Treatment of chronic venous insufficiency in Latin America.

OBJECTIVE: Venous disease is common in Latin America, with an estimated 68.11% prevalence of chronic venous disease. The diverse social, political, and economic characteristics of the many nations that make up Latin America mean that different conditions affect how these diseases are diagnosed and treated, which may differ markedly from the way they are treated by the health care systems of the United States and Europe. Our goal was to review the current state of treatment of chronic venous insufficiency (CVI) in Latin America. METHODS: This is a narrative review of the medical literature on the subject and synthesizes sometimes fragmentary information on CVI across a large and diverse region. RESULTS: CVI represents an unmet medical need in Latin America. Conservative treatments, such as compression stockings, may be used at first, and there are nonpharmacologic and complementary and alternative medicine approaches in use. Endovenous approaches, such as endovenous thermal ablation, have largely replaced surgical interventions. In Europe and the United States, such procedures are mainly carried out in ambulatory facilities, whereas they are mainly performed in the hospital in Latin America. CONCLUSIONS: Recent strong economic growth in Latin America and improvements in social security and health care suggest that innovative approaches to chronic venous disease and CVI will be implemented.

Minimización de costos: inmunoglobulina IV vs. plasmaféresis en síndrome de Guillain Barré / Cost minimization: intravenous inmunoglobulin vs. plasmapheresis in Guillain Barré syndrome

Introducción: el síndrome de Guillain Barré es considerada una de las principales causas de parálisis neuromuscular aguda. Actualmente existen dos alternativas igual de efectivas clínicamente en el tratamiento de esta enfermedad: la inmunoglobulina intravenosa y la plasmaféresis. Objetivo: estimar cuál de los dos tratamientos es menos costoso en la atención hospitalaria de pacientes con diagnóstico de síndrome de Guillain Barré en estadios moderados a severos en la Fundación Cardioinfantil en Bogotá, Colombia. Materiales y métodos: se incluyeron todos los pacientes que egresaron entre enero y diciembre de 2014 con síndrome de Guillain Barré según el sistema de información clínica de la Fundación Cardioinfantil. La información de los costos por cada paciente fue provista por el Departamento de Cuentas Médicas de la Fundación Cardioinfantil y se estableció el costo total de la atención desde el ingreso hasta el egreso del paciente. La comparación del costo total de la atención de los pacientes tratados con inmunoglobulina intravenosa (IGIV) vs., los pacientes tratados con plasmaféresis, se realizó por medio de la prueba de Mann-Whitney. Resultados: la atención de los pacientes con IGIV tuvo un costo total de 9.976 USD, mientras el costo de los pacientes tratados con plasmaféresis fue de 23.354 USD. El costo de atención en este último grupo de pacientes se ve afectado por el mayor número de complicaciones derivadas del mismo tratamiento. Conclusión: entre los dos tratamientos considerados en el síndrome de Guillain Barré en estadios avanzados, la IGIV ofrece una buena alternativa para minimizar costos en la atención hospitalaria del paciente con diagnóstico de síndrome de Gullian Barré en la Fundación Cardioinfantil de Bogotá.

Introduction: Guillain Barre Syndrome is considered one of the most important causes of acute neuromuscular paralysis. Currently there are two clinically effective therapies for the treatment of disease: IVIG and plasmapheresis. Objective: To estimate which therapy is less expensive for the in-hospital care of patients diagnosed with moderate to severe Guillain Barre in the Fundación Cardioinfantil of Bogotá, Colombia. Materials and Methods: All patients that were discharged between January and December 2014 with GuillainBarre syndrome diagnosis were included. The cost information for each patient was provided by department of medical bills and the total cost of care was established from admission to patient discharge. The comparison of the total costs of care of patients treated with IVIG vs. patients treated with plasmapheresis was performed by means of the Mann-Whitney analysis. Results: The cost of care of patients with intravenous immunoglobulin was 9,976 USD while the total cost of patients with plasmapheresis was 23,354 USD. The higher cost of care in this last group of patients was driven by the increased number of complications arising from the same treatment. Conclusion:Between the two treatments considered in the advanced states of Guillain Barre Syndrome, IVIG offers an adequate strategy to minimize the cost of hospital patient care in patients with a diagnosis of Guillain-Barre syndrome in the Fundación Cardioinfantil of Bogotá.