No abstract

Management of rheumatoid arthritis (RA) in many Latin-American countries is impaired by fragmentation and scarce healthcare provision, resulting in obstacles to access, diagnosis, and treatment, and consequently in poor health outcomes. The aim of this study is to propose a comprehensive care program as a model to provide healthcare to RA patients receiving synthetic DMARDs in a Colombian setting by describing the model and its results. Health outcomes were prospectively collected in all patients entering the program. By protocol, patients are followed up during 24 months using a treat-to-target strategy with a patientcentered care (PCC) model, meaning that a patient should be seen by rheumatologist, physical and occupational therapist, physiatrist, nutritionist and psychologist, at least three times a year according to disease activity by DAS28. Otherwise, patients receive standard therapy. The incidence of remission and low disease activity (LDA) was calculated by periods of follow-up. A total of 968 patients entered the program from January 2015 to December 2016; 80.2% were women. At baseline, 41% of patients were in remission, 17% in LDA and 42% in MDS/SDA. At 24 months of follow-up, 66% were in remission, 18% in LDA and only 16% in MDS/SDA. Regarding DAS28, the mean at the beginning of the time analysis was 3.1 (SD 1.0) and after 24 months it was 2.4 (SD 0.7), showing a statistically significant improvement (p < 0.001). In all patients, the reduction of disease activity was 65% (95% CI, 58-71). Patients entering the PCC program benefited from a global improvement in disease activity in terms of DAS28.

Background: Influenza is considered a leading public health problem because its large economic burden of disease worldwide, especially in low-and middle-income countries, such as Colombia. Objective: We aimed to estimate the economic costs of influenzaconfirmed patients in a pediatric hospital in Cartagena, Colombia. Methods: We conducted a retrospective costing analysis. We estimated the direct (direct medical and out-of-pocket expenditures) and indirect costs for influenza-confirmed severe acute respiratory infection cases from a societal perspective. Total economic costs were calculated adding direct medical costs, out-of-pocket expenditures, and indirect costs owing to loss of productivity of caregivers. Mean, median, 95% confidence interval (95% CI) and interquartile range (IQR) of costs were measured. All costs are reported in USD ($1.00 ¼ COP$2000.7) Results: Forty-four cases were included in the analysis: 30 had influenza B, 10 influenza A and B, and 4 influenza AH1N1. Thirty patients were hospitalized in the general ward, 14 went to the intensive care unit. The average duration of stay was ~9 days (95% CI, 6.

Recibido el 12 de marzo de 2015; aceptado el 13 de abril de 2015 Disponible en Internet el 10 de junio de 2015 PALABRAS CLAVEInfección respiratoria aguda grave; Costos directos de atención; Nicaragua ResumenObjetivo: Estimar los costos de tratamiento hospitalario de la infección respiratoria aguda grave (IRAG) en niños en Nicaragua. Métodos: Se estimaron costos de tratamiento de pacientes hospitalizados a partir del microcosteo retrospectivo de una muestra aleatoria de casos ocurridos durante el periodo 2009-2011 en Nicaragua y atendidos en un hospital pediátrico universitario de alta complejidad. Se calculó una muestra aleatoria de pacientes con diagnósticos de IRAG (CIE-10), según parámetros extraídos de la literatura. En esta, se estimó el costo promedio por paciente. Los costos fueron expresados en moneda local de 2011 y dólares americanos. Resultados: El costo promedio total de atención de caso en niños fue de 314,9 US$ (intervalo de confianza [IC] 95%: 280,1-349,7 US$) y de 971,6 (655,5-1.287,8 US$) para los que requirieron UCI. El 41% de los costos en los que solo requieren hospitalización general se explican por gastos de hotelería, mientras que en los que requieren UCI el 52% es por medicamentos. Conclusión: El microcosteo de los casos incluidos de IRAG permitió estimar un valor medio por caso tratado, con sus respectivos IC y estos podrían tener validez para el total de la población atendida por estos diagnósticos en hospitales con similar perfil epidemiológico y similar nivel de complejidad en Nicaragua.

Introducción: la pobreza es un determinante sensible del estado de salud de una población y directamente relacionado con la presencia de algunas condiciones patológicas.Objetivo: estudiar las desigualdades departamentales y regionales de la tasa de mortalidad infantil en Colombia en 1993 y 2005.Materiales y métodos: se realizó estudio ecológico que mide las desigualdades regionales de la tasa de mortalidad infantil (TMI) en Colombia, para los años de los censos de población de 1993 y 2005. Para esto se utilizaron indicadores como: razón y diferencia de tasas (RT y DT), índice de efecto y riesgo atribuible poblacional (RAP).Resultados: en 1993 la diferencia absoluta entre los departamentos con mayor y menor pobreza (Chocó: 80.4%; Bogotá, D.C.:17.3%) fue 63.1%. Para 2005, esta diferencia pasó a ser del 70.4%. Para los mismos años, entre estos departamentos la RT de mortalidad infantil fue de 2.9 y 4.2 y las DT fue de 56.4 y 59.2 respectivamente.La pobreza (NBI) explicó en mayor medida la mortalidad infantil en el 2005, comparado con el año censal de 1993 (R22005: 63.8% versus R21993: 34.2%). El coeficiente β de la regresión lineal para 1993 fue 0.3393 (IC95%:0.1669-0.5518), por cada punto porcentual que disminuyó el NBI en los departamentos, se observó reducción en la TMIde 0.3393 muertes por cada mil nacidos vivos. Para 2005 esta reducción fue de 0.6456 por cada mil nacidos vivos (IC95%:0,4679-0.8234).Conclusiones: aunque Colombia mantiene una tendencia de permanente reducción de la TMI, persisten grandes desigualdades entre departamentos y regiones las cuales se incrementaron en el periodo intercensal analizado. Rev.cienc.biomed. 2015;6(1):29-37

A253 the study period. Controls were selected based on a propensity score methodology ensuring exactly the same baseline lung disease distribution between the 2 groups and no medical claim for PH across the entire study period. RESULTS: A total of 2,236 cases met study criteria. On average, cases were significantly (p< 0.01) younger (67 vs. 71), more females (64% vs 58%) and higher comorbid burden (2.8 vs 2.09) compared to controls. After adjusting for all baseline characteristics cases had significantly higher (p< 0.001) inpatient admissions (5.0 vs 2.4), physician office visits (16.5 vs 12.5), emergency room visits (0.7 vs 0.5), pharmacy claims (67 vs 54). This translated into higher expenditures among cases ($42,914) vs controls ($16,745) at per patient per year level. CONCLUSIONS: Using health plan data this study showed that Group 3-PH poses a significant economic burden to payers. PHS36HoSPitalization coStS due to Severe acute reSPiratory infection (Sari) in tHree central american countrieS

Background Health systems need to optimize the use of resources, especially in high-cost diseases as rheumatoid arthritis (RA). We aimed to evaluate the efficiency of using centers of excellence (CoE) as a strategy for improving RA treatment in Colombia. Methods A cost description analysis was carried out using the standard costing technique. We estimated the costs of medical consultations, laboratories, images, and medications for RA. Categories of care standards stratified by severity were defined using the disease activity score in 28 joints (DAS28). We evaluated the impact, in terms of costs (US dollars), for providing RA clinical care for a previously described cohort using the CoE approach. Statistical analyses were performed in Microsoft Excel ® , and R. Results Expenditure on therapeutic drugs increases as the severity of RA increases. Drugs represent 53.6% of the total cost for the low disease activity (LDA) stage, 75.2% for moderate disease activity (MDA), 88.5% for severe disease activity (SDA) and 97% for SDA with biologic treatment (SDA+Biologic). Treating 968 patients would cost US$612,639 (US$487,978–1,220,160) at baseline, per year. After a year of follow-up at the CoE, treating the same patients would cost US$388,765 (US$321,710–708,476), which implies potential cost-savings of up to US$223,874 per year. Conclusion The strategy of providing clinical care for RA through CoE can save US$231.3 per patient-per year. The results of our study show that CoE could greatly impact the public policies dealing with treatment of RA in Colombia. Applying the CoE model in our country would both improve health outcomes, as well as being more efficient in terms of costs.

No abstract