Loss of Health State Utilities Attributable to Obesity.

OBJECTIVES: This study aimed to quantify the association between the loss of health state utilities (LHSU) and obesity, considering different obesity categories. This is relevant to interventions economic evaluations and for public policy decision planning. METHODS: Using data from the Chilean National Health Survey, this study uses linear regression models and counterfactual scenarios to calculate the prevalent burden, population averages, and total sum of LHSU attributable to obesity for the Chilean national level on people older than 15 years, year 2017. Adjustments for socioeconomic status and associated noncommunicable diseases (NCDs) are considered. Calculating the LHSU using these methods enables the approximation of loss of prevalent quality-adjusted life-years (QALYs). RESULTS: The raw obesity LHSU burden was 9.1% (95% uncertainty interval [UI] 5.1-13). When adjustment is considered, the LHSU attributable to obesity reaches 4.6% (95% UI 0.6-8.5) being responsible for 121 045 prevalent QALYs. Socioeconomic status adjusted analysis of higher body mass index (BMI, in kg/m2) categories of obesity shows a dose-response effect for LHSU, being the BMI ≥ 40 category with the highest population average of attributable LHSU (10.1; 95% UI 5.5-14.5, scale 0 [full health] to 100 [dead]). Burden for BMI ≥ 35 categories showed the biggest change after NCD adjustment. CONCLUSIONS: Obesity carries a significant burden of QALY loss. Policy decision-making addressing obesity should focus specially on the BMI ≥ 40 group. NCD comorbidity should be considered for policies addressing the BMI ≥ 35 group.

Guidelines for Utility Measurement for Economic Analysis: The Brazilian Policy.

INTRODUCTION: Health-related quality of life is expressed in utilities, also referred to as utility estimates or parameters. Considerations about the source and type of utility values are especially important in a modeling context, where the lack of transparency, including the lack of a hierarchy for utility data sources, is a major issue to any estimation and can potentially compromise model reliability. OBJECTIVES: This document aims to present the first version of the Brazilian guidelines for utility measurement to support economic analysis. METHODS: A virtual workshop and a modified Delphi panel with 10 health technology specialists followed a rapid evaluation of 110 technical documents and indexed publications. The recommendations are based on the proposition that has received the most votes, although contentious issues are addressed in the suggestion or discussion. The rationale for the final decision is included in the text. RESULTS: The consensus includes 50 recommendations with the following topics: Transparency and Reliability, Model Design, Conditions Under Which Generic Questionnaires Are Not Sensible or Valid, Utility Evidence Hierarchy, Utility Data Searching, Modeling Utility Values, Extrapolating Quality Adjusted Life-Years for Models With Lifetime Horizons, Caregiver Utility, Utility Data Synthesis, Quality/Certainty of the Evidence, and Utility Estimates in End-of-Life Conditions. CONCLUSIONS: The goal of this project is to create unified national standards for using utility metrics in economic analysis in Brazil. This set of recommendations is not obligatory, but it is meant to serve as a guide and lead to the development of better and more transparent economic models in the country.

The Development of a New International Generic Measure (EQ-HWB): Face Validity and Psychometric Stages in Argentina.

OBJECTIVES: This study aimed to present the face validity and psychometric stages performed in Spanish in Argentina, the only Spanish-speaking country of an international collaboration that undertook the construction of a new measure that can be used in economic evaluation across health, social care, and public health, the EQ EQ-HWB (EQ Health and Wellbeing). We also explored the relationship among 3-level version EQ-5D (EQ-5D-3L), 5-level version EQ-5D (EQ-5D-5L), and EQ-HWB. METHODS: Face validity was based on semistructured face to face interviews of a purposive sample to explore translatability of language and concepts of 97 candidate items, translated into Argentina Spanish. The psychometric evaluation using an online panel assessed the psychometric properties of 64 items that were carried forward (floor and ceiling effects, item correlations, known-group differences in relevant prespecified subgroups by the international and local teams, exploratory and confirmatory factor analysis, and item response theory). EQ-5D-3L, EQ-5D-5L, and EQ-HWB correlations were explored. RESULTS: In the face validity stage, 24 interviews with carers, general public, patients, and users of social services were included. Most items showed adequate face validity. In the psychometric assessment, 497 participants were recruited (64% reporting a long-term health condition). Most of the items showed adequate psychometrics in an Argentinian context. EQ-5D-3L and EQ-5D-5L had strong correlations, and EQ-HWB was moderately correlated to EQ visual analog scale. The Argentina team recommended 23 of the final 25 items. CONCLUSIONS: The assessment of Spanish items contributed to the overall development of EQ-HWB and helped inform the design of an internationally relevant 25-item and a short 9-item measure intended to be used in economic evaluations.

The addition of mirror therapy improved upper limb motor recovery and level of independence after stroke: a randomized controlled trial / A terapia do espelho melhora a recuperação motora do membro superior e o nível de independência após AVC: um ensaio clínico randomizado

Abstract Introduction In stroke survivors, the prevalence of upper motor disability remains high. There has not been much report on the success of post-stroke mirror therapy, especially in developing countries. Objective The focus of this research is to see how mirror therapy, in addition to standard rehabilitation for hand paresis, affects upper limb motor recovery and level of independence in self-care after stroke at an Indonesian teaching hospital. Method This was a randomized controlled trial with no assessor blinding. The study included 18 subacute stroke patients who did not have cognitive or visual impairment. The mirror group received a 20-minute mirror therapy session in addition to conventional rehabilitation, while the control group received only the standard program for 5 weeks (2 times per week). The Brunnstrom score and self-care level of independence elements of the Functional Independence Measure (FIM) were used as outcome measures. Results Baseline comparisons of lesion type and Brunnstrom score showed significant between-group differences. The ANACOVA test showed the difference had no effect on the FIM change in scores (P > 0.05). One patient (mirror group) was dropped out from the study. After 5 weeks (n=17), the mirror group showed improvement in both the Brunnstrom and FIM scores (P < 0.05) compared to the control group. Conclusions Mirror treatment improves upper limb motor recovery and level of independence in self-care after stroke when combined with standard hand paresis rehabilitation 2 times a week for 5 weeks.

Resumo Introdução Em sobreviventes de AVC, a prevalência de deficiência motora nos membros superiores permanece alta. Não há muitos relatos sobre o sucesso da terapia do espelho pós-AVC, especialmente em países em desenvolvimento. Objetivo O foco desta pesquisa é ver como a terapia do espelho, além da reabilitação padrão para paresia da mão, afeta a recuperação motora do membro superior e o nível de independência no autocuidado após o AVC em um hospital universitário da Indonésia. Método Ensaio clínico randomizado sem cegamento do avaliador. O estudo incluiu 18 pacientes com AVC subagudo que não tinham deficiência cognitiva ou visual. O grupo de espelho recebeu uma sessão de terapia de espelho de 20 minutos além da reabilitação convencional, enquanto o grupo de controle recebeu apenas o programa padrão por 5 semanas (2 vezes por semana). O escore de Brunnstrom e os elementos do nível de independência do autocuidado da Medida de Independência Funcional (MIF) foram usados ​​como medidas de desfecho. Resultados As comparações da linha de base do tipo de lesão e do escore de Brunnstrom mostraram diferenças significativas entre os grupos. O teste ANACOVA mostrou que a diferença não teve efeito na mudança da MIF nos escores (P> 0,05). Um paciente (grupo espelho) foi retirado do estudo. Após 5 semanas (n = 17), o grupo espelho mostrou melhora em ambos os escores de Brunnstrom e FIM (P <0,05) em comparação com o grupo de controle. Conclusão O tratamento com espelho melhora a recuperação motora dos membros superiores e o nível de independência no autocuidado após o AVC quando combinado com a reabilitação de paresia de mão padrão 2 vezes por semana durante 5 semanas.

Cost-Effectiveness Analysis of Prostate Cancer Screening in Brazil.

INTRODUCTION: Prostate cancer is one of the most common malignancies among men worldwide. Prostate-specific antigen (PSA) screening shows uncertain benefits and harms from clinical and economic perspectives, resulting in an important impact on healthcare systems. Because of nonstandardized studies and substantial differences among populations, data are still inconclusive. OBJECTIVE: The objective of this study was to carry out long-term cost-effectiveness and cost-utility analysis on the PSA-screened population from the service provider's perspective in the Brazilian population. METHODS: We performed a cost-effectiveness and cost-utility analysis using clinical outcomes obtained from 9692 men enrolled in the PSA screening program. Prostate cancer treatments, 5-year follow-up outcomes, and all related costs were examined. Data were compared with a nonscreened prostate cancer population to calculate incremental cost-effectiveness ratio (ICER) and incremental cost-utility ratio (ICUR). ICER and ICUR were compared with the Brazilian-established willingness-to-pay (WTP) threshold (WTP = R$ 114 026.55). RESULTS: A total of 251 of 9692 men had a diagnosis of prostate cancer (2.6%), of which 90% had localized disease. Two hundred and five patients were treated as follows: surgery (45.37%); radiation therapy (11.22%); radiation plus androgen deprivation therapy (21.95%); active surveillance (13.17%); exclusive androgen deprivation therapy (7.32%); and watchful waiting (0.98%). Two simulated cohorts were compared based on screening and nonscreening groups. Values obtained were-ICER of R$ 44 491.39 per life saved and ICUR of R$ 10 851.56 per quality-adjusted life year (QALY) gained-below the Brazilian WTP threshold and showed cost-effectiveness and cost-utility advantages. CONCLUSION: According to the Brazilian WTP, PSA screening is a cost-effective policy from a hospital and long-term perspective and should have more standardized studies developed in different populations and economies.

International cost-effectiveness analysis evaluating endoscopic screening for gastric cancer for populations with low and high risk.

BACKGROUND: Gastric cancer remains one of the 3 most common causes of cancer death worldwide. Understanding the health and economic factors that affect screening cost-effectiveness in different countries will help address when and where it makes most sense to screen for gastric cancer. METHODS: We performed a cost-effectiveness analysis using a Markov model to compare screening and surveillance strategies for gastric cancer in Brazil, France, Japan, Nigeria, and the United States. Primary outcome was the incremental cost-effectiveness ratio. We then performed a sensitivity analysis to determine how each variable affected the overall model. RESULTS: In all countries, the most cost-effective strategies, measured by incremental cost-effectiveness ratio relative to no screening, were screening every 10 years, surveillance of high- and low-risk patients every 5 and 10 years, respectively, and screening every 5 years. Only Japan had at least one cost-effective screening strategy. The most important variables across different screening strategies and countries were starting age of screening, cost of endoscopy, and baseline probability of local gastric cancer at time of diagnosis. CONCLUSIONS: Our model suggests that screening for gastric cancer is cost-effective in countries with higher incidence and lower costs of screening, but screening may still be a viable option in high-risk populations within low incidence countries.

Cost-Effectiveness of Secukinumab Versus Other Biologics in the Treatment of Psoriatic Arthritis: An Argentinean Perspective.

OBJECTIVE: Psoriatic arthritis (PsA) is a chronic, systemic inflammatory disease. This study assessed the cost-effectiveness of secukinumab, an interleukin-17A inhibitor, versus other biologics in PsA from the Argentinean social security perspective. METHODS: A semi-Markov model evaluated subcutaneous (sc) treatment with secukinumab 150 mg and 300 mg against other sc treatments such as adalimumab, certolizumab pegol, etanercept, golimumab, ustekinumab, and intravenous treatment infliximab in biologic-naïve (with or without moderate to severe psoriasis) and biologic-experienced PsA patients over a lifetime horizon. Response to treatments was determined using the PsA Response Criteria (PsARC) at 12 weeks. Model inputs were derived from randomized controlled trials, network meta-analyses, published literature, and other Argentinean sources. Model outcomes included quality-adjusted life years (QALYs) gained and incremental cost-effectiveness ratios. Sensitivity analyses and alternative scenarios with a higher cost option were also conducted. RESULTS: Among biologic-naïve PsA patients without psoriasis, secukinumab 150 mg provided the highest QALYs (7.18) versus all sc biologics at the lowest cost ($3 755 678 Argentine peso), thus dominating them. Among biologic-naïve PsA patients with psoriasis and biologic-experienced PsA patients, secukinumab 300 mg provided highest QALYs (6.99 and 7.53, respectively), dominated infliximab, and was cost-effective versus other sc biologics. Deterministic sensitivity analyses indicated sensitivity of results to variation in PsARC rates, drug acquisition costs, Health Assessment Questionnaire change, and utilities. A probabilistic sensitivity analysis showed maximum net monetary benefits with both secukinumab doses. Results from an alternative scenario analysis were similar to base-case analysis. CONCLUSIONS: For both biologic-naïve and experienced PsA patients, secukinumab is either a dominant or cost-effective treatment option compared with other biologics in Argentina.

Measuring the Benefits of Healthcare: DALYs and QALYs - Does the Choice of Measure Matter? A Case Study of Two Preventive Interventions.

BACKGROUND: The measurement of health benefits is a key issue in health economic evaluations. There is very scarce empirical literature exploring the differences of using quality-adjusted life years (QALYs) or disability-adjusted life years (DALYs) as benefit metrics and their potential impact in decision-making. METHODS: Two previously published models delivering outputs in QALYs, were adapted to estimate DALYs: a Markov model for human papilloma virus (HPV) vaccination, and a pneumococcal vaccination deterministic model (PNEUMO). Argentina, Chile, and the United Kingdom studies were used, where local EQ-5D social value weights were available to provide local QALY weights. A primary study with descriptive vignettes was done (n = 73) to obtain EQ-5D data for all health states included in both models. Several scenario analyses were carried-out to evaluate the relative importance of using different metrics (DALYS or QALYs) to estimate health benefits on these economic evaluations. RESULTS: QALY gains were larger than DALYs avoided in all countries for HPV, leading to more favorable decisions using the former. With discounting and age-weighting - scenario with greatest differences in all countries - incremental DALYs avoided represented the 75%, 68%, and 43% of the QALYs gained in Argentina, Chile, and United Kingdom respectively. Differences using QALYs or DALYs were less consistent and sometimes in the opposite direction for PNEUMO. These differences, similar to other widely used assumptions, could directly influence decision-making using usual gross domestic products (GDPs) per capita per DALY or QALY thresholds. CONCLUSION: We did not find evidence that contradicts current practice of many researchers and decision-makers of using QALYs or DALYs interchangeably. Differences attributed to the choice of metric could influence final decisions, but similarly to other frequently used assumptions.

Economic value of treating lumbar disc herniation in Brazil.

OBJECT: Lumbar discectomy is one of the most common surgical spine procedures. In order to understand the value of this surgical care, it is important to understand the costs to the health care system and patient for good results. The objective of this study was to evaluate for the first time the cost-effectiveness of spine surgery in Latin America for lumbar discectomy in terms of cost per quality-adjusted life year (QALY) gained for patients in Brazil. METHODS: The authors performed a prospective cohort study involving 143 consecutive patients who underwent open discectomy for lumbar disc herniation (LDH). Patient-reported outcomes were assessed utilizing the SF-6D, which is derived from a 12-month variation of the SF-36. Direct medical costs included medical reimbursement, costs of hospital care, and overall resource consumption. Disability losses were considered indirect costs. A 4-year horizon with 3% discounting was applied to health-utilities estimates. Sensitivity analysis was performed by varying utility gain by 20%. The costs were expressed in Reais (R$) and US dollars ($), applying an exchange rate of 2.4:1 (the rate at the time of manuscript preparation). RESULTS: The direct and indirect costs of open lumbar discectomy were estimated at an average of R$3426.72 ($1427.80) and R$2027.67 ($844.86), respectively. The mean total cost of treatment was estimated at R$5454.40 ($2272.66) (SD R$2709.17 [$1128.82]). The SF-6D utility gain was 0.044 (95% CI 0.03197-0.05923, p = 0.017) at 12 months. The 4-year discounted QALY gain was 0.176928. The estimated cost-utility ratio was R$30,828.35 ($12,845.14) per QALY gained. The sensitivity analysis showed a range of R$25,690.29 ($10,714.28) to R$38,535.44 ($16,056.43) per QALY gained. CONCLUSIONS: The use of open lumbar discectomy to treat LDH is associated with a significant improvement in patient outcomes as measured by the SF-6D. Open lumbar discectomy performed in the Brazilian supplementary health care system provides a cost-utility ratio of R$30,828.35 ($12,845.14) per QALY. The value of acceptable cost-effectiveness will vary by country and region.

Cost-Effectiveness of Radiofrequency Ablation for Supraventricular Tachycardia in Guatemala: Patient Outcomes and Economic Analysis from a Low- to Middle-Income Country.

BACKGROUND: Radiofrequency ablation (RFA) is an established but expensive treatment alternative for many forms of supraventricular tachycardia (SVT). Currently, no studies exist on the cost-effectiveness of RFA compared with that of medical treatment (MT) in adult Latin American population. METHODS: Between 2007 and 2012, we identified 103 adults who underwent RFA for SVT in the National Unit of Cardiovascular Surgery (Unidad Nacional de Cirugía Cardiovascular [UNICAR]) in Guatemala. A decision tree was developed with all clinical outcome parameter estimates obtained from the Adult Electrophysiology Clinic. Cost data were obtained from UNICAR's administration. A cost-effectiveness analysis that evaluated costs and quality-adjusted life-years to compare interventions in terms of their incremental cost-effectiveness ratios was conducted. RESULTS: The first RFA had an 83% success rate, and a cumulative success rate of 94% was achieved with a second. The cost of the RFA procedure itself was $5411. RFA gained 1.46 quality-adjusted life-years and saved $7993 compared with MT for patients with SVT. This demonstrates that in Guatemala, RFA dominates MT in the management of SVT. Using assumptions based largely on the outcomes in UNICAR, we found that RFA is highly cost-effective. This is a consistent finding, even after varying assumptions about efficacy, complication rates, and quality of life. CONCLUSIONS: RFA dominates MT by improving quality of life and reducing expenditures when used to treat patients with severe symptoms of SVT in Guatemala. The robustness of these finding to variations in parameter assumptions suggests that these findings may hold in other similar settings.

Systematic review of the cost-effectiveness of the vaccination against HPV in Brazil.

In Brazil, almost 16,000 new cases of cervical cancer (CC), the type of neoplasia that claims the more lives of young women than any other, are expected in 2014. Although the vaccine against HPV has been developed, the application of this strategies to large populations is costly, and its use in Brazil is limited. Studies of the economic implications of new preventive technologies for CC may support rational and evidence-based decisions in public health. A systematic search of articles published between 2000 and 2014 was conducted using MEDLINE, EMBASE, the Cochrane Collaboration of Systematic Reviews, and LILACS. The aim of this search was the identification of original articles that evaluated the cost-effectiveness of vaccination against HPV in Brazil. A total of 6 articles are included in this review, evaluating the addition of a vaccine against HPV in comparison to population screening. Although the vaccine against HPV increases the cost of preventing cervical cancer, this new preventive technology presents favorable cost-effectiveness profiles in the case of Brazil. Failure to utilize the newly available preventative technologies against CC can lead to misguided and perverse consequences in a country in which programs based on the Papanicolaou test have been only partially successful.

Results from a preliminary study to develop the quality adjustments for quality adjusted life year values for Trinidad and Tobago / Resultados de un estudio preliminar para desarrollar ajustes de calidad para los valores de un año de vida ajustado por calidad en Trinidad y Tobago

OBJECTIVE: No country can afford to provide all necessary healthcare for its citizens, so prioritization among interventions must feature in all health systems. Resources in health should be allocated among interventions/facilities/patients in such a way as to be in line with the objectives of the health system. To achieve this, resource allocation decisions must be informed by the relative contributions that prospective interventions will make to societal health and to costs. Internationally, the EQ-5D based quality adjusted life year (QALY) now dominates this kind of analysis. This paper reports on a pilot study to develop an EQ-5D-3L value set for Trinidad and Tobago based on a protocol that avoids some of the issues that are associated with other approaches to developing such value sets such as the complex elicitation tasks that respondents must carry out, and the large respondent samples required for collecting multiple valuation subset values using blocked designs. METHODS: An orthogonal discrete choice experiment design was used to elicit a set of choices from a sample of respondents. RESULTS: The choice data were analysed using mixed multinomial logistic regression to produce an internally valid model that predicts well. CONCLUSION: This paper marks an important milestone in the development of health resource allocation in the Caribbean. It sets out the importance of incorporating the impact of health interventions to inform health resource allocation decisions, describes the elicitation and analysis methods used in the pilot and provides an illustration ofthe use ofthe EQ-5D value set.

OBJETIVO: Ningún país puede permitirse ofrecer toda la atención a la salud necesaria para sus ciudadanos, de modo que la necesidad de establecer prioridades en las intervenciones constituye un rasgo característico de todos los sistemas de salud. Los recursos de salud deben asignarse entre las intervenciones/instalaciones/pacientes de tal manera que se correspondan con los objetivos del sistema de salud. Para lograr esto, las decisiones en cuanto a la asignación de recursos deben reportarse en términos de las contribuciones relativas que las intervenciones prospectivas representarán para la salud social y los costos. Internacionalmente, el EQ - 5D basado en el año de vida ajustado por calidad (AVAC), domina ahora este tipo de análisis. El presente trabajo reporta un estudio piloto para desarrollar un conjunto de valores EQ - 5D - 3L para Trinidad y Tobago, basado en un protocolo que evite algunos de los problemas asociados con otros enfoques usados para desarrollar estos conjuntos de valores, tales como tareas complejas de obtención de datos, que los encuestados tienen que llevar a cabo, y las grandes muestras de respuestas requeridas para recoger varios subconjuntos de valoración múltiple utilizando diseños bloqueados. MÉTODOS: Un diseño de experimento de elección discreta ortogonal se utiliza para obtener un conjunto de opciones de una muestra de encuestados. RESULTADOS: Los datos de la elección se analizaron mediante regresión logística multinomial mixta para producir un modelo internamente válido que predice bien. CONCLUSION: Este documento marca un hito importante en el desarrollo de la asignación de recursos de salud en el Caribe. El mismo establece la importancia de incorporar el impacto de las intervenciones de salud para informar las decisiones de asignación de recursos de salud, describe los métodos de obtención y análisis utilizados en el programa piloto, y proporciona una ilustración del uso del conjunto de valores EQ - 5D.

Costo-utilidad del trasplante renal frente a la hemodiálisis en el tratamiento de la insuficiencia renal crónica terminal en un hospital peruano / Cost utility of renal transplant vs. hemodialysis in the treatment of end stage chronic kidney failure in a peruvian hospital

Objetivos. Determinar y comparar las razones de costo-utilidad de los trasplantes renales con donante cadavérico (TRDC) practicados en el Hospital Nacional Guillermo Almenara Irigoyen los años 2000-2001, frente a hemodiálisis (HD), cinco años después del inicio del tratamiento. Material y métodos. Se realizó un estudio de costo utilidad, estudiando a todos los pacientes continuadores cinco años post TRDC, a quienes se asignó como controles, dos pacientes con cinco años de HD pareados por edad, sexo y tiempo de enfermedad. Se evaluaron los costos de cada procedimiento, los años de vida ajustados a la calidad (AVAC) utilizando el cuestionario SF-36v2TM y se calcularon las razones de costo utilidad (CU) y costo utilidad incremental (CUI). Resultados. Se realizaron 58 TRDC los años 2000-2001. Cinco años después, 17 (29 por ciento) pacientes fallecieron y 27 (47 por ciento) continuaron con su tratamiento post-TRDC. Treinta y uno (53 por ciento) TRDC fracasaron; 26 por ciento por rechazo al trasplante, 55 por ciento por complicación y 19 por ciento por tratamiento irregular. Los puntajes SF-36v2TM promedio obtenidos por los TRDC y HD fueron 95±13 y 87±18 puntos respectivamente. En ambos años, los AVAC obtenidos por los TRDC y HD fueron de 251 y 229 puntos respectivamente; las razones de CU para los TRDC y los HD fueron de USD 11 984 y USD 9243, y la razón de CUI fue de USD 40 669. Conclusiones. Los TRDC realizados los años 2000-2001, cinco años después resultaron menos costo útiles que las HD; y los TRDC realizados el 2000 tuvieron una menor razón de costo utilidad incremental que los efectuados el 2001, probablemente por su mayor razón de tratamientos irregulares.

Objectives. To assess and compare the cost utility of the cadaveric donor renal transplant (CDRT) at the Hospital Nacional Guillermo Almenara Irigoyen between 2000 to 2001, against haemodialysis (HD), 5 years after treatment initiation. Materials and Methods. A cost utility study design was used, which evaluated every patient continuing treatment after 5 years of having the CDRT done, and 2 controls consisting in patients having received HD for 5 years, matched by age, sex and disease duration. The costs of each procedure and their Quality-adjusted life years (QALY´s) were evaluated using the questionnaire of quality of life SF-36v2TM, finally calculating the cost utility (CU) and incremental cost utility (ICU) ratios. Results. Fifty-eight CDRT were performed between 2000-1. Five years later, 17 (29 percent) patients died and only 27 (47 percent) continued the treatment after CDRT. Out of the 31 patients (53 percent) having treatment failures, 26 percent rejected the transplant, 55 percent presented a complication and 19 percent were irregular. The mean SF-36v2TM scores obtained by the CDRT and HD patients were 95±12 and 87±18 points, respectively. The QALYs obtained by the CDRT and HD groups were 251 and 229 points, respectively; the CU ratios for the CDRT and HD were USD 11,984 and USD 9,243; and the ICU ratio for the period was USD 40,669. Conclusions. CDRTs performed during the years 2000-1 at the HNGAI, were 5 years later surprisingly less cost effective than the HD and CDRT´s performed at year 2000 had a lower incremental cost utility ratio that those performed the 2001, probably because of the highest rate of irregular treatment.