span>&#8364;&#46; Como puede apreciarse en la <a class="elsevierStyleCrossRef" href="#fig3">figura 3</a>&#44; la repercusi&#243;n presupuestaria de incrementar la introducci&#243;n de Metoject<span class="elsevierStyleSup">&#174;</span> sobre el gasto sanitario de la poblaci&#243;n diana estimada supone un incremento del 1&#44;4&#37; del coste de la patolog&#237;a&#46;</p><elsevierMultimedia ident="tbl5"></elsevierMultimedia><elsevierMultimedia ident="fig3"></elsevierMultimedia><p class="elsevierStylePara elsevierViewall">El an&#225;lisis de sensibilidad del impacto presupuestario nos muestra que el incremento anual del uso de Metoject entre un 10&#8211;30&#37; provocar&#237;a como m&#225;ximo un coste directo neto del 4&#44;1&#37; del presupuesto &#40;<a class="elsevierStyleCrossRef" href="#tbl5">tabla 5</a>&#41;&#46; Asimismo&#44; cuando se estudia solo el impacto farmacol&#243;gico de la mayor introducci&#243;n de Metoject<span class="elsevierStyleSup">&#174;</span> se observa que el coste asciende al 2&#44;2&#8211;2&#44;5&#37; en el caso base y alcanza el 6&#44;6&#8211;7&#44;4&#37; al asumir un incremento del 30&#37; &#40;<a class="elsevierStyleCrossRef" href="#tbl5">tabla 5</a>&#41;&#46;</p></span></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discusi&#243;n</span><p class="elsevierStylePara elsevierViewall">Hasta la actualidad los datos existentes de eficacia comparativa no permit&#237;an concluir que el metotrexato por v&#237;a parenteral fuese mayor que el metotrexato por v&#46;o&#46;&#44; si bien la eficacia del f&#225;rmaco est&#225; m&#225;s que probada y es respaldada por las sociedades m&#233;dicas internacionales&#44; entre ellas la Sociedad Espa&#241;ola de Reumatolog&#237;a<a class="elsevierStyleCrossRef" href="#bib27"><span class="elsevierStyleSup">27</span></a>&#46; Con la aparici&#243;n del estudio de Braun et al<a class="elsevierStyleCrossRef" href="#bib10"><span class="elsevierStyleSup">10</span></a>&#44; se constata con un mayor grado de evidencia que la eficacia del metotrexato administrado por v&#237;a subcut&#225;nea&#44; como Metoject<span class="elsevierStyleSup">&#174;</span>&#44; es mayor que la eficacia del mismo f&#225;rmaco administrado por v&#46;o&#46; debido a la superior biodisponibilidad en la administraci&#243;n parenteral&#46; Esta mejora de la biodisponibilidad junto a la ya demostrada necesidad del tratamiento precoz de la AR con FAME<a class="elsevierStyleCrossRefs" href="#bib28"><span class="elsevierStyleSup">28&#44;29</span></a> ofrece&#44; tal como se muestra en nuestro estudio&#44; mayores posibilidades de modificar el curso de la enfermedad&#46; Asimismo&#44; se observa que el uso precoz de Metoject<span class="elsevierStyleSup">&#174;</span> aporta al paciente una ganancia de alrededor de 0&#44;103&#8211;0&#44;145 AVAC a los 5 a&#241;os&#44; llegando a suponer en toda la vida aproximadamente entre 0&#44;308&#8211;0&#44;396 AVAC&#46;</p><p class="elsevierStylePara elsevierViewall">Aparte de valorar en la pr&#225;ctica cl&#237;nica espa&#241;ola los efectos de la mayor eficacia de Metoject<span class="elsevierStyleSup">&#174;</span> a lo largo de la vida del paciente&#44; nuestro estudio sugiere que los costes adicionales de Metoject<span class="elsevierStyleSup">&#174;</span> respecto a metotrexato oral se ven compensados por su mejor efectividad&#44; expresada en t&#233;rminos de AVAC&#46; Hasta el momento&#44; la informaci&#243;n sobre el coste-efectividad del metotrexato en el tratamiento de la AR atendiendo a su v&#237;a de administraci&#243;n no hab&#237;a sido estudiada en profundidad debido a la carencia de ensayos cl&#237;nicos que comparasen la eficacia del f&#225;rmaco seg&#250;n su administraci&#243;n subcut&#225;nea u oral&#44; aunque hubiese sido posible llevar a cabo estudios de minimizaci&#243;n de costes&#46; Nuestra investigaci&#243;n es&#44; en definitiva&#44; un nuevo punto de partida para posibles estudios de evaluaci&#243;n econ&#243;mica que pueden permitir validar externamente que el uso de Metoject<span class="elsevierStyleSup">&#174;</span> en pacientes con AR es una terapia eficiente y por tanto&#44; de elecci&#243;n ante la disyuntiva de qu&#233; v&#237;a de administraci&#243;n utilizar&#46;</p><p class="elsevierStylePara elsevierViewall">El an&#225;lisis del impacto presupuestario es una t&#233;cnica utilizada para estimar cuantitativamente la alteraci&#243;n prevista en el gasto sanitario para la atenci&#243;n de una patolog&#237;a con la mayor introducci&#243;n de una nueva intervenci&#243;n sanitaria para su tratamiento<a class="elsevierStyleCrossRef" href="#bib30"><span class="elsevierStyleSup">30</span></a>&#46; En el caso de la mayor introducci&#243;n de Metoject<span class="elsevierStyleSup">&#174;</span> en el Sistema Nacional de Salud&#44; el impacto se deber&#225; esencialmente a la disminuci&#243;n del gasto por la progresi&#243;n de la enfermedad evitada y el coste diferencial del nuevo tratamiento&#46;</p><p class="elsevierStylePara elsevierViewall">Cabe destacar que la perspectiva adoptada en el estudio es la del Sistema Nacional de Salud y por tanto&#44; hemos excluido otros costes que ser&#237;an considerados importantes desde un punto vista social&#44; por ejemplo&#44; los costes asociados a la p&#233;rdida de horas laborales o el coste de la ayuda de los familiares&#46; Es conocido que la mayor&#237;a de los costes de la AR son indirectos&#44; ya que aproximadamente duplican a los costes directos<a class="elsevierStyleCrossRef" href="#bib31"><span class="elsevierStyleSup">31</span></a> y que el tratamiento eficaz de una persona a la que se le ha diagnosticado una AR tambi&#233;n puede reducir la carga que soporta la persona y la sociedad&#46;</p><p class="elsevierStylePara elsevierViewall">Una de las principales limitaciones del estudio deriva de la utilizaci&#243;n de datos de diferentes procedencias respecto a costes a corto y largo plazo&#44; pron&#243;stico a largo plazo&#44; par&#225;metros de eficacia&#44; calidad de vida&#44; mortalidad y utilidades ya que no existen datos espa&#241;oles que pudiesen reflejar los valores para todos los estados de salud necesarios&#46; Esta disparidad de estudios usados para establecer el modelo&#44; al no disponer de datos comparativos a medio&#47;largo plazo pueden estar influenciando los resultados debido a que la pr&#225;ctica cl&#237;nica de nuestro &#225;mbito puede no ser la misma pr&#225;ctica cl&#237;nica derivada de los estudios de los cuales hemos asumido los valores&#44; aunque en todo momento fue validada por el panel de expertos&#46; Asimismo&#44; cabe mencionar que la opci&#243;n de inicio de tratamiento con metrotexato oral en nuestro modelo puede no corresponderse con la pr&#225;ctica cl&#237;nica habitual&#44; en la que pacientes en que este tratamiento no es eficaz son cambiados a la forma SC&#46; Sin embargo&#44; dado que no existen evidencias de una mayor eficacia del tratamiento SC m&#225;s all&#225; del periodo inicial que se observ&#243; en el estudio de Braun&#44; la consideraci&#243;n de este cambio de oral a SC no se ha podido incluir en el modelo&#46;</p><p class="elsevierStylePara elsevierViewall">Adem&#225;s&#44; se tiene que tener en cuenta en la valoraci&#243;n de estos resultados la limitaci&#243;n por tratarse de un modelo te&#243;rico basado en resultados de ensayos cl&#237;nicos&#44; sobre todo del estudio de Braun et al<a class="elsevierStyleCrossRef" href="#bib10"><span class="elsevierStyleSup">10</span></a> que podr&#237;a estar sobreestimando los beneficios del metotrexato inyectable comparado con estudios de un solo brazo&#46; Hay que tener en cuenta que Braun et al<a class="elsevierStyleCrossRef" href="#bib10"><span class="elsevierStyleSup">10</span></a> demuestran que metotrexato subcut&#225;neo es posiblemente m&#225;s eficaz que metotrexato oral a dosis de 15<span class="elsevierStyleHsp" style=""></span>mg semanales&#46; Ello puede observarse en ACR20 y 70 pero no en ACR50&#46; Por lo tanto&#44; nuestro estudio te&#243;rico se basa en datos comparativos solo a corto plazo &#40;6 meses&#41; y l&#237;mite de dosis razonable &#44;sin embargo&#44; de 15<span class="elsevierStyleHsp" style=""></span>mg semanales&#46; Por otro lado&#44; en la misma l&#237;nea que el estudio de Braun&#44; 2 estudios recientes observacionales prospectivos llevados a cabo en Reino Unido han demostrado de nuevo que metotrexato subcut&#225;neo es m&#225;s eficaz que metotrexato oral y que se tolera bien en los pacientes con AR&#44; incluso en los casos en los que la enfermedad es m&#225;s cr&#243;nica<a class="elsevierStyleCrossRefs" href="#bib32"><span class="elsevierStyleSup">32&#44;33</span></a>&#46;</p><p class="elsevierStylePara elsevierViewall">Por &#250;ltimo&#44; aunque el coste por AVAC ganado del estudio cae dentro del l&#237;mite arbitrariamente aceptado en pa&#237;ses occidentales&#44; est&#225; bastante pr&#243;ximo al margen superior aceptado para el mismo&#46; Ser&#237;a pues deseable disponer de nuevos estudios comparativos directos en la pr&#225;ctica cl&#237;nica que permitiesen un mejor ajuste de las valoraciones tanto de la efectividad como de los costes&#46;</p><p class="elsevierStylePara elsevierViewall">De nuestra investigaci&#243;n se desprende que el estudio de la AR debe continuar intentando abordar aspectos no contemplados&#44; como el cumplimiento terap&#233;utico o la satisfacci&#243;n de los pacientes&#44; o sobre c&#243;mo reducir la incertidumbre respecto a la efectividad a largo plazo y a los costes &#40;directos&#47;indirectos&#41; asociados a la AR a nivel nacional&#46; Por otro lado&#44; aunque existen algunos estudios donde se ha evaluado la calidad de vida de los pacientes con AR en Espa&#241;a<a class="elsevierStyleCrossRef" href="#bib34"><span class="elsevierStyleSup">34</span></a> a&#250;n son necesarios estudios de calidad de vida con mayor n&#250;mero de pacientes que estudien en profundidad los estados de salud y con medidas equivalentes a las preferencias de los mismos como es el caso del EuroQol-5D&#46;</p><p class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; aunque se precisan m&#225;s datos a medio largo plazo para confirmar nuestros resultados&#44; nuestro estudio sugiere que los costes adicionales de Metoject<span class="elsevierStyleSup">&#174;</span> respecto a metotrexato oral se ver&#237;an compensados por su mejora en efectividad&#44; revelando que Metoject<span class="elsevierStyleSup">&#174;</span> podr&#237;a ser un tratamiento costeefectivo para el sistema sanitario espa&#241;ol seg&#250;n el umbral asumido&#44; con un impacto relativo al gasto generado actualmente por estos pacientes muy limitado&#46;</p></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Financiaci&#243;n</span><p class="elsevierStylePara elsevierViewall">El estudio fue financiado por Gebro Pharma&#44; pero la empresa no particip&#243; en la recogida de datos&#44; en la interpretaci&#243;n de ellos ni en la decisi&#243;n de publicar&#46;</p></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicto de intereses</span><p class="elsevierStylePara elsevierViewall">Jordi Galv&#225;n trabaja en Gebro Pharma que es la empresa promotora del estudio&#46; Max Brosa y Carlos Crespo trabajan para la consultora Oblikue Consulting que recibi&#243; honorarios de la empresa promotora del estudio en concepto de ayuda a la investigaci&#243;n&#46;</p></span></span>"
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              "titulo" => "Perspectiva&#44; horizonte temporal y descuento"
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            4 => array:1 [
              "titulo" => "An&#225;lisis coste-efectividad"
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            5 => array:1 [
              "titulo" => "An&#225;lisis del impacto presupuestario"
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          "titulo" => "Resultados"
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              "titulo" => "Efectos sobre la salud y los costes"
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            1 => array:1 [
              "titulo" => "An&#225;lisis coste-efectividad"
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              "titulo" => "An&#225;lisis del impacto presupuestario"
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    "fechaRecibido" => "2009-05-06"
    "fechaAceptado" => "2009-11-05"
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            0 => "Metotrexato"
            1 => "Coste-efectividad"
            2 => "Calidad de vida"
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        0 => array:4 [
          "clase" => "keyword"
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            1 => "Cost-effectiveness"
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    "resumen" => array:2 [
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p class="elsevierStyleSimplePara elsevierViewall">El objetivo de este estudio ha sido comparar la eficiencia de utilizar el metotrexato subcut&#225;neo &#40;Metoject<span class="elsevierStyleSup">&#174;</span>&#41; con respecto al metotrexato oral en el manejo de pacientes con AR en Espa&#241;a&#46;</p> <span class="elsevierStyleSectionTitle">M&#233;todos</span><p class="elsevierStyleSimplePara elsevierViewall">Se ha realizado un an&#225;lisis coste-efectividad&#47;utilidad del tratamiento de la AR temprana utilizando un modelo de Markov&#46; El modelo ha permitido estimar la efectividad a largo plazo del tratamiento de la AR en funci&#243;n de los datos de la literatura y de la opini&#243;n de expertos y combinarlo con informaci&#243;n de los costes en Espa&#241;a&#46; El an&#225;lisis se ha realizado desde la perspectiva del Sistema Nacional de Salud&#44; utilizando un horizonte temporal de 5 a&#241;os y de toda la vida del paciente&#46; Todos los costes se expresaron en euros del a&#241;o 2009 y se ha utilizado una tasa de descuento del 3&#37;&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">La raz&#243;n de coste &#40;solo costes farmacol&#243;gicos&#41; por a&#241;o de vida ajustado por calidad &#40;AVAC&#41; ganado con Metoject<span class="elsevierStyleSup">&#174;</span> fue de 25&#46;173&#8211;35&#46;807<span class="elsevierStyleHsp" style=""></span>&#8364; a los 5 a&#241;os y de 19&#46;056&#8211;25&#46;351<span class="elsevierStyleHsp" style=""></span>&#8364; para toda la vida&#46; Al tener en cuenta los costes directos de la AR se observ&#243; que el coste-efectividad a los 5 a&#241;os fue de 29&#46;682&#8211;42&#46;175<span class="elsevierStyleHsp" style=""></span>&#8364;&#47;AVAC ganado y para toda la vida fue de 22&#46;514&#8211;29&#46;848<span class="elsevierStyleHsp" style=""></span>&#8364;&#47;AVAC ganado&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">Los costes adicionales de Metoject<span class="elsevierStyleSup">&#174;</span> respecto a metotrexato oral se ver&#237;an compensados por su mejora en efectividad&#44; expresada en t&#233;rminos de AVAC&#44; revelando que Metoject<span class="elsevierStyleSup">&#174;</span> podr&#237;a ser un tratamiento costeefectivo para la AR en el Sistema Nacional de Salud seg&#250;n el umbral asumido en Espa&#241;a&#46;</p>"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><p class="elsevierStyleSimplePara elsevierViewall">The aim of this study was to compare the clinical and economic consequences of using subcutaneous methotrexate &#40;Metoject<span class="elsevierStyleSup">&#174;</span>&#41; with respect to oral methotrexate in the management of rheumatoid arthritis &#40;RA&#41; in Spain&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p class="elsevierStyleSimplePara elsevierViewall">A cost-effectiveness analysis was performed to compare early treatment of RA using a Markov model&#46; The model allowed us to estimate long term efficacy of RA treatment based on data from the literature and expert opinion&#44; and to combine this data with costs of managing RA in Spain&#46; The perspective of the study was from the National Health System point of view&#44; using a time horizon of 5 years and patient lifetime&#46; All costs were expressed in 2009 euros and a 3&#37; discount rate was applied&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">The cost &#40;only pharmacologic costs&#41; per quality-adjusted life year &#40;QALY&#41; gained with Metoject<span class="elsevierStyleSup">&#174;</span> went from 25&#44;173 to 35&#44;807<span class="elsevierStyleHsp" style=""></span>&#8364; at 5 years and from 19&#44;056 to 25&#44;351<span class="elsevierStyleHsp" style=""></span>&#8364; for patient lifetime&#46; When direct costs in RA treatment were considered&#44; it was observed that cost-effectiveness at 5 years went from 29&#44;682 to 42&#44;175<span class="elsevierStyleHsp" style=""></span>&#8364;&#47;QALY gained&#44; and for patient lifetime from 22&#44;514 to 29&#44;848<span class="elsevierStyleHsp" style=""></span>&#8364;&#47; QALY gained&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">Additional costs of Metoject<span class="elsevierStyleSup">&#174;</span> with respect to oral methotrexate would be offset by their improved effectiveness&#44; expressed in QALY&#44; showing that Metoject<span class="elsevierStyleSup">&#174;</span> could be a cost-effective treatment option for RA in the Spanish Health System assuming a spanish threshold&#46;</p>"
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleBold">DE</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">METOJECT<span class="elsevierStyleSup">&#174;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">MTX Oral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">FAME&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">MET&#43;FAME&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Anti-TNF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">METOJECT<span class="elsevierStyleSup">&#174;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">MTX Oral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">FAME&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">MET&#43;FAME&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Anti-TNF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">METOJECT<span class="elsevierStyleSup">&#174;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">MTX Oral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">FAME&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">MET&#43;FAME&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Anti-TNF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">METOJECT<span class="elsevierStyleSup">&#174;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">MTX Oral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">FAME&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">MET&#43;FAME&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Anti-TNF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="5" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Remisi&#243;n</span></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">METOJECT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&#44;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#44;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MTX oral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&#44;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#44;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;94&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FAME&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&#44;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Visitas reumat&#243;logo &#40;visitas de seguimiento&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#44;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">91&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">95&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Visitas traumat&#243;logo &#40;primera visita&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&#44;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Visitas traumat&#243;logo &#40;visitas de seguimiento&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&#44;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Visitas rehabilitaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#44;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Visitas m&#233;dico atenci&#243;n primaria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#44;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Visitas urgencias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">108&#44;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Estancias hospitalarias &#40;reuma&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">374&#44;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hematolog&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">92&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bioqu&#237;mica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">92&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Orina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tomograf&#237;a computarizada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">228&#44;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Resonancia magn&#233;tica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">465&#44;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ecograf&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">131&#44;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">17&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">17&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Radiograf&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&#44;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">75&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">75&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Electromiograf&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">74&#44;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">3&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Administraci&#243;n tratamiento anual del paciente</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Visitas enfermer&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#44;59&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">97&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">91&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Visitas enfermer&#237;a domiciliarias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#44;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Visitas enfermer&#237;a atenci&#243;n primaria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#44;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Costes no farmacol&#243;gicos</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Anual</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;008&#44;23<span class="elsevierStyleHsp" style=""></span>&#8364;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">844&#44;13<span class="elsevierStyleHsp" style=""></span>&#8364;</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Semestral</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">504&#44;11<span class="elsevierStyleHsp" style=""></span>&#8364;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">422&#44;07<span class="elsevierStyleHsp" style=""></span>&#8364;</td></tr></tbody></table>
                  """
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          "leyenda" => "<p class="elsevierStyleSimplePara elsevierViewall">FAME&#58; f&#225;rmaco modificador de enfermedad&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">Coste farmacol&#243;gico semestral</span></td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " rowspan="2" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Costes directos semestrales &#40;no farmacol&#243;gicos&#41; &#40;<span class="elsevierStyleItalic">&#8364;&#41;</span></td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " rowspan="2" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Fuente</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">Primeros 6 meses &#40;&#8364;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Siguientes 6 meses &#40;<span class="elsevierStyleItalic">&#8364;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">METOJECT<span class="elsevierStyleSup">&#174;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">458&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">470&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">504&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#44; 20 y opini&#243;n de expertos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Metotrexato oral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">422&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#44; 20 y opini&#243;n de expertos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Otros FAME</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sustituci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t">19&#44; 20&#44; 22 y opini&#243;n de expertos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Medicaci&#243;n concomitante&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">19&#44; 20&#44; 22 y opini&#243;n de expertos&nbsp;\t\t\t\t\t\t\n
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                  """
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          "leyenda" => "<p class="elsevierStyleSimplePara elsevierViewall">AVAC&#58; a&#241;os de vida ajustados por calidad&#59; &#916;&#58; incremento&#46;</p>"
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            0 => array:2 [
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                0 => """
                  <a target="_blank" href="main.stripin/si0002.gif"><span class="e-comp" style="background:PowderBlue;" title="Click here to view Table Image">Click&nbsp;Here&nbsp;To&nbsp;View&nbsp;Stripin</span></a><p style="margin-bottom:0em"></p><table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#916; costes farmacol&#243;gicos&#44; &#8364;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#916; Costes directos&#44; &#8364;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#916; AVAC&#44; &#8364;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Coste&#47;AVAC &#40;farmacol&#243;gicos&#41;&#44; &#8364;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Coste&#47;AVAC &#40;directos&#41;&#44; &#8364;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="6" align="" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">6 meses&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">44&#46;037&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">43&#46;612&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">36&#46;481&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&#44;5 a&#241;os&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">33&#46;840&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10 a&#241;os&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">7&#46;662&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;2976&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">21&#46;818&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">8&#46;206&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">7&#46;541&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">8&#46;910&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;396&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#46;514&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "si0002.jpeg"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p class="elsevierStyleSimplePara elsevierViewall">Coste adicional de METOJECT<span class="elsevierStyleSup">&#174;</span> por AVAC ganado en los diferentes escenarios en su comparaci&#243;n con metotrexato oral</p>"
        ]
      ]
      7 => array:7 [
        "identificador" => "tbl5"
        "etiqueta" => "Tabla 5"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Incremento anual esperado&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " colspan="6" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Coste directo neto</span>&#44; &#37;</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">2&#46;489&#46;284 &#40;1&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">3&#46;209&#46;363 &#40;1&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#46;977&#46;160 &#40;1&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">1&#46;244&#46;642 &#40;0&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;362&#46;217 &#40;0&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;604&#46;682 &#40;0&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">1&#46;815&#46;053 &#40;0&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#46;988&#46;580 &#40;0&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#46;733&#46;926 &#40;2&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">4&#46;086&#46;651 &#40;2&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#46;814&#46;045 &#40;2&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">5&#46;445&#46;158 &#40;2&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;965&#46;740 &#40;2&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">4&#46;978&#46;568 &#40;2&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">5&#46;448&#46;868 &#40;2&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">6&#46;418&#46;726 &#40;2&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;260&#46;211 &#40;2&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;954&#46;320 &#40;2&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;223&#46;210 &#40;3&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;811&#46;084 &#40;3&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;023&#46;408 &#40;3&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;075&#46;263 &#40;3&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;942&#46;900 &#40;3&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46;467&#46;852 &#40;3&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46;173&#46;301 &#40;4&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;628&#46;089 &#40;4&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;890&#46;316 &#40;4&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;931&#46;480 &#40;4&#44;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Coste farmacol&#243;gico neto&#44;</span> &#37;</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Caso base &#40;10&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;145&#46;080 &#40;2&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;327&#46;343 &#40;2&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;741&#46;209 &#40;2&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;097&#46;748 &#40;2&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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          "es" => "<p class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis de sensibilidad del impacto presupuestario neto variando el n&#250;mero de paciente esperados con METOJECT&#174;</p>"
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Información del artículo
ISSN: 1699258X
Idioma original: Español
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