Attributable Costs of Lung Cancer for the Colombian Health System: A Cost-of-Illness Study.

OBJECTIVES: Lung cancer imposes a significant economic burden on most countries. Nevertheless, there is scarce information about this burden on health systems in low- and middle-income countries. This study aims to estimate the economic burden of lung cancer on the Colombian health system, a middle-income country with universal health coverage in Latin America. METHODS: We conducted a cost-of-illness study that included all direct costs generated by prevalent cases of lung cancer in Colombia during 2017. We used administrative databases containing patient-level information on consumption of healthcare services and reports on healthcare spending published by the Colombian Ministry of Health. To decrease the probability of misallocation of costs, we used propensity score matching to estimate the marginal costs of delivering healthcare services to patients with lung cancer. Additionally, ordinary least squares and variations in case definitions were used to assess the robustness of all estimates. RESULTS: Total costs attributable to lung cancer in 2017 ranged from $50 039 588 to $74 468 111, with important differences across insurance regimes (from $4 629 938 for the subsidized regime to $55 342 357 for the contributory regime). Notably, 43% of all costs ($27 081 348) were caused by the consumption of services not included in the health benefit package. There were no significant differences between inpatient and outpatient costs. CONCLUSIONS: Lung cancer imposes a significant economic burden on the Colombian health system. Although all affiliates are entitled to a unique health benefit package, there were important differences in costs across insurance regimes. Further research is needed to identify the main mechanisms underlying these differences.

Understanding treatment-subgroup effect in primary and secondary prevention of cardiovascular disease: An exploration using meta-analyses of individual patient data.

BACKGROUND AND OBJECTIVE: Recommendations for preventing cardiovascular (CV) disease are currently separated into primary and secondary prevention. We hypothesize that relative effects of interventions for CV prevention are not different across primary and secondary prevention cohorts. Our aim was to test for differences in relative effects on CV events in common preventive CV interventions across primary and secondary prevention cohorts. METHODS AND RESULTS: A systematic search was performed to identify individual patient data (IPD) meta-analyses that included both primary and secondary prevention populations. Eligibility assessment, data extraction, and risk of bias assessment were conducted independently and in duplicate. We extracted relative risks (RR) with 95% confidence intervals (95% CI) of the interventions over patient-important outcomes and estimated the ratio of RR for primary and secondary prevention populations. We identified five eligible IPDs representing 524,570 participants. Quality assessment resulted in overall low-to-moderate methodological quality. We found no subgroup effect across prevention categories in any of the outcomes assessed. CONCLUSION: In the absence of significant treatment-subgroup interactions between primary and secondary CV prevention cohorts for common preventive interventions, clinical practice guidelines could offer recommendations tailored to individual estimates of CV risk without regard to membership to primary and secondary prevention cohorts. This would require the development of reliable ASCVD risk estimators that apply across both cohorts.

Devising and validating a headache diary in a series of patients with chronic daily headache from Colombia.

OBJECTIVE: To devise and test the reliability and validity of a brief headache diary in a series of Colombian patients with chronic daily headache. METHODS: The study was designed in five stages: selection of domains (group of patients and experts); initial devising of the items (writing group); identification of non-understandable items (n=20); assessment of internal consistency (n=100); assessment of validity and assessment of sensitivity to change during seven consecutive days (n=25, 175 observations). RESULTS: Five domains were selected: headache presence, severity and length of pain, analgesics intake, and missing workdays. The headache diary is internally consistent (≈75% of rotated variance), correlates with the medical interview (Spearman's rho and Kendall's tau over 0.8 for each domain) and it has an adequate and stable sensitivity and specificity (82 to 96%). CONCLUSIONS: This headache diary is a reliable and valid instrument and represents the most important features affecting Colombian patients with chronic daily headache.

Devising and validating a headache diary in a series of patients with chronic daily headache from Colombia / Diseño y validación de un diario de cefalea en pacientes con cefalea crónica diaria en Colombia

OBJECTIVE: To devise and test the reliability and validity of a brief headache diary in a series of Colombian patients with chronic daily headache. METHODS: The study was designed in five stages: selection of domains (group of patients and experts); initial devising of the items (writing group); identification of non-understandable items (n=20); assessment of internal consistency (n=100); assessment of validity and assessment of sensitivity to change during seven consecutive days (n=25, 175 observations). RESULTS: Five domains were selected: headache presence, severity and length of pain, analgesics intake, and missing workdays. The headache diary is internally consistent (≈75 percent of rotated variance), correlates with the medical interview (Spearman's rho and Kendall's tau over 0.8 for each domain) and it has an adequate and stable sensitivity and specificity (82 to 96 percent). CONCLUSIONS: This headache diary is a reliable and valid instrument and represents the most important features affecting Colombian patients with chronic daily headache.

OBJETIVO: Diseñar y testar la validez y reproducibilidad de un diario de cefalea en una serie de pacientes Colombianos con cefalea crónica diaria. MÉTODOS: El estudio fue diseñado en cinco fases: selección de los dominios (grupo de pacientes y expertos); diseño inicial de los ítems (grupo redactor); identificación de ítems no comprensibles (n=20); determinación de la consistencia interna (n=100); determinación de la validez y la sensibilidad al cambio durante siete días consecutivos (n=25, 175 observaciones). RESULTADOS: Fueron seleccionados cinco dominios: presencia, severidad y duración del dolor, ingesta de analgésicos y días laborales perdidos. El diario tiene una adecuada consistencia interna (≈75 por ciento de la varianza), se correlaciona con la entrevista médica (rho de Spearman y tau de Kendall >0.8 para cada dominio) y tiene sensibilidad y especificidad estables y satisfactorias (82 a 96 por ciento). CONCLUSIONES: Este diario de cefalea es un instrumento confiable y registra las principales características de las cefaleas en pacientes con cefalea crónica diaria.