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Objective To assess the cost-effectiveness of carbetocin versus oxytocin for prevention of postpartum hemorrhage (PPH) due to uterine atony after vaginal delivery/ cesarean section in women with risk factors for bleeding. Methods A decision tree was developed for vaginal delivery and another one for cesarean, in which a sequential analysis of the results was obtained with the use of carbetocin and oxytocin for prevention of PPH and related consequences. A third-party payer perspective was used; only direct medical costs were considered. Incremental costs and effectiveness in terms of quality-adjusted life years (QALYs) were evaluated for a one-year time horizon. The costs were expressed in 2016 Colombian pesos (1 USD ¼ 3,051 Col$). Results In the vaginal delivery model, the average cost of care for a patient receiving prophylaxis with uterotonic agents was Col$ 347,750 with carbetocin and Col$ 262,491 with oxytocin, while the QALYs were 0.9980 and 0.9979, respectively. The incremental costeffectiveness ratio is above the cost-effectiveness threshold adopted by Colombia. In the model developed for cesarean section, the average cost of a patient receiving prophylaxis with uterotonics was Col$ 461,750 with carbetocin, and Col$ 481,866 with oxytocin, and the QALYs were 0.9959 and 0.9926, respectively. Carbetocin has lower cost and is more effective, with a saving of Col$ 94,887 per avoided hemorrhagic event. Conclusion In case of elective cesarean delivery, carbetocin is a dominant alternative in the prevention of PPH compared with oxytocin; however, it presents higher costs than oxytocin, with similar effectiveness, in cases of vaginal delivery.

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Introducción: el estudio busca estimar los costos de formar un médico en Colombia, tanto en una universidad pública como privada, desde la perspectiva de la sociedad. Materiales y métodos: se calcularon los costos directos e indirectos en pesos colombianos de 2016 (tasa de cambio promedio 3051 COP por USD), así como el retorno a la inversión (expresado en valor actual neto van, retorno sobre la inversión rsi, y tasa interna de retorno [TIR]) y el periodo de recuperación de la inversión de estudiar medicina frente al contrafactual de estudiar otra carrera. Se empleó una tasa de descuento de 12%. Se realizó un análisis de sensibilidad con varios escenarios. Resultados: en el escenario base, el costo total de la formación de un médico en Colombia es de $80 971,80 USD en una universidad privada y $54 971,79 USD en una pública (de los cuales $14 436,57 USD son aportados por el Estado). El tiempo de retorno de la inversión es de 3 años y 6 meses en una universidad pública y 7 años y 3 meses en una privada. Aplicando tasas de descuento de 5%, 7,5% y 12%, estudiar medicina presenta mayor retorno que el obtenido con otra carrera. Conclusiones: el costo de formación de un médico en Colombia es un 70% mayor al requerido para la formación de otro profesional; sin embargo, los retornos son mayores debido los mayores ingresos percibidos. Los retornos son mayores en los egresados de universidades públicas, debido a que la inversión es menor y los ingresos percibidos son similares.

0 1 7 ) A 8 5 3 -A 9 4 3 A867 generated a tornado diagram, and a two-way deterministic one considering the two key parameters that differentiate CRRT from IRRT: the daily implementation cost difference and the cumulative risk of dialysis dependence. We used the threshold of 3 times per capita GDP, that is, R $ 84,741 (3 X R $ 28,247) as the threshold for cost-effectiveness. Results: CRRT is dominant vs. IRRT from 18 months of treatment. Based our assumptions, the cohort of patients initially treated with CRRT had better clinical outcomes QALY´s and lower total costs of treatment. Patients treated with CRRT are more likely to recover renal function. ConClusions: CRRT when compared to IRRT can be considered a dominant therapy, that is, it offers better outcomes and lower total treatment costs, under the perspective of the private healthcare system in Brazil. objeCtives:The aim of this study is to identify the cost-effectiveness of International Normalized Ratio (INR) monitoring in patients with coagulation disorders by comparing portable coagulometers with conventional hospital care in the Mexican context. Methods: A Markov model was developed with 3 health states: no event, permanent disability and death; with 100 patients in the cohort. In addition, the following complications were considered: major bleeding, minor hemorrhage, thrombotic event and temporal disability. Costs within the Mexican Health Care System were estimated for each health status and the cost-effectiveness ratio between hospital and portable coagulometers in a hospital setting, considering a 10-year time horizon. Main Outcomes: Years of Life gained; Total costs; Incremental Cost-Effectiveness Ratio (ICER); And Avoided Events. Results: The most effective treatment alternative were portable coagulometers reporting 6,998 years of life gained, which is 2% higher than the result obtained with hospital care; In addition, it was the least costly alternative with $ 8,811 USD per patient, which is 20% lower than the total cost calculated for hospital care. Therefore, portable coagulometers approach is a dominant alternative compared to hospital care; it has potential savings of $ 2,309 USD and it reports an incremental effectiveness of 0.1135 years of life gained per patient. ConClusions: The results of the present economic study show that using portable coagulometers in a hospital environment is a cost-saving alternative for the care of patients with long-term oral anticoagulation treatment (Warfarin). This is due to the fact that portable coagulometers, compared with hospital care, significantly reduces the costs of monitoring, thrombotic events and disability; While 6 minor hemorrhages and 12 thrombotic events are avoided per cohort. Therefore, it is possible to conclude that the present study identified portable coagulometers as the dominant alternative for the monitoring of INR in patients under oral anticoagulation therapy.

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