Molecular testing dynamics is reactive to COVID-19 incidence: Observations from the colombian experience

There was a positive correlation between molecular tests conducted and COVID-19 incidence and death rate (r = 0.79, p < 0.01 and r = 0.64, p < 0.01, respectively). The cointegration (ADF) test revealed a statistically significant and closely time-dependent stochastic structure between daily COVID-19 cases and number of molecular tests (ADF, -3.50; p < 0.01)

Costos de la otitis media aguda en niños de una ciudad de la costa caribe colombiana

Acute otitis media is the main cause of consultation, antibiotic use, and ambulatory surgery in developed countries; besides, it is associated with an important economic burden. However, non-medical indirect costs of acute otitis media, which are relevant in this pathology, have been underestimatedLa otitis media aguda es la principal causa de consultas médicas, de uso de antibióticos y de cirugías ambulatorias en los países desarrollados. Está asociada con una significativa carga económica, pero sus costos indirectos no médicos, los cuales son relevantes en esta enfermedad, se han subestimad

Education and pneumonia mortality: a trend analysis of its inequalities in Colombian adults

Objective To explore the existence and trends of social inequalities related to pneumonia mortality in Colombian adults using educational level as a proxy of socioeconomic status. Methods We obtained individual and anonymised registries from death certificates due to pneumonia for 1998–2015. Educational level data were gathered from microdata of the Colombian Demography Health Surveys. Rate ratios (RR) were estimated by using Poisson regression models, comparing mortality of educational groups with mortality in the highest education group. Relative index of inequality (RII) was measured to assess changes in disparities, regressing mortality on the midpoint of the cumulative distribution of education, thereby considering the size of each educational group. Results For adults 25+ years, the risk of dying was significantly higher among lower educated. The RRs depict increased risks of dying comparing lower and highest education level, and this tendency was stronger in woman than in men (RR for primary education=2.34 (95% CI 2.32 to 2.36), RR for secondary education=1.77 (95% CI 1.75 to 1.78) versus RR for primary education=1.83 (95% CI 1.81 to 1.85), RR for secondary education=1.51 (95% CI 1.50 to 1.53)). According to age groups, young adults (25–44 years) showed the largest inequality in terms of educational level; RRs for pneumonia mortality regarding the tertiary educated groups show increased mortality in the lower and secondary educated, and these differences decreased with ages. RII in pneumonia mortality among adult men was 2.01 (95% CI 2.00 to 2.03) and in women 2.46 (95% CI 2.43 to 2.48). The RII was greatest at young ages, for both sexes. Time trends showed steadily significant increases for RII in both men and women (estimated annual percentage change (EAPC)men=3.8; EAPCwomen=2.6). Conclusion A significant increase on the educational inequalities in mortality due to pneumonia during all period was found among men and women. Efforts to reduce pneumonia mortality in adults improving population health by raising education levels should be strengthened with policies that assure widespread access to economic and social opportunitie

Characteristics and monetary compensation of caregivers for patients with rheumatic conditions

Musculoskeletal disorders (MD) are highly prevalent conditions that affect quality of life. MD cause physical and psychological dependence. Usually, the care of a patient with MD is assumed by a caregiver. The aim of this study was to describe the sociodemographic characteristics and the monetary remuneration associated to the care of a patient with MD. A cross sectional study was carried out in order to estimate the monetary remuneration related to the health care of patients with MD. A survey was applied to caregivers of patients with MD. Demographic data was collected. We asked about the relationship with the patient, the time as a caregiver and all data related to the monetary compensation. Descriptive epidemiology was done. We reported monetary data in American Dollars (USD) using the average exchange rate for 2018. We surveyed 132 caregivers. Mean age was 52 years [standard deviation 19], 72% were women, 78% were taking care of a patient with rheumatoid arthritis, 12% osteoarthrosis 2% lupus, and 2% osteoporosis. The remaining 6% were caregivers of patients with ankylosing spondylitis, fibromyalgia and Sjogren syndrome. Regarding the time as a caregiver, 48% had less than a year, 16% between two and three years, 18% more than three years, 13% more than four years, and 5% were temporarily caregivers. In our study, 85% of caregivers were a family member, while 15% a nurse or a non-related person. Regarding the compensation, 97% did not receive any salary or payment for being caregiver, the remaining 3% received between 265 and 530 USD per month. Our study demonstrated that the care for patients with MD is mainly assumed by family members. Our results agree with other studies in chronic conditions where only a small proportion of caregivers is paid. Caregivers should be considered for the health system

Centers of excellence implementation for treating rheumatoid arthritis in Colombia: A cost-analysis

Background: Health systems need to optimize the use of resources, especially in high-cost diseases as rheumatoid arthritis (RA). We aimed to evaluate the efficiency of using centers of excellence (CoE) as a strategy for improving RA treatment in Colombia. Methods: A cost description analysis was carried out using the standard costing technique. We estimated the costs of medical consultations, laboratories, images, and medications for RA. Categories of care standards stratified by severity were defined using the disease activity score in 28 joints (DAS28). We evaluated the impact, in terms of costs (US dollars), for providing RA clinical care for a previously described cohort using the CoE approach. Statistical analyses were performed in Microsoft Excel®, and R. Results: Expenditure on therapeutic drugs increases as the severity of RA increases. Drugs represent 53.6% of the total cost for the low disease activity (LDA) stage, 75.2% for moderate disease activity (MDA), 88.5% for severe disease activity (SDA) and 97% for SDA with biologic treatment (SDA+Biologic). Treating 968 patients would cost US$612,639 (US$487,978– 1,220,160) at baseline, per year. After a year of follow-up at the CoE, treating the same patients would cost US$388,765 (US$321,710– 708,476), which implies potential cost-savings of up to US$223,874 per year. Conclusion: The strategy of providing clinical care for RA through CoE can save US$231.3 per patient-per year. The results of our study show that CoE could greatly impact the public policies dealing with treatment of RA in Colombia. Applying the CoE model in our country would both improve health outcomes, as well as being more efficient in terms of costs

Economic burden of chonic kidney Disease in Colombia, 2015-2016

Objetivo: Estimar la carga económica asociada a la enfermedad renal crónica (ERC) en Colombia, para el periodo 2015-2016. Materiales y métodos: Se estimó la carga económica de la ERC en Colombia a partir de datos de terceros pagadores. Se realizó un costeo de los estadios de la ERC mediante la técnica de macro-costeo o top-down, con el fin de conocer el impacto económico de cada estadio en la carga global de la enfermedad. Se construyó un modelo de Markov que simulara la historia natural de la enfermedad. Se utilizó una tasa de descuento del 5% y ciclos anuales. A cada estado de la ERC se le asignó un costo relacionado con la atención, con lo cual se obtuvo un estimado del costo y de la carga de enfermedad de todos los pacientes con ERC. Resultados: Al final de los ciclos de todos los pacientes desde el estadio 1-5, incluyendo el trasplante, se estimó una carga económica que asciende a COP 10,5 billones (IC 95% COP 8,7- COP 14,4). En el escenario con tasa de descuento del 5%, la carga económica asciende a COP 7,8 billones. Conclusión: La ERC representa una alta carga económica al sistema de salud colombiano, la cual oscila entre COP 8,7 y COP 14,4 billones, que representarían entre el 1,6% y el 2,7% del producto interno bruto de Colombia en el 2015.Objective: Estimate the economic burden due to chronic kidney disease (CKD) in Colombia, for 2015-2016. Methods: We estimated the economic burden of CKD through third payer’s data. A topdown technique was used to estimate the costs related to CKD as input to estimate the economic burden of the disease. A Markov model was conducted to simulate the natural history of the disease. A 5% discount rate and annual cycles were used. Each stage of the disease had a cost associated with the disease, producing and estimation of the economic burden of all patients with CKD. Results: At the end of the modeling from stages 1-5, including transplantation, the economic burden of CKD was COP $10.5 billion (IC 95$8.7-$14.4). In the discount rate scenario, the economic burden was COP$7.8 billons. Conclusion: CKD represents a high economic burden on the Colombian health system, which ranges from COP $8.7-$ 14.4 billion that would represent between 1.6% and 2.7% of Colombia's Gross Domestic Product, 2015

Direct medical costs of severe asthma in two colombian reference centers

Objectives: Severe asthma, although infrequent, generates an important clinical and economic burden in both patients and healthcare system. We aimed to describe demographic and clinical characteristics, exacerbations, healthcare resource utilization (HRU), and annual direct medical costs in a severe asthma patient cohort in Colombia. Methods: Cost ofillness study from payer perspective. Patients with clinicianconfirmed severe asthma diagnosis (GINA criteria) from two specialized reference centers between January 2014 and August 2018 were included. The last year within this period under GINA step 4/5 therapy was observed for each patient. Clinical information was extracted from medical records, and HRU from hospital invoices and public price lists. Results: 147 patients were included, 59% female. Mean (6SD) age and time with asthma diagnosis was 46615 and 21617 years, respectively. Most frequent comorbidities were allergic rhinitis (70%), conjunctivitis (27%) and hypertension (19%). Most common sensitization cause was house dust mite (61%). Median baseline blood eosinophil count was 260 cells/ml (range 10-4,040), mean total IgE serum level was 69761,893 IU/ml. The mean annual frequency of HRU was 5.064.0 for laboratory tests, 4.161.2 for medical visits, 1.061.5 for emergency visits, 0.360.7 for hospitalizations, and 0.160.3 for ICU. Omalizumab was prescribed in 42.2% of patients, with a mean among users of 30.2620.3 vials per year. Mean annual direct cost for outpatient care was 4,743.666,331.1 USD (range 256.7-31,286.1) (1 USD=2,956.4 COP); medications were responsible for 98% of costs. Data from 55 hospitalizations was obtained, 4 in ICU. Mean stay and cost per episode were 6.564.9 days and 1,010.561,379.9 USD in general ward, and 14.164.1 days and 3768.963748.2 USD in ICU. Conclusions: Severe asthma is a costly disease for the Colombian health system. Most of the direct outpatient medical costs in this cohort were caused by pharmacological therapy, particularly omalizumab. Funding: GSK (PRJ2813