Original article
Cost-Benefit Analysis of Amniotic Membrane Transplantation for Venous Ulcers of the Legs That Are Refractory to Conventional Treatment
Estudio coste-beneficio del trasplante de membrana amniótica para úlceras venosas de extremidades inferiores refractarias a tratamiento convencional
S. Gutiérrez-Morenoa, M. Alsina-Gibertb,
, L. Sampietro-Colomc, S. Pedregosa-Fausted, P. Ayala-Blancod
Corresponding author
a Departamento Innovación y Evaluación, Fundació Clínic per la Recerca Biomèdica, Barcelona, Spain
b Servicio de Dermatología, Hospital Clínic, TSF, Universitat de Barcelona, Barcelona, Spain
c Dirección Innovación, Hospital Clínic, Barcelona, Spain
d Servicio de Dermatología, Hospital Clínic, Barcelona, Spain
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"apellidos" => "Gutiérrez-Moreno" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "M." "apellidos" => "Alsina-Gibert" "email" => array:1 [ 0 => "malsina@clinic.ub.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "L." "apellidos" => "Sampietro-Colom" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "S." "apellidos" => "Pedregosa-Fauste" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "P." "apellidos" => "Ayala-Blanco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Departamento Innovación y Evaluación, Fundació Clínic per la Recerca Biomèdica, Barcelona, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Clínic, TSF, Universitat de Barcelona, Barcelona, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Dirección Innovación, Hospital Clínic, Barcelona, Spain" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Clínic, Barcelona, Spain" "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "*" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estudio coste-beneficio del trasplante de membrana amniótica para úlceras venosas de extremidades inferiores refractarias a tratamiento convencional" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2010-10-01" "fechaAceptado" => "2011-01-25" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec84905" "palabras" => array:3 [ 0 => "Amniotic membrane" 1 => "Cost-benefit analysis" 2 => "Venous ulcern" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec84904" "palabras" => array:3 [ 0 => "Membrana amniótica" 1 => "Coste-beneficio" 2 => "Úlcera venosa" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Standard compression therapy for venous ulcers of the legs does not promote healing. Although autografting accelerates tissue repair, it is difficult to use in patients with concomitant diseases or when multiple grafts are required. The amniotic membrane has been used as a covering material and promotes epithelialization, making it a good potential treatment option when autografts are not indicated.</p> <span class="elsevierStyleSectionTitle">Objectives</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To analyze the literature on the safety and efficacy of amniotic membrane grafting and compare the cost of currently available grafts (autografts, amniotic membrane grafts, and biocompatible skin substitutes) to promote tissue repair in venous ulcers.</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A systematic review of the literature on the use of amniotic membrane grafts for the treatment of venous ulcers was performed up to 2010. A cost-minimization analysis of direct healthcare costs was then performed (at 3 and 6 months). A sensitivity analysis was performed to confirm the stability of the results.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Only 1 study addressing safety and efficacy was identified. The cost-minimization analysis showed that autografts are always the least-expensive option (€ 1053 compared with € 1825 for amniotic membrane grafts and € 5767 for biocompatible skin grafts). At 6 months, however, amniotic membrane grafts would have cost € 6765 less than the use of biocompatible skin substitutes.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Despite having excellent therapeutic potential for the re-epithelialization of venous ulcers that do not respond to conventional treatment, amniotic membrane transplant remains an experimental therapy. Autograft is the most efficient treatment but amniotic membrane graft is less expensive than the use of biocompatible skin substitutes.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Introducción</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El tratamiento estándar compresivo de las úlceras venosas de extremidades inferiores no promueve la cicatrizacion. El autoinjerto es uno de los tratamientos que acelera la reparación tisular, sin embargo, su aplicación es difícil en pacientes pluripatológicos o cuando se requieren aplicaciones múltiples. La membrana amniótica se ha empleado como material de cobertura y como epitelizante, por lo que podría ser una buena opción terapéutica para cuando el autoinjerto no esté indicado.</p> <span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Analizar el estado de conocimiento científico sobre la seguridad y la eficacia de la membrana amniótica y comparar los costes de los injertos disponibles actualmente (autoinjertos, membrana amniótica y sustitutos cutáneos biocompatibles) para promover la reparación tisular de las úlceras venosas.</p> <span class="elsevierStyleSectionTitle">Material y métodos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se realizó una búsqueda y revisión sistemática de la literatura científica hasta marzo del 2010 sobre el uso de la membrana amniótica como tratamiento de las úlceras venosas. Asimismo, se realizó un análisis coste-minimización (horizonte temporal 3 y 6 meses). Se consideraron los costes directos sanitarios. Para comprobar la estabilidad de los resultados se llevó a cabo un análisis de sensibilidad.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se identificó un único estudio sobre seguridad y eficacia. El análisis de costes mostró que el autoinjerto es siempre la opción más barata (1.053 € versus 1.825 € membrana amniótica, 5.767 € sustitutos cutáneos biocompatibles). A los 6 meses la membrana amniótica costaría 6.765 € menos que el uso de los sustitutos cutáneos biocompatibles.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">El transplante de membrana amniótica para la reepitelización de úlceras venosas refractarias al tratamiento convencional es una opción terapéutica de gran potencial, pero aún en estado experimental. El autoinjerto es el tratamiento más eficiente; pero la membrana amniótica es más económica que los sustitutos cutáneos biocompatibles.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:12 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Skin grafting for venous leg ulcers" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.E. Jones" 1 => "E.A. Nelson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Cochrane Database of Systematic Reviews" "fecha" => "2007" "volumen" => "2" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Análisis coste-efectividad del tratamiento de pacientes con úlceras venosas, debidas a insuficiencia venosa crónica, con fracción flavonoica purificada micronizada y terapia compresiva o con terapia compresiva solamente" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C. Rubio-Terrés" 1 => "A. Domínguez-Gil" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Esp de Econ Salud" "fecha" => "2004" "volumen" => "3" "paginaInicial" => "283" "paginaFinal" => "289" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis and treatment of venous ulcers" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L. Collins" 1 => "S. Seraj" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am Fam Physician" "fecha" => "2010" "volumen" => "81" "paginaInicial" => "989" "paginaFinal" => "996" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20387775" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Skin substitutes and wound healing: current status and challenges" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D. Eisenbud" 1 => "N.F. Huang" 2 => "S. Luke" 3 => "M. Silberklang" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Wounds" "fecha" => "2004" "volumen" => "16" "paginaInicial" => "2" "paginaFinal" => "17" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Amniotic membrane use in dermatology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "V. Lo" 1 => "E. Pope" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-4632.2009.04173.x" "Revista" => array:6 [ "tituloSerie" => "Int J Dermatol" "fecha" => "2009" "volumen" => "48" "paginaInicial" => "935" "paginaFinal" => "940" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19702975" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Desarrollo de líneas celulares primarias germinativas pluriponientes del limbo esclero-corneal y de la conjuntiva sobre sustrato de membrana amniótica íntegra para aplicaciones terapéuticas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R.P. Cassaroli" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:2 [ "fecha" => "2009" "editorial" => "Proyecto TSF-Banco de Tejidos" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7." "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Gris Castellón O. Transplante de membrana amniótica en patología de la superficie ocular Tesis Doctoral (ISBN: 84-688-7778-9). Barcelona: 2004 Universidad Autónoma de Barcelona; Available at: <a class="elsevierStyleInterRef" href="http://www.%20tdx.%20cat/TDX-1124104-170340/%23documents">www.tdx.cat/TDX-1124104-170340/#documents</a>" ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Use of amniotic membrane transplantation in the treatment of venous ulcers" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "I. Mermet" 1 => "N. Pottier" 2 => "J.M. Sainthillier" 3 => "C. Malugani" 4 => "S. Cairey-Remonnay" 5 => "S. Maddens" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1524-475X.2007.00252.x" "Revista" => array:6 [ "tituloSerie" => "Wound Repair Regen" "fecha" => "2007" "volumen" => "15" "paginaInicial" => "459" "paginaFinal" => "464" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17650088" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib9" "etiqueta" => "9." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Grading quality of evidence and strength of recommendations" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "GRADE, Working Group" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bmj.328.7430.1" "Revista" => array:6 [ "tituloSerie" => "BMJ" "fecha" => "2004" "volumen" => "328" "paginaInicial" => "1" "paginaFinal" => "8" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14703521" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib10" "etiqueta" => "10." "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Haycox A, Walker A. What is cost-minimization analysis? Published by Hayward Medical Communications 2009. Available at: <a class="elsevierStyleInterRef" href="http://www.medicine.ox.ac.uk/bandolier/painres/download/whatis/What_is_cost-min.pdf">www.medicine.ox.ac.uk/bandolier/painres/download/whatis/What_is_cost-min.pdf</a>." ] ] ] 10 => array:3 [ "identificador" => "bib11" "etiqueta" => "11." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rapid healing of venous ulcers and lack of clinical rejection with an allogeneic cultured human skin equivalent Human Skin Equivalent Investigators Group" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V. Falanga" 1 => "D. Margolis" 2 => "O. Álvarez" 3 => "M. Auletta" 4 => "F. Maggiacomo" 5 => "M. Altman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "1998" "volumen" => "134" "paginaInicial" => "293" "paginaFinal" => "300" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9521027" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib12" "etiqueta" => "12." "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Evaluation of the Cryopreserved Amniotic Membranes in the Care of Resistant Vascular Ulcers (MAUV). Phase II study. University Hospital, Limoges. Available at: <a class="elsevierStyleInterRef" href="http://www.clinicaltrials.%20gov.%20identifier%3a%20nct00820274/">www.ClinicalTrials. gov. Identifier: NCT00820274</a>." ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010200000004/v1_201304241543/S1578219011708046/v1_201304241543/en/main.assets" "Apartado" => array:4 [ "identificador" => "6256" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original article" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010200000004/v1_201304241543/S1578219011708046/v1_201304241543/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219011708046?idApp=UINPBA000044" ]
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| 2024 January | 37 | 48 | 85 |
| 2023 December | 49 | 33 | 82 |
| 2023 November | 43 | 65 | 108 |
| 2023 October | 55 | 60 | 115 |
| 2023 September | 58 | 83 | 141 |
| 2023 August | 39 | 30 | 69 |
| 2023 July | 21 | 43 | 64 |
| 2023 June | 32 | 39 | 71 |
| 2023 May | 29 | 31 | 60 |
| 2023 April | 21 | 33 | 54 |
| 2023 March | 20 | 26 | 46 |
| 2023 February | 28 | 26 | 54 |
| 2023 January | 30 | 30 | 60 |
| 2022 December | 32 | 39 | 71 |
| 2022 November | 18 | 27 | 45 |
| 2022 October | 18 | 26 | 44 |
| 2022 September | 16 | 51 | 67 |
| 2022 August | 17 | 46 | 63 |
| 2022 July | 18 | 44 | 62 |
| 2022 June | 21 | 36 | 57 |
| 2022 May | 27 | 63 | 90 |
| 2022 April | 29 | 50 | 79 |
| 2022 March | 35 | 62 | 97 |
| 2022 February | 26 | 48 | 74 |
| 2022 January | 28 | 98 | 126 |
| 2021 December | 17 | 70 | 87 |
| 2021 November | 25 | 65 | 90 |
| 2021 October | 28 | 70 | 98 |
| 2021 September | 31 | 63 | 94 |
| 2021 August | 21 | 96 | 117 |
| 2021 July | 17 | 56 | 73 |
| 2021 June | 23 | 57 | 80 |
| 2021 May | 15 | 49 | 64 |
| 2021 April | 56 | 110 | 166 |
| 2021 March | 39 | 63 | 102 |
| 2021 February | 27 | 52 | 79 |
| 2021 January | 29 | 27 | 56 |
| 2020 December | 24 | 30 | 54 |
| 2020 November | 20 | 24 | 44 |
| 2020 October | 35 | 22 | 57 |
| 2020 September | 35 | 15 | 50 |
| 2020 August | 21 | 26 | 47 |
| 2020 July | 27 | 20 | 47 |
| 2020 June | 25 | 35 | 60 |
| 2020 May | 27 | 47 | 74 |
| 2020 April | 22 | 48 | 70 |
| 2020 March | 18 | 29 | 47 |
| 2020 February | 2 | 13 | 15 |
| 2020 January | 0 | 4 | 4 |
| 2019 December | 0 | 19 | 19 |
| 2019 November | 0 | 8 | 8 |
| 2019 October | 0 | 9 | 9 |
| 2019 September | 0 | 7 | 7 |
| 2019 August | 0 | 7 | 7 |
| 2019 July | 0 | 13 | 13 |
| 2019 June | 0 | 8 | 8 |
| 2019 May | 1 | 35 | 36 |
| 2019 April | 0 | 1 | 1 |
| 2019 March | 0 | 8 | 8 |
| 2018 April | 0 | 1 | 1 |
| 2018 February | 28 | 3 | 31 |
| 2018 January | 22 | 6 | 28 |
| 2017 December | 44 | 11 | 55 |
| 2017 November | 12 | 4 | 16 |
| 2017 October | 16 | 2 | 18 |
| 2017 September | 19 | 7 | 26 |
| 2017 August | 25 | 11 | 36 |
| 2017 July | 23 | 2 | 25 |
| 2017 June | 26 | 21 | 47 |
| 2017 May | 32 | 2 | 34 |
| 2017 April | 27 | 5 | 32 |
| 2017 March | 24 | 68 | 92 |
| 2017 February | 22 | 7 | 29 |
| 2017 January | 24 | 12 | 36 |
| 2016 December | 44 | 4 | 48 |
| 2016 November | 35 | 5 | 40 |
| 2016 October | 31 | 15 | 46 |
| 2016 September | 42 | 4 | 46 |
| 2016 August | 41 | 8 | 49 |
| 2016 July | 41 | 5 | 46 |
| 2016 June | 7 | 0 | 7 |
| 2016 May | 6 | 2 | 8 |
| 2016 April | 4 | 2 | 6 |
| 2016 March | 7 | 0 | 7 |
| 2016 February | 4 | 1 | 5 |
| 2016 January | 11 | 0 | 11 |
| 2015 December | 5 | 2 | 7 |
| 2015 November | 16 | 0 | 16 |
| 2015 October | 4 | 3 | 7 |
| 2015 September | 1 | 2 | 3 |
| 2015 August | 15 | 4 | 19 |
| 2015 July | 44 | 5 | 49 |
| 2015 June | 55 | 7 | 62 |
| 2015 May | 76 | 12 | 88 |
| 2015 April | 37 | 6 | 43 |
| 2015 March | 41 | 11 | 52 |
| 2015 February | 34 | 5 | 39 |
| 2015 January | 41 | 10 | 51 |
| 2014 December | 37 | 11 | 48 |
| 2014 November | 45 | 12 | 57 |
| 2014 October | 37 | 17 | 54 |
| 2014 September | 53 | 14 | 67 |
| 2014 August | 49 | 14 | 63 |
| 2014 July | 71 | 23 | 94 |
| 2014 June | 61 | 16 | 77 |
| 2014 May | 63 | 16 | 79 |
| 2014 April | 51 | 10 | 61 |
| 2014 March | 57 | 24 | 81 |
| 2014 February | 41 | 10 | 51 |
| 2014 January | 52 | 15 | 67 |
| 2013 December | 53 | 24 | 77 |
| 2013 November | 36 | 15 | 51 |
| 2013 October | 34 | 18 | 52 |
| 2013 September | 41 | 17 | 58 |
| 2013 August | 41 | 23 | 64 |
| 2013 July | 35 | 33 | 68 |
| 2013 June | 34 | 43 | 77 |
| 2013 May | 30 | 26 | 56 |
| 2013 April | 9 | 17 | 26 |
| 2013 March | 10 | 16 | 26 |
| 2013 February | 6 | 9 | 15 |
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