Aurelio Mejía

Accesibilidad a la citología cervical en Medellín, Colombia en 2006

Fundamento: en paises en desarrollo no se han logrado suficientes avances en reduccion de la carga de la enfermedad por cancer cervical, por lo que es importante mejorar la cobertura, condiciones de acceso y efectividad de los programas de tamizaje. El objetivo de este trabajo es analizar el acceso real de mujeres usuarias del tamizaje citologico ofrecido por la Secretaria de Salud de Medellin (Colombia). Metodos: se analizaron 1.519 registros de mujeres, provenientes de un estudio transversal realizado en un area urbana de Medellin (Colombia). Se realizo un analisis descriptivo y se estimo un modelo de regresion logistica para explicar la practica de citologia reciente (aquella realizada hace maximo 36 meses, previos a la aplicacion de la encuesta). Resultados: El 68,7% de las mujeres se habian practicado una citologia recientemente, el 17,2% tenia citologias previas pero no recientes, y el 14,2% era la primera vez que acudia al servicio. La probabilidad de haberse realizado una citologia reciente es mayor para mujeres con mas edad, antecedente familiar de cancer cervical, antecedente personal de infecciones de transmision sexual, mujeres con algun grado de educacion y las que se encuentran en union estable o estan (o estuvieron) casadas. Conclusiones: hay indicios de que la demanda por la citologia esta concentrada, con una buena frecuencia para un numero limitado de mujeres, mientras otras no la practican o dejan de hacerlo.

[Quality assessment of economic evaluations in health care in Colombia: a systematic review].

INTRODUCTION Economic evaluation is a tool that can provide useful information to decision-makers in health. The methodological quality of Colombian studies has not been assessed in a systematic way. OBJECTIVE To assess the methodological quality of economic evaluations in health care in Colombia. MATERIALS AND METHODS Systematic review of economic studies that assessed both costs and effectiveness of at least two technologies related to a decision problem in Colombia. Search was performed in international and Colombian databases and was completed with manual searches and contact with authors. Data was synthesized in tables that included relevant information about the studies. Methodological quality was evaluated using a predefined instrument. Searches were performed between January and February. RESULTS 48 studies were included in the review. Perspective of the study, incremental analyzes and description of alternatives were usually well specified. However, more than half of the articles did not state clearly the time horizon or discount rate and most studies did not address equity and implementation issues. Management of uncertainty was also problematic. CONCLUSIONS Economic evaluation in health care in Colombia has grown considerably in recent years. However, methods vary considerably between studies and therefore their usefulness for decisionmaking in health is limited. It is necessary to standardize methods in order to generate evidence of higher quality to support decisions within the Colombian health care system.

Análisis de costo efectividad de ondansetrón para el tratamiento del vómito en niños menores de cinco años con gastroenteritis en Colombia

INTRODUCTION Ondansetron reduces hospitalization rates for diarrhea and vomiting in children, but is not yet routinely used. OBJECTIVE To estimate from a social perspective the relative cost-effectiveness of ondansetron for the treatment of vomiting in children with gastroenteritis and at risk of dehydration in Colombia. METHODS Cost-effectiveness analysis from a social perspective, including direct medical costs and costs for caregivers. With a decision tree we compared costs and health outcomes of usual treatment without antiemetic to usual treatment plus ondansetron in children under 5 years with gastroenteritis and vomiting. Effectiveness of intervention was measured as reduction in hospitalization rates, and the time horizon of the model was the episode. Probabilities were obtained from clinical trials and systematic reviews, measurement of resources use was based on protocols and expert opinions, while unit costs were obtained from Colombian tariff manuals. We performed a survey to estimate indirect costs for caregivers (n=81) that included questions about wage loss, transportation, meals expenditures and other out-of-pocket payments. Deterministic and probabilistic sensitivity analyses were performed. RESULTS Usual treatment plus ondansetron is a dominant strategy compared to usual treatment without antiemetic yielding fewer hospitalizations and saving

Cost-effectiveness analysis of zinc supplementation for treatment of acute diarrhea in children younger than 5 years in Colombia.

44.562 Colombian pesos (23,98USD) per episode. Ondansetron was dominant in 98,91% of simulations of the probabilistic analysis. CONCLUSIONS Ondansetron is a dominant intervention that reduces hospitalization rates and costs for health system and caregivers. We recommend assessing the inclusion of this drug in the Colombian Health Benefit Plan for the treatment of gastroenteritis in children under 5 years.

Cost-effectiveness analysis of ticagrelor compared to clopidogrel for the treatment of patients with acute coronary syndrome in Colombia

Objective: The objective of this study was to determine the cost-effectiveness of zinc supplementation for the treatment of acute diarrhea (AD) in children younger than 5 years in Colombia. Methods: The cost-effectiveness analysis was performed from the perspective of the Colombian health system. The standard treatment with the addition of zinc was compared with the standard treatment without zinc in children younger than 5 years. The time horizon was 1 month. Effectiveness was extracted from a systematic review of literature. The specific data for Colombia were taken from local databases and observational studies. To determine the costs, a typical case was constructed by reviewing guidelines and medical records and validated by experts. To evaluate the resources consumed, Colombian tariff manuals were used. Costs were stated in Colombian pesos (COP) and US dollar (USD) for 2010. Deterministic sensitivity analysis was performed to evaluate the impact of changes in cost and effectiveness of the strategies on the results from the model. Results: The results from the model indicate that zinc supplementation is a dominant strategy; it is less costly and more effective than standard treatment without zinc (reduction of

Costos de la rehidratación oral y nasogástrica comparadas con la rehidratación endovenosa en niños con diarrea en Colombia

15,210 COP [8.14 USD] per child). The results are sensitive to changes in the probability of hospitalization and of persistent diarrhea. Conclusions: Zinc for the treatment of AD is a highly cost-effective strategy and is recommended for inclusion in the benefit plan of the Colombian health system. This intervention is more cost-effective in children with a higher risk of persistent diarrhea and hospitalization.

Cost-effectiveness of a nurse facilitated, cognitive behavioural self-management programme compared with usual care using a CBT manual alone for patients with heart failure: secondary analysis of data from the SEMAPHFOR trial

INTRODUCTION Acute coronary syndrome is one of the most frequent medical emergencies in developing countries. OBJECTIVE To determine, from the perspective of the Colombian health system, the cost-effectiveness of ticagrelor compared to clopidogrel for the treatment of patients with acute coronary syndrome. MATERIALS AND METHODS We conducted a cost-effectiveness analysis from the perspective of the Colombian health system comparing ticagrelor and clopidogrel for the treatment of patients with acute coronary syndrome. To estimate the expected costs and outcomes, a Markov model was constructed in which patients could remain stable without experiencing new cardiovascular events, suffer from a new event, or die. For the baseline case, a 10-year time horizon and a discount ratio of 3% for costs and benefits were adopted. The transition probabilities were extracted from the PLATO (Platelet Inhibition and Patient Outcomes) clinical trial. Vital statistics were drawn from the Departmento Administrativo Nacional de Estadística (DANE) and additional information from Colombian patients included in the Access registry. To identify and measure resource use, a standard case was built by consulting guidelines and protocols. Unit costs were obtained from Colombian rate lists. A probabilistic sensitivity analysis was conducted in which costs were represented by a triangular distribution, and the effectiveness through a beta distribution. RESULTS In the base case, the additional cost per quality-adjusted life-year gained with ticagrelor was COP

Evaluación de la calidad metodológica de la literatura en evaluación económica en salud en Colombia: una revisión sistemática

28,411,503. The results were sensitive to changes in the time horizon and the unit cost of clopidogrel. For a willingness-to-pay equivalent to three times the Colombian per capita gross domestic product, the probability of ticagrelor being cost-effective was 75%. CONCLUSIONS Ticagrelor is a cost-effective strategy for the treatment of patients with acute coronary syndrome in Colombia.

Evaluación económica de programas y servicios de salud

OBJECTIVE To evaluate the costs of oral rehydration therapy (ORT) and nasogastric rehydration therapy (NRT) compared with intravenous rehydration therapy (IRT) to treat dehydration in children under 5 years of age with diarrhea. METHODOLOGY Cost-minimization analysis from the perspective of the Colombian Health System, comparing ORT, (followed by NRT when ORT fails), with IRT. The time horizon was the duration of rehydration. The effectiveness measure was obtained from a systematic review of the literature. To determine costs, a typical case was created based on current guidelines and medical records; this case was validated by experts. Unit costs were obtained from Colombian databases and were provided in Colombian pesos (COP) and US dollars (USD) for 2010. One- and two-way sensitivity analyzes were performed. RESULTS ORT and ERT are similarly effective to prevent hospitalization and to achieve rehydration. In the base case, the expected cost of ORT was

Is tax funding of health care more likely to be regressive than systems based on social insurance in low and middle-income countries?

91,221 COP (40.5 USD) and for IRT was