Prediction of pharmaceutical and non-pharmaceutical expenditures associated with Diabetes Mellitus type II based on clinical risk.

OBJECTIVE: To assess the effectiveness of different machine learning models in estimating the pharmaceutical and non-pharmaceutical expenditures associated with Diabetes Mellitus type II diagnosis, based on the clinical risk index determined by the analysis of comorbidities. MATERIALS AND METHODS: In this cross-sectional study, we have used data from 11,028 anonymized records of patients admitted to a high-complexity hospital in Bogota, Colombia between 2017-2019 with a primary diagnosis of Diabetes. These cases were classified according to Charlson's comorbidity index in several risk categories. The main variables analyzed in this study are hospitalization costs (which include pharmaceutical and non-pharmaceutical expenditures), age, gender, length of stay, medicines and services consumed, and comorbidities assessed by the Charlson's index. The model's dependent variable is expenditure (composed of pharmaceutical and non-pharmaceutical expenditures). Based on these variables, different machine learning models (Multivariate linear regression, Lasso model, and Neural Networks) were used to estimate the pharmaceutical and non-pharmaceutical expenditures associated with the clinical risk classification. To evaluate the performance of these models, different metrics were used: Mean Absolute Percentage Error (MAPE), Mean Squared Error (MSE), Root Mean Squared Error (RMSE), Mean Absolute Error (MAE), and Coefficient of Determination (R2). RESULTS: The results indicate that the Neural Networks model performed better in terms of accuracy in predicting pharmaceutical and non-pharmaceutical expenditures considering the clinical risk based on Charlson's comorbidity index. A deeper understanding and experimentation with Neural Networks can improve these preliminary results, therefore we can also conclude that the main variables used and those that were proposed can be used as predictors for the medical expenditures of patients with diabetes type-II. CONCLUSIONS: With the increase of technology elements and tools, it is possible to build models that allow decision-makers in hospitals to improve the resource planning process given the accuracy obtained with the different models tested.

Artritis reumatoide: carga económica y calidad de vida relacionada con la salud en Colombia y en el mundo: Revisión de alcance / Rheumatoid arthritis: its economic burden and health-related quality of life in Colombia and worldwide: A Scoping Review

Introducción: el aumento de las enfermedades crónicas es una de las mayores amenazas para la salud y la sostenibilidad de los sistemas de atención. Para ello, los ajustes del riesgo permiten desarrollar programas de clasificación de la población y se vuelven instrumentos para implementar nuevos modelos de atención, estructurados a partir de la morbilidad, clasificando el riesgo con el gasto asociado, y así desarrollar modelos predictivos y análisis del gasto per cápita según las características de la población, con lo cual se logra una mejor gestión financiera. Como atención primaria, la gestión del riesgo debe anticiparse a las enfermedades para diagnosticarlas de manera precoz y brindar tratamientos oportunos orientados a disminuir la severidad y secuelas. Algunas ocasionan grandes costos para el sistema de salud afectando su equilibrio y sostenibilidad, como la artritis reumatoide (AR), considerada de alto costo por su impacto y la asociación con otras comorbilidades. Objetivo: revisar los estudios realizados sobre carga económica (CE), carga de enfermedad (CE1), gastos de bolsillo, gastos catastróficos en salud (GCS) y calidad de vida relacionada con la salud (CVRS), en pacientes con AR en Colombia y en el mundo entre 2010 y 2022. Métodos: revisión de alcance de 482 artículos, 139 de CE y CE1, 14 de gastos de bolsillo y GCS, y 329 para CVRS, en literatura indexada utilizando las bases Scopus, Medline a través de Pubmed y JSTOR en inglés y español. Resultados: se observó tendencia en el crecimiento de la literatura, pero con predominio de reportes asociados con terapias biológicas tanto en CE y CE1 como CVRS, seguidos de estudios de atención médica y revisiones sistemáticas de literatura (RSL). Estados Unidos lidera las investigaciones seguido del Reino Unido; el cuestionario predominante para evaluar la calidad de vida relacionada con la salud fue el SF-36 (41,9%) seguido del EQ- 5D (19%) y aunque se cuenta con el Qol­RA (Quality of Life in Rheumatoid Arthritis Scale) validado en Colombia, su uso infrecuente. Conclusiones: el aumento de estudios sobre costos en salud ha tomado gran relevancia para comprender la realidad e instruir sobre aspectos de gestión del riesgo, enseñar conceptos, analizar escenarios de impacto y estudio de sensibilidades, mostrando todos los posibles resultados.

de Medicina y CirugíaREPERT MED CIR. 2023;32(3):197-207198ABSTRACTIntroduction: the rise in chronic diseases is one of the major threats to health and sustainability of care systems. To this end, risk adjustments allow the development of population classication programs which become instruments to implement care models based on morbidity, risk classication and cost, and for developing predictive models and analyzing per capita costs based on population characteristics, leading to achieve a better nancial management. As part of primary care, risk management should anticipate diseases for their early diagnosis and timely treatment, aimed at reducing their severity and sequelae. Some cause great costs for the health care system, aecting its balance and sustainability, such as, rheumatoid arthritis (RA), considered a high-cost disease, due to its impact and comorbidities. Objective: to review studies on economic burden (EB), burden of disease (BoD1), out-of-pocket expenses, catastrophic health expenditures (CHE) and health-related quality of life (HRQoL), in patients with RA in Colombia and worldwide, between 2010 and 2022. Methods: a scoping review of 482 articles, 139 on EB and BoD1, 14 on out-of-pocket expenses and CHE, and 329 on HRQoL, found in the indexed literature in the Scopus, Medline through Pubmed and JSTOR databases in English and Spanish. Results: a trend in the growth of the literature, was observed, with a predominance of reports on biological therapies, considering EB and BoD1 and HRQoL as well, followed by healthcare studies and systematic literature reviews (SLR). The United States leads this research, followed by the United Kingdom; the most used questionnaire to assess health-related quality of life was the SF-36 (41.9%) followed by the EQ- 5D (19%) and although the Qol­RA (Quality of Life in Rheumatoid Arthritis Scale) validated in Colombia is available, it is seldom used. Conclusions: the increase of studies on healthcare costs has gained great relevance for learning about reality and creating instructions on risk management, teach concepts, analyze impact scenarios, and study sensitivities, while showing all the possible results. Key words: economic burden, burden of disease, out-of-pocket expenditure, catastrophic expenditure, health-related quality of life, rheumatoid arthritis, scoping review.

Relevance of barriers and facilitators in the use of health technology assessment in Colombia.

OBJECTIVES: Several studies, mostly from developed countries, have identified barriers and facilitators with regard to the uptake of health technology assessment (HTA). This study elicited, using best-worst scaling (BWS), what HTA experts in Colombia consider to be the most important barriers and facilitators in the use of HTA, and makes a comparison to results from the Netherlands. METHODS: Two object case surveys (one for barriers, one for facilitators) were conducted among 18 experts (policymakers, health professionals, PhD students, senior HTA-researchers) from Colombia. Seven respondents were employees of the national HTA agency Instituto de Evaluación Tecnológica de Salud (IETS). In total, 22 barriers and 19 facilitators were included. In each choice task, participants were asked to choose the most and least important barrier/facilitator from a set of five. Hierarchical Bayes modeling was used to compute the mean relative importance scores (RIS) for each factor, and a subgroup analysis was conducted to assess differences between IETS and non-IETS respondents. The final ranking was further compared to the results from a similar study conducted in the Netherlands. RESULTS: The three most important barriers (RIS >6.00) were "Inadequate presentation format", "Absence of policy networks", and "Insufficient legal support". The six most important facilitators (RIS >6.00) were "Appropriate timing", "Clear presentation format", "Improving longstanding relation", "Appropriate incentives", "Sufficient qualified human resources", and "Availability to relevant HTA research". The perceived relevance of the barriers and facilitators differed slightly between IETS and non-IETS employees, while the differences between the rankings in Colombia and the Netherlands were substantial. CONCLUSION: The study suggests that barriers and facilitators related to technical aspects of processing HTA reports and to the contact and interaction between researchers and policymakers had the greatest importance in Colombia.

Programas de gestión de enfermedades en el siglo XXI / Disease management programs in the 21st century

Resumen La gestión de enfermedades inició en EE. UU. durante los años 70 y tuvo el fin de reducir la variabilidad de los procesos asistenciales y administrativos, controlar el gasto y mejorar la calidad de la atención. En lo corrido del presente siglo, se cuenta con una documentación amplia que permite realizar un balance sobre conceptos, componentes, metodologías y retos de los programas de gestión de enfermedades. Estos programas constituyen una práctica integradora e innovadora que permite involucrar a los distintos grupos de interés en su implementación y desarrollo. Tales grupos también se relacionan con los procesos de gestión y manejo de las enfermedades crónicas.

Abstract Disease management started in the U.S. during the 1970s in order to decrease variability in clinical and managerial processes, control costs, and improve the quality of attention. Throughout the 21st century, a growing body of literature has emerged allowing the assessment of concepts, components, methodologies and challenges of management disease programs. These programs have become into a unifying and innovative practice that allows involvement and coordination of different interest groups during implementation and development phases; such groups are also related to the management processes of chronic diseases.

[THE CASE OF ENTERAL NUTRITIONAL SUPPORT TUBE IN COLOMBIA: INSTITUTIONAL COORDINATION PROBLEMS]. / EL CASO DEL SOPORTE NUTRICIONAL ENTERAL POR SONDA EN COLOMBIA: PROBLEMAS DE COORDINACIÓN INSTITUCIONAL.

INTRODUCTION: this paper examines the case of prescription enteral nutritional support tube in Colombia, analyzed from the perspective of the Social Security System in Health, and explained as the result of a problem of institutional coordination. The role and incentives of different actors are identified and shown how the interaction of these discourages the use of enteral nutrition in cases where it is necessary, with corresponding clinical effect for the patient and increased cost for the system. METHODS: analysis of the effects it may have in clinical practice the problem of institutional coordination of regulators in the country, analyze their origin and the incentives and interests of the various stakeholders, prior synthesis of the relevant literature review. The search was conducted in the following databases: PubMed, Medline, and Embase ScienceDirect. CONCLUSIONS: the current situation of enteral nutritional support in Colombia is the result of a suboptimal equilibrium, resulting from a problem of institutional coordination that can only be solved when the agents to look beyond their local incentives, and nutritional support is a key component of hospital care and constitutes a means to the end: the health of the population served.

Introducción: el presente artículo estudia el caso de la prescripción del soporte nutricional enteral por sonda en Colombia, analizada desde el marco del Sistema de Seguridad Social en Salud, y lo explica como resultado de un problema de coordinación institucional. Para ello se identifican el papel y los incentivos de los distintos agentes y se muestra cómo la interacción de los mismos desincentiva el uso de la nutrición enteral, en casos en los que esta es necesaria, con su correspondiente efecto clínico para el paciente y el aumento de costes para el sistema. Métodos: análisis de los efectos que puede tener en la práctica clínica el problema de la coordinación institucional de los entes reguladores del país. Analiza su origen y los incentivos e intereses de los distintos agentes involucrados, previa síntesis de la revisión bibliográfica pertinente. Se realizó la búsqueda en las siguientes bases de datos: PubMed, Medline, ScienceDirect y Embase. Conclusiones: la situación actual del soporte nutricional enteral en Colombia es un equilibrio subóptimo, resultado de un problema de coordinación institucional que solo puede ser resuelto cuando los agentes miren más allá de sus incentivos locales, ya que el soporte nutricional es un componente fundamental de la atención hospitalaria y se constituye en un medio para lograr el objetivo de la salud de la población atendida.