Desafíos en el empleo de los medicamentos huérfanos

Las enfermedades raras son aquellas que tienen baja prevalencia y que, por lo tanto, el desarrollo de medicamentos para tratarlas no es rentable para las empresas farmacéuticas debido a la baja demanda. A pesar de que ya se cuenta con diferentes políticas públicas alrededor del mundo para incentivar a las industrias farmacéuticas a investigar estos medicamentos, conocidos como medicamentos huérfanos, su desarrollo conlleva muchas dificultades en las evaluaciones clínicas y el precio final para el público es muy elevado. Si bien en años recientes se ha planteado el uso de tecnología de impresión en 3D para producir estos medicamentos o incluso recurrir a otros medicamentos previamente aprobados para tratar enfermedades raras, existe un historial de mal uso de las legislaciones por parte de las empresas con el fin de generar beneficios comerciales, por lo que estas políticas deben reforzarse para que cumplan su propósito; ayudar a una población muy vulnerable. El objetivo del presente texto es exponer los resultados de una revisión documental sobre el panorama científico y sociopolítico en el que se encuentra el problema de las enfermedades raras y los medicamentos huérfanos, así como las posibles soluciones que se están desplegando para abordarlo. Deriva de un estudio que se desarrolla en el momento actual en la Universidad Autónoma Metropolitana, de Ciudad de México.

The strange illnesses are those that have low prevalence and that, therefore, the development of medications to treat them is not profitable for the pharmaceutical companies due to the drop demands. Although it is already counted with different political public around the world to motivate to the pharmaceutical industries to investigate these medications, well-known as orphan medications, their development bears many difficulties in the clinical evaluations and the final price for the public it is very high. Although in recent years he/she has thought about the use of impression technology in 3D to produce these medications or even to appeal to other medications previously approved to treat strange illnesses, a record of wrong use of the legislations exists on the part of the companies with the purpose of generating commercial benefits, for what these politicians should be reinforced so that they complete its purpose; to help a very vulnerable population. The objective of the present text is to expose the results of a documental revision on the scientific and sociopolitical panorama in which is the problem of the strange illnesses and the orphan medications, as well as the possible solutions that they are spreading to approach it. It derives of a study that is developed in the current moment in the Metropolitan Autonomous University, of Mexico City.

Multimedia como herramienta educativa e instructiva para mejorar la calidad de vida del adulto medio / Multimedia as an educational and instructive tool to improve the quality of life in middle-aged adults

RESUMEN Introducción: Villa Clara es la provincia más envejecida del país, pues el adulto medio ocupa un alto porciento dentro de su población. Durante esta etapa de la vida, si bien algunos cambios fisiológicos se deben a factores genéticos y biológicos personales, también es importante considerar la influencia del modo de vida, experimentado en la actual calidad de vida del adulto medio, que puede ser mejorada con la actividad física. Objetivos: Diseñar una multimedia como herramienta educativa e instructiva para mejorar la calidad de vida del adulto medio, en la Facultad de Tecnología de la Salud-Enfermería, de la Universidad de Ciencias Médicas de Villa Clara. Métodos: Se realizó un estudio de tipo innovación tecnológica en el período de septiembre de 2018 a septiembre de 2019. El universo de estudio estuvo constituido por 397 profesores, que constituyen el total de docentes a tiempo completo; la muestra fue de 40 profesores. Como criterio de exclusión se consideró a los que no estaban ubicados en el rango de edad correspondiente con el adulto medio. Las variables fueron: edad, peso, talla, sexo, ejercicios físicos, enfermedades crónicas no transmisibles y tipo de alimentación. Se utilizaron métodos teóricos, empíricos y de nivel matemático-estadístico. Resultados: El producto final proporcionó beneficios, pues con él se motivó al adulto medio hacia el desarrollo de habilidades y capacidades que le permitan tomar decisiones correctas para elevar la calidad de vida. Conclusiones: La multimedia educativa constituye una vía novedosa y motivadora para influir en la calidad de vida del adulto medio.

ABSTRACT Introduction: Villa Clara is the oldest province in the country, since middle-aged adults occupy a high percentage of its population. During this stage of life, although some physiological changes are due to individuals' genetic and biological factors, it is also important to consider the influence of lifestyle, experienced in the current quality of life in middle-aged adults, which can be improved with physical activity. Objective: to design a multimedia, at the Faculty of Health Technology and Nursing in the University of Medical Sciences of Villa Clara, as an educational and instructive tool to improve the quality of life in middle-aged adults. Methods: a technological innovation study was carried out from September 2018 to September 2019. The universe of study consisted of 397 teachers, who constituted the total number of full-time teachers; the sample was 40 teachers. Those who were not in the age range corresponding to middle-aged adults were considered as an exclusion criterion. Age, weight, height, gender, physical exercises, non-communicable chronic diseases and type of diet were among the variables studied. Theoretical, empirical and mathematical-statistical methods were used. Results: the final product provided benefits, since middle-aged adults were motivated towards the development of skills and abilities, allowing them to make correct decisions in order to improve their quality of life. Conclusions: educational multimedia is a novel and motivating way to influence the quality of life in middle-aged adults.

Carga de la enfermedad y costos en salud por la exposición a mercurio: revisión de alcance / Burden of disease and health costs from mercury exposure: Scoping review

Resumen Introducción: El mercurio circula por el aire; persiste en suelos, sedimentos y agua, y causa efectos en la salud humana. Las mujeres en edad fértil y los neonatos son la población más vulnerable. Objetivo: Analizar las evidencias sobre la carga de enfermedad ocasionada por la exposición a mercurio, así como el impacto económico sobre el sistema de salud. Metodología: Revisión de alcance de la literatura, de las bases de datos PUBMED y EPISTEMONIKOS, búsqueda manual de documentos técnicos de entidades oficiales de diferentes continentes. Resultados: Se identificaron 311 registros en bases de datos y 4 en búsqueda manual en entidades oficiales; 19 artículos fueron incluidos. Discusión: Predomina la afectación del desarrollo neurológico y cognitivo en niños de madres expuestas y lactantes. Los costos se midieron por la pérdida del coeficiente intelectual. Conclusión: Efectos en salud por la exposición a metilmercurio se traducen en gastos para la sociedad y los sistemas de salud.

Abstract Introduction: Mercury circulates through the air, persists in soils, sediments and water, and can affect human health. Women of childbearing age and newborns are the most vulnerable population. Objective: To analyze the evidence on the burden of disease caused by mercury exposure, as well as the economic impact on the health system. Methodology: Review of the literature, PUBMED and EPISTEMONIKOS databases, manual search of technical documents of official entities from different continents. Results: A total of 311 records were identified in databases and four in manual searches from official entities; 19 articles were included. Discussion: Neurological and cognitive development in children of exposed mothers and infants are more predominant. Costs were measured by IQ loss. Conclusion: Health effects of methylmercury exposure translate into costs for society and health systems.

The impact of the COVID-19 pandemic on people living with HIV in Zimbabwe

The COVID-19 pandemic was reported from March 2020 in Zimbabwe. COVID-19 containment measures which included repeated lockdowns have disrupted community interactions, reduced working hours, restricted travel and restricted HIV services for people living with HIV (PLHIV), among others. The study adopted a cross-sectional design. Both qualitative and quantitative data were collected in all the 10 provinces and analysed. A sample size of 480 was calculated for the cross-sectional survey. Secondary data on HIV early warning indicators from 2018 to 2021 were extracted from 20 randomly selected health facilities and used for modelling. Mathematical modelling was conducted to assess the impact of COVID-19 on PLHIV. AIDS-related deaths increased from 20 100 in 2019 to 22 200 in 2020. In addition, there were significant years of life lost (yLLs) from premature mortality and years of life lost due to disability (yLDs) from COVID-19. Prevalence of COVID-19 among PLHIV was 4%. COVID-19 vaccination coverage was 64%, which is higher than the national average of 42%. Stress and breach of confidentiality as ARV medicines were given out in open spaces and fear of contracting COVID-19 were the perceived psychological issues. COVID-19 disrupted HIV service provision, increased AIDS-related deaths and caused psychological challenges

Cost-Effectiveness Analysis of Cervical Anterior Fusion and Cervical Artificial Disc Replacement in the Korean Medical System

OBJECTIVE: This study is a retrospective cost-benefit analysis of cervical anterior interbody fusion and cervical artificial disc replacement, which are the main surgical methods to treat degenerative cervical disc disease.METHODS: We analyzed 156 patients who underwent anterior cervical disc fusion and cervical artificial disc replacement from January 1, 2008 to December 31, 2009, diagnosed with degenerative cervical disc disorder. In this study, the costs and benefits were analyzed by using quality adjusted life year (QALY) as the outcome index for patients undergoing surgery, and a Markov model was used for the analysis. Only direct medical costs were included in the analysis; indirect medical costs were excluded. Data were analyzed with TreeAge Pro 2015™ (TreeAge Software, Inc, Williamstown, MA, USA).RESULTS: Patients who underwent cervical anterior fusion had a total cost of KRW 2501807/USD 2357 over 5 years and obtained a utility of 3.72 QALY. Patients who underwent cervical artificial disc replacement received 4.18 QALY for a total of KRW 3685949/USD 3473 over 5 years. The cumulative cost-effectiveness ratio of cervical spine replacement surgery was KRW 2549511/QALY (USD 2402/QALY), which was lower than the general Korean payment standard.CONCLUSION: Both cervical anterior fusion and cervical artificial disc replacement are cost-effective treatments for patients with degenerative cervical disc disease. Cervical artificial disc replacement may be an effective alternative to obtain more benefits.

Cost-Effectiveness Analysis of Cervical Anterior Fusion and Cervical Artificial Disc Replacement in the Korean Medical System

OBJECTIVE: This study is a retrospective cost-benefit analysis of cervical anterior interbody fusion and cervical artificial disc replacement, which are the main surgical methods to treat degenerative cervical disc disease. METHODS: We analyzed 156 patients who underwent anterior cervical disc fusion and cervical artificial disc replacement from January 1, 2008 to December 31, 2009, diagnosed with degenerative cervical disc disorder. In this study, the costs and benefits were analyzed by using quality adjusted life year (QALY) as the outcome index for patients undergoing surgery, and a Markov model was used for the analysis. Only direct medical costs were included in the analysis; indirect medical costs were excluded. Data were analyzed with TreeAge Pro 2015™ (TreeAge Software, Inc, Williamstown, MA, USA). RESULTS: Patients who underwent cervical anterior fusion had a total cost of KRW 2501807/USD 2357 over 5 years and obtained a utility of 3.72 QALY. Patients who underwent cervical artificial disc replacement received 4.18 QALY for a total of KRW 3685949/USD 3473 over 5 years. The cumulative cost-effectiveness ratio of cervical spine replacement surgery was KRW 2549511/QALY (USD 2402/QALY), which was lower than the general Korean payment standard. CONCLUSION: Both cervical anterior fusion and cervical artificial disc replacement are cost-effective treatments for patients with degenerative cervical disc disease. Cervical artificial disc replacement may be an effective alternative to obtain more benefits.

Therapeutic lumbar facet joint nerve blocks in the treatment of chronic low back pain: cost utility analysis based on a randomized controlled trial

BACKGROUND: Related to escalating health care costs and the questionable effectiveness of multiple interventions including lumbar facet joint interventions, cost effectiveness or cost utility analysis has become the cornerstone of evidence-based medicine influencing coverage decisions. METHODS: Cost utility of therapeutic lumbar facet joint nerve blocks in managing chronic low back pain was performed utilizing data from a randomized, double-blind, controlled trial with a 2-year follow-up, with direct payment data from 2016. Based on the data from surgical interventions, utilizing the lowest proportion of direct procedural costs of 60%, total cost utility per quality adjusted life year (QALY) was determined by multiplying the derived direct cost at 1.67. RESULTS: Patients in this trial on average received 5.6 ± 2.6 procedures over a period of 2 years, with average relief over a period of 2 years of 82.8 ± 29.6 weeks with 19 ± 18.77 weeks of improvement per procedure. Procedural cost for one-year improvement in quality of life showed USD $2,654.08. Estimated total costs, including indirect costs and drugs with multiplication of direct costs at 1.67, showed a cost of USD $4,432 per QALY. CONCLUSIONS: The analysis of therapeutic lumbar facet joint nerve blocks in the treatment of chronic low back pain shows clinical effectiveness and cost utility at USD $2,654.08 for the direct costs of the procedures, and USD $4,432 for the estimated overall cost per one year of QALY, in chronic persistent low back pain non-responsive to conservative management.

Comparison of the Marginal Utility and Disease Burden of Hearing Loss and Other Chronic Diseases / 가정의학회지

BACKGROUND: Compared with other chronic diseases, hearing loss is generally overlooked from the perspective of disease burden. However, hearing loss is emerging as an important issue in the current society. The objective of this study was to investigate disease burdens and marginal utilities associated with hearing loss and other chronic diseases. METHODS: This study analyzed the cross-sectional data of 32,986 participants aged 19 years and older who completed the Korea National Health and Nutrition Examination Surveys between 2009 and 2013. Additionally, this study used the pure tone audiometric test, European Quality of Life-Five Dimensions Questionnaire, and chronic disease status. The data were analyzed using a multiple linear regression method. RESULTS: The data of 23,297 people who underwent a pure tone audiogram and completed the European Quality of Life-Five Dimensions Questionnaire were used in this analysis. The marginal utility of hearing loss ranked fifth among nine chronic diseases. The estimated loss of quality-adjusted life years associated with hearing loss was −93.69 years per 100,000 people, which is similar to other chronic diseases. CONCLUSION: This study assessed the marginal utilities and public burdens of hearing loss and eight chronic diseases in a South Korean population. Although the values may vary depending on country and race, this study may provide an indispensable foundation for more detailed studies on hearing loss.

Static model simulation for routine mumps vaccination in Japan: with a result of mumps-related complications in a Japanese community hospital

PURPOSE: Mumps vaccine has not been included in the routine national immunization program in Japan, leading to low vaccine coverage rates and periodic epidemics approximately every 5 years. Our hospital (a secondary community hospital in Japan) experienced an increased number of mumps-related complications with a nationwide epidemic in 2016. Using previously reported data and mumps-related cases in our hospital, we estimated the cost-effectiveness of routine mumps vaccination in Japan with a static model using current epidemiologic data. MATERIALS AND METHODS: With a decision tree flowchart of mumps infection and adverse events, we estimated the burden of mumps-related complications in our hospital for 5 years, and calculated the current annual national burden. Finally, we compared the current burden and assumptive burden of the stable state after routine vaccination in Japan using a static model. RESULTS: The cost-benefit ratios with sensitivity analysis were 3.69 (1.08-9.52) and 6.84 (1.51-23.73) in independent inoculation and simultaneous inoculation, respectively, from a social perspective in addition to an annual gain of 9,487 (3,227-14,659) quality adjusted life years. CONCLUSION: We contributed additional evidence in terms of cost-effectiveness that routine mumps vaccination should be introduced in Japan with simultaneous inoculation.

Costo utilidad en Colombia del uso de los nuevos anticoagulantes orales comparados con los antagonistas de la vitamina K para la prevención de discapacidad por ataque cerebrovascular en pacientes con fibrilación auricular no valvular / Cost-Utility analyisis for the use of new oral anticoagulants compared to vitamin K antagonists for stroke disability prevention in patients with non-valvular atrial fibrillationin Colombia

Resumen Objetivos: establecer si en Colombia en pacientes con fibrilación auricular no valvular (FA) el uso de los nuevos anticoagulantes orales (NACO) son costo útiles cuando se comparan con los antagonistas de la vitamina K (AVK), para el desenlace de ataque cerebrovascular (ACV) Métodos: estudio de costo utilidad, mediante un proceso de Markov, cuyo desenlace se estimó en términos de años de vida ajustados por calidad (AVAC), comparando NACO como grupo contra AVK. Se realizó revisión sistemática para obtener estudios de la literatura. Se evaluaron 4 estados que fueron: ACV, independiente, dependiente y muerte; adicionalmente se evaluaron complicaciones no cerebrales. Se simuló una cohorte, iniciando a los 60 años con un horizonte temporal de 24 años. Se realizaron análisis de sensibilidad. Resultados: se hallaron 3 estudios que cumplían criterios de inclusión. En el análisis de costo utilidad encontramos un incremento de AVAC de 0,28 años con un costo incremental de $10.559.367 de los NACO respecto a AVK con una razón de costo efectividad incremental (RCEI) de $38.394.817, lo cual está dentro del umbral de disponibilidad a pagar. Los análisis de sensibilidad mostraron que los NACO solo se hacen costo efectiva con tasas de descuento bajas o con horizontes temporales de 19 años o más. La principal fuente de variabilidad fue el costo de los NACO Conclusiones: los NACO son una alternativa costo útil a los AVK para pacientes con FA bajo los supuestos de nuestro modelo.

Summary Objectives: Our objective was to develop a cost utility analysis in Colombian patients with non-valvular atrial fibrillation (AF) contrasting the new oral anticoagulants (NOAC) with vitamin K antagonists (VKA) for the stroke outcome. Methods: We executed a cost utility analysis, through a Markov process, its outcome was estimated in Quality-adjusted life year (QALY), comparing NOAC as a group with VKA. We performed a systematic revision in search for relevant publications. We evaluated 4 outcome stroke states (no stroke, independent, dependent and dead); also, we included non-brain complications. We simulated a cohort starting at 60 years old with a temporal horizon of 24 years. At the end, we performed sensibility analysis. Results: We found 3 studies that fulfilled inclusion criteria. Cost utility analysis showed a QALY increase of 0.28 years and an incremental cost of $10´559.367 of NOAC compared with VKA, with an incremental cost-effectiveness ratio (ICER) of $38.394.817, which was within cost-per-QALY threshold. Sensitivity analysis displayed that NOAC were cost effective only with low discount rates and with temporal horizons beyond 19 years. The main variability factor was NOAC costs. Conclusions: NOAC become a cost useful alternative compared to VKA in the treatment of AF patients under our model assumptions.

Aplicabilidade dos estudos de carga de doença nos distúrbios fonoaudiológicos / Applicability of burden of disease methodology in human communication disorders

RESUMO: A metodologia de mensuração da carga de doença, composta pelo cálculo de indicadores específicos, propõe mensurar os efeitos de agravos (ou de doenças) sobre o bem estar físico, emocional e social, seja a partir dos efeitos da morte prematura e da morbidade, bem como de comorbidades sobre as condições de saúde da população. O estudo teve como objetivo verificar a possibilidade de aplicação dos conceitos de carga de doença no estudo das metodologias e melhor caracterização do cenário de agravos fonoaudiológicos. O estudo envolveu revisão integrativa da literatura nas bases Scielo, Lilacs e Pubmed, com apresentação de conceitos e uma análise crítica dos indicadores de carga de doença e suas potenciais aplicações no campo da fonoaudiologia. Os achados indicam que existe uma carência de estudos utilizando os conceitos relacionados à carga de doença aplicados à comunicação humana e seus distúrbios, bem como às implicações destas na vida do sujeito a partir da metodologia proposta pela Organização Mundial da Saúde. Há oportunidades de aplicação da metodologia foco da pesquisa, tanto para que forneça o impacto dos agravos no indivíduo, como para a avaliação da qualidade de vida e para a mensuração da efetividade das intervenções no campo dos distúrbios fonoaudiológicos.

ABSTRACT: The burden of disease methodology is composed by the calculation of specific indicators, and proposes to measure the effects of diseases on the physical, emotional and social welfare, either from the effects of premature death and morbidity, as well as comorbidities on the health conditions of the population. This study aimed to verify the possibility of application of the concept of the burden of disease in the study of human communication disorders in an attempt to introduce new methodologies and better characterize the setting of these diseases. This study involved an integrative literature review in Scielo, Lilacs and Pubmed bases, with presentation of concepts and a critical analysis of burden of disease's indicators and their potential applications in the field of speech, language and hearing sciences. The findings indicate a lack of studies using the concepts related to burden of disease as applied to human communication and its disorders as well as their implications on the life of the subject according to the methodology proposed by the World Health Organization. There are opportunities to apply the burden of disease concept and methodology in the field of communication disorders, both, to identify the impact of diseases on the individual, as for the evaluation of the quality and also to measure the effectiveness of interventions in the field of communication disorders.

Economic Evaluation of Home Total Parenteral Nutrition

The restricted resources on healthcare highlights the importance of clinical and cost effectiveness. The social and economic costs of chronic diseases are increasing. Home total parenteral nutrition (home TPN) for the patients with intestinal failure is a life-sustaining therapy until intestinal transplantation. An economic evaluation of home TPN has not been conducted in Korea. Three types of economic evaluations for home TPN are cost benefit analysis, cost effectiveness analysis, and cost utility analysis. Korea's medical market is competitive due to the limited health care resources. A health care delivery system from hospital to home needs to be established under the supervision of professional Nutrition Support Team staff including the systematic policies and social recognition.

Qualidade de vida relacionada à saúde e tempo de sobrevida ajustado para a qualidade de vida em pacientes com câncer internados em unidades de terapia intensiva / Quality of life related to health and quality-adjusted life years in patients with cancer admitted to intensive care units

Introdução: Há poucos estudos avaliando qualidade de vida relacionada à saúde (QVRS) e anos de vida ajustados para qualidade de vida (QALY) em pacientes com câncer que necessitam internação em unidades de terapia intensiva. O objetivo deste estudo foi avaliar sobrevida, QVRS e QALY durante o seguimento a longo prazo de pacientes com câncer internados em UTI. Métodos: Realizamos uma coorte prospectiva de pacientes com câncer admitidos em duas UTIs do estado de São Paulo. Coletamos dados na admissão da UTI, incluindo QVRS antes da doença aguda que motivou internação em UTI e no seguimento em 15 dias, 3 meses, 6 meses, 12 meses e 18 meses para avaliar a QVRS e status vital. Adicionalmente, o status vital foi avaliado em 24 meses. QVRS foi determinada com o questionário EQ-5D-3L. A sobrevida foi calculada com o estimador de Kaplan-Meier e o QALY com uma adaptação do estimador Zhao e Tsiatis. Resultados: Foram incluídos 792 pacientes. A média de idade foi 61,6±14,3 anos, 42,5% dos pacientes eram do sexo feminino e metade foi admitida após cirurgia eletiva. A média do escore SAPS3 foi 47,4±15.6. A probabilidade de sobreviver 12 e 18 meses foi 42.4% e 38.1%, respectivamente. A média do índice de utilidade da QVRS antes da internação na UTI foi 0,47±0,43, aos 15 dias pós-admissão a UTI 0,41±0,44, aos 3 meses 0,56±0,42, aos 6 meses 0,60±0,41, aos 12 meses 0,67±0,35 e aos 18 meses 0,67±0,35. A probabilidade de atingir 12 e 18 meses de vida ajustados para qualidade de vida foi de 30.1% e 19.1%, respectivamente. Houve diferenças estatisticamente significativas do tempo de sobrevida e QALY conforme as características de base consideradas (admissão após cirurgia eletiva, cirurgia de urgência ou clínica; SAPS3; extensão do câncer; status do câncer; cirurgia prévia; quimioterapia prévia; radioterapia prévia; capacidade funcional; e QVRS prévia). No entanto, apenas QVRS prévia e capacidade funcional foram associados a QVRS ao longo do seguimento de 18 meses. Conclusão: Em...

Introduction: Only few studies assessed health-related quality of life (HRQOL) and quality-adjusted life years (QALY) of cancer patients admitted to intensive care units (ICU). We aimed to assess the long-term HRQOL and QALY of cancer patients admitted to ICUs. Methods: We conducted a prospective cohort study of cancer patients admitted to two ICUs from the state of São Paulo, Brazil. We assessed the HRQOL with the EQ-5D-3L before ICU admission, 15 days, 3, 6, 12 and 18 months. In addition, the vital status was assessed at 24 months. Survival was calculated with the Kaplan-Meier estimator and QALY with the adapted Zhao and Tsiatis estimator. Results: The mean age of the subjects was 61.6 ± 14.3 years, 42.5% were female and half were admitted after elective surgery. The mean Simplified Acute Physiology Score (SAPS) 3 was 47.4 ± 15.6. Survival at 12 and 18 months was 42.4% and 38.1%, respectively. The mean EQ5D utility measure before admission to the ICU was 0.47±0.43, at 15 days it was 0.41±0.44, at 90 days 0.56±0.42, at 6 months 0.60±0.41, at 12 months 0.67±0.35 and at 18 months 0.67±0.35. The probabilities for attaining 12 and 18 months of quality-adjusted survival were 30.1% and 19.1%, respectively. There were statistically significant differences in survival time and QALYs according to all assessed baseline characteristics (ICU admission after elective surgery, emergency surgery or medical admission; SAPS3; cancer extension; cancer status; previous surgery; previous chemotherapy; previous radiotherapy; performance status; and previous HRQOL). Only the previous HRQOL and performance status were associated with the HRQOL during the 18-month follow-up. Conclusion: Long-term HRQOL, survival and QALY expectancy of cancer patients admitted to the ICU are limited. Nevertheless, these clinical outcomes exhibit wide variability among patients and are associated with simple characteristics present at the time of ICU admission, which may help healthcare professionals...

Cost-effectiveness of para-aortic lymphadenectomy before chemoradiotherapy in locally advanced cervical cancer / 부인종양

OBJECTIVE: To evaluate the cost-effectiveness of nodal staging surgery before chemoradiotherapy (CRT) for locally advanced cervical cancer in the era of positron emission tomography/computed tomography (PET/CT). METHODS: A modified Markov model was constructed to evaluate the cost-effectiveness of para-aortic staging surgery before definite CRT when no uptake is recorded in the para-aortic lymph nodes (PALN) on PET/CT. Survival and complication rates were estimated based on the published literature. Cost data were obtained from the Korean Health Insurance Review and Assessment Service. Strategies were compared using an incremental cost-effectiveness ratio (ICER). Sensitivity analyses were performed, including estimates for the performance of PET/CT, postoperative complication rate, and varying survival rates according to the radiation field. RESULTS: We compared two strategies: strategy 1, pelvic CRT for all patients; and strategy 2, nodal staging surgery followed by extended-field CRT when PALN metastasis was found and pelvic CRT otherwise. The ICER for strategy 2 compared to strategy 1 was $19,505 per quality-adjusted life year (QALY). Under deterministic sensitivity analyses, the model was relatively sensitive to survival reduction in patients who undergo pelvic CRT alone despite having occult PALN metastasis. A probabilistic sensitivity analysis demonstrated the robustness of the case results, with a 91% probability of cost-effectiveness at the willingness-to-pay thresholds of $60,000/QALY. CONCLUSION: Nodal staging surgery before definite CRT may be cost-effective when PET/CT imaging shows no evidence of PALN metastasis. Prospective trials are warranted to transfer these results to guidelines.

Cost-Utility Analysis of Screening Strategies for Diabetic Retinopathy in Korea

This study involved a cost-utility analysis of early diagnosis and treatment of diabetic retinopathy depending on the screening strategy used. The four screening strategies evaluated were no screening, opportunistic examination, systematic fundus photography, and systematic examination by an ophthalmologists. Each strategy was evaluated in 10,000 adults aged 40 yr with newly diagnosed diabetes mellitus (hypothetical cohort). The cost of each strategy was estimated in the perspective of both payer and health care system. The utility was estimated using quality-adjusted life years (QALY). Incremental Cost Effectiveness Ratio (ICER) for the different screening strategies was analyzed. After exclusion of the weakly dominating opportunistic strategy, the ICER of systematic photography was 57,716,867 and that of systematic examination by ophthalmologists was 419,989,046 from the perspective of the healthcare system. According to the results, the systematic strategy is preferable to the opportunistic strategy from the perspective of both a payer and a healthcare system. Although systematic examination by ophthalmologists may have higher utility than systematic photography, it is associated with higher cost. The systematic photography is the best strategy in terms of cost-utility. However systematic examination by ophthalmologists can also be a suitable policy alternative, if the incremental cost is socially acceptable.

Costo utilidad de profilaxis con palivizumab versus no profilaxis en niños con riesgo de infección de virus sincitial respiratorio en Colombia / Cost utility of prophylaxis with palivizumab versus no prophylaxis in children with risk of infection of syncitial respiratory virus in Colombia

Objetivo: determinar la costo utilidad de la profilaxis del palivizumab en niños con factores de riesgo para infección por virus sincitial respiratorio. Materiales y métodos: fue realizado un árbol de decisión, desde la perspectiva del pagador, en niños pretérmino (menores de 35 semanas) o con enfermedad cardiaca congénita, usando datos de costos locales y datos de efectividad para el cálculo de años de vida ajustado a calidad (AVAC) provenientes de estudios clínicos controlados con un horizonte temporal de toda la expectativa de vida. Los costos fueron reportados en pesos colombianos (ColP$) y se aplicó una tasa de descuento de 3,5 %. El modelo se evaluó usando una simulación de Monte Carlo. Resultados: en el grupo pretérmino los costos de palivizumab fueron $8 944 789 y en el grupo de no palivizumab $1 846 634. Los AVAC en estos grupos fueron de 72,28 y 72,17, respectivamente. La razón de costo utilidad incremental fue de $ 65 528 681/AVAC adicional. En el grupo de niños con enfermedad cardiaca congénita los costos de palivizumab fueron de $15 191 700 y de $4 657 187 en el grupo de no palivizumab. Los AVAC en estos grupos fueron de 72,16, respectivamente. La razón de costo utilidad incremental fue de $47 884 150/AVAC adicional. Existe una probabilidad mayor del 50 % de ser costo útil con una disposición a pagar mayor de $60 000 000. Conclusión: palivizumab es una alternativa costo útil en niños con riesgo de infección por virus sincitial respiratorio.

ABSTRACT Objective: To determine the incremental cost utility ratio (ICUR) of prophylaxis with palivizumab in children with risk factors for infection by respiratory syncytial virus (RSV). Material and methods: A decision tree using the perspective of the Colombian health sector was conducted in preterm infants (<35weeks) and children with congenital heart disease (CHD) using local data on costs and effectiveness data for the calculation of quality adjusted life years (QALYs) from randomized clinical trials with a time horizon of their life expectancy. Costs were reported in Colombian pesos ($ ColP) and a discount rate of 3.5 % was applied. The model was evaluated using a Monte Carlo simulation. Results: The costs of palivizumab in the preterm group were $8'944.789 and the group of non palivizumab $1'846.634. The QALY in these groups were 72.28 and 72.17 respectively. The ICUR was $65'528.681/QALY additional. In the group of children with CHD the costs of palivizumab were $15'191.700 and $4'657.187 in no palivizumab group. The QALYs in these groups were 72.16 and 71.94, respectively. The ICUR was $47'884.150/QALY. There is a probability greater than 50 % of being cost-effective with a willingness to pay of $60'000.000. Conclusions: Palivizumab provides a costeffective alternative of prophylaxis against RSV infection.

Costo-utilidad de prednisolona y aciclovir en pacientes con parálisis deBell en Colombia / Cost-utility of prednisolone and acyclovir in patients with Bell’s palsy in Colombia

Existen múltiples alternativas terapéuticas para pacientes con parálisis de Bell; sin embargo, sedesconoce la eficiencia de estas en el sistema de salud colombiano. El objetivo del presente estudio es determinarla razón de costo utilidad incremental (RCUI) y el valor esperado de información perfecta (VEIP) delos diferentes tratamientos para esta condición.Materiales y métodos: Se realizó un estudio de costo utilidad desde la perspectiva del pagador usando unárbol de decisión con un horizonte temporal menor de un año que evaluó: a. prednisolona sola, b. antiviralessolos, c. combinación prednisolona y antivirales, y d. observación. Se obtuvieron los costos directos del tarifarioISS+30%. Se calcularon los años de vida ajustados a calidad (AVAC) usando los datos de utilidad de fuentessecundarias. Se realizó una simulación de Monte Carlo con 10.000 iteraciones y 1.000 microsimulaciones.Resultados: Los costos totales esperados fueron prednisolona sola: $COP 48,315 (95%IC: 16,434-84,252);observación: $COP 49,868 (95%IC: 22,760-84,540); esteroides y antivirales $COP 62,237 (95%IC: 32,112-96,750) y antivirales solos $COP: 96,402 (95%IC: 56,372-139,926). Todas las alternativas obtuvieron 0.72 AVAC(95%IC: 0.68-0.75). La prednisolona sola fue la alternativa dominante para todos los valores de la disposición apagar. El VEIP para las disposiciones a pagar de $COP 47’512,194 y 222’802,847 fueron de $COP: 32’623,700y 134’383,920 respectivamente.Conclusión: La prednisolona sola es la estrategia dominante para cualquier disposición a pagar. El VEIP enColombia para la mayor disposición a pagar fue de $COP: 134’383,920...

There are multiple therapeutic alternatives for patients with Bell’s palsy, however their efficiencywithin the Colombian health system is unknown. The objective of this study is to determine the incrementalcost-utility ratio (ICUR) and the expected value of perfect information (EVPI) of different treatments forthis condition.Materials and methods: A cost-utility analysis was conducted from the perspective of the payer using adecision tree with a time horizon of less than one year. This model evaluated the following alternatives: a.prednisolone only, b. antivirals only, c. a combination of prednisolone and antivirals; d. observation. Directcosts were obtained from national tariff (ISS+30%). Quality adjusted life-years (QALYs) using utility data fromsecondary sources were calculated. Monte Carlo simulation with 10,000 iterations and 1,000 microsimulationwas performe...

Health economics and health preference concepts to orthopedics practitioners

The aim of this study was to describe concepts of health economics in order to update and provide the orthopedic practitioner decision making parameters based on preferences. Four basic types of studies of economical evaluation were presented (cost minimization analysis, cost-benefit, cost-effectiveness and cost-utility), as well as the origin, the concept, advantages and disadvantages of using QALY and utility. It was discussed the importance of costs and of SF-6D, an instrument able to get through the utility data from the Medical Outcomes Study 36-item Short Form Health Survey (SF-36). Physicians, especially orthopedic practitioners, are increasingly using technologies which are progressively expensive, thus, they should be able to understand health economics concepts, the importance of utility in clinical decision making process and economic analysis in health.09+.

Study on the burden of diseases among senior people in Shiyan city of Hubei province / 中华老年医学杂志

Objective To explore the burden of diseases among senior people in Shiyan city population by epidemiologic investigation,and to find out the main diseases that threaten their health,so as to provide scientific guide for priority allocation of health resources.Methods Disabilityadjusted life years(DALY) were calculated using the death monitoring statistics of Shiyan during 2007-2009.Results There were 16.11％ of people above 60 years old in Shiyan city,the average mortality and DALY were 20.9％ and 299.5/1000 respectively.Noncommunicable diseases were the main cause of death (89.7％).In the causes of death and burden of disease,cardiovascular diseases (47.7％,105.6/1000),malignant neoplasms (28.2％,66.6/1000),respiratory diseases (7.2％,15.5/1000) were the top three.In addition to nutritional deficiencies,diabetes and genitourinary diseases,DALY caused by other 14 kinds of diseases of male were higher than those of female,and DALY caused by nutritional deficiency was the third cause in female.Conclusions DALY caused by disease among senior people is lower in Shiyan city population than in the national average.Noncommunicable diseases are the foremost disease among senior people,and special attention should be paid to cardiovascular disease and malignant tumor.Gender distribution characteristics should be concerned to prevent and control the disease in the elderly.

What matters most?: evidence-based findings of health dimensions affecting the societal preferences for EQ-5D health states / O que importa mais?: evidências empíricas das dimensões que afetam as preferências sociais para estados de saúde do EQ-5D / ¿Qué es lo que más importa?: evidencias empíricas sobre las dimensiones que afectan a las preferencias sociales por los estados de salud en EQ-5D

This study analyzes how different health dimensions defined by the EQ-5D-3L instrument affect average individual preferences for health states. This analysis is an important benchmark for the incorporation of health technologies as it takes into consideration Brazilian population preferences in health resource allocation decisions. The EQ-5D instrument defines health in terms of five dimensions (mobility, daily activities, self-care activities, pain/discomfort, and anxiety/depression) each divided into three levels of severity. Data came from a valuation study with 3,362 literate individuals aged between 18 and 64 living in urban areas of Minas Gerais State, Brazil. The main results reveal that health utility decreases as the level of severity increases. With regard to health issues, mobility stands out as the most important EQ-5D dimension. Independently of severity levels of the other EQ-5D-3L dimensions, the highest decrements in utilities are associated with severe mobility problems.

Este estudo analisa como as diferentes dimensões dos estados de saúde definidas pelo instrumento EQ-5D-3L afetam, em média, as preferências dos indivíduos por estados de saúde. Essa análise é importante para balizar a incorporação de tecnologias em saúde uma vez que viabiliza considerar as preferências da população brasileira na decisão de alocação de recursos em saúde. O EQ-5D-3L define a saúde em cinco dimensões (mobilidade, atividades habituais, auto-cuidado, dor/desconforto e ansiedade/depressão) contendo três níveis de severidade. Os dados são provenientes de uma pesquisa inédita no Brasil que entrevistou 3.362 pessoas com idade entre 18 e 64 anos vivendo em áreas urbanas de Minas Gerais. Os principais resultados mostram que o decremento na utilidade dos indivíduos é crescente com o nível de severidade. No que se refere às dimensões de saúde, a mobilidade se destaca como a mais importante. Independentemente dos níveis de severidade das demais dimensões do EQ-5D, os maiores decrementos nas utilidades estão associados ao problema de mobilidade severa.

Este estudio analiza cómo las diferentes dimensiones de la salud, definidas por el instrumento EQ-5D-3L, afectan, en promedio, las preferencias individuales por los estados de salud. Este análisis es un punto de referencia para la incorporación de tecnologías en salud, ya que hace posible considerar las preferencias de la población brasileña en las decisiones sobre la asignación de recursos de salud. El EQ-5D define la salud en cinco dimensiones (movilidad, actividades habituales, cuidado personal, dolor/malestar y ansiedad/depresión) con tres niveles de severidad. Los datos provienen de una investigación inédita en Brasil, que entrevistó a 3.362 personas entre 18 y 64 años y que viven en zonas urbanas de Minas Gerais. Los principales resultados muestran que la disminución en la utilidad de los individuos aumenta con el nivel de severidad. Con respecto a las dimensiones de salud, la movilidad se destaca como la más importante. Independientemente de los niveles de severidad de las otras dimensiones, los mayores decrementos en la utilidad están asociados con graves problemas de movilidad.