[Celiac disease: diagnosis prevalence in a community hospital]. / Enfermedad celíaca: prevalencia del diagnóstico en un hospital de comunidad.

INTRODUCTION: Celiac disease (CD) is a gluten-sensitive enteropathy characterized by a chronic injury of the small bowel, caused by gluten intolerance in genetically predisposed individuals. The different forms of presentation of CD resemble more a multisystem disorder than a primary gastrointestinal disease and it is frequently underdiagnosed. OBJECTIVE: To determine the prevalence of CD diagnosis in the population of affiliates to the HMO of the Hospital Italiano de Buenos Aires. METHODS: This is a cross sectional study, using secondary databases of diagnosis and laboratory from the electronic medical record (EMR) in a HMO population between 1998 and 2006. The criteria used to define a case was based on a diagnosis of CD in the EMR and/or a IgA antitransglutaminase antibodies value >15 AU/mL. RESULTS: According to these criteria, 283 patients with CD were identified in 128,748 individuals of the HMO. The prevalence of CD was 0.22%. The mean age of this group was of 42.3 years, and 80.2% of them were female. CONCLUSIONS: In a primary care HMO setting, using secondary databases from EMR we found 1 case of celiac disease every 470 affiliates, giving a prevalence of 0.22%. The rate between serological prevalence of CD and clinical diagnosis carried out in our center was near 3.3 to 1. Although this level of diagnosis could be considered relatively high, an important proportion of patients are left without diagnosis, considering the local estimated prevalence reported using serological tests. An increased level of awareness and clinical suspicion is needed at the primary care level.

A Comparison of 1-Year Treatment Costs in Patients with Type 2 Diabetes Following Initiation of Insulin Glargine or Insulin Detemir in Argentina.

OBJECTIVE: To estimate and compare type 2 diabetes mellitus treatment costs in insulin-naive patients following initiation of therapy with either insulin glargine (IG) or insulin detemir (ID) over 1-year time horizon from a payers' perspective in Argentina. METHODS: We used a pharmacoeconomic model based on a randomized trial comparing IG and ID (Rosenstock J, Davies M, Home PD, et al. A randomised, 52-week, treat-to-target trial comparing insulin detemir with insulin glargine when administered as add-on to glucose-lowering drugs in insulin-naive people with type 2 diabetes. Diabetologia 2008;51:408-16) and Argentinean sources. Clinical, resource use, and cost data were combined to estimate direct medical costs (insulin, test strips, and needles) during the first year. Price per international unit of insulin is similar for IG and ID in the local market. Deterministic analysis was performed on insulin unit cost and probabilistic sensitivity analyses on clinical, resource use, and unit costs to evaluate contribution to variance on the difference in total annual treatment cost. RESULTS: Annual mean treatment cost (Argentinean pesos 2013) was AR $6229 for IG and AR $9257 for ID, showing 33% total cost reduction with IG (AR $3028; exchange rate US $1.00 = AR $5.30). Probabilistic sensitivity analysis showed that IG was cost saving in 88% of the simulations. The most influential parameter was the difference in insulin dose requirements. Threshold analysis showed that if the unit price of ID is reduced by 43%, ceteris paribus, the total annual costs per person for both insulin regimens would be the same. CONCLUSIONS: From a payer's perspective in Argentina, cost savings related to the use of IG represented one third of total treatment costs. Sensitivity analyses confirmed the robustness of these results.