Budget impact of secondary hyperparathyroidism treatment in chronic kidney disease in an Ecuadorian social security hospital.

BACKGROUND: Chronic kidney disease (CKD) is a disorder with high morbidity and mortality worldwide whose complications generate multiple costs. In Ecuador, only a few healthcare institutions have implemented management protocols aimed to reduce costs and to improve the quality of life of patients. The aim of this study is to evaluate the short-term (1-year) and long-term (5-year) costs and savings in the management of secondary hyperparathyroidism (SHPT) of hemodialyzed CKD patients by comparing calcitriol and paricalcitol in a large social security hospital in Quito, Ecuador. METHODS: The estimation model assessed the resources used in the management of SHPT by comparing prospectively the cost savings within 1-year and 5-year time horizon with calcitriol and paricalcitol. Hospitalization, erythropoietin (EPO), treatment doses, intravenous iron consumption, and medical supplies were estimated according international references, based on the initial parathormone level (iPTH) of patients. The Ecuadorian National Reference costs (2014-2015) and institutional costs were used to calculate treatment costs. A statistical sensitivity analysis was also performed. RESULTS: The study was based on data from 354 patients of whom 147 (41.4 %) had a value of iPTH in the range 300-600 pg/ml, 45 (12.8 %) in the range 601-800 pg/ml, and 162 (45.7 %) over 800 pg/ml. The 1-year estimated costs per patient for calcitriol and paricalcitol, respectively, were: medication, 63.88 USD and 1,123.44 USD; EPO, 19,522.95 USD and 16,478 USD; intravenous iron 143.21 USD and 187.76 USD. Yearly hospitalization costs per patient were 11,647.99 USD with calcitriol and 8,019.41 USD with paricalcitol. Total yearly costs per patient amounted to 31,378.02 USD with calcitriol and 25,809.50 USD with paricalcitol. Total savings using paricalcitol were 5,568.52 USD per patient compared with calcitriol. The 5-year cumulative medication costs were 319 USD for calcitriol and 2,403 USD for paricalcitol; EPO with calcitriol was 97,615 USD and with paricalcitol 82,394 USD; intravenous iron with calcitriol was 716 USD and paricalcitol 939 USD. Hospitalization costs for patients with calcitriol and paricalcitol were 43,095 USD and 62,595 USD, respectively. Total savings using paricalcitol amounted 32,414 USD per patient compared with calcitriol. CONCLUSIONS: Paricalcitol use generated more cost savings than calcitriol after 1 and 5 years.

Cambio estacionll en la fauna acompañante de lapesquería artesanal de arrastree de camarón del golfo de salamanca, mar caribe de Colombia / Seasonal Shift of Bycatch in the Artisanal Shrimp Trawl Fishery of the Gulf of Salamanca, Caribbean Sea of Colombia

La evaluación de la fauna acompañante en las pesquerías de arrastre se ha referido generalmente a una escala anual, ignorando eventuales variaciones estacionales. En el golfo de Salamanca, recientemente opera una flota artesanal de arrastre de camarón, cuya fauna acompañante es evaluada por primera vez en el presente estudio, considerando la estacionalidad climática y oceanográfica que domina la región (descargas continentales y surgencia). Para ello, 90 lances en la época de calmas o lluviosa (noviembre 2010) y 86 en la época de vientos (abril 2011) fueron muestreados a bordo de embarcaciones pesqueras. La proporción fauna acompañante - camarón resultó ser 2,69 (2,37 - 3,21; IC 95 %) y 6,37 (5,10 - 8,24; IC 95 %) en la época de calmas y vientos, respectivamente. Un total de 101 taxa se registraron, con un elevado número de juveniles. La estructura comunitaria de la fauna acompañante difirió entre las épocas climáticas (Anosim, P < 0,001), siendo caracterizada en las dos épocas por Stellifer spp., Symphurus caribbeanus y Callinectes sapidus, en tanto que, adicionalmente, la época de calmas fue caracterizada por Cathorops mapale, Anchovia clupeoides, Trichiurus lepturus y la época de vientos por Larimus breviceps, Cnidaria (medusas), Cetengraulis edentulus (Simper). Los resultados evidenciaron un cambio estacional en la fauna acompañante, indicando la necesidad de implementar programas de monitoreo y medidas de manejo que atiendan a esa variabilidad temporal. Los efectos ecológicos negativos de esta pesquería urgen la utilización de estrategias de mitigación, concertadas con los pescadores, para balancear las necesidades sociales y la conservación del ecosistema.

Bycatch assessments in trawl fisheries have been mainly referred to an annual scale, ignoring possible seasonal variations. In the Gulf of Salamanca, an artisanal shrimp trawl fleet operates recently and this study evaluates its bycatch for first time, considering the climatic and oceanographic seasonality that dominates the region (runoff and upwelling). 90 hauls in the calm or rainy season (November 2010) and 86 in the windy season (April 2011) were sampled on board of fishing boats. The bycatch to shrimp ratio was 2,69 (2,37 -3,21, 95 % CI) and 6,37 (5,10 - 8,24, 95 % CI) for the calm season and windy season respectively. We recorded a total of 101 taxa, with a large number of juveniles. The community structure of bycatch differed between seasons (ANOSIM, p < 0,001), being characterized both seasons by Stellifer spp., Symphurus caribbeanus y Callinectes sapidus, whereas, in addition, the calm season was characterized by Cathorops mapale, Anchovia clupeoides, Trichiurus lepturus, and the windy season by Larimus breviceps, Cnidaria (jellyfish), Cetengraulis edentulus (Simper). The results showed a seasonal change in the bycatch, raising the need to implement monitoring programs and management measures that address that temporal variability. Negative ecological effects of this fishery prompt the use of mitigation strategies, involving fishermen, to balance social needs and the ecosystem conservation.