Case and Research Letters
Incremental Cost-Effectiveness Ratio Analysis of Biologic Treatments for Psoriasis at Clinically Significant Evaluation Time Points
Análisis de coste-eficacia incremental de los tratamientos biológicos para la psoriasis en los momentos de valoración significativos para la práctica clínica
L. Puig
, A. López-Ferrer, E. Vilarrasa
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Servicio de Dermatología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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(A) January 2011. (B) March 2012. The inflammatory margins progressed centrifugally upwards to the medial aspect of the thigh. (C) September 2012. The margins reached the left hip and gluteus.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.M. Mir-Bonafé, J.C. Santos-Durán, A. Santos-Briz, E. Fernández-López" "autores" => array:4 [ 0 => array:2 [ "nombre" => "J.M." "apellidos" => "Mir-Bonafé" ] 1 => array:2 [ "nombre" => "J.C." "apellidos" => "Santos-Durán" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Santos-Briz" ] 3 => array:2 [ "nombre" => "E." 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Puig, A. López-Ferrer, E. Vilarrasa" "autores" => array:3 [ 0 => array:4 [ "nombre" => "L." "apellidos" => "Puig" "email" => array:1 [ 0 => "lpuig@santpau.cat" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A." "apellidos" => "López-Ferrer" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Vilarrasa" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Análisis de coste-eficacia incremental de los tratamientos biológicos para la psoriasis en los momentos de valoración significativos para la práctica clínica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 686 "Ancho" => 2920 "Tamanyo" => 132130 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Incremental cost effectiveness ratio for PASI 50 response at week 24.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0010" class="elsevierStylePara elsevierViewall">The Spanish guidelines for the treatment of psoriasis recommend that drug choice should be guided by the criteria established in the Summary of Product Characteristics (SPC) for each agent and that decisions should be made on a case-by-case basis and take into account economic considerations.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Since the introduction of biologic agents, several authors have studied their cost-efficacy.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–4</span></a> However, none of these studies present an overall view of the results at clinically significant evaluation time points. The equation used for cost-effectiveness analysis, which can support therapeutic decisions, is the incremental cost effectiveness ratio (ICER): ICER = (C1–C2)/(E1–E2), where C1 and E1 are the cost and effect in the treatment group and C2 and E2 are the cost and effect in the control group.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The present analysis is intended to provide useful information to guide clinical practice based on the results of a recent meta-analysis,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> evaluating the most important variables at each time point. The outcomes and time points used were as follows: a 50% reduction in PASI score (PASI 50) at the time point the SPC recommends assessment of response in order to identify primary treatment failure, and PASI 50 and PASI 75 responses at week 24 (the end of the induction phase). The cost of each treatment was calculated on the basis of the pharmaceutical company's sale price as of January 2014 less the mandatory deduction under Spanish law (Real Decreto 08/2010) plus VAT.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> In the case of infliximab, the cost was calculated for a patient weighing 80 kg and included the additional expense of intravenous infusion at the updated price published by the SOIKOS-OBLIKUE program for 2014 (€254.68).<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> No other additional costs were included in the analysis. The ICER was calculated by dividing the cost of treatment up to the time point when response should be assessed by the mean incremental efficacy (drug minus placebo). ICER 95% CI were calculated using the lower and upper 95% CI limits of the incremental efficacy values published in the meta-analysis.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Analysis of incremental cost-effectiveness for PASI 50 at the time point recommended in the SPC for treatment response assessment to identify nonresponders (week 12 for etanercept, week 16 for adalimumab, week 22 for infliximab, and week 28 for ustekinumab) shows that the drug with the lowest ICER is adalimumab (€7076), followed by etanercept (€8818), ustekinumab 45 mg (€10 916), infliximab (€13 172), and ustekinumab 90 mg (€21 777) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>.)</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">While the analysis was carried out at the time point recommended in the SPC for the assessment of primary response, the treatment had not, in some cases, reached maximum efficacy. Owing to this difference in time to maximum response and the large differences in the number of weeks specified before treatment response assessment for each drug (16 weeks between ustekinumab and etanercept, assessed at week 28 and 12, respectively), imputing the cost-efficacy of treatments at these very different time points does not result in an equitable analysis. The same reasoning can be applied to the analysis of the ICER for the time point at which the PASI 75 response is assessed to provide registry data for each drug.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The assessment of PASI response at week 24 is a very useful variable in clinical practice because the decision concerning the success or failure of treatment can be made at that time. By week 24, the induction phase has been completed in all the biologic agents and efficacy tends to have reached a plateau.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Moreover, analysis at this time implies calculating the cost of treatment at the same point for all the drugs. The ICER results for a PASI 50 response at week 24 are as follows: ustekinumab 45 mg (€9703), followed by adalimumab (€10 384€), etanercept (€12 735€), infliximab (€13 536), and ustekinumab 90 mg (€19 674 ) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). As shown in <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>, the 95% CIs of the ICERs for etanercept and infliximab overlap considerably, both one with another and with adalimumab. It is therefore not possible to establish any significant differences.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The results for a PASI 75 response at week 24 show that the treatment with the lowest ICER is ustekinumab 45 mg (€10 371), followed by adalimumab (€10 549 ), infliximab (€14 514 €), etanercept (€16 080 ), and ustekinumab 90 mg (€20 880 ) (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). In this case, the 95% CIs for ustekinumab 45 mg and adalimumab almost overlap, and both are significantly favorable compared to infliximab, etanercept, and ustekinumab 90 mg.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">To stratify the data on treatment with ustekinumab, we used the weight distribution of patients with psoriasis in the Spanish BIOBADADERM registry.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>According to this data, 9.25% of these patients weigh over 100 kg. If we estimate that half of these patients are treated with ustekinumab 45 mg and half with ustekinumab 90 mg (in some regions this regimen is not reimbursed), the ICER values at week 24 for ustekinumab adjusted for weight distribution would be as follows: PASI 50, €10 189 and PASI 75 €10 994. When the ICER for PASI 50 at week 24 is evaluated, ustekinumab adjusted for weight distribution is still the most cost-effective treatment, while in the case of PASI 75 it is the second most cost-effective treatment, coming after adalimumab. In both cases, the 95% CI for ustekinumab adjusted for weight distribution overlaps that of adalimumab, meaning that the numerical differences would not be significant. In all cases, the calculations performed represent an extrapolation which, despite its limitations, approximates routine clinical practice.</p><p id="par0040" class="elsevierStylePara elsevierViewall">As psoriasis is a chronic disease, long-term results should be included in the analysis, including the additional cost of combining, escalating, or switching treatments in patients who do not achieve an optimal response or experience a loss of initial response over time, as well as the potential savings in patients in whom treatment intensity can be reduced or an intermittent regimen can be used.</p><p id="par0045" class="elsevierStylePara elsevierViewall">However, the cost of the induction phase before a population-based plateau of treatment response is achieved represents an important component of the total cost of treatment in the first year. The present analysis may be useful as regards treatment decisions, which must always be made on a case-by-case basis.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Puig L, López-Ferrer A, Vilarrasa E. Análisis de coste-eficacia incremental de los tratamientos biológicos para la psoriasis en los momentos de valoración significativos para la práctica clínica. Actas Dermosifiliogr. 2014;105:951–953.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 883 "Ancho" => 3003 "Tamanyo" => 135676 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Incremental cost effectiveness ratio for PASI 50 response at the time primary treatment success assessment is recommended in the Summary of Product Characteristics (week 12 for etanercept, week 16 for adalimumab, week 22 for infliximab, and week 28 for ustekinumab).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 686 "Ancho" => 2920 "Tamanyo" => 132130 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Incremental cost effectiveness ratio for PASI 50 response at week 24.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 769 "Ancho" => 3003 "Tamanyo" => 133109 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Incremental cost effectiveness ratio for PASI 75 response at week 24.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Directrices españolas basadas en la evidencia para el tratamiento de la psoriasis con agentes biológicos, 2013. I. Consideraciones de eficacia y selección del tratamiento" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Puig" 1 => "J.M. Carrascosa" 2 => "G. Carretero" 3 => "P. de la Cueva" 4 => "R.F. Lafuente-Urrez" 5 => "I. Belinchón" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.adengl.2013.04.013" "Revista" => array:6 [ "tituloSerie" => "Actas Dermosifiliogr" "fecha" => "2013" "volumen" => "104" "paginaInicial" => "694" "paginaFinal" => "709" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24018211" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cost-efficacy of adalimumab, etanercept, infliximab and ustekinumab for moderate-to-severe plaque psoriasis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C. Ferrandiz" 1 => "A. García" 2 => "A.J. Blasco" 3 => "P. Lázaro" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1468-3083.2011.04357.x" "Revista" => array:7 [ "tituloSerie" => "J Eur Acad Dermatol Venereol" "fecha" => "2012" "volumen" => "26" "numero" => "Suppl" "paginaInicial" => "768" "paginaFinal" => "777" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22126264" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cost per responder analysis of ustekinumab and etanercept for moderate to severe plaque psoriasis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S. Martin" 1 => "S.R. Feldman" 2 => "M. Augustin" 3 => "P. Szapary" 4 => "B. Schenkel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3109/09546634.2010.542800" "Revista" => array:6 [ "tituloSerie" => "J Dermatolog Treat" "fecha" => "2011" "volumen" => "22" "paginaInicial" => "138" "paginaFinal" => "143" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21254886" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cost per responder associated with biologic therapies for Crohn's disease psoriasis, and rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y. Liu" 1 => "E.Q. Wu" 2 => "A.G. Bensimon" 3 => "C.P. Fan" 4 => "Y. Bao" 5 => "A. Ganguli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s12325-012-0035-7" "Revista" => array:6 [ "tituloSerie" => "Adv Ther" "fecha" => "2012" "volumen" => "29" "paginaInicial" => "620" "paginaFinal" => "634" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22843208" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy of biologics in the treatment of moderate to severe plaque psoriasis: A systematic review and meta-analysis of randomized controlled trials with different time points" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L. Puig" 1 => "A. Lopez" 2 => "E. Vilarrasa" 3 => "I. García" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "J Eur Acad Dermatol Venereol" "fecha" => "2013" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Nomenclator DIGITALIS-INTEGRA (December 2013). Ministerio de Sanidad, Asuntos Sociales e Igualdad. [cited 2013 Dec 21]. Disponible en: <a id="intr0010" class="elsevierStyleInterRef" href="http://www.msc.es/profesionales/farmacia/nomenclatorDI.htm">http://www.msc.es/profesionales/farmacia/nomenclatorDI.htm</a>" ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Conselleria de Sanitat. Catálogo de procedimientos de enfermería en hospitalización de día. Versión 2002. Catálogos SIE. Generalitat Valenciana: Conselleria de Sanitat Valencia; 2003." ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "BIOBADADERM. Registro español de tratamientos sistémicos en psoriasis. [cited 2013 Dec 21]. Available from: <a id="intr0015" class="elsevierStyleInterRef" href="https://biobadaser.ser.es/biobadaderm/">https://biobadaser.ser.es/biobadaderm/</a>" ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010500000010/v1_201411260035/S1578219014002844/v1_201411260035/en/main.assets" "Apartado" => array:4 [ "identificador" => "6157" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010500000010/v1_201411260035/S1578219014002844/v1_201411260035/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219014002844?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 5 | 11 | 16 |
| 2024 Octubre | 66 | 44 | 110 |
| 2024 Septiembre | 66 | 63 | 129 |
| 2024 Agosto | 100 | 71 | 171 |
| 2024 Julio | 58 | 38 | 96 |
| 2024 Junio | 67 | 33 | 100 |
| 2024 Mayo | 64 | 38 | 102 |
| 2024 Abril | 67 | 28 | 95 |
| 2024 Marzo | 64 | 37 | 101 |
| 2024 Febrero | 52 | 34 | 86 |
| 2024 Enero | 34 | 36 | 70 |
| 2023 Diciembre | 36 | 17 | 53 |
| 2023 Noviembre | 43 | 24 | 67 |
| 2023 Octubre | 42 | 11 | 53 |
| 2023 Septiembre | 33 | 21 | 54 |
| 2023 Agosto | 37 | 11 | 48 |
| 2023 Julio | 43 | 30 | 73 |
| 2023 Junio | 41 | 21 | 62 |
| 2023 Mayo | 79 | 19 | 98 |
| 2023 Abril | 66 | 19 | 85 |
| 2023 Marzo | 61 | 19 | 80 |
| 2023 Febrero | 47 | 20 | 67 |
| 2023 Enero | 50 | 16 | 66 |
| 2022 Diciembre | 62 | 52 | 114 |
| 2022 Noviembre | 27 | 18 | 45 |
| 2022 Octubre | 21 | 17 | 38 |
| 2022 Septiembre | 20 | 24 | 44 |
| 2022 Agosto | 30 | 41 | 71 |
| 2022 Julio | 31 | 35 | 66 |
| 2022 Junio | 23 | 18 | 41 |
| 2022 Mayo | 56 | 36 | 92 |
| 2022 Abril | 63 | 28 | 91 |
| 2022 Marzo | 45 | 42 | 87 |
| 2022 Febrero | 33 | 22 | 55 |
| 2022 Enero | 37 | 28 | 65 |
| 2021 Diciembre | 33 | 35 | 68 |
| 2021 Noviembre | 44 | 35 | 79 |
| 2021 Octubre | 55 | 43 | 98 |
| 2021 Septiembre | 38 | 38 | 76 |
| 2021 Agosto | 26 | 28 | 54 |
| 2021 Julio | 66 | 26 | 92 |
| 2021 Junio | 36 | 18 | 54 |
| 2021 Mayo | 49 | 27 | 76 |
| 2021 Abril | 99 | 58 | 157 |
| 2021 Marzo | 67 | 15 | 82 |
| 2021 Febrero | 51 | 24 | 75 |
| 2021 Enero | 26 | 16 | 42 |
| 2020 Diciembre | 28 | 14 | 42 |
| 2020 Noviembre | 19 | 13 | 32 |
| 2020 Octubre | 21 | 7 | 28 |
| 2020 Septiembre | 18 | 10 | 28 |
| 2020 Agosto | 23 | 13 | 36 |
| 2020 Julio | 29 | 13 | 42 |
| 2020 Junio | 16 | 14 | 30 |
| 2020 Mayo | 17 | 14 | 31 |
| 2020 Abril | 21 | 19 | 40 |
| 2020 Marzo | 19 | 12 | 31 |
| 2020 Febrero | 3 | 5 | 8 |
| 2020 Enero | 4 | 6 | 10 |
| 2019 Diciembre | 8 | 1 | 9 |
| 2019 Noviembre | 4 | 0 | 4 |
| 2019 Septiembre | 4 | 3 | 7 |
| 2019 Agosto | 4 | 7 | 11 |
| 2019 Julio | 4 | 5 | 9 |
| 2019 Junio | 6 | 10 | 16 |
| 2019 Mayo | 4 | 40 | 44 |
| 2019 Abril | 2 | 11 | 13 |
| 2019 Marzo | 4 | 8 | 12 |
| 2019 Febrero | 0 | 4 | 4 |
| 2019 Enero | 5 | 0 | 5 |
| 2018 Diciembre | 0 | 6 | 6 |
| 2018 Noviembre | 9 | 0 | 9 |
| 2018 Octubre | 59 | 0 | 59 |
| 2018 Septiembre | 6 | 0 | 6 |
| 2018 Mayo | 0 | 2 | 2 |
| 2018 Marzo | 1 | 1 | 2 |
| 2018 Febrero | 30 | 3 | 33 |
| 2018 Enero | 21 | 3 | 24 |
| 2017 Diciembre | 26 | 8 | 34 |
| 2017 Noviembre | 21 | 2 | 23 |
| 2017 Octubre | 18 | 5 | 23 |
| 2017 Septiembre | 15 | 5 | 20 |
| 2017 Agosto | 21 | 11 | 32 |
| 2017 Julio | 19 | 3 | 22 |
| 2017 Junio | 20 | 10 | 30 |
| 2017 Mayo | 21 | 6 | 27 |
| 2017 Abril | 20 | 12 | 32 |
| 2017 Marzo | 16 | 12 | 28 |
| 2017 Febrero | 17 | 5 | 22 |
| 2017 Enero | 15 | 8 | 23 |
| 2016 Diciembre | 20 | 10 | 30 |
| 2016 Noviembre | 33 | 8 | 41 |
| 2016 Octubre | 26 | 12 | 38 |
| 2016 Septiembre | 0 | 7 | 7 |
| 2016 Agosto | 0 | 1 | 1 |
| 2016 Julio | 8 | 1 | 9 |
| 2016 Junio | 18 | 2 | 20 |
| 2016 Mayo | 12 | 1 | 13 |
| 2016 Abril | 12 | 6 | 18 |
| 2016 Marzo | 6 | 4 | 10 |
| 2016 Febrero | 4 | 2 | 6 |
| 2016 Enero | 10 | 4 | 14 |
| 2015 Diciembre | 10 | 2 | 12 |
| 2015 Noviembre | 15 | 1 | 16 |
| 2015 Octubre | 11 | 8 | 19 |
| 2015 Septiembre | 7 | 4 | 11 |
| 2015 Agosto | 11 | 3 | 14 |
| 2015 Julio | 20 | 3 | 23 |
| 2015 Junio | 15 | 1 | 16 |
| 2015 Mayo | 12 | 5 | 17 |
| 2015 Abril | 6 | 1 | 7 |
| 2015 Marzo | 17 | 4 | 21 |
| 2015 Febrero | 18 | 6 | 24 |
| 2015 Enero | 3 | 5 | 8 |
| 2014 Diciembre | 4 | 0 | 4 |
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