Cost-Effectiveness of 20-Valent Pneumococcal Conjugate Vaccine in Argentinean Adults.

INTRODUCTION: In Argentina, vaccination with 13-valent pneumococcal conjugate vaccine (PCV13) followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23; PCV13 → PPSV23) has been recommended for all adults aged ≥ 65 years and younger adults with chronic medical ("moderate-risk") or immunocompromising ("high-risk") conditions since 2017. With the approval of a 20-valent PCV (PCV20), we evaluated the cost-effectiveness of PCV20 versus current recommendations for moderate-/high-risk adults aged 18-64 years and all adults 65-99 years. METHODS: A probabilistic cohort model was used to project lifetime outcomes and costs associated with invasive pneumococcal disease (IPD) and all-cause non-bacteremic pneumonia (NBP), and the expected impact of vaccination. Clinical outcomes were projected annually based on Argentinean data. Economic costs were estimated based on cases and corresponding medical costs (adjusted to 2023 USD) and costs of vaccine and administration. Cost-effectiveness of PCV20 was evaluated versus the current strategy, PCV13 → PPSV23, and alternatively, versus sequentially administered 15-valent PCV and PPSV23 (PCV15 → PPSV23), and presented as cost per quality-adjusted life year gained; a healthcare system perspective was used. Costs and benefits were discounted at 3%/year. RESULTS: PCV20 in lieu of PCV13 → PPSV23 among moderate-/high-risk adults aged 18-64 years and all adults 65-99 years (N = 13.4M) prevented 3838 IPD, 4377 inpatient NBP, and 6003 outpatient NBP cases, and 1865 disease-related deaths; relative to PCV15 → PPSV23 the corresponding reductions were 2775, 3285, 4518, and 1348. PCV20 was projected to be the dominant strategy versus PCV13 → PPSV23 and PCV15 → PPSV23 as overall costs were lower by $87.6M and $80.8M, respectively. In probabilistic sensitivity analyses, PCV20 was dominant (i.e., more effective, less costly) in 100% of 1000 simulations. CONCLUSIONS: Analyses suggest implementing a PCV20 vaccination program in moderate-/high-risk adults aged 18-64 years and all adults ≥ 65 years-in lieu of PCV13 → PPSV23-would yield substantial reductions in pneumococcal disease and would be cost saving to the Argentinean healthcare system.

Pneumococcal pneumonia has a high disease burden in both children and adults. Older adults and those with certain underlying conditions are more susceptible to severe pneumococcal disease resulting in considerable economic burden on the healthcare system. In Argentina, vaccination with 13-valent pneumococcal conjugate vaccine (PCV13) followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23) a year later is recommended for all adults aged ≥ 65 years and adults aged 18­64 years with underlying risk conditions. Despite vaccination efforts, prevalence of pneumococcal disease remains high. Two higher-valent PCVs­15-valent PCV (PCV15) and 20-valent PCV (PCV20)­are available for use in adults with PCV20 offering additional serotype coverage. This study assessed the cost-effectiveness of replacing current (PCV13 → PPSV23) and alternative (PCV15 → PPSV23) vaccination strategies with PCV20 alone. The use of PCV20 was evaluated among Argentinean adults aged 18­64 years with underlying risk conditions and all adults aged 65­99 years (N = 13 million). Over a lifetime time horizon, compared to PCV13 → PPSV23, PCV20 use would avert 14,218 cases and 1865 deaths, and increase quality-adjusted life years by 8655. Compared to PCV15 → PPSV23, PCV20 reduced cases and deaths by 10,578 and 1348, respectively, and increased quality-adjusted life years by 6341. In both comparisons, PCV20 use was cost saving with $87.6 million and $80.8 million lower costs compared to PCV13 → PPSV23 and PCV15 → PPSV23, respectively. Results of the cost-effectiveness analyses suggest that the use of PCV20 is a cost-saving strategy, reducing overall costs to the healthcare system and improving public health.

Adherencia al tratamiento farmacológico en esquizofrenia / Adherence to pharmacological treatment in schizophrenia

INTRODUCCIÓN La esquizofrenia es un trastorno crónico que requiere de tratamiento farmacológico con antipsicóticos a largo plazo siendo uno de los principales problemas la no-adherencia de los pacientes a la medicación. OBJETIVOS Estimar la prevalencia local, factores asociados y costos directos de la no adherencia al tratamiento farmacológico en pacientes con esquizofrenia. MÉTODOS Se realizó un estudio multicéntrico de tipo observacional, analítico, longitudinal y prospectivo y se empleó como herramienta para cuantificar adherencia el cuestionario de Morisky-Green. RESULTADOS Un total de 118 pacientes fueron evaluados, 89 pacientes fueron incluidos en la cohorte y 72 finalizaron el período de 3 meses de seguimiento. Al momento del alta de los 89 pacientes evaluados 32 (36%) no presentaban adherencia. Las variables asociadas a la no adherencia al momento del alta fueron; (1) la falta de cobertura del sistema de salud (p=0.04); (2) la severidad de la enfermedad determinado por la PANSS (p=0.01); (3) el deterioro cognitivo (p=0.04); (4) la cantidad de tomas diarias de medicación (p<0.001) y (5) el consumo de alcohol (p=0.02). Se estimó un Odds Ratio (OR) para la asociación entre el consumo del alcohol y la no adherencia de 3,82 (IC 95%;1,53-9,52). A los 3 meses de la externación, 41,7% de los pacientes perdieron la adherencia. Las variables asociadas a la pérdida de la adherencia fueron; (1) la menor edad (p=0.04) y (2) la menor duración de la enfermedad (p=0.01). Durante el seguimiento, se perdieron los pacientes con mayor severidad de la enfermedad. Los costos directos relacionados a la re-internación por pérdida de adherencia fueron ARS24.000, aproximadamente ARS10.000 más que las re-internaciones por otras causas. DISCUSIÓN La falta de adherencia al tratamiento farmacológico es un problema de alta prevalencia a nivel local. El alcoholismo es un factor asociado importante pero no es el único. En el seguimiento prospectivo, los más jóvenes y con menos años de enfermedad pierden adherencia pero no se pueden excluir otros factores ya que durante el seguimiento se pierden los pacientes más severos. El costo directo de las re-internaciones por mala adherencia duplica los costos de re-internaciones por otras causas

Major depression in hospitalized Argentine general medical patients: Prevalence and risk factors.

BACKGROUND: Depression is not uncommon among medically hospitalized patients, though reported prevalence has varied widely, often in samples involving elderly patients with particular illnesses. Accordingly, we evaluated risk of major depression in three metropolitan general hospitals in Buenos Aires, in subjects with a range of medical disorders and ages, comparing several standard screening methods to expert clinical examinations. METHODS: Consecutively hospitalized general medical patients were evaluated over a six-months. Excluded were subjects under age 18 and those unable to participate in assessments because of illness, medication, sensory or speech impairment, or lack of language fluency, or scored <25 on the Mini Mental State Examination (MMSE). Consenting participants were examined for DSM-IV-TR major depression by psychiatrists guided by MINI examinations, compared with other standard screening methods. Risk factors were assessed by preliminary bivariate analyses followed by multivariate logistic regression modeling. RESULTS: Overall prevalence of major depression in 257 subjects was 27% by psychiatric examination. The rate was most similar (25%) with the Hospital Anxiety & Depression Scale (HADS), and much higher with the Beck Depression Inventory-II (BDI, 44%) and Patient Health Questionnaire (PHQ, 56%). Factors associated independently with depression by multivariate modeling included: prior psychotropic-drug treatment, female sex, more children, and heavy smoking. Depression was associated most with neoplastic, urological, and infectious disorders, least with pulmonary, neurological, and hematologic conditions. LIMITATIONS: Modest numbers limited power to test for associations of depression with specific medical conditions. CONCLUSIONS: Major depression was identified in over one-quarter of Argentine, general medical inpatients, with marked differences among screening methods. Several risk factors were identified. The findings encourage assertive identification of depression in hospitalized medical patients using valid, reliable, and cost-effective means of improving their care.

[Budgetary impact analysis in health: update with a model using a generic approach]. / El análisis de impacto presupuestario en salud: puesta al día con un modelo de abordaje genérico.

Budgetary Impact Analysis (BIA) applied to health care can be defined as the estimate of the net financial costs that a given intervention would represent for a health care institution given the case it was covered. Routinely, BIAs are used to decide the inclusion or exclusion of drugs in therapeutic schemes; actually, the increased use of BIAs have raised awareness about the fact that health economic evaluations represent a partial view in the analysis of the consequences of incorporating health technologies. This paper seeks to identify the determinants and components of BIA, and to describe the development of a spreadsheet model that enables us to assess the Budget impact of any health technology and perform estimations with differing degrees of complexity. Its design explicitly adapts to the user skills and gaps in information, thus seeking to promote the development of these tools in the management fields in our countries.

El análisis de impacto presupuestario en salud: puesta al día con un modelo de abordaje genérico / Budgetary impact analysis in health: update with a model using a generic approach

El Análisis de Impacto Presupuestario (AIP) en el campo de la salud puede ser definido como la estimación de los costos financieros netos que le representarían a una institución dar cobertura a una determinada intervención. En la práctica, los AIP se utilizan frecuentemente para decidir la inclusión o exclusión de medicamentos en formularios terapéuticos y notoriamente han obligado a reconocer que las Evaluaciones Económicas representan una mirada parcial en el análisis de las consecuencias de la incorporación de tecnologías sanitarias. Este trabajo procura identificar los determinantes y componentes de los análisis de impacto presupuestario, y a partir de ello describir el desarrollo de un modelo creado en una planilla de cálculo que permite considerar cualquier tecnología sanitaria y obtener estimaciones con diferentes grados de complejidad. Su diseño incorpora de forma explícita las habilidades del usuario y las deficiencias de información, buscando a su vez promover el desarrollo de estas herramientas en los ámbitos de gestión de nuestros países.

Budgetary Impact Analysis (BIA) applied to health care can be defined as the estimate of the net financial costs that a given intervention would represent for a health care institution given the case it was covered. Routinely, BIAs are used to decide the inclusion or exclusion of drugs in therapeutic schemes; actually, the increased use of BIAs have raised awareness about the fact that health economic evaluations represent a partial view in the analysis of the consequences of incorporating health technologies. This paper seeks to identify the determinants and components of BIA, and to describe the development of a spreadsheet model that enables us to assess the Budget impact of any health technology and perform estimations with differing degrees of complexity. Its design explicitly adapts to the user skills and gaps in information, thus seeking to promote the development of these tools in the management fields in our countries.