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        "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&#46; Although autografting accelerates tissue repair&#44; it is difficult to use in patients with concomitant diseases or when multiple grafts are required&#46; The amniotic membrane has been used as a covering material and promotes epithelialization&#44; making it a good potential treatment option when autografts are not indicated&#46;</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 &#40;autografts&#44; amniotic membrane grafts&#44; and biocompatible skin substitutes&#41; to promote tissue repair in venous ulcers&#46;</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&#46; A cost-minimization analysis of direct healthcare costs was then performed &#40;at 3 and 6 months&#41;&#46; A sensitivity analysis was performed to confirm the stability of the results&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Only 1 study addressing safety and efficacy was identified&#46; The cost-minimization analysis showed that autografts are always the least-expensive option &#40;&#8364; 1053 compared with &#8364; 1825 for amniotic membrane grafts and &#8364; 5767 for biocompatible skin grafts&#41;&#46; At 6 months&#44; however&#44; amniotic membrane grafts would have cost &#8364; 6765 less than the use of biocompatible skin substitutes&#46;</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&#44; amniotic membrane transplant remains an experimental therapy&#46; Autograft is the most efficient treatment but amniotic membrane graft is less expensive than the use of biocompatible skin substitutes&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El tratamiento est&#225;ndar compresivo de las &#250;lceras venosas de extremidades inferiores no promueve la cicatrizacion&#46; El autoinjerto es uno de los tratamientos que acelera la reparaci&#243;n tisular&#44; sin embargo&#44; su aplicaci&#243;n es dif&#237;cil en pacientes pluripatol&#243;gicos o cuando se requieren aplicaciones m&#250;ltiples&#46; La membrana amni&#243;tica se ha empleado como material de cobertura y como epitelizante&#44; por lo que podr&#237;a ser una buena opci&#243;n terap&#233;utica para cuando el autoinjerto no est&#233; indicado&#46;</p> <span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Analizar el estado de conocimiento cient&#237;fico sobre la seguridad y la eficacia de la membrana amni&#243;tica y comparar los costes de los injertos disponibles actualmente &#40;autoinjertos&#44; membrana amni&#243;tica y sustitutos cut&#225;neos biocompatibles&#41; para promover la reparaci&#243;n tisular de las &#250;lceras venosas&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; una b&#250;squeda y revisi&#243;n sistem&#225;tica de la literatura cient&#237;fica hasta marzo del 2010 sobre el uso de la membrana amni&#243;tica como tratamiento de las &#250;lceras venosas&#46; Asimismo&#44; se realiz&#243; un an&#225;lisis coste-minimizaci&#243;n &#40;horizonte temporal 3 y 6 meses&#41;&#46; Se consideraron los costes directos sanitarios&#46; Para comprobar la estabilidad de los resultados se llev&#243; a cabo un an&#225;lisis de sensibilidad&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se identific&#243; un &#250;nico estudio sobre seguridad y eficacia&#46; El an&#225;lisis de costes mostr&#243; que el autoinjerto es siempre la opci&#243;n m&#225;s barata &#40;1&#46;053 &#8364; versus 1&#46;825 &#8364; membrana amni&#243;tica&#44; 5&#46;767 &#8364; sustitutos cut&#225;neos biocompatibles&#41;&#46; A los 6 meses la membrana amni&#243;tica costar&#237;a 6&#46;765 &#8364; menos que el uso de los sustitutos cut&#225;neos biocompatibles&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">El transplante de membrana amni&#243;tica para la reepitelizaci&#243;n de &#250;lceras venosas refractarias al tratamiento convencional es una opci&#243;n terap&#233;utica de gran potencial&#44; pero a&#250;n en estado experimental&#46; El autoinjerto es el tratamiento m&#225;s eficiente&#59; pero la membrana amni&#243;tica es m&#225;s econ&#243;mica que los sustitutos cut&#225;neos biocompatibles&#46;</p>"
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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,
Autor para correspondencia
malsina@clinic.ub.es

Corresponding author.
, L. Sampietro-Colomc, S. Pedregosa-Fausted, P. Ayala-Blancod
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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        "resumen" => "<span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El tratamiento est&#225;ndar compresivo de las &#250;lceras venosas de extremidades inferiores no promueve la cicatrizacion&#46; El autoinjerto es uno de los tratamientos que acelera la reparaci&#243;n tisular&#44; sin embargo&#44; su aplicaci&#243;n es dif&#237;cil en pacientes pluripatol&#243;gicos o cuando se requieren aplicaciones m&#250;ltiples&#46; La membrana amni&#243;tica se ha empleado como material de cobertura y como epitelizante&#44; por lo que podr&#237;a ser una buena opci&#243;n terap&#233;utica para cuando el autoinjerto no est&#233; indicado&#46;</p> <span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Analizar el estado de conocimiento cient&#237;fico sobre la seguridad y la eficacia de la membrana amni&#243;tica y comparar los costes de los injertos disponibles actualmente &#40;autoinjertos&#44; membrana amni&#243;tica y sustitutos cut&#225;neos biocompatibles&#41; para promover la reparaci&#243;n tisular de las &#250;lceras venosas&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; una b&#250;squeda y revisi&#243;n sistem&#225;tica de la literatura cient&#237;fica hasta marzo del 2010 sobre el uso de la membrana amni&#243;tica como tratamiento de las &#250;lceras venosas&#46; Asimismo&#44; se realiz&#243; un an&#225;lisis coste-minimizaci&#243;n &#40;horizonte temporal 3 y 6 meses&#41;&#46; Se consideraron los costes directos sanitarios&#46; Para comprobar la estabilidad de los resultados se llev&#243; a cabo un an&#225;lisis de sensibilidad&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se identific&#243; un &#250;nico estudio sobre seguridad y eficacia&#46; El an&#225;lisis de costes mostr&#243; que el autoinjerto es siempre la opci&#243;n m&#225;s barata &#40;1&#46;053 &#8364; versus 1&#46;825 &#8364; membrana amni&#243;tica&#44; 5&#46;767 &#8364; sustitutos cut&#225;neos biocompatibles&#41;&#46; A los 6 meses la membrana amni&#243;tica costar&#237;a 6&#46;765 &#8364; menos que el uso de los sustitutos cut&#225;neos biocompatibles&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">El transplante de membrana amni&#243;tica para la reepitelizaci&#243;n de &#250;lceras venosas refractarias al tratamiento convencional es una opci&#243;n terap&#233;utica de gran potencial&#44; pero a&#250;n en estado experimental&#46; El autoinjerto es el tratamiento m&#225;s eficiente&#59; pero la membrana amni&#243;tica es m&#225;s econ&#243;mica que los sustitutos cut&#225;neos biocompatibles&#46;</p>"
      ]
    ]
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