Carga económica de la Enfermedad Renal Crónica en Colombia

Objetivo: Estimar la carga económica asociada a la Enfermedad Renal Crónica (ERC) en Colombia, para el periodo 2015-2016. Materiales y métodos: Se estimó la carga económica de la ERC en Colombia, a partir de datos de terceros pagadores. Se realizó un costeo de los estadios de la ERC mediante la técnica de macro-costeo o top-down, con el fin de conocer el impacto económico de cada estadio en la carga global de la enfermedad. Se construyó un modelo de Markov que simulara la historia natural de la enfermedad. Se utilizó una tasa de descuento del 5% y ciclos anuales. A cada estado de la ERC, se le asignó un costo relacionado con la atención, obteniendo un estimado del costo y de la carga de enfermedad de todos los pacientes con ERC. Resultados: Al final de los ciclos de todos los pacientes desde el estadio 1-5 e incluyendo el trasplante, se estimó una carga económica que asciende a $10.5 billones de pesos (IC 95$8.7-$14.4). En el escenario con tasa de descuento del 5$7.8 billones de pesos. Conclusión: La ERC representa una alta carga económica al sistema de salud colombiano, que oscila entre $8.7 -$14.4 billones de pesos que representarían entre el 1,6% y el 2,7% del Producto Interno Bruto de Colombia, 2015

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

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

Budgetary impact analysis of preexposure prophylaxis (prep) strategy for the prevention of hiv in Colombia, 2019-2021

We aimed to estimate the budgetary impact of a PrEP strategy for the prevention and control of HIV in men who have sex with men (MSM) and transgender women (TGW) in Colombia. We adapted a budgetary impact model developed by Fundación Oswaldo Fiocruz, Brazil. Modelling was performed from the third-payer perspective over a 3-year period. Epidemiological and cost inputs were extracted from literature reviews and Colombian data. Two scenarios were simulated: 1. No PrEP scenario; and, 2. New scenario: MSM and TGW would have access to a PrEP program, which potentially reduce the HIV cases. Costs include the sum of PrEP program costs for MSM and TGW, and the treatment costs of cases that will occur in the 3-years of implementation. The new scenario was modelled at different risk and PrEP program coverage levels. Budget impact analysis (BIA) was calculated as the difference between the two scenarios. Cost were reported in Colombian pesos (COP). At a PrEP coverage of 80% and an incidence of 4.5 per 100 person-year would be avoid 4,057, 4,315 and 4,383 HIV cases in MSM for years 1, 2 and 3, respectively. The BIA was COP$47 billion for year 1; COP$20 billion for the second, and for the third year the PrEP program would save COP$11 billion. In TGW, at a PrEP coverage of 80$3.3 billion, COP$-2.1 billion and COP$-8.1 billion, respectively. PrEP strategy should focus on small fractions of the population at high risk, such as those addressed in our study. Our results suggest that PrEP program would avoid cases and save costs for the Colombian health system

Centers of excellence implementation for treating rheumatoid arthritis in Colombia: A cost-analysis

Background: Health systems need to optimize the use of resources, especially in high-cost diseases as rheumatoid arthritis (RA). We aimed to evaluate the efficiency of using centers of excellence (CoE) as a strategy for improving RA treatment in Colombia. Methods: A cost description analysis was carried out using the standard costing technique. We estimated the costs of medical consultations, laboratories, images, and medications for RA. Categories of care standards stratified by severity were defined using the disease activity score in 28 joints (DAS28). We evaluated the impact, in terms of costs (US dollars), for providing RA clinical care for a previously described cohort using the CoE approach. Statistical analyses were performed in Microsoft Excel®, and R. Results: Expenditure on therapeutic drugs increases as the severity of RA increases. Drugs represent 53.6% of the total cost for the low disease activity (LDA) stage, 75.2% for moderate disease activity (MDA), 88.5% for severe disease activity (SDA) and 97% for SDA with biologic treatment (SDA+Biologic). Treating 968 patients would cost US$612,639 (US$487,978– 1,220,160) at baseline, per year. After a year of follow-up at the CoE, treating the same patients would cost US$388,765 (US$321,710– 708,476), which implies potential cost-savings of up to US$223,874 per year. Conclusion: The strategy of providing clinical care for RA through CoE can save US$231.3 per patient-per year. The results of our study show that CoE could greatly impact the public policies dealing with treatment of RA in Colombia. Applying the CoE model in our country would both improve health outcomes, as well as being more efficient in terms of costs

Economic cost of severe acute respiratory infection associated to influenza in Colombian children

Background: Influenza is considered a leading public health problem because its large economic burden of disease worldwide, especially in low-and middle-income countries, such as Colombia. Objective: We aimed to estimate the economic costs of influenzaconfirmed patients in a pediatric hospital in Cartagena, Colombia. Methods: We conducted a retrospective costing analysis. We estimated the direct (direct medical and out-of-pocket expenditures) and indirect costs for influenza-confirmed severe acute respiratory infection cases from a societal perspective. Total economic costs were calculated adding direct medical costs, out-of-pocket expenditures, and indirect costs owing to loss of productivity of caregivers. Mean, median, 95% confidence interval (95% CI) and interquartile range (IQR) of costs were measured. All costs are reported in USD ($1.00 = COP$2000.7) Results: Forty-four cases were included in the analysis: 30 had influenza B, 10 influenza A and B, and 4 influenza AH1N1. Thirty patients were hospitalized in the general ward, 14 went to the intensive care unit. The average duration of stay was ∼9 days (95% CI, 6.3-11.5). The median direct medical cost for hospitalized case in general ward was $743.50 (IQR$590.20-$1404.60) and in intensive care unit$4669.80 (IQR $1614.60-$7801.50). The economic cost per hospitalized case was $1826.10 (IQR$1343.30-$2376.50); direct medical costs represented 93.8$82.10 (IQR $41.10-$133.40) and the median out-of-pocket expenditure per case was $45.70 (IQR$29.50-$64.90). Conclusions: Severe acute respiratory infection is an important source of economic burden for the health system, families, and society in Colombia. Seasonal influenza vaccination should be strengthened to prevent more cases and save economic resources

Déterminants sociaux de la tentative de suicide chez les jeunes colombiens.

The present study studies the prevalence and analyzes the factors that determine suicide attempts in young people between 10-24 years. This is a descriptive-correlational study with a sample of 10,677 young people. Sociodemographic characteristics were described and a probit model was made to estimate the factors associated with suicide attempts in the young population studied. 2% of the sample reported suicide attempts and 70.8% showed up in women. The level of schooling of the youth and parents, suicidal ideations and physical abuse were important predictors of suicide attempts in youth in the Montes de María.El presente estudio estudia la prevalencia y analiza los factores que determinan los intentos de suicidio en jóvenes entre 10-24 años. Se trata de un estudio descriptivo-correlacional con una muestra de 10.677 jóvenes. Se describieron las características sociodemográficas y se realizó un modelo probit para estimar los factores que se asocian a los intentos de suicidio en la población joven estudiada. El 2% de la muestra reportó intentos de suicidio y el 70,8% se presentó en mujeres. El nivel de escolaridad del joven y los padres, las ideaciones suicidas y el maltrato físico fueron importantes predictores de los intentos de suicidios en jóvenes de los Montes de María.La présente étude étudie la prévalence et analyse les facteurs qui déterminent les tentatives de suicide chez les jeunes de 10 à 24 ans. Il s’agit d’une étude descriptive-corrélationnelle avec un échantillon de 10 677 jeunes. Les caractéristiques sociodémographiques ont été décrites et un modèle probit a été élaboré pour estimer les facteurs associés aux tentatives de suicide dans la population jeune étudiée. 2% de l’échantillon ont signalé des tentatives de suicide et 70,8% se sont présentés chez les femmes. Le niveau de scolarité des jeunes et des parents, les idées suicidaires et les violences physiques étaient d’importants prédicteurs de tentatives de suicide chez les jeunes des Montes de María

Economic burden of chonic kidney Disease in Colombia, 2015-2016

Objetivo: Estimar la carga económica asociada a la enfermedad renal crónica (ERC) en Colombia, para el periodo 2015-2016. Materiales y métodos: Se estimó la carga económica de la ERC en Colombia a partir de datos de terceros pagadores. Se realizó un costeo de los estadios de la ERC mediante la técnica de macro-costeo o top-down, con el fin de conocer el impacto económico de cada estadio en la carga global de la enfermedad. Se construyó un modelo de Markov que simulara la historia natural de la enfermedad. Se utilizó una tasa de descuento del 5% y ciclos anuales. A cada estado de la ERC se le asignó un costo relacionado con la atención, con lo cual se obtuvo un estimado del costo y de la carga de enfermedad de todos los pacientes con ERC. Resultados: Al final de los ciclos de todos los pacientes desde el estadio 1-5, incluyendo el trasplante, se estimó una carga económica que asciende a COP 10,5 billones (IC 95% COP 8,7- COP 14,4). En el escenario con tasa de descuento del 5%, la carga económica asciende a COP 7,8 billones. Conclusión: La ERC representa una alta carga económica al sistema de salud colombiano, la cual oscila entre COP 8,7 y COP 14,4 billones, que representarían entre el 1,6% y el 2,7% del producto interno bruto de Colombia en el 2015.Objective: Estimate the economic burden due to chronic kidney disease (CKD) in Colombia, for 2015-2016. Methods: We estimated the economic burden of CKD through third payer’s data. A topdown technique was used to estimate the costs related to CKD as input to estimate the economic burden of the disease. A Markov model was conducted to simulate the natural history of the disease. A 5% discount rate and annual cycles were used. Each stage of the disease had a cost associated with the disease, producing and estimation of the economic burden of all patients with CKD. Results: At the end of the modeling from stages 1-5, including transplantation, the economic burden of CKD was COP $10.5 billion (IC 95$8.7-$14.4). In the discount rate scenario, the economic burden was COP$7.8 billons. Conclusion: CKD represents a high economic burden on the Colombian health system, which ranges from COP $8.7-$ 14.4 billion that would represent between 1.6% and 2.7% of Colombia's Gross Domestic Product, 2015

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

Impact in hospitalization costs of a cardiovascular risk management program in Colombia: a propensity score matching model

Cardiovascular diseases (CVD) are the leading cause of death and burden of disease in Colombia and globally. In 2017, CVD represented the 12% of total DALYs. CVD is a costly disease from patient, family and societal perspectives. Effective prevention and risk management programs reduces the incidence of CVD by as much as 80%. We aimed to estimate the impact of direct medical hospitalization costs related to adherence in a risk management program in Colombia, 2018. We retrospectively collected data from 6,243 patients with data of enrollment in a cardiovascular risk management program (DTC, in Spanish) of a subsidized insurer, who presented arterial hypertension (AH) or AH+ type 2 diabetes mellitus (DM2). 1,065 were identified adherent to the program (treated) and 5.178 non adherent (controls). We designed a propensity score matching model adjusted with confounding variables to estimate the effect of treatment (program adherence) over hospitalization cost. Costs were calculated based on hospitalization invoices and expressed in Colombian pesos (COP) 2018. DTC has an average negative effect on cost of treated population. Being treated avoids hospitalization costs; these results were statistically significant at the 5% and 10% level (with 95%CI that goes through zero). Hence, being in the DTC program reduces hospital costs that ranges from COP-$11,346,372 to -$ 799,259 (95%CI) compared to the average cost. The overall impact on program costs is a significant saving of COP583,670 per event-year. If all members of the DTC program fulfilled its activities by more than 80%, the savings generated by the program would be close to COP$ 6.85 billion. DTC risk management program reduces direct hospitalization costs of events associated to CVD. Our results are important to design policies focused on the cost and risk management of patients with CVD in poor population