Cost-Effectiveness of Non-Vitamin K Antagonist Oral Anticoagulants for Atrial Fibrillation in Portugal

INTRODUCTION AND OBJECTIVES:Recently, three novel non-vitamin K antagonist oral anticoagulants received approval for reimbursement in Portugal for patients with non-valvular atrial fibrillation (AF). It is therefore important to evaluate the relative cost-effectiveness of these new oral anticoagulants in Portuguese AF patients. METHODS: A Markov model was used to analyze disease progression over a lifetime horizon. Relative efficacy data for stroke (ischemic and hemorrhagic), bleeding (intracranial, other major bleeding and clinically relevant non-major bleeding), myocardial infarction and treatment discontinuation were obtained by pairwise indirect comparisons between apixaban, dabigatran and rivaroxaban using warfarin as a common comparator. Data on resource use were obtained from the database of diagnosis-related groups and an expert panel. Model outputs included life years gained, quality-adjusted life years (QALYs), direct healthcare costs and incremental cost-effectiveness ratios (ICERs). RESULTS:Apixaban provided the most life years gained and QALYs. The ICERs of apixaban compared to warfarin and dabigatran were €5529/QALY and €9163/QALY, respectively. Apixaban was dominant over rivaroxaban (greater health gains and lower costs). The results were robust over a wide range of inputs in sensitivity analyses. Apixaban had a 70% probability of being cost-effective (at a threshold of €20 000/QALY) compared to all the other therapeutic options. CONCLUSIONS:Apixaban is a cost-effective alternative to warfarin and dabigatran and is dominant over rivaroxaban in AF patients from the perspective of the Portuguese national healthcare system. These conclusions are based on indirect comparisons, but despite this limitation, the information is useful for healthcare decision-makers.

Influence of aluminum hydroxide on potassium release from two Colombian soils

The effect of sesquioxides on the mechanisms of chemical reactions that govern the transformation between exchangeable potassium (Kex) and non-exchangeable K (Knex) was studied on acid tropical soils from Colombia: Caribia with predominantly 2 : 1 clay minerals and High Terrace with predominantly 1 : 1 clay minerals and sesquioxides. Illite and vermiculite are the main clay minerals in Caribia followed by kaolinite, gibbsite, and plagioclase, and kaolinite is the major clay mineral in High Terrace followed by hydroxyl-Al interlayered vermiculite, quartz, and pyrophyllite. The soils have 1.8 and 0.5% of K2O, respectively. They were used either untreated or prepared by adding AlCl3 and NaOH, which produced aluminum hydroxide. The soils were percolated continuously with 10mM NH4OAc at pH 7.0 and 10 mM CaCl2 at pH 5.8 for 120 h at 6 mL h(-1) to examine the release of Kex and Knex. In the untreated soils, NH4+ and Ca-2(+) released the same amounts of Kex from Caribia, whereas NH4+ released about twice as much Kex as Ca2+ from High Terrace. This study proposes that the small ionic size of NH4+ (0.54nm) enables it to enter more easily into the K sites at the broken edges of the kaolinite where Ca2+ (0.96 nm) cannot have access. As expected for a soil dominated by 2 : 1 clay minerals, Ca2+ caused Knex to be released from Caribia with no release by NH4+. No Knex was released by either ion from High Terrace. After treatment with aluminum hydroxide, K release from the exchangeable fraction was reduced in Caribia due to the blocking of the exchange sites but release of Knex was not affected. The treatment increased the amount of Kex released from the High Terrace soil and the release of Knex remained negligible although with Ca2+ the distinction between Kex and Knex was unclear. The increase in Kex was attributed to the initially acidic conditions produced by adding AlCl3 which may have dissolved interlayered aluminum hydroxide from the vermiculite present, thus exposing trapped K as exchangeable K. The subsequent precipitation of aluminum hydroxide when NaOH was added did not interfere with the release of this K, and so was probably formed mostly on the surface of the dominant kaolinite. Measurement of availability of K by standard methods using NH4 salts could result in overestimates in High Terrace and this may be a more general shortcoming of the methods in kaolinitic soils.

Potássio nas frações texturais de um Latossolo

The aim of this work was to study the distribution of non-exchangeable forms of potassium in different size fractions of an Oxisol, cultivated with banana for two years in plots with and without irrigation (main plot) and varying potassium levels (0, 300, 600 and 900 kg ha(-1) of K(2)O) (sub-plots), in a randomized split-plot block design. It was verified that the highest K levels (exchangeable and non-exchangeable forms) derived from the finest particle size fractions: clay and silt. The K moving trough soil layers was associated with the presence and action of percolating water in the soil profile. The role of irrigation was significant in the distribution of the different K forms in the soil. Irrigated plots showed the best distribution of K from the surface down to 60 cm of depth. Statistical significant effects of the doses of K on the non-exchangeable K Forms could be explained by the translocation of K from Soil solution to Soil exchange complex, and from that to strongly retained forms. Amounts of K absorbed by the plants were greater than the variation of exchangeable K content, suggesting that non-exchangeable forms are being taken up.

Potassium cycling in a corn-brachiaria cropping system

Growing corn mixed with forage crops can be an alternative for pasture and Mulch production during relatively dry winters in tropical areas, making no-till feasible in some regions. However, little is known about nutrient dynamics in this cropping system. The objective of the present work was to evaluate K dynamics in a production system in which corn was either grown as a sole crop or mixed with Brachiaria brizantha. In the second year of the experiment, nitrogen rates ranging from 0 to 200 kg ha(-1) were applied to the system. Dry matter yields and potassium contents in the soil, as well as residues and plants were determined at corn planting and harvest. Potassium balance in the system was calculated. Corn grain yield in mixed crop responded up to 200 kg ha(-1) N. The introduction of brachiaria in the system resulted in higher amounts of straw on the soil Surface and higher K recycling. Soil exchangeable K balance showed an excess K for both N rates only in the mixed system, however, when non-exchangeable K was also included in calculations, excess K was found in both mixed and sole corn systems. Large amounts of non-exchangeable K were taken up in the system involving brachiaria, which showed a considerable capacity in recycling K, increasing its contents in the surface soil layer. (c) 2008 Elsevier B.V. All rights reserved.

Lixiviação de potássio em função da textura e da disponibilidade do nutriente no solo

O manejo correto da adubação potássica pode minimizar perdas assim como evitar o esgotamento de K do solo. Objetivou-se estudar a dinâmica do K no perfil do solo em função do teor de argila e do teor do nutriente resultantes da adubação da soja. Foram coletados solos de texturas média e argilosa, que vinham sendo adubados com 0, 60, 120, e 180 kg ha-1 de K2O na soja por 6 anos. O experimento foi conduzido em casa de vegetação, em tubos de PVC estratificados nas profundidades de 0-5, 5-10, 10-20, e 20-40 cm. Na superfície das colunas, aplicaram-se mais 80 kg ha-1 de K2O. Durante 16 semanas, foi aplicada, semanalmente, água em quantidade equivalente a 100 mm de chuva. em cada aplicação, o volume de solução percolada foi determinado, assim como as quantidades de K contidas nessa solução. Após a desmontagem das colunas de solo, foram determinados os teores de K trocável e não-trocável nas diferentes profundidades. A percolação de K foi maior no solo de textura argilosa, que tinha mais K disponível devido ao maior efeito residual da adubação potássica anterior. A intensidade de lixiviação foi proporcional ao teor de K disponível, mas inicialmente a lixiviação foi mais intensa no solo mais arenoso, decrescendo com o tempo. No argiloso, as perdas foram mais constantes. Houve proporcionalidade entre teor inicial e lixiviação no perfil do solo, nas duas formas de K e nos dois tipos de solo. Conclui-se que o efeito residual da adubação potássica aumentou as quantidades de K percolado. A movimentação de K no perfil do solo teve boa relação com o teor inicial de K no solo, resultante da adubação potássica anterior nos dois tipos de solo. A passagem de K considerado não-trocável para trocável foi rápida e influenciou na lixiviação.

Suprimento de potássio em função da adubação potássica residual em um Latossolo Vermelho do Cerrado

Em alguns solos com baixos teores de potássio trocável, formas não trocáveis participam do suprimento às plantas. Há evidências de que a disponibilização do K não trocável depende mais da demanda das plantas pelo nutriente do que das propriedades do solo. O objetivo deste trabalho foi avaliar o suprimento e a exaustão de formas de K em um Latossolo Vermelho do Cerrado em decorrência da adubação potássica residual e do cultivo de Brachiaria ruziziensis (Syn. Urochloa ruziziensis). Amostras de solos foram coletadas na camada de 0-20 cm, em parcelas de um experimento de campo em que a soja vinha sendo adubada anualmente, por 10 anos, com 0, 60, 120 e 180 kg ha-1 de K2O. em casa de vegetação, as amostras de solo receberam a aplicação de 0, 150 e 300 mg dm-3 de K e foram cultivadas com B. ruziziensis, com cinco cortes sucessivos. O suprimento de K às plantas dependeu mais do fertilizante recém-adicionado do que do efeito residual de adubações anteriores. O K não trocável foi responsável, ao longo do tempo, pela manutenção dos teores de K trocáveis e, na ausência de adubação potássica, constituiu a principal fonte de K para as plantas de B. ruziziensis. As plantas de B. ruziziensis possuem capacidade de extrair quantidade considerável de K do solo, confirmando sua importância como cultura de cobertura, na ciclagem do nutriente no solo.

Potássio no solo em conseqüência da adubação sobre a palha de milheto e chuva simulada

O objetivo deste trabalho foi avaliar a lixiviação de potássio (K), no solo, e sua presença nas formas trocável e não trocável, em conseqüência da aplicação de chuva simulada e adubação potássica sobre palha de milheto, na superfície do solo. Vasos com terra e palha de milheto na superfície (quantidade equivalente a 8 t ha-1) receberam ou não adubação potássica, na dose de 150 kg ha-1 de K2O, na forma de KCl, aplicados sobre a palha. Na seqüência, foram aplicadas lâminas de água de 0 a 50 mm. O solo foi analisado em diversas profundidades, quanto aos teores de K trocável e não trocável. A palha do milheto revelou-se fonte importante de K, que é lixiviado até 4 cm de profundidade por chuvas superiores a 30 mm. A lixiviação de K, em profundidade no solo, é proporcional à chuva aplicada; entretanto, uma chuva de 50 mm não carreia o nutriente para profundidades superiores a 8 cm. A passagem de K trocável para não trocável é rápida, conforme atestado pelo conteúdo de K não trocável na camada de solo abaixo de 4 cm.

Fontes de potássio não trocável e potássio total em quatro solos do Estado do Ceará

The mineralogical composition of the soil plow layer (0-20 cm) was analyzed for the following soil suborders (according to the Brazilian soil taxonomy): Neossolo Quartzarênico. Argissolo Vermelho-Amarelo, Cambissolo Háplico and Latossolo Vermelho-Amarelo which samples were collected from different regions of the Ceará State. The present study had the objectives of identifying potential sources of both total and non-exchangeable potassium forms for plants located at the different soil fractions. Then highest content of K occurred in the Cabissolo Háplico soil, including both the total and non-exchangeable K forms. In the Neossolo Quartzarênico. Argissolo Vermelho-Amarelo and Latossolo Vermelho-Amarelo, the highest contents of both forms of potassium were impregnated at the sand fraction. The amount of potassium found in the both sand and silt fractions has its origin in the orthoclase mineral which was detected in the mineralogical analysis. In the clay fractio, the origin of the potassium is illite and a inter-stratified mineral (mica+montmorillonite). As compared with the total content, the amount of non-exchangeable potassium is low for all the four soils. It was more concentrated at clay fraction of the Cambissolo soil. The potassium content sequence in the soil was the following: Cambissolo Háplico > Argissolo Vermelho-Amarelo > Neossolo Quartzarênico > Latossolo Vermelho-Amarelo. The results showed that the distribution of the forms of potassium among the soils differ as a function of the nature of the dominating minerals detected in the mineralogical analysis (illite and orthoclase) which was discussed above.

Doses de potássio no sistema integração lavoura-pecuária

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Balanço de potássio no sistema solo-planta influenciado pela textura e adubação potássica em solos tropicais

Pós-graduação em Agronomia (Agricultura) - FCA

Initial physic nut nutrition and potassium balance in the soil-plant system

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Nitrogen and potassium fertilization of 'Nanicao' banana (Musa AAA Cavendish subgroup) under irrigated and non-irrigated conditions

A field experiment was carried out in São Paulo State, Brazil, with the objective of investigating the response of 'Nanicao' banana (Musa AAA Cavendish subgroup) to nitrogen and potassium fertilization under irrigated and non-irrigated conditions during two crop seasons. The effects of cropping on some soil chemical properties were also investigated. A split-plot design was used with irrigation (micro-sprinkler) and no irrigation applied to main plots, and a combination of four rates of N (0, 200, 400 and 800 kg N ha-1) and K (0, 300, 600 and 900 kg K2O ha-1) as the sub-plot treatments. Irrigation caused a significant increase in fruit yield and determined the response to N and K fertilizers. In spite of a high level of exchangeable K, a positive response to K application was observed on the plant crop in non-irrigated plants. Fruit yield was impaired by N application in the plant crop (1st cycle). A positive response to N application was observed in the 2nd cycle. Soil pH decreased with increasing N rates. Exchangeable K was significantly reduced due to crop exhaustion.