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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">De los s&#237;ndromes dolorosos cr&#243;nicos que son motivo de consulta&#44; el s&#237;ndrome de fibromialgia &#40;SFM&#41; tiene un impacto significativo en la calidad de vida y en la disminuci&#243;n de la productividad<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a>&#46; La principal manifestaci&#243;n del s&#237;ndrome es dolor m&#250;sculo-esquel&#233;tico generalizado&#44; con presencia de alodinia e hiperalgesia&#59; frecuentemente se acompa&#241;a de alteraciones del sue&#241;o&#44; ansiedad&#44; depresi&#243;n&#44; cefalea y s&#237;ndrome de intestino irritable&#44; entre otros<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La prevalencia mundial reportada para el SFM se encuentra entre el 3 y el 5&#37; de la poblaci&#243;n adulta &#40;entre 20 a 60 a&#241;os de edad&#41;&#44; con predominio significativo en las mujeres&#46; En M&#233;xico&#44; la frecuencia estimada es del 0&#44;68&#37; &#40;IC del 95&#37;&#44; 0&#44;56-0&#44;80&#41;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">El impacto negativo del SFM se manifiesta en las actividades cotidianas de la vida y se traduce en ausencias laborales y&#47;o escolares&#44; con repercusi&#243;n en la productividad&#44; cuya reducci&#243;n se ha estimado hasta en un 65&#37;&#46; As&#237;&#44; el impacto econ&#243;mico m&#225;s importante del SFM ocurre en los costos asociados con la p&#233;rdida de productividad&#44; los cuales representan hasta el 70&#37; de la carga de la enfermedad<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#46; El abordaje terap&#233;utico del SFM es multidisciplinario y el objetivo principal es reducir el dolor y mejorar la capacidad funcional&#46; El tratamiento debe incluir&#58; educaci&#243;n al paciente&#44; cambios de estilo de vida&#44; fisioterapia y tratamiento farmacol&#243;gico<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">El tratamiento farmacol&#243;gico m&#225;s frecuentemente estudiado es el uso de antidepresivos tric&#237;clicos&#46; Un metaan&#225;lisis reciente muestra que el tama&#241;o del efecto en la reducci&#243;n del dolor con amitriptilina en el SFM&#44; calculado como diferencia promedio estandarizada &#40;DPE&#41; fue de &#8211;1&#44;64 &#40;IC del 95&#37;&#44; &#8211;2&#44;57 a &#8211;0&#44;71&#41;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&#46; Dada la alta incidencia de efectos adversos asociados al uso de antidepresivos tric&#237;clicos y en la b&#250;squeda un mejor perfil de seguridad&#44; los inhibidores selectivos de la recaptura de serotonina &#40;ISRS&#41; han sido una alternativa en el tratamiento&#46; El mismo metaan&#225;lisis reporta la DPE en el caso del dolor al utilizar fluoxetina y paroxetina de &#8211;0&#44;39 &#40;IC del 95&#37;&#44; &#8211;0&#44;77 a &#8211;0&#44;01&#41; y al utilizar en el tratamiento los inhibidores selectivos de noradrenalina &#40;ISNA&#41;&#59; los autores reportan el efecto para duloxetina y milnacipran con DPE de &#8211;0&#44;36 &#40;IC del 95&#37;&#44; &#8211;0&#44;46 a &#8211;0&#44;25&#41;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Se ha estudiado tambi&#233;n la combinaci&#243;n de al menos 2 f&#225;rmacos con distintos modos de acci&#243;n&#46; Para el efecto analg&#233;sico se ha documentado que la combinaci&#243;n de tramadol con acetaminof&#233;n&#44; se ha identificado una reducci&#243;n de al menos del 50&#37; de la escala de dolor basal en el 35&#37; de los casos&#59; asimismo la combinaci&#243;n de f&#225;rmacos es bien tolerada y se observ&#243; una mejora significativa en la funcionalidad medido por cuestionario de impacto de fibromialgia &#40;FIQ&#44; por sus siglas en ingl&#233;s&#41;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#46; Por otro lado&#44; la combinaci&#243;n de amitriptilina y fluoxetina reporta mejor&#237;a en las escalas de FIQ y EVA en comparaci&#243;n con el uso de monoterapia<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Otras alternativas recientemente identificadas son los ligandos de la subunidad auxiliar &#945;2-&#948; de los canales de calcio&#44; dependientes de voltaje en el SNC &#40;pregabalina&#44; gabapentina&#41;&#46; En varios ensayos cl&#237;nicos han sido reportados una mejora significativa del dolor en pacientes con SFM&#44; pero adem&#225;s mejor&#237;a en la funcionalidad&#44; el estado de &#225;nimo y las alteraciones del sue&#241;o&#46; Por otro lado&#44; los datos de los ensayos cl&#237;nicos han sido integrados en un metaan&#225;lisis donde se muestra una modificaci&#243;n del dolor con DPE del &#8211;0&#44;28 &#40;IC del 95&#37;&#44; &#8211;0&#44;36 a &#8211;0&#44;20&#41;&#59; mejor&#237;a en las alteraciones del sue&#241;o de &#8211;0&#44;39 &#40;IC del 95&#37;&#44; &#8211;0&#44;48 a &#8211;0&#44;39&#41; y mejor&#237;a en la calidad de vida de &#8211;0&#44;30 &#40;IC del 95&#37;&#44; &#8211;0&#44;46 a &#8211;0&#44;15&#41;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#46; Es importante mencionar que la <span class="elsevierStyleItalic">Food and Drug Administration</span> ha aprobado al menos 3 medicamentos para el tratamiento del SFM&#58; pregabalina &#40;en 2007&#41;&#44; duloxetina &#40;en 2008&#41; y milnacipran &#40;en 2009&#41;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Uno de los problemas a los que se enfrentan los pacientes en cualquier sistema de salud es el acceso a f&#225;rmacos eficaces&#46; Muchos de los programas asistenciales se encuentran dise&#241;ados con definiciones de alto nivel de evidencia&#44; pero tambi&#233;n con una pol&#237;tica de contenci&#243;n de costes&#44; en funci&#243;n de la disponibilidad de recursos que casi siempre son limitados&#46; De esta forma&#44; el objetivo del presente trabajo fue identificar cu&#225;l de los tratamientos farmacol&#243;gicos disponibles en el sector p&#250;blico del sistema de salud en M&#233;xico para el tratamiento del SFM es el m&#225;s coste-efectivo&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Material y m&#233;todos</span><p id="par0040" class="elsevierStylePara elsevierViewall">Se realiz&#243; un an&#225;lisis econ&#243;mico de tipo coste-efectividad&#44; con la construcci&#243;n de un modelo de Markov&#44; para comparar los costes y las efectividades de las alternativas farmacol&#243;gicas de primera l&#237;nea disponibles en M&#233;xico para el tratamiento del SFM&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Alternativas de tratamiento en comparaci&#243;n</span><p id="par0045" class="elsevierStylePara elsevierViewall">Con apego a las gu&#237;as internacionales para el tratamiento del SFM<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> y de acuerdo con el listado de medicamentos autorizado por el Consejo de Salubridad General para la atenci&#243;n de pacientes en el sistema p&#250;blico de salud en M&#233;xico&#44; se identificaron las siguientes opciones de tratamiento disponibles&#58; amitriptilina &#40;comparador basal&#41; en una dosis inicial de 25<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#44; e incremento a 50<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#46; Del grupo de los ISRS se incluyeron fluoxetina&#44; con dosis inicial de 20<span class="elsevierStyleHsp" style=""></span>mg al d&#237;a e incremento a 80<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#44; y duloxetina&#44; con dosis inicial de 60<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a y seguimiento de 120<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#46; De los ligandos de &#945;2-&#948; se eligieron gabapentina&#44; con dosis inicial de 900<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a e incremento&#44; de ser necesario&#44; a 1&#46;200<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#44; y pregabalina&#44; con dosis inicial de 300<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a y seguimiento de 450<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#46; De los analg&#233;sicos se incluy&#243; la combinaci&#243;n de tramadol &#40;37&#44;5<span class="elsevierStyleHsp" style=""></span>mg&#41; con acetaminof&#233;n &#40;325<span class="elsevierStyleHsp" style=""></span>mg&#41;&#44; con dosis inicial de 150<span class="elsevierStyleHsp" style=""></span>mg&#47;1&#46;300<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a y seguimiento de 300<span class="elsevierStyleHsp" style=""></span>mg&#47;2600<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#46; Finalmente&#44; se agreg&#243; como una alternativa m&#225;s la combinaci&#243;n de fluoxetina m&#225;s amitriptilina&#44; con dosis de inicio de 20<span class="elsevierStyleHsp" style=""></span>mg&#47;12&#44;5<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a y en el seguimiento de 80<span class="elsevierStyleHsp" style=""></span>mg&#47;50<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Modelo econ&#243;mico</span><p id="par0050" class="elsevierStylePara elsevierViewall">El s&#237;ntoma m&#225;s importante del SFM es el dolor cr&#243;nico y sus consecuencias en la funcionalidad y calidad de vida&#46; Para fines del modelo se utiliz&#243; la informaci&#243;n disponible medida a trav&#233;s de la escala visual an&#225;loga &#40;EVA&#41;&#44; donde 0 representa la ausencia de dolor y 10 la mayor intensidad de dolor posible&#46; En caso de la funcionalidad en el SFM se busc&#243; informaci&#243;n estimada a trav&#233;s del FIQ&#44; que mide de manera multidimensional el estado de salud de los pacientes con SFM&#46; La puntuaci&#243;n del FIQ se encuentra entre el 0 y 100&#44; donde el 0 representa la capacidad funcional m&#225;s alta y 100 el peor estado de salud<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">El modelo de Markov utilizado fue adaptado del publicado por Tarride et al&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&#46; Si bien el modelo mencionado anteriormente corresponde a otra indicaci&#243;n &#40;dolor neurop&#225;tico&#41; distinta de la del presente an&#225;lisis&#44; la inclusi&#243;n de la EVA como factor determinante para evaluar la severidad del dolor ha sido ampliamente recomendada para la evaluaci&#243;n de pacientes con fibromialgia seg&#250;n la literatura actual en la materia<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&#46; Por otro lado&#44; dentro de los supuestos de modelo se establece que ingresan al mismo pacientes adultos<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>18 a&#241;os de edad&#44; diagnosticados con fibromialgia&#44; hombres y mujeres&#44; con dolor m&#250;sculo-esquel&#233;tico cr&#243;nico&#46; Los pacientes permanecen con tratamiento durante todo el ciclo o hasta el final del periodo de observaci&#243;n &#40;12 meses&#41;&#46; De acuerdo con la historia natural de la enfermedad&#44; no se considera riesgo de muerte asociada a SFM y asimismo no se consideran cambios de tratamiento durante todo el periodo de observaci&#243;n&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">El esquema b&#225;sico del modelo se muestra en la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>&#46; Existen 3 estados de salud definidos por las puntuaciones de EVA&#58; ausencia del dolor o dolor leve &#40;EVA<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>4 puntos&#41;&#44; dolor moderado &#40;EVA 4 a 7 puntos&#41; y dolor severo &#40;EVA<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>7 puntos&#41;&#46; Al modelo ingresan pacientes con dolor moderado a severo&#46; La probabilidad de transitar a un estado de menor dolor se identifica al modificar el EVA del basal a un disminuci&#243;n del 50&#37; como consecuencia del tratamiento y una disminuci&#243;n del FIQ del 30&#37;&#46; La probabilidad de migrar a un estado de peor dolor se identifica como fracaso terap&#233;utico&#44; que se da en funci&#243;n de p&#233;rdida de la efectividad o de la suspensi&#243;n del tratamiento por intolerancia a eventos adversos&#59; de estos se consideraron&#44; para el caso de los antidepresivos&#44; los efectos anticolin&#233;rgico&#44; serotonin&#233;rgicos y gastrointestinales&#44; as&#237; como el v&#233;rtigo y la somnolencia que producen los ligandos de la subunidad auxiliar &#945;2-&#948;&#46; Los ciclos del modelo se definieron por periodos de 3 meses para un horizonte temporal total de 12 meses&#44; por lo que se construyeron 4 ciclos&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Efectividades</span><p id="par0065" class="elsevierStylePara elsevierViewall">Las medidas de efectividad resultantes del modelo fueron&#58; <span class="elsevierStyleItalic">a&#41;</span> la tasa de &#233;xito analg&#233;sico&#44; medida como el porcentaje de pacientes en quienes disminuyen su escala de EVA en un 50&#37; o m&#225;s con respecto a la medici&#243;n basal&#44; y <span class="elsevierStyleItalic">b&#41;</span> la tasa de mejor&#237;a global&#44; calculada mediante el porcentaje de pacientes que disminuyen en un 30&#37; su escala FIQ con respecto a su medici&#243;n basal&#46; Ambas medidas alcanzadas y sostenidas al final del horizonte temporal &#40;12 meses&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Fuentes de informaci&#243;n</span><p id="par0070" class="elsevierStylePara elsevierViewall">Para obtener las probabilidades que se asignaron a cada uno de los estados de salud se realiz&#243; una revisi&#243;n sistem&#225;tica de la literatura&#44; que identific&#243; la modificaci&#243;n de la EVA y del FIQ&#44; as&#237; como la tasa de abandono del tratamiento secundaria a eventos adversos severos&#44; de pacientes con SFM tratados con las alternativas farmacol&#243;gicas propuestas para el an&#225;lisis&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">La revisi&#243;n consider&#243; un periodo de publicaciones de 20 a&#241;os &#40;1988-2008&#41;&#46; Se incluyeron solo ensayos cl&#237;nicos aleatorizados&#46; Se obtuvieron datos de 3 estudios de pregabalina<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#8211;20</span></a>&#44; uno de tramadol con acetaminof&#233;n<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#44; 2 de duloxetina<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a>&#44; uno de gabapentina<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a>&#44; 4 de amitriptilina<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;24&#8211;26</span></a>&#44; 3 de fluoxetina<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23&#44;27&#44;28</span></a> y uno de la combinaci&#243;n de fluoxetina con amitriptilina<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#46; En estos estudios se verific&#243; previamente la existencia de heterogeneidad con el estad&#237;stico Q de Cochrane y finalmente se calcularon los promedios ponderados para obtener el dato puntual&#59; asimismo&#44; se calcularon los intervalos de confianza del 95&#37; para cada uno de los datos estimados&#46; Los datos aplicados al modelo se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Costes</span><p id="par0080" class="elsevierStylePara elsevierViewall">La informaci&#243;n para el c&#225;lculo de los costes se obtuvo a trav&#233;s de la identificaci&#243;n del uso de recursos y consiguiente valuaci&#243;n en pesos mexicanos 2010&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">La identificaci&#243;n del tipo y la cantidad de recursos utilizados por pacientes con SFM se realiz&#243; a trav&#233;s una muestra aleatoria de 5&#46;000 pacientes atendidos por el Instituto Mexicano del Seguro Social &#40;IMSS&#41;&#44; registrados en las bases propias del instituto denominadas Sistema de Informaci&#243;n M&#233;dico Operativa &#40;SIMO&#41;&#44; Sistema &#218;nico de Informaci&#243;n-Subsistema de motivos de egresos hospitalarios &#40;SUI-13&#41;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> y el Sistema &#218;nico de Informaci&#243;n-Subsistema de demanda en consulta externa &#40;SUI-27&#41;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> en el a&#241;o 2006&#46; El promedio &#177; DE de edad de los pacientes incluidos fue de 36<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14 a&#241;os&#59; el 55&#37; fueron mujeres&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">El coste unitario de los f&#225;rmacos se obtuvo del sitio web del IMSS&#44; en su portal de transparencia&#44; en el que se reportaron los precios de adquisici&#243;n por la instituci&#243;n de los medicamentos para el 2007<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a>&#46; La informaci&#243;n del coste de los servicios ofertados por el IMSS se identific&#243; a trav&#233;s del Bolet&#237;n de Informaci&#243;n Oportuna del IMSS<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a>&#46; Todos los costes fueron ajustados por inflaci&#243;n acumulada al mes de diciembre de 2010&#44; de acuerdo con lo reportado por el Banco de M&#233;xico &#40;4&#37;&#41; con el &#237;ndice de precios al consumidor&#46; Los costes unitarios de cada recurso y la frecuencia anual de utilizaci&#243;n se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Perspectiva&#44; horizonte temporal y tasa de descuento</span><p id="par0095" class="elsevierStylePara elsevierViewall">El estudio se realiz&#243; para apoyar a los tomadores de decisiones en el &#225;mbito de la seguridad social en M&#233;xico&#44; por lo que la perspectiva fue la del proveedor de servicios p&#250;blicos de salud&#46; El an&#225;lisis inicial de coste-efectividad se realiza para un horizonte temporal de un a&#241;o y posteriormente se realizaron proyecciones a 3&#44; 5 y 10 a&#241;os para estimar el impacto econ&#243;mico en cada una de las alternativas&#59; en estos casos&#44; se aplic&#243; una tasa de descuento del 5&#37;&#44; tanto a los costes como a las efectividades&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">An&#225;lisis econ&#243;mico y an&#225;lisis de sensibilidad</span><p id="par0100" class="elsevierStylePara elsevierViewall">El modelo estim&#243; las razones de coste-efectividad para cada una de las alternativas farmacol&#243;gicas del tratamiento del SFM y las razones de coste-efectividad incremental&#46; Se realiz&#243; un an&#225;lisis de sensibilidad de tipo probabil&#237;stico&#44; con la t&#233;cnica no param&#233;trica de <span class="elsevierStyleItalic">bootsrapping</span>&#59; para la estimaci&#243;n se realizaron 250 iteraciones&#46; El modelo fue realizado en Microsoft Excel&#44; 2007<span class="elsevierStyleSup">&#174;</span>&#44; auxiliados por la herramienta <span class="elsevierStyleItalic">Simulation tools</span> para Microsoft Excel&#44; 2007<span class="elsevierStyleSup">&#174;</span>&#46; Las pruebas de heterogeneidad y las curvas de aceptabilidad se realizaron con el m&#243;dulo estad&#237;stico Microsoft Excel&#44; 2007<span class="elsevierStyleSup">&#174;</span>&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Resultados</span><p id="par0105" class="elsevierStylePara elsevierViewall">Los resultados del caso base se muestra en las <a class="elsevierStyleCrossRefs" href="#tbl0015">tablas 3 y 4</a>&#46; En relaci&#243;n con los costes esperados para el primer a&#241;o de tratamiento&#44; el menor coste fue obtenido para el tratamiento con amitriptilina &#40;&#36; 9&#46;047&#44;01&#41;&#44; seguido de fluoxetina como monoterapia &#40;&#36; 10&#46;183&#44;89&#41; y fluoxetina en combinaci&#243;n con amitriptilina &#40;&#36; 10&#46;866&#44;08&#41;&#46; La alternativa de mayor coste fue para el tratamiento con duloxetina &#40;&#36; 28&#46;768&#44;49&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Al identificar los resultados en salud&#44; la probabilidad de alcanzar una reducci&#243;n de la EVA en m&#225;s del 50&#37; de su condici&#243;n basal &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41; fue mayor con el tratamiento con pregabalina &#40;44&#44;8&#37;&#41;&#44; la siguiente mejor alternativa es gabapentina &#40;38&#44;1&#37;&#41; y duloxetina &#40;34&#44;2&#37;&#41;&#46; La alternativa de tratamiento con la menor efectividad para la reducci&#243;n de la EVA fue con el uso de fluoxetina como monoterapia &#40;6&#44;2&#37;&#41;&#46; Cuando se analiza el porcentaje de reducci&#243;n en la escala FIQ &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#44; la mayor proporci&#243;n se alcanza con el tratamiento de pregabalina &#40;31&#44;6&#37;&#41;&#44; seguido de gabapentina &#40;29&#44;1&#37;&#41; y duloxetina &#40;28&#44;5&#37;&#41;&#46; La alternativa de tratamiento en donde se alcanza una menor mejora global medida por el FIQ es con el uso de fluoxetina como monoterapia&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Los tratamientos con pregabalina&#44; gabapentina o duloxetina tienen mejores resultados en las modificaciones de la EVA y del FIQ&#44; pero son m&#225;s costosos que su comparador&#44; amitriptilina&#46; Entre estos 3 comparadores&#44; pregabalina ofrece mejores resultados cl&#237;nicos a un menor coste&#44; dominando de manera absoluta a la gabapentina y la duloxetina&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">El an&#225;lisis de ahorros netos per c&#225;pita&#44; en el horizonte de 3&#44; 5 y 10 a&#241;os&#44; se presenta en la <a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#59; los datos muestran la diferencia en costes y modificaciones en el FIQ que se espera obtener al tratar a los pacientes con pregabalina&#44; gabapentina o duloxetina&#44; en relaci&#243;n con lo esperado con el uso habitual de amitriptilina a lo largo del tiempo&#46; Se aprecia que en ninguno de estos casos existen ahorros&#46; Sin embargo&#44; entre estas 3 alternativas&#44; pregabalina resulta ser un tratamiento ahorrador con mayor mejor&#237;a global a un menor coste a los 3&#44; 5 y 10 a&#241;os de tratamiento&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">En el an&#225;lisis de sensibilidad probabil&#237;stico&#44; al construir las curvas de aceptabilidad&#44; a partir de un nivel de disposici&#243;n a pagar de &#36; 50&#46;000 &#40;&#8776; US&#36; 3&#46;850&#59; tasa de cambio&#58; 13&#44;0 pesos mexicanos por un d&#243;lar americano&#41; por un paciente adicional para alcanzar el &#233;xito en la modificaci&#243;n de la EVA&#44; la pregabalina es una alternativa coste-efectiva en el 80&#37; de los casos&#46; La curva se muestra en la <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a>&#46; Para la medida de efectividad del porcentaje de reducci&#243;n del FIQ&#44; a una disposici&#243;n a pagar de &#36; 75&#46;000 &#40;&#8776; US&#36; 5&#46;770&#41; por un paciente adicional con mejora global&#44; pregabalina es coste efectiva en el 70&#37; de los casos &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discusi&#243;n</span><p id="par0130" class="elsevierStylePara elsevierViewall">Los s&#237;ndromes dolorosos cr&#243;nicos&#44; especialmente los de origen m&#250;sculo-esquel&#233;tico&#44; han sido objeto de atenci&#243;n en los servicios de salud&#44; ya que se han incrementado como motivo de consulta&#44; afectan a la poblaci&#243;n econ&#243;micamente activa y representan un alto impacto en t&#233;rminos de costos directos&#44; indirectos e incluso los no tangibles&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Nuestros resultados muestran que los mejores efectos cl&#237;nicos del tratamiento del SFM se esperan con el uso de duloxetina&#44; gabapentina y pregabalina&#46; De entre las 3 alternativas&#44; pregabalina alcanza la mayor proporci&#243;n de pacientes con &#233;xito cl&#237;nico para el control del dolor &#40;44&#37;&#41; y el mayor impacto en la mejora global de la funcionalidad medida por el FIQ &#40;31&#37;&#41;&#46; Tambi&#233;n entre las tres&#44; pregabalina genera los menores costos asociados&#46; De esta forma&#44; en la comparaci&#243;n entre estas 3 alternativas de tratamiento para el SFM&#44; pregabalina domina de manera absoluta&#44; al ofrecer mejores resultados cl&#237;nicos con un menor coste&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Al comparar pregabalina con el tratamiento habitual&#44; que para el caso corresponde a amitriptilina&#44; pregabalina tiene mejores resultados cl&#237;nicos pero con un coste m&#225;s alto&#46; El coste adicional que se tendr&#225; que asumir&#44; por un paciente adicional con un mejor control del dolor y mejora en la funcionalidad&#44; se encuentra entre &#36; 50&#46;000 y &#36; 75&#46;000 pesos anuales&#46; En un nivel hipot&#233;tico de disposici&#243;n a pagar de &#36; 50&#46;000 por un paciente adicional con adecuado control del dolor y &#36; 75&#46;000 por mejora global&#44; pregabalina es una alternativa coste-efectiva en el 60 y el 80&#37; de los casos&#44; respectivamente&#44; para el tratamiento del SFM en el sistema de salud p&#250;blico en M&#233;xico&#46; Es correcto mencionar que M&#233;xico a&#250;n no cuenta con umbrales de costo-efectividad aceptados para las medidas de efectividad utilizadas en esta investigaci&#243;n&#44; ni tampoco han sido observados para otros autores dentro de la literatura&#46; Sin embargo&#44; es v&#225;lido mencionar que niveles de &#36; 50&#46;000 o &#36; 75&#46;000 se encuentran por debajo del producto interno bruto per c&#225;pita en el pa&#237;s &#40;&#8776; &#36; 130&#46;000&#47;US&#36; 13&#46;900&#41;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a>&#44; por lo que aun bajo estos par&#225;metros&#44; los resultados de la investigaci&#243;n indicar&#237;an que las alternativas ser&#237;an altamente coste-efectivas&#44; como sugiere la Organizaci&#243;n Mundial de la Salud<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a>&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Los datos obtenidos en el presente estudio son semejantes a los publicados por Choy et al&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a> en un modelo realizado para el sistema de salud del Reino Unido&#44; donde los comparadores que utilizaron fueron amitriptilina&#44; duloxetina&#44; tramadol y gabapentina&#46; En este &#250;ltimo modelo se estim&#243; que con una disposici&#243;n a pagar &#163; 30&#46;000 por a&#241;o de vida ajustado por calidad de vida &#40;QALY&#44; por sus siglas en ingl&#233;s&#41;&#44; la pregabalina ser&#237;a una alternativa coste-efectiva en el 60&#37; de los casos&#46; Por otro lado&#44; un reciente estudio realizado en los Estados Unidos de Am&#233;rica<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a>&#44; donde se analiz&#243; el uso de duloxetina frente al tratamiento habitual mostr&#243; razones de coste-efectividad incremental por QALY ganado cercanas a US&#36; 47&#46;500 en el tratamiento de primera l&#237;nea y de US&#36; 16&#46;565 en el tratamiento de segunda l&#237;nea&#44; en un horizonte de tiempo de 2 a&#241;os&#46; En este sentido&#44; en concordancia con nuestro an&#225;lisis&#44; duloxentina podr&#237;a ser una opci&#243;n de segunda l&#237;nea&#44; ya que de nuestro estudio la RCEI de esta alternativa result&#243; ser alta en comparaci&#243;n a pregabalina&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">La literatura m&#233;dica no es amplia en relaci&#243;n con los an&#225;lisis econ&#243;micos para SFM&#59; existen otros modelos hechos para alternativas no farmacol&#243;gicas&#44; que muestran ser coste-efectivos en comparaci&#243;n con el placebo y que requieren infraestructura adicional<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">36&#44;37</span></a>&#46; En los datos mostrados tanto en el Reino Unido como en M&#233;xico&#44; existe consistencia con este comportamiento farmacoecon&#243;mico&#44; por lo que puede ser tomado en cuenta como una alternativa viable para el tratamiento del SFM&#46; Es importante considerar que aun cuando la perspectiva con la que se trabaj&#243; el estudio considera solo los costes directos&#44; la responsabilidad social que tienen las instituciones de salud de reincorporar a su &#225;mbito laboral y recuperar la calidad de vida de los pacientes puede justificar los costes adicionales necesarios para utilizar las nuevas alternativas de tratamiento&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Las limitaciones del presente estudio se encuentran en relaci&#243;n con la construcci&#243;n de un modelo&#44; que intenta representar la realidad del curso cl&#237;nico del SFM y las potenciales modificaciones asociadas a los distintos tratamientos en comparaci&#243;n&#46; El modelo se aliment&#243; de informaci&#243;n de fuentes externas&#44; por lo que no existe una distribuci&#243;n conjunta de los costes y los resultados cl&#237;nicos&#44; y asimismo&#44; no hay una comparaci&#243;n <span class="elsevierStyleItalic">&#171;face to face&#187;</span> entre las distintas alternativas de tratamiento&#46; Sin embargo&#44; se realizaron las pruebas necesarias para asegurar que la informaci&#243;n vertida en el modelo tuviera la validez interna suficiente para ser tomada en cuenta&#59; de esta forma&#44; los sesgos que se encuentran en los resultados de esta investigaci&#243;n son los asociados a los de las propias publicaciones&#44; sin que exista un sesgo diferencial por alguna de las alternativas de tratamiento que se compararon&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">La informaci&#243;n obtenida de la presente evaluaci&#243;n econ&#243;mica entre las alternativas farmacol&#243;gicas para el tratamiento del SFM podr&#225; ser &#250;til para apoyar a los tomadores de decisiones en sistemas de salud&#44; semejantes a las instituciones que ofrecen servicios de salud p&#250;blicos en M&#233;xico&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Responsabilidades &#233;ticas</span><p id="par0175" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Protecci&#243;n de personas y animales</span>&#46; Los autores declaran que para esta investigaci&#243;n no se han realizado experimentos en seres humanos ni en animales&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Confidencialidad de los datos</span>&#46; Los autores declaran que han seguido los protocolos de su centro de trabajo sobre la publicaci&#243;n de datos de pacientes y que todos los pacientes incluidos en el estudio han recibido informaci&#243;n suficiente y han dado su consentimiento informado por escrito para participar en dicho estudio&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Derecho a la privacidad y consentimiento informado</span>&#46; El presente trabajo fue realizado por fuentes secundarias&#44; de bases de datos ya construidas para otros fines diferentes a la investigaci&#243;n y de informaci&#243;n ya publicada&#44; por lo que se requiri&#243; consentimiento informado&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicto de intereses</span><p id="par0170" class="elsevierStylePara elsevierViewall">El presente trabajo se realiz&#243; con apoyo financiero de Pfizer S&#46;A de C&#46;V&#46; sin que esto genere alg&#250;n tipo de compromiso legal y&#47;o sobre los resultados&#46; Al momento de la actualizaci&#243;n del escrito&#44; el Dr&#46; Joaqu&#237;n F Mould Quevedo era empleado de Pfizer S&#46;A de C&#46;V&#46;</p></span></span>"
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            0 => "Resumen"
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              "titulo" => "Alternativas de tratamiento en comparaci&#243;n"
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    "fechaRecibido" => "2011-09-22"
    "fechaAceptado" => "2011-12-16"
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            0 => "Coste-efectividad"
            1 => "Evaluaci&#243;n econ&#243;mica"
            2 => "M&#233;xico"
            3 => "Pregabalina"
            4 => "S&#237;ndrome de fibromialgia"
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          "palabras" => array:5 [
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            1 => "Economic evaluation"
            2 => "Fibromyalgia syndrome"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Identificar desde la perspectiva del proveedor de servicios de salud p&#250;blica en M&#233;xico el tratamiento m&#225;s coste-efectivo para pacientes con s&#237;ndrome de fibromialgia &#40;SFM&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Mediante un modelo de Markov con 3 estados de salud&#44; definidos por la intensidad del dolor &#40;ausencia o presencia de dolor leve&#59; moderado o severo&#41;&#44; en ciclos de 3 meses&#44; se estimaron los costes y las efectividades de amitriptilina &#40;50<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#41;&#44; fluoxetina &#40;80<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#41;&#44; duloxetina &#40;120<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#41;&#44; gabapentina &#40;900<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#41;&#44; pregabalina &#40;450<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#41;&#44; tramadol&#47;acetaminof&#233;n &#40;150<span class="elsevierStyleHsp" style=""></span>mg&#47;1300<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#41; y amitriptilina&#47;fluoxetina &#40;50<span class="elsevierStyleHsp" style=""></span>mg&#47;80<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#41; en el tratamiento del SFM&#46; El resultado cl&#237;nico de inter&#233;s fue el porcentaje de control del dolor al a&#241;o de tratamiento&#46; Las probabilidades asignadas al modelo se obtuvieron de la literatura publicada&#46; Los costes m&#233;dicos directos del tratamiento SFM se calcularon a trav&#233;s bases de datos del Instituto Mexicano del Seguro Social &#40;IMSS&#41; en 2006 y se expresaron en pesos mexicanos de 2010&#46; El an&#225;lisis de sensibilidad fue probabil&#237;stico&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">El mejor control del dolor se obtiene con el uso de pregabalina &#40;44&#44;8&#37;&#41;&#44; seguido de gabapentina &#40;38&#44;1&#37;&#41; y duloxetina &#40;34&#44;2&#37;&#41;&#46; El tratamiento con menor coste&#44; fue con amitriptilina &#40;&#36; 9&#46;047&#44;01&#41;&#44; seguido de fluoxetina &#40;&#36; 10&#46;183&#44;89&#41; y amitriptilina&#47;fluoxetina &#40;&#36; 10&#46;866&#44;01&#41;&#46; Al comparar pregabalina vs amitriptilina&#44; el coste anual adicional por paciente con control del dolor se encuentra entre &#36; 50&#46;000 y &#36; 75&#46;000 y resulta ser coste-efectivo entre el 70 y el 80&#37; de los casos&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Entre las alternativas de tratamiento para el SFM&#44; pregabalina alcanza el mejor control del dolor y es coste-efectiva hasta en el 80&#37; de los pacientes del sistema de salud p&#250;blico en M&#233;xico&#46;</p>"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To identify&#44; from the Mexican Public Health System perspective&#44; which would be the most cost-effective treatment for patients with Fibromyalgia &#40;FM&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A Markov model including three health states&#44; divided by pain intensity &#40;absence or presence of mild&#44; moderate or severe pain&#41; and considering three-month cycles&#59; costs and effectiveness were estimated for amitriptyline &#40;50<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41;&#44; fluoxetine &#40;80<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41;&#44; duloxetine &#40;120<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41;&#44; gabapentin &#40;900<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41;&#44; pregabalin &#40;450<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41;&#44; tramadol&#47;acetaminophen &#40;150<span class="elsevierStyleHsp" style=""></span>mg&#47;1300<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#41; and amitriptyline&#47;fluoxetine &#40;50<span class="elsevierStyleHsp" style=""></span>mg&#47;80<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#41; for the treatment of FM&#46; The clinical outcome considered was the annual rate of pain control&#46; Probabilities assigned to the model were collected from published literature&#46; Direct medical costs for FM treatment were retrieved from the 2006 data of the Mexican Institute of Social Security &#40;IMSS&#41; databases and were expressed in 2010 Mexican Pesos&#46; Probabilistic Sensitivity Analyses were conducted&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The best pain control rate was obtained with pregabalin &#40;44&#46;8&#37;&#41;&#44; followed by gabapentin &#40;38&#46;1&#37;&#41; and duloxetine &#40;34&#46;2&#37;&#41;&#46; The lowest treatment costs was for amitriptyline &#40;&#36; 9047&#46;01&#41;&#44; followed by fluoxetine &#40;&#36; 10&#44;183&#46;89&#41; and amitriptyline&#47;fluoxetine &#40;&#36; 10&#44;866&#46;01&#41;&#46; By comparing pregabalin vs amitriptyline&#44; additional annual cost per patient for pain control would be around &#36; 50&#46;000 and &#36; 75&#46;000 and would result cost-effective in 70&#37; and 80&#37; of all cases&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Among all treatment options for FM&#44; pregabalin achieved the highest pain control and was cost-effective in 80&#37; of patients of the Mexican Public Health System&#46;</p>"
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">EVA&#58; escala visual an&#225;loga&#59; FIQ&#58; cuestionario del impacto de la fibromialgia &#40;por sus siglas en ingl&#233;s&#41;&#59; IC del 95&#37;&#58; intervalo de confianza del 95&#37;&#46;</p>"
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                  \t\t\t\t  " rowspan="2" align="left" valign="middle">Duloxetina</td><td class="td" title="\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="middle">Arnold<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t">&#40;0&#44;184&#44; 0&#44;222&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="middle">Gabapentina</td><td class="td" title="\n
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                  \t\t\t\t">&#8211;0&#44;659&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;160&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  " rowspan="2" align="left" valign="middle">Arnold<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;&#8211;0&#44;505&#44; &#8211;0&#44;618&#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="left" valign="\n
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                  \t\t\t\t">&#40;&#8211;0&#44;593&#44; &#8211;0&#44;725&#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">&#40;0&#44;144&#44; 0&#44;176&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="middle">Amitriptilina</td><td class="td" title="\n
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                  \t\t\t\t">&#8211;0&#44;407&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">&#8211;0&#44;145&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">0&#44;070&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  " rowspan="2" align="left" valign="middle">Goldenberg<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#44; Hannonen<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a>&#44; Carette<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25&#44;26</span></a></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;&#8211;0&#44;182&#44; &#8211;0&#44;437&#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</td><td class="td" title="\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="middle">Fluoxetina</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="middle">Fluoxetina&#47;amitriptilina</td><td class="td" title="\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="middle">Goldenberg<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Coste anual<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Fuente&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Servicios</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
                  \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></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Consulta ambulatoria en UMF&nbsp;\t\t\t\t\t\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">&#36; 535&#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;75&nbsp;\t\t\t\t\t\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">&#36; 936&#44;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="5" align="left" valign="middle">Bolet&#237;n de Informaci&#243;n Oportuna IMSS<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> Subsistema de Informaci&#243;n M&#233;dico Operativa 13 y 27<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Consulta ambulatoria por especialista&nbsp;\t\t\t\t\t\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">&#36; 850&#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;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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#36; 467&#44;50&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>D&#237;a de estancia hospitalaria<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></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">&#36; 4&#46;939&#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;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">&#36; 5&#46;432&#44;90&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudios de laboratorio&nbsp;\t\t\t\t\t\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">&#36; 84&#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;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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#36; 178&#44;08&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Otros auxiliares diagn&#243;stico&nbsp;\t\t\t\t\t\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">&#36; 3&#46;700&#44;16&nbsp;\t\t\t\t\t\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;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
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#36; 8&#46;214&#44;36&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="left" 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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tratamiento farmacol&#243;gico</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Pregabalina &#40;c&#225;psulas de 150<span class="elsevierStyleHsp" style=""></span>mg&#46; Envase con 28&#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">&#36; 324&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;032&nbsp;\t\t\t\t\t\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">&#36; 4&#46;229&#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  " rowspan="6" align="left" valign="middle">Portal de transparencia IMSS<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tramadol&#47;acetaminof&#233;n &#40;tableta con tramadol 37&#44;5 mg&#47;acetaminof&#233;n 325<span class="elsevierStyleHsp" style=""></span>mg&#46; Envase con 20 tabletas&#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">&#36; 105&#44;95&nbsp;\t\t\t\t\t\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&#46;190&nbsp;\t\t\t\t\t\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">&#36; 1&#46;933&#44;60&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Duloxetina &#40;c&#225;psulas de 60<span class="elsevierStyleHsp" style=""></span>mg&#46; Envase con 14&#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">&#36; 325&#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">730&nbsp;\t\t\t\t\t\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">&#36; 8&#46;490&#44;33&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Gabapentina &#40;c&#225;psulas de 300<span class="elsevierStyleHsp" style=""></span>mg&#46; Envase con 15&#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">&#36; 105&#44;14&nbsp;\t\t\t\t\t\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&#46;460&nbsp;\t\t\t\t\t\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">&#36; 2&#46;558&#44;35&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Amitriptilina &#40;tabletas de 25<span class="elsevierStyleHsp" style=""></span>mg&#46; Envase con 20&#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">&#36; 40&#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">688&nbsp;\t\t\t\t\t\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">&#36; 730&#44;96&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fluoxetina &#40;c&#225;psulas de 20<span class="elsevierStyleHsp" style=""></span>mg&#46; Envase con 14&#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">&#36; 6&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;376&nbsp;\t\t\t\t\t\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">&#36; 118&#46;08&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="left" 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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tratamiento de efectos adversos de los f&#225;rmacos</span><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">d</span></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">&#36; 401&#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="char" valign="\n
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                  \t\t\t\t">0&#44;16&nbsp;\t\t\t\t\t\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">&#36; 58&#44;40&nbsp;\t\t\t\t\t\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></tr></tbody></table>
                  """
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              "nota" => "<p class="elsevierStyleNotepara">Coste del d&#237;a cama hospitalaria incluye&#58; hoteler&#237;a&#44; atenci&#243;n m&#233;dica y de enfermer&#237;a&#44; medicamentos&#44; materiales de curaci&#243;n y alimentos&#46;</p>"
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              "nota" => "<p class="elsevierStyleNotepara">La frecuencia de uso de f&#225;rmacos expresa el n&#250;mero de tabletas o c&#225;psulas requeridas en un a&#241;o&#46;</p>"
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              "nota" => "<p class="elsevierStyleNotepara">La frecuencia de los efectos adversos de los tratamientos se estim&#243; del reporte en la literatura&#44; de los ensayos cl&#237;nicos incluidos en el estudio&#46; Los costes se estimaron considerando el manejo convencional de cada evento&#44; tomando en cuenta los auxiliares diagn&#243;sticos y tratamiento farmacol&#243;gico correspondiente&#46;</p>"
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          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">IC del 95&#37;&#58; intervalo de confianza del 95&#59; &#916; Costos&#58; costos incrementales&#44; EVA&#58; escala visual an&#225;loga&#59; RCE&#58; raz&#243;n coste-efectividad&#59; RCEI&#58; raz&#243;n coste-efectividad incremental&#46;</p>"
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Amitriptilina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pregabalina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Tramadol&#47;acetaminof&#233;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Duloxetina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Gabapentina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Fluoxetina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Fluoxetina &#43; amitriptilina&nbsp;\t\t\t\t\t\t\n
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                  \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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&#40;IC del 95&#37;&#41;&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">&#40;IC del 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#40;IC del 95&#37;&#41;&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\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&#40;IC del 95&#37;&#41;&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\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&#40;IC del 95&#37;&#41;&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\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&#40;IC del 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&#40;IC del 95&#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  " rowspan="2" align="left" valign="middle">Costes<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#36; 9&#46;047&#44;01&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">&#36; 21&#46;129&#44;18&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">&#36; 21&#46;942&#44;55&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">&#36; 28&#46;768&#44;49&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#36; 24&#46;495&#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="left" valign="\n
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                  \t\t\t\t">&#36; 10&#46;183&#44;89&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">&#36; 10&#46;866&#44;08&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">&#40;&#36; 8&#46;626&#44;08&#44; &#36; 9&#46;467&#44;95&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#40;&#36; 20&#46;694&#46;38&#44; &#36; 21&#46;563&#44;97&#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">&#40;&#36; 21&#46;536&#44;09&#44; &#36; 22&#46;349&#44;03&#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="left" valign="\n
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                  \t\t\t\t">&#40;&#36; 28&#46;374&#44;04&#44; &#36; 29&#46;165&#44;08&#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">&#40;&#36; 24&#46;108&#44;66&#44; &#36; 24&#46;882&#44;76&#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="left" valign="\n
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                  \t\t\t\t">&#40;&#36; 9&#46;779&#44;63&#44; &#36; 10&#46;588&#44;15&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#40;&#36; 10&#46;349&#44;35&#44; &#36; 11&#46;192&#44;48&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="middle">&#916; Costes</td><td class="td" title="\n
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                  \t\t\t\t">&#36; 12&#46;082&#44;16&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#36; 12&#46;895&#44;54&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">&#36; 19&#46;721&#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
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#36; 15&#46;448&#44;70&nbsp;\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">&#36; 1&#46;136&#44;88&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">&#36; 1&#46;819&#44;07&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;&#36; 11&#46;298&#44;43&#44; &#36; 12&#46;865&#44;90&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;&#36; 11&#46;956&#44;65&#44; &#36; 13&#46;834&#44;43&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;&#36; 16&#46;045&#44;51&#44; &#36; 23&#46;397&#44;45&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;&#36; 13&#46;513&#44;98&#44; &#36; 17&#46;383&#44;42&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;&#36; 924&#44;72&#44; &#36; 1&#46;349&#44;04&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;&#36; 1&#46;592&#44;83&#44; &#36; 2&#46;045&#44;31&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="middle">Reducci&#243;n de EVA &#62; 50&#37;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#44;8&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#44;9&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&#44;2&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#44;1&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;2&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#44;6&#37;&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;21&#37;&#44; 24&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;42&#37;&#44; 48&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;17&#37;&#44; 19&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;28&#37;&#44; 41&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;33&#37;&#44; 43&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;5&#37;&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;12&#37;&#44; 15&#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  " rowspan="2" align="left" valign="middle">&#916; reducci&#243;n del EVA &#62; 50&#37;</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#44;6&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;4&#44;3&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#44;0&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#44;9&#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="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t">&#916; reducci&#243;n en FIQ&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#36; &#8211;77&#46;101&#44;20&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Reducci&#243;n en FIQ&#42;&#42;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">20&#44;9&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">26&#44;7&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Ahorro neto</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#36; &#8211;13&#46;953&#44;80&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#36; &#8211;48&#46;459&#44;80&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#36; 89&#46;044&#44;88&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#36; 227&#46;292&#44;67&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Coste&#42;</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  " colspan="4" align="center" valign="\n
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                  \t\t\t\t">Gabapentina</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tratamiento farmacol&#243;gico&nbsp;\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">&#36; &#8211;16&#46;860&#44;32&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#36; &#8211;58&#46;553&#44;78&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#36; 107&#46;592&#44;56&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#36; &#8211;274&#46;636&#44;81&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tratamiento hospitalario&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#36; 494&#44;36&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#36; 1&#46;716&#44;85&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#36; 3&#46;154&#44;73&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#36; 8&#46;052&#44;62&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Consulta m&#233;dica&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">&#36; &#8211;150&#44;13&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#36; &#8211;521&#44;41&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#36; &#8211;958&#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
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                  \t\t\t\t">&#36; &#8211;2&#46;445&#44;61&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudios de laboratorio y gabinete&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">&#36; 1&#46;072&#44;04&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#36; 3&#46;723&#44;03&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">&#36; 6&#46;841&#44;07&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#36; 17&#46;462&#44;26&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Efectos adversos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#36; &#8211;4&#44;64&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#36; &#8211;16&#44;09&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#36; &#8211;29&#44;57&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#36; &#8211;75&#44;48&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#36; &#8211;15&#46;448&#44;70&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#36; 53&#46;651&#44;40&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#36; &#8211;98&#46;584&#44;44&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#36; 251&#46;643&#44;02&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Beneficio</span>&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">&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">&nbsp;\t\t\t\t\t\t\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">&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Reducci&#243;n en FIQ&#42;&#42;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13&#44;9&#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
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                  \t\t\t\t">16&#44;1&#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
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                  \t\t\t\t">17&#44;8&#37;&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">22&#44;7&#37;&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
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                  \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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Ahorro neto</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="left" valign="\n
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                  \t\t\t\t">&#36; &#8211;51&#46;024&#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="left" valign="\n
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                  \t\t\t\t">&#36; &#8211;177&#46;202&#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="left" valign="\n
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                  \t\t\t\t">&#36; &#8211;325&#46;609&#44;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="left" valign="\n
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                  \t\t\t\t">&#36; 831&#46;138&#44;47&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
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                  \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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Costo&#42;</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  " colspan="4" align="center" valign="\n
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                  \t\t\t\t">Duloxetina</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tratamiento farmacol&#243;gico&nbsp;\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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Original
Análisis de coste-efectividad en el tratamiento farmacológico del síndrome de fibromialgia en México
Cost-effectiveness analysis of pharmacologic treatment of fibromyalgia in Mexico
Héctor Arreola Ornelasa, Alfonso Rosado Buzzob, Lourdes Garcíab, Javier Dorantes Aguilarb, Iris Contreras Hernándezc, Joaquín F. Mould Quevedod,
Autor para correspondencia
joaquin.mould@pfizer.com

Autor para correspondencia.
a Programa Competitividad y Salud, Fundación Mexicana para la Salud, Colonia El Arenal, Tlalpan, México D.F. México
b Links and Links S.A., Colonia Barrio Niño Jesús, Tlalpan, México D.F., México
c Instituto Mexicano del Seguro Social (IMSS), Hospital General de Zona N.° 1-A Venados, Municipio Libre N.° 270, Col. Portales, Del. Benito Juárez, México D.F., México
d Health Economics & Outcomes Research, Latin America and Primary Care Emerging Market Business Unit, Pfizer Inc., New York, Estados Unidos
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">De los s&#237;ndromes dolorosos cr&#243;nicos que son motivo de consulta&#44; el s&#237;ndrome de fibromialgia &#40;SFM&#41; tiene un impacto significativo en la calidad de vida y en la disminuci&#243;n de la productividad<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a>&#46; La principal manifestaci&#243;n del s&#237;ndrome es dolor m&#250;sculo-esquel&#233;tico generalizado&#44; con presencia de alodinia e hiperalgesia&#59; frecuentemente se acompa&#241;a de alteraciones del sue&#241;o&#44; ansiedad&#44; depresi&#243;n&#44; cefalea y s&#237;ndrome de intestino irritable&#44; entre otros<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La prevalencia mundial reportada para el SFM se encuentra entre el 3 y el 5&#37; de la poblaci&#243;n adulta &#40;entre 20 a 60 a&#241;os de edad&#41;&#44; con predominio significativo en las mujeres&#46; En M&#233;xico&#44; la frecuencia estimada es del 0&#44;68&#37; &#40;IC del 95&#37;&#44; 0&#44;56-0&#44;80&#41;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">El impacto negativo del SFM se manifiesta en las actividades cotidianas de la vida y se traduce en ausencias laborales y&#47;o escolares&#44; con repercusi&#243;n en la productividad&#44; cuya reducci&#243;n se ha estimado hasta en un 65&#37;&#46; As&#237;&#44; el impacto econ&#243;mico m&#225;s importante del SFM ocurre en los costos asociados con la p&#233;rdida de productividad&#44; los cuales representan hasta el 70&#37; de la carga de la enfermedad<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#46; El abordaje terap&#233;utico del SFM es multidisciplinario y el objetivo principal es reducir el dolor y mejorar la capacidad funcional&#46; El tratamiento debe incluir&#58; educaci&#243;n al paciente&#44; cambios de estilo de vida&#44; fisioterapia y tratamiento farmacol&#243;gico<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">El tratamiento farmacol&#243;gico m&#225;s frecuentemente estudiado es el uso de antidepresivos tric&#237;clicos&#46; Un metaan&#225;lisis reciente muestra que el tama&#241;o del efecto en la reducci&#243;n del dolor con amitriptilina en el SFM&#44; calculado como diferencia promedio estandarizada &#40;DPE&#41; fue de &#8211;1&#44;64 &#40;IC del 95&#37;&#44; &#8211;2&#44;57 a &#8211;0&#44;71&#41;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&#46; Dada la alta incidencia de efectos adversos asociados al uso de antidepresivos tric&#237;clicos y en la b&#250;squeda un mejor perfil de seguridad&#44; los inhibidores selectivos de la recaptura de serotonina &#40;ISRS&#41; han sido una alternativa en el tratamiento&#46; El mismo metaan&#225;lisis reporta la DPE en el caso del dolor al utilizar fluoxetina y paroxetina de &#8211;0&#44;39 &#40;IC del 95&#37;&#44; &#8211;0&#44;77 a &#8211;0&#44;01&#41; y al utilizar en el tratamiento los inhibidores selectivos de noradrenalina &#40;ISNA&#41;&#59; los autores reportan el efecto para duloxetina y milnacipran con DPE de &#8211;0&#44;36 &#40;IC del 95&#37;&#44; &#8211;0&#44;46 a &#8211;0&#44;25&#41;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Se ha estudiado tambi&#233;n la combinaci&#243;n de al menos 2 f&#225;rmacos con distintos modos de acci&#243;n&#46; Para el efecto analg&#233;sico se ha documentado que la combinaci&#243;n de tramadol con acetaminof&#233;n&#44; se ha identificado una reducci&#243;n de al menos del 50&#37; de la escala de dolor basal en el 35&#37; de los casos&#59; asimismo la combinaci&#243;n de f&#225;rmacos es bien tolerada y se observ&#243; una mejora significativa en la funcionalidad medido por cuestionario de impacto de fibromialgia &#40;FIQ&#44; por sus siglas en ingl&#233;s&#41;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#46; Por otro lado&#44; la combinaci&#243;n de amitriptilina y fluoxetina reporta mejor&#237;a en las escalas de FIQ y EVA en comparaci&#243;n con el uso de monoterapia<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Otras alternativas recientemente identificadas son los ligandos de la subunidad auxiliar &#945;2-&#948; de los canales de calcio&#44; dependientes de voltaje en el SNC &#40;pregabalina&#44; gabapentina&#41;&#46; En varios ensayos cl&#237;nicos han sido reportados una mejora significativa del dolor en pacientes con SFM&#44; pero adem&#225;s mejor&#237;a en la funcionalidad&#44; el estado de &#225;nimo y las alteraciones del sue&#241;o&#46; Por otro lado&#44; los datos de los ensayos cl&#237;nicos han sido integrados en un metaan&#225;lisis donde se muestra una modificaci&#243;n del dolor con DPE del &#8211;0&#44;28 &#40;IC del 95&#37;&#44; &#8211;0&#44;36 a &#8211;0&#44;20&#41;&#59; mejor&#237;a en las alteraciones del sue&#241;o de &#8211;0&#44;39 &#40;IC del 95&#37;&#44; &#8211;0&#44;48 a &#8211;0&#44;39&#41; y mejor&#237;a en la calidad de vida de &#8211;0&#44;30 &#40;IC del 95&#37;&#44; &#8211;0&#44;46 a &#8211;0&#44;15&#41;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#46; Es importante mencionar que la <span class="elsevierStyleItalic">Food and Drug Administration</span> ha aprobado al menos 3 medicamentos para el tratamiento del SFM&#58; pregabalina &#40;en 2007&#41;&#44; duloxetina &#40;en 2008&#41; y milnacipran &#40;en 2009&#41;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Uno de los problemas a los que se enfrentan los pacientes en cualquier sistema de salud es el acceso a f&#225;rmacos eficaces&#46; Muchos de los programas asistenciales se encuentran dise&#241;ados con definiciones de alto nivel de evidencia&#44; pero tambi&#233;n con una pol&#237;tica de contenci&#243;n de costes&#44; en funci&#243;n de la disponibilidad de recursos que casi siempre son limitados&#46; De esta forma&#44; el objetivo del presente trabajo fue identificar cu&#225;l de los tratamientos farmacol&#243;gicos disponibles en el sector p&#250;blico del sistema de salud en M&#233;xico para el tratamiento del SFM es el m&#225;s coste-efectivo&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Material y m&#233;todos</span><p id="par0040" class="elsevierStylePara elsevierViewall">Se realiz&#243; un an&#225;lisis econ&#243;mico de tipo coste-efectividad&#44; con la construcci&#243;n de un modelo de Markov&#44; para comparar los costes y las efectividades de las alternativas farmacol&#243;gicas de primera l&#237;nea disponibles en M&#233;xico para el tratamiento del SFM&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Alternativas de tratamiento en comparaci&#243;n</span><p id="par0045" class="elsevierStylePara elsevierViewall">Con apego a las gu&#237;as internacionales para el tratamiento del SFM<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> y de acuerdo con el listado de medicamentos autorizado por el Consejo de Salubridad General para la atenci&#243;n de pacientes en el sistema p&#250;blico de salud en M&#233;xico&#44; 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Para fines del modelo se utiliz&#243; la informaci&#243;n disponible medida a trav&#233;s de la escala visual an&#225;loga &#40;EVA&#41;&#44; donde 0 representa la ausencia de dolor y 10 la mayor intensidad de dolor posible&#46; En caso de la funcionalidad en el SFM se busc&#243; informaci&#243;n estimada a trav&#233;s del FIQ&#44; que mide de manera multidimensional el estado de salud de los pacientes con SFM&#46; La puntuaci&#243;n del FIQ se encuentra entre el 0 y 100&#44; donde el 0 representa la capacidad funcional m&#225;s alta y 100 el peor estado de salud<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">El modelo de Markov utilizado fue adaptado del publicado por Tarride et al&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&#46; Si bien el modelo mencionado anteriormente corresponde a otra indicaci&#243;n &#40;dolor neurop&#225;tico&#41; distinta de la del presente an&#225;lisis&#44; la inclusi&#243;n de la EVA como factor determinante para evaluar la severidad del dolor ha sido ampliamente recomendada para la evaluaci&#243;n de pacientes con fibromialgia seg&#250;n la literatura actual en la materia<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&#46; Por otro lado&#44; dentro de los supuestos de modelo se establece que ingresan al mismo pacientes adultos<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>18 a&#241;os de edad&#44; diagnosticados con fibromialgia&#44; hombres y mujeres&#44; con dolor m&#250;sculo-esquel&#233;tico cr&#243;nico&#46; Los pacientes permanecen con tratamiento durante todo el ciclo o hasta el final del periodo de observaci&#243;n &#40;12 meses&#41;&#46; De acuerdo con la historia natural de la enfermedad&#44; no se considera riesgo de muerte asociada a SFM y asimismo no se consideran cambios de tratamiento durante todo el periodo de observaci&#243;n&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">El esquema b&#225;sico del modelo se muestra en la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>&#46; Existen 3 estados de salud definidos por las puntuaciones de EVA&#58; ausencia del dolor o dolor leve &#40;EVA<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>4 puntos&#41;&#44; dolor moderado &#40;EVA 4 a 7 puntos&#41; y dolor severo &#40;EVA<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>7 puntos&#41;&#46; Al modelo ingresan pacientes con dolor moderado a severo&#46; La probabilidad de transitar a un estado de menor dolor se identifica al modificar el EVA del basal a un disminuci&#243;n del 50&#37; como consecuencia del tratamiento y una disminuci&#243;n del FIQ del 30&#37;&#46; La probabilidad de migrar a un estado de peor dolor se identifica como fracaso terap&#233;utico&#44; que se da en funci&#243;n de p&#233;rdida de la efectividad o de la suspensi&#243;n del tratamiento por intolerancia a eventos adversos&#59; de estos se consideraron&#44; para el caso de los antidepresivos&#44; los efectos anticolin&#233;rgico&#44; serotonin&#233;rgicos y gastrointestinales&#44; as&#237; como el v&#233;rtigo y la somnolencia que producen los ligandos de la subunidad auxiliar &#945;2-&#948;&#46; Los ciclos del modelo se definieron por periodos de 3 meses para un horizonte temporal total de 12 meses&#44; por lo que se construyeron 4 ciclos&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Efectividades</span><p id="par0065" class="elsevierStylePara elsevierViewall">Las medidas de efectividad resultantes del modelo fueron&#58; <span class="elsevierStyleItalic">a&#41;</span> la tasa de &#233;xito analg&#233;sico&#44; medida como el porcentaje de pacientes en quienes disminuyen su escala de EVA en un 50&#37; o m&#225;s con respecto a la medici&#243;n basal&#44; y <span class="elsevierStyleItalic">b&#41;</span> la tasa de mejor&#237;a global&#44; calculada mediante el porcentaje de pacientes que disminuyen en un 30&#37; su escala FIQ con respecto a su medici&#243;n basal&#46; Ambas medidas alcanzadas y sostenidas al final del horizonte temporal &#40;12 meses&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Fuentes de informaci&#243;n</span><p id="par0070" class="elsevierStylePara elsevierViewall">Para obtener las probabilidades que se asignaron a cada uno de los estados de salud se realiz&#243; una revisi&#243;n sistem&#225;tica de la literatura&#44; que identific&#243; la modificaci&#243;n de la EVA y del FIQ&#44; as&#237; como la tasa de abandono del tratamiento secundaria a eventos adversos severos&#44; de pacientes con SFM tratados con las alternativas farmacol&#243;gicas propuestas para el an&#225;lisis&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">La revisi&#243;n consider&#243; un periodo de publicaciones de 20 a&#241;os &#40;1988-2008&#41;&#46; Se incluyeron solo ensayos cl&#237;nicos aleatorizados&#46; Se obtuvieron datos de 3 estudios de pregabalina<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#8211;20</span></a>&#44; uno de tramadol con acetaminof&#233;n<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#44; 2 de duloxetina<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a>&#44; uno de gabapentina<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a>&#44; 4 de amitriptilina<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;24&#8211;26</span></a>&#44; 3 de fluoxetina<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23&#44;27&#44;28</span></a> y uno de la combinaci&#243;n de fluoxetina con amitriptilina<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#46; En estos estudios se verific&#243; previamente la existencia de heterogeneidad con el estad&#237;stico Q de Cochrane y finalmente se calcularon los promedios ponderados para obtener el dato puntual&#59; asimismo&#44; se calcularon los intervalos de confianza del 95&#37; para cada uno de los datos estimados&#46; Los datos aplicados al modelo se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Costes</span><p id="par0080" class="elsevierStylePara elsevierViewall">La informaci&#243;n para el c&#225;lculo de los costes se obtuvo a trav&#233;s de la identificaci&#243;n del uso de recursos y consiguiente valuaci&#243;n en pesos mexicanos 2010&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">La identificaci&#243;n del tipo y la cantidad de recursos utilizados por pacientes con SFM se realiz&#243; a trav&#233;s una muestra aleatoria de 5&#46;000 pacientes atendidos por el Instituto Mexicano del Seguro Social &#40;IMSS&#41;&#44; registrados en las bases propias del instituto denominadas Sistema de Informaci&#243;n M&#233;dico Operativa &#40;SIMO&#41;&#44; Sistema &#218;nico de Informaci&#243;n-Subsistema de motivos de egresos hospitalarios &#40;SUI-13&#41;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> y el Sistema &#218;nico de Informaci&#243;n-Subsistema de demanda en consulta externa &#40;SUI-27&#41;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> en el a&#241;o 2006&#46; El promedio &#177; DE de edad de los pacientes incluidos fue de 36<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14 a&#241;os&#59; el 55&#37; fueron mujeres&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">El coste unitario de los f&#225;rmacos se obtuvo del sitio web del IMSS&#44; en su portal de transparencia&#44; en el que se reportaron los precios de adquisici&#243;n por la instituci&#243;n de los medicamentos para el 2007<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a>&#46; La informaci&#243;n del coste de los servicios ofertados por el IMSS se identific&#243; a trav&#233;s del Bolet&#237;n de Informaci&#243;n Oportuna del IMSS<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a>&#46; Todos los costes fueron ajustados por inflaci&#243;n acumulada al mes de diciembre de 2010&#44; de acuerdo con lo reportado por el Banco de M&#233;xico &#40;4&#37;&#41; con el &#237;ndice de precios al consumidor&#46; Los costes unitarios de cada recurso y la frecuencia anual de utilizaci&#243;n se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Perspectiva&#44; horizonte temporal y tasa de descuento</span><p id="par0095" class="elsevierStylePara elsevierViewall">El estudio se realiz&#243; para apoyar a los tomadores de decisiones en el &#225;mbito de la seguridad social en M&#233;xico&#44; por lo que la perspectiva fue la del proveedor de servicios p&#250;blicos de salud&#46; El an&#225;lisis inicial de coste-efectividad se realiza para un horizonte temporal de un a&#241;o y posteriormente se realizaron proyecciones a 3&#44; 5 y 10 a&#241;os para estimar el impacto econ&#243;mico en cada una de las alternativas&#59; en estos casos&#44; se aplic&#243; una tasa de descuento del 5&#37;&#44; tanto a los costes como a las efectividades&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">An&#225;lisis econ&#243;mico y an&#225;lisis de sensibilidad</span><p id="par0100" class="elsevierStylePara elsevierViewall">El modelo estim&#243; las razones de coste-efectividad para cada una de las alternativas farmacol&#243;gicas del tratamiento del SFM y las razones de coste-efectividad incremental&#46; Se realiz&#243; un an&#225;lisis de sensibilidad de tipo probabil&#237;stico&#44; con la t&#233;cnica no param&#233;trica de <span class="elsevierStyleItalic">bootsrapping</span>&#59; para la estimaci&#243;n se realizaron 250 iteraciones&#46; El modelo fue realizado en Microsoft Excel&#44; 2007<span class="elsevierStyleSup">&#174;</span>&#44; auxiliados por la herramienta <span class="elsevierStyleItalic">Simulation tools</span> para Microsoft Excel&#44; 2007<span class="elsevierStyleSup">&#174;</span>&#46; Las pruebas de heterogeneidad y las curvas de aceptabilidad se realizaron con el m&#243;dulo estad&#237;stico Microsoft Excel&#44; 2007<span class="elsevierStyleSup">&#174;</span>&#46;</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Resultados</span><p id="par0105" class="elsevierStylePara elsevierViewall">Los resultados del caso base se muestra en las <a class="elsevierStyleCrossRefs" href="#tbl0015">tablas 3 y 4</a>&#46; En relaci&#243;n con los costes esperados para el primer a&#241;o de tratamiento&#44; el menor coste fue obtenido para el tratamiento con amitriptilina &#40;&#36; 9&#46;047&#44;01&#41;&#44; seguido de fluoxetina como monoterapia &#40;&#36; 10&#46;183&#44;89&#41; y fluoxetina en combinaci&#243;n con amitriptilina &#40;&#36; 10&#46;866&#44;08&#41;&#46; La alternativa de mayor coste fue para el tratamiento con duloxetina &#40;&#36; 28&#46;768&#44;49&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Al identificar los resultados en salud&#44; la probabilidad de alcanzar una reducci&#243;n de la EVA en m&#225;s del 50&#37; de su condici&#243;n basal &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41; fue mayor con el tratamiento con pregabalina &#40;44&#44;8&#37;&#41;&#44; la siguiente mejor alternativa es gabapentina &#40;38&#44;1&#37;&#41; y duloxetina &#40;34&#44;2&#37;&#41;&#46; La alternativa de tratamiento con la menor efectividad para la reducci&#243;n de la EVA fue con el uso de fluoxetina como monoterapia &#40;6&#44;2&#37;&#41;&#46; Cuando se analiza el porcentaje de reducci&#243;n en la escala FIQ &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#44; la mayor proporci&#243;n se alcanza con el tratamiento de pregabalina &#40;31&#44;6&#37;&#41;&#44; seguido de gabapentina &#40;29&#44;1&#37;&#41; y duloxetina &#40;28&#44;5&#37;&#41;&#46; La alternativa de tratamiento en donde se alcanza una menor mejora global medida por el FIQ es con el uso de fluoxetina como monoterapia&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Los tratamientos con pregabalina&#44; gabapentina o duloxetina tienen mejores resultados en las modificaciones de la EVA y del FIQ&#44; pero son m&#225;s costosos que su comparador&#44; amitriptilina&#46; Entre estos 3 comparadores&#44; pregabalina ofrece mejores resultados cl&#237;nicos a un menor coste&#44; dominando de manera absoluta a la gabapentina y la duloxetina&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">El an&#225;lisis de ahorros netos per c&#225;pita&#44; en el horizonte de 3&#44; 5 y 10 a&#241;os&#44; se presenta en la <a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#59; los datos muestran la diferencia en costes y modificaciones en el FIQ que se espera obtener al tratar a los pacientes con pregabalina&#44; gabapentina o duloxetina&#44; en relaci&#243;n con lo esperado con el uso habitual de amitriptilina a lo largo del tiempo&#46; Se aprecia que en ninguno de estos casos existen ahorros&#46; Sin embargo&#44; entre estas 3 alternativas&#44; pregabalina resulta ser un tratamiento ahorrador con mayor mejor&#237;a global a un menor coste a los 3&#44; 5 y 10 a&#241;os de tratamiento&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">En el an&#225;lisis de sensibilidad probabil&#237;stico&#44; al construir las curvas de aceptabilidad&#44; a partir de un nivel de disposici&#243;n a pagar de &#36; 50&#46;000 &#40;&#8776; US&#36; 3&#46;850&#59; tasa de cambio&#58; 13&#44;0 pesos mexicanos por un d&#243;lar americano&#41; por un paciente adicional para alcanzar el &#233;xito en la modificaci&#243;n de la EVA&#44; la pregabalina es una alternativa coste-efectiva en el 80&#37; de los casos&#46; La curva se muestra en la <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a>&#46; Para la medida de efectividad del porcentaje de reducci&#243;n del FIQ&#44; a una disposici&#243;n a pagar de &#36; 75&#46;000 &#40;&#8776; US&#36; 5&#46;770&#41; por un paciente adicional con mejora global&#44; pregabalina es coste efectiva en el 70&#37; de los casos &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discusi&#243;n</span><p id="par0130" class="elsevierStylePara elsevierViewall">Los s&#237;ndromes dolorosos cr&#243;nicos&#44; especialmente los de origen m&#250;sculo-esquel&#233;tico&#44; han sido objeto de atenci&#243;n en los servicios de salud&#44; ya que se han incrementado como motivo de consulta&#44; afectan a la poblaci&#243;n econ&#243;micamente activa y representan un alto impacto en t&#233;rminos de costos directos&#44; indirectos e incluso los no tangibles&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Nuestros resultados muestran que los mejores efectos cl&#237;nicos del tratamiento del SFM se esperan con el uso de duloxetina&#44; gabapentina y pregabalina&#46; De entre las 3 alternativas&#44; pregabalina alcanza la mayor proporci&#243;n de pacientes con &#233;xito cl&#237;nico para el control del dolor &#40;44&#37;&#41; y el mayor impacto en la mejora global de la funcionalidad medida por el FIQ &#40;31&#37;&#41;&#46; Tambi&#233;n entre las tres&#44; pregabalina genera los menores costos asociados&#46; De esta forma&#44; en la comparaci&#243;n entre estas 3 alternativas de tratamiento para el SFM&#44; pregabalina domina de manera absoluta&#44; al ofrecer mejores resultados cl&#237;nicos con un menor coste&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Al comparar pregabalina con el tratamiento habitual&#44; que para el caso corresponde a amitriptilina&#44; pregabalina tiene mejores resultados cl&#237;nicos pero con un coste m&#225;s alto&#46; El coste adicional que se tendr&#225; que asumir&#44; por un paciente adicional con un mejor control del dolor y mejora en la funcionalidad&#44; se encuentra entre &#36; 50&#46;000 y &#36; 75&#46;000 pesos anuales&#46; En un nivel hipot&#233;tico de disposici&#243;n a pagar de &#36; 50&#46;000 por un paciente adicional con adecuado control del dolor y &#36; 75&#46;000 por mejora global&#44; pregabalina es una alternativa coste-efectiva en el 60 y el 80&#37; de los casos&#44; respectivamente&#44; para el tratamiento del SFM en el sistema de salud p&#250;blico en M&#233;xico&#46; Es correcto mencionar que M&#233;xico a&#250;n no cuenta con umbrales de costo-efectividad aceptados para las medidas de efectividad utilizadas en esta investigaci&#243;n&#44; ni tampoco han sido observados para otros autores dentro de la literatura&#46; Sin embargo&#44; es v&#225;lido mencionar que niveles de &#36; 50&#46;000 o &#36; 75&#46;000 se encuentran por debajo del producto interno bruto per c&#225;pita en el pa&#237;s &#40;&#8776; &#36; 130&#46;000&#47;US&#36; 13&#46;900&#41;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a>&#44; por lo que aun bajo estos par&#225;metros&#44; los resultados de la investigaci&#243;n indicar&#237;an que las alternativas ser&#237;an altamente coste-efectivas&#44; como sugiere la Organizaci&#243;n Mundial de la Salud<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a>&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Los datos obtenidos en el presente estudio son semejantes a los publicados por Choy et al&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a> en un modelo realizado para el sistema de salud del Reino Unido&#44; donde los comparadores que utilizaron fueron amitriptilina&#44; duloxetina&#44; tramadol y gabapentina&#46; En este &#250;ltimo modelo se estim&#243; que con una disposici&#243;n a pagar &#163; 30&#46;000 por a&#241;o de vida ajustado por calidad de vida &#40;QALY&#44; por sus siglas en ingl&#233;s&#41;&#44; la pregabalina ser&#237;a una alternativa coste-efectiva en el 60&#37; de los casos&#46; Por otro lado&#44; un reciente estudio realizado en los Estados Unidos de Am&#233;rica<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a>&#44; donde se analiz&#243; el uso de duloxetina frente al tratamiento habitual mostr&#243; razones de coste-efectividad incremental por QALY ganado cercanas a US&#36; 47&#46;500 en el tratamiento de primera l&#237;nea y de US&#36; 16&#46;565 en el tratamiento de segunda l&#237;nea&#44; en un horizonte de tiempo de 2 a&#241;os&#46; En este sentido&#44; en concordancia con nuestro an&#225;lisis&#44; duloxentina podr&#237;a ser una opci&#243;n de segunda l&#237;nea&#44; ya que de nuestro estudio la RCEI de esta alternativa result&#243; ser alta en comparaci&#243;n a pregabalina&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">La literatura m&#233;dica no es amplia en relaci&#243;n con los an&#225;lisis econ&#243;micos para SFM&#59; existen otros modelos hechos para alternativas no farmacol&#243;gicas&#44; que muestran ser coste-efectivos en comparaci&#243;n con el placebo y que requieren infraestructura adicional<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">36&#44;37</span></a>&#46; En los datos mostrados tanto en el Reino Unido como en M&#233;xico&#44; existe consistencia con este comportamiento farmacoecon&#243;mico&#44; por lo que puede ser tomado en cuenta como una alternativa viable para el tratamiento del SFM&#46; Es importante considerar que aun cuando la perspectiva con la que se trabaj&#243; el estudio considera solo los costes directos&#44; la responsabilidad social que tienen las instituciones de salud de reincorporar a su &#225;mbito laboral y recuperar la calidad de vida de los pacientes puede justificar los costes adicionales necesarios para utilizar las nuevas alternativas de tratamiento&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Las limitaciones del presente estudio se encuentran en relaci&#243;n con la construcci&#243;n de un modelo&#44; que intenta representar la realidad del curso cl&#237;nico del SFM y las potenciales modificaciones asociadas a los distintos tratamientos en comparaci&#243;n&#46; El modelo se aliment&#243; de informaci&#243;n de fuentes externas&#44; por lo que no existe una distribuci&#243;n conjunta de los costes y los resultados cl&#237;nicos&#44; y asimismo&#44; no hay una comparaci&#243;n <span class="elsevierStyleItalic">&#171;face to face&#187;</span> entre las distintas alternativas de tratamiento&#46; Sin embargo&#44; se realizaron las pruebas necesarias para asegurar que la informaci&#243;n vertida en el modelo tuviera la validez interna suficiente para ser tomada en cuenta&#59; de esta forma&#44; los sesgos que se encuentran en los resultados de esta investigaci&#243;n son los asociados a los de las propias publicaciones&#44; sin que exista un sesgo diferencial por alguna de las alternativas de tratamiento que se compararon&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">La informaci&#243;n obtenida de la presente evaluaci&#243;n econ&#243;mica entre las alternativas farmacol&#243;gicas para el tratamiento del SFM podr&#225; ser &#250;til para apoyar a los tomadores de decisiones en sistemas de salud&#44; semejantes a las instituciones que ofrecen servicios de salud p&#250;blicos en M&#233;xico&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Responsabilidades &#233;ticas</span><p id="par0175" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Protecci&#243;n de personas y animales</span>&#46; Los autores declaran que para esta investigaci&#243;n no se han realizado experimentos en seres humanos ni en animales&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Confidencialidad de los datos</span>&#46; Los autores declaran que han seguido los protocolos de su centro de trabajo sobre la publicaci&#243;n de datos de pacientes y que todos los pacientes incluidos en el estudio han recibido informaci&#243;n suficiente y han dado su consentimiento informado por escrito para participar en dicho estudio&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Derecho a la privacidad y consentimiento informado</span>&#46; El presente trabajo fue realizado por fuentes secundarias&#44; de bases de datos ya construidas para otros fines diferentes a la investigaci&#243;n y de informaci&#243;n ya publicada&#44; por lo que se requiri&#243; consentimiento informado&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicto de intereses</span><p id="par0170" class="elsevierStylePara elsevierViewall">El presente trabajo se realiz&#243; con apoyo financiero de Pfizer S&#46;A de C&#46;V&#46; sin que esto genere alg&#250;n tipo de compromiso legal y&#47;o sobre los resultados&#46; Al momento de la actualizaci&#243;n del escrito&#44; el Dr&#46; Joaqu&#237;n F Mould Quevedo era empleado de Pfizer S&#46;A de C&#46;V&#46;</p></span></span>"
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          "titulo" => array:5 [
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        3 => array:2 [
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        4 => array:2 [
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        5 => array:3 [
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            0 => array:2 [
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              "titulo" => "Alternativas de tratamiento en comparaci&#243;n"
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            1 => array:2 [
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              "titulo" => "Modelo econ&#243;mico"
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            2 => array:2 [
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              "titulo" => "Efectividades"
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              "titulo" => "Perspectiva&#44; horizonte temporal y tasa de descuento"
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              "titulo" => "An&#225;lisis econ&#243;mico y an&#225;lisis de sensibilidad"
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          "titulo" => "Resultados"
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          "titulo" => "Responsabilidades &#233;ticas"
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          "titulo" => "Conflicto de intereses"
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        10 => array:1 [
          "titulo" => "Bibliograf&#237;a"
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    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2011-09-22"
    "fechaAceptado" => "2011-12-16"
    "PalabrasClave" => array:2 [
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec114064"
          "palabras" => array:5 [
            0 => "Coste-efectividad"
            1 => "Evaluaci&#243;n econ&#243;mica"
            2 => "M&#233;xico"
            3 => "Pregabalina"
            4 => "S&#237;ndrome de fibromialgia"
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        0 => array:4 [
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          "identificador" => "xpalclavsec114065"
          "palabras" => array:5 [
            0 => "Cost-effectiveness"
            1 => "Economic evaluation"
            2 => "Fibromyalgia syndrome"
            3 => "Mexico"
            4 => "Pregabalin"
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    "resumen" => array:2 [
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        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Identificar desde la perspectiva del proveedor de servicios de salud p&#250;blica en M&#233;xico el tratamiento m&#225;s coste-efectivo para pacientes con s&#237;ndrome de fibromialgia &#40;SFM&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Mediante un modelo de Markov con 3 estados de salud&#44; definidos por la intensidad del dolor &#40;ausencia o presencia de dolor leve&#59; moderado o severo&#41;&#44; en ciclos de 3 meses&#44; se estimaron los costes y las efectividades de amitriptilina &#40;50<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#41;&#44; fluoxetina &#40;80<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#41;&#44; duloxetina &#40;120<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#41;&#44; gabapentina &#40;900<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#41;&#44; pregabalina &#40;450<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#41;&#44; tramadol&#47;acetaminof&#233;n &#40;150<span class="elsevierStyleHsp" style=""></span>mg&#47;1300<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#41; y amitriptilina&#47;fluoxetina &#40;50<span class="elsevierStyleHsp" style=""></span>mg&#47;80<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#41; en el tratamiento del SFM&#46; El resultado cl&#237;nico de inter&#233;s fue el porcentaje de control del dolor al a&#241;o de tratamiento&#46; Las probabilidades asignadas al modelo se obtuvieron de la literatura publicada&#46; Los costes m&#233;dicos directos del tratamiento SFM se calcularon a trav&#233;s bases de datos del Instituto Mexicano del Seguro Social &#40;IMSS&#41; en 2006 y se expresaron en pesos mexicanos de 2010&#46; El an&#225;lisis de sensibilidad fue probabil&#237;stico&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">El mejor control del dolor se obtiene con el uso de pregabalina &#40;44&#44;8&#37;&#41;&#44; seguido de gabapentina &#40;38&#44;1&#37;&#41; y duloxetina &#40;34&#44;2&#37;&#41;&#46; El tratamiento con menor coste&#44; fue con amitriptilina &#40;&#36; 9&#46;047&#44;01&#41;&#44; seguido de fluoxetina &#40;&#36; 10&#46;183&#44;89&#41; y amitriptilina&#47;fluoxetina &#40;&#36; 10&#46;866&#44;01&#41;&#46; Al comparar pregabalina vs amitriptilina&#44; el coste anual adicional por paciente con control del dolor se encuentra entre &#36; 50&#46;000 y &#36; 75&#46;000 y resulta ser coste-efectivo entre el 70 y el 80&#37; de los casos&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Entre las alternativas de tratamiento para el SFM&#44; pregabalina alcanza el mejor control del dolor y es coste-efectiva hasta en el 80&#37; de los pacientes del sistema de salud p&#250;blico en M&#233;xico&#46;</p>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To identify&#44; from the Mexican Public Health System perspective&#44; which would be the most cost-effective treatment for patients with Fibromyalgia &#40;FM&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A Markov model including three health states&#44; divided by pain intensity &#40;absence or presence of mild&#44; moderate or severe pain&#41; and considering three-month cycles&#59; costs and effectiveness were estimated for amitriptyline &#40;50<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41;&#44; fluoxetine &#40;80<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41;&#44; duloxetine &#40;120<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41;&#44; gabapentin &#40;900<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41;&#44; pregabalin &#40;450<span class="elsevierStyleHsp" style=""></span>mg&#47;day&#41;&#44; tramadol&#47;acetaminophen &#40;150<span class="elsevierStyleHsp" style=""></span>mg&#47;1300<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#41; and amitriptyline&#47;fluoxetine &#40;50<span class="elsevierStyleHsp" style=""></span>mg&#47;80<span class="elsevierStyleHsp" style=""></span>mg&#47;d&#237;a&#41; for the treatment of FM&#46; The clinical outcome considered was the annual rate of pain control&#46; Probabilities assigned to the model were collected from published literature&#46; Direct medical costs for FM treatment were retrieved from the 2006 data of the Mexican Institute of Social Security &#40;IMSS&#41; databases and were expressed in 2010 Mexican Pesos&#46; Probabilistic Sensitivity Analyses were conducted&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The best pain control rate was obtained with pregabalin &#40;44&#46;8&#37;&#41;&#44; followed by gabapentin &#40;38&#46;1&#37;&#41; and duloxetine &#40;34&#46;2&#37;&#41;&#46; The lowest treatment costs was for amitriptyline &#40;&#36; 9047&#46;01&#41;&#44; followed by fluoxetine &#40;&#36; 10&#44;183&#46;89&#41; and amitriptyline&#47;fluoxetine &#40;&#36; 10&#44;866&#46;01&#41;&#46; By comparing pregabalin vs amitriptyline&#44; additional annual cost per patient for pain control would be around &#36; 50&#46;000 and &#36; 75&#46;000 and would result cost-effective in 70&#37; and 80&#37; of all cases&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Among all treatment options for FM&#44; pregabalin achieved the highest pain control and was cost-effective in 80&#37; of patients of the Mexican Public Health System&#46;</p>"
      ]
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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Modelo de Markov de los estadios de salud del s&#237;ndrome de fibromialgia&#46; Fuente&#58; elaboraci&#243;n propia de los autores&#44; a partir de Tarride et al&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&#46;</p>"
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          "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Curvas de aceptaci&#243;n del coste-efectividad de pregabalina frente a amitriptilina en el tratamiento del s&#237;ndrome de fibromialgia&#46; EVA&#58; escala visual an&#225;loga&#59; FIQ&#58; cuestionario de impacto de fibromialgia&#46;</p>"
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                  \t\t\t\t  " rowspan="6" align="left" valign="middle">Portal de transparencia IMSS<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tramadol&#47;acetaminof&#233;n &#40;tableta con tramadol 37&#44;5 mg&#47;acetaminof&#233;n 325<span class="elsevierStyleHsp" style=""></span>mg&#46; Envase con 20 tabletas&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#36; 105&#44;95&nbsp;\t\t\t\t\t\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&#46;190&nbsp;\t\t\t\t\t\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">&#36; 1&#46;933&#44;60&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Duloxetina &#40;c&#225;psulas de 60<span class="elsevierStyleHsp" style=""></span>mg&#46; Envase con 14&#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">&#36; 325&#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">730&nbsp;\t\t\t\t\t\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">&#36; 8&#46;490&#44;33&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Gabapentina &#40;c&#225;psulas de 300<span class="elsevierStyleHsp" style=""></span>mg&#46; Envase con 15&#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">&#36; 105&#44;14&nbsp;\t\t\t\t\t\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&#46;460&nbsp;\t\t\t\t\t\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">&#36; 2&#46;558&#44;35&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Amitriptilina &#40;tabletas de 25<span class="elsevierStyleHsp" style=""></span>mg&#46; Envase con 20&#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">&#36; 40&#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">688&nbsp;\t\t\t\t\t\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">&#36; 730&#44;96&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fluoxetina &#40;c&#225;psulas de 20<span class="elsevierStyleHsp" style=""></span>mg&#46; Envase con 14&#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">&#36; 6&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;376&nbsp;\t\t\t\t\t\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">&#36; 118&#46;08&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="left" 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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tratamiento de efectos adversos de los f&#225;rmacos</span><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">d</span></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">&#36; 401&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;16&nbsp;\t\t\t\t\t\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">&#36; 58&#44;40&nbsp;\t\t\t\t\t\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
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              "nota" => "<p class="elsevierStyleNotepara">Coste del d&#237;a cama hospitalaria incluye&#58; hoteler&#237;a&#44; atenci&#243;n m&#233;dica y de enfermer&#237;a&#44; medicamentos&#44; materiales de curaci&#243;n y alimentos&#46;</p>"
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              "nota" => "<p class="elsevierStyleNotepara">La frecuencia de los efectos adversos de los tratamientos se estim&#243; del reporte en la literatura&#44; de los ensayos cl&#237;nicos incluidos en el estudio&#46; Los costes se estimaron considerando el manejo convencional de cada evento&#44; tomando en cuenta los auxiliares diagn&#243;sticos y tratamiento farmacol&#243;gico correspondiente&#46;</p>"
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          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">IC del 95&#37;&#58; intervalo de confianza del 95&#59; &#916; Costos&#58; costos incrementales&#44; EVA&#58; escala visual an&#225;loga&#59; RCE&#58; raz&#243;n coste-efectividad&#59; RCEI&#58; raz&#243;n coste-efectividad incremental&#46;</p>"
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                  \t\t\t\t\tvoid\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">&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Amitriptilina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Gabapentina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Fluoxetina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Fluoxetina &#43; amitriptilina&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">&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&#40;IC del 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&#40;IC del 95&#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-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&#40;IC del 95&#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-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&#40;IC del 95&#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-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&#40;IC del 95&#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-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&#40;IC del 95&#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-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&#40;IC del 95&#37;&#41;&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="2" align="left" valign="middle">Costes<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a></td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#36; 9&#46;047&#44;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#36; 21&#46;129&#44;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#36; 21&#46;942&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#36; 28&#46;768&#44;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#36; 24&#46;495&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#36; 10&#46;183&#44;89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#36; 10&#46;866&#44;08&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;&#36; 8&#46;626&#44;08&#44; &#36; 9&#46;467&#44;95&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;&#36; 20&#46;694&#46;38&#44; &#36; 21&#46;563&#44;97&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;&#36; 21&#46;536&#44;09&#44; &#36; 22&#46;349&#44;03&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;&#36; 28&#46;374&#44;04&#44; &#36; 29&#46;165&#44;08&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;&#36; 24&#46;108&#44;66&#44; &#36; 24&#46;882&#44;76&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;&#36; 9&#46;779&#44;63&#44; &#36; 10&#46;588&#44;15&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;&#36; 10&#46;349&#44;35&#44; &#36; 11&#46;192&#44;48&#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  " rowspan="2" align="left" valign="middle">&#916; Costes</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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#36; 12&#46;082&#44;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#36; 12&#46;895&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#36; 19&#46;721&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#36; 15&#46;448&#44;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#36; 1&#46;136&#44;88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#36; 1&#46;819&#44;07&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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;&#36; 11&#46;298&#44;43&#44; &#36; 12&#46;865&#44;90&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;&#36; 11&#46;956&#44;65&#44; &#36; 13&#46;834&#44;43&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;&#36; 16&#46;045&#44;51&#44; &#36; 23&#46;397&#44;45&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;&#36; 13&#46;513&#44;98&#44; &#36; 17&#46;383&#44;42&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;&#36; 924&#44;72&#44; &#36; 1&#46;349&#44;04&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;&#36; 1&#46;592&#44;83&#44; &#36; 2&#46;045&#44;31&#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  " rowspan="2" align="left" valign="middle">Reducci&#243;n de EVA &#62; 50&#37;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#44;2&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44&#44;8&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#44;9&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&#44;2&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38&#44;1&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#44;2&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#44;6&#37;&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;21&#37;&#44; 24&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;42&#37;&#44; 48&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;17&#37;&#44; 19&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;28&#37;&#44; 41&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;33&#37;&#44; 43&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;5&#37;&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;12&#37;&#44; 15&#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  " rowspan="2" align="left" valign="middle">&#916; reducci&#243;n del EVA &#62; 50&#37;</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
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#44;6&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;4&#44;3&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#44;0&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#44;9&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;16&#44;0&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;8&#44;6&#37;&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
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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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;21&#37;&#44; 24&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;&#8211;5&#37;&#44; &#8211;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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;10&#37;&#44; 14&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;14&#37;&#44; 18&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;&#8211;19&#37;&#44; &#8211;13&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;&#8211;10&#37;&#44; &#8211;8&#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  " rowspan="2" align="left" valign="middle">RCE &#40;EVA&#41;</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#36; 40&#46;752&#44;32&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#36; 47&#46;132&#44;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#36; 122&#46;816&#44;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#36; 84&#46;067&#44;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#36; 64&#46;234&#44;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#36; 164&#46;465&#44;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#36; 80&#46;173&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;&#36; 39&#46;972&#44;57&#44; &#36; 41&#46;632&#44;65&#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="left" valign="\n
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                  \t\t\t\t">&#40;&#36; 45&#46;172&#44;60&#44; &#36; 59&#46;096&#44;66&#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="left" valign="\n
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                  \t\t\t\t">&#40;&#36; 116&#46;601&#44;64&#44; &#36; 130&#46;006&#44;51&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;&#36; 71&#46;831&#44;33&#44; &#36; 101&#46;910&#44;53&#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="left" valign="\n
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                  \t\t\t\t">&#40;&#36; 57&#46;987&#44;06&#44; &#36; 72&#46;269&#44;91&#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">&#40;&#36; 144&#46;102&#44;75&#44; &#36; 194&#46;172&#44;97&#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="left" valign="\n
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                  \t\t\t\t">&#40;&#36; 73&#46;446&#44;56&#44; &#36; 87&#46;206&#44;38&#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  " rowspan="2" align="left" valign="middle">RCEI &#40;EVA&#41;</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
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#36; 53&#46;399&#44;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#36; &#8211;297&#46;363&#44;88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#36; 164&#46;101&#44;69&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">&#36; 96&#46;965&#44;08&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">&#36; &#8211;7&#46;100&#44;76&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#36; 21&#46;030&#44;93&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">&#40;&#36; 46&#46;893&#44;49&#44; &#36; 60&#46;807&#44;53&#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">&#40;&#36; &#8211;344&#46;064&#44;68&#44; &#36; &#8211;257&#46;001&#44;90&#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">&#40;&#36; 112&#46;537&#44;70&#44; &#36; 239&#46;291&#44;93&#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">&#40;&#36; 75&#46;381&#44;30&#44; &#36; 124&#46;728&#44;90&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tratamiento farmacol&#243;gico&nbsp;\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">&#36; &#8211;13&#46;933&#44;98&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#36; &#8211;48&#46;390&#44;96&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#36; &#8211;88&#46;918&#44;39&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#36; 226&#46;969&#44;64&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tratamiento hospitalario&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#36; 541&#44;39&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#36; 1&#46;880&#44;20&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#36; 3&#46;454&#44;87&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">&#36; 8&#46;818&#44;83&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Consulta m&#233;dica&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">&#36; &#8211;214&#44;29&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">&#36; &#8211;744&#44;17&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">&#36; &#8211;1&#46;367&#44;42&nbsp;\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">&#36; &#8211;3&#46;490&#44;42&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudios de laboratorio y gabinete&nbsp;\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">&#36; 1&#46;530&#44;02&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">&#36; 5&#46;313&#44;58&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">&#36; 9&#46;763&#44;71&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">&#36; 24&#46;922&#44;49&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Efectos adversos&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#36; &#8211;5&#44;32&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">&#36; &#8211;18&#44;49&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">&#36; &#8211;33&#44;98&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">&#36; 86&#44;74&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"><span class="elsevierStyleHsp" style=""></span>Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#36; &#8211;12&#46;082&#44;17&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#36; &#8211;41&#46;959&#44;84&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">&#36; &#8211;77&#46;101&#44;20&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">&#36; &#8211;196&#46;805&#44;70&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"><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
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                  \t\t\t\t"><span class="elsevierStyleItalic">Beneficio</span>&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">&nbsp;\t\t\t\t\t\t\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">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Reducci&#243;n en FIQ&#42;&#42;&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">16&#44;4&#37;&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">18&#44;9&#37;&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">20&#44;9&#37;&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">26&#44;7&#37;&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
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                  \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  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Ahorro neto</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="left" valign="\n
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                  \t\t\t\t">&#36; &#8211;13&#46;953&#44;80&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">&#36; &#8211;48&#46;459&#44;80&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#36; 89&#46;044&#44;88&nbsp;\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">&#36; 227&#46;292&#44;67&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"><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  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Coste&#42;</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  " colspan="4" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Gabapentina</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tratamiento farmacol&#243;gico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#36; &#8211;16&#46;860&#44;32&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#36; &#8211;58&#46;553&#44;78&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#36; 107&#46;592&#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
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                  \t\t\t\t">&#36; &#8211;274&#46;636&#44;81&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tratamiento hospitalario&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#36; 494&#44;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#36; 1&#46;716&#44;85&nbsp;\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">&#36; 3&#46;154&#44;73&nbsp;\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">&#36; 8&#46;052&#44;62&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Consulta m&#233;dica&nbsp;\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">&#36; &#8211;150&#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
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                  \t\t\t\t">&#36; &#8211;521&#44;41&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#36; &#8211;958&#44;10&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">&#36; &#8211;2&#46;445&#44;61&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudios de laboratorio y gabinete&nbsp;\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">&#36; 1&#46;072&#44;04&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#36; 3&#46;723&#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
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                  \t\t\t\t">&#36; 6&#46;841&#44;07&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#36; 17&#46;462&#44;26&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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Efectos adversos&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="left" valign="\n
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                  \t\t\t\t">&#36; &#8211;4&#44;64&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#36; &#8211;16&#44;09&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#36; &#8211;29&#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
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                  \t\t\t\t">&#36; &#8211;75&#44;48&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#36; &#8211;15&#46;448&#44;70&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">&#36; 53&#46;651&#44;40&nbsp;\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">&#36; &#8211;98&#46;584&#44;44&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="left" valign="\n
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                  \t\t\t\t">&#36; 251&#46;643&#44;02&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  " colspan="5" align="left" valign="\n
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                  \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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Beneficio</span>&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">&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\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Reducci&#243;n en FIQ&#42;&#42;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13&#44;9&#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="left" valign="\n
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                  \t\t\t\t">16&#44;1&#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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#44;8&#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="left" valign="\n
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                  \t\t\t\t">22&#44;7&#37;&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
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                  \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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Ahorro neto</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="left" valign="\n
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                  \t\t\t\t">&#36; &#8211;51&#46;024&#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="left" valign="\n
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                  \t\t\t\t">&#36; &#8211;177&#46;202&#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="left" valign="\n
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                  \t\t\t\t">&#36; &#8211;325&#46;609&#44;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="left" valign="\n
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                  \t\t\t\t">&#36; 831&#46;138&#44;47&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
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                  \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  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Costo&#42;</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  " colspan="4" align="center" valign="\n
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                  \t\t\t\t">Duloxetina</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tratamiento farmacol&#243;gico&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#36; &#8211;20&#46;906&#44;80&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#36; &#8211;72&#46;606&#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="left" valign="\n
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                  \t\t\t\t">&#36; &#8211;133&#46;414&#44;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#36; 340&#46;549&#44;77&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tratamiento hospitalario&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#36; 371&#44;64&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">&#36; 1&#46;290&#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
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                  \t\t\t\t">&#36; 2&#46;371&#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
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                  \t\t\t\t">&#36; 6&#46;053&#44;60&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Consulta m&#233;dica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#36; &#8211;133&#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="left" valign="\n
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                  \t\t\t\t">&#36; &#8211;464&#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
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                  \t\t\t\t">&#36; &#8211;853&#44;58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#36; &#8211;2&#46;178&#44;81&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estudios de laboratorio y gabinete&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#36; 955&#44;09&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#36; 3&#46;316&#44;88&nbsp;\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">&#36; 6&#46;094&#44;78&nbsp;\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">&#36; 15&#46;557&#44;30&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Efectos adversos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#36; 7&#44;63&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="left" valign="\n
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                  \t\t\t\t">&#36; &#8211;26&#44;51&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#36; 48&#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="left" valign="\n
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                  \t\t\t\t">-&#36;124&#46;34&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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#36; 19&#46;721&#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="left" valign="\n
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                  \t\t\t\t">&#36; 68&#46;490&#44;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#36; 125&#46;850&#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="left" valign="\n
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                  \t\t\t\t">&#36; 321&#46;242&#44;03&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
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                  \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  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Beneficio</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
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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
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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
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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
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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="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Reducci&#243;n en FIQ&#42;&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#44;3&#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
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                  \t\t\t\t">16&#44;1&#37;&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="left" valign="\n
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ISSN: 1699258X
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2023 Marzo 160 41 201
2023 Febrero 127 53 180
2023 Enero 102 24 126
2022 Diciembre 149 40 189
2022 Noviembre 202 48 250
2022 Octubre 133 49 182
2022 Septiembre 113 62 175
2022 Agosto 122 58 180
2022 Julio 130 69 199
2022 Junio 90 58 148
2022 Mayo 174 89 263
2022 Abril 119 53 172
2022 Marzo 127 84 211
2022 Febrero 124 63 187
2022 Enero 154 99 253
2021 Diciembre 185 79 264
2021 Noviembre 204 86 290
2021 Octubre 175 109 284
2021 Septiembre 157 84 241
2021 Agosto 93 59 152
2021 Julio 146 67 213
2021 Junio 135 71 206
2021 Mayo 150 71 221
2021 Abril 428 136 564
2021 Marzo 183 74 257
2021 Febrero 128 46 174
2021 Enero 93 63 156
2020 Diciembre 81 35 116
2020 Noviembre 142 72 214
2020 Octubre 114 56 170
2020 Septiembre 92 35 127
2020 Agosto 106 37 143
2020 Julio 74 31 105
2020 Junio 87 26 113
2020 Mayo 118 59 177
2020 Abril 101 34 135
2020 Marzo 115 26 141
2020 Febrero 107 34 141
2020 Enero 70 32 102
2019 Diciembre 80 29 109
2019 Noviembre 79 50 129
2019 Octubre 84 35 119
2019 Septiembre 58 47 105
2019 Agosto 71 42 113
2019 Julio 73 35 108
2019 Junio 86 44 130
2019 Mayo 113 84 197
2019 Abril 93 65 158
2019 Marzo 81 33 114
2019 Febrero 77 23 100
2019 Enero 62 25 87
2018 Diciembre 170 57 227
2018 Noviembre 172 11 183
2018 Octubre 92 13 105
2018 Septiembre 67 8 75
2018 Agosto 43 11 54
2018 Julio 39 5 44
2018 Mayo 9 5 14
2018 Abril 58 6 64
2018 Marzo 72 14 86
2018 Febrero 59 14 73
2018 Enero 50 12 62
2017 Diciembre 73 11 84
2017 Noviembre 80 9 89
2017 Octubre 75 11 86
2017 Septiembre 65 11 76
2017 Agosto 63 9 72
2017 Julio 80 8 88
2017 Junio 77 8 85
2017 Mayo 96 19 115
2017 Abril 96 11 107
2017 Marzo 71 26 97
2017 Febrero 64 9 73
2017 Enero 68 17 85
2016 Diciembre 112 26 138
2016 Noviembre 168 31 199
2016 Octubre 179 28 207
2016 Septiembre 247 29 276
2016 Agosto 154 23 177
2016 Julio 90 17 107
2016 Junio 0 23 23
2016 Mayo 0 16 16
2016 Abril 2 28 30
2016 Marzo 0 23 23
2016 Febrero 1 16 17
2016 Enero 3 28 31
2015 Diciembre 3 0 3
2015 Noviembre 1 17 18
2015 Septiembre 3 28 31
2015 Agosto 4 0 4
2015 Julio 91 11 102
2015 Junio 96 22 118
2015 Mayo 146 19 165
2015 Abril 111 18 129
2015 Marzo 127 14 141
2015 Febrero 128 9 137
2015 Enero 96 20 116
2014 Diciembre 76 20 96
2014 Noviembre 108 23 131
2014 Octubre 99 25 124
2014 Septiembre 91 22 113
2014 Agosto 89 15 104
2014 Julio 102 16 118
2014 Junio 121 20 141
2014 Mayo 123 20 143
2014 Abril 91 18 109
2014 Marzo 96 26 122
2014 Febrero 73 21 94
2014 Enero 50 17 67
2013 Diciembre 68 15 83
2013 Noviembre 73 15 88
2013 Octubre 67 25 92
2013 Septiembre 58 16 74
2013 Agosto 69 27 96
2013 Julio 87 17 104
2013 Junio 79 25 104
2013 Mayo 62 29 91
2013 Abril 79 28 107
2013 Marzo 54 38 92
2013 Febrero 35 16 51
2013 Enero 45 33 78
2012 Diciembre 46 27 73
2012 Noviembre 45 35 80
2012 Octubre 31 40 71
2012 Septiembre 25 46 71
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