Preferences based interventions to address the use of antibiotics without prescription: A discrete choice experiment.

BACKGROUND: In many countries, concerns have arisen over the population using antibiotics without consulting a physician. This practice can place patients at risk and increase antibiotic resistance in the community. OBJECTIVE: To evaluate individuals' preferences regarding the use of antibiotics. The study also assessed the likely effectiveness of interventions aimed at reducing inappropriate use of antibiotics. METHODS: A discrete choice experiment (DCE) was conducted in Bogotá, Colombia. The attributes were determined by a systematic literature review and four focus group sessions. The DCE included nine factors - cost, time to get attention, level of symptoms, efficacy, safety, among others- and one label -using or not antibiotics. Data analysis was carried out using a generalized multinomial logit (GMNL) model. Marginal probabilities of different sets of attributes' levels were compared to estimate the likely effectiveness of interventions. RESULTS: The survey was administered to 222 participants from diverse socioeconomic backgrounds. The results suggest that participants preferred not taking antibiotics and having a physician as an advisor, but the probability of inappropriate antibiotic use increased as the waiting time or the cost of receiving advice rose. The pharmacy was the preferred source of antibiotics, and participants chose the pharmacy worker (nonprofessional) as an advisor over the nurse on the phone. In the absence of any interventions aimed at reducing the use of antibiotics, approximately 47.3% of people would misuse antibiotics. This reduces to 26.5% when people perceive the efficacy of the antibiotics as low and the potential risks of self-medicating as high. An alternative model using a nursing service would likely lower inappropriate use of antibiotics. CONCLUSIONS: Even though people prefer not using antibiotics or visiting a physician in case of disease rather than self-medicating, current access conditions might discourage them from appropriately use antibiotics. The results suggest that interventions that informing people about the risks of self-medication and the low efficacy might significantly reduce inappropriate use of antibiotics. Our results also suggest that programs that empower other health professionals to provide access to antibiotics would likely further lower inappropriate use.

Cost-effectiveness analysis of the bivalent and quadrivalent human papillomavirus vaccines from a societal perspective in Colombia.

OBJECTIVE: To compare costs and effectiveness of three strategies used against cervical cancer (CC) and genital warts: (i) Screening for CC; (ii) Bivalent Human Papillomavirus (HPV) 16/18 vaccine added to screening; (iii) Quadrivalent HPV 6/11/16/18 vaccine added to screening. METHODS: A Markov model was designed in order to simulate the natural history of the disease from 12 years of age (vaccination) until death. Transition probabilities were selected or adjusted to match the HPV infection profile in Colombia. A systematic review was undertaken in order to derive efficacy values for the two vaccines as well as for the operational characteristics of the cytology test. The societal perspective was used. Effectiveness was measured in number of averted Disability Adjusted Life Years (DALYS). RESULTS: At commercial prices reported for 2010 the two vaccines were shown to be non-cost-effective alternatives when compared with the existing screening strategy. Sensitivity analyses showed that results are affected by the cost of vaccines and their efficacy values, making it difficult to determine with certainty which of the two vaccines has the best cost-effectiveness profile. To be 'cost-effective' vaccines should cost between 141 and 147 USD (Unite States Dollars) per vaccinated girl at the most. But at lower prices such as those recommended by WHO or the price of other vaccines in Colombia, HPV vaccination could be considered very cost-effective. CONCLUSIONS: HPV vaccination could be a convenient alternative for the prevention of CC in Colombia. However, the price of the vaccine should be lower for this vaccination strategy to be cost-effective. It is also important to take into consideration the willingness to pay, budgetary impact, and program implications, in order to determine the relevance of a vaccination program in this country, as well as which vaccine should be selected for use in the program.

The impact of under-recording on cervical cancer-related mortality rates in Colombia: an equity analysis involving comparison by provenance / Impacto del sub-registro en la mortalidad por cáncer cervical por procedencia, en Colombia. Un análisis de equidad

Objective Comparing cervical cancer mortality rates in Colombian departments, as well as in urban and rural areas and examining the potential causes of any differences. Methodology This was an ecologic study. Mortality due to cervical cancer was estimated from data collected between 2005 and 2008 by the Colombian National Statistics Bureau (DANE).This included overall mortality in Colombia, mortality by department and mortality by rural and urban area. DANE provided theunder-recording indicator for mortality by departments and the unmet basic needs index. Spearman correlation coefficient was estimated for average mortality by department, unmet basic needs and under-recording variables. Results The overall annual mortality rate from 2005 to 2008 due to cervical cancer in Colombia ranged from 10 to 11.1 per 100,000 females. Mortality reported in urban areas was higher than in rural areas (10.3-11.7 cf 7.6-8.7). The lowest average mortality was reported from the Chocó department (4.7) and the highest from Meta (18.2). An inverse correlation was found between average mortality by department and unmet basic needs. The ‘under-reporting' indicator had an inverse correlation with mortality, meaning that departments having recording issues also reported lower mortality rates. Conclusions Health systems must adopt strategies designed to improve information systems for supporting decision-making and optimise the use of health resources, particularly for vulnerable populations and populations having unmet basic needs. Comparing mortality amongst departments and areas will not lead to reliable conclusions in such under-recording conditions.

Objetivo Comparar las tasas de mortalidad por cáncer de cuello uterino en los departamentos de Colombia, tanto en las zonas urbanas como en las zonas rurales y examinar las posibles causas de las diferencias. Métodos Este fue un estudio ecológico. La mortalidad causada por cáncer de cuello uterino fue estimada a partir de los datos recolectados entre los años2005 y 2008 por el Departamento Administrativo Nacional de Estadística (DANE).La mortalidad global en Colombia, la mortalidad por departamento y la mortalidad por zonas rurales y urbanas fueron incluidas en estas cifras. El DANE proporcionó el indicador del sub registro de la mortalidad por departamentos y el índice de las necesidades básicas insatisfechas (NBI). El coeficiente de correlación de Spearman fue estimada por mortalidad promedio por departamento, NBI y las variables de sub registro. Resultados La tasa anual de mortalidad global desde el año 2005 hasta el año 2008, causado por cáncer de cuello uterino en Colombia, osciló entre 10 hasta 11,1 por 100.000 mujeres. La mortalidad registrada en las zonas urbanos tenía una tasa más alta que en los zonas rurales (10.3-11.7 cf 7.6-8.7). La tasa más baja de mortalidad promedio fue registrada en el departamento de Chocó (4.7) y la más alta del departamento de Meta (18.2). Se encontró una correlación inversa entre la mortalidad promedio por departamento y las NBI. El indicador del sub registro tenía una correlación inversa con la mortalidad, significando que los departamentos que tienen problemas relacionadas con el registro también registraron tasas más bajas de mortalidad. Conclusiones Los sistemas de salud deben adoptar estrategias encaminadas a mejorar los sistemas de información para apoyar a la toma de decisiones y optimizar el uso de los recursos sanitarios, particularmente para las poblaciones vulnerables y las poblaciones con necesidades básicas insatisfechas. Al comparar la mortalidad entre los departamentos y las zonas no conducirá a conclusiones confiables en tales condiciones de registro.

The impact of under-recording on cervical cancer-related mortality rates in Colombia: an equity analysis involving comparison by provenance.

OBJECTIVE: Comparing cervical cancer mortality rates in Colombian departments, as well as in urban and rural areas and examining the potential causes of any differences. METHODOLOGY: This was an ecologic study. Mortality due to cervical cancer was estimated from data collected between 2005 and 2008 by the Colombian National Statistics Bureau (DANE).This included overall mortality in Colombia, mortality by department and mortality by rural and urban area. DANE provided the under-recording indicator for mortality by departments and the unmet basic needs index. Spearman correlation coefficient was estimated for average mortality by department, unmet basic needs and under-recording variables. RESULTS: The overall annual mortality rate from 2005 to 2008 due to cervical cancer in Colombia ranged from 10 to 11.1 per 100,000 females. Mortality reported in urban areas was higher than in rural areas (10.3-11.7 cf 7.6-8.7). The lowest average mortality was reported from the Chocó department (4.7) and the highest from Meta (18.2). An inverse correlation was found between average mortality by department and unmet basic needs. The 'under-reporting' indicator had an inverse correlation with mortality, meaning that departments having recording issues also reported lower mortality rates. CONCLUSIONS: Health systems must adopt strategies designed to improve information systems for supporting decision-making and optimise the use of health resources, particularly for vulnerable populations and populations having unmet basic needs. Comparing mortality amongst departments and areas will not lead to reliable conclusions in such under-recording conditions.

Interpretación de estudios de costo-efectividad en ginecología / Interpreting cost-effectiveness analysis studies in gynecology

Objetivo: explicar los conceptos propios de las evaluaciones económicas mediante el análisis crítico de un estudio tipo costo-efectividad. Materiales y métodos: con base en una pregunta clínica se hace una búsqueda en la base de datos Medline vía PubMed. Se selecciona un estudio que aborda el problema de la costo-efectividad en la ginecología. Se exponen los elementos que debe tener en cuenta el lector, los cuales se explican por medio de ejemplos de estudios de evaluación económica en ginecología ya publicados; y se hace el análisis crítico de estos aspectos en la publicación seleccionada. Resultados: para la lectura crítica de un estudio de costo-efectividad es necesario evaluar los siguientes elementos: clara definición de las alternativas a comparar, estimación de los costos incurridos en cada una, evaluación de su efectividad, estimación de la relación costo-efectividad y análisis de sensibilidad. La comprensión de los anteriores elementos permitirá realizar una evaluación profunda de estos estudios. Conclusiones: los análisis económicos merecen consideración por parte de los profesionales de la salud, pues conducen a la toma de decisiones eficientes en el tratamiento de los pacientes...

Objetivo: explicar los conceptos propios de las evaluaciones económicas mediante el análisis crítico de un estudio tipo costo-efectividad. Materiales y métodos: con base en una pregunta clínica se hace una búsqueda en la base de datos Medline vía PubMed. Se selecciona un estudio que aborda el problema de la costo-efectividad en la ginecología. Se exponen los elementos que debe tener en cuenta el lector, los cuales se explican por medio de ejemplos de estudios de evaluación económica en ginecología ya publicados; y se hace el análisis crítico de estos aspectos en la publicación seleccionada. Resultados: para la lectura crítica de un estudio de costo-efectividad es necesario evaluar los siguientes elementos: clara definición de las alternativas a comparar, estimación de los costos incurridos en cada una, evaluación de su efectividad, estimación de la relación costo-efectividad y análisis de sensibilidad. La comprensión de los anteriores elementos permitirá realizar una evaluación profunda de estos estudios. Conclusiones: los análisis económicos merecen consideración por parte de los profesionales de la salud, pues conducen a la toma de decisiones eficientes en el tratamiento de los pacientes...