Costo-efectividad de la colecistectomía laparoscópica y de la abierta en una muestra de población colombiana

Introduction: Cholecystectomy has been the subject of several clinical and cost comparison studies. Objective: The results of open or laparoscopy cholecystectomy were compared in terms of cost and effectiveness from the perspective of healthcare institutions and from that of the patients. Materials and methods: The cost-effectiveness study was undertaken at two university hospitals in Bogotá, Colombia. The approach was to select the type of cholecystectomy retrospectively and then assess the result prospectively. The cost analysis used the combined approach of micro-costs and daily average cost. Patient resource consumption was gathered from the time of surgery room entry to time of discharge. A sample of 376 patients with cholelithiasis/cystitis (May 2005-June 2006) was selected-156 underwent open cholecystectomy and 220 underwent laparoscopic cholecystectomy. The following data were tabulated: (1) frequency of complications and mortality, post-surgical hospital stay, (2) reincorporation to daily activities, (3) surgery duration, (4) direct medical costs, (5) costs to the patient, and (6) mean and incremental cost-effectiveness ratios. Results: Frequency of complications was 13.5% for open cholecystectomy and 6.4% for laparoscopic cholecystectomy (p=0.02); hospital stay was longer in open cholecystectomy than in laparoscopic cholecystectomy (p=0.003) as well as the reincorporation to daily activities reported by the patients (p less than 0.001). The duration of open cholecystectomy was 22 min longer than laparoscopic cholecystectomy (p less than 0.001). The average cost of laparoscopic cholecystectomy was lower than open cholecystectomy and laparoscopic cholecystectomywas more cost-effective than open cholecystectomy (US$995 vs. US$ 1,048, respectively). The patient out-of-pocket expenses were greater in open cholecystectomy compared to laparoscopic cholecystectomy (p=0.015). Mortality was zero. Conclusions: The open laparoscopy procedure was associated with longer hospital stays, whereas the cholecystectomy procedure required a longer surgical duration. The direct cost of the latter was lower for both for the healthcare institution and patients. The cost-effectiveness for both procedures was comparable

Costo-efectividad de la colecistectomía laparoscópica y de la abierta en una muestra de población colombiana

Introduction: Cholecystectomy has been the subject of several clinical and cost comparison studies. Objective: The results of open or laparoscopy cholecystectomy were compared in terms of cost and effectiveness from the perspective of healthcare institutions and from that of the patients. Materials and methods: The cost-effectiveness study was undertaken at two university hospitals in Bogotá, Colombia. The approach was to select the type of cholecystectomy retrospectively and then assess the result prospectively. The cost analysis used the combined approach of micro-costs and daily average cost. Patient resource consumption was gathered from the time of surgery room entry to time of discharge. A sample of 376 patients with cholelithiasis/cystitis (May 2005-June 2006) was selected-156 underwent open cholecystectomy and 220 underwent laparoscopic cholecystectomy. The following data were tabulated: (1) frequency of complications and mortality, post-surgical hospital stay, (2) reincorporation to daily activities, (3) surgery duration, (4) direct medical costs, (5) costs to the patient, and (6) mean and incremental cost-effectiveness ratios. Results: Frequency of complications was 13.5% for open cholecystectomy and 6.4% for laparoscopic cholecystectomy (p=0.02); hospital stay was longer in open cholecystectomy than in laparoscopic cholecystectomy (p=0.003) as well as the reincorporation to daily activities reported by the patients (p less than 0.001). The duration of open cholecystectomy was 22 min longer than laparoscopic cholecystectomy (p less than 0.001). The average cost of laparoscopic cholecystectomy was lower than open cholecystectomy and laparoscopic cholecystectomywas more cost-effective than open cholecystectomy (US$995 vs. US$ 1,048, respectively). The patient out-of-pocket expenses were greater in open cholecystectomy compared to laparoscopic cholecystectomy (p=0.015). Mortality was zero. Conclusions: The open laparoscopy procedure was associated with longer hospital stays, whereas the cholecystectomy procedure required a longer surgical duration. The direct cost of the latter was lower for both for the healthcare institution and patients. The cost-effectiveness for both procedures was comparable

In COVID-19 health messaging, loss framing increases anxiety with Little-to-No concomitant benefits: Experimental evidence from 84 countries

The COVID-19 pandemic (and its aftermath) highlights a critical need to communicate health information effectively to the global public. Given that subtle differences in information framing can have meaningful effects on behavior, behavioral science research highlights a pressing question: Is it more effective to frame COVID-19 health messages in terms of potential losses (e.g., “If you do not practice these steps, you can endanger yourself and others”) or potential gains (e.g., “If you practice these steps, you can protect yourself and others”)? Collecting data in 48 languages from 15,929 participants in 84 countries, we experimentally tested the effects of message framing on COVID-19-related judgments, intentions, and feelings. Loss- (vs. gain-) framed messages increased self-reported anxiety among participants cross-nationally with little-to-no impact on policy attitudes, behavioral intentions, or information seeking relevant to pandemic risks. These results were consistent across 84 countries, three variations of the message framing wording, and 560 data processing and analytic choices. Thus, results provide an empirical answer to a global communication question and highlight the emotional toll of loss-framed messages. Critically, this work demonstrates the importance of considering unintended affective consequences when evaluating nudge-style interventions