Interpretation of Consolidated Health Economic Evaluation Reporting Standards 2022 / 中华流行病学杂志

The number of studies related to health economics evaluation is increasing. Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) contains 28 items. Based on CHEERS 2013, CHEERS 2022 adds a health economic analysis plan, model sharing, and community, patient, public, and other relevant stakeholders' participation in the statement, taking into account the future development direction of health economics evaluation. It provides a useful review tool for peer reviewers, editors, and readers and supports health technology assessment agencies in establishing standard reporting standards for health economics evaluations. In this study, we briefly introduced and interpreted the CHEERS 2022 statement and analyzed an example of health economics evaluation in infectious disease epidemiology to provide a reference for researchers to report studies regarding health economics evaluation standardly.

Análisis de costos de la atención hospitalaria en un paciente con fibrilación auricular no valvular y accidente cerebrovascular a repetición / Cost analysis of in hospital attention in a non-valvular atrial fibrillation patient and recurrent stroke

RESUMEN INTRODUCCIÓN: Paciente de 71 años con diagnóstico de fibrilación auricular y ataques cerebrovasculares recurrentes, tratada con varios anticoagulantes. El costo del tratamiento del ictus en Colombia para el año 2008 fue de $450.000 millones de pesos colombianos. OBJETIVO: Estimar el costo hospitalario de la atención de un paciente con ictus a repetición secundario a fibrilación auricular. MÉTODOS: Estudio económico parcial de microcosteo de la atención intrahospitalaria para un caso de espectro severo recurrente, que no necesariamente refleja el caso promedio. El consumo de recursos se valoró mediante el uso de tarifas de referencia nacionales. Los resultados se presentan en precios actuales del 2019 (peso colombiano y dólar americano). RESULTADOS: Paciente con 3 eventos hospitalarios, que estuvo 31 días hospitalizada. Las hospitalizaciones tuvieron unos costos de: $53.883.490 (USD 16.141,1), $6.343.096 (USD 1.900,1) y $15.719.443 (USD 4.708,9) respectivamente, con un precio promedio por cada hospitalización de $25.315.343 (USD 7.583,4), costo total de $75.946.029 (USD 22.750,1) costo día de $2.449.872 (USD 729,5). El rubro que aumentó consistentemente los costos fueron los procedimientos (35,7 %). CONCLUSIONES: El ictus recurrente causado por fibrilación auricular no valvular se asocia con un incremento significativo de los costos directos, con un impacto de casi dos veces el PIB per cápita. Un diagnóstico oportuno y una selección adecuada pueden reducirlo.

ABSTRACT INTRODUCTION: A 71-year-old patient with a diagnosis of atrial fibrillation and recurrent strokes, treated with various anticoagulants, the stroke treatment in Colombia for 2008 was $ 450 billion Colombian pesos. OBJECTIVE: To estimate the hospital cost of caring for a patient with recurrent stroke secondary to atrial fibrillation. METHODS: Partial economic study of micro costing of in-hospital care for a case of recurrent severe spectrum stroke, which does not necessarily reflect the average case. Resource consumption was valued using national reference rates. The results are presented in current 2019 prices (Colombian pesos and US dollars). RESULTS: Patient with 3 hospital events, who was hospitalized for 31 days. Hospitalizations had costs of $ 53,883,490 (USD 16,141.1), $ 6,343,096 (USD 1,900.1) and $ 15,719,443 (USD 4,708.9) respectively, with an average price for each hospitalization of $ 25,315,343 (USD 7,583.4), total cost of $ 75,946,029 (USD 22,750.1) daily cost of $ 2,449,872 (USD 729.5). The item that consistently increased costs was procedures (35.7 %). CONCLUSIONS: Recurrent stroke caused by nonvalvular atrial fibrillation is associated with a significant increase in direct costs, with an impact of almost twice the GDP per capita. A timely diagnosis and proper selection can reduce it.

Decisions based on health economic analysis

@#Family and community practitioners sometimes will decide on what community-oriented interventions to propose and implement. The cost and effectiveness of such interventions are often debated by policy makers. A set of formal, quantitative methods for comparing alternative strategies in resource use and expected outcomes is known as health economic analysis. This article presents a tool to help family and community practitioners decide on the cost and effectiveness of such interventions.

Personas mayores en Chile: el nuevo desafío social, económico y sanitario del Siglo XXI / Older people in Chile: the new social, economic and health challenge for the 21st century

Ageing will be one of the most significant social transformations of the 21st century worldwide. In the last 40 years, Chile has tripled its older adult population. As a result, by 2050 the country will have the highest proportion of older adults in Latin America. This remarkable growth reinforces the need to identify their current situation and to revise what is the society doing to maintain older people as active members. In this context, this narrative revision aimed to describe the sociodemographic, epidemiologic and sociocultural profile of the older Chilean adults. Besides, programs and public policies focused on the improvement of their quality of life were identified.

Costes informales: definición, obtención y análisis. La importancia de su incorporación en las evaluaciones económicas en salud / Informal costs: definition, obtaining and analysis. The importance of its incorporation in economic evaluations in health

Introducción: Los costes informales derivan de cuidados informales que es la atención prestada a un enfermo o discapacitado por parte de personas que no son profesionales socio sanitarios y que no reciben una remuneración económica. El objetivo del trabajo es explicar los costes informales en salud, su definición, su obtención, análisis y el im­ pacto en su incorporación en las evaluaciones económicas en salud. Materiales y métodos: Se realizó una búsqueda del tema sobre costes informales en la base de datos de Medline­Pubmed y en la búsqueda de la biblioteca de la Universidad Carlos III Madrid vía internet a través de varias bases de datos como EconLit y ABI/IN­ FORM collection. Resultados: Se define los cuidados informales, los métodos para su medición en tiempo, en preferencias reveladas, preferencias establecidos fijados, otros métodos, la importan­ cia de incorporar los costos informales en las evaluaciones económicas en salud. Conclusión: La evaluación económica a nivel de la perspectiva de la sociedad se debe incluir, pero muchas veces se realiza según el pagador por lo difícil que puede ser su medición.

Introduction: Informal costs derive from informal care, which is the care provided to a sick or disabled person by people who are not socio­health professionals and who do not receive financial compensation. The objective of the work is to explain the informal costs in health, its definition, its obtaining, analysis and the impact on its incorporation in the economic health evaluations. Material and methods: A search of the topic on informal costs was carried out in the Medli­ ne­Pubmed database and in the search of the Carlos III Madrid University library via the In­ ternet through several databases such as EconLit and ABI / INFORM collection. Results: Informal care is defined, the methods for its measurement in time, in revealed preferences, established preferences, other methods, the importance of incorporating informal costs in economic health evaluations. Conclusion: The economic evaluation at the level of the society perspective must be in­ cluded, but many times it is carried out according to the payer because of how difficult its measurement can be done

Auditoria em saúde e economia da saúde: análise de um estudo de caso / Audit in health and health economics: analysis of a case study

Objective: to analyze the results of the health audit in the area of orthoses, prostheses and special materials (OPM), multiple and sequential surgeries (CMS), performed by the State Health Department of Rio Grande do Sul, Brazil (SES/RS). Methodology: Descriptive quantitative study, based on secondary data from SES/RS, in the area of OPM and CMS, referring to the period of post-payment audit practice, from March 2013 to January 2017, using the case study approach. Results: 1,004 completed observations were analyzed for the period; the number of administrative processes requiring a return of financial resources did not have a tendency in the analyzed historical series, a result influenced by the presence of administrative processes that were not conclusive, especially from 2014, on the execution of the audit or even the judicialisation of the subject audited institutions. As for the financial value requested for the return of the analyzed processes, it was higher in 2014, decreasing in 2015 and decreasing considerably in the years 2016 and 2017. Considering the 30 health regions of the state of Rio Grande do Sul, Brasil, three hospitals were highlighted, the first with 43 administrative processes requesting the return of financial resources; the second with 30; and the third with 28. Conclusion: health actions in this area can be qualified through special attention to the regions of health and hospital institutions that repeat more and have large financial volume glossed. (AU).

Objetivo: analisar os resultados da auditoria em saúde na área de órteses, próteses e materiais especiais (OPM) e cirurgias múltiplas e sequenciais (CMS), realizada pela Secretaria Estadual de Saúde do Rio Grande do Sul (SES/RS). Metodologia: estudo quantitativo descritivo, baseado em dados secundários da SES/RS, na área de OPM e CMS, referente ao período da prática de auditoria de pós-pagamento, de março de 2013 a janeiro de 2017, utilizando a abordagem estudo de caso. Resultados: foram analisadas 1.004 observações concluídas para o período; o número de processos administrativos com solicitação de devolução de recursos financeiros não teve uma tendência na série histórica analisada, resultado influenciado pela presença de processos administrativos não conclusos, em especial a partir de 2014, relativos à execução da auditoria ou até mesmo a judicialização do assunto pelas instituições auditadas. Quanto ao valor financeiro solicitado para devolução dos processos analisados, foi maior em 2014, decrescendo em 2015 e diminuiu consideravelmente nos anos 2016 e 2017. Considerando as 30 regiões de saúde do estado do Rio Grande do Sul, três instituições hospitalares tiveram destaque, a primeira com 43 processos administrativos com solicitação de devolução de recursos financeiros; a segunda com 30; e a terceira com 28. Conclusão: as ações em saúde, nessa área, podem ser qualificadas por meio de atenção especial para as regiões de saúde e instituições hospitalares que mais reincidem e tem grandes volumes financeiros glosados. (AU).

Objetivo: analizar los resultados de la auditoría de salud en el área de ortesis, prótesis y materiales especiales (OPM), cirugías múltiples y secuenciales (CMS), realizadas por el Departamento de Salud del Estado de Rio Grande do Sul, Brasil (SES / RS). Metodología: estudio cuantitativo descriptivo, basado en datos secundarios de SES / RS, en el área de OPM y CMS, en referencia al período de la práctica de auditoría posterior al pago, desde marzo de 2013 hasta enero de 2017, utilizando el enfoque de estudio de caso. Resultados: se analizaron 1,004 observaciones completas para el período; el número de procesos administrativos que requirieron un retorno de los recursos financieros no tuvo una tendencia en las series históricas analizadas, un resultado influenciado por la presencia de procesos administrativos que no fueron concluyentes, especialmente a partir de 2014, en la ejecución de la auditoría o incluso la judicialización del sujeto Instituciones auditadas. En cuanto al valor financiero solicitado para el retorno de los procesos analizados, fue mayor en 2014, disminuyó en 2015 y disminuyó considerablemente en los años 2016 y 2017. Considerando las 30 regiones de salud del estado de Rio Grande do Sul, Brasil, se destacaron tres hospitales, el primero con 43 procesos administrativos solicitando la devolución de recursos financieros; el segundo con 30; y el tercero con 28. Conclusión: las acciones de salud en esta área se pueden calificar a través de una atención especial a las regiones de salud y las instituciones hospitalarias que repiten más y tienen grandes volúmenes financieros. (AU).

Economic studies of fertilization and embryo transfer / 浙江大学学报·医学版

fertilization and embryo transplantation (IVF-ET) technology is one of the main treatments for infertility. But IVF-ET is expensive and has not be covered by health insurance in most developing countries. Therefore, how to obtain the maximum success rate with the minimum cost is a common concern of clinicians and patients. At present, the economic studies on IVF-ET mainly focus on different ovulation stimulating drugs, different ovulation stimulating protocols, different transplantation methods and the number of transplants. But the process of IVF-ET is complex, the relevant methods of economic study are diverse, and there are no unified standard for outcome indicators, so there is no unified conclusion for more economical and effective protocol by now. Therefore, to analyze the economic studies of IVF-ET, and to explore appropriate evaluation methods and cost-effective protocols will be helpful for reasonable allocation of medical resources and guidance of clinical selection. It would provide policy reference to include the costs of IVF-ET treatment in health insurance in the future.

Impacto económico institucional del programa Receta Resurtible con pacientes diabéticos / Institutional economic impact of the Receta Resurtible (Resupply Prescription) program in diabetic patients

Objetivo: determinar el impacto económico institucional del programa Receta Resurtible con pacientes diabéticos. Material y métodos: estudio de costos antes y después del programa Receta Resurtible con pacientes diabéticos. El costo promedio incluyó perfil de uso y costo unitario. El perfil de uso se determinó para Consulta externa, Farmacia y medicamentos. En el análisis se plantearon escenarios y se adoptaron supuestos. Resultados: el promedio de consultas antes y después se ubica en 6.45 y 4.73, respectivamente. La dotación de medicamentos fue 55.8% y 99%. El impacto del programa para una unidad de medicina familiar con 6400 pacientes diabéticos, de los cuales 18% se encuentra en el programa Receta Resurtible, permite un ahorro de $ 490 366 en la consulta de Medicina familiar y atención en Farmacia, sin embargo existe un incremento de $112 100 por consumo de medicamentos, el ahorro total en este escenario es de $378 266. Conclusión: el impacto económico del programa Receta Resurtible es benéfico para la institución.

Objective: To determine the institutional economic impact of the Resupply Prescription program in diabetic patients. Material and methods: Study of costs before and after the Resupply Prescription program with diabetic patients. The average cost included usage profile and unit cost. The profile of use was determined for External consultation, Pharmacy and medication. In the analysis, scenarios were raised and assumptions were adopted. Results: The average of before and after consultations is located at 6.45 and 4.73, respectively. The medication provision was 55.8 and 99%. The impact of the program for a Family Medicine Unit with 6400 diabetic patients, of which 18% is in the Resupply Prescription program, allows a saving of $ 490 366 in the consultation of Family Medicine and Pharmacy, however there is a increase of $ 112 100 for drug consumption, the total saving in this scenario is $ 378 266. Conclusion: The economic impact of the Resupply Prescription program is beneficial for the institution.

Términos económicos más utilizados en la salud (II parte) / Most used economic terms in health (II part)

En este artículo se ofrece el resto de los términos económicos, organizados alfabéticamente de la letra E a la Z, con lo cual se completa el glosario iniciado en el número anterior de esta revista. Se espera que pueda ser útil a todos los estudiantes y profesionales de las ciencias médicas que lo necesiten como material de consulta, y para todos aquellos lectores que deseen incrementar su acervo cultural en la esfera económica.

In this work the rest of the economic terms alphabetically organized are offered from E to Z letters, with which the glossary initiated in the previous number of the present journal is completed. It is expected that this glossary can be useful to all the students and professionals of the medical sciences that need it as consultation material, and for all those readers that want to increase their cultural heritage in the economic sphere.

Epidemiología social y economía política: la UCI como punto de encuentro / Social epidemiology and political economy: ICU as point of convergence / Epidemiologia social e economia política: a UTI como ponto de encontro

Las interrogantes acerca de epidemiología, economía y cuidado crítico suelen estar en la mente de casi cualquier profesional de la salud. Sin embargo, casi nunca se tiene presente que la epidemiología y la economía pueden converger -a pesar de ser campos de estudio aparentemente separados- y que lo pueden hacer para explicar la situación actual o las tendencias futuras de un servicio hospitalario o de salud pública. Este ensayo presenta brevemente el devenir de la epidemiología social y de la economía política y cómo ambas actividades académicas pueden encontrar intereses comunes a propósito de la Unidad de Cuidado Intensivo (UCI), en particular para generar interrogantes, posibles áreas de investigación y alternativas hacia el desarrollo de servicios de salud más eficientes, más efectivos y más humanos.

Questions around epidemiology, economics and critical care are often in the mind of almost any healthcare professional. However, it is seldom realized that epidemiology and economymay converge -in spite of being apparently separated fields of study- in order to explain the present situation or future trends of a hospital or public health service. This essay briefly depictshow social epidemiology and political economy have developed and how both academic activities may find a common ground about the Intensive Care Unit (ICU), particularly to pose questions, to create possible research lines and feasible alternatives towards more efficient, effective and humane health services.

As interrogantes sobre de epidemiologia, economia e cuidado crítico acostumam estar na mente de quase qualquer professional da saúde. Porém, quase nunca se tem presente que a epidemiologia e a economia podem convergir -apesar de ser campos de estudo aparentemente separados- e que o podem fazer para explicar a situação atual ou as tendências futuras de um serviço hospitalar ou de saúde pública. Este ensaio apresenta brevemente o devir da epidemiologia social e da economia política e como ambas atividades acadêmicas podem encontrar interesses comuns a propósito da Unidade de Tratamento Intensivo (UTI), em particular para gerar interrogantes, possíveis áreas de investigação e alternativas para o desenvolvimento de serviços de saúde mais eficientes, maisefetivos e mais humanos.

Situación financiera y propuesta de sostenibilidad régimen enfermedad – maternidad del Instituto Hondureño de Seguridad Social, periodo 2008 - 2022

El seguro social de Honduras tiene tres formas de organizar la provisión de serviciosde salud: i) a través de su red propia de hospitales y clínicas en las que se brindanatenciones de los tres niveles de atención; ii) por medio de proveedores privados -servicios sub rogados que ofrecen atenciones de primer y segundo nivel; y, iii) elservicio médico de empresas que otorga cuidados de primer nivel.El IHSS tiene las tasas de cotización más bajas de Centroamérica y un déficitfinanciero ya inoperable por lo bajo de dichas tasas; en cinco de los últimos ochoaños los flujos de recursos financieros para garantizar la entrega oportuna de lasprestaciones del REM, han venido presentando déficits en sus balances operativos,situación que podría agravarse en los próximos años, debido esencialmente (i) elestablecimiento de un techo máximo de cotización relativamente bajo, (ii) el cambioen la política cambiaria de estado, la que paso de un tipo de cambio fijo a uno dedeslizamiento reptante1, la que produce un encarecimiento relativo de los insumosimportados, sobre todo medicamentos y material de reposición periódica, (iii) la bajacobertura poblacional, y (iv) al potencial efecto de la desaceleración de la economía.En aras superar esta difícil situación financiera y operativa se propone diferentesmecanismos de solución potencial, para ello se simularon cuatro escenarios a fin deque las autoridades del IHSS tengan un abanico de opciones al respecto. En aras superar esta difícil situación financiera y operativa se propone diferentesmecanismos de solución potencial, para ello se simularon cuatro escenarios a fin deque las autoridades del IHSS tengan un abanico de opciones al respecto...

Perfil do cirurgião plástico no Estado de Goiás, Brasil / Profile of plastic surgeons in the state of Goias, Brazil

INTRODUÇÃO: A Cirurgia Plástica tem sido popularizada nos últimos anos, por meio do acesso aos procedimentos e exposição nos meios de comunicação. O contexto atual relata dificuldades no mercado de trabalho devido à competividade e diminuição de honorários. O objetivo deste estudo é relatar o perfil do cirurgião plástico que atua no Estado de Goiás. MÉTODOS: A pesquisa foi realizada com cirurgiões plásticos que atuam no estado de Goiás registrados na regional da Sociedade Brasileira de Cirurgia Plástica (SBCP) até janeiro de 2015. Os dados foram divididos em perfil socioeconômico e demográfico. Foram considerados como critérios de inclusão residência pelo Ministério da Educação ou pela SBCP e estar atuando em Cirurgia Plástica no estado de Goiás. Como critérios de exclusão ser médico residente em cirurgia plástica e não estar atuando na área de Cirurgia Plástica. RESULTADOS: Obteve-se o índice de resposta de 70%. A maioria tem menos de 40 anos, masculino, casado, com 1 a 2 filhos, atuando em Goiás, há menos de 10 anos, são especialistas, trabalhando de 40 a 60 horas semanais e atuam na área estética e reconstrutiva e a maioria não usa auxiliar em mais de 50% das cirurgias realizadas. CONCLUSÃO: O perfil do cirurgião plástico do estado de Goiás é o de um médico jovem, do sexo masculino, casado, com até 2 filhos, que atua principalmente na capital, sendo a maioria especialista, que trabalha de 40 a 60 horas semanais, e atuando na cirurgia estética e reconstrutiva.

INTRODUCTION: Plastic surgery has become popular in the recent years for the access to procedures and exposure in the media. The current scenario brings difficulties in the job market because of competitiveness and reduced fees. This study describes the profile of the plastic surgeons working in the state of Goias. METHODS: The survey was conducted with plastic surgeons who work in the state of Goias and are registered in local chapter of the Brazilian Society of Plastic Surgery in January 2015. Data were divided into socio-economic and demographic profile. Inclusion criteria were residence certified by the Brazilian Ministry of Education or by the Brazilian Society of Plastic Surgery,, practice of plastic surgery in the state of Goias. We excluded residents in plastic surgery, and those who not practice in plastic surgery area. RESULTS: Rate of response was 70%. Most participants were younger than 40 years old, men, married, with 1-2 children, work in Goias, had less than 10 years as a surgeion, had specialization in plastic surgery, work 40-60 hours weekly and main practice was in aesthetic and reconstructive area, the majority of them do not employ assistances in more than 50% of surgeries. CONCLUSION: The profile of plastic surgeon in state of Goias is composed by young physicians, men, married, with no more than 2 children, and whom practice mainly in the state capital, most of them are specialists, work 40-60 hours per week, and their main practice is with aesthetic and reconstructive surgery.

Projections of Demand for Cardiovascular Surgery and Supply of Surgeons

BACKGROUND: While demand for cardiovascular surgery is expected to increase gradually along with the rapid increase in cardiovascular diseases with respect to the aging population, the supply of thoracic and cardiovascular surgeons has been continuously decreasing over the past 10 years. Consequently, this study aims to achieve guidance in establishing health care policy by analyzing the supply and demand for cardiovascular surgeries in the medical service area of Korea. METHODS: After investigating the actual number of cardiovascular surgeries performed using the National Health Insurance claim data of the Health Insurance Review and Assessment Service, as well as drawing from national statistics concerning the elderly population aged 65 and over, this study estimated the number of future cardiovascular surgeries by using a cell-based model. To be able to analyze the supply and demand of surgeons, the recent status of new surgeons specializing in thoracic and cardiovascular surgeries and the ratio of their subspecialties in cardiovascular surgeries were investigated. Then, while taking three different scenarios into account, the number of cardiovascular surgeons expected be working in 5-year periods was projected. RESULTS: The number of cardiovascular surgeries, which was recorded at 10,581 cases in 2014, is predicted to increase consistently to reach a demand of 15,501 cases in 2040—an increase of 46.5%. There was a total of 245 cardiovascular surgeons at work in 2014. Looking at 5 year spans in the future, the number of surgeons expected to be supplied in 2040 is 184, to retire is 249, and expected to be working is 309—an increase of −24.9%, 1.6%, and 26.1%, respectively compared to those in 2014. This forecasts a demand-supply imbalance in every scenario. CONCLUSION: Cardiovascular surgeons are the most central resource in the medical service of highly specialized cardiovascular surgeries, and fostering the surgeons requires much time, effort, and resources; therefore, by analyzing the various factors affecting the supply of cardiovascular surgeons, an active intervention of policies can be prescribed for the areas that have failed to meet the appropriate market distributions.

Análisis de costo efectividad de prasugrel, comparado con clopidogrel para pacientes con síndrome coronario agudo sometidos a intervención coronaria percutánea en Colombia / Analysis of cost effectiveness of prasugrel compared with clopidogrel for patients with acute coronary syndrome undergoing percutaneous coronary intervention in Colombia

Objetivo: determinar, desde la perspectiva del sistema de salud colombiano, la relación de costo-efectividad del prasugrel comparado con clopidogrel, para el tratamiento de pacientes adultos con síndrome coronario agudo. Material y métodos: se construyó un modelo de Markov con ciclos anuales en el cual los pacientes pueden permanecer sin experimentar nuevos eventos cardiovasculares, sufrir un nuevo evento o morir. En el caso base se adoptó un horizonte temporal de 10 años y una tasa de descuento de 3%. Las probabilidades de transición se extrajeron del ensayo clínico TRITON-TIMI 38, de las estadísticas vitales del Departamento Nacional de Estadística y de la información de los pacientes colombianos del registro ACCESS. Para identificar y medir el uso de recursos se diseñó un caso típico a partir de la revisión de guías y protocolos; para la valoración se emplearon manuales tarifarios colombianos. Se realizaron análisis de sensibilidad determinísticos y probabilísticos. Resultados: en el caso base, el costo por año de vida ajustado por calidad ganado con prasugrel es $79 987 695 pesos colombianos. Los resultados son sensibles a cambios en el horizonte temporal y al costo del clopidogrel. Bajo un umbral de disposición a pagar de tres veces el PIB per cápita colombiano, la probabilidad de que el prasugrel sea costo efectivo es 7%. Conclusiones: la decisión respecto a la inclusión del prasugrel en el tratamiento de pacientes con síndrome coronario agudo, sometidos a intervención coronaria percutánea depende fundamentalmente del costo del clopidogrel que el decisor considere relevante para realizar la comparación. (Acta Med Colomb 2015; 40: 310-317).

Objective: to determine the cost-effectiveness relation of prasugrel compared with clopidogrel for the treatment of adult patients with acute coronary syndrome from the perspective of Colombian health system. Material and methods: a Markov model with annual cycles in which patients can remain without experiencing new cardiovascular events, have a new event or die, was built. In the base case a time horizon of 10 years and a discount rate of 3% was adopted. Transition probabilities were taken from the clinical trial TRITON-TIMI 38, of vital statistics from the National Department of Statistics and from the information of Colombian patients in ACCESS registry. To identify and measure the use of resources, a typical case was designed from the review of guidelines and protocols; Colombian tariff manuals were used for assessment. Deterministic and probabilistic sensitivity analyzes were performed. Results: in the base case, the cost per year of quality-adjusted life gained with prasugrel is $ 79,987,695 Colombian pesos. The results are sensitive to changes in the timeframe and cost of clopidogrel. Under a threshold willingness to pay three times the per capita GDP of Colombia, the probability that prasugrel may be cost-effective, is 7%. Conclusions: the decision on the inclusion of prasugrel in the treatment of patients with acute coronary syndrome undergoing percutaneous coronary intervention depends mainly on the cost of clopidogrel that the decision maker considers relevant to perform the comparison. (Acta Med Colomb 2015; 40: 310-317).

Impacto económico del uso secuencial de los antimicrobianos en los niños con apendicitis aguda complicada / Economic impact of the sequential use of antimicrobials in children with complicated acute appendicitis

FUNDAMENTO: el presente estudio mostró el resultado económico conseguido con la aplicación secuencial de los antimicrobianos en los niños tratados por apendicitis aguda complicada en el servicio de cirugía pediátrica de Camagüey. MÉTODO: se realizó un estudio cuasi-experimental transversal en todos los casos de niños tratados por apendicitis aguda complicada entre enero de 2010 y diciembre de 2013, en el servicio de cirugía pediátrica del Hospital Pediátrico Universitario Eduardo Agramonte Piña de Camagüey. Los resultados económicos fueron comparados con los enfermos tratados por la misma enfermedad entre enero de 2006 y diciembre de 2009. RESULTADOS: se incluyeron en el estudio 401 enfermos. Entre los años 2006-2009 la estadía hospitalaria fue de 7, 03 días/enfermo, en tanto entre el 2010-2013 fue de 4, 2 días. La media de los costos por pacientes fue $ 578, 8 para los casos y de $ 953, 6 para los controles. El consumo de los antimicrobianos entre el 2006-2009 fue de 3 755 bulbos de ceftriaxona, 2 253 bulbos de amikacina y de 4 506 frascos de metronidazol; entre el 2010-2013 solo fueron utilizados 1 965 bulbos de ceftriaxona, 1 179 bulbos de amikacina y 2 358 frascos de metronidazol. CONCLUSIONES: el estudio demostró una notable reducción en la estancia, los costos hospitalarios y en la utilización de antimicrobianos costosos.

BACKGROUND: the present study demonstrates the economic results achieved with the sequential application of antimicrobials in children treated because of complicated acute appendicitis in the pediatric surgery department of Camagüey. METHOD: a transversal quasi-experimental study was conducted in all the cases of children treated because of complicated acute appendicitis between January, 2010 and December, 2013 in the pediatric surgery department of the Eduardo Agramonte Piña Pediatric Teaching Hospital of Camagüey. The economic results were compared to those obtained from the patients treated because of the same disease between January, 2006 and December, 2009. RESULTS: four hundred and one patients were included in the study. Between the years 2006-2009 the hospital stay was of 7, 03 days/ patient; on the other hand, between the years 2010-2013 it was of 4, 02 days/patient. On average, the cost per patient was $ 578, 8 for the cases and $ 953, 6 for the controls. The consumption of antimicrobials, between 2006 and 2009, was of 3 755 ampoules of ceftriaxone, 2 253 ampoules of amikacin and 4 506 bottles of metronidazole; between 2010 and 2013 only 1 965 ampules of ceftriaxone, 1 179 ampoules of amikacine and 2 358 bottles of metronidazole were used. CONCLUSIONS: the study demonstrated a notable reduction in hospital stay and costs and in the use of expensive antimicrobials.

Evaluación económica del tratamiento de la Hepatitis B crónica en la Provincia de Misiones / Economic Evaluation of Treatment of Chronic Hepatitis B in the Province of Misiones

La infección crónica por hepatitis B representa una importante carga sanitaria en el mundo y en Argentina. Existen varias estrategias terapéuticas, cuyo objetivo es reducir la carga viral. OBJETIVO: Evaluar la costo-efectividad de las diferentes estrategias de tratamiento, tanto en pacientes positivos como negativos al antígeno e de hepatitis B (HBeAg). MÉTODOS: Se utilizó un modelo de decisión determinístico, que contempló los principales estados de salud asociados al virus de la hepatitis B desde la perspectiva del sistema de seguridad social de Misiones en un lapso de 10 años. Se recabaron los costos de las drogas, de los eventos clínicos y sus complicaciones. Se efectuaron diversos análisis de sensibilidad de una vía para evaluar la incertidumbre. RESULTADOS: El tratamiento con monoterapia de tenofovir se asoció con menores costos y mayor eficacia. Esto se demostró tanto en pacientes positivos como negativos al HBeAg, donde se observó un ahorro, con un costo inferior a un producto bruto interno per cápita por año de vida ajustado por calidad y tasa de costo-efectividad incremental dominante en ambos escenarios. Los análisis de sensibilidad confirmaron los valores del escenario base (con el costo del tenofovir como variable de mayor influencia). CONCLUSIONES: El tratamiento con tenofovir resultó ser relativamente ahorrativo en términos de costos. Estos modelos podrían facilitar la toma de decisiones por parte de las autoridades de salud pública de Misiones...

Chronic infection by hepatitis B is a serious health burden worldwide and in Argentina.There are several therapeutic strategies aiming at reducing the viral load. OBJECTIVE: To evaluate the cost-effectiveness of different treatment strategies, both in hepatitis B e antigen (HBeAg)-positive and -negative patients. METHODS: A deterministic decision model was used, which considered the main health outcomes associated with hepatitis B virus from the perspective of social security system of the province of Misiones in a 10-year term. The study collected data about costs of drugs, clinical events and complications. Several one-way sensitivity analyses were performed to evaluate uncertainty. RESULTS: Treatment with Tenofovir monotherapy was associated with lower costs and higher efficacy. This was proved both in HBeAg-positive and -negativepatients, since Tenofovir treatment was cost-saving,with a cost lower than one gross domestic product per capita per quality-adjusted life year, being the incremental cost-effectiveness rate strategy dominant in both scenarios. Sensitivity analyses confirmed the values of the baselin escenario and showed that the most influential parameterwas Tenofovir cost. CONCLUSIONS: Tenofovir treatment proved to be relatively cost-saving. These models may beuseful for the decision-making by public health authoritiesin the province of Misiones...

Considerações sobre a asma de interesse para a atenção primária: epidemiologia, impacto econômico e políticas públicas / Asthma from the perspective of public health: epidemiology, economic impact and public policy

A asma se configura como um problema de saúde pública afetando indivíduos em todas as partes do mundo. Com prevalência variável, tem no Brasil uma de suas taxas mais elevadas. Acomete crianças e adolescentes, configurando-se como uma das principais doenças crônicas nesse período da vida. As limitações às atividades físicas impostas pelos sintomas da doença afetam a qualidade de vida de seus portadores. A reflexão sobre os custos sociais e econômicos da doença, bem como diretrizes que fundamentem a consolidação de políticas públicas permitem concluir a necessidade de fontes de financiamento consistentes para os programas consolidados, particularmente no que tange a aquisição de medicamentos e incorporação da dinâmica de captação e acompanhamento sistemático de asmáticos pela atenção primária.

Asthma is characterized as a public health problem affecting individuals in all parts of the world. With a variable prevalence, in Brazil it has one of its highest rates. It affects children and adolescents, being indicated as one of the major chronic diseases in this period of life. The limitations imposed on physical activity by the symptoms of this disease affect the quality of life of its sufferers. Thinking about the social and economic costs of this disease, as well as guidelines underlying the consolidation of public policies, allows us to deduce the need for consistent funding sources for the consolidated programs, particularly with respect to obtaining medicines and incorporating the dynamics of containing and systematic monitoring of asthma by the primary care system.