[An economic assessment of genetic testing for familial adenomatous polyposis]. / Evaluación económica de la prueba genética de la poliposis adenomatosa familiar.

OBJECTIVE: To analyze the cost-effectiveness of genetic testing for first-degree relatives of patients with colon cancer to identify mutations in the APC gene (Adenomatous Polyposis Coli). METHODOLOGY: Analyses were performed from the perspective of the health system. We used a Markov model. We compared genetic testing for the APC gene, the cause of familial adenomatous polyposis (FAP), which results in colon cancer, versus no genetic testing for said gene. The effectiveness measure used was quality-adjusted life-years (QALYs), and costs were measured in euros for 2005. The costs of interventions were extracted from the costs of health services provided by centers under the Andalusian Public Health System, and other parameters were obtained from the literature. RESULTS: The performance of genetic testing is the dominant strategy when compared to the absence of genetic testing given the latter option has an incremental cost of 7,676.34 euros and is less effective. A sensitivity analysis found that genetic testing remains the dominant strategy for a plausible range of costs of the test itself, and for the probability of developing adenocarcinoma. CONCLUSIONS: Our analysis showed that in this patient group genetic testing to detect APC gene mutations is on average less costly and improves QALYs versus no testing.

Evaluación económica de la prueba genética de la poliposis adenomatosa familiar / No disponible

Objetivo: analizar el coste-utilidad de la prueba genética a familiaresde primer grado de pacientes con cáncer de colon para determinarmutaciones del gen APC (Adenomatous Polyposis Coli).Metodología: los análisis se realizaron desde el punto de vistadel sistema sanitario. Se utilizó un modelo de Markov. Realizaciónde la prueba genética para el gen APC, causante de la poliposisadenomatosa familiar (PAF), que produce cáncer de colon frentea la no realización de la misma. La medida de efectividad utilizadafueron los años de vida ajustados por calidad (AVAC) y la unidadde coste los euros de 2005. Los costes de las intervenciones fueronextraídos de los precios públicos de los servicios sanitariosprestados por centros dependientes del Sistema Sanitario PúblicoAndaluz y los valores de la efectividad y de utilidad de la literatura.Resultados: la realización de la prueba genética se muestracomo una estrategia dominante a la no realización de la misma,ya que esta última tiene un coste incremental de 7.676,34 €, ademásde una menor efectividad. Los análisis de sensibilidad mostraronque la realización de la prueba genética se mantiene como laestrategia dominante dentro de un amplio rango de coste de laprueba y de probabilidad de desarrollar adenocarcinomas.Conclusiones: los análisis mostraron que, para este grupo depacientes, la realización de la prueba genética para la detecciónde la mutación del gen APC es en promedio menos costosa yademás produce una mejora en AVAC comparado con la no realizaciónde la misma

Objective: to analyze the cost-effectiveness of genetic testingfor first-degree relatives of patients with colon cancer to identifymutations in the APC gene (Adenomatous Polyposis Coli).Methodology: analyses were performed from the perspectiveof the health system. We used a Markov model. We comparedgenetic testing for the APC gene, the cause of familialadenomatous polyposis (FAP), which results in colon cancer,versus no genetic testing for said gene. The effectiveness measureused was quality-adjusted life-years (QALYs), and costswere measured in euros for 2005. The costs of interventionswere extracted from the costs of health services provided bycenters under the Andalusian Public Health System, and otherparameters were obtained from the literature.Results: the performance of genetic testing is the dominantstrategy when compared to the absence of genetic testing giventhe latter option has an incremental cost of € 7,676.34 and is lesseffective. A sensitivity analysis found that genetic testing remainsthe dominant strategy for a plausible range of costs of the test itself,and for the probability of developing adenocarcinoma.Conclusions: our analysis showed that in this patient groupgenetic testing to detect APC gene mutations is on average lesscostly and improves QALYs versus no testing

[Patients who refuse antiretroviral treatment in prison]. / Pacientes que rehúsan el tratamiento antirretroviral en el medio penitenciario.

INTRODUCTION: Current studies of HIV+ patients in the prison population have been carried out without considering differences that might exist between patients who accept retroviral treatment and those who do not. One possible reason for this may be the difficulty in gaining access to patients who refuse antiretroviral treatment. However, the prison environment makes it possible to locate and study this type of patient, who up till now has not been the subject of study. The aim of this article is to describe the clinical and psychosocial state of HIV+ inmates who refuse ARVT and compare this data with patients receiving treatment and others for whom treatment has not been indicated. METHODS: Cross-sectional study using 585 HIV+ inmates in three prisons in Andalusia from May to June 2004. Refusal, acceptance and non-indication of ARVT treatment was the grouping variable used. The independent variables were socio-demographic, psychosocial, clinical and other variables relating to the prison environment. RESULTS: 16.8% of patients refused ARVT, while 56.3% were receiving treatment and another 26.8 were not indicated for any medication. Amongst the patients that refused ARVT there was a greater prevalence of HIV co-infection, higher inprison consumption of opiates and methadone treatment, more cases pending and higher rates of recidivism. CONCLUSIONS: these results highlight the existence of a group with unique characteristics that is accessible thanks to the special conditions within the prison environment. It is a group that chooses not to follow therapeutic indications and which represents a risk factor not only for its own health, but also for the community at large.

Pacientes que rehúsan el tratamiento antirretroviralen el medio penitenciario / Patients who refuse antiretroviral treatment in prison

Introducción: En los estudios existentes sobre pacientes VIH+ la población a estudio ha sido tomada de manera homogénea,sin diferenciar aquella que cumple los requerimientos terapéuticos de la que no lo hace. Quizás por la dificultad en elacceso al grupo de pacientes que rehúsan el tratamiento antirretroviral. El medio penitenciario nos permite acceder a esta población,hasta hoy no estudiada. El objetivo de este estudio es describir el estado clínico y psicosocial de los reclusos seropositivosque rehúsan el TARV, comparándolo con el de aquellos que sí están en TARV o no se les indica tomarlo.Métodos: Estudio transversal con 585 reclusos VIH positivos ingresados en tres prisiones andaluzas entre mayo-juliode 2004. Como variable de agrupación se empleó rehusar el TARV, tomarlo o no hacerlo por no estar indicado. Como independientesse incluyeron sociodemográficas, psicosociales, clínicas y relacionadas con el medio penitenciario.Resultados: El 16,8% de los reclusos rehusaban el TARV, mientras el 56,3% estaban en tratamiento y al 26,8% no le estabaindicado. Entre los reclusos que rehusaban el TARV aparece una mayor prevalencia de coinfección por VHC, mayorconsumo intrapenitenciario de opiáceos y tratamiento con metadona, más juicios pendientes y más entradas en prisión.Conclusiones: Estos resultados ponen de relieve la existencia de un grupo poblacional, accesible gracias al medio penitenciario,con características propias que no sigue las indicaciones terapéuticas y que representa un riesgo no sólo para su salud, sino para la de la comunidad (AU)

Introduction: Current studies of HIV+ patients in the prison population have been carried out without considering differencesthat might exist between patients who accept retroviral treatment and those who do not. One possible reason forthis may be the difficulty in gaining access to patients who refuse antiretroviral treatment. However, the prison environmentmakes it possible to locate and study this type of patient, who up till now has not been the subject of study. The aim of thisarticle is to describe the clinical and psychosocial state of HIV+ inmates who refuse ARVT and compare this data with patientsreceiving treatment and others for whom treatment has not been indicated.Methods: Cross-sectional study using 585 HIV+ inmates in three prisons in Andalusia from May to June 2004. Refusal,acceptance and non-indication of ARVT treatment was the grouping variable used. The independent variables were socio-demographic, psychosocial, clinical and other variables relating to the prison environment.Results: 16.8% of patients refused ARVT, while 56.3% were receiving treatment and another 26.8 were not indicated (AU)