Evaluación socioeconómica del puerto de Concepción del Uruguay

En este trabajo se realiza una evaluación socioeconómica del dragado y balizamiento del Río Uruguay desde el Km. 0 hasta el Puerto de Concepción del Uruguay, para establecer la conveniencia de su realización y brindar información adicional a los tomadores de decisión. Se utiliza como marco general la teoría de Evaluación Social de Proyectos, y en particular se realiza una aplicación de la Metodología de Evaluación de Proyectos de Transporte al caso de una vía fluvial. El valor actual neto ($18.667.383,36), la tasa interna de retorno (18.1%), la razón beneficio costo (1.42) y el período de recupero de la inversión (5 años) justifican la realización del proyecto; y en base a los supuestos realizados para el análisis de riesgo, la probabilidad de obtener resultados negativos (VAN<0 y TIR<12%) es del 10%. El trabajo difunde la utilización de las herramientas de evaluación social de proyectos, siendo su principal aporte la realización de un análisis coste-beneficio de un proyecto de infraestructura fluvial con efectos sobre la red de transporte terrestre.Facultad de Ciencias Económica

Evaluación socioeconómica del puerto de Concepción del Uruguay

En este trabajo se realiza una evaluación socioeconómica del dragado y balizamiento del Río Uruguay desde el Km. 0 hasta el Puerto de Concepción del Uruguay, para establecer la conveniencia de su realización y brindar información adicional a los tomadores de decisión. Se utiliza como marco general la teoría de Evaluación Social de Proyectos, y en particular se realiza una aplicación de la Metodología de Evaluación de Proyectos de Transporte al caso de una vía fluvial. El valor actual neto ($18.667.383,36), la tasa interna de retorno (18.1%), la razón beneficio costo (1.42) y el período de recupero de la inversión (5 años) justifican la realización del proyecto; y en base a los supuestos realizados para el análisis de riesgo, la probabilidad de obtener resultados negativos (VAN<0 y TIR<12%) es del 10%. El trabajo difunde la utilización de las herramientas de evaluación social de proyectos, siendo su principal aporte la realización de un análisis coste-beneficio de un proyecto de infraestructura fluvial con efectos sobre la red de transporte terrestre.Facultad de Ciencias Económica

Relation between cost of drug treatment and body mass index in people with type 2 diabetes in Latin America

Aims Despite the frequent association of obesity with type 2 diabetes (T2D), the effect of the former on the cost of drug treatment of the latest has not been specifically addressed. We studied the association of overweight/obesity on the cost of drug treatment of hyperglycemia, hypertension and dyslipidemia in a population with T2D. Methods This observational study utilized data from the QUALIDIAB database on 3,099 T2D patients seen in Diabetes Centers in Argentina, Chile, Colombia, Peru, and Venezuela. Data were grouped according to body mass index (BMI) as Normal (18.5BMI<25), Overweight (25BMI<30), and Obese (BMI30). Thereafter, we assessed clinical and metabolic data and cost of drug treatment in each category. Statistical analyses included group comparisons for continuous variables (parametric or non-parametric tests), Chi-square tests for differences between proportions, and multivariable regression analysis to assess the association between BMI and monthly cost of drug treatment. Results Although all groups showed comparable degree of glycometabolic control (FBG, HbA1c), we found significant differences in other metabolic control indicators. Total cost of drug treatment of hyperglycemia and associated cardiovascular risk factors (CVRF) increased significantly (p<0.001) with increment of BMI. Hyperglycemia treatment cost showed a significant increase concordant with BMI whereas hypertension and dyslipidemia did not. Despite different values and percentages of increase, this growing cost profile was reproduced in every participating country. BMI significantly and independently affected hyperglycemia treatment cost. Conclusions Our study shows for the first time that BMI significantly increases total expenditure on drugs for T2D and its associated CVRF treatment in Latin America.Fil: Elgart, Jorge Federico. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - la Plata. Centro de Endocrinología Experimental y Aplicada. Universidad Nacional de la Plata. Facultad de Ciencias Médicas. Centro de Endocrinología Experimental y Aplicada; ArgentinaFil: Prestes, Mariana. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - la Plata. Centro de Endocrinología Experimental y Aplicada. Universidad Nacional de la Plata. Facultad de Ciencias Médicas. Centro de Endocrinología Experimental y Aplicada; ArgentinaFil: Gonzalez, Lorena. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - la Plata. Centro de Endocrinología Experimental y Aplicada. Universidad Nacional de la Plata. Facultad de Ciencias Médicas. Centro de Endocrinología Experimental y Aplicada; ArgentinaFil: Rucci, Enzo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - la Plata. Centro de Endocrinología Experimental y Aplicada. Universidad Nacional de la Plata. Facultad de Ciencias Médicas. Centro de Endocrinología Experimental y Aplicada; ArgentinaFil: Gagliardino, Juan Jose. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - la Plata. Centro de Endocrinología Experimental y Aplicada. Universidad Nacional de la Plata. Facultad de Ciencias Médicas. Centro de Endocrinología Experimental y Aplicada; Argentin

Diabetes in Argentina: Cost and management of diabetes and its complications and challenges for health policy

Background: Diabetes is an expensive disease in Argentina as well as worldwide, and its prevalence is continuously rising affecting the quality of life of people with the disease and their life expectancy. It also imposes a heavy burden to the national health care budget and on the economy in the form of productivity losses.Aims: To review and discuss a) the reported evidence on diabetes prevalence, the degree of control, the cost of care and outcomes, b) available strategies to decrease the health and economic disease burden, and c) how the disease fits in the Argentinian health care system and policy. Finally, to propose evidence-based policy options to reduce the burden of diabetes, both from an epidemiological as well as an economic perspective, on the Argentinian society. The evidence presented is expected to help the local authorities to develop and implement effective diabetes care programmes.Methodology: A comprehensive literature review was performed using databases such as MEDLINE, EMBASE and LILACS (Latin American and Caribbean Health Sciences). Literature published from 1980 to 2011 was included. This information was complemented with grey literature, including data from national and provincial official sources, personal communications and contacts with health authorities and diabetes experts in Argentina.Results: Overall diabetes prevalence increased from 8.4% in 2005 to 9.6% 2009 at national level. In 2009, diabetes was the seventh leading cause of death with a mortality rate of 19.2 per 100,000 inhabitants, and it accounted for 1,328,802 DALYs lost in the adult population, mainly affecting women aged over fifty. The per capita hospitalisation cost for people with diabetes was significantly higher than for people without the disease, US$1,628 vs. US$ 833 in 2004. Evidence shows that implementation of combined educative interventions improved quality of care and outcomes, decreased treatment costs and optimised the use of economic resources.Conclusions: Based on the evidence reviewed, we believe that the implementation of structured health care programmes including diabetes education at every level, could improve quality of care as well as its clinical, metabolic and economic outcomes. If implemented across the country, these programmes could decrease the disease burden and optimise the use of human and economic resources.Centro de Endocrinología Experimental y Aplicad

Self-monitoring of blood glucose: Use, frequency drivers, and cost in Argentina

Background: Although test strips for self-monitoring of blood glucose (SMBG) represent around 50% of diabetes treatment cost in Argentina, little is known about their current use and relationship with different types of treatment. We therefore aimed to estimate the current use of test strips and identify the major use drivers and the percentage they represent of total prescription costs in 2 entities of the social security system (SSS) of Argentina. Methods: Observational retrospective study measuring test strip prescriptions delivered by pharmacies from the province of Buenos Aires (8115 records collected during 3 months provided by the Colegio de Farmacéuticos de la Provincia de Buenos Aires) of affiliates with type 2 diabetes (T2DM) from 2 large entities of the SSS system. Results: The average monthly test strips/patient used for SMBG was 97.5 ± 70.1. This number varied according to treatment: monotherapy with oral antidiabetic drugs (OAD) < combined OAD therapy < insulin treatment. Test strips represented a higher percentage of the total prescription cost in people under OAD monotherapy (84.6%) and lower in those with insulin analogs (46.9%). Conclusions: In our population, the type of hyperglycemia treatment was the main driver of test strip use for SMBG and its impact on the total prescription cost depends on the kind of such treatment. Since it has been shown that patients' education and prescription audit can optimize test strip use and treatment outcomes, implementation of such strategies could appropriately support, optimize, and reduce ineffective test strip use in people with T2DM.Facultad de Ciencias MédicasCentro de Endocrinología Experimental y Aplicad

The burden of diabetes in Argentina

OBJECTIVE: To measure the economic burden of diabetes in Argentina by age, gender and region for the year 2005, in disability-adjusted life years (DALYs).METHODS: DALYs were estimated by the sum of years of life lost due to premature death (YLL) and years of life lived with disability (YLD).RESULTS: In the population studied (20 to 85 years), the burden of diabetes without complications was 1.3 million DALYs, 85% of which were caused by disabilities. Whereas mortality rates (YLL) increased as a function of age, YLD showed the opposite relationship. Women had higher burden of disease values, represented by 51 and 61% of YLL and YLD, respectively, independently of age.CONCLUSIONS: Our results demonstrate that disabilities are a key component of diabetes burden; its regular and systematic estimation would allow to design effective prevention strategies, to assess the impact of their implementation and to optimize resource allocation based on objective evidence.Centro de Endocrinología Experimental y Aplicad

Changes in quality of care and costs induced by implementation of a diabetes program in a social security entity of Argentina

Purpose: To measure the impact of a diabetes and cardiovascular risk factors program implemented in a social security institution upon short- and long-term clinical/metabolic outcomes and costs of care. Methods: Observational longitudinal cohort analysis of clinical/metabolic data and resource use of 300 adult male and female program participants with diabetes before (baseline) and 1 and 3 years after implementation of the program. Data were obtained from clinical records (Qualidiab) and the administration's database. Results: The implementation of the program in "real world" conditions resulted in an immediate and sustainable improvement of the quality of care provided to people with diabetes incorporated therein. We also recorded a more appropriate oral therapy prescription for hyperglycemia and cardiovascular risk factors (CVRFs), as well as a decrease of events related to chronic complications. This improvement was associated with an increased use of diagnostic and therapeutic resources, particularly those related to pharmacy prescriptions, not specifically used for the control of hyperglycemia and other CVRFs. Conclusion: The implementation of a diabetes program in real-world conditions results in a significant short- and long-term improvement of the quality of care provided to people with diabetes and other CVRFs, but simultaneously increased the use of resources and the cost of diagnostic and therapeutic practices. Since controlled studies have shown improvement in quality of care without increasing costs, our results suggest the need to include management-control strategies in these programs for appropriate medical and administrative feedback to ensure the simultaneous improvement of clinical outcomes and optimization of the use of resources.Centro de Endocrinología Experimental y AplicadaFacultad de Ciencias MédicasFacultad de Ciencias Económica

Relation between cost of drug treatment and body mass index in people with type 2 diabetes in Latin America

Despite the frequent association of obesity with type 2 diabetes (T2D), the effect of the former on the cost of drug treatment of the latest has not been specifically addressed. We studied the association of overweight/obesity on the cost of drug treatment of hyperglycemia, hypertension and dyslipidemia in a population with T2D.Facultad de Ciencias MédicasCentro de Endocrinología Experimental y Aplicad

Health inequalities and the impact on the prevalence of cardiovascular risk factors and chronic complications in Argentina: a study on national risk factors surveys

Introducción: Argentina muestra evidencia de desigualdades en salud medida, tanto a nivel general como utilizando el ingreso como parámetro de posición social. Sin embargo, pocos estudios abordan la problemática de la equidad en salud a nivel de enfermedades crónicas como los factores de riesgo cardiovascular. Objetivo: Describir las desigualdades en salud utilizando como trazador de enfermedades crónicas a los factores de riesgo cardiovascular a nivel subnacional y su evolución temporal. Para complementar, se busca identificar las diferencias en la calidad de atención brindada a personas con factores de riesgo cardiovascular entre 2005 y 2009. Métodos: Estudio observacional y cuantitativo basado en métodos descriptivos. Se analizó la Encuesta Nacional de Factores de Riesgo 2005 y 2009 para evaluar hipertensión, diabetes, dislipemia y sobrepeso/obesidad en las cohortes correspondientes, las asociaciones entre el estado de salud y diversas variables demográficas, epidemiológicas y socioeconómicas. Adicionalmente, y utilizando la base de datos del registro Quality of Diabetes Care (QUALIDIAB), se analizaron las características clínicas y metabólicas de las personas con diabetes y otros factores de riesgo cardiovascular en los años 2005 y 2009. Resultados: Los factores de riesgo cardiovascular se presentan más frecuentemente en personas con menor posición socioeconómica, independientemente del indicador considerado. Las desigualdades detectadas mostraron peores indicadores en los estratos con educación e ingreso más bajo, manifestándose tanto a nivel nacional como regional. En general, son más acentuadas en el año 2009. Su magnitud varió según región y factor de riesgo cardiovascular considerado. De 2005 a 2009, se incrementan los valores de índice de masa corporal, glucemia y hemoglobina glicosilada, disminuyeron los de presión arterial sistólica y los triglicéridos, sin cambios significativos en el colesterol total y presión arterial diastólica. Conclusiones: En nuestro medio, los factores de riesgo cardiovascular presentan desigualdades condicionadas por su posición social, manifestándose tanto a nivel nacional como regional.Background: In Argentina, there is evidence of health inequalities, measured both at the general level and also using income as a parameter of social status. However, few studies address the issue of health equality in chronic diseases such as cardiovascular risk factors. Objective: To describe health inequalities, using cardiovascular risk factors as a tracer for chronic diseases in different areas of the country and over time. In addition, we aim to identify differences in the quality of care provided to people with cardiovascular risk factors, between 2005 and 2009. Methods: This is an observational study, which used descriptive and quantitative methods. Data from the National Risk Factors Survey from 2005 and 2009 in the cohorts who have chronic diseases (hypertension, diabetes, dyslipidemia and overweight/obesity) were analyzed to assess associations between health status and several demographic, epidemiological and socioeconomic variables. Additionally, clinical and metabolic characteristics of people with diabetes and other cardiovascular risks factors were analyzed in 2005 and 2009 using the database Quality of Diabetes Care (QUALIDIAB). Results: Cardiovascular risk factors are more frequent in people with lower socioeconomic status, regardless of the indicator. The inequalities detected showed the worst indicators in strata with lower education and income, with the same results both nationwide and separated by region. This inequalities were more pronounced in 2009, and their magnitude changed by region and cardiovascular risk factor. From 2005 to 2009, body mass index, blood glucose and HbA1c value increased. In contrast, both systolic blood pressure and triglycerides decreased, with no significant changes in total cholesterol and diastolic blood pressure. Conclusion: Cardiovascular risk factors present inequalities attributed to social status manifesting at both national and regional levels.Centro de Endocrinología Experimental y Aplicada (CONICET- Universidad Nacional de La Plata

Education of people with type 2 diabetes through peers with diabetes: is it cost effective?

Introducción: La inadecuada calidad de atención brindada a personas con diabetes tipo 2, genera un gran impacto socioeconómico y un grave problema de salud pública. La educación de estas personas a través de pares con diabetes mellitus es una alternativa, a la brindada por equipos profesionales (educación tradicional), que logra resultados no inferiores a esta última. Sin embargo, hay escasa evidencia de costo-efectividad de la educación a través de pares respecto de la tradicional. Objetivo: Evaluar la relación costo-efectividad de la educación de personas con diabetes tipo 2, durante un año por un equipo profesional (educación tradicional), versus educación y apoyo impartida por un par con diabetes mellitus (educación de pares). Métodos: Análisis de costo-efectividad basado en un estudio clínico prospectivo aleatorizado, desarrollado en la ciudad de La Plata sobre 199 personas con diabetes tipo 2, organizados en dos grupos: uno que recibió educación tradicional y otro educación a través de pares con diabetes mellitus. Como indicador primario de efectividad se consideró el cambio en la hemoglobina glicosilada y como secundarios otros como índice de masa corporal, presión arterial sistólica, presión arterial diastólica, glucemia en ayunas, colesterol total y triglicéridos. Se estimó el costo directo de cada estrategia basándose en recursos utilizados en el estudio clínico y evaluándose tres escenarios de costos para la educación de pares. La robustez de los resultados se evaluó mediante análisis de sensibilidad univariado. Resultados: El costo por unidad de descenso (%) de hemoglobina glicosilada con educación tradicional fue de $2621 pesos argentinos; y con educación a través de pares fue de$1508, $1779 y$2071 pesos argentinos, para cada uno de los tres escenarios considerados (escenario 1, escenario 2 y escenario 3), respectivamente. Por cada $100 pesos argentinos invertidos se logró descender 0,04Conclusión: La educación de personas con diabetes tipo 2 a través de pares, complementaria al control y tratamiento de la enfermedad, es costo efectiva respecto a la educación tradicional.Introduction: Inadequate quality of care provided to people with type 2 diabetes mellitus, generates a significant socioeconomic burden and a serious public health problem. Diabetes education through peers with diabetes is an alternative to that provided by professional educators (traditional education) which achieves non-inferior results. However, there is little evidence of cost-effectiveness of education trough peers over traditional education. Objetive: To evaluate cost-effectiveness of education of people with type 2 diabetes mellitus, during a year, by a team of professional educators (traditional education) versus education and support delivered by trained peers with diabetes. Methods: Cost-effectiveness analysis based on a randomized prospective clinical study conducted in the city of La Plata, including 199 people with type 2 diabetes mellitus, divided in two groups:, one receiving traditional education and another receiving the same education but delivered by peer educators with type 2 diabetes mellitus. Change in glycosylated hemoglobin (HbA1c) was considered as a primary indicator of effectiveness and secondary indicators were others, such as body mass index, systolic blood pressure, diastolic blood pressure, fasting blood glucose, total cholesterol and triglyceride levels. The direct cost of each strategy was estimated based on resources used in the trial, evaluating three cost scenarios for peer education. The strength of the results was assessed by univariate sensitivity analysis. Results: Cost per unit decrease ($2 621; peer education: $1 508,$1 779 y $2 071 for each of the three scenarios considered (scenario 1, scenario 2, scenario 3), respectively. For each$100 invested a decrease of 0.04% in the HbA1c with traditional education was achieved; and 0.07% in scenario 1; 0.06% in scenario 2 and 0.05% in scenario 3, with education delivered by peer educators. Sensitivity analysis showed the strength of the results. Conclusion: Education of type 2 diabetes mellitus patients through peers as a complement to control and treatment of the disease, is cost-effective compared to traditional education.Centro de Endocrinología Experimental y Aplicad