Incremental Healthcare Costs of Diabetes Mellitus in a Middle-Income Country Using Administrative Healthcare Data.

OBJECTIVES: To estimate the incremental medical cost of diabetes mellitus using information from administrative databases in Colombia. METHODS: We carried out a retrospective cohort study with administrative health databases from Colombian population affiliated in the contributory health insurance scheme. We used an operative definition to select the cohort with diabetes. Incremental cost and cost ratio of diabetes were estimated using an inverse probability weighting of treatment approach to find the causal effect of having the disease. Weights were calculated by a propensity score method using a Random Forest model. The flexibility of this machine learning algorithm allows to have a better specification and bias reduction. Additionally, we reported incremental costs and cost ratios with confidence intervals using bootstrapping and analyzed costs by age groups and complications associated with diabetes. RESULTS: The estimated prevalence of diabetes was 2834 per 100 000 cases, in 2018. The group with diabetes was comprised 634 015 people and the control group 1 524 808. The calculated annual direct medical cost was $860, for which the incremental cost was $493 and the cost ratio 2.34. The incremental annual cost for some type of complication ranges from $1239 to $2043, renal complication being the most expensive. Incremental cost by age groups ranges from $347 to $878, being higher in younger people. CONCLUSIONS: Although the cost of diabetes in Colombia ranges among the global averages and is similar to other Latin-American countries, a greater incremental cost was found in patients with renal, circulatory, and neurologic complications.

Evaluation of the safety profile of the quadrivalent vaccine against human papillomavirus in the risk of developing autoimmune, neurological, and hematological diseases in adolescent women in Colombia.

BACKGROUND: Cervical cancer eradication is one of the main goals for 2030 by the World Health Organization, which can only be achieved with high vaccination rates against Human Papilloma Virus. In Colombia, more and better scientific evidence is required to increase confidence in vaccination. The objective of this study is to evaluate the safety profile of the quadrivalent vaccine against HPV in the risk of developing autoimmune, neurological, and hematological diseases in adolescent women in Colombia. METHODS: We designed a cohort study based on national HPV vaccination records and incident diagnostic data for the diseases of special interest during 2012 and 2021. We included adolescent women between 9 and 19 years old and compared vaccinated and non-vaccinated cohorts using an Inverse Probability of Treatment Weighting (IPWT) method for each scenario disease and follow-up period (180 and 360 days). FINDINGS: The Odds Ratio (OR) of developing diseases of interest was estimated during two follow up periods, 180 and 360 days after the follow-up index date (Vaccination Day). The OR for developing rheumatoid arthritis was 4·4; CI95% (1·74 - 11·14), juvenile idiopathic arthritis was 2·76 IC95% (1·50 - 5·11), idiopathic thrombocytopenic purpura was 2·54 IC95% (1·28 - 5·02) and thyrotoxicosis was 2·86 IC95% (1·03 - 7·95), when comparing the vaccinated versus unvaccinated population. However, the temporal distribution of cases incident did not reveal a clear difference between the cohorts, since the rate of appearance of new cases has a constant linear behavior for the two groups. INTERPRETATION: For rheumatoid arthritis, juvenile idiopathic arthritis, idiopathic thrombocytopenic purpura, and thyrotoxicosis; the application of the vaccine had an effect on the development of the disease. Nevertheless, our results should be interpreted with caution and be further studied, considering that the biological plausibility of the events occurred without a clear temporal pattern in relation to the exposure to the vaccine.

Estimation of Prevalence and Incremental Costs of Systemic Lupus Erythematosus in a Middle-Income Country Using Machine Learning on Administrative Health Data.

OBJECTIVES: Systemic lupus erythematosus (SLE) is a chronic, autoimmune disease that may cause physical and functional disability. The objective of this study is to measure prevalence and estimate incremental cost of SLE treatment using information from administrative databases in Colombia. METHODS: We use data from the patients on the Colombian contributive health system with a period of study from 2015 to 2017. The incremental cost of SLE is estimated using a matched study by propensity score and multivariate balance of covariates. To reduce the effect of possible specification problems, we use Extreme Gradient Boosting, a flexible machine learning algorithm. We use paired t statistical comparison and Bootstrap to validate the robustness of the method. In addition, we use a machine learning regression approach on the cost of control patients to achieve double robustness and compare the results. RESULTS: SLE prevalence ranges between 41.65 and 54.47 (cases/100 000), which is lower than other Latin American countries. Using the operative definition of SLE, 5527 patients were selected. The potential control sample was composed of 1 942 253 patients. The total annual direct estimated cost per patient was US $2172. Adjusted incremental cost was US $1662. Considering 4 severity classes of SLE, the cost ranges from US $8823 for severe to US $447 for mild cases. CONCLUSIONS: Incremental costs of SLE in Colombia are similar to those from other middle-income countries. Compared with high-income countries, the cost is lower; nevertheless, if it is calculated proportional to the per capita health expenditure, it is comparable.