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

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

Sediment properties as important predictors of carbon storage in zostera marina meadows: a comparison of four European areas

Seagrass ecosystems are important natural carbon sinks but their efficiency varies greatly depending on species composition and environmental conditions. What causes this variation is not fully known and could have important implications for management and protection of the seagrass habitat to continue to act as a natural carbon sink. Here, we assessed sedimentary organic carbon in Zostera marina meadows (and adjacent unvegetated sediment) in four distinct areas of Europe (Gullmar Fjord on the Swedish Skagerrak coast, Asko in the Baltic Sea, Sozopol in the Black Sea and Ria Formosa in southern Portugal) down to similar to 35 cm depth. We also tested how sedimentary organic carbon in Z. marina meadows relates to different sediment characteristics, a range of seagrass-associated variables and water depth. The seagrass carbon storage varied greatly among areas, with an average organic carbon content ranging from 2.79 +/- 0.50% in the Gullmar Fjord to 0.17 +/- 0.02% in the area of Sozopol. We found that a high proportion of fine grain size, high porosity and low density of the sediment is strongly related to high carbon content in Z. marina sediment. We suggest that sediment properties should be included as an important factor when evaluating high priority areas in management of Z. marina generated carbon sinks

Evolution of the use of corticosteroids for the treatment of hospitalised COVID-19 patients in Spain between March and November 2020: SEMI-COVID national registry

Objectives: Since the results of the RECOVERY trial, WHO recommendations about the use of corticosteroids (CTs) in COVID-19 have changed. The aim of the study is to analyse the evolutive use of CTs in Spain during the pandemic to assess the potential influence of new recommendations. Material and methods: A retrospective, descriptive, and observational study was conducted on adults hospitalised due to COVID-19 in Spain who were included in the SEMI-COVID- 19 Registry from March to November 2020. Results: CTs were used in 6053 (36.21%) of the included patients. The patients were older (mean (SD)) (69.6 (14.6) vs. 66.0 (16.8) years; p < 0.001), with hypertension (57.0% vs. 47.7%; p < 0.001), obesity (26.4% vs. 19.3%; p < 0.0001), and multimorbidity prevalence (20.6% vs. 16.1%; p < 0.001). These patients had higher values (mean (95% CI)) of C-reactive protein (CRP) (86 (32.7-160) vs. 49.3 (16-109) mg/dL; p < 0.001), ferritin (791 (393-1534) vs. 470 (236- 996) µg/dL; p < 0.001), D dimer (750 (430-1400) vs. 617 (345-1180) µg/dL; p < 0.001), and lower Sp02/Fi02 (266 (91.1) vs. 301 (101); p < 0.001). Since June 2020, there was an increment in the use of CTs (March vs. September; p < 0.001). Overall, 20% did not receive steroids, and 40% received less than 200 mg accumulated prednisone equivalent dose (APED). Severe patients are treated with higher doses. The mortality benefit was observed in patients with oxygen saturation </=90%. Conclusions: Patients with greater comorbidity, severity, and inflammatory markers were those treated with CTs. In severe patients, there is a trend towards the use of higher doses. The mortality benefit was observed in patients with oxygen saturation </=90%

Terapia convencional y biológica en pacientes con artritis reumatoide. Un análisis de costos en Colombia.

Objectives The aim of this study is to describe costs related to conventional and biological therapies in patients diagnosed with rheumatoid arthritis in Colombia. Methods This is a cost description analysis focusing on quantifying direct medical cost by bottom-up approach. We calculated the use of resources of patients treated under a patient centered care model (PCC) in a specialized rheumatology center in Bogotá, Colombia. We estimated costs of conventional and biological therapies in patients with rheumatoid arthritis. Direct medical costs were analyzed from the third payer perspective. Costs were calculated using billing and price information and the official national prices health services databases such as the official Colombian Tariff Manual (SOAT in Spanish), which standardize the maximum price of medical, surgical and hospital prices. Drugs costs were estimated using a national official drugs database (SISMED in Spanish), which contains median estimates and range prices for drugs in the country. Costs were estimated in Colombian pesos and American dollars (1 US$= COP$3,000.71) of 2016. Results The direct medical median cost of treating patients with rheumatoid arthritis using the conventional therapy was COP$3,662.000 (US$1,220.4). Of these, 1.6% were due to specialized consultation, 3% to laboratory and images tests, 3.3% to other costs and 92.1% due to DMARDs drugs. The direct medical cost of biological therapy was COP$28,591,014 (US$9,528). The main driver of the direct cost were the biological drugs (92.9%). Also, 5.9% of the cost was due to conventional therapy, and 1,2% due to outpatient visits, labs and images tests. Comparing these therapies, we can highlight that treating patients with biological treatment is 7.8 times costlier that the ones treated with conventional treatment. Conclusions Rheumatoid arthritis is a leading problem of public health worldwide. Conventional and biological drugs were the largest expenditure in the treatment of rheumatoid arthritis..Los objetivos El objetivo de este estudio es describir los costos relacionados con las terapias convencionales y biológicas en pacientes diagnosticados con artritis reumatoide en Colombia. Los metodos Este es un análisis de la descripción de costos que se enfoca en cuantificar el costo médico directo mediante un enfoque de abajo hacia arriba. Calculamos el uso de recursos de pacientes tratados bajo un modelo de atención centrada en el paciente (PCC) en un centro de reumatología especializado en Bogotá, Colombia. Estimamos los costos de las terapias convencionales y biológicas en pacientes con artritis reumatoide. Los costos médicos directos fueron analizados desde la perspectiva del tercer pagador. Los costos se calcularon utilizando la información de facturación y precios y las bases de datos oficiales de los servicios de salud de los precios nacionales, como el Manual Oficial de Aranceles de Colombia (SOAT), que estandariza el precio máximo de los precios médicos, quirúrgicos y hospitalarios. Los costos de los medicamentos se calcularon utilizando una base de datos oficial nacional de medicamentos (SISMED), que contiene estimaciones de la mediana y precios de rango para los medicamentos en el país. Los costos se estimaron en pesos colombianos y dólares estadounidenses (1 US $= COP$ 3,000.71) de 2016. Resultados El costo medico directo para tratar a pacientes con artritis reumatoidea usando la terapia convencional fue de COP $3,662.000 (US$ 1,220.4). De estos, el 1.6% se debió a consultas especializadas, el 3% a pruebas de laboratorio e imágenes, el 3.3% a otros costos y el 92.1% debido a los medicamentos DMARD. El costo médico directo de la terapia biológica fue de COP $28,591,014 (US$ 9,528). El principal impulsor del costo directo fueron los medicamentos biológicos (92.9%). Además, el 5,9% del costo se debió a la terapia convencional y el 1,2% a visitas ambulatorias, laboratorios y pruebas de imágenes. Comparando estas terapias, podemos destacar que tratar a los pacientes con tratamiento biológico es 7.8 veces más costoso que los tratados con el tratamiento convencional. Conclusiones La artritis reumatoide es un problema importante de salud pública en todo el mundo. Los fármacos convencionales y biológicos fueron el mayor gasto en el tratamiento de la artritis reumatoide

Memorias del I Congreso Internacional de Bioingeniería y Sistemas Inteligentes de Rehabilitación - CIBSIR 2017

El I Congreso Internacional de Bioingeniería y Sistemas Inteligentes de Rehabilitación, se celebró en Quito, capital del Ecuador. Su organización estuvo a cargo de profesores e investigadores de la Escuela Politécnica Nacional (EPN), Universidad Politécnica Salesiana (UPS), Universitat Politécnica de Valencia (UPV), Universidad Técnica del Norte (UTN), Escuela Superior Politécnica del Chimborazo (ESPOCH), Universidad de las Fuerzas Armadas (ESPE), Universidad Central del Ecuador (UCE), Escuela Superior Politécnica del Litoral (ESPOL), Universidad San Francisco de Quito (USFQ), Universidad de Las Américas (UDLA) y Universidad Mariana de Colombia. Todas ellas universidades que han trabajado de manera rigurosa para la creación de un programa académico que sirva de marco para la investigación y el intercambio de conocimientos y experiencias, así como para el desarrollo de oportunidades de colaboración para promover la difusión de tecnologías relacionadas con estos campos. Este congreso fue dirigido tanto a académicos como a profesionales y estudiantes interesados en compartir conocimientos y experiencias en las áreas de Bioingeniería y Sistemas Inteligentes de Rehabilitación. En la actualidad, el creciente avance tecnológico dedicado a los campos de la Bioingeniería y Sistemas de Rehabilitación, hace necesaria la disponibilidad de un espacio de difusión para las investigaciones que se han desarrollado en instituciones de educación superior e investigación dedicadas a estos trabajos