Oscar Gamboa

Cost-effectiveness of iso- versus low-osmolality contrast media in outpatients with high risk of contrast medium-induced nephropathy

INTRODUCTION Contrast media can cause acute renal failure by direct toxic effects on the tubular cells and kidney ischemia. Diabetics and hospitalized patients have a greater risk of developing contrast-induced nephropathy than the general population. OBJECTIVE The cost effectiveness of iso and low-osmolality contrast media was assessed in high risk outpatients. MATERIALS AND METHODS The analysis was based on a systematic literature review comparing the nephrotoxic effects of iso- to low-osmolality contrast media. Only direct costs were considered; these were obtained from the official tariff manual. Incremental cost-effectiveness ratios, efficiency curves and acceptability curves were calculated. Univariate sensitivity analyses were performed for costs and effects, as well as probabilistic analyses. Zero and 3% discounts were applied to results. The cost-effectiveness threshold was equal to the per capita GDP per life-year gained. RESULTS Alternatives with Iopamidol and Iodixanol are preferable to the others, because both reduce risk of contrast-induced nephropathy and are less costly. The incremental cost-effectiveness of the Iodixanol alternative compared to the Iopamidol alternative is US

Cost-Effectiveness of CT, EUS and PET/CT in Evaluating Patients with Symptoms of Pancreatic Cancer in Colombia

14,660 per additional life year gained; this is more than twice the threshold. CONCLUSION The low-osmolality contrast medium, Iopamidol, appears to be cost-effective when compared with Iohexol or other low-osmolality contrast media (Iopromide, Iobitridol, Iomeprol, Iopentol and Ioxilan) in contrast-induced nephropathy, high-risk outpatients. The choice of the iso-osmolality contrast medium, Iodixanol, depends on its cost per vial and on the willingness to pay.INTRODUCTION Epidemiological studies indicate that obesity is associated with an increased risk of 20-25% with several types of cancer. OBJECTIVE The frequency of chromosome aberrations was evaluated in lymphocytes from postmenopausal obese and non-obese women. MATERIALS AND METHODS Twenty obese and 20 non-obese women, all post-menopause, were recruited. The groups were matched according to age (± 5 years) and place of origin. After signing the consent form, women were interviewed using a structured questionnaire, and a blood sample (5 ml) was drawn into vacutainer tubes. From each sample, lymphocyte cell cultures were established with and without mitomycin C (challenge assay). Afterwards, the frequency of chromosome aberrations were recorded for each group and treatment. Data were analyzed using the statistical program SPSS, v. 14.0. RESULTS Obese women had a higher frequency of chromosome aberrations when compared with non-obese women. After exposing the cell cultures to mitomycin C, obese women presented an increase in the number of total chromosome aberrations in comparison to non-obese women (3.7± 0.6 vs. 2.70±0.6; p=0.001). CONCLUSIONS The higher frequency of chromosome aberrations in lymphocytes from postmenopausal obese women compared to non-obese women suggested differences in the DNA repair capacity. This may indicate an association between genomic instability and the higher incidence of cancer in this population.

Análisis de costo-efectividad en Colombia de anastrazol Vs. tamoxifeno como terapia inicial en mujeres con cáncer temprano de mama y receptor hormonal positivo

Introduction: An estimated 1,399 new cases of pancreatic cancer (PC) and 1,406 deaths from the same cause occurred in Colombia in 2002. We evaluate the cost-effectiveness of multidetector computed tomography (CT), endoscopic ultrasonography (EUS) and positron emission tomography with computed tomography (PET/CT) in diagnosis and staging of patients with clinical suspicion of PC.Materials and methods: We conducted a cost-effectiveness analysis based upon a systematic search to determine the strategies´ sensitivity and specificity. The costs of administering and monitoring were taken from the official tariff manuals. The results were assessed in terms of number of correct behaviours. We performed deterministic and probabilistic sensitivity analyses.Results: CT showed the best cost-effectiveness indicator (Col

Costo-efectividad de medios de contraste isoosmolales e hiposmolales en pacientes con alto riesgo de nefropatía inducida por medio de contraste

3,397,163 for each appropriate behaviour). The cost of changing the strategy to that of CT plus EUS was Col

Instructivo para la incorporación de la evaluación económica en guías de práctica clínica

7,893,573 for each additional appropriate behavior. In the probabilistic analysis the cost-effective strategy was USE for a willingness to pay higher than Col

Cost Effectiveness of Adding Natriuretic Peptid Type B to the Lee Index in Cardiovascular Risk for Non-Cardiac Surgery (Costo-Efectividad de Añadir el Péptido Natriurético Tipo B al Índice de Lee en la Evaluación del Riesgo Cardiovascular en Cirugía Mayor No Cardiaca) (Spanish)

9,000,000 per additional unit, or TAC for smaller values.Conclusion: The cost-effective strategy in the evaluation of patients suspected PCis the multidetector CT. For values of willingness to pay more than Col

COSTO-EFECTIVIDAD DE AADIR EL PPTIDO NATRIURTICO TIPO B AL NDICE DE LEE EN LA EVALUACIN

7,893,573 and Col

Costo-Efectividad de Realizar Plasmaféresis Previa a Timectomía Abierta en el Tratamiento de la Miastenia Gravis (Cost-Effectiveness of Performing Plasmapheresis Prior to Open Thymectomy in the Treatment of Myasthenia Gravis)

9,000,000 per additional unit cost-effective alternatives are EUS or CT plus EUS in series.