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)

Health care resource utilization in patients with spondyloarthritis: A single setting analysis in Colombia

The aim of this study was to estimate the health care resource utilization in patients with spondylitis from a rheumatology care center located in Bogotá, D.C. Colombi

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

Burden of disease in young population of a colombian health insurance company

To estimate the burden of disease of population between 10-24 years old enrolled in the SER JOVEN program of a Colombian insurance company using disability-adjusted life-years (DALYs). Incidences were estimated from the administrative claims data of Mutual SER EPS. The ICD-10 codes of the main diagnosis were identified and regrouped according to the categories of diseases reported in the global burden of disease (GBD) study. To estimate the years of life lost (YLL), the difference between the age of death and the life expectancy at that age was obtained in a reference mortality population. The years lived with disability (YLD) were obtained by multiplying the estimated morbidity and the disability weights of the GBD 2017. DALYs were calculated by adding YLD and YLLs. We used the information of 512 patients insured to Mutual SER-EPS between 10-24 years, who died during January 2015 to December 2017 from all causes, and the healthcare registers of young people aged 10-24 years residing in 21 municipalities where Mutual SER EPS has presence. In the studied population, premature deaths and disability produced 5,355 DALYs, for 2017. Of these, 67.1% (3,591) of the burden of disease was due to non-communicable causes; followed by communicable, maternal, neonatal, and nutritional diseases (15.9%). The remaining 17% were due to unintentional and vital injuries and unclassified causes. The specific causes with the highest reported burden were substance use disorders and mental disorders, and this relationship remained constant between 2015-2017. In both sexes the first cause was non-communicable diseases; in men, injuries; and in women, communicable, maternal, neonatal diseases. In the analyzed population there was a considerable burden of disease associated with mental disorders and substance use. It is recommended to implement effective strategies that allow prioritizing the diseases that generate the greatest burden

Adherence to long-acting reversible contraceptive methods in low- income young women from the caribbean region of Colombia

Adolescent pregnancies are more likely to occur in poor communities, commonly driven by lack of education and employment opportunities. We aimed to estimate the subdermal implant discontinuation rate and to establish the factors associated with the discontinuation of long-acting reversible contraceptive (LARC) methods in a cohort of poor women in the Caribbean region of Colombia. A retrospective cohort study of LARC method use through review of administrative record data was conducted. A population of 2,192 adolescents and young women between 10-24 years old enrolled in the “SER JOVEN” program and who received subdermal implants between 2015-2018 was considered for eligibility. This program is for young people affiliated to a health care company in the Caribbean region of Colombia. We realized a follow-up time-person of the retrospective cohort, and we estimated the incidence of discontinuation of the subdermal implant at six months, one year, two years, and three years. Kaplan-Meier estimator for survival curves, and Cox proportional hazard model were used to ascertain factors associated with method discontinuation risk. A p-value <0.050 was considered significant. A total of 2,192 women were selected with a mean (standard deviation -SD) age of 19.4 (2.8) years and a mean duration of use of subdermal implant of 2.6 (0.8) years. We estimated the subdermal implant discontinuation rate at six months in 0.7% [CI95% 0.3-1.1], a year later in 1.5% [CI95% 1-2], two years later in 2.1% [CI95% 1.5-2.7] and finally at three years in 2.2% [CI95% 1.6-2.8]. Women who stated they have children at baseline were about 70% less risk to discontinue subdermal implants (HR: 0.3 [CI95% 0.1 – 0.8]). Adolescent pregnancy is a public health problem, and it is an important cause of poverty and illness. Then, the use of subdermal implants is an effective alternative to prevent unintended pregnancies

Medical resource use in patients with psoriatic arthritis in a comprehensive rheumatological center in Colombia

Psoriatic arthritis (PsA), a chronic systemic inflammatory disorder, impairs the quality of life of patients. The aim of this study was to describe the medical resource use in patients with PsA in a comprehensive rheumatological center in Colombia. We retrospectively analyzed patients diagnosed with PsA who were attended in a center of excellence for rheumatic diseases located in Bogotá, D.C. Colombia, from January to December 2019. A database of medical records was analyzed to identify the use of medical resources classified by specialized physician visits, medications and ambulatory services (e.g., diagnostic, laboratory or image procedures, physical therapy). We reported absolute and relative frequencies among diagnostic groups. This study had no risk for patients. Ninety-six patients with PsA were studied, 57% were women. The mean age was 58.08 (±12.3 years), 90.63% of diagnostic was arthropathic psoriasis, other diagnostics were rheumatoid arthritis without rheumatoid factor, unspecified site (2.08%) and psoriasis, unspecified (2.08%) (ICD-10 code L405, M060, L409, respectively). In terms of treatments, most of the patients used a conventional disease-modifying antirheumatic drugs (DMARDs), methotrexate was the most frequent (represented the 14% of prescription and 78% of patients). On the other hand, 56.25% of patients receive treatment with biological DMARDs (10% of prescription). Among these biologicals, adalimumab (17.71%) and secukinumab (16.67%) were the most used. Regarding other health services, the visit to the specialist and the RX were the most common (83.33% of patients). Chest RX and column RX (17.71% each) had the highest frequency. This is one of the first approaches to the estimation of use of medical resources of PsA in Colombia. Frequency of DMARS use was associated to the severity and medical control of patients

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