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

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

Bajo peso al nacer en recién nacidos y factores maternos y neonatales asociados en un hospital ginecológico-obstétrico colombiano

Objectives To determine the prevalence of Low Birth Weight (LBW) in newborns treated at the Rafael Calvo Maternity Clinic (CMRC) during 2016 and their possible maternal and neonatal factors associated. Methods Cross-sectional retrospective observational study with a population of 7,217 pregnant women who had a live birth in the CMRC. The prevalence of total and term (≥37 gestation weeks "GW") LBW were estimated from the weight of the newborn. Risk factors associated with LBW were estimated through a logistic regression model. Modeled variables were weight, maternal age, prenatal control, mother´s education level, area of residence and multiplicity of pregnancy. Statistical significance was defined in 5% and 10%. Results The prevalence of total and term LBW in the CMRC were 11.6% (838 cases out of 7,217) and 4.2% (259 out of 6,203) respectively. The risk of LBW is 16.6% (p=0.061) and 37.0% (p=0.044) lower in mothers between 20 and 34 years and 35 years or more respectively, than in mothers under 20. A child born at term represents a lower risk (β = 0.03, p=0.000) of LBW than a pre-term (<37GW). Mothers with controlled pregnancy (4 or more prenatal visits) have a lower risk (β =18.6%, p=0.042) to have a baby with LBW than mothers who are not controlled. Expecting two or more children in the same pregnancy increases the risk (β=3.3, p=0.000) of LBW compared to expecting a single child. Living in urban areas decreases the risk of LBW by 21% (p = 0.057) compared to living in rural areas. Conclusions We found significant low birth weight in newborns in the CMRC. The prevalence of total LBW (11.6%) was above figures for Colombia (9.0%) and Cartagena (8.9%) in 2015. Controlling the risk factors associated to LBW could be favorable for its reduction.Los objetivos Determinar la prevalencia de bajo peso al nacer (LBW) en recién nacidos tratados en la Clínica de maternidad Rafael Calvo (CMRC) durante 2016 y sus posibles factores maternos y neonatales asociados. Los metodos Estudio observacional retrospectivo transversal con una población de 7,217 mujeres embarazadas que tuvieron un nacimiento vivo en el CMRC. La prevalencia de LBW total y a término (≥37 semanas de gestación "GW") se estimó a partir del peso del recién nacido. Los factores de riesgo asociados con el BPN se estimaron a través de un modelo de regresión logística. Las variables modeladas fueron peso, edad materna, control prenatal, nivel de educación de la madre, área de residencia y multiplicidad del embarazo. La significación estadística se definió en 5% y 10%. Resultados La prevalencia de LBW total y a término en el CMRC fue de 11.6% (838 casos de 7,217) y 4.2% (259 de 6,203) respectivamente. El riesgo de LBW es 16.6% (p = 0.061) y 37.0% (p = 0.044) más bajo en madres entre 20 y 34 años y 35 años o más respectivamente, que en madres menores de 20 años. Un niño nacido a término representa un riesgo menor (β = 0.03, p = 0.000) de LBW que un término previo (<37GW). Las madres con embarazo controlado (4 o más visitas prenatales) tienen un riesgo menor (β = 18.6%, p = 0.042) para tener un bebé con LBW que las madres que no están controladas. Esperar a dos o más hijos en el mismo embarazo aumenta el riesgo (β = 3.3, p = 0.000) de LBW en comparación con la expectativa de un solo hijo. Vivir en áreas urbanas disminuye el riesgo de BPN en un 21% (p = 0.057) en comparación con vivir en áreas rurales. Conclusiones Encontramos un peso bajo al nacer significativo en recién nacidos en el CMRC. La prevalencia del LBW total (11.6%) estuvo por encima de las cifras de Colombia (9.0%) y Cartagena (8.9%) en 2015. El control de los factores de riesgo asociados a LBW podría ser favorable para su reducción

Frecuencia de histerectomías en una población afiliada a una aseguradora de salud pública en Colombia; 2012 - 2016

Objectives To describe the frequency of hysterectomies of women affiliated to a public health insurance company in Colombia, segmented by five-year groups over a period of five years. Methods A retrospective dynamic cohort from a subsidized and public health insurance company was followed between 2012-2016. An average of 2,034 annual hysterectomies were performed on an average population of 765,431 women. To calculate the incidence of hysterectomies, the number of events (hysterectomies) were taken from the procedures database performed by the insurer. Every procedure was identified through the unique procedure codes (CUPS) from Colombia. Risk of hysterectomies (number of hysterectomies / number of women) and hysterectomy rates (# of hysterectomies / 10,000 women-year) were calculated from the number of events identified and follow-up of the dynamic cohort. Results The cumulative incidence of hysterectomies was 0.002. The frequencies of hysterectomies on the population presented a normal distribution, where the highest number of hysterectomies performed during the five years was concentrated in women between 45-49 years (23.7%), followed by women between 40-44 (22.5% ). The hysterectomy rate for the age group of 45-49 was 98.9 per 10,000 women-year (95% CI 79.9-121.9) and for the 40-44 group was 91.5 per 10,000 women- year (95% CI: 75.5-102.1). The risk of hysterectomies in women aged 45-49 years was 1.009% (95% CI 0.84% -1.15%), while for the 40-44 group it was 0.93% (95% CI 0.82% -1.03%) during the period. Diagnoses that most generated these procedures were leiomyoma of the uterus without another specification (49.9%) and unspecified abnormal vaginal and uterine bleeding (11.6%). Conclusions Similar to other studies findings, hysterectomies were related mostly to leiomyomas diagnoses and were mostly concentrated in the group of 40 to 49 years.Los objetivos Describir la frecuencia de las histerectomías de mujeres afiliadas a una compañía pública de seguros de salud en Colombia, segmentadas por grupos de cinco años en un período de cinco años. Los metodos Entre 2012 y 2016, se realizó un seguimiento de una cohorte dinámica retrospectiva de una compañía de seguros de salud pública y subsidiada. Un promedio de 2,034 histerectomías anuales se realizaron en una población promedio de 765,431 mujeres. Para calcular la incidencia de histerectomías, el número de eventos (histerectomías) se tomó de la base de datos de procedimientos realizada por el asegurador. Cada procedimiento fue identificado a través de los códigos de procedimientos únicos (CUPS) de Colombia. El riesgo de histerectomías (número de histerectomías / número de mujeres) y tasas de histerectomía (número de histerectomías / 10,000 mujeres-año) se calcularon a partir del número de eventos identificados y el seguimiento de la cohorte dinámica. Resultados La incidencia acumulada de histerectomías fue de 0,002. Las frecuencias de histerectomías en la población presentaron una distribución normal, donde el mayor número de histerectomías realizadas durante los cinco años se concentró en mujeres entre 45-49 años (23.7%), seguido de mujeres entre 40-44 (22.5%). La tasa de histerectomía para el grupo de edad de 45-49 fue de 98.9 por 10,000 mujeres-año (95% CI 79.9-121.9) y para el grupo de 40-44 fue de 91.5 por 10,000 mujeres-año (95% CI: 75.5-102.1). El riesgo de histerectomías en mujeres de 45 a 49 años fue de 1.009% (IC 95%: 0.84% ​​-1.15%), mientras que para el grupo de 40-44 fue de 0.93% (IC 95% 0.82% -1.03%) durante el período. Los diagnósticos que más generaron estos procedimientos fueron leiomioma del útero sin otra especificación (49.9%) y sangrado vaginal y uterino anormal no especificado (11.6%). Conclusiones Al igual que en los hallazgos de otros estudios, las histerectomías se relacionaron principalmente con los diagnósticos de leiomiomas y se concentraron principalmente en el grupo de 40 a 49 años