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

Direct medical costs of severe asthma in two colombian reference centers

Objectives: Severe asthma, although infrequent, generates an important clinical and economic burden in both patients and healthcare system. We aimed to describe demographic and clinical characteristics, exacerbations, healthcare resource utilization (HRU), and annual direct medical costs in a severe asthma patient cohort in Colombia. Methods: Cost ofillness study from payer perspective. Patients with clinicianconfirmed severe asthma diagnosis (GINA criteria) from two specialized reference centers between January 2014 and August 2018 were included. The last year within this period under GINA step 4/5 therapy was observed for each patient. Clinical information was extracted from medical records, and HRU from hospital invoices and public price lists. Results: 147 patients were included, 59% female. Mean (6SD) age and time with asthma diagnosis was 46615 and 21617 years, respectively. Most frequent comorbidities were allergic rhinitis (70%), conjunctivitis (27%) and hypertension (19%). Most common sensitization cause was house dust mite (61%). Median baseline blood eosinophil count was 260 cells/ml (range 10-4,040), mean total IgE serum level was 69761,893 IU/ml. The mean annual frequency of HRU was 5.064.0 for laboratory tests, 4.161.2 for medical visits, 1.061.5 for emergency visits, 0.360.7 for hospitalizations, and 0.160.3 for ICU. Omalizumab was prescribed in 42.2% of patients, with a mean among users of 30.2620.3 vials per year. Mean annual direct cost for outpatient care was 4,743.666,331.1 USD (range 256.7-31,286.1) (1 USD=2,956.4 COP); medications were responsible for 98% of costs. Data from 55 hospitalizations was obtained, 4 in ICU. Mean stay and cost per episode were 6.564.9 days and 1,010.561,379.9 USD in general ward, and 14.164.1 days and 3768.963748.2 USD in ICU. Conclusions: Severe asthma is a costly disease for the Colombian health system. Most of the direct outpatient medical costs in this cohort were caused by pharmacological therapy, particularly omalizumab. Funding: GSK (PRJ2813

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

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

Estimating the impact of a gender-neutral quadrivalent human papillomavirus vaccination program in all hpv 6/11/16/18 -related diseases in Colombia

We assessed the public health and economic impact of adding males to the existing female-only quadrivalent HPV vaccine (4vHPV) program in Colombia, analyzing different gender-neutral vaccination (GNV) vaccine coverage rates (VCRs). A published HPV-type dynamic transmission model was used to compare female-only vaccination (FOV) versus GNV with two-dose 4vHPV in the 9-10-year-old cohort over a 100-year timeframe in Colombia. The model compared 35% VCR for FOV with GNV at VCRs of 35% (scenario A), 50% (scenario B) and different VCRs between females/males (50%/35%, scenario C). The predicted health outcomes included HPV 6/11/16/18-related disease and deaths averted [cervical intraepithelial neoplasia, cervical, vaginal, vulvar, penile, anal and head and neck cancers, genital warts (GW), and recurrent respiratory papillomatosis], direct healthcare cost prevented by vaccination, and incremental cost-effectiveness ratios (ICERs). All GNV scenarios are estimated to provide faster and greater reductions in HPV 6/11/16/18-related diseases relative to FOV at 35% VCR, mainly scenarios B and C. The highest cumulative reductions in the incidence of HPV 6/11/16/18-related disease and deaths were seen in scenario B relative to FOV at 35% VCR at year 100, averting 28,001 cervical cancer (CC) cases, 11,968 non-CC cases (4,753 in females and 7,215 in males) and 15,141 deaths. The greatest projected reductions in health care costs are due to diseases caused by HPV-6/11 infection, driven by GW. The cost savings varied from 88 (scenario A) to 184 million (scenario B) relative to FOV at 35%. The ICER for all scenarios was <0, indicating that under the model assumptions it is cost-saving to implement a GNV-4vHPV in Colombia. In Colombia, a GNV-4vHPV program is a cost-saving strategy in the three scenarios analyzed relative to the current FOV program and result in greater improvement of the public health and economic impact in both women and men

Prevalence of parasite intestinal infections in a rural community of the Caribbean north of Colombia

Objectives: To estimate the prevalence of protozoan and helminth infections in a rural town of the Caribbean coast of Colombia and to identify potential risk factors. Methods: The study was conducted in Santa Catalina, a town and municipality located in the Bolívar during 2014. Parasitological analyses were done using 0.85% saline solution and lugol staining. A questionnaire was applied to participants in order to identify possible risk factors for parasite infections. Results: Mean age of sample population (N = 685) was 29.8 SD 622.46 and 68% were females. There is no sewage access in this town. Most of them were infected by any protozoan species (80%) or soil-transmitted helminthes (71%). The most common protozoan found was Entamoeba coli (53%) followed by Giardia duodenalis (13%), Blastocistys hominis (4%) and E. histolytica 82%). Ascaris lumbricoides was the most prevalent helminth (63%) followed by Trichuris trichuria (36%), hookworms (2%), Taenia sp (2%) and Hymenolepys nana (2%). Frequency rates of protozoan and helminthic infections were significantly lower in those living in a house build made of bricks (versus wood or "bahereque") or with a floor material distinct from soil/earth. Drinking boiled water was associated only with lower rates of trichuriasis (aOR: 0.59 95%CI: 0.41-0.78), but not ascariasis. Almost half of of subjects (56%) reported to have received deworming treatment in the last year, but this was not associated with having any parasite infection. In a sub-group of 109 with available data, Ascaris infection was associated with lower hemoglobin levels (B=0.75, SE: 0.25, p = 0.003, adjusted by age and gender). Conclusions: The prevalence of protozoan and helminth infections in this town, representative of the rural area of the Caribbean coast of Colombia, is high. Indicators of poverty and lower hygienic conditions are positively associated with parasite infections

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

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