Economic evaluation of sunitinib versus pazopanib and best supportive care for the treatment of metastatic renal cell carcinoma in Chile: cost-effectiveness analysis and a mixed treatment comparison

© 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group. Background: Sunitinib and Pazopanib are two metastatic renal cell carcinoma (MRCC) treatment alternatives, however the health system in Chile does not consider coverage for any. The cost-effectiveness versus relevant comparator was assessed to support evidence-based decision making. Methods: A four health states Markov model was built: first, second line treatments, BSC and death. Benefits were measured in QALYs, and efficacy estimates were obtained from an indirect treatment comparison. A 10-year time horizon and a 3% undifferentiated discount rate were considered. Deterministic and probabilistic sensitivity analyses were performed. Results: The costs of treating MRCC with Sunitinib were higher than Pazopanib and BSC. When comparing Sunitinib versus Pazopanib, the incremental benefit is small favoring Sunitinib (0.03 QALYs). The base case scenario shows an average ICER of PA versus BSC of US$62,327.11/QALY and of US$85,885/QALY for Sunitinib versus Pazopanib. The ICER was most sensitive to the OS relative to BSC, where evidence was associated to important bias. Conclusions: Sunitinib or Pazopanib can be considered cost-effective if a 3 GDP per-capita threshold is assumed. The decision between SU or PA is highly sensitive to the price of the drugs, rather than the outcomes. Therefore, the decision might be made based on cost-minimization exercise

El Océano Austral y el patrimonio territorial argentino

Nos proponemos en este trabajo —que forma parte de uno mayor referido a la propuesta papal conocida sobre la mal denominada “cuestión del Beagle”— ponderar las consecuencias territoriales que puede tener para nuestro país la aceptación de la existencia del océano Austral o Antártico. El problema rebasa la mera cuestión científica, de neto carácter oceanógrafico, pues se relaciona con el denominado “principio bioceánico” que fundamenta la posición argentina en las cuestiones limítrofes pendientes con Chile, se vincula con el status político de la Antártida y su correspondiente delimitación geográfica e incide, finalmente, en el futuro de las islas Georgias del Sur y Sandwich del Sur.Universidad Nacional de La Plat

The Minimum of Solar Cycle 23: As Deep as It Could Be?

In this work we introduce a new way of binning sunspot group data with the purpose of better understanding the impact of the solar cycle on sunspot properties and how this defined the characteristics of the extended minimum of cycle 23. Our approach assumes that the statistical properties of sunspots are completely determined by the strength of the underlying large-scale field and have no additional time dependencies. We use the amplitude of the cycle at any given moment (something we refer to as activity level) as a proxy for the strength of this deep-seated magnetic field. We find that the sunspot size distribution is composed of two populations: one population of groups and active regions and a second population of pores and ephemeral regions. When fits are performed at periods of different activity level, only the statistical properties of the former population, the active regions, is found to vary. Finally, we study the relative contribution of each component (small-scale versus large-scale) to solar magnetism. We find that when hemispheres are treated separately, almost every one of the past 12 solar minima reaches a point where the main contribution to magnetism comes from the small-scale component. However, due to asymmetries in cycle phase, this state is very rarely reached by both hemispheres at the same time. From this we infer that even though each hemisphere did reach the magnetic baseline, from a heliospheric point of view the minimum of cycle 23 was not as deep as it could have been

Costs and consequences of chronic pain due to musculoskeletal disorders from a health system perspective in Chile

Copyright © 2018 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The International Association for the Study of Pain. Background: Chronic pain is a prevalent and distressing condition caused by an unceasing pain lasting more than 3 months or a pain that persists beyond the normal healing time. There is evidence of inadequate management partly explained by the unawareness regarding the magnitude of the problem. Objectives: To estimate the annual expected costs and consequences of chronic pain caused by musculoskeletal diseases from the health system perspective in Chile. Methods: A Markov cohort model was built to represent chronic pain and estimate expected costs and consequences over 1-year time horizon. Transition probabilities were obtained through expert elicitation. Consequences examined were: years lost to disability (YLD), depression, anxiety, and productivity losses. Direct health care costs were estimated using local sources. Probabilistic sensitivity analysis was performed to characterize second-order uncertainty. Results: The annual expected cost due to musculoskeletal chronic pain was estimated in USD $1387.2 million, equivalent to 0.417$94 million (Bayesian credibility interval 95% $49.1-$156.26). Productivity losses were also important cost, although early retirement and presenteeism were not measured. Chronic pain causes 137,037 YLDs. Conclusion: Chronic pain is not only an important cause of disability but also responsible for high social and financial burden in Chile. Public health programs focused on managing chronic pain may decrease burden of disease and possibly reduce costs.

“Perfil sociodemográfico y estado de salud de la población adulta mayor del departamento Zonda, San Juan. Año 2012”.

El envejecimiento es un proceso caracterizado por la limitación de la capacidad deadaptación a los cambios biológicos, psicológicos, sociales y una disminución de lacapacidad de reserva de todos los órganos y sistemas. Los ancianos tienen mayor riesgode presentar enfermedades crónicas resultantes de la interacción de factores genéticos yambientales. El propósito del estudio fue describir la realidad demográfica,socioeconómica y sanitaria de los adultos mayores que residen en Zonda. El diseño dela Investigación fue de tipo descriptivo, transversal y observacional, utilizando comoprincipal instrumento una entrevista cerrada, historias clínicas, balanza y tallímetro. Eluniverso fueron los adultos mayores de 65 años, de ambos sexos que habitan en Zonda.Se aplicó muestreo aleatorio simple, nivel de confianza 99%, error muestral 1%. Seutilizó programa SPSS. Siguiendo normas internacionales se garantizó laconfidencialidad de los datos y consentimiento informado. La población bajo estudio seconcentra predominantemente en el rango etáreo de 65 a 74 años. El análisis de loshábitos de vida muestra que menos del 30% de la población realiza actividad física, másde la mitad de los varones presenta hábitos perjudiciales para la salud, 65% tabaquismoy 51% consumo de bebidas alcohólicas. La mayoría de las mujeres participan deactividades recreativas. El 75% de las mujeres y el 53% de los varones presentanmalnutrición por exceso. El 50% presenta hipertensión arterial y el 40% dislipemia.El patrón epidemiológico coincide con la tendencia demográfica mundial, revelando unaumento de ECNT, hábitos de vida perjudiciales para la salud y crecimiento de lapoblación mayor de 80 años

Prevalencia de obesidad en escolares del departamento Zonda, San Juan, año 2010.

La epidemia de la obesidad tiene una especial repercusión en los niños, superando el 15% de suprevalencia en algunos países, umbral crítico considerado por la Organización Mundial de la Salud(OMS). Esto lleva a considerarla un fenómeno global, una epidemia creciente y no controlada, congran impacto negativo en la salud biopsicosocial

“Determinantes de la incorporación precoz de alimentos en niños menores de 6 meses de edad que asisten a los Centros de Atención Primaria de la Salud de Zona Sanitaria I Central, 2012”.

La necesidad de una adecuada alimentación complementaria en la infancia conduce a evaluar posibles factores determinantes de la incorporación precoz dealimentos en niños menores de 6 meses de edad y su estado nutricional, de todos los Centros de Atención Primaria de la Salud de la Zona Sanitaria I Central, 2012. El trabajopropuso caracterizar población, contexto familiar y contexto socio-cultural; determinar tipo y calidad de información de las madres y evaluar nutricionalmente a niños menoresde 12 meses de edad. Se realizaron encuestas a madres en edad fértil que asisten periódicamente a los CAPS de la Zona Sanitaria I Central. Valoración del estado nutricional a los respectivos hijos menores de 12 meses de edad

Solar energetic electron events measured by MESSENGER and Solar Orbiter. Peak intensity and energy spectrum radial dependences: statistical analysis

Context/Aims: We present a list of 61 solar energetic electron (SEE) events measured by the MESSENGER mission and the radial dependences of the electron peak intensity and the peak-intensity energy spectrum. The analysis comprises the period from 2010 to 2015, when MESSENGER heliocentric distance varied between 0.31 and 0.47 au. We also show the radial dependencies for a shorter list of 12 SEE events measured in February and March 2022 by spacecraft near 1 au and by Solar Orbiter around its first close perihelion at 0.32 au. Results: Due to the elevated background intensity level of the particle instrument on board MESSENGER, the SEE events measured by this mission are necessarily large and intense; most of them accompanied by a CME-driven shock, being widespread in heliolongitude, and displaying relativistic ($\sim$1 MeV) electron intensity enhancements. The two main conclusions derived from the analysis of the large SEE events measured by MESSENGER, which are generally supported by Solar Orbiter's data results, are: (1) There is a wide variability in the radial dependence of the electron peak intensity between $\sim$0.3 au and $\sim$1 au, but the peak intensities of the energetic electrons decrease with radial distance from the Sun in 27 out of 28 events. On average and within the uncertainties, we find a radial dependence consistent with $R^{-3}$. (2) The electron spectral index found in the energy range around 200 keV ($\delta$200) of the backward-scattered population near 0.3 au measured by MESSENGER is harder in 19 out of 20 (15 out of 18) events by a median factor of $\sim$20% ($\sim$10%) when comparing to the anti-sunward propagating beam (backward-scattered population) near 1 au.Comment: 20 pages, 13 figure