[Costs of interventions for patients with chronic renal disease]. / Costos de intervenciones para pacientes con insuficiencia renal crónica.

INTRODUCTION: The results of a study which identified the cost of health interventions in the management of patients with chronic renal disease are presented. MATERIAL AND METHOD: The costing method was based on a consensus technique and the instrumentation of case management through the identification of the materials used and functions of production for the demand of each service solicited. The interventions included: peritoneal dialysis, hemodialysis, and renal transplant. RESULTS: The cost per event in U.S. dollars was $3.71, $57.95, and $8,778.32, respectively. The annual cost of case management was: Peritoneal Dialysis $5,643.07, Hemodialysis $9,631.60 and renal transplant $3,021.67. CONCLUSIONS: The information generated from the costs of the events differed considerably from the information that was generated by the annual cost of case management. These differences are significant for the design and evaluation of patterns for allocating resources.

[Cost-effectiveness of interventions for end-stage renal disease]. / Costo-efectividad de intervenciones para insuficiencia renal crónica terminal.

OBJECTIVE: The study reports the cost-effectiveness results of end-stage renal disease (ESDR) patients in Mexico in terms of years of life gained and quality of life and the economic cost with regards to three treatment alternatives that could be considered mutually exclusive: continuous peritoneal ambulatory dialysis (CAPD), hemodialysis (HD) and renal transplant (RT). METHOD: The economic costs were calculated by using the average cost case-management methodology and further, the probable of life expectancy and the quality of life were cross-sectionally assessed by means of the Quality Adjusted Life Years (QALY) measured by the Rosser Index. RESULTS: The results show that economic costs in US$ of the three treatment alternatives were: CAPD $5,643.07, HD $9,631.60, and RT $3,021.63. The probability of life expectancy for CAPD and RT for the first and third year were: 86.2% and 66.9%, and 89.9% and 79.6%, respectively. The QALY scores for patients were: CAPD 0.8794, HD 0.8640, and RT 0.9783. CONCLUSION: The intervention with the highest cost-effectiveness coefficient was the renal transplant (3,088.69), followed by the CAPD (6,416.95) and HD (11,147.68). A significant difference was found between the transplanted patients and patients undergoing dialysis. Finally, this study concluded that the RT offers the least expensive alternative and the greatest number of years of life gained as well as providing significant changes in the quality of life of ESRD patients.

Changes in the quality of life of patients with end-stage renal disease treated with high-efficiency bicarbonate hemodialysis in Mexico.

In accordance with the epidemiological changes in Mexico, the results of this study are intended to contribute to the evaluation of the end-stage renal disease (ESRD) program of the health services in Mexico. We measured the quality of life of 21 ESRD patients before and after 6 months of exposure to treatment with high-efficiency hemodialysis with bicarbonate (HEHD/bicarbonate). We cross-sectionally assessed the Quality Adjusted Life Year (QALY) index and the biochemical status of the subject pool. The QALY score for patients undergoing HEHD/bicarbonate after 6 months was significantly higher than with the previous dialysis modality (0.95 and 0.74, respectively, p = 0.02). The marked similarities of the biochemical status variables indicated there was little or no effect in the improvement of the quality of life of patients. Dialysis modality likely exerts an important influence on the quality of life of chronic dialysis patients; thus we believe HEHD/bicarbonate does offer greater benefits than hemodialysis alone. Longitudinal studies are needed to better ascertain the effect of the case mix, the treatment approach, and the characteristics of the dialysis in relation to the improvement of the quality of life of ESRD patients.

Cost of diseases in Brazil: breast cancer, enteritis, cardiac valve disease and bronchopneumonia.

The results from the need to develop methodologies for performing cost analysis in developing countries, principally in the region of Latin America, were studied. It, furthermore, serves to generate knowledge from an economic evaluation in order to support decision-making related to the organization of health systems, particularly in the efficient use of resources which are allocated for the provision of medical services. Two chronic diseases (breast cancer and cardiac valve disease) and two infections (enteritis and bronchopneumonia) were selected for the study. The results recommend the use of a valid methodology for economic cost analysis of any disease to be studied and the use of this information in the decision-making process.

[An approach to the study of health services costs in Mexico]. / Una aproximación al estudio de costos de servicios de salud en México.

OBJECTIVE: To approach the cost analysis of the health services for eight tracer conditions, in three institutions of the public sector and in five of the private sector. MATERIAL AND METHODS: First, production functions and inputs required for standard case-management of each tracer condition were identified. Subsequently, tracer case-management was adjusted for each institution through expert consensus techniques. Once the type and amount of inputs necessary to produce tracer-specific health care services were identified, case-management costs were estimated. Tracer conditions were: hypertension, diabetes, diarrheas, pneumonia, appendicectomy, labor and delivery care, routine ambulatory medical care and vaccines. RESULTS: Results indicate significant differences with regards to the production of medical services between both sectors and within each one. CONCLUSIONS: The comparative analysis in the cost per case-management for each tracer presents differences that could be explained due to the quantitative and qualitative processes that characterized each institution in the combination of inputs to produce services and for the different costs of the inputs for each of the sectors analyzed, resulting in lower costs in the public sector and higher costs in the private sector, particularly for private health insurance.

Leukocytosis and natural killer cell function parallel neurobehavioral fatigue induced by 64 hours of sleep deprivation.

The hypothesis that sleep deprivation depresses immune function was tested in 20 adults, selected on the basis of their normal blood chemistry, monitored in a laboratory for 7 d, and kept awake for 64 h. At 2200 h each day measurements were taken of total leukocytes (WBC), monocytes, granulocytes, lymphocytes, eosinophils, erythrocytes (RBC), B and T lymphocyte subsets, activated T cells, and natural killer (NK) subpopulations (CD56/CD8 dual-positive cells, CD16-positive cells, CD57-positive cells). Functional tests included NK cytotoxicity, lymphocyte stimulation with mitogens, and DNA analysis of cell cycle. Sleep loss was associated with leukocytosis and increased NK cell activity. At the maximum sleep deprivation, increases were observed in counts of WBC, granulocytes, monocytes, NK activity, and the proportion of lymphocytes in the S phase of the cell cycle. Changes in monocyte counts correlated with changes in other immune parameters. Counts of CD4, CD16, CD56, and CD57 lymphocytes declined after one night without sleep, whereas CD56 and CD57 counts increased after two nights. No changes were observed in other lymphocyte counts, in proliferative responses to mitogens, or in plasma levels of cortisol or adrenocorticotropin hormone. The physiologic leukocytosis and NK activity increases during deprivation were eliminated by recovery sleep in a manner parallel to neurobehavioral function, suggesting that the immune alterations may be associated with biological pressure for sleep.