ABSTRACT
BACKGROUND: The Los Angeles County (LAC) Division of HIV and STD Programs implemented a medical care coordination (MCC) program to address the medical and psychosocial service needs of people with HIV (PWH) at risk for poor health outcomes. METHODS: Our objective was to evaluate the impact and cost-effectiveness of the MCC program. Using the CEPAC-US model populated with clinical characteristics and costs observed from the MCC program, we projected lifetime clinical and economic outcomes for a cohort of high-risk PWH under 2 strategies: (1) No MCC and (2) a 2-year MCC program. The cohort was stratified by acuity using social and clinical characteristics. Baseline viral suppression was 33% in both strategies; 2-year suppression was 33% with No MCC and 57% with MCC. The program cost $2700/person/year. Model outcomes included quality-adjusted life expectancy, lifetime medical costs, and cost-effectiveness. The cost-effectiveness threshold for the incremental cost-effectiveness ratio (ICER) was $100 000/quality-adjusted life-year (QALY). RESULTS: With MCC, life expectancy increased from 10.07 to 10.94 QALYs, and costs increased from $311 300 to $335 100 compared with No MCC (ICER, $27 400/QALY). ICERs for high/severe, moderate, and low acuity were $30 500/QALY, $25 200/QALY, and $77 400/QALY. In sensitivity analysis, MCC remained cost-effective if 2-year viral suppression was ≥39% even if MCC costs increased 3-fold. CONCLUSIONS: The LAC MCC program improved survival and was cost-effective. Similar programs should be considered in other settings to improve outcomes for high-risk PWH.
ABSTRACT
Conocer la frecuencia de patología de cuello en las adolescentes que acudieron a la consulta de Ginecología Infantil Juvenil del Hospital "Dr. Domingo Luciani", durante el período septiembre 2001 a septiembre de 2002. Se realizó un estudio descriptivo, y prospectivo. La muestra estuvo constituida por 125 pacientes, con edades entre 14-19 años, la edad promedio fue 17,28 años. Las citologías reportaron inflamación inespecíficas (58.4%), inflamación específicas (32%) y de éstas el 57% presentó Garnerella, 25% Cándida, 12,5 Tricomona y 5% Leptotrix. 95 colposcopias fueron normales (76%), 12 (10%) insatisfactorias y 18 (14%) reportaron epitelio blanco. De 18 biopsias 14 no presentaron lesiones (78%) y 4 (22%) reportaron VPH, a éstas se les realizó PCR, siendo negativas. Las adolescentes representan un grupo de riesgo por lo que se deben establecer programa sanitario para despistaje de patología de cuello, programas escolares para evitar ETS y orientar a las pacientes de riesgo elevado para tener un adecuado control ginecológico.
