ABSTRACT
OBJECTIVES: This study aimed to calculate the healthcare resource utilization and direct medical costs in patients with 2 subtypes of axial spondyloarthritis (axSpA) in a rheumatic care center in Colombia. METHODS: This is a retrospective cost-of-illness study. Patients with at least 1 medical consultation associated with an axSpA diagnosis between October 2018 and October 2019 were identified. Patients were classified as having radiographic (r-axSpA) or nonradiographic axSpA (nr-axSpA). Direct medical costs were calculated in Colombian pesos and expressed in American dollars using an exchange rate of 3263 Colombian pesos = 1 US dollar ($). Predictors of total direct costs were identified using a generalized linear model with gamma distribution and log-link. RESULTS: A total of 162 patients with a mean age of 49.6 years (± 13.7) were included in the study. Among these, 147 (90.7%) were considered as having r-axSpA and 15 (9.3%) nr-axSpA, with mean costs of $6600 (± 6203) and $843 (± 1135), respectively (P < .001). The total direct mean cost was calculated at $6067 (± 6144) per patient. Medication costs were the main driver of total costs (97.6%, $5921), with biologic disease-modifying antirheumatic drugs accounting for nearly 92.0% ($5582) of these costs. Rheumatologist (100%) and physiatrist (64.2%) visits were the most frequently used medical service. CONCLUSIONS: The economic burden associated with axSpA in the Colombian setting is substantial. There is a significant difference in direct medical costs between the r-axSpA and the nr-axSpA. Health policies aimed at the comprehensive management of nr-axSpA would have an important role in the reduction of the associated direct medical costs.
Subject(s)
Axial Spondyloarthritis , Spondylarthritis , Spondylitis, Ankylosing , Humans , Middle Aged , Spondylarthritis/diagnosis , Spondylarthritis/drug therapy , Spondylitis, Ankylosing/diagnosis , Spondylitis, Ankylosing/drug therapy , Colombia , Retrospective Studies , Delivery of Health CareABSTRACT
La tuberculosis (TBC) es una enfermedad infecciosa, crónica, causada por Mycobacterium tuberculosis y M. bovis. Reemerge como enfermedad epidémica en 1986, considerandose la epidemia concomitante de SIDA como factor contributivo importante. En la actualidad ha infectado a 1,7 millores de personas, con 8 millones de casos nuevos y 3 millones de muertes por año, siendo la principal causa de muerte en SIDA (más del 30 porciento). En Colombia, se notifican aproximadamente 10.000 casos nuevos/año, 8-30 porciento relacionados con VIH. El número de personas coinfectadas en toda el mundo se calcula en 5, 6 millones. EL VIH ataca directamente el mecanismo de defenza contra la TBC, lo que favorece la diseminación de la enfermedad. El riesgo de progresar la Tbc activa en los coinfectados es de 8 porciento por año, contra 0.2 porciento/año en los infectados solo por TBC. Este riesgo aumenta en pacientes PPD >5 mm, anérgicos o con CD4+ <200/ul. Las características clínicas de los pacientes coinfectados varía con el grado de inmunosupresión y tiempo de adquisición del M. tuberculosis. La PPD, radiografía de tórax y BK de esputo siguen siendo los pilares diagnosticos. Los pacientes coinfectados deben recibir el mejor tratamiento antituberculoso disponible. El esquema debe ser corto, supervisado estrictamente y basarse en: rinfanpicina, isoniazida, pirazinamida y estreptomicina o ethambutol. Se recomienda la profilaxis en áreas con alta prevalencia de TBC. La coinfección por VIH agrava la situación epidemiológica de la TBC, especialmente en paises en desarrollo. Existen pruebas de que la TBC agrava el curso de la infección por VIH
