Introduction/objectives
The objective of this study is to describe the treatment patterns and use of healthcare resources in a cohort of Colombian patients with rheumatoid arthritis (RA) treated with biological disease-modifying antirheumatic drugs (bDMARDs) or tofacitinib.
Method
This is a descriptive study from a retrospective cohort of patients diagnosed with RA who were treated with bDMARDs or tofacitinib after failure of conventional DMARDs (cDMARDs) or first bDMARD. Patients who were receiving pharmacological treatment between 01 January 2014 and 30 June 2018 were included. The analysis is through the revision of claim database and electronical medical records. Demographic and clinical data were collected. The costs of healthcare resources were estimated from the billing expense of healthcare service provider.
Results
We evaluated 588 RA patients on treatment with bDMARDs (n = 505) or tofacitinib (n = 83), most of them were in combination with cDMARDs (85.4%). The 88.1% were females and mean age was 57.3 ± 12.5 years. The median evolution of RA since diagnosis was 9 years (IQR:4–17.2). The mean duration of use during follow-up of the bDMARDs or tofacitinib was similar, with a mean of 9.8 ± 1.9 months. It was identified that 394 (67.0%) discontinued therapy. The average annual direct cost of care per patient was USD 8997 ± 2172, where 97.2% was due to drug costs. The average annual cost of treatment per patient with bDMARDs was USD 8604 and tofacitinib was USD 6377.
Conclusions
In the face of a first failure of cDMARD, bDMARDs are frequently added. A high frequency of patients do not persist treatment during the first year of follow-up. The pharmacological treatment is the most representative cause of healthcare costs.
Key Points• Rheumatoid arthritis is a disease with a high burden of comorbidities, complications, and worse health-related quality of life and is associated with elevated healthcare costs.• The biological disease-modifying antirheumatic drugs or tofacitinib medications are indicated for those with significant progression of the disease and when there is a need for alternatives to achieve low levels of activity and remission.• Patients with rheumatoid arthritis treated with biological disease-modifying antirheumatic drugs or tofacitinib represent a significant economic burden to the health system, especially in the costs derived from pharmacological treatment.
Objectives To assess budget impact of the implementation of an anticoagulation clinic (AC) compared to usual care (UC), in patients with non-valvular atrial fibrillation (NVAF). Method A decision tree was designed to analyze the cost and events rates over a 1-year horizon. The patients were distributed according to treatment, 30% Direct Oral Anticoagulant (DOAC) regimens and the rest to warfarin. The thromboembolism and bleeding were derived from observational studies which demonstrated that ACs had important impact in reducing the frequency of these events compared with UC, due to higher adherence with DOACs and proportion of time in therapeutic range (TTR) with warfarin. Costs were derived from the transactional platform of Colombian government, healthcare authority reimbursement and published studies. The values were expressed in American dollars (USD). The exchanged rate used was COP $3.693 per dollar. Results During 1 year of follow-up, in a cohort of 228 patients there were estimated 48 bleedings, 6 thromboembolisms in AC group versus 84 bleedings, and 12 thromboembolisms events in patients receiving UC. Total costs related to AC were $126 522 compared with $141 514 in UC. The AC had an important reduction in the cost of clinical events versus UC ($52 085 vs $110 749) despite a higher cost of care facilities ($74 436 vs $30 765). A sensibility analysis suggested that in the 83% of estimations, the AC produced savings varied between $27 078 and $135 391. Conclusions This study demonstrated that AC compared with UC, produced an important savings in the oral anticoagulation therapy for patients with NVAF.
Purpose: To describe the clinical characteristics, resource utilization, and direct cost of febrile neutropenia (FN) in a healthcare institution in Colombia for patients seen between 2017-2019.Methods: A descriptive and retrospective study of a cohort of patients hospitalized due to FN. Costs were extracted from the review of medical records from diagnosis of FN until discharge or death, and official sources were used to estimate the cost. Results: Forty-four FN episodes were included. Median age was 61 years (IQR: 53-72). Solid tumors accounted for 68.8%. In first-line treatment were 14 (31.8%), same in proportion in adjuvant/neoadjuvant, and 5 (11.4%) in second-line. FN occurred in 15 (34.0%) high-risk patients. Mean LOS per episode was 5.1 ± 2.5 days. All patients were discharged alive. The median overall cost was $925 ± $783 per episode, with hospital stay being the main driver-cost.Conclusion: FN occurred mainly in advanced-stage solid tumors and in low-risk group. Higher costs in this cohort were found in long length of stay and high-risk patients.
Objectives: To determine the sociodemographic and clinical variables associated with hip fracture and its complications on ambulation, functionality and survival in a population of older adults in Caldas, Colombia. Methods: Descriptive study. Adults of any sex over 65 years who entered the emergency department at SES Hospital de Caldas with a diagnosis of hip fracture, between January/2016-February/2018 were included. The information was obtained from the clinical records. Sociodemographic and clinical variables regarding the mechanism of fall, type of fracture and outcomes (complications, gait status and survival) were obtained. Results: A total of 229 patients were identified, with a mean age of 80.467.8 years and female predominance (n=151, 65.9%). The main cause of falls during everyday activities (82.5%) mainly by slip or stumble and 29.7% had a previous diagnosis of osteoporosis. The main comorbidity was hypertension (68.6%). The average Barthel score at admission was 37.5618.5. In addition, 95.6% of the patients were admitted to osteosynthesis or hip replacement surgery, with a mean of days from admission to procedure of 6.2 6 25.2 days. When evaluating in-hospital complications, 37.6% of the patients presented hydroelectrolytic alterations, 31.0% delirium and 10.0% pneumonia. Among the outcomes evaluated, it was found that 44.5% of the patients had stood up at 48 hours and 69.4% were already walking at hospital discharge. It was possible to follow up 90 patients at 90 days, of those 67.8% were alive. Conclusions: Hip fractures in the elderly are a major public health problem. The timing of surgical intervention was prolonged and only two thirds of patients could walk at discharge. Research in this area is essential to identify and formulate strategies aimed to achieve the best health outcomes in this population.
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