[Cost-effectiveness of a brief intervention to support indigenous women in Hidalgo (Mexico) who live with alcohol abusers]. / Costo-efectividad de una intervención breve de apoyo a mujeres indígenas de Hidalgo, México, que viven con consumidores excesivos de alcohol.

Objective Estimate the cost-effectiveness ratio of a five-step brief intervention aimed at reducing the stress and symptoms of depression caused by living with an alcohol abuser. Methods The cost-effectiveness analysis was carried out with a decision tree, based on symptoms of depression measured on the CES-D scale. The effectiveness of the brief intervention was evaluated by comparing a group of indigenous women who received the intervention (n = 43) with a similar group who did not (n = 30). The groups were evaluated before, immediately after, and 12 months after the intervention, in the state of Hidalgo (Mexico). Pharmacological treatment was selected for comparison, using different estimates. Cost-effectiveness and incremental cost-effectiveness ratios were used to calculate the value of the remission of depressive symptoms. Sensitivity analyses were also conducted. Results The brief intervention turned out to be more effective than the pharmacological one in terms of the remission of depressive symptoms. Its cost was also lower ($US 31.24 versus $US 107.60). The brief intervention would cease to be cost-effective only if its cost increased by 338% or more, or if its effectiveness were 22.8% or less. Conclusions The five-step brief intervention is a cost-effective option that results in significant reductions in depressive symptoms in indigenous women caused by living with alcohol abusers. It is also an affordable option for primary mental health care.

Costo-efectividad de una intervención breve de apoyo a mujeres indígenas de Hidalgo, México, que viven con consumidores excesivos de alcohol / Cost-effectiveness of a brief intervention to support indigenous women in Hidalgo (Mexico) who live with alcohol abusers

RESUMEN Objetivo Estimar la razón de costo-efectividad de una intervención breve de cinco pasos dirigida a reducir el estrés y los síntomas depresivos causados por convivir con un consumidor excesivo de alcohol. Métodos El análisis costo-efectividad se realizó usando un árbol de decisión y se basó en los síntomas depresivos medidos con la escala CES-D. La efectividad de la intervención breve se evaluó comparando un grupo de mujeres indígenas que recibieron la intervención (n = 43) con otro similar sin intervención (n = 30). Los grupos se evaluaron antes, inmediatamente después de la intervención y a los 12 meses y se llevó a cabo en el Estado de Hidalgo, en México. El tratamiento farmacológico fue seleccionado como alternativa de comparación utilizando distintas estimaciones. Para evaluar el valor de la remisión de los síntomas de depresión se emplearon las razones de cos-to-efectividad y costo-efectividad incremental. Asimismo, se realizaron análisis de sensibilidad. Resultados La intervención breve resultó ser más efectiva que la farmacológica en la remisión de síntomas depresivos y su costo fue más bajo ($US 31,24 y $US 107,60, respectivamente). Solo si la intervención breve incrementara su costo por encima de 338% o si su efectividad fuera menor de 22,8% dejaría de ser costo-efectiva. Conclusiones La intervención breve de cinco pasos es una alternativa costo-efectiva con la cual se consiguen reducir significativamente los síntomas de depresión de las mujeres indígenas ocasionados por convivir con un consumidor excesivo de alcohol, así como una opción accesible para la atención de la salud mental en el primer nivel de atención.

ABSTRACT Objective Estimate the cost-effectiveness ratio of a five-step brief intervention aimed at reducing the stress and symptoms of depression caused by living with an alcohol abuser. Methods The cost-effectiveness analysis was carried out with a decision tree, based on symptoms of depression measured on the CES-D scale. The effectiveness of the brief intervention was evaluated by comparing a group of indigenous women who received the intervention (n = 43) with a similar group who did not (n = 30). The groups were evaluated before, immediately after, and 12 months after the intervention, in the state of Hidalgo (Mexico). Pharmacological treatment was selected for comparison, using different estimates. Cost-effectiveness and incremental cost-effectiveness ratios were used to calculate the value of the remission of depressive symptoms. Sensitivity analyses were also conducted. Results The brief intervention turned out to be more effective than the pharmacological one in terms of the remission of depressive symptoms. Its cost was also lower ($US 31.24 versus $US 107.60). The brief intervention would cease to be cost-effective only if its cost increased by 338% or more, or if its effectiveness were 22.8% or less. Conclusions The five-step brief intervention is a cost-effective option that results in significant reductions in depressive symptoms in indigenous women caused by living with alcohol abusers. It is also an affordable option for primary mental health care.

[Cost effectiveness of posaconazole versus fluconazole/itraconazole in the prophylactic treatment of invasive fungal infections in Mexico]. / Costo efectividad de posaconazol versus fluconazol/itraconazol en el tratamiento profiláctico de las infecciones fúngicas invasivas en México.

UNLABELLED: Cost effectiveness of posaconazole versus fluconazole/itraconazole therapy in the prophylaxis against invasive fungal Infections among high-risk neutropenic patients in Mexico. OBJECTIVE: To estimate the cost effectiveness and long-term combined effects of Posaconazole versus fluconazole/itraconazole (standard azole) therapy in the prophylaxis against invasive fungal Infections among high-risk neutropenic patients in Mexico. METHODS: A previously validated Markov model was used to compare the projected lifetime costs and effects of two theoretical groups of patients, one receiving Posaconazole and the other receiving standard azole. The model estimates total costs, numbers of IFIs, and QALY per patient in each prophylaxis group. To extrapolate trial results to a lifetime horizon, the model was extended with one-month Markov cycles in which mortality risk is specific to the underlying disease. Data on the probabilities of IFI were obtained from Study Protocol PO1899. Drug costs were taken from average wholesale drug reports for 2009. Cost and health effects were discounted at 5% according to the Mexican guideline. The analysis was conducted from the Mexican healthcare perspective using 2008 unit cost prices. RESULTS: Our model projects an accumulated cost to the Mexican healthcare system per patient receiving the Posaconazol regimen of $US 5,634 compared to $US 7,463 for the standard azole regimen. The accumulated discounted effect is 3.13 LY or 2.25 QALYs per patient receiving Posaconazol, compared to 2.96 LY or 2.13 QALYs per patient receiving standard azole. Posaconazol remained the dominant strategy across each scenario. Probabilistic sensitivity analysis tested numerous assumptions about the model cost and efficacy parameters and found that the results were robust to most changes. CONCLUSION: Posaconazole provides modest incremental benefits compared with standard azole therapy in the prophylaxis against IFIs among high-risk neutropenic patients. Routine Posaconazole use appears a cost saving when the likelihood of IFIs or the cost of treatment medications is high.

[Cost effectiveness of treatment with salmeterol/fluticasone compared to montelukast for the control of persistent asthma in children]. / Costo-efectividad del tratamiento de salmeterol/fluticasona en comparación con leucotrieno montelukast para el control del asma infantil.

OBJECTIVE: To assess the incremental cost-effectiveness of SFC compared with MON for the control of persistent asthma in children. METHODS: We conducted an economic evaluation on a 12-week prospective randomized open-label parallel-group comparison of SFC versus MON in children with symptomatic asthma receiving inhaled corticosteroids and short-acting ß2-agonists. Asthma-related medication, unscheduled physician contacts and hospitalizations were collected prospectively. The main effectiveness measure was percentage of asthma-controlled week with no short-acting ß2-agonist use during the study period. The analysis was conducted from the Mexican healthcare perspective using 2010 unit cost prices, and only direct costs were considered, all costs are reported in US dollar. . The model was made fully probabilistic to reflect the joint uncertainty in the model parameters. RESULTS: Over the whole treatment period, the median percentages of asthma-controlled weeks were 83.3% in the SFC group and 66.7% in the MON group (SFC-MON difference, 16.7%; 95% CI, 8.3-16.7; P < 0.001 in favor of SFC). The mean total cost of the SFC regimen was $ 2,323 compared with $ 3,230 for the MON regimen. The SFC was the dominant strategy (both more effective and less expensive) using the SFC was associated with an incremental cost per additional asthma-controlled of $ (5,467). Probabilistic sensitivity analysis tested numerous assumptions about the model cost and efficacy parameters and found that the results were robust to most changes. CONCLUSIONS: This analysis demonstrates that, compared with MON, SFC may be cost saving from the Mexican health care perspective for the treatment of pediatric patients with asthma. SFC provided a reduction in the number of severe exacerbations, frequent asthma symptoms and rescue medication use. Incremental cost-effectiveness analysis indicated the dominance of SFC because of both lower costs and greater efficacy.