Home-based specimen collection could result in similar levels of index case management for CT or NG infection when compared with clinic-based specimen collection. Increases in the proportion of individuals tested as a result of home-based, compared with clinic-based, specimen collection are offset by a lower proportion of positive results. The harms of home-based specimen collection compared with clinic-based specimen collection have not been evaluated. Future RCTs to assess the effectiveness of home-based specimen collection should be designed to measure biological outcomes of STI case management, such as proportion of participants with negative tests for the relevant STI at follow-up.

ObjectiveTo compare costs and effectiveness of three strategies used against cervical cancer (CC) and genital warts: (i) Screening for CC; (ii) Bivalent Human Papillomavirus (HPV) 16/18 vaccine added to screening; (iii) Quadrivalent HPV 6/11/16/18 vaccine added to screening. MethodsA Markov model was designed in order to simulate the natural history of the disease from 12 years of age (vaccination) until death. Transition probabilities were selected or adjusted to match the HPV infection profile in Colombia. A systematic review was undertaken in order to derive efficacy values for the two vaccines as well as for the operational characteristics of the cytology test. The societal perspective was used. Effectiveness was measured in number of averted Disability Adjusted Life Years (DALYS). ResultsAt commercial prices reported for 2010 the two vaccines were shown to be non-cost-effective alternatives when compared with the existing screening strategy. Sensitivity analyses showed that results are affected by the cost of vaccines and their efficacy values, making it difficult to determine with certainty which of the two vaccines has the best cost-effectiveness profile. To be ‘cost-effective’ vaccines should cost between 141 and 147 USD (Unite States Dollars) per vaccinated girl at the most. But at lower prices such as those recommended by WHO or the price of other vaccines in Colombia, HPV vaccination could be considered very cost-effective.ConclusionsHPV vaccination could be a convenient alternative for the prevention of CC in Colombia. However, the price of the vaccine should be lower for this vaccination strategy to be cost-effective. It is also important to take into consideration the willingness to pay, budgetary impact, and program implications, in order to determine the relevance of a vaccination program in this country, as well as which vaccine should be selected for use in the program.

Objective: The use of antibiotics without prescription is common in Colombia as well as in other developing countries. The objective of this study is to explore the attitudes and motivations associated with the use of antibiotics without prescription. Methods: Focus group sessions were held with residents of Bogotá. Different socioeconomic groups were approached to identify possible differences of opinion. A semi-structured interview guide was used to guide the discussion, with thematic analysis used to identify central themes. Results: In total, 21 people, aged between 25 and 50 years participated in four focus groups. The results suggest that the use of antibiotics without prescription is common practice. The main reasons included barriers to access to prescribed medications due to limited health insurance. Even those with adequate access to health insurance report being willing to use a treatment without a prescription if they have confidence in its effectiveness. The relationship with the physician is important, but pharmacy storekeepers are also highly trusted. While some participants understood that antibiotics can cure infections but cause serious adverse events, several misconceptions about antibiotics therapy were identified. These included a lack of knowledge of resistance transmissibility among communities. Conclusions: The results have implications for interventions aimed at reducing inappropriate use of antibiotics, highlighting i) how lack of access to timely care creates an incentive to self-prescribe, ii) the key role that pharmacy storekeepers play in the Colombian healthcare system and the need to include them in interventions, and iii) the misconceptions about inappropriate use of medications that need to be addressed by educational programs. These findings provide insights to other countries where antibiotics misuse is also a problem.

Objetivo: explicar los conceptos propios de las evaluaciones económicas mediante el análisis crítico de un estudio tipo costo-efectividad. Materiales y métodos: con base en una pregunta clínica se hace una búsqueda en la base de datos Medline vía PubMed. Se selecciona un estudio que aborda el problema de la costo-efectividad en la ginecología. Se exponen los elementos que debe tener en cuenta el lector, los cuales se explican por medio de ejemplos de estudios de evaluación económica en ginecología ya publicados; y se hace el análisis crítico de estos aspectos en la publicación seleccionada. Resultados: para la lectura crítica de un estudio de costo-efectividad es necesario evaluar los siguientes elementos: clara definición de las alternativas a comparar, estimación de los costos incurridos en cada una, evaluación de su efectividad, estimación de la relación costo-efectividad y análisis de sensibilidad. La comprensión de los anteriores elementos permitirá realizar una evaluación profunda de estos estudios.Conclusiones: los análisis económicos merecen consideración por parte de los profesionales de la salud, pues conducen a la toma de decisiones eficientes en el tratamiento de los pacientes. Palabras clave: evaluaciones económicas en salud, análisis costo-efectividad. sUMMarYObjectives: explaining concepts related to economic evaluation in healthcare by using a critical cost-effectiveness analysis (CEA) study. Materials and methods: a search was made of the Medline database via PubMed based on a clinical question. A study was selected which approached the matter in hand. The elements which a reader should bear in mind were set out; they were explained by means of examples from already published economic evaluation in healthcare studies regarding gynecology and a critical analysis was made of these aspects in the selected publication.

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Background: In many countries, concerns have arisen over the population using antibiotics without consulting a physician. This practice can place patients at risk and increase antibiotic resistance in the community. Objective: To evaluate individuals' preferences regarding the use of antibiotics. The study also assessed the likely effectiveness of interventions aimed at reducing inappropriate use of antibiotics. Methods: A discrete choice experiment (DCE) was conducted in Bogotá, Colombia. The attributes were determined by a systematic literature review and four focus group sessions. The DCE included nine factors – cost, time to get attention, level of symptoms, efficacy, safety, among others- and one label -using or not antibiotics. Data analysis was carried out using a generalized multinomial logit (GMNL) model. Marginal probabilities of different sets of attributes' levels were compared to estimate the likely effectiveness of interventions. Results: The survey was administered to 222 participants from diverse socioeconomic backgrounds. The results suggest that participants preferred not taking antibiotics and having a physician as an advisor, but the probability of inappropriate antibiotic use increased as the waiting time or the cost of receiving advice rose. The pharmacy was the preferred source of antibiotics, and participants chose the pharmacy worker (nonprofessional) as an advisor over the nurse on the phone. In the absence of any interventions aimed at reducing the use of antibiotics, approximately 47.3% of people would misuse antibiotics. This reduces to 26.5% when people perceive the efficacy of the antibiotics as low and the potential risks of self-medicating as high. An alternative model using a nursing service would likely lower inappropriate use of antibiotics. Conclusions: Even though people prefer not using antibiotics or visiting a physician in case of disease rather than self-medicating, current access conditions might discourage them from appropriately use antibiotics. The results suggest that interventions that informing people about the risks of self-medication and the low efficacy might significantly reduce inappropriate use of antibiotics. Our results also suggest that programs that empower other health professionals to provide access to antibiotics would likely further lower inappropriate use.

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