A 1 -A 3 1 8 A133 eficiaries who had a diagnosis of hypertension and CKD, aged 67 and above and continuously enrolled in Medicare Part D from 2008 to 2013 are included. Baseline characteristics examined using a two year lookback period. Adherence to ACEIs, ARBs and other blood pressure/ lipid lowering agents was measured using proportion of days covered (PDC). Multivariate Cox regression models were used to assess the association between medication adherence and progression to end stage renal disease (ESRD) and death. Results: A total of 115,769 hypertensive patients with CKD were included. Approximately 2.5% of them developed ESRD and 57.5% of them died during 2008-2013. Adherence to ACEIs and ARBs was associated with a significant decreased hazard of developing ESRD (Hazard Ratio: 0.29 95%CI [0.25-0.33] p< 0.0001; 0.49 95% CI [0.42, 0.57] p< 0.0001, respectively) after adjusting for demographic and clinical confounders. Patients with increased use of ACEIs and ARBs had reduced risk of death (Hazard Ratio: 0.76 95%CI [0.74-0.78] p< 0.0001; 0.64 95% CI [0.62, 0.66] p< 0.0001, respectively). Increased adherence to diuretics and statins were associated with lower ESRD and mortality risk, while calcium channel blockers and beta blockers were associated with increased ESRD risk and lower mortality risk. ConClusions: Increased adherence to ACEIs and ARBs for elderly patients diagnosed with hypertensive CKD is associated with delay in CKD progression and lower mortality risk. These findings could have significant implications for hypertension management in this population.
A725robust in the one-way sensibility analyses and the probabilistic sensitivity analysis indicating that the absence of monitoring strategy has the highest probability of cost-effectiveness ConClusions: Long-run WBC monitoring based on current national detection guidelines is not cost-effective, even by unrealistically high agranulocytosis prevalence. New guidelines are needed to improve WBC monitoring in schizophrenic patients receiving Clozapine.
PSY2 OSteOtOmia De acOrtamientO raDial en la enfermeDaD De KienbOcK (SeguimientO De 5 añOS)Vazquez Alonso F. imss hospital de traumatologia y ortopedia lomas verdes, naucalpa edo de mexico, Mexico objeCtivos: evaluar los resultados clinicos y funcionales ( grado de satisfacción ) de paciente con enfermedad de kienbock ttratados con osteotomia de acortamiento radial. MetodologíAs: estudio realizado en la umae de traumatologia y ortopedia lomas verdes del imss, en el servicio de cirugia de mano, en un periodo comprendido entre 2000 al 2003, con seguimiento de 5 años.estudio retrospectivo, observacional, transversal. se estudiaron ´18 pacientes de ambos sexos con diagnostico de enfermedad de kienbock utilizando la clasificacion de litchman, evaluados con las escala de wrist mayo score y QDash. pba estadistica de wiscolson ResultAdos: se obtuviero 18 paciente 9 mujeres y 9 hombres, el 84% obreros 16% al hogar, de acuerdo al resultados de la escla funcional wrist mayo score fueron 56% buenos, 33% excelentes, 5.5% malo, 5% regulares, con 25 puntos de grado de satifaccion de acuerdo al QDash. un paciente fue reintervenido 2 años posteriores al cual se le realizo una artrodesis delas cuatro esquinas. ConClusiones: la evaluacion clinica y funcional, sugiere una eficacia aceptable de la osteotomia de acortamiento radial y provee datos alentadorespara continuar con este tipo de tratamiento.
PSY3 the relatiOnShiP between SPecific annual bleeD rateS anD healthOutcOmeS amOng chilDren with Severe hemOPhilia a in latin america
A671 and quality-adjusted life years (QALYs) were discounted at 3% annually. One-way sensitivity analyses were conducted. Results: Using a $20,000/QALY threshold, baseline screening with S5 dominated S3 and S4 by reducing overall cost, annual cancer incidence, and improving QALYs; and was cost-effective compared to S1 and S2. In the 1-year follow-up scenario, S5 was cost-effective compared to all other strategies. Detection of HPV 16/18 with S5 resulted in earlier diagnosis of clinically relevant CIN 2/3 at the initial visit as well as more efficient use of screening tests during follow-up. Sensitivity analyses showed that test sensitivities were the most impactful on model results. ConClusions: Incorporating the cobas HPV test with HPV 16/18 genotyping was cost-effective compared to various CxCa screening strategies, and resulted in improved protection against CxCa. Trends in HealTH Care sTudies Tr1 self-reporTed HealTH sTaTus and eQ-5d-3l Values of THe argenTine populaTion:
A913health system 41 (36.6%) of the studies were observational, 64 (57.1%) comprised literature reviews and 7 (0.06%) were experimental. Observational studies have also comprised much of the results obtained for the SUS representing 86% of all studies, as a result of analytical studies with cohort design about cost-effectiveness, representing 68% of the total. Analysis of patient's coverage by Obamacare financing system accounted for 31.2% of all the results. Most studies on diagnosis and prevention in Obamacare system are systematic reviews (54.2%), while for the SUS, 83.3% of the results were observational studies, in both systems the analysis focused on the cost-effectiveness of diagnostic techniques and the impact generated by them on a large scale. ConClusions: None of the health systems studied completely meet the requirements for offering coverage to universal health care, as recommended by WHO. The ACA significantly increased the participation of state and federal US governments in financing public health, proposing to decrease the uncovered population, yet there are still large expenditures spent by the user. With wide population coverage, SUS tries today to expand the availability of services to all the population without requiring additional tax rates.
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