Introduction: Diabetic foot ulcers are one of the most frequent complications of diabetes; such ulcers cause an increase in the costs of the health care of the diabetic patient and can even cause disability due to amputation in the patient. Although a proportion of patients achieve a spontaneous closure of ulcers, others require medical or surgical treatment. Objective: To determine the cost-effectiveness of the intra- and perilesional application of recombinant human epidermal growth factor (rhEGF), as opposed to conventional therapy for the management of patients diagnosed with Wagner’s 3 or 4 diabetic foot ulcer in Colombia. Methodology: Using a Markov model, the process of care of a diabetic patient with diagnosis of Wagner’s 3 or 4 ulcer receiving conventional treatment, or intra- and perilesional rhEGF, is configured. The evaluation cycles of the treatments are weekly over a 5-year horizon and the outcomes evaluated are quality-adjusted life years (QALYs) and the number of amputations avoided by each treatment scheme, in addition to the total costs for treatments. Results: For the analysed base case, in the outcome of amputations, it was found that the factor presents 39 fewer amputations, in a cohort of 100 patients, compared with conventional treatment. Likewise, QALYs are 0.65 more with the use of rhEGF in an average patient. The estimated cost-utility ratio for the base case would be below the threshold established for Colombia. Conclusions: The intra- and perilesional application of rhEGF is a more effective therapeutic option than conventional therapy in the treatment of patients with Wagner’s 3 or 4 diabetic foot ulcers and is cost-effective, taking as an outcome the QALYs for Colombia from the perspective of the health system.
A first-order Markov decision-analytic model was developed to compare cost-effectiveness of vaccination with PCV13, PPSV23 and no vaccination in the Czech Republic. PPSV23 effectiveness was derived from literature and PCV13 was extrapolated from impact in children adjusting for immunosenescence in older persons. Pneumonia, bacteremia and meningitis hospitalization and cost data were acquired from health authorities and DRG system in CR; outpatient data were based on retrospective patient survey. The model used a lifetime time horizon and 3% discount rate. RESULTS: Used according to Czech guidelines, PCV13 vaccination is associated with 0.0002 life-years gained for an additional EUR 1.002 on average (EUR 3,812,478 in total) compared to no vaccination and 0.0004 life-years gained for additional EUR 0.97 on average (EUR 3,704,061 in total) compared to PPSV23. This leads to an ICER of EUR/LYG 4,950 and 2,265 under current reimbursement. If all moderate and high risk people were vaccinated, the ICER would increase to EUR/LYG 5,582 and 6,691, respectively, under current reimbursement and to ICER of EUR/LYG 8,676 and 7,057 under full reimbursement. CONCLUSIONS: Confronting the national GDP per capita with the WHO recommendation on health care spending per QALY gained, PCV13 national immunization program in the Czech Republic can be considered cost-effective even under a full reimbursement policy. OBJECTIVES:The Women's Health Initiative (WHI) estrogen+progestin (E+P) clinical trial provides a large sample to estimate health state utility values for post-menopausal women with an intact uterus in the United States. To facilitate future health economic evaluations in this large population sub-group, we estimated utilities for trial participants stratified by age group (50-59, 60-69, 70-79) and randomization assignment (E+P or placebo). METHODS: We measured health state utility values for all 16,608 trial participants with the Short Form-6D (SF-6D) utility index using a validated Bayesian mapping algorithm and U.S. weights. We calculated cross-sectional mean baseline and 1-year utilities, and mean within-patient utility change from baseline to 1-year. Patients included in the baseline analysis completed the SF-36 within 7 days of randomization, and
Resumen Objetivo Describir las características demográficas, clínicas, los recursos de salud utilizados y los costos directos del tratamiento del cáncer de próstata resistente a la castración metastásico (CPRCm), tratados con enzalutamida o acetato de abiraterona en Colombia. Métodos Mediante un estudio de corte transversal se analizaron datos de utilización de servicios de una EPS (entidad promotora de salud) colombiana. Para ello, se identificaron los pacientes que durante el 1 de julio de 2016 y 30 de junio de 2017 (fecha índice) presentaron registro de uso de enzalutamida o acetato de abiraterona y se confirmaron sus antecedentes de castración química o quirúrgica (6 meses previos a la fecha índice). Se establecieron las frecuencias de uso de servicios en dicha población y se extrajo el consumo reportado asociado a consultas (urgencias, consulta externa), procedimientos y medicamentos en el periodo de análisis. Los costos se organizaron por categorías y se reportaron en pesos colombianos (COP) 2016. Resultados se identificaron 161 pacientes con CPRCm con edad media de 77 años, se determinó que el departamento colombiano con más población de CPRCm en esta cohorte fue el Valle del Cauca, que 98,1% de los pacientes pertenecen al régimen contributivo y que 1,9% al subsidiado. El cálculo de la supervivencia con el índice de comorbilidad de Charlson mostró que esos pacientes tendrían una tasa de supervivencia de 0% a 10 años. Las comorbilidades más frecuentes encontradas fueron hipertensión, diabetes mellitus, insuficiencia renal y otras patologías tumorales relacionadas. El costo total de manejo de un paciente con CPRCm, que recibe de manera continua durante 12 meses abiraterona o enzalutamida es promedio $131.942.292 COP año. Esa cifra incluye tanto el uso de servicios como el consumo de medicamentos, y ese último representa cerca del 90% del costo. Conclusiones los pacientes con cáncer en estadio metastásico se caracterizan por presentar alta demanda de medicamentos, laboratorios, imágenes diagnósticas, visitas ambulatorias e ingresos hospitalarios. Debido a que es una muestra pequeña de pacientes, se requiere desarrollar una valoración posterior que permita corroborar los hallazgos encontrados en este estudio retrospectivo.
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