Impact of access to treatment on patient-reported outcomes among rheumatoid arthritis patients with tDMARDs and bDMARDS in two Latin-American countries: A prospective observational study.

Background and Aims: A noninterventional prospective study was performed in Colombia and Peru. The aim was to describe the impact of access to treatment on Patient-reported outcomes (PRO) in patients with Rheumatoid arthritis (RA) after failure to conventional disease-modifying antirheumatic drugs (DMARDs) in real-life conditions. Methods: The impact of access to treatment was measured by access barriers, time to supply (TtS) and interruption evaluating their effect in changes of PROs between baseline and 6-month follow-up between February 2017 and November 2019. The association of access to care with disease activity, functional status, health-related quality of life was assessed using bivariate and multivariable analysis. Results are expressed in least mean difference; TtS in mean number of days for delivery of treatment at baseline. Variability measures were standard deviation and standard error. Results: One hundred seventy patients were recruited, 70 treated with tofacitinib and 100 with biological DMARDs. Thirty-nine patients reported access barriers. The mean of TtS was 23 ± 38.83 days. The difference from baseline to 6-month visit in PROs were affected by access barriers and interruptions. There was not statistically significant difference in the of PRO's score among visits in patients that reported delay of supply of more than 23 days compared to patients with less days of delay. Conclusion: This study suggested the access to treatment can affect the response to the treatment at 6 months of follow-up. There seems to be no effect in the PROs for delay of TtS during the studied period.

The starch-deficient plastidic PHOSPHOGLUCOMUTASE mutant of the constitutive crassulacean acid metabolism (CAM) species Kalanchoë fedtschenkoi impacts diel regulation and timing of stomatal CO2 responsiveness.

BACKGROUND AND AIMS: Crassulacean acid metabolism (CAM) is a specialized type of photosynthesis characterized by a diel pattern of stomatal opening at night and closure during the day, which increases water-use efficiency. Starch degradation is a key regulator of CAM, providing phosphoenolpyruvate as a substrate in the mesophyll for nocturnal assimilation of CO2. Growing recognition of a key role for starch degradation in C3 photosynthesis guard cells for mediating daytime stomatal opening presents the possibility that starch degradation might also impact CAM by regulating the provision of energy and osmolytes to increase guard cell turgor and drive stomatal opening at night. In this study, we tested the hypothesis that the timing of diel starch turnover in CAM guard cells has been reprogrammed during evolution to enable nocturnal stomatal opening and daytime closure. METHODS: Biochemical and genetic characterization of wild-type and starch-deficient RNAi lines of Kalanchoë fedtschenkoi with reduced activity of plastidic phosphoglucomutase (PGM) constituted a preliminary approach for the understanding of starch metabolism and its implications for stomatal regulation in CAM plants. KEY RESULTS: Starch deficiency reduced nocturnal net CO2 uptake but had negligible impact on nocturnal stomatal opening. In contrast, daytime stomatal closure was reduced in magnitude and duration in the starch-deficient rPGM RNAi lines, and their stomata were unable to remain closed in response to elevated concentrations of atmospheric CO2 administered during the day. Curtailed daytime stomatal closure was linked to higher soluble sugar contents in the epidermis and mesophyll. CONCLUSIONS: Nocturnal stomatal opening is not reliant upon starch degradation, but starch biosynthesis is an important sink for carbohydrates, ensuring daytime stomatal closure in this CAM species.

Cost Effectiveness of Tofacitinib for the Treatment of Moderate to Severe Active Ulcerative Colitis in Colombia.

OBJECTIVE: The aim of this study was to evaluate the cost effectiveness of tofacitinib versus other treatment options currently available in Colombia in naïve to biologics (first-line) and exposed to biologics (second-line) patients with moderate to severe active ulcerative colitis (UC). METHODS: A Markov model was constructed with 8-week cycles, simulating a cohort of patients in a 5-year time horizon. The health states included remission, treatment response, active UC, and colectomy. The transition probabilities for the induction and maintenance phase were obtained from a network meta-analysis, and effectiveness was measured using quality-adjusted life-years (QALYs). Unit costs were derived from official national sources. RESULTS: For first line, the incremental cost-effectiveness ratio (ICER) per QALY was $883 for tofacitinib and $3619 for infliximab, compared with adalimumab. Sensitivity analysis showed that tofacitinib is cost effective in 45% of the iterations, adalimumab in 5%, and infliximab in 50%. Meanwhile, the ICER of adalimumab was $14,927 compared with tofacitinib in second-line treatment. In the sensitivity analysis, tofacitinib was cost effective in 64% of the iterations, followed by adalimumab in 36%. Infliximab and golimumab were not included due to data limitations in the network meta-analysis of second-line treatment. CONCLUSION: The analysis suggests that in Colombia, treatment with tofacitinib for patients with moderate-to-severe UC is a cost-effective option in both lines compared with other treatment options.

Effectiveness of Telemedicine Compared with Standard Care for Patients with Rheumatic Diseases: A Systematic Review.

Objective: The aim of this study was to systematically review the evidence on the effectiveness of telemedicine compared to standard care for patients with rheumatic diseases. Methods: A search was performed in MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews; for the gray literature, GREYNET databases and a snowball search were used. MeSH or Emtree terms. Three authors independently selected systematic reviews, randomized controlled trail (RCTs), or non-RCTs with patients with autoimmune or inflammatory rheumatic diseases, where telemedicine was compared with standard care. Effectiveness was measured in terms of disease activity, quality of life, and functional activity. The patients' satisfaction was also measured. The risk of bias was assessed by the Cochrane collaboration tool for RCTs and AMSTAR II for systematic reviews. Results: Four RCTs, one cross-out study, and five systematic reviews were included. The studies were conducted with rheumatoid arthritis patients, and one study involved patients with systematic lupus erythematosus. The interventions mainly involved teleconsultation and telemonitoring, with patient-reported outcomes (PROs) being compared with standard care. Four studies measured the effectiveness of telemedicine using PROs, in which three of the RCTs did not find differences in the clinical outcomes, and one found that telemedicine improved the remission of diseases, functional impairment, and radiographic joint damage progression. Two studies measured patient satisfaction with telemedicine and standard care without a significant difference between the groups. Conclusions: Despite heterogeneity between studies, the findings were remarkably consistent in demonstrating that there was no significant difference between the telemedicine group and the control group in terms of PROs and patient satisfaction. Patients should be offered the option of telemedicine to manage their diseases as part of health-care support. Further research is needed on the effectiveness of telemedicine in the long term for patients with rheumatic diseases.

The origin and evolution of stomata.

The acquisition of stomata is one of the key innovations that led to the colonisation of the terrestrial environment by the earliest land plants. However, our understanding of the origin, evolution and the ancestral function of stomata is incomplete. Phylogenomic analyses indicate that, firstly, stomata are ancient structures, present in the common ancestor of land plants, prior to the divergence of bryophytes and tracheophytes and, secondly, there has been reductive stomatal evolution, especially in the bryophytes (with complete loss in the liverworts). From a review of the evidence, we conclude that the capacity of stomata to open and close in response to signals such as ABA, CO2 and light (hydroactive movement) is an ancestral state, is present in all lineages and likely predates the divergence of the bryophytes and tracheophytes. We reject the hypothesis that hydroactive movement was acquired with the emergence of the gymnosperms. We also conclude that the role of stomata in the earliest land plants was to optimise carbon gain per unit water loss. There remain many other unanswered questions concerning the evolution and especially the origin of stomata. To address these questions, it will be necessary to: find more fossils representing the earliest land plants, revisit the existing early land plant fossil record in the light of novel phylogenomic hypotheses and carry out more functional studies that include both tracheophytes and bryophytes.

Phosphorolytic degradation of leaf starch via plastidic α-glucan phosphorylase leads to optimized plant growth and water use efficiency over the diel phases of Crassulacean acid metabolism.

In plants with Crassulacean acid metabolism (CAM), it has been proposed that the requirement for nocturnal provision of phosphoenolpyruvate as a substrate for CO2 uptake has resulted in a re-routing of chloroplastic starch degradation from the amylolytic route to the phosphorolytic route. To test this hypothesis, we generated and characterized four independent RNAi lines of the obligate CAM species Kalanchoë fedtschenkoi with a >10-fold reduction in transcript abundance of plastidic α-glucan phosphorylase (PHS1). The rPHS1 lines showed diminished nocturnal starch degradation, reduced dark CO2 uptake, a reduction in diel water use efficiency (WUE), and an overall reduction in growth. A re-routing of starch degradation via the hydrolytic/amylolytic pathway was indicated by hyperaccumulation of maltose in all rPHS1 lines. Further examination indicated that whilst operation of the core circadian clock was not compromised, plasticity in modulating net dark CO2 uptake in response to changing photoperiods was curtailed. The data show that phosphorolytic starch degradation is critical for efficient operation of the CAM cycle and for optimizing WUE. This finding has clear relevance for ongoing efforts to engineer CAM into non-CAM species as a means of boosting crop WUE for a warmer, drier future.

Crassulacean acid metabolism (CAM) supersedes the turgor loss point (TLP) as an important adaptation across a precipitation gradient, in the genus Clusia.

As future climates continue to change, precipitation deficits are expected to become more severe across tropical ecosystems. As a result, it is important that we identify plant physiological traits that act as adaptations to drought, and determine whether these traits act synergistically or independently of each other. In this study, we assessed the role of three leaf-level putative adaptations to drought: crassulacean acid metabolism (CAM), the turgor loss point (TLPΨ) and water storage hydrenchyma tissue. Using the genus Clusia as a model, we were able to explore the extent to which these leaf physiological traits co-vary, and also how they contribute to species' distributions across a precipitation gradient in Central and South America. We found that CAM is independent of the TLPΨ and hydrenchyma depth in Clusia. In addition, we provide evidence that constitutive CAM is an adaptation to year-long water deficits, whereas facultative CAM appears to be more important for surviving acute dry seasons. Finally, we find that the other leaf traits tested did not correlate with environmental precipitation, suggesting that the reduced transpirational rates associated with CAM obviate the need to adapt the TLPΨ and hydrenchyma depth in this genus.

Evaluation of Treatment Patterns and Direct Costs Associated with the Management of Neuropathic Pain.

Background: Neuropathic pain has a prevalence of 2-17% in the general population. Diagnosis and treatment of neuropathic pain are not fully described in different populations. The aim was to determine the treatment patterns and direct costs of care associated with the management of neuropathic pain from the onset of the first symptom to up to two years after diagnosis. Methods: From a drug-claim database, a cohort of randomly selected outpatients diagnosed with neuropathic pain was obtained from an insurer in Colombia and followed up for two years after diagnosis. The clinical records were reviewed individually to identify the study variables, including the time needed to make the diagnosis, the medical and paraclinical resources used, the pharmacological therapy for pain management, and the direct costs associated with care. Results: We identified 624 patients in 49 cities, with a mean age of 50.3 ± 14.1 years, of which 324 were men (51.9%). An average of 90 days passed from the initial consultation until the diagnosis of neuropathic pain, the most frequent being lumbosacral radiculopathy (57.9%). 34.5% of the cohort had at least one diagnostic imaging procedure, and 16% had an electromyography. On average, they were treated by a general practitioner twice. 91.7% received initial treatment with tramadol, carbamazepine, amitriptyline, imipramine, or pregabalin, and 60.4% received combined therapy. The mean cost of care for two years for each patient was US$246.3. Conclusions: Patients with neuropathic pain in Colombia are being diagnosed late, are using therapeutic agents not recommended as first-line treatment by clinical practice guidelines, and are being treated for short periods of time.

Peeling back the layers of crassulacean acid metabolism: functional differentiation between Kalanchoë fedtschenkoi epidermis and mesophyll proteomes.

Crassulacean acid metabolism (CAM) is a specialized mode of photosynthesis that offers the potential to engineer improved water-use efficiency (WUE) and drought resilience in C3 plants while sustaining productivity in the hotter and drier climates that are predicted for much of the world. CAM species show an inverted pattern of stomatal opening and closing across the diel cycle, which conserves water and provides a means of maintaining growth in hot, water-limited environments. Recent genome sequencing of the constitutive model CAM species Kalanchoë fedtschenkoi provides a platform for elucidating the ensemble of proteins that link photosynthetic metabolism with stomatal movement, and that protect CAM plants from harsh environmental conditions. We describe a large-scale proteomics analysis to characterize and compare proteins, as well as diel changes in their abundance in guard cell-enriched epidermis and mesophyll cells from leaves of K. fedtschenkoi. Proteins implicated in processes that encompass respiration, the transport of water and CO2 , stomatal regulation, and CAM biochemistry are highlighted and discussed. Diel rescheduling of guard cell starch turnover in K. fedtschenkoi compared with that observed in Arabidopsis is reported and tissue-specific localization in the epidermis and mesophyll of isozymes implicated in starch and malate turnover are discussed in line with the contrasting roles for these metabolites within the CAM mesophyll and stomatal complex. These data reveal the proteins and the biological processes enriched in each layer and provide key information for studies aiming to adapt plants to hot and dry environments by modifying leaf physiology for improved plant sustainability.

Undervalued potential of crassulacean acid metabolism for current and future agricultural production.

The potential for crassulacean acid metabolism (CAM) to support resilient crops that meet demands for food, fiber, fuel, and pharmaceutical products far exceeds current production levels. This review provides background on five families of plants that express CAM, including examples of many species within these families that have potential agricultural uses. We summarize traditional uses, current developments, management practices, environmental tolerance ranges, and economic values of CAM species with potential commercial applications. The primary benefit of CAM in agriculture is high water use efficiency that allows for reliable crop yields even in drought conditions. Agave species, for example, grow in arid conditions and have been exploited for agricultural products in North and South America for centuries. Yet, there has been very little investment in agricultural improvement for most useful Agave varieties. Other CAM species that are already traded globally include Ananas comosus (pineapple), Aloe spp., Vanilla spp., and Opuntia spp., but there are far more with agronomic uses that are less well known and not yet developed commercially. Recent advances in technology and genomic resources provide tools to understand and realize the tremendous potential for using CAM crops to produce climate-resilient agricultural commodities in the future.

Descripción del uso de ertapenem en un hospital público de alta complejidad en Medellín, Colombia / Description of the use of ertapenem in a high complexity public hospital in Medellin, Colombia

Objetivo: describir el uso de ertapenem y las características clínico-microbiológicas de los pacientes durante la admisión en centro de cuarto nivel de complejidad en Medellín, Colombia entre 2009 y 2012. Materiales y métodos: estudio descriptivo retrospectivo en pacientes que recibieron ertapenem como terapia antibiótica. Resultados: 1390 historias clínicas revisadas, 835 cumplieron criterios de selección. Ertapenem se usó un 36,9% para manejo de infecciones urinarias y 28,1% en infección intraabdominal principalmente; en 84% se realizó cultivo microbiológico y en 80% se aisló algún germen, entre ellos 42,5% E. coli, 24,3% K. pneumoniae y 5,8% P. mirabilis. Las cepas Beta Lactamasa de Espectro Extendido de E. coli y K. pneumoniae fueron 39,8% y 57% respectivamente. La susceptibilidad a ertapenem en E. coli fue de 96,6% y K. pneumoniae 94,4%. Conclusiones: ertapenem ofrece resultados clínicos favorablesen el manejo de infecciones urinarias e intraabdominales. Es una alternativa para el manejo empírico de infecciones de origen comunitario y como terapia dirigida en infecciones hospitalarias..(AU)

Objective: to describe the use of ertapenem along with the clinical and microbiological characteristics of patients during their admission to a fourth-level health care facility in Medellin, Colombia between 2009 and 2012. Materials and Methods: a descriptive retrospective study on patients that were given antibiotic therapy with ertapenem.Results: 1390 clinical charts were reviewed, selecting 835 according to selection criteria. Ertapenem was prescribed in 36,9% for urinary tract infections and 28,1% for intraabdominal infections; 60% of the patients were located on general wards at the time of treatment with ertapenem. Microbiological cultures were performed for 84% of patients and 80% of those were positive, with 42,5% E. coli, 24,3% K. pneumoniae and 5,8% P. mirabilis. Extended spectrum betalactamases were found in 39,8% of the E. coli and 57% K. pneumoniae strains. Susceptibility of E. coli strains to ertapenem was 96,6% and 94,4% for K. pneumoniae. Conclusions: ertapenem offers favorable results when used for the treatment of urinary tract and intraabdominal infections. It is an alternative for empirical management of infections acquired outside the hospital setting, and and as directed therapy in hospital infections..(AU)

Costo-efectividad de las estatinas para el tratamiento de dislipidemia en Colombia / Cost-effectiveness of statins for the treatment of dyslipidemia in Colombia

Objetivo: determinar la relación de costo-efectividad relativa de las estatinas entre sí en pacientes adultos con dislipidemia con predominio de hipercolesterolemia para la prevención de eventos cardiocerebrovasculares, en Colombia, desde la perspectiva del sistema de salud colombiano. Métodos: se construyó un modelo de Markov con años de vida ajustados por calidad (AVAC) ganados como desenlace principal, tasa de descuento de 3% tanto para costos como desenlaces, y cinco años de horizonte temporal. Probabilidades y costos se extrajeron de la literatura y de fuentes oficiales del país, respectivamente. El umbral de costo-efectividad fue tres veces el PIB per cápita de 2012. Se realizaron análisis de sensibilidad univariados, probabilísticos, umbral y curva de aceptabilidad. Resultados: el costo promedio del tratamiento con estatinas para un paciente con dislipidemia en cinco años es de $3 472 733. La ganancia en AVAC en rosuvastatina fue mayor con respecto a las otras estatinas; sin embargo, es la estrategia más costosa. La atorvastatina, que resultó segunda, es la más costo-efectiva. Conclusión: la intervención más costo-efectiva para pacientes con dislipidemia con predominio de hipercolesterolemia e indicación de manejo farmacológico con terapia moderada y alta con estatinas en Colombia es la atorvastatina. (Acta Med Colomb 2015; 40: 118-124).

Objective: to determine the relative cost-effectiveness among statins in adult patients with dyslipidemia with predominant hypercholesterolemia to prevent cardiocerebrovascular events in Colombia, from the perspective of Colombian health system. Methods: a Markov model with quality-adjusted life years (QALY) gained as the main outcome, discount rate of 3% for both costs and outcomes, and five-year time horizon was built. Probabilities and costs were extracted from the literature and from official sources in the country, respectively. The threshold for cost-effectiveness was three times the 2012 per capita GDP. Univariate probabilistic, sensitivity analysis, threshold and acceptability curve were performed. Results: the average cost of statin therapy for a patient with dyslipidemia in five years is $3 472 733. The QALY gain was higher in rosuvastatin compared to other statins, however, it is the most costly strategy. Atorvastatin, which was second, is the most cost-effective. Conclusion: the most cost-effective intervention for patients with dyslipidemia with predominant hypercholesterolemia and indication of pharmacological management with moderate and high statin therapy in Colombia is atorvastatin. (Acta Med Colomb 2015; 40: 118-124).

[Cost-effectiveness analysis (CEA) regarding vitamin A in children aged less than 5 years-old in Colombia]. / Análisis de costo efectividad de la vitamina A en niños menores de 5 años en Colombia.

OBJECTIVE: Evaluating the relative cost-effectiveness of using vitamin A in children aged less than 5-years-old regarding the reduction of events involving diarrhoea, malaria and mortality from the Colombian health-related social security system (CHSSS). MATERIALS AND METHODS: A decision tree was constructed, using deaths averted as outcome. Probabilities were taken from the pertinent literature and costs from official sources. The cost-effectiveness threshold was three times greater than the per capita Colombian gross domestic product (GDP) in 2012. Probabilistic and deterministic sensitivity analyses were made and cost effectiveness acceptability curves were drawn. RESULTS: Providing a cohort of 100,000 children with vitamin A (as opposed to not doing so) would represent a saving regarding medical attention costs of $ 340,306,917 due to the number of events involving diarrhea (4,268) and malaria (76), having become reduced, as well as cases requiring hospitalization. A saving for the CHSSS was consistently obtained in sensitivity analysis. CONCLUSION: Providing vitamin supplements for children aged less than 5 years-old would seem to be the least costly and most effective (dominant) strategy for the CHSSS, i.e. compared to not doing so).

Validez diagnóstica de los volúmenes pulmonares por pletismografía para el diagnóstico clínico y el seguimiento de la fibrosis pulmonar idiopática / Diagnostic validity of lung volumes by plethysmography for clinical diagnosis and follow-up of idiopathic pulmonary fibrosis

INTRODUCCIÓN: La fibrosis pulmonar idiopática es definida como una forma de neumonía intersticial crónica, progresiva, de causa desconocida, limitada a los pulmones, la cual se presenta principalmente en adultos mayores de 65 años. El diagnóstico de la enfermedad incluye la presencia de un patrón radiológico compatible con neumonía intersticial o hallazgos histopatológicos compatibles con neumonía intersticial usual y la exclusión de: enfermedades ocupacionales, toxicidad por drogas o enfermedades del colágeno que puedan producir enfermedad intersticial. La determinación de los volúmenes pulmonares por pletismografía permite identificar la presencia de trastornos restrictivos y la gravedad de estos en los estados patológicos del pulmón. OBJETIVO: Determinar la validez de la medición de los volúmenes pulmonares por pletismografía como apoyo del proceso diagnóstico de la fibrosis pulmonar idiopática y como medida del seguimiento de la progresión de la enfermedad. MÉTODOS: Dos estudios fueron incluidos, estos evaluaban pacientes con fibrosis pulmonar idiopática en los que se realizaron volúmenes pulmonares por pletismografía y se correlacionaron los datos de CPT con la tasa de sobrevida, la progresión de la enfermedad y las exacerbaciones. Se encontró que la media de sobrevida de estos pacientes es de 36 meses proximadamente y se asocia a bajos niveles de capacidad vital forzada y capacidad pulmonar total entre otros. Adicionalmente que pacientes con una reducción combinada de CPT y CV por debajo de los valores predichos presentan un deterioro restrictivo de la función pulmonar y un reducción de la sobrevida. CONCLUSIONES: La medición de los volúmenes pulmonares es un método complementario a la espirometría para determinar las capacidades y volúmenes pulmonares que ayudan a definir la gravedad de las alteraciones obstructivas, restrictivas o ambas, que está comprometiendo al paciente. La evidencia existente no soporta su efectividad en la confirmación diagnóstica de la fibrosis pulmonar idiopática, para la cual existen otras pruebas de mayor utilidad diagnóstica y tampoco soporta su como método de seguimiento de la progresión de la enfermedad.(AU)

Validez diagnóstica de la detección de anticuerpos anti-acuaporina 4 (AQP4) para el diagnóstico clínico de neuromielitis óptica (NMO) / Diagnostic validity of the detection of anti-aquaporin 4 antibodies (AQP4) for the clinical diagnosis of optic neuromyelitis (NMO)

Introducción: La neuromielitis óptica (NMO) es un trastorno autoinmune inflamatorio del sistema nervioso \r\ncentral (SNC) que hasta hace poco se consideraba parte del espectro de la esclerosis múltiple (EM). Sinembargo, desde la identificación del anticuerpo anti-NMO se diferenció de otras enfermedades esmielinizantes; la detección del anticuerpo es ahora un factor determinante para el adecuado diagnóstico de NMO. Objetivo: Confirmar la validez diagnóstica de la detección de los anti-NMO para un adecuado diagnóstico de NMO. Métodos: Se realizó una búsqueda sistemática de la literatura para encontrar cuál es la efectividad en \r\nel diagnóstico clínico de los anti-NMO y las distintas pruebas inmunológicas que existen para la detección de los mismos. Resultados: Se encontró que la detección de los anti-NMO es altamente específica y que en la actualidad existen 7 pruebas inmunológicas disponibles para su detección. Conclusiones: Se realizó un metanálisis con los resultados disponibles de la sensibilidad y especificidad de las pruebas de detección de anti-NMO y se encontró que la de mejores características operativas corresponden a la prueba basada en células.(AU)

Análisis de costo efectividad de la vitamina A en niños menores de 5 años en Colombia / Cost-effectiveness analysis (CEA) regarding vitamin A in children aged less than 5 years-old in Colombia

Objetivo evaluar la costo-efectividad relativa del uso de vitamina a en los niños menores de 5 años en la disminución de eventos de diarrea, malaria y la mortalidad, bajo la perspectiva del sistema de salud colombiano (SGSSS). Materiales y Métodos se construyó unárbol de decisión con muertes evitadas como desenlace. Las probabilidades se extrajeron de la literatura y los costos de fuentes oficiales. El umbral de costo-efectividad fue tres veces el producto interno bruto (PIB) per cápita colombiano de 2012. Se realizaron análisis de sensibilidad determinísticos, probabilísticos y curva de aceptabilidad. Resultados En una cohorte de cien mil niños, la administración de vitamina a, frente no hacerlo, representaría un ahorro en costos de atención médica de $ 340.306.917, debido a que reduce el número de eventos de diarrea (4.268) y de malaria (76), así como los casos en los que se requiere hospitalización. En todos los análisis de sensibilidad se obtuvo un ahorro para el sistema. Conclusión Dentro del sistema de salud colombiano, la suplementación con vitamina a para niños menores de 5 años, comparado con no hacerlo, es la estrategia menos costosa y más efectiva (dominante).

Objective Evaluating the relative cost-effectiveness of using vitamin A in children aged less than 5-years-old regarding the reduction of events involving diarrhoea, malaria and mortality from the Colombian health-related social security system (CHSSS). Materials and Methods A decision tree was constructed, using deaths averted as outcome. Probabilities were taken from the pertinent literature and costs from official sources. The cost-effectiveness threshold was three times greater than the per capita Colombian gross domestic product (GDP) in 2012. Probabilistic and deterministic sensitivity analyses were made and cost effectiveness acceptability curves were drawn. Results Providing a cohort of 100,000 children with vitamin A (as opposed to not doing so) would represent a saving regarding medical attention costs of $ 340,306,917 due to the number of events involving diarrhea (4,268) and malaria (76), having become reduced, as well as cases requiring hospitalization. A saving for the CHSSS was consistently obtained in sensitivity analysis. Conclusion Providing vitamin supplements for children aged less than 5 years-old would seem to be the least costly and most effective (dominant) strategy for the CHSSS, i.e. compared to not doing so).