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1.
World J Urol ; 37(5): 861-866, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-30116964

RESUMEN

PURPOSE: To assess the cost-utility of the photovaporization of the prostate (PVP) with GreenLight™ laser 180 W XPS compared to transurethral resection of the prostate with monopolar energy (M-TURP) for lower urinary tract symptoms (LUTS) due to benign prostatic enlargement (BPE) from a healthcare perspective in Colombia. METHODS: We designed a Markov model to compare four health states following treatment with either PVP or M-TURP to estimate expected costs and outcomes. We used the results of the only randomized clinical trial published to date comparing PVP versus M-TURP to estimate surgical outcomes, complications, re-operation and re-intervention rates. Time horizon was defined at 2 years with four cycles of 6 months each. Resource-use estimation involved a random selection of clinical records from a local institution and cost list from public healthcare system. Costs were obtained in Colombian pesos and converted to US dollars. Threshold was defined at three-times the Colombian gross domestic product (GDP) per capita. Quality-adjusted-life-years (QALYs) were used based on the utilities of the available literature. Uncertainty was analyzed with deterministic and probabilistic models using a Monte Carlo simulation. RESULTS: Patients who underwent PVP gained 1.81 QALYs compared to 1.59 with M-TURP. Costs were US$6797.98 and US$7777.59 for M-TURP and PVP, respectively. Incremental cost-effectiveness ratio was US$4452.81 per QALY, favoring PVP as a cost-effective alternative in our context. CONCLUSIONS: In Colombia, with current prices, PVP is cost-effective when compared to M-TURP for LUTS due to BPE for a 2-year time horizon.


Asunto(s)
Terapia por Láser/métodos , Síntomas del Sistema Urinario Inferior/cirugía , Hiperplasia Prostática/cirugía , Resección Transuretral de la Próstata/métodos , Colombia , Análisis Costo-Beneficio , Humanos , Terapia por Láser/economía , Síntomas del Sistema Urinario Inferior/etiología , Masculino , Método de Montecarlo , Complicaciones Posoperatorias/epidemiología , Hiperplasia Prostática/complicaciones , Años de Vida Ajustados por Calidad de Vida , Reoperación , Resección Transuretral de la Próstata/economía
2.
Cost Eff Resour Alloc ; 17: 11, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31285695

RESUMEN

BACKGROUND: In many countries, economic assessments of the routine use of pulse oximetry in the detection of Critical Congenital Heart Disease (CCHD) at birth has not yet been carried out. CCHDs necessarily require medical intervention within the first months of life. This assessment is a priority in low and medium resource countries. The purpose of this study was to assess the cost-effectiveness (CE) relation of pulse oximetry in the detection of cases of CCHD in Colombia. METHODS: A full economic assessment of the cost-effectiveness type was conducted from the perspective of society. A decision tree was constructed to establish a comparison between newborn physical examination plus pulse oximetry, versus physical examination alone, in the diagnosis of CCHDs. The sensitivity and specificity of pulse oximetry were estimated from a systematic review of the literature; to assess resource use, micro-costing analyses and surveys were conducted. The time horizon of the economic evaluation was the first week after birth and until the first year of life. The incremental cost-effectiveness ratio (ICER) was determined and, to control for uncertainty, deterministic and probabilistic sensitivity analysis were made, including the adoption of different scenarios of budgetary impact. All costs are expressed in US dollars from 2017, using the average exchange rate for 2017 [$2,951.15 COP for 1 dollar]. RESULTS: The costs of pulse oximetry screening plus physical examination were $102; $7 higher than physical examination alone. The effectiveness of pulse oximetry plus the physical examination was 0.93; that is, 0.07 more than the physical examination on its own. The ICER was $100 for pulse oximetry screening; that is, if one wishes to increase 1% the probability of a correct CCHD diagnosis, this amount would have to be invested. A willingness to pay of $26.292 USD (direct medical cost) per probability of a correct CCHD diagnosis was assumed. CONCLUSIONS: At current rates and from the perspective of society, newborn pulse oximetry screening at 24 h in addition to physical examination, and considering a time horizon of 1 week, is a cost-effective strategy in the early diagnosis of CCHDs in Colombia.Trial registration "retrospectively registered".

3.
Front Insect Sci ; 4: 1339143, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38469344

RESUMEN

Helicoverpa armigera, the cotton bollworm moth, is one of the world's most important crop pests, and is spreading throughout the New World from its original range in the Old World. In Brazil, invasive H. armigera has been reported to hybridize with local populations of Helicoverpa zea. The correct identification of H. armigera-H. zea hybrids is important in understanding the origin, spread and future outlook for New World regions that are affected by outbreaks, given that hybridization can potentially facilitate H. zea pesticide resistance and host plant range via introgression of H. armigera genes. Here, we present a genome admixture analysis of high quality genome sequences generated from two H. armigera-H. zea F1 hybrids generated in two different labs. Our admixture pipeline predicts 48.8% and 48.9% H. armigera for the two F1 hybrids, confirming its accuracy. Genome sequences from five H. zea and one H. armigera that were generated as part of the study show no evidence of hybridization. Interestingly, we show that four H. zea genomes generated from a previous study are predicted to possess a proportion of H. armigera genetic material. Using unsupervised clustering to identify non-hybridized H. armigera and H. zea genomes, 8511 ancestry informative markers (AIMs) were identified. Their relative frequencies are consistent with a minor H. armigera component in the four genomes, however its origin remains to be established. We show that the size and quality of genomic reference datasets are critical for accurate hybridization prediction. Consequently, we discuss potential pitfalls in genome admixture analysis of H. armigera-H. zea hybrids, and suggest measures that will improve such analyses.

4.
J Health Econ Outcomes Res ; 11(1): 141-148, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38800495

RESUMEN

Background: Congenital heart disease is the most common congenital condition worldwide, with a prevalence of 80 cases per 10 000 live births. In addition to perinatal morbidity and mortality, it entails long-term consequences such as multiple surgeries, prolonged hospitalizations, lifelong cardiac follow-up, reduced quality of life, risk of heart failure, and premature mortality in adulthood. This significant health and economic burden on healthcare systems and families highlights the relevance of evaluating the cost-effectiveness of methods for early detection of this condition. Objective: To conduct a systematic literature review (SLR) to identify and analyze existing economic evaluations on prenatal detection of congenital heart diseases through ultrasound, focusing on the reported cost-effectiveness results and the methodological quality of the evaluated studies according to established criteria. Methods: An SLR of economic evaluations was conducted following PRISMA guidelines. A quantitative synthesis of key methodological components of each economic evaluation was performed. The incremental medical costs, effectiveness measures, and cost-effectiveness ratios reported in each study were compiled and compared. The methodological quality was assessed according to compliance with the 24 CHEERS criteria. Results: We found 785 articles, of which only 7 met all inclusion criteria. Most were cost-effectiveness analyses, with the most common outcome being number of cases detected. Screening with only 4-chamber views interpreted by general practitioners or cardiologists were dominant strategies compared with screening with 4-chamber plus outflow views interpreted by a general practitioner. Fetal echocardiography was most effective but most expensive. Screening with 4-chamber and outflow view, followed by referral to a specialist, were recommended as the least expensive strategy per defect detected. On average, articles met 17 of the 24 CHEERS criteria. Discussion: While recent cost-effectiveness analyses demonstrated improved methodological quality, there was a lack of homogeneity due to differences in comparators and population subgroups analyzed. Despite this heterogeneity, fetal ultrasonography screening was consistently identified as a cost-effective strategy, with its cost-effectiveness heavily influenced by the expertise of the interpreting physician. Conclusion: Most studies recommend implementing obstetric ultrasonography screening, without routine fetal echocardiography, for detecting congenital heart diseases.

5.
J Robot Surg ; 17(1): 243-250, 2023 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-35668314

RESUMEN

To assess the cost-effectiveness of the robotic-assisted laparoscopic radical prostatectomy (RALRP) compared to open radical prostatectomy (ORP) for localized prostate cancer from a healthcare perspective in Colombia. A systematic review was conducted in Embase, Scopus, Web of Science, PubMed, and Cochrane CENTRAL databases, to identify relevant publications up to January 2020 to summarize clinical outcomes related to effectiveness of robot-assisted and open radical prostatectomy. A tree decision model was designed given the clinical outcomes and possibilities of complication and success. Outcomes were defined as complications according to Clavien - Dindo classification and success measured as urethral stricture rate. Cost was divided into two categories: surgical procedure and complications. Incremental cost-effectiveness ratio (ICER) was calculated and a deterministic sensitivity analysis was performed to evaluate the impact of the uncertainty on the conclusions of the model. A 90-day horizon was defined. Direct medical costs associated with RALRP were $6.511 ($ 5.127- $8.138), and for ORP were $4.476 ($2.170-$ 6.511). The average cost for complication management was rated at $ 327 for RALRP and $ 382 for ORP, based on an augmented risk of post-operative urethral stricture in the ORP group (2.4% vs 10.8%). ICER was calculated in USD $18.987. The cost of RALRP has to be reduced to around USD 5.345 to achieve an ICER under 1 GDP making the intervention feasible. Using a 3 GDP per capita threshold, the implementation of RALRP could be cost-effective for the treatment of localized prostate cancer in emerging economies. Bolder measures including the use of one needle carrier, three robotic arms, and a shorten hospitalization program of 24 h, can save around $1000 for each patient, achieving the goal cost of $5345 needed for a favorable ICER.


Asunto(s)
Laparoscopía , Neoplasias de la Próstata , Procedimientos Quirúrgicos Robotizados , Estrechez Uretral , Masculino , Humanos , Procedimientos Quirúrgicos Robotizados/métodos , Análisis de Costo-Efectividad , Estrechez Uretral/cirugía , Prostatectomía/métodos , Neoplasias de la Próstata/cirugía , Laparoscopía/métodos , Resultado del Tratamiento
6.
Insects ; 11(7)2020 Jul 10.
Artículo en Inglés | MEDLINE | ID: mdl-32664300

RESUMEN

Until recently, the Old World bollworm (OWB) Helicoverpa armigera (Hübner) and the corn earworm Helicoverpa zea (Boddie) (Lepidoptera: Noctuidae) were geographically isolated. Both species are major pests of agricultural commodities that are known to develop insecticide resistance, and they now coexist in areas where H. armigera invaded the Americas. This is the first study to compare the susceptibility of the two species to conventional insecticides. The susceptibility of third instar H. armigera and H. zea larvae to indoxacarb, methomyl, spinetoram, and spinosad was determined using a diet-overlay bioassay in a quarantine laboratory in Puerto Rico. Mortality was assessed at 48 h after exposure for up to eight concentrations per insecticide. Spinetoram exhibited the highest acute toxicity against H. armigera, with a median lethal concentration (LC50) of 0.11 µg a.i./cm2, followed by indoxacarb and spinosad (0.17 µg a.i./cm2 for both) and methomyl (0.32 µg a.i./cm2). Spinetoram was also the most toxic to H. zea (LC50 of 0.08 µg a.i./cm2), followed by spinosad (0.17 µg a.i./cm2) and methomyl (0.18 µg a.i./cm2). Indoxacarb was the least toxic to H. zea, with an LC50 of 0.21 µg a.i./cm2. These findings could serve as a comparative reference for monitoring the susceptibility of H. armigera and H. zea to indoxacarb, methomyl, spinetoram, and spinosad in Puerto Rico, and may facilitate the detection of field-selected resistance for these two species and their potential hybrids in areas recently invaded by H. armigera.

7.
F1000Res ; 8: 242, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31372214

RESUMEN

Background: Undiagnosed congenital heart disease in the prenatal stage can occur in approximately 5 to 15 out of 1000 live births; more than a quarter of these will have critical congenital heart disease (CCHD). Late postnatal diagnosis is associated with a worse prognosis during childhood, and there is evidence that a standardized measurement of oxygen saturation in the newborn by cutaneous oximetry is an optimal method for the detection of CCHD. We conducted a systematic review of the literature and meta-analysis comparing the operational characteristics of oximetry and physical examination for the detection of CCHD. Methods: A systematic review of the literature was conducted on the following databases including published studies between 2002 and 2017, with no language restrictions: Pubmed, Science Direct, Ovid, Scopus and EBSCO, with the following keywords: oximetry screening, critical congenital heart disease, newborn OR oximetry screening heart defects, congenital, specificity, sensitivity, physical examination. Results: A total of 419 articles were found, from which 69 were selected based on their titles and abstracts. After quality assessment, five articles were chosen for extraction of data according to inclusion criteria; data were analyzed on a sample of 404,735 newborns in the five included studies. The following values were found, corresponding to the operational characteristics of oximetry in combination with the physical examination: sensitivity: 0.92 (CI 95%, 0.87-0.95), specificity: 0.98 (CI 95%, 0.89-1.00), for physical examination alone sensitivity: 0.53 (CI 95%, 0.28-0.78) and specificity: 0.99 (CI 95%, 0.97-1.00). Conclusions: Evidence found in different articles suggests that pulse oximetry in addition to neonatal physical examination presents optimal operative characteristics that make it an adequate screening test for detection of CCHD in newborns, above all this is essential in low and middle-income settings where technology medical support is not entirely available.


Asunto(s)
Cardiopatías Congénitas/diagnóstico , Tamizaje Neonatal , Oximetría , Bases de Datos Factuales , Humanos , Recién Nacido , Sensibilidad y Especificidad
8.
Revista Colombiana de Neumología ; 35(1): 9-10, Jun 1, 2023.
Artículo en Español | LILACS, COLNAL | ID: biblio-1537320

RESUMEN

Colombia está mostrando los resultados de la falta de regulación, fácil acceso y ausencia de campañas promocionales de los cigarrillos electrónicos, a tal punto que en Bogotá el 37.8 % de los universitarios ha probado algún tipo de dispositivo, demostrando que puede ser la puerta de entrada al consumo y aumenta el consumo de tabaco a nivel poblacional (1). Nuestro país hace parte del Convenio Marco para el Control del Tabaco de la OMS (2), que está reglamentado con la Ley 1335 de 2009 y continua vigente. Manifestamos nuestra preocupación por la cercanía de la industria tabacalera a los profesionales de la salud, la cual estimula el tema del abordaje al consumo de tabaco y temas como reducción del daño, promoviendo de alguna manera los productos de tabaco calentado o similares, lo cual va en contra de lo reglamentado por la Ley 1335 de 2009, norma que prohíbe todas formas de promoción de productos de tabaco y sus derivados en sus artículos 16 y 17 (3). Es de anotar que se desconoce la seguridad de estos dispositivos a largo plazo, por la ausencia de estudios de seguimiento.


Asunto(s)
Humanos
9.
Rev. colomb. neumol ; 22(4)dic. 2010.
Artículo en Español | LILACS | ID: lil-652636

RESUMEN

Objetivo: determinar si los coticoesteroides orales son la vía más efectiva y menos costosa con respecto a los corticosteroides endovenosos para el manejo de la crisis asmática moderada o severa. Diseño: usando un análisis de decisiones, se realizó un estudio de minimización de costos. Material y métodos: el estudio se realizó en el Hospital Universitario de San Ignacio de Bogotá, Colombia, institución privada de tercer nivel. La determinación de los costos y de los recursos usados, se realizó revisando historias clínicas de pacientes con asma que fueron atendidos entre 1988 y 1997. Se realizó una proyección para 1.000 sujetos atendidos por dicho padecimiento. La determinación de la efectividad de los corticosteroides orales vs los endovenosos se basó en un meta-análisis. Resultados: los pacientes recibieron en promedio 4 días de corticosteroides endovenosos, lo que lleva a que el costo de la administración de este medicamento para 1.000 personas, sea de $ 148.404.000 y de $ 8.493.000 (5,7%) si se hubiera usado oral a dosis de 1 mg/kg/día de prednisolona o su equivalente. Simultáneamente en dos meta-análisis encontrados en la literatura se pudo demostrar que la actividad de los corticoesteroides usados por vía oral o por vía endovenosa es similar y que excepto exista una contraindicación para la vía oral, los efectos esperados en los pacientes van a ser similares. Conclusiones: dado que la eficacia de los corticosteroides orales es semejante a la de los corticosteroides endovensos en el manejo de la crisis asmática y que el costo de la terapia oral es mucho menor, se recomienda dar tratamiento a los pacientes con corticosteroides orales excepto cuando exista contraindicación para el uso de la vía oral.


Asunto(s)
Asma , Ahorro de Costo , Corticoesteroides/economía , Estado Asmático , Colombia
10.
Acta méd. colomb ; 34(2): 73-79, abril.-junio. 2009. tab
Artículo en Español | LILACS | ID: lil-523806

RESUMEN

Objetivos: calcular la incidencia de sangrado gastrointestinal significativo y no significativo en pacientes de la Unidad de Cuidado Intensivo del Hospital San Ignacio, admitidos entre agosto y noviembre de 2007 y la mortalidad relacionada con este.Diseño del estudio: estudio descriptivo de incidencia.Lugar del estudio: Unidad de Cuidado Intensivo del Hospital Universitario San Ignacio.Pacientes: mayores de 16 años que ingresan a la unidad de cuidado intensivo, con una estancia mayor de 24 horas y que no ingresen por hemorragia digestiva o hayan recibido tratamiento previo con cualquier tipo de inhibidor de bomba de protones, sucralfate, antiH2, o antiácido.Intervenciones: ninguna Mediciones: sangrado gastrointestinal significativo, sangrado gastrointestinal no significativo, muerte por sangrado gastrointestinal.Resultados: muestra recolectada de 524 sujetos. Promedio de edad 57 años (máx. 94-min 17 años), 236 mujeres y 285 hombres. Incidencia acumulada de sangrado gastrointestinal 3.44 por ciento. Incidencia de sangrado significativo 2.6 por ciento. Incidencia de sangrado no significativo 0.76 por ciento. Mortalidad global 9.34 por ciento, mortalidad por sangrado 0 por ciento.Conclusiones: la incidencia de sangrado gastrointestinal significativo se encuentra entre rangos mencionados en la literatura, algo inferior a algunos estudios, lo cual podría estar en relación con el alto porcentaje de profilaxis manejado. La incidencia de sangrado gastrointestinal no significativo es baja comparativamente con la mencionada en otros estudios; sin embargo, se encontraron deficiencias en el registro de datos en la historia clínica, y muchos pacientes recibieron profilaxis o tratamiento aún sin tener un alto riesgo o claro diagnóstico del origen del sangrado. La mortalidad global fue de 49 pacientes (9.35 por ciento), ninguna atribuible a sangrado gastrointestinal.


Asunto(s)
Humanos , Hemorragia , Unidades de Cuidados Intensivos , Inhibidores de la Bomba de Protones , Ranitidina
11.
Bogotá; IETS; oct. 2014. 41 p.
No convencional en Español | BRISA, LILACS | ID: biblio-875882

RESUMEN

INTRODUCCIÓN: La fibrosis pulmonar idiopática es definida como una forma de neumonía intersticial crónica, progresiva, de causa desconocida, limitada a los pulmones, la cual se presenta principalmente en adultos mayores de 65 años. El diagnóstico de la enfermedad incluye la presencia de un patrón radiológico compatible con neumonía intersticial o hallazgos histopatológicos compatibles con neumonía intersticial usual y la exclusión de: enfermedades ocupacionales, toxicidad por drogas o enfermedades del colágeno que puedan producir enfermedad intersticial. La determinación de los volúmenes pulmonares por pletismografía permite identificar la presencia de trastornos restrictivos y la gravedad de estos en los estados patológicos del pulmón. OBJETIVO: Determinar la validez de la medición de los volúmenes pulmonares por pletismografía como apoyo del proceso diagnóstico de la fibrosis pulmonar idiopática y como medida del seguimiento de la progresión de la enfermedad. MÉTODOS: Dos estudios fueron incluidos, estos evaluaban pacientes con fibrosis pulmonar idiopática en los que se realizaron volúmenes pulmonares por pletismografía y se correlacionaron los datos de CPT con la tasa de sobrevida, la progresión de la enfermedad y las exacerbaciones. Se encontró que la media de sobrevida de estos pacientes es de 36 meses proximadamente y se asocia a bajos niveles de capacidad vital forzada y capacidad pulmonar total entre otros. Adicionalmente que pacientes con una reducción combinada de CPT y CV por debajo de los valores predichos presentan un deterioro restrictivo de la función pulmonar y un reducción de la sobrevida. CONCLUSIONES: La medición de los volúmenes pulmonares es un método complementario a la espirometría para determinar las capacidades y volúmenes pulmonares que ayudan a definir la gravedad de las alteraciones obstructivas, restrictivas o ambas, que está comprometiendo al paciente. La evidencia existente no soporta su efectividad en la confirmación diagnóstica de la fibrosis pulmonar idiopática, para la cual existen otras pruebas de mayor utilidad diagnóstica y tampoco soporta su como método de seguimiento de la progresión de la enfermedad.(AU)


Asunto(s)
Humanos , Pletismografía/métodos , Fibrosis Pulmonar Idiopática/diagnóstico , Mediciones del Volumen Pulmonar/métodos , Análisis Costo-Beneficio , Colombia
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