The Triglycerides and Glucose Index: A Cost-Effectiveness Analysis Compared With the Homeostatic Model Assessment for Insulin Resistance.

OBJECTIVES: This study aimed to evaluate the cost-effectiveness of the triglycerides and glucose index (TyG) versus the homeostatic model assessment for insulin resistance index (HOMA-IR) for diagnosing insulin resistance. METHODS: A cost-effectiveness analysis using a decision tree based on the false-negative and false-positive tests and the true-positive and true-negative tests of both the TyG and HOMA-IR was conducted. Based on the costs and effectiveness of both tests, the average and incremental cost-effectiveness ratios were calculated. Furthermore, one-way sensitivity analysis was conducted regarding sensitivity of both indexes. Using the Monte Carlo simulation with 10 000 iterations, a probabilistic sensitivity analysis that included sensitivity, specificity, and cost of diagnostic tests was conducted. Finally, using the α and ß values obtained from the primary data, the beta distribution was used for estimation of sensitivity and specificity. RESULTS: The cost-effectiveness per test was $1.64 versus $4.26 for TyG and HOMA-IR. The effectiveness of true-positive (0.77 vs 0.74) and true-negative (0.17 vs 0.15) tests was higher for the TyG than HOMA-IR. The cost-effectiveness ratio was lower for the TyG than the HOMA-IR, for both the true-positive ($1.64 vs $4.26) and true-negative ($7.33 vs $20.70) tests. Diagnosing IR using the TyG was 61.5% lower than using the HOMA-IR. CONCLUSIONS: Our findings indicate that the TyG is a high effectiveness and cost-effective test for diagnosing insulin resistance than the HOMA-IR.

Cost-effectiveness analysis of using oral magnesium supplementation in the treatment of prediabetes.

INTRODUCTION: Evidence from clinical trials supports the efficacy of oral magnesium supplementation in the treatment of glucose-related disorders. Thus, we evaluate the cost-effectiveness of using oral magnesium chloride (MgCl2) in prediabetes treatment. METHODS: A cost-effectiveness analysis was performed. For such purpose, we used original information from a randomized controlled clinical trial. Analysis was carried out based on a health services provider perspective, a 10-year time horizon, and 3% discount rate for costs and effectiveness. Taking into account risk factor profiles, a Markov micro-simulation model was used, and a probabilistic sensibility analysis was performed. RESULTS: The oral MgCl2 was dominant with lower cost and greater effectiveness as compared with placebo. As compared with placebo, 22.3% and 22.0% of men using MgCl2 did not develop diabetes or cardiovascular disease. The cost per person of using MgCl2 as compared with placebo, in the individuals without complications, was $2206 versus $4048 USD for men, and $1984 versus $3272 USD for women. The sensitivity analysis confirmed the robustness of the base case. CONCLUSIONS: Our results suggest that using oral MgCl2 for at least 4 months, in adults with prediabetes and hypomagnesemia, is a cost-effective option for reducing complications and direct medical costs.

Socioeconomic factors associated with drug consumption in Mexico.

BACKGROUND: Illicit drug consumption in Mexico has been growing constantly and has begun to be a public health problem. The aim of this study is to identify the principal characteristics and socioeconomic variables associated with consumption of illegal drugs in Mexico. METHODS: Using information from the 2016 national addictions survey in Mexico, we develop a logistic regression model to determine the variables associated with drug consumption, sometime in lifetime or recently, in the general population of Mexico. RESULTS: Analyzing information from 56,877 persons, the prevalence of the use of illicit drugs at least once in lifetime was 15.4% and 3.6% for males and females, respectively. The variables associated with more consumption of illegal drugs was utilization of substances with alcohol (RR 9.3; 95% CI 7.9-10.8) and nicotine products (RR 4.7; 95% CI 4.3-5.1), male gender (RR 2.6; 95% CI 2.4-2.8), and relatives' drug consumption (RR 2.1; 95% CI 1.8-2.4). CONCLUSIONS: Having more education, being older, and having a partner was associated with lower illicit drug consumption sometime in lifetime; in the case of recent consumption, in addition, having a job or active child-rearing in the house in a positive sense.

Avoidable Hospitalization Trends From Ambulatory Care-Sensitive Conditions in the Public Health System in México.

OBJECTIVES: To estimate and identify the variations in rates of Avoidable Hospitalization for Ambulatory Care Sensitive Conditions (AH-ACSC) in public institutions of the Mexican health system during the period 2010-2017. METHODS: Secondary analysis of the hospital discharge database of the Ministry of Health (MoH) from 2010 to 2017. AH for ACSC was calculated by age group and sex per 100,000. Variations per year between institutions were calculated with the extreme quotient (EQ), coefficient of variation (CV) and systematic component of variance (SCV). Adjusted AH rates were calculated by group of causes (acute, chronic and preventable by vaccination). Adjusted AH trend rates were analyzed by Join Point Regression. RESULTS: For the period 2010-2017, the number of AH for ACSC decreased from 676,705 to 612,897, going from almost 13% to 10.7% of hospital discharges. There is consistency in terms of relative variance magnitude. But, with regards to SCV, the change remained constant, and in a second period of 2015-2017, high variation was observed by SCV ≥ 3. All-cause AH is diminishing in all institutions. AH rates for diabetes are the highest, but like other chronic diseases, there was a decline in the period from 2010 to 2017. The relative reduction varied from 15% for heart failure to 38% for complications from diabetes or hypertension, to 75% for angina. CONCLUSIONS: AH for ACSC is an indirect indicator of quality and access to first-level care. Variations by institutions are observed. This variation in CV and SCV across subsystems and states may be due to inequities in the provision of services. The factors that contribute to the burden of AH for ACSC in the Mexican Health System require detailed analysis.

[The annual cost of medical care for patients with moderate to severe atopic dermatitis in Mexico. A multicenter study]. / Costo anual de la atención médica de pacientes con dermatitis atópica moderada a grave en México. Estudio multicéntrico.

BACKGROUND: In Mexico, the economic burden of medical care for patients with atopic dermatitis is unknown. OBJECTIVE: To determine the annual direct medical costs of the treatment for patients with moderate to severe atopic dermatitis who receive medical attention at "Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado" (Institute for Social Security and Social Services for State Workers, better known as ISSSTE), as well as the main variables associated with it. METHODS: A multicenter, retrospective cohort study. Clinical records of patients with moderate to severe atopic dermatitis were reviewed and a multivariate analysis was designed by using a generalized linear model. RESULTS: 65 patients were included; 41 of them (63.07 %) had moderate atopic dermatitis, and 24 (36.92 %) had severe AD; 39 (60 %) of them were female patients. In groups with severe atopic dermatitis, statistically significant differences were observed in matters of the duration of the evolution of the disease, comorbidities, intense pruritus, and depression. The average annual cost of medical care for patients with moderate atopic dermatitis was 1527 ± 623 USD, and for patients with severe atopic dermatitis the cost was 9487 ± 8990 USD. Significant differences were observed in dermatology consultations, referrals, laboratory and diagnostic studies, and the number of drugs prescribed by physicians. With the multivariate analysis, it was identified that the highest cost was presented by severe patients (p = 0.0001) who were younger and had comorbidities, along with diagnosis of depression. CONCLUSIONS: The severity of atopic dermatitis, the age average, the presence of comorbidities, and the diagnosis of depression are the variables with the highest association and impact on the direct cost of medical care.

Antecedentes: En México se desconoce el impacto económico de la atención médica de los pacientes con dermatitis atópica. Objetivo: Determinar los costos médicos directos anuales del tratamiento de pacientes con dermatitis atópica moderada y grave que se atienden en el Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, y las principales variables asociadas. Métodos: Estudio multicéntrico de cohorte retrospectiva. Se revisaron los expedientes clínicos de pacientes con dermatitis atópica clasificada como moderada o grave y se diseñó un modelo de análisis multivariado mediante un modelo lineal generalizado. Resultados: Se incluyeron 65 pacientes, 41 (63.07 %) tuvieron dermatitis atópica moderada y 24 (36.92 %), grave; 39 (60 %) fueron del sexo femenino. En los grupos con dermatitis atópica grave se observaron diferencias estadísticamente significativas en años de evolución de la enfermedad, comorbilidades, prurito intenso y depresión. El costo promedio anual de la atención médica para dermatitis atópica moderada fue de 1527 ± 623 USD y para dermatitis atópica grave, de 9487± 8990 USD. Se obtuvieron diferencias estadísticamente significativas en consultas de dermatología, interconsultas, estudios de laboratorio y gabinete y número de medicamentos prescritos. Con el análisis multivariado se identificó que el costo mayor lo presentaban los pacientes graves (p = 0.0001), más jóvenes, con comorbilidades y diagnóstico de depresión. Conclusiones: La gravedad de la dermatitis atópica, la edad, presentar comorbilidades y contar con el diagnóstico de depresión son las variables con mayor asociación e impacto en el costo directo de la atención médica.

General surgery referral´s outcomes and solution time / Desenlace y tiempos de solución de las referencias a cirugía general

Background: There are a variety of instruments and indicators to assess continuity of care; however there is a lack of those that describe the result of coordination between the health care levels. Objective: To show two indicators that summarizes the result of the complete circuit primary level-secondary level-primary level. Methods: An observational prospective cohort study was conducted, with a one-year follow-up of a random sample of the references to general surgery services in a family medicine unit of the IMSS. Two indicators were analyzed: the outcome of the reference to general surgery, categorized as resolved, withdrawal and not resolved; and the time of solution of the surgical problem, which measures the median in calendar days from the issuance of the reference to the counter-reference for the reason of original sending. The indicators were compared by characteristics of the patient and the first level physician. Results: The 84.8% of cases were resolved in a median time of 72 days (50-112), 14.1% of patients reject surgery and 1% wasn´t resolved. No statistically significant differences were found according the evaluated characteristics. Conclusions: The overall solution time of the surgical problem in the medical unit is within the range built with previous studies, but in specific diagnoses there are significant variations. The frequency of solution of the surgical problem was high for diagnoses of greater risk.

Introducción: entre la gran variedad de instrumentos e indicadores para evaluar continuidad de la atención, escasean los que describen el resultado de la coordinación entre niveles de atención a la salud. Objetivo: mostrar dos indicadores que resumen el resultado del circuito completo primer nivel de atención-segundo nivel de atención-primer nivel de atención. Métodos: estudio observacional de cohorte prospectiva, con seguimiento a un año de una muestra aleatoria de las referencias realizadas por una unidad de primer nivel de atención a los servicios de cirugía general. Se analizaron dos indicadores: el desenlace de la referencia a cirugía general, categorizado como resuelto/abandono/no resuelto; y el tiempo de solución del problema quirúrgico, que mide la mediana en días naturales desde la emisión de la referencia hasta la contrarreferencia por el motivo de envío original. Se compararon los indicadores por características del paciente y del médico de primer nivel. Resultados: 84.8% de los casos se resolvió en un tiempo mediano de 72 días (rango de 50 a 112), 14.1% de los pacientes rechazaron la cirugía y 1% no se resolvió. No se encontraron diferencias estadísticamente significativas en las características analizadas. Conclusiones: el tiempo de solución global del problema quirúrgico en la unidad médica está dentro del rango construido con estudios previos, pero en diagnósticos específicos hay variaciones significativas. La frecuencia de solución del problema quirúrgico fue alta para diagnósticos de mayor riesgo.

Costos medicos directos en pacientes con enfermedad pulmonar obstructiva Crónica en Mexico.

INTRODUCTION: chronic obstructive pulmonary disease (COPD) is a progressive, incurable and potentially mortal. COPD generates a high burden of illness and decreased quality of life in patients. The aim of this study was to determine the direct medical cost of COPD and the primary variables associated. METHODOLOGY: We conducted a multicenter clinical study, based in a retrospective cohort as base of a partial economic evaluation in patients diagnosed with moderate to severe COPD. It was considered an institutional point of view to determine medical costs, with an annual time horizon. For analysis of associations between explanatory and end point variables, a generalized lineal regression model was developed. RESULTS: We analyzed data from 283 patients, Fifty-nine percent were women, the average age was 72 years ± 11, Sixty-five percent of patients had a history of smoking and 57.6 % were exposed to wood smoke. The annual direct medical costs (MXN 2016) was 20,754 and 41,887 for patients with moderate and severe COPD, respectively, this difference is mainly due to the use of oxygen as well as longer hospital stay (12.9 vs. 24.7 days) of patients with severe COPD. CONCLUSIONS: Although the severity level is associated with greater health care costs, the quality of life of the patients should be considered carefully because it is inversely associated with the cost of care for patients with COPD.

Triggering factors of primary care costs in the years following type 2 diabetes diagnosis in Mexico.

BACKGROUND AND AIMS: Diabetes represents a high epidemiological and economic burden worldwide. The cost of diabetes care increases slowly during early years, but it accelerates once chronic complications set in. There is evidence that adequate control may delay the onset of complications. Management of diabetes falls almost exclusively into primary care services until chronic complications appear. Therefore, primary care is strategic for reducing the expedited growth of costs. The objective of this study was to identify predictors of primary care costs in patients without complications in the years following diabetes diagnosis. METHODS: Direct medical costs for primary care were determined from the perspective of public health services provider. Information was obtained from medical records of 764 patients. Microcosting and average cost techniques were combined. A generalized linear regression model was developed including characteristics of patients and facilities. Primary health care costs for different patient profiles were estimated. RESULTS: The mean annual primary care cost was USD$465.1. Gender was the most important predictor followed by weight status, insulin use, respiratoty infections, glycemic control and dyslipidemia. A gap in costs was observed between genders; women make greater use of resources (42.1% on average). Such differences are reduced with obesity (18.1%), overweight (22.8%), respiratory infection (20.8%) and age >80 years (26.8%). Improving glycemic control shows increasing costs but at decreasing rates. CONCLUSIONS: Modifiable factors (glycemic control, weight status and comorbidities) drive primary care costs the first 10 years. Those factors had a larger effect in costs for males than in for females.

[Cost-effectiveness of two hospital care schemes for psychiatric disorders]. / Costo-efectividad de dos esquemas de atención hospitalaria psiquiátrica.

BACKGROUND: In Mexico, six of every twenty Mexicans suffer psychiatric disorders at some time in their lives. This disease ranks fifth in the country. The objective was to determine and compare the cost-effectiveness of two models for hospital care (partial and traditional) at a psychiatric hospital of Instituto Mexicano del Seguro Social (IMSS). METHODS: a multicenter study with a prospective cohort of 374 patients was performed. We made a cost-effectiveness analysis from an institutional viewpoint with a six-month follow-up. Direct medical costs were analyzed, with quality of life gains as outcome measurement. A decision tree and a probabilistic sensitivity analysis were used. RESULTS: patient care in the partial model had a cost 50 % lower than the traditional one, with similar results in quality of life. The cost per successful unit in partial hospitalization was 3359 Mexican pesos while in the traditional it increased to 5470 Mexican pesos. CONCLUSIONS: treating patients in the partial hospitalization model is a cost-effective alternative compared with the traditional model. Therefore, the IMSS should promote the infrastructure that delivers the psychiatric services to the patient attending to who requires it.

Introducción: en México, seis de cada veinte mexicanos presentan trastornos psiquiátricos alguna vez en la vida. Está enfermedad ocupa el quinto lugar en nuestro país. El objetivo de este estudio fue determinar y comparar el costo-efectividad de los dos modelos de atención médica hospitalaria (parcial y tradicional) del IMSS. Métodos: estudio multicéntrico, con cohorte prospectiva de 374 pacientes y análisis de costo-efectividad con perspectiva institucional y seguimiento de seis meses. Se analizaron los costos médicos directos, con la ganancia en calidad de vida como medida de resultados. Se empleó un árbol de decisiones y un análisis probabilístico de sensibilidad. Resultados: la atención de pacientes del modelo de hospitalización parcial implicó un costo 50 % menor al tradicional, con resultados similares en calidad de vida. El costo por unidad de éxito en hospitalización parcial fue de 3359, mientras que en tradicional se incrementó a 5470 (ambas cantidades en pesos mexicanos). Conclusiones: tratar a los pacientes en el modelo de hospitalización parcial es una alternativa costo-efectiva con respecto a la tradicional; el IMSS debe considerar la promoción de la infraestructura que permita ofrecer este servicio a los pacientes que lo requieran.

Socioeconomic factors associated with drug consumption in prison population in Mexico.

BACKGROUND: Consumption of illegal drugs is a public health problem in Mexico, and the prison population is a vulnerable group with higher rates of prevalence than in the general population. The objective of this study was to determine the main socioeconomic variables associated with drug consumption in the prison population. METHODS: Utilizing data from the Second Incarcerated Population Survey carried out by the Centre of Research and Teaching of Economics (CIDE) in Mexico, a logistic model in two stages was developed. The first stage analyzed the determinants of habitual drug consumption by prisoners (prior to admittance into prisons), while the second stage of the model addressed drug consumption within prisons. RESULTS: Prevalence of drug consumption previous to incarceration was 28.5%, although once people were imprisoned this figure dropped to 7.4%. The characteristics that most heavily influenced against the possibility of habitual drug consumption prior to admittance to prison were: preparatory school or higher, being employed and having children; while the variables associated negatively were: male gender, childhood home shared with adults who consumed illegal drugs; abandoning childhood home; and having previous prison sentences. Once in prison, the negative conditions in there are associated with drug consumption. CONCLUSIONS: Work and study during incarceration, in addition to being instruments for rehabilitation, seem to exert an important positive association against drug consumption. However, this correlation seems to be minimized in the face of negative conditions of the penal institution; thus, public policies are necessary to improve the prisoner's environment.

[Cost-effectiveness of anxiolytics in anxiety disorders]. / Costo-efectividad de ansiolíticos en los trastornos de ansiedad.

BACKGROUND: adequate treatment of anxiety disorders reduces the economic impact, improves functionality in daily life activities and quality of life. Pharmacologic treatment depends on patient's characteristics and doctor's experience. The aim of this study was to determine the use of resources in anxiety disorder and to analyze its cost-effectiveness. METHODS: use of resources related to chronic treatment of anxiety disorders and cost-effectiveness of drugs were determined, as well as patients' out-of-pocket expenses and productivity loss. A one-year time horizon and decision tree with benzodiazepines, selective inhibitor of serotonin re-intake (SISR) and tricyclic antidepressant drugs were included. RESULTS: benzodiazepines were the treatment that had the lowest total cost ($147,587 MXP), followed by SISR (incremental cost of $2,182 MXP), and the highest cost was tricyclic antidepressant drugs ($155,903 MXP). CONCLUSIONS: benzodiazepines are good alternative for anxiety disorder because of their high effectiveness to control symptoms and because they reduce hospital costs.

[Cost-effectiveness of the treatment of acute and chronic rhinosinusitis at the IMSS]. / Costo-efectividad del tratamiento de rinosinusitis aguda y crónica en el IMSS.

INTRODUCTION: Rhinosinusitis is one of the more common diseases encountered in outpatient visits to health care. The objective of this study was to determine the most cost-effective antibiotic treatment for patients with acute (RSA) and chronic rhinosinusitis (RSC) that is available at the Mexican Institute of Social Security (IMSS). METHODS: Cost-effectiveness analysis of RSA and RSC treatment from an institutional perspective. Effectiveness outcome was defined as the percentage of cure. A decision tree with a Bayesian approach included the following therapeutic alternatives: ciprofloxacin, gatifloxacin, trimetoprim/sulfametoxazol (TMP/SMX), amoxicilin/clavulanic acid (AAC) and clindamicin. RESULTS: Treatment for RSA with AAC showed a mean cost per cured patient of $ 878 pesos. The remaining antibiotics had a higher cost per unit of success, and therefore the results showed that AAC was the best alternative considering this criterion. The therapy that showed a larger percentage of cured patients in RSC was clindamicin; however, the therapeutic alternative with the lowest cost per successful unit was the one based on ciprofloxacin, which dominates gatifloxacin and AAC. CONCLUSIONS: The most cost-effective alternative in the antibiotic treatment of patients with RSA was ACC while for RSC it was ciprofloxacin; sensitivity analysis showed the strength of the base study results.

[Prescription of temporal disability certificates in workers attending to IMSS from the perspective of health economy]. / Prescripción de certificados de incapacidad temporal en el IMSS. Perspectiva desde la economía de la salud.

The repercussion of health-disease state on social life or individual includes his/her work performance. In many countries, social security is one of the options for diffusing and buffering the impact of the disease. This paper is focused on the analysis of the unjustified prescription of temporary sick leave certificates (CITT), which combines the social security medical components and economic benefits (subsidies). The objective is to analyze the mechanism of prescription of CITT from the perspective of health economics and health care services. The detailed flow of CITT at the Mexican Institute of Social Security is described, as are some concepts of the health economics perspective that contribute to explain the prescription of CITT. Statistical data of sick leaves due to work-related and non-work-related diseases are presented from the institutional perspective. Finally, it is emphasized that although CITT are a medical prescription, it is advisable to take into account the economic perspective and its concepts in order to achieve an efficient use of resources.

Cost-effectiveness of chronic hepatitis C treatment with thymosin alpha-1.

BACKGROUND: More than one million individuals in Mexico are infected with hepatitis C virus (HCV), and 80% are at risk for developing a chronic infection that could lead to hepatic cirrhosis and other complications that impact quality of life and institutional costs. The objective of the study was to determine the most cost-effective treatment against HCV among the following: peginterferon, peginterferon plus ribavirin, peginterferon plus ribavirin plus thymosin, and no treatment. METHODS: We carried out cost-effectiveness analysis using the institutional perspective, including a 45-year time frame and a 3% discount rate for costs and effectiveness. We employed a Bayesian-focused decision tree and a Markov model. One- and two-way sensitivity analyses were performed, as well as threshold-oriented and probabilistic analyses, and we obtained acceptability curves and net health benefits. RESULTS: Triple therapy (peginterferon plus ribavirin plus thymosin alpha-1) was dominant with lower cost and higher utility in relationship with peginterferon + ribavirin option, peginterferon alone and no-treatment option. In triple therapy the cost per unit of success was of 1,908 [USD/quality-adjusted life years (QALY)] compared with peginterferon plus ribavirin 2,277/QALY, peginterferon alone 2,929/QALY, and no treatment 4,204/QALY. Sensitivity analyses confirmed the robustness of the base case. CONCLUSIONS: Peginterferon plus ribavirin plus thymosin alpha-1 option was dominant (lowest cost and highest effectiveness). Using no drug was the most expensive and least effective option.

Direct medical costs for partial refractory epilepsy in Mexico.

BACKGROUND: The aim was to determine the direct medical costs in patients with partial refractory epilepsy at the Mexican Institute of Social Security (IMSS) in Mexico. METHODS: We carried out a multicenter, retrospective-cohort partial-economic evaluation study of partial refractory epilepsy (PRE) diagnosed patients and analyzed patient files from four secondary- and tertiary-level hospitals. PRE patients >12 years of age with two or more antiepileptic drugs and follow-up for at least 1 year were included. The perspective was institutional (IMSS). Only direct healthcare costs were considered, and the timeline was 1 year. Cost techniques were microcosting, average per-service cost, and per-day cost, all costs expressed in U.S. dollars (USD, 2004). RESULTS: We reviewed 813 files of PRE patients: 133 had a correct diagnosis, and only 72 met study inclusion criteria. Fifty eight percent were females, 64% were <35 years of age, 47% were students, in 73% maximum academic level achieved was high school, and 53% were single. Fifty one percent of cases experienced simple partial seizures and 94% had more than one monthly seizure. Annual healthcare cost of the 72 patients was 190,486 USD, ambulatory healthcare contributing 76% and hospital healthcare with 24%. CONCLUSIONS: Annual mean healthcare cost per PRE patient was 2,646 USD; time of disease evolution and severity of the patient's illness did not affect costs significantly.