Carlos Vallejos

Docencia e investigación en Medicina Legal: Situación actual y desafíos para las Facultades de Medicina de Chile

Fourteen deans answered the questionnaire. In all theresponding faculties, forensic medicine is an obligatory course, generally during the fifth yearand mostly combining theory with practice. In seven faculties, forensic medicine concepts areincluded in other courses. Forensics is taught in only two of 10 dental schools, two of 17 nursingschools, one of nine midwives schools and one of nine medical technology schools. It is nottaught in phonoaudiology, kinesiology and nutrition schools. There are 74 physicians that teachthe specialty but only 10 are certified by the National Board of Medical Specialty Certification(CONACEM). Treatment of most topics on forensics is insufficient. Thanatology is the strongesttopic and forensic dentistry is the weakest. There are 52 publications in the area, mostly on“medical law”.

Latin American Clinical Epidemiology Network Series – Paper 8: Ticagrelor was cost-effective vs. clopidogrel in acute coronary syndrome in Chile

OBJECTIVE To evaluate the incremental cost-effectiveness ratio (ICER) of the use of ticagrelor as a substitute for clopidogrel for secondary prevention of acute coronary syndrome in Chile. STUDY DESIGN AND SETTING Cost-effectiveness analysis based on a Markov model: Safety and effectiveness data of ticagrelor were obtained from a systematic review of the literature. Costs are expressed in Chilean pesos (CLP) as of 2013. The evaluation was conducted from the payer standpoint. A probabilistic sensitivity analysis comprising discount rates and national cost variability was done. A budget impact analysis estimated for 2015 was conducted to calculate the total cost for both treatments. RESULTS The ICER with a discount rate of 6% for ticagrelor vs. clopidogrel was CLP 4,893,126 per quality-adjusted life-year (QALY) gained (=9,689 US

Impacto de Dos Métodos Alternativos de Asignación de Costos Indirectos Estructurales de Hospitales Públicos Chilenos en el Costo Final de Producción de Servicios Sanitarios

). In the budget impact analysis for the baseline scenario, considering 100% of treatment, coverage, and adherence, ticagrelor represented an additional cost of CLP 5,233,854,272, for 979 QALYs gained compared with clopidogrel. CONCLUSIONS Ticagrelor is cost-effective in comparison with clopidogrel for the secondary prevention of acute coronary syndrome. These findings are similar to those reported in other international cost-effectiveness studies.

Series: the Latin American Clinical Epidemiology Network (LatinCLEN)Latin American Clinical Epidemiology Network Series – Paper 8: Ticagrelor was cost-effective vs. clopidogrel in acute coronary syndrome in Chile

OBJECTIVE The main goal of this study is to measure the impact of two alternative methods of overhead cost allocation of chilean public hospitals into the final production cost of 256 health care services which are recurrent in health problems whose burden of disease is high in Chile. METHODS A purposively sample of six important hospitals of metropolitan region in Chile was considered. A survey was applied to them in order to collect analytic cost data of resource use (labor, medical supplies and use of capital) in the production of health care services. The data of overhead cost (electricity, central heating, laundry, administrative support, transport, maintenance, etc.) were obtained from the Information System of each hospital. The final cost of each health care service was calculated from the perspective of health public system, in two ways: (1) using a proxy rate of common use, and (2) using overhead cost rates as a result of a step-down methodology. The final costs calculated with each method were compared and analized. RESULTS Considering that the gold standard method for allocation of overhead cost is the step-down methodology, the results using proxy rate revealed that 185 services (72,3%) are under costing, and 71 health care services (27,7%) are over costing. CONCLUSION The use of proxy rates to allocate overhead costs into the final cost lead to important under costing and over costing of health services. This finding is important at least by two reasons: (1) for the management of hospitals, (2) in economic evaluations, the variations in cost can modify the ratio of cost-effectiveness, cost-utility or cost-benefit, influencing the health public decision.

Costo efectividad y análisis de impacto presupuestario del óxido nítrico inhalatorio neonatal en un hospital, desde la perspectiva del sistema público de salud

OBJECTIVE To evaluate the incremental cost-effectiveness ratio (ICER) of the use of ticagrelor as a substitute for clopidogrel for secondary prevention of acute coronary syndrome in Chile. STUDY DESIGN AND SETTING Cost-effectiveness analysis based on a Markov model: Safety and effectiveness data of ticagrelor were obtained from a systematic review of the literature. Costs are expressed in Chilean pesos (CLP) as of 2013. The evaluation was conducted from the payer standpoint. A probabilistic sensitivity analysis comprising discount rates and national cost variability was done. A budget impact analysis estimated for 2015 was conducted to calculate the total cost for both treatments. RESULTS The ICER with a discount rate of 6% for ticagrelor vs. clopidogrel was CLP 4,893,126 per quality-adjusted life-year (QALY) gained (=9,689 US

Ticagrelor was cost-effective vs. clopidogrel in acute coronary syndrome in Chile

). In the budget impact analysis for the baseline scenario, considering 100% of treatment, coverage, and adherence, ticagrelor represented an additional cost of CLP 5,233,854,272, for 979 QALYs gained compared with clopidogrel. CONCLUSIONS Ticagrelor is cost-effective in comparison with clopidogrel for the secondary prevention of acute coronary syndrome. These findings are similar to those reported in other international cost-effectiveness studies.

Asociación entre la asimetría fetal medida por las relaciones CC/CA y LF/CA y asimetría neonatal medida por el índice ponderal

Inhaled nitric oxide (iNO) is currently the first-line therapy in severe hypoxaemic respiratory failure of the newborn. Most of regional neonatal centres in Chile do not have this therapeutic alternative. OBJECTIVE To determine the cost effectiveness of inhaled nitric oxide in the treatment of respiratory failure associated with pulmonary hypertension of the newborn compared to the usual care, including the transfer to a more complex unit. PATIENTS AND METHOD A clinical decision tree was designed from the perspective of Chilean Public Health Service. Incremental cost effectiveness rates (ICER) were calculated, deterministic sensitivity analysis was performed, and probabilistic budget impact was estimated using: TreeAge Pro Healthcare 2014 software. RESULTS The iNO option leads to an increase in mean cost of

Principales aspectos metodológicos en la Evaluación de Tecnologías Sanitarias

11.7 million Chilean pesos (€15,000) per patient treated, with an ICER compared with the usual care of

Análisis Costo Efectividad del Stent Farmacológico V/S Stent no Farmacológico en Cardiopatía Isquémica en Chile

23 million pesos (€30,000) in case of death or ECMO avoided. By sensitising the results by incidence, it was found that from 7 cases and upwards treated annually, inhaled nitric oxide is less costly than the transfer to a more complex unit. CONCLUSIONS From the perspective of a Chilean regional hospital, incorporating inhaled nitric oxide into the management of neonatal respiratory failure is the optimal alternative in most scenarios.

Identificación de factores de riesgo y factores protectores del embarazo en adolescentes de la Novena región

OBJECTIVE To evaluate the incremental cost-effectiveness ratio (ICER) of the use of ticagrelor as a substitute for clopidogrel for secondary prevention of acute coronary syndrome in Chile. STUDY DESIGN AND SETTING Cost-effectiveness analysis based on a Markov model: Safety and effectiveness data of ticagrelor were obtained from a systematic review of the literature. Costs are expressed in Chilean pesos (CLP) as of 2013. The evaluation was conducted from the payer standpoint. A probabilistic sensitivity analysis comprising discount rates and national cost variability was done. A budget impact analysis estimated for 2015 was conducted to calculate the total cost for both treatments. RESULTS The ICER with a discount rate of 6% for ticagrelor vs. clopidogrel was CLP 4,893,126 per quality-adjusted life-year (QALY) gained (=9,689 US