Cost-Effectiveness Analysis Of Triple Therapy With Peginterferon, Ribavirin, And Boceprevir For The Treatment Of Chronic Hepatitis C Virus Genotype 1 With Severe Fibrosis Under “Real-Life” Conditions

Abstract

e154 Volume 37 Number 8S Background: Controlled hypotension during anaesthesia may improve the quality of the surgical field in Ear-Nose-and-Throat (ENT) interventions. A number of drugs are used to that purpose, including alpha-2 adrenergic agonists (A2AA). A systematic review of efficacy data on the use of A2AA as part of hypotensive anaesthesia in ENT has been conducted. Methods: A MEDLINE and Scopus search (1980-2015) was done to identify clinical trials comparing an A2AA as a part of hypotensive anaesthesia regimen in ENT. Additional references were identified through cross-link references. Abstracts were reviewed by two investigators for eligibility, and full papers were fully reviewed if reporting randomised trials comparing A2AA in adult patients undergoing ENT surgery. Data was extracted and synthesized for studied population, surgical procedure, type of anaesthesia, treatments compared, bleeding results and overall report quality. Due to heterogeneity in variables, synthesis of data was based on a qualitative description of trials characteristics, and also of results on the assessments of surgical field bleeding, because of the heterogeneity in the type of variables used for its assessment. Results: A total of 79 publications were identified, from which 22 randomised clinical trials were selected (15 double-blind, 4 singleblind and 3 open-label) including information on 1278 patients undergoing either nasal, sinusal or ear surgeries and comparing A2AA (clonidine (n = 11) or dexmedetomidine (n = 11)) with placebo (n = 9), remifentanil (n = 3), esmolol (n = 2), midazolam (n = 2), magnesium sulphate (n = 2), fentanyl (n = 1) or no treatment (n = 3). Sixteen trials including 1168 patients measured surgical field bleeding, of which 14 showed better results for A2AA. None of the studies compared directly clonidine and dexmedetomidine. Conclusions: Alpha-2 adrenergic agonists have repeatedly shown to improve surgical field bleeding during ENT surgery; there are no comparative data between different A2AA.