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

How expensive is treating patients in a center of excellence for rheumatoid arthritis in Colombia?

We aimed to estimate the cost of treating patients with rheumatoid arthritis (RA) in a Center of Excellence (CoE) for rheumatic diseases located in Bogotá, Colombia. We performed a cost analysis from the standard cost estimation of a CoE program for RA care. We estimated costs of consultations, laboratory and imaging tests, and pharmacological treatment from the measurement of the health care resource utilization of the CoE standard protocol according to the activity level of the disease (DAS28). Costing process was done following the recommendation of the Colombian Institute of Health Technology Assessment (IETS, in Spanish). Mean, minimum and maximum costs were reported annually for a type case depending on severity and classified as Remission, low disease activity (LDA), moderate disease activity (MDA) and severe disease activity -SDA- (with and without bDMARD). All costs were reported in American 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. Mean total direct medical cost to treat a patient in remission is US$235.7 (213.0-336.4), in LDA is US325.2 (288.0-464.6) and in MDA is US$835.5 ($573.1-$2,187.1). There is a considerable increase in direct medical costs from a patient in SDA and SDA+Biologics: US$2,555.5 ($2,301.1-$3,890.9) to US$8,032.4 ($7,564.4-$8,400.3). The largest share of the cost was related to drugs, representing 39.9% for Remission, 53.6% for LDA, 75.2 for MDA, and in SDA and SDA+Biologics the proportion of what is spent on drugs for RA treatment is 88.5% and 96.7%, respectively. As the severity of the disease increases, the expenditure rate on drugs rises over the total of each activity level. With the introduction of the biological therapy, the treatment of RA is expensive, however, the CoE is an efficient way of care for RA

Quality of life and the relationship with family income in patients with rheumatoid arthritis

Objectives: To evaluate the quality of life (QoL) of patients with rheumatoid arthritis (RA) using the Quality of life in Rheumatoid Arthritis (RAQol) questionnaire. Also, to explore its relationship with income in patients attended at a specialized RA center in Bogotá, Colombia, 2018. Methods: We performed a descriptive study. The RAQol version in Spanish was applied to RA patients. The scale of the RAQol has a score from 1-10, where 10 is associated with better QoL. We excluded patients with psychological or psychiatric disorders. We asked about the monthly family income according to the Colombian minimum wage. Descriptive epidemiology was performed for each variable. A comparison of means regarding age and RAQol score was carried out. Therefore, we performed a bivariate analysis in order to explore the relationship between income and QoL, reporting Odds Ratios (OR) and confidence intervals 95% (CI95%). Results related to family income were reported in US$with the average exchange rate for 2018. Results: We interviewed 310 patients, 92$265, 47% between US$266- US$530, 9% between US$531-US$795 and 3% more than US$1300. Patients with an income greater than US$531 per/month had a higher average score in the RAQoL scale (7.1, SD5.5). The relationship of having a score lower than 6 in the RAQoL and a monthly income lower than US$530 showed an OR of 2.48 IC95% (0.99-6.22) (P=0.03). Conclusions: Our study showed that patient with a low income reports a lower QoL. Further research is needed to evaluate the alternatives that can improve QoL in patients with RA

Costs and disease activity in patients with rheumatoid arthritis treated with biologic dmards: findings in a real-life setting

Objectives: Biological DMARDs have demonstrated to modify the natural course of the disease through the inhibition of specific molecules of the immune and inflammatory responses. The objective of our study is to describe the use of biological therapy, disease activity and costs related to the treatment of patients with RA in a real-life setting in Colombia. Methods: Patients were analyzed retrospectively for 36 months and followed-up under T2T standards with a multidisciplinary approach. DAS28 was used as main clinical outcome. We included patients with severe or moderate disease activity using biological therapy. We described the percentage of patients who reached low disease activity or remission. Most expensive biological therapies were described and costed. Costs were reported in US dollars at the official rate of exchange for December 2018. Statistical analyses were done in Microsoft Excel. Results: We followed-up 1054 patients during three years, 85% were female, mean age was 57 years (SD 7.7). At the beginning of the follow-up, 52% of patients were in MDA and 48% in SDA. The most used treatment regime was certolizumab (24.57%) followed by etanercept (16.51%) and abatacept (12.81%). At the end of the follow-up, 92% patients achieved remission. Regarding costs, the most expensive therapy per/ year was etanercept (USD $12,522.70) followed by golimumab ($11,535.00) and (adalimumab). When we calculated the average cost for all biological therapy and then compared to the number of patients who achieved remission, the costs during three years to achieve remission was $27,738,839.54 USD. Conclusions: Our study showed that biological therapy is effective when is used under a T2T strategy and with a multidisciplinary approach. However, it is an expensive option that might be used in adherent patients and candidates who met the profile for prescribing this type of pharmacological therapy, especially in developing countries where the health budgets are limited

Educational inequality trends in mortality due to pneumonia in Colombia, 1998-2015

We aimed to explore the existence and trends of social inequalities related to pneumonia mortality in Colombian adults using education as a proxy of socioeconomic status. We obtained death certificates due to pneumonia and population data from Departamento Administrativo Nacional de Estadística for 1998-2015. Educational level data were gathered from microdata of the Colombian Demography Health Surveys. Annual trends in Age Standardized Mortality Rates by sex and educational level were quantified by calculating the Estimated Annual Percentage Change (EAPC). We estimated Rate Ratios (RR) by using Poisson regressionmodels, comparing mortality of educational groups with mortality in the highest education group. We estimated the Relative Index of Inequality (RII) to assess changes in disparities, regressing mortality on the mid-point of the cumulative distribution of education, thereby considering the size of each educational group. All analyses were conducted in SAS®V.9.2. 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 [RRprimary=2.34 (2.32-2.36), RRsecondary=1.77 (1.75-1.78) vs. RRprimary=1.83(1.81-1.85), RR secondary=1.51 (1.50-1.53)]. According to age groups, young adults (25-44 years) showed the largest inequality in terms of educational level; RRs for pneumonia mortality regarding to 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 2.00-2.03) and in women 2.46 (95%CI 2.43-2.48). The RII was greatest at young ages, for both sexes. Time trends showed steadily significant increases for RII in both men and women (EAPCmen=3.8; EAPCwomen=2.6). Pneumonia mortality rates in adults evidenced a clear age-dependency, with lowest rates for young and much higher rates for senior adults. All estimated mortality rates were higher in men than in women

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

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

Secuencia did?ctica para la ense?anza y aprendizaje de los n?meros racionales.

210 p. Recurso Electr?nicoLos problemas de la ense?anza y el aprendizaje de los n?meros racionales han sido indagados por diferentes investigadores, encontrando en los docentes problemas como falta de comprensi?n de los conceptos matem?ticos. La Instituci?n Educativa Francisco de Miranda, sede Laura Mar?a Zarate de Gil, zona urbana del municipio de Rovira, Tolima (Colombia), no es ajena a esta problem?tica. Esta preocupaci?n llev? a implementar una secuencia did?ctica dise?ada, teniendo en cuenta a Guy Brousseau y D?az Barriga; para la conceptualizaci?n matem?tica: concepto de n?mero y su utilizaci?n en diferentes contextos a Castro, Rico, & Castro y la fenomenolog?a de las estructuras matem?ticas de Hans Freudenthal y en cuanto a la resoluci?n de problemas a George P?lya. La secuencia did?ctica, fue estructurada en 8 sesiones o clases. Desde la primera sesi?n a la ?ltima, tiene en cuenta el uso de las tecnolog?as de informaci?n y la comunicaci?n, como el contexto social, cultural y econ?mico del municipio de Rovira, y desde all?, todas las actividades son desarrolladas para hacer del contexto, una mediaci?n para aprender las matem?ticas. Con una investigaci?n acci?n participativa y un an?lisis de la implementaci?n de la secuencia did?ctica a partir de an?lisis cualitativo y cuantitativo el cual muestra que los estudiantes comprendieron el concepto fracci?n y son capaces de aplicarlo en la resoluci?n de problemas. Se resalta que esta secuencia did?ctica ayuda a docentes a comprender conceptos matem?ticos como el de fracci?n y por lo tanto a ense?arlo y a evaluarlo, y que puede ser usada por los docentes de b?sica primaria y media. Y a los estudiantes les ayuda a desarrollar las competencias matem?ticas: competencias de comunicaci?n, representaci?n y modelaci?n, planteamiento de problemas y resoluci?n de problemas, razonamiento y argumentaci?n; y competencias tecnol?gicas y en uso de las tecnolog?as de la informaci?n y de la comunicaci?n. La L?nea de investigaci?n Educaci?n Matem?tica dirigida por la directora de este trabajo de grado, pensando siempre en las dificultades conceptuales, did?cticas y evaluativas de los docentes del departamento del Tolima, nos propuso dise?ar e implementar la Secuencia did?ctica que a continuaci?n se presenta como el aporte relevante de esta investigaci?n para la comunidad educativa de la regi?n y porque no decirlo para el pa?s. Palabras Claves: Secuencia did?ctica, ense?anza y aprendizaje, fracci?n, n?mero racional, resoluci?n de problemas.The problems of the teaching and learning of rational numbers have been investigated by different investigations, finding in the teachers problems such as the lack of understanding of mathematical concepts. The Francisco de Miranda Educational Institution, headquarters of Laura Mar?a Zarate de Gil, an urban area of the municipality of Rovira, Tolima (Colombia), is no stranger to this problem. This concern led me to implement a didactic sequence designed, taking into account Guy Brousseau and D?az Barriga; for the mathematical conceptualization: concept of number and its use in different contexts to Castro, Rico, & Castro and the phenomenology of the mathematical structures of Hans Freudenthal. Regarding the resolution of problems to George P?lya. The didactic sequence was structured in 8 sessions or classes. From the first session to the last, it takes into account the use of information and communication technologies, such as the social, cultural and economic context of the municipality of Rovira, and from there, all activities are developed to make the context, a mediation to learn mathematics. With a participatory action research and an analysis of the implementation of the didactic sequence from qualitative and quantitative analysis which shows that the students understood the concept fraction and are able to apply it in solving problems. It is emphasized that this didactic sequence helps teachers to understand mathematical concepts such as the fraction and therefore to teaches and evaluate it, and that it can be used by elementary and middle school teachers. And to the students it helps them to develop mathematical competences: communication, representation and modeling competencies, problem solving and problem solving, reasoning and argumentation; and technological competences and in use of information and communication technologies. The Line of Mathematical Education research directed by the director of this degree work, always thinking about the conceptual, didactic and evaluative difficulties of the teachers of the department of Tolima, proposed us to design and implement the didactic Sequence that is presented next as, the relevant contribution of this research the educational community of the region and why not say it for the country. Keywords: didactic sequence, teaching and learning, fraction, rational number