Potential cost-savings due to the application of a center of excellence care model in rheumatoid arthritis in Colombia

To evaluate the economic efficiency of a Center of Excellence (CoE) care model for rheumatic diseases located in Bogotá-Colombia. Biomab CoE is based on an adaptation of Colombian clinical practice guideline for the management of rheumatoid arthritis (RA). Care standards are defined by the severity of the disease (DAS28), involving an interdisciplinary team and differential types and frequencies of health services for each level of severity [remission, low (LDA), moderate (MDA) and severe disease activity (SDA)]. A cost-analysis was conducted to analyze the health economic impact after the application of a CoE model in a cohort of RA patients followed during a year. Mean, minimum, and maximum treatment costs were calculated at different moments in time: baseline, follow-up at month six, and after a year. This was done by multiplying the number of patients at each cut-off by the estimated cost per stage of the disease, according to the recommendations of the Colombian Institute of Health Technology Assessment. Statistical analyses were performed using Microsoft Excel® and R. All estimated costs were expressed in United States dollars, using the average exchange rate from January to December of 2018, reported by Banco de la República de Colombia: US$1=$2,951.3 Colombian pesos(COP). As preliminary results, 968 patients were followed during a year. At the beginning of the follow-up, treating all patients in the CoE with an integral attention would cost COP$1,808,096,027 ($1,440,179,796-$3,601,084,711). Same number of patients treated at month six of follow-up would cost COP$1,377,186,140 ($1,127,818,822-$2,570,342,964), and COP$1,147,370,864 ($949,470,612-$2,090,941,567) after a year of follow-up. Treating these patients in a CoE means potential cost-savings of up to COP$660,725,163 annually. As patients are treated in the CoE for RA, their health outcomes improve from severe disease activity status to low disease activity and remission, saving costs to the Colombian health system

How expensive is treating patients in a center of excellence for rheumatoid arthritis in Colombia?

We aimed to estimate the cost of treating patients with rheumatoid arthritis (RA) in a Center of Excellence (CoE) for rheumatic diseases located in Bogotá, Colombia. We performed a cost analysis from the standard cost estimation of a CoE program for RA care. We estimated costs of consultations, laboratory and imaging tests, and pharmacological treatment from the measurement of the health care resource utilization of the CoE standard protocol according to the activity level of the disease (DAS28). Costing process was done following the recommendation of the Colombian Institute of Health Technology Assessment (IETS, in Spanish). Mean, minimum and maximum costs were reported annually for a type case depending on severity and classified as Remission, low disease activity (LDA), moderate disease activity (MDA) and severe disease activity -SDA- (with and without bDMARD). All costs were reported in American dollars, using the average exchange rate from January to December of 2018, reported by Banco de la República de Colombia: US$1 =$2,951.3 Colombian pesos. Mean total direct medical cost to treat a patient in remission is US$235.7 (213.0-336.4), in LDA is US325.2 (288.0-464.6) and in MDA is US$835.5 ($573.1-$2,187.1). There is a considerable increase in direct medical costs from a patient in SDA and SDA+Biologics: US$2,555.5 ($2,301.1-$3,890.9) to US$8,032.4 ($7,564.4-$8,400.3). The largest share of the cost was related to drugs, representing 39.9% for Remission, 53.6% for LDA, 75.2 for MDA, and in SDA and SDA+Biologics the proportion of what is spent on drugs for RA treatment is 88.5% and 96.7%, respectively. As the severity of the disease increases, the expenditure rate on drugs rises over the total of each activity level. With the introduction of the biological therapy, the treatment of RA is expensive, however, the CoE is an efficient way of care for RA

Educational inequality trends in mortality due to pneumonia in Colombia, 1998-2015

We aimed to explore the existence and trends of social inequalities related to pneumonia mortality in Colombian adults using education as a proxy of socioeconomic status. We obtained death certificates due to pneumonia and population data from Departamento Administrativo Nacional de Estadística for 1998-2015. Educational level data were gathered from microdata of the Colombian Demography Health Surveys. Annual trends in Age Standardized Mortality Rates by sex and educational level were quantified by calculating the Estimated Annual Percentage Change (EAPC). We estimated Rate Ratios (RR) by using Poisson regressionmodels, comparing mortality of educational groups with mortality in the highest education group. We estimated the Relative Index of Inequality (RII) to assess changes in disparities, regressing mortality on the mid-point of the cumulative distribution of education, thereby considering the size of each educational group. All analyses were conducted in SAS®V.9.2. 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 [RRprimary=2.34 (2.32-2.36), RRsecondary=1.77 (1.75-1.78) vs. RRprimary=1.83(1.81-1.85), RR secondary=1.51 (1.50-1.53)]. According to age groups, young adults (25-44 years) showed the largest inequality in terms of educational level; RRs for pneumonia mortality regarding to 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 2.00-2.03) and in women 2.46 (95%CI 2.43-2.48). The RII was greatest at young ages, for both sexes. Time trends showed steadily significant increases for RII in both men and women (EAPCmen=3.8; EAPCwomen=2.6). Pneumonia mortality rates in adults evidenced a clear age-dependency, with lowest rates for young and much higher rates for senior adults. All estimated mortality rates were higher in men than in women

Quality of life and the relationship with family income in patients with rheumatoid arthritis

Objectives: To evaluate the quality of life (QoL) of patients with rheumatoid arthritis (RA) using the Quality of life in Rheumatoid Arthritis (RAQol) questionnaire. Also, to explore its relationship with income in patients attended at a specialized RA center in Bogotá, Colombia, 2018. Methods: We performed a descriptive study. The RAQol version in Spanish was applied to RA patients. The scale of the RAQol has a score from 1-10, where 10 is associated with better QoL. We excluded patients with psychological or psychiatric disorders. We asked about the monthly family income according to the Colombian minimum wage. Descriptive epidemiology was performed for each variable. A comparison of means regarding age and RAQol score was carried out. Therefore, we performed a bivariate analysis in order to explore the relationship between income and QoL, reporting Odds Ratios (OR) and confidence intervals 95% (CI95%). Results related to family income were reported in US$with the average exchange rate for 2018. Results: We interviewed 310 patients, 92$265, 47% between US$266- US$530, 9% between US$531-US$795 and 3% more than US$1300. Patients with an income greater than US$531 per/month had a higher average score in the RAQoL scale (7.1, SD5.5). The relationship of having a score lower than 6 in the RAQoL and a monthly income lower than US$530 showed an OR of 2.48 IC95% (0.99-6.22) (P=0.03). Conclusions: Our study showed that patient with a low income reports a lower QoL. Further research is needed to evaluate the alternatives that can improve QoL in patients with RA

Costs and disease activity in patients with rheumatoid arthritis treated with biologic dmards: findings in a real-life setting

Objectives: Biological DMARDs have demonstrated to modify the natural course of the disease through the inhibition of specific molecules of the immune and inflammatory responses. The objective of our study is to describe the use of biological therapy, disease activity and costs related to the treatment of patients with RA in a real-life setting in Colombia. Methods: Patients were analyzed retrospectively for 36 months and followed-up under T2T standards with a multidisciplinary approach. DAS28 was used as main clinical outcome. We included patients with severe or moderate disease activity using biological therapy. We described the percentage of patients who reached low disease activity or remission. Most expensive biological therapies were described and costed. Costs were reported in US dollars at the official rate of exchange for December 2018. Statistical analyses were done in Microsoft Excel. Results: We followed-up 1054 patients during three years, 85% were female, mean age was 57 years (SD 7.7). At the beginning of the follow-up, 52% of patients were in MDA and 48% in SDA. The most used treatment regime was certolizumab (24.57%) followed by etanercept (16.51%) and abatacept (12.81%). At the end of the follow-up, 92% patients achieved remission. Regarding costs, the most expensive therapy per/ year was etanercept (USD $12,522.70) followed by golimumab ($11,535.00) and (adalimumab). When we calculated the average cost for all biological therapy and then compared to the number of patients who achieved remission, the costs during three years to achieve remission was $27,738,839.54 USD. Conclusions: Our study showed that biological therapy is effective when is used under a T2T strategy and with a multidisciplinary approach. However, it is an expensive option that might be used in adherent patients and candidates who met the profile for prescribing this type of pharmacological therapy, especially in developing countries where the health budgets are limited

Prevalence of juvenile idiophatic arthritis in Colombia

To estimate the prevalence of Juvenile Idiophatic Arthritis (JIA) in Colombia. This cross-sectional study identified patients with a diagnosis code for AIJ (ICD-10 M08-M09) using a nationally-representative database of health care resource utilization provided by the “Sistema Integral de Información de la Protección Social (SISPRO)” in 2017. In addition, estimated prevalence was contrasted using data of personal history of JIA using a database of patients with ≤ 16 years affiliated to a subsidized-regime insurance company (N = 397,160) of the Caribbean region of Colombia. The estimated prevalences were extrapolated to the overall Colombian population using the demographic projections of individuals with ≤ 16 years of age (14,588,845) provided by the Departamento Administrativo Nacional de Estadisticas (DANE). In 2017, the prevalence of JIA in the subsidized-regime company was 13 per 100,000 (52/397.160). According to the data of SISPRO the prevalence of JIA in Colombia was 10.9 per 100,000 (1,602/14,588,845). Extrapolating these estimations to the general population of Colombia, the estimated number of prevalent cases of JIA in Colombia could be approximately 1.602 and 1.896 cases, respectively. These estimations are lower in Colombia compared to previously reported prevalence globally (between 60 and 400 cases per 100,000)

Effectiveness of a cardiovascular risk management program in the reduction of premature mortality associated to cardiovascular events in the Caribbean region of Colombia

Objectives: To establish the effectiveness of a cardiovascular risk management program [“De Todo Corazon (DTC)” program in Mutual SER-EPS] in the reduction of premature mortality associated to cardiovascular events (CVE) (male , 55 years, female , 60 years). Methods: The population eligible for the study were patients over 18 years of age affiliated to Mutual SER insurance company between June 2015 and June 2018 and residents of the Caribbean region of Colombia, enrolled or not to DTC program in which a cardiovascular event (CVE) occurred. The main outcomes considered were age of occurrence of cardiovascular events (AOCVE), age at death due to CVE (ADCVE) and years life lost (YLL). For the evaluation of the effectiveness, differences in AOCVO, ADCVO and the YPLL between the patients enrolled and nonenrolled in the DTC program were estimated using a Simple Linear Regression model. Results: A total of 3.902 CVE occurred in the study period among both groups. The enrolled patients had an average of AOCVE of 4.96 years (95% CI 3.85-6.06) higher than in non-enrolled patients. The ADCVE average was 4.64 years (95% CI 1.47 - 7.81) higher in the enrolled patients compared with the non-enrolled patients. Patients enrolled in the DTC program had on average -3.54 (95% CI -5.62 - -1.46) YLL compared to the non-enrolled patients. Conclusions: The DTC program in Mutual SER-EPS was effective to delay the AOCVE, ADCVE and YPLL. DTC program is an effective strategy to reduce the incidence and premature mortality due to CVE in the Caribbean region of Colombia

Prevalence of familial hyperlipidemia in the adult population of the Colombian Caribbean

Objectives: To estimate the prevalence of Familial Hyperlipidemia (FH) in a population of the Colombian Caribbean affiliated with Colombian Public Health Insurance Company (PHIC) and project this estimate to the population of the Colombian Caribbean. Methods: Data on a history of hyperlipidemia was collected by study investigators at including adults patients affiliated with PHIC (64,667) with ICD-10 diagnosis of hyperlipidemia (E78), or with a personal history of hyperlipidemia; or with abnormal lipid profile; or patients under treatment with lipid-lowering drugs. Data on personal or family history of premature coronary artery disease (CAD), presence of xanthomas and family history of FH were included. FHHe corresponded to LDL-C .190 mg/dL (5 mmol/L) for adults and/or with 1 first-degree relative similarly affected or with CAD. FHHo corresponded to LDL-C .500 mg/dL (13 mmol/ L) or LDL-C .300 mg/dL (8 mmol/L) under treatment with statins and/or 1 or both parents having clinically diagnosed FH. For the projection of the estimated prevalence of FH to the population of the Colombian Caribbean, the data of the adult population projections for the Colombian Caribbean of 2015 (general 10,442,134, adults 6,685,734) of the Departamento Administrativo Nacional de Estadisticas (DANE) were used. Results: If we assume that 1 of 5 patients with LDL-C .190 mg/dL (5 mmol/L) may have HF. The prevalence of patients with FH was 0.13% (87/64,667). The prevalence of adults with heterozygous FH (FHHe) was 0.13% (85/64,639). The prevalence of adults with homozygous HF (FHHo) was 0.0015% (1/64,639). Applying these estimates to the general population of Colombian Caribbean in 2015, the estimated number of cases of HF, FHHe and FHHo in the Caribbean Colombian could be approximately 13,574, 8,691 and 140, respectively. Conclusions: The estimated prevalence of FH, FHHe and FHHo in Colombian Caribbean was 1 of 769, 1 of 769 and 2 of 100,000 patients, respectivel

Prevalence of four statin benefit groups in a population of the Caribbean region of Colombia

Objectives: To estimate the prevalence of four Statin Benefit Groups (SBG) according to the 2018 ACC/AHA Multisociety Guideline on the Management of Blood Cholesterol, in a population of the Caribbean region of Colombia enrolled to DTC program Mutual SER-EPS in 2015 Methods: Data on a history of hyperlipidemia was collected by study investigators at including adults patients enrolled to DTC program Mutual SER-EPS in 2015 (N = 64,667) with ICD-10 diagnosis of hyperlipidemia (E78), or with a personal history of hyperlipidemia; or with abnormal lipid profile; or patients under treatment with lipid-lowering drugs. The four SBG were comprised adult patients $21 years of age with clinical atherosclerotic cardiovascular disease (ASCVD) (SBG1); adults$21 years of age with LDL-C $190 mg/dL (not due to secondary modifiable causes) (SBG2); adults aged 40 to 75 years without ASCVD, but with diabetes and with LDL-C 70 to 189 mg/dL (SBG3); and adults ages 40 to 75 years without ASCVD or diabetes, with LDL-C 70 to 189 mg/dL, and an estimated 10-year risk for ASCVD of$ 20% as determined by the Framingham Risk Score (SBG4). The prevalence of statin use by SBG and factors associated with statin use were estimated. Results: The prevalence of SBG1, SBG2, SBG3 and SBG4 in patients enrolled to DTC program Mutual SER-EPS in 2015 were 4.6% (2,985), 0.5% (337), 2.5% (1,633) and 1.3% (891), respectively. The prevalence of statin use in SBG1, SBG2, SBG3 and SBG4 were 69.1% (2,064), 40.6% (137), 47% (768) and 59.1% (463), respectively. Arterial hypertension (OR: 2.70; 95% IC 1.70-4.28) and personal history of ASCVD (OR: 3.43; 95% IC 2.15-5.46) were very significantly associated with statin use. Conclusions: The prevalence of SBG and statin use in patients enrolled to DTC program Mutual SEREPS in 2015 were 9% (5,846) and 58.7% (3,432), respectively

Association between exposure/adherence to a cardiovascular risk management program and the incidence and mortality of cardiovascular events in the Caribbean region of Colombia

Objectives: To establish the association between the exposure to a cardiovascular risk management program [“De Todo Corazon (DTC)” program in Mutual SER-EPS] and the reduction of incidence and mortality by cardiovascular events (CVE: AMI, Stroke, congestive heart failure). Methods: Cohort study that compared the occurrence of CVE among patients over 18 years of age exposed and non-exposed to the DTC program (N = 113,277). Enrolled patients in the DTC program between June 2015 and June 2017 were considered as the exposed population and patients enrolled in the DTC program between July 2017 and July 2018 were considered as the unexposed population. Patients who achieved clinical goals (blood pressure, 140/90 mmHg, HbA1c, 7.5% and LDL cholesterol, 100 mg/dl) were considered adherent to the DTC program. Incidence and mortality rates were compared and Incidence rate ratio (IRR) was used to evaluate the effect of the program. A Poisson regression model was used to assess the association between exposure to the program and CVE adjusting by socio-demographic characteristics and clinical goals. Results: The incidence of CVE in exposed and unexposed patients was 6.8 and 9.5 per 1.000 persons per year, respectively [IRR of 0.72 (95% CI 0.60-0.87)]. Mortality associated to CVE in exposed and unexposed patients was 0.46 and 0.56 per 1.000 persons per year, respectively [IRR 0.82 (95% CI 0.40-1.95)]. When adjusting the estimation by age, sex and achievement of clinical goals, a lower incidence rate of CVE among patients who were adherent to the program was observed [IRR = 0.62 (CI 95% 0.46 - 0.86)]. Conclusions: Exposure to the DTC program significantly decreased the incidence and mortality CVE by 28% and 18%, respectively. Adherence to the DTC program significantly decreased the incidence of CVE by 38%