ABSTRACT
OBJECTIVE: To assess cost-effectiveness of antifungal treatment on patients with persistent fever neutropenia: empiric antifungal therapy (EAT) vs. anticipated antifungal therapy (AAT). METHODS: A decision model was performed to evaluate the cost-effectiveness of antifungal treatment strategies in patients with febrile neutropenia not responding to a broad spectrum antibiotic treatment. The strategies included were: 1) EAT with amphotericin B deoxycholate; 2) EAT with liposomal amphotericin B; 3) EAT with caspofungin; and 4) AAT with voriconazole and amphotericin B deoxycholate or liposomal amphotericin B or caspofungin in patients who initiate treatment despite having negative CT scan and galactomannan or fail to voriconazole. Effectiveness was measured as the number of deaths averted. Cost-effectiveness and incremental cost-effectiveness ratios were calculated. Deterministic and probabilistic sensitivity analyzes were performed. RESULTS: EAT with Amphotericin B deoxycholate was the least expensive and least effective strategy. The EAT with caspofungin was the most effective. The cost per death averted for caspofungin when compared with amphotericin B deoxycholate was $17,011,073.83, which would indicate that this strategy would be cost-effective for the country if the willingness to pay per death averted is equal to or greater than this value. EAT with liposomal amphotericin B and AAT with voriconazole were dominated by AET with caspofungin, which is less costly and more effective. CONCLUSIONS: EAT with caspofungin would be cost-effective for Colombia if the threshold per death averted is greater to $18.000.000. If the threshold is lesser the EAT with amphotericin B deoxycholate would be the election.
ABSTRACT
Antecedentes: El síndrome nefrótico es una de las manifestaciones más frecuentes de patología renal. No obstante, existen pocos estudios que lo relacionen con entidades histopatológicas específicas. Métodos: Este es un estudio observacional retrospectivo en el cual se analizaron las biopsias renales procesadas en el laboratorio de Patología de la Fundación Santa Fe de Bogotá remitidas para estudio de síndrome nefrótico y proteinuria en rango no nefrótico. Se analizaron 526 reportes distribuidos según el motivo de remisión, género, edad y diagnóstico histopatológico definitivo. Resultados: Existe una asociación estadísticamente significativa entre síndrome nefrótico y ciertas entidades, las cuales en su mayoría afectan la célula epitelial, mientras que la proteinuria en rango no nefrótico tiene asociación con patologías mediadas por complejos inmunes. Conclusión: Las asociaciones encontradas pueden ser un reflejo de mecanismos fisiopatológicos específicos, y pueden ser la base para futuros estudios
Introduction: Nephrotic syndrome is one of the most common signs of renal disease. However, there are few studies linking it with specific histopathological diagnosis. Materials and methods: This is a retrospective study based in the files of renal biopsies sent to the Pathology Laboratory in the Fundación Santa Fe de Bogotá with clinical diagnosis of nephrotic syndrome or proteinuria in non-nephrotic cases. A total of 526 reports taking in account gender, clinical diagnosis and definitive histopathological diagnosis were analyzed. Results: An statistically significant relationship between nephrotic syndrome and certain diseases, mostly those that affect the epithelial cell was found, while the proteinuria in non-nephrotic rank was associated with pathologies mediated by immune complexes. Conclusion: Associations found in the present study can be a sign of specific physiopathologic mechanisms, and also a base for future studies
