Cost effectiveness of daclatasvir/asunaprevir versus peginterferon/ribavirin and protease inhibitors for the treatment of hepatitis c genotype 1b Naïve patients in Chile

© 2015 Vargas et al. Introduction: Daclatasvir and Asunaprevir (DCV/ASV) have recently been approved for the treatment of chronic hepatitis C virus infection. In association, they are more effective and safer than previous available treatments, but more expensive. It is unclear if paying for the additional costs is an efficient strategy considering limited resources. Methods: A Markov model was built to estimate the expected costs in Chilean pesos (CL$) and converted to US dollars (US$) and benefits in quality adjusted life years (QALYs) in a hypothetic cohort of naive patients receiving DCV/ASV compared to protease inhibitors (PIs) and Peginterferon plus Ribavirin (PR). Efficacy was obtained from a mixed-treatment comparison study and costs were estimated from local sources. Utilities were obtained applying the EQ-5D survey to local patients and then valued with the Chilean tariff. A time horizon of 46 years and a discount rate of 3% for costs and outcomes was considered. The ICERs were estimated for a range of DCV/ASV prices. Deterministic and probabilistic sensitivity analyses were performed. Results: PIs were extendedly dominated by DCV/ASV. The ICER of DCV/ASV compared to PR was US$16,635/QALY at a total treatment price of US$ 77,419; US$11,581 /QALY at a price of US$ 58,065; US$6,375/QALY at a price of US$ 38,710; and US$1,364 /QALY at a price of US$ 19,355. The probability of cost-effectiveness at a price of US$38,710 was 91.6$ 19,355. Although the results are sensitive to certain parameters, the ICER did not increase above the suggested threshold of 1 GDP per capita. Conclusions: DCV/ASV can be considered cost-effective at any price of the range studied. These results provide decision makers useful information about the value of incorporating these drugs into the public Chilean healthcare system

Complaint Management in the Public Sector Organization in the Philippines

Participatory governance is a democratic process intended to involve citizens in the management of public institution. By providing them platforms through which they can access the government, transparency and accountability in public governance is enhanced.  The Department of Public Works and Highways (DPWH) acknowledges its importance through the establishment of different platforms of communications wherein clients can raise their concerns.  The study aims at   describing and evaluating the Complaints Management Program of the DPWH Nueva Ecija 2nd District Engineering Office based in Cabanatuan City. The analysis was drawn from Fifteen (15) client feedbacks received in 2017.  The   data were gathered using qualitative and quantitative approaches while multi-stakeholders framework for complaint management was adapted to measure the effectiveness of the feedback and complaint management mechanisms of the agency. The study  found that the agency : a)  institutionalizes and observes procedures in handling complaints; b) resolves complaints based on the principles of fairness, accessibility, responsiveness, efficiency , trust and citizens participation; however, there are limitations identified in regard to the administrative support in terms of  personnel assigned, training and availability of vehicle  use to verify various complaints on the ground. Civic engagement is an effective tool to promote democracy and enhance open government. They are proven to create enabling   environment  that tends to yield positive   political outcomes and policy implementation results. Keywords: Participatory governance, Complaint management ,Feedback mechanism, DPWH –Philippines DOI: 10.7176/PPAR/9-2-0

Ubiquitylation and SUMOylation: An Orchestrated Regulation During DNA Damage Repair

DNA double-strand breaks (DSBs) are cytotoxic DNA lesions that must be repaired as soon as possible because it can cause chromosomal aberrations and cell death. Homologous recombination (HR) and nonhomologous end joining (NHEJ) are the pathways that mainly repair these ruptures. HR process is finely regulated by synchronized posttranslational modifications including phosphorylation, ubiquitylation, and SUMOylation. The ubiquitin (Ub) modifications at damaged chromatin serve as recruitment platforms for DSB repair complexes by facilitating binding sites or regulating the interaction between proteins. Thus, SUMOylation has been associated with protein interaction, enzymatic activity, and chromatin mobility. Several DNA damage factors have been found to be ubiquitylated and SUMOylated including histones (H2AX) and proteins such as Mre11, Rad51, NBS1, and BRCA1. Regarding ubiquitylation-mediated regulation of DNA repair, RNF168 and RNF8 E3 ligases have turned out to be a key step in DNA damage repair regulation. Interestingly, there is evidence that the Ub signaling mechanism is ancestral, and this emphasizes its importance

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

Imaginario Social : una aproximación desde la obra de Michel Maffesoli

En este texto presentamos una revisión, -a modo de ejercicio de reflexión colectiva-, de la extensa producción bibliográfica de Michel Maffesoli, buscando articular desde los supuestos presentes en su obra, la noción de imaginario social. Para comprender el contexto de producción de este sociólogo francés, hemos comenzado por hacer una breve revisión de sus principales trabajos e influencias teóricas. Posteriormente hemos centrado la reflexión sobre sus textos fundamentales: El conocimiento ordinario, La orgía, El tiempo de las tribus, Elogio de la razón sensible y El instante eterno. Finalmente, nos aproximamos a la intersección de su obra con el imaginario social de acuerdo a cuatro categorías temáticas propuestas por Enrique Carretero (2003): el significado de la utopía, la problemática en torno a la modernidad, la integración simbólica del neotribalismo y la legitimidad del orden social.In the following text we display a review, -a sort of collective reflection exercise-, regarding the extensive bibliographic production of Michel Maffesoli, trying to articulate the notion of social imaginary departing from the suppositions present in Maffesoli's work. In order to understand the production context of this French sociologist, we began by a brief review of his main work as well as other theoretical influences. Afterwards, his fundamental texts are the subject to a reflection: Ordinary Knowledge, The orgy, The Time of the Tribes, Praise of a Sensible Reason, and The Eternal Instant. Finally, several elements studied were integrated in an approach to the notion of social imaginary, facing four thematic categories following Enrique Carretero's (2003) proposals: utopia's meaning, problems concerning modernity, symbolic integration of neotribalism, and the legitimacy of social order

Narrative, resistance and sense in Hannah Arendt and Gilles Deleuze

Artículo científico indizadoEn este estudio se realiza una comparación de las posiciones de Hannah Arendt y Gilles Deleuze con respecto a la importancia de la narratividad como medio para resistir y dar sentido a la vida humana. Tanto Hannah Arendt como Gilles Deleuze sostendrían que el ejercicio de la escritura es un medio para resistir al totalitarismo y a la banalidad del mal, en términos de la filósofa judeoalemana; o una manera de hacer clínica de una sociedad enferma que busca asfixiar cualquier clase de vitalismo individual, en palabras de Gilles Deleuze.Universidad de Guanajuato UAE

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.

Deforestación y reforestación en la Sierra de Guadalupe, Estado de México, como un sistema social en red.

Deforestation is a complex and multifactorial problem. In Mexico, this phenomenon is exacerbated by urbanization in metropolitan areas. The Sierra de Guadalupe is situated in the Valley of Mexico and is a Protected Natural Area (PNA) that has been continually devastated by encroaching human settlement. In the area of mountain range located in the State of Mexico, attempts have been made to counteract deforestation with reforestation in degraded areas. However, these activities have been modified by the social, economic and political realities of this area. Our aim was to analyze the reforestation process in the Sierra de Guadalupe in the State of Mexico, during the period 2009-2020, by analyzing the social network and the structural phenomenon generated between social actors, reforested places and species used. Results indicated that 416.9 hectares have been reforested, affecting 75 localities, with participation of around 300 social actors, using 50 species, of which only 15 are native to the Sierra de Guadalupe ecosystem. Unequal distribution of resources used for reforestation was apparent, when comparing the municipalities analyzed (Coacalco, Ecatepec, Tlalnepantla and Tultitlán), despite being part of the same ecological corridor.La deforestación es una problemática compleja y multifactorial. En México, este fenómeno se agudiza por la urbanización en las zonas metropolitanas. En la Cuenca de México, se encuentra la Sierra de Guadalupe, un Área Natural Protegida que ha sido devastada continuamente por los asentamientos humanos. En la porción de la sierra ubicada en el Estado de México, se ha tratado de contrarrestar la deforestación con reforestaciones en zonas degradadas. Sin embargo, estas actividades se han visto modificadas por las realidades sociales, econó­micas y políticas de dicha zona. El objetivo, fue analizar el proceso de reforestación en la Sierra de Guadalupe en el Estado de México, en el periodo 2009-2020, utilizando el análisis de redes sociales y la representación estructural generada entre actores sociales, lugares reforestados y especies empleadas. Los resultados mostraron que se han reforestado 416.9 hectáreas, incidiendo en 75 localidades, donde han participado alrededor de 300 actores sociales, utilizándose 50 especies, de las cuales, únicamente 15 son nativas del ecosistema de la Sierra de Guadalupe. Se observó una distribución desigual de los recursos utilizados en las reforestaciones, entre los municipios analizados (Coacalco, Ecatepec, Tlalnepantla y Tultitlán), a pesar de ser parte del mismo corredor ecológico

An Anti-Glitch in a Magnetar

Magnetars are neutron stars showing dramatic X-ray and soft $\gamma$-ray outbursting behaviour that is thought to be powered by intense internal magnetic fields. Like conventional young neutron stars in the form of radio pulsars, magnetars exhibit "glitches" during which angular momentum is believed to be transferred between the solid outer crust and the superfluid component of the inner crust. Hitherto, the several hundred observed glitches in radio pulsars and magnetars have involved a sudden spin-up of the star, due presumably to the interior superfluid rotating faster than the crust. Here we report on X-ray timing observations of the magnetar 1E 2259+586 which we show exhibited a clear "anti-glitch" -- a sudden spin down. We show that this event, like some previous magnetar spin-up glitches, was accompanied by multiple X-ray radiative changes and a significant spin-down rate change. This event, if of origin internal to the star, is unpredicted in models of neutron star spin-down and is suggestive of differential rotation in the neutron star, further supporting the need for a rethinking of glitch theory for all neutron stars