The Economic Analyses of the Drosophila suzukii's Invasions: A Mini-review.

The objective of this paper is to bring to the fore the type of economic analyses that have been carried out on the invasion of the Drosophila suzukii Matsumura (Diptera: Drosophilidae) and what has been learned. The analysis is limited to the original research articles published in peer-reviewed journals and book chapters. A total of 20 relevant studies are identified. The studies are analysed based on their main purpose, which is either economic impact assessment or economic evaluation of management programmes. The analysis also considers the key methodological points highlighted in recent reviews of the economic literature on alien invasive species. Over time, the focus of these studies has gradually shifted from raising awareness of the magnitude of the impact, particularly on agricultural production, to supporting the decision-making process concerning effective pest management. Most studies have been conducted from a private perspective, measuring private costs and providing guidance to the industry. However, some papers include, or focus on, the societal costs caused by the invasions of D. suzukii. This review has found few impact studies in the recently invaded areas and no economic evaluation of management programmes. There are not only geographical areas, but also themes that need more attention and analysis in the economic studies on D. suzukii. Assessing the economic effectiveness of integrated pest management programmes in specific settings, included the Latin American countries, is crucial.

Lean methodology: contributions to improving work processes in health and nursing / Metodología Lean: aportes a la mejora de los procesos de trabajo en salud y enfermería / Metodologia Lean: contribuições para melhoria dos processos de trabalho em saúde e enfermagem

ABSTRACT Objective: to investigate the contributions of applying the Lean methodology to improve work processes in health and nursing and its impact on associated financial aspects. Method: an integrative review, carried out in six databases, whose sample of ten (100.0%) studies was analyzed and summarized descriptively. Results: the outcomes obtained were stratified into: benefits/barriers to Lean Healthcare implementation; economic aspects involving Lean Healthcare implementation; and process improvements through Lean Healthcare implementation. The majority of studies (60.0%) were carried out in university hospitals, contexts that need to continually improve the quality of services provided, generally with scarce and limited resources, which support the viability of maintaining the teaching, research and extension tripod. Conclusion: three (30.0%) studies highlighted the financial aspects associated with Lean methodology application. The others only mentioned the possibility of financial gains through improving processes and reducing waste.

RESUMEN Objetivo: investigar las contribuciones de la aplicación de la metodología Lean a la mejora de los procesos de trabajo en salud y enfermería y su impacto en los aspectos financieros asociados. Método: revisión integradora, realizada en seis bases de datos, cuya muestra de diez (100,0%) estudios fue analizada y resumida de forma descriptiva. Resultados: los resultados obtenidos se estratificaron en: beneficios/barreras para la implementación de Lean Healthcare; aspectos económicos que implican la implementación de Lean Healthcare; y mejoras de procesos mediante la implementación de Lean Healthcare. La mayoría de los estudios (60,0%) se realizaron en hospitales universitarios, contextos que necesitan mejorar continuamente la calidad de los servicios prestados, generalmente con recursos escasos y limitados, que sustentan la viabilidad de mantener el trípode de docencia, investigación y extensión. Conclusión: tres (30,0%) estudios destacaron los aspectos financieros asociados a la aplicación de la metodología Lean. Los demás solo mencionaron la posibilidad de obtener ganancias financieras mejorando los procesos y reduciendo el desperdicio.

RESUMO Objetivo: investigar as contribuições da aplicação da metodologia Lean para melhoria dos processos de trabalho em saúde e enfermagem e sua repercussão nos aspectos financeiros associados. Método: revisão integrativa, realizada em seis bases de dados, cuja amostra de dez (100,0%) estudos foi analisada e sintetizada descritivamente. Resultados: os desfechos obtidos foram estratificados em: benefícios/barreiras para implantação do Lean Healthcare; aspectos econômicos envolvendo a implantação do Lean Healthcare; e melhorias em processos por meio da implantação do Lean Healthcare. A maioria dos estudos (60,0%) foi realizada em hospitais universitários, contextos que precisam melhorar, continuamente, a qualidade dos serviços prestados, geralmente com recursos escassos e limitados, os quais sustentam a viabilidade da manutenção do tripé ensino, pesquisa e extensão. Conclusão: três (30,0%) estudos evidenciaram os aspectos financeiros associados à aplicação da metodologia Lean. Os demais apenas mencionaram a possibilidade de ganhos financeiros por meio da melhoria de processos e redução de desperdícios.

Análisis de costo-efectividad de los cuidados paliativos a pacientes oncológicos de fin de vida / Cost-effectiveness analysis of palliative care of cancer patients in the end of life / Análise de custo-efetividade dos cuidados paliativos de pacientes oncológicos na terminalidade da vida

En pacientes con enfermedad terminal, los servicios de cuidados paliativos domiciliarios pueden alinear sus preferencias de cuidado en domicilio con resultados sanitarios deseables. El objetivo fue estudiar la costo-efectividad de los cuidados paliativos domiciliarios en pacientes oncológicos en el último año de vida en el subsector público de salud de una provincia argentina. Se desarrolló un modelo de Markov de costo-efectividad desde una perspectiva social y del financiador de salud, de modo que el mismo pudiera reflejar la realidad de los cuidados paliativos domiciliarios en el ámbito local, en comparación con los cuidados habituales. Se calcularon los costos directos para el sistema de salud, con base en información local, así como también los costos indirectos de los cuidados informales no remunerados. La provisión de cuidados paliativos incrementó en un 10,32% la probabilidad que los pacientes fallezcan en el hogar, en relación con los cuidados habituales, con un ahorro anual de USD 750 y USD 1.012 por paciente desde la perspectiva social y del financiador, respectivamente, en el subsector público de salud de Río Negro. Tanto desde la perspectiva social como del financiador, la estrategia de implementación de un servicio organizado de cuidados tiene una mayor efectividad, medida en porcentaje de pacientes que fallecen en su domicilio, a un menor costo. El principal inductor de costos corresponde, desde la perspectiva social, a los cuidados informales provistos por las familias, mientras que desde la perspectiva del financiador corresponde a los salarios del personal de salud.

Home palliative care services of terminal patients may associate home care preferences with desirable health outcomes. This study aimed to evaluate the cost-effectiveness of home palliative care of cancer patients in the last year of life in the public health subsector in a province of Argentina. A cost-effectiveness Markov model was developed from a social and the health funder's perspective in order to reflect the reality of home palliative care at the local level compared with usual care. Direct costs to the health system and indirect costs of unpaid informal care were estimated based on local information. Palliative care increased the likelihood of patients dying at home by 10.32% compared with usual care, with annual savings of USD 750 and USD 1,012 per patient, respectively, from both the social and the funder's perspective in the public health subsector in Río Negro. From both the social and financial perspective, the strategy to implement organized care services was more effective and lower-cost, measured by the percentage of patients who died at home. From a social perspective, the main cost inducer was the formal care provided by families, but from the funder's perspective, it refers to the salaries of the health team.

Os serviços de cuidados paliativos domiciliares de pacientes terminais podem associar as preferências de cuidado domiciliar com resultados desejáveis de saúde. O objetivo deste texto foi avaliar a relação custo-efetividade dos cuidados paliativos domiciliares em pacientes oncológicos no último ano de vida, no subsetor de saúde pública de uma província na Argentina. Um modelo Markov de custo-efetividade foi desenvolvido a partir de uma perspectiva social e do financiador de saúde para que pudesse refletir a realidade dos cuidados paliativos domiciliares em âmbito local comparado aos cuidados habituais. Os custos diretos para o sistema de saúde e os custos indiretos de cuidados informais não remunerados foram calculados com base em informações locais. A prestação de cuidados paliativos aumentou 10,32% a probabilidade de os doentes morrerem em casa em relação com os cuidados habituais, com uma economia anual de USD 750 e USD 1.012 por paciente, respetivamente, na perspectiva social e do financiador, no subsetor da saúde pública de Rio Negro. Tanto do ponto de vista social como no financeiro, a estratégia de implantação de serviços de cuidados organizados foi mais eficaz e com menor custo, medida pelo percentual de pacientes que faleceram em casa. O principal indutor de custos corresponde, do ponto de vista social, aos cuidados informais prestados pelas famílias, enquanto do ponto de vista do financiador se refere aos salários da equipe de saúde.

Measuring the overall cost efficiency of water companies and its determinants: an empirical study of stochastic frontier models.

Several methodological approaches have been applied to evaluate the performance of water companies for regulatory purposes. Performance assessment involving a long-time period is relevant to consider the heterogeneity of the water companies as many changes might have occurred across years. In this study, we applied three different parametric models to estimate cost efficiency scores for a sample of English and Welsh water companies over the years 1991-2018. Two out of three models employed allowed us to decompose overall cost efficiency (OCE) into persistent and transient cost efficiency, i.e. allow identifying the drivers of OCE. The assessment covered six price reviews, and therefore, OCE estimations were linked with water industry regulation. Results revealed that OCE scores are sensitive to model specification as the average values for models 1, 2 and 3 were 0.959, 0.514 and 0.669, respectively. Nevertheless, the three models converge in identifying the source of raw water as an environmental variable affecting OCE. Cost efficiency estimations evidenced that price reviews conducted in 1999 and 2004 were challenging for water companies as OCE scores decreased. The opposite effect was identified for the subsequent price reviews. Beyond the estimated OCE score for the empirical application carried out, this study highlights the importance of selecting robust and adequate methods to evaluate the performance of water companies considering the main objective of such evaluation.

Evidências científicas sobre custos em saúde: estudo bibliométrico / Evidencias científicas sobre costos en salud: estudio bibliométrico / Scientific evidence about health costs: bibliometic study

RESUMO Objetivo: Analisar as evidências científicas disponíveis sobre custos em saúde publicados em bases de dados nacionais e uma biblioteca virtual por enfermeiros brasileiros. Método: Trata-se de análise bibliométrica das publicações de enfermeiros brasileiros acerca dos custos em saúde, sem limite temporal de busca, em diferentes idiomas, indexadas em bases de dados nacionais e em uma biblioteca virtual, são elas: Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Base de Dados de Enfermagem (BDENF), e Scientific Eletronic Library online (SciELO), respectivamente. Resultados: Segundo a análise, identificaram-se 212 artigos publicados em periódicos brasileiros, no período de 1983 a 2022. Destes, a maioria foi desenvolvida na Região Sudeste, com destaque para maior número de publicações em 2015. Houve maior frequência de publicação em seis periódicos, com predomínio na Revista da Escola de Enfermagem da Universidade de São Paulo com 33 artigos sobre custos em saúde. Destaca-se que 64,2% das publicações direcionaram-se às ações em serviços de alta complexidade. Conclusão: A interpretação dos dados permitiu expor que, apesar do baixo número de publicações no decorrer dos anos de 1980 a 1990, a partir de 2006 é expressivo o crescimento da produção científica brasileira quanto aos custos em saúde, demonstrando a possibilidade de acesso e interesse dos enfermeiros para entender as ferramentas da gestão de custos imbricados no processo de trabalho da enfermagem, o que pode otimizar a gestão financeira dos serviços de saúde.

RESUMEN Objetivo: analizar las evidencias científicas disponibles sobre costos en salud publicados en bases de datos nacionales y una biblioteca virtual por enfermeros brasileños. Método: se trata de análisis bibliométrico de las publicaciones de enfermeros brasileños acerca de los costos en salud, sin límite temporal de búsqueda, en diferentes idiomas, indexadas en bases de datos nacionales y en una biblioteca virtual, son ellas: Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS), Base de Dados de Enfermagem (BDENF), y Scientific Eletronic Library Online (SciELO), respectivamente. Resultados: según el análisis, se identificaron 212 artículos publicados en revistas brasileñas, en el período de 1983 a 2022. De estos, la mayoría fue desarrollada en la Región Sudeste de Brasil, con destaque para mayor número de publicaciones en 2015. Hubo mayor frecuencia de publicación en seis revistas, con predominio en la Revista da Escola de Enfermagem de la Universidad de São Paulo con 33 artículos sobre costos en salud. Se destaca que el 64,2% de las publicaciones se dirigieron a las acciones en servicios de alta complejidad. Conclusión: la interpretación de los datos permitió exponer que, a pesar del bajo número de publicaciones a lo largo de los años 1980 a 1990, a partir de 2006 es expresivo el crecimiento de la producción científica brasileña en cuanto a los costos en salud, demostrando la posibilidad de acceso e interés de los enfermeros para entender las herramientas de la gestión de costos presentes en el proceso de trabajo de la enfermería, lo que puede optimizar la gestión financiera de los servicios de salud.

ABSTRACT Objective: To analyze available scientific evidence on healthcare costs published in national databases and in a virtual library by Brazilian nurses. Method: This is a bibliometric analysis of publications by Brazilian nurses about health costs, with no search time limit, in different languages, indexed in national databases and in a virtual library, namely: Latin American and Caribbean Literature in Health Sciences (LILACS), Base de Dados de Enfermagem (BDENF), and Scientific Electronic Library online (SciELO), respectively. Results: According to the analysis, 212 articles published in Brazilian journals were identified, from 1983 to 2022. Of these, most were developed in the Southeast Region, with emphasis on the greater number of publications in 2015. There was a higher frequency of publication in six journals, with predominance in Revista da Escola de Enfermagem of the University of São Paulo with 33 articles on health costs. It is noteworthy that 64.2% of publications were directed to actions in highly complex services. Conclusion: The interpretation of the data allowed exposing that, despite the low number of publications over the years 1980 to 1990, from 2006 onwards, the growth of Brazilian scientific production regarding health costs is significant, demonstrating the possibility of access and interest of nurses to understand the cost management tools embedded in the nursing work process, which can optimize the financial management of health services.

IUI needs fairer appraisal to improve patient and stakeholder choices.

Information supporting IVF at the expense of intrauterine insemination (IUI) has become commonplace, but it lacks critical analyses. Data from poorly practiced IUI, without an equivalent comparison to IVF, has been generalised to recommend a total abandonment of IUI in favour of IVF treatment. Our intention with this paper is to reappraise and balance arguments so that patients and stakeholders can have an unbiased informed choice. We provide information that reveals IUI to predominate over IVF in terms of integrated success, risks and cost to deliver one live birth whilst obviating the maternal and neonatal costs. Exceptional cost savings are demonstrated for IUI over IVF for fee-paying agencies and patients with lowered risks of maternal and neonatal care along with other risks including OHSS, fetal reduction and termination of pregnancies. This analysis supports the view that patients and stakeholders can choose IUI instead of IVF in most instances, except with bilateral tubal blockage and severe male factor infertility. It is apparent that fertility clinics need to re-evaluate and reconsider this field, and IUI can be of benefit to both subfertile patients and the stakeholders.

Retinal exams requested at Primary Care Unit: indications, results and alternative strategies of evaluation / Exames de retina solicitados em Unidades Básicas de Saúde: indicações, resultados e estratégias alternativas de avaliação

ABSTRACT Objective To evaluate indications, results and strategy of retinal exams requested at Primary Care Units. Methods A retrospective study that analyzed the indications and results of retinal exams, in the modalities clinical dilated fundus exams and color fundus photographs. In the following situations, patients were considered eligible for color fundus photographs if visual acuity was normal and ocular symptoms were absent: diabetes mellitus and/or hypertension, in use of drugs with potential retinal toxicity, diagnosis or suspicion of glaucoma, stable and asymptomatic retinopathies, except myopia greater than -3.00 diopters. Results A total of 1,729 patients were evaluated (66% female, age 63.5±15.5 years), and 1,190 underwent clinical dilated fundus exam and 539 underwent color fundus photographs. Diabetes was present in 32.2%. The main indications were diabetes (23.7%) and glaucoma evaluation (23.5%). In 3.4% of patients there was no apparent indication. The main results were a large cup/disc ratio (30.7%) and diabetic retinopathy (13.2%). Exam was normal in 9.6%, detected peripheral changes in 7% and could not be performed in 1%. Considering patients eligible for fundus photographs (22.4%), more than half underwent clinical dilated fundus exams. Conclusion Regarding exam modality, there were no important differences in the distribution of indications or diagnosis. Color fundus photograph is compatible with telemedicine and more cost-effective, and could be considered the strategy of choice in some scenarios. Since there are no clear guidelines for retinal exams indications or the modality of choice, this study may contribute to such standardization, in order to optimize public health resources.

RESUMO Objetivo Avaliar as indicações, os resultados e a estratégia de exames de retina solicitados em Unidades Básicas de Saúde. Métodos Estudo retrospectivo no qual foram analisados as indicações e os resultados de exames de retina, nas modalidades mapeamento de retina e retinografia. Em casos de boa acuidade visual e sintomas oculares ausentes, foram considerados elegíveis para avaliação por retinografia: pacientes com diabetes mellitus e/ou hipertensão arterial sistêmica, em uso de medicação com potencial toxicidade retiniana, diagnóstico ou suspeita de glaucoma, e retinopatias estáveis e assintomáticas, exceto miopia maior que -3,00 dioptrias. Resultados Foram avaliados 1.729 pacientes (66% do sexo feminino, idade 63,5±15,5 anos). Destes, 1.190 realizaram mapeamento de retina e 539 realizaram retinografia. Diabetes estava presente em 32,2%. As principais indicações para solicitação do exame foram diabetes (23,7%) e investigação de glaucoma (23,5%). Em 3,4%, não havia indicação aparente. Os principais resultados foram aumento da escavação papilar (30,7%) e retinopatia diabética (13,2%). O exame foi normal em 9,6%; detectou alterações periféricas em 7%; e sua realização foi impossível em 1%. Dos pacientes elegíveis para retinografia (22,4%), mais da metade foi submetida ao mapeamento de retina. Conclusão Não houve diferenças importantes nas distribuições de indicações ou diagnósticos em relação à modalidade de exame. A retinografia, compatível com telemedicina e mais custo-efetiva, pode ser considerada a modalidade de escolha em determinadas situações. Na ausência de consenso quanto às indicações para a solicitação de exames da retina ou sua modalidade, este estudo pode contribuir para tal padronização, de modo a otimizar recursos do sistema público de saúde.

Value-based medicine and palliative care: how do they converge?

Introduction: Sick persons need doctors who understand their pathology, know how to treat their problem, and accompany them through their illness. This study aimed to synthesize the state of knowledge regarding the concept of value-based medicine (VBM) through an integrative literature review, and establish how VBM can be applied in palliative care. Areas covered: An integrative review was conducted with the keywords 'value-based medicine,' 'patient-centered care,' and 'medicina baseada em valor' (Portuguese for VBM) in PubMed and Virtual Health Library, identifying 17,189 articles in total. Of these, 10 articles met the eligibility criteria. VBM combines the highest level of technical-scientific data with patients' values. It is defined as the combination of evidence-based medicine, patient-centered care, and cost-effectiveness. Patients' values are a set of preferences, concerns, and expectations that contribute toward accommodating their needs in the treatment clinic. Expert opinion: Like VBM, palliative care focuses on patients' values and quality of life, respecting natural limits. The early development of a care plan with active participation of the patient in the face of life-threatening diseases should be encouraged and can bring peace and comfort in a person's final moments.

Análise custo-efetividade de antimicrobianos usados em pacientes infectados por Klebsiella Pneumoniae Carbapenemase / Cost-effectiveness analysis of antimicrobials used in patients infected with Klebsiella Pneumoniae Carbapenemase

Introdução: A infecção por Klebsiella pneumoniae produtora de carbapenemase vem aumentando ao longo dos últimos anos a nível mundial, necessitando do uso de antimicrobianos de última geração. No entanto, o uso destes antimicrobianos e da terapia associada durante a infecção eleva o custo do tratamento sem impactar no aumento da efetividade do mesmo. Objetivo: Realizar análise custo-efetividade de antimicrobianos usados no tratamento de pacientes infectados por Klebsiella pneumoniae produtora de carbapenemase internados em hospital terciário. Método: trata-se de um estudo de custo-efetividade realizado com dados de vida real, originados em uma coorte prospectiva. A efetividade foi avaliada por meio do sucesso terapêutico do tratamento antimicrobiano, negativação do antibiograma, reinfecção e taxa de óbito hospitalar. O custo direto foi mensurado por meio do tratamento antimicrobiano, exames laboratoriais, diária hospitalar e tratamento medicamentoso associado. Resultado: a monoterapia de amicacina apresentou a melhor razão de custo-efetividade (R$ 9.345) por morte evitada ao considerar todos os tratamentos antimicrobianos. Ao ser considerado somente as terapias combinadas, o tratamento baseado em amicacina e meropenem apresentou a melhor razão de custo-efetividade por morte evitada (R$ 13.389). A alteração dos custos e efetividades por meio da análise de sensibilidade reforçaram os dados da análise de custo-efetividade. Conclusão: o tratamento basesado na combinação de amicacina e meropenem pode ser utilizado como alternativa para o tratamento de pacientes infectados por Klebsiella pneumoniae produtora de carbapenemase, pois possui boa relação custo-efetividade e reduz a possibilidade do aumento da resistência bacteriana.

Introduction: Klebsiella pneumoniae carbapenemase infection has increased over the last few years worldwide, requiring the use of state-of-the-art antimicrobial agents. However, the use of these antimicrobials and associated therapy during infection may increase the cost of treatment without impacting the effectiveness of the treatment. Objective: To evaluate the cost-effectiveness analysis of antimicrobials used in the treatment of patients infected with Klebsiella pneumoniae carbapenemase admitted to a tertiary hospital. Method: This is a cost-effectiveness study carried out with real-life data, originated in a prospective cohort. The effectiveness was evaluated through the therapeutic success of antimicrobial treatment, antibiogram negativity, reinfection and hospital death rate. The direct cost was measured through antimicrobial treatment, laboratory tests, hospital daily and associated drug treatment. Results: amikacin monotherapy had the best cost-effectiveness ratio (R$ 9,345.65) when considering all antimicrobial treatments. When considering only the combination therapies, the treatment based on amikacin and meropenem presented the best cost-effectiveness ratio (R$ 13,389.09). The change in costs and effectiveness through the sensitivity analysis reinforced the data of the cost-effectiveness analysis. Conclusion: the treatment based on the combination of amikacin and meropenem can be used as a first alternative for the treatment of patients infected by Klebsiella pneumoniae carbapenemase, since it is cost-effective and reduces the possibility of increased bacterial resistance.

Jejum pré-operatório abreviado favorece realimentação pós-operatória com menor custo de internação hospitalar em pacientes oncológicos / Abbreviated preoperative fasting favours postoperative oral intake at lower hospital admission costs for cancer patients

RESUMO Objetivo: avaliar a viabilidade de abreviação do jejum em cirurgias colorretais oncológicas, bem como, o impacto no desfecho cirúrgico dos pacientes. Métodos: estudo prospectivo comparativo randomizado com pacientes submetidos à cirurgias eletivas colorretais, por câncer, no período de maio a setembro de 2017. Os pacientes foram randomizados eletronicamente em dois grupos de acordo com o jejum pré-operatório a ser adotado: convencional ou abreviado. Resultados: dos 33 pacientes incluídos, 15 seguiram o protocolo de jejum abreviado e 18 de jejum convencional. Ambos os grupos apresentaram perfis comparáveis. Nenhum paciente foi submetido a preparo mecânico do cólon. Em 69,7% dos casos, a cirurgia envolveu dissecção baixa do reto. Os procedimentos foram equivalentes em relação às variáveis intraoperatórias e complicações graves. O tempo para atingir realimentação plena foi menor para o jejum abreviado (10 versus 16 dias, p=0,001), assim como, o tempo de internação hospitalar (2 versus 4 dias, p=0,009). Os custos hospitalares foram menores no jejum abreviado (331 versus 682 reais, p<0,001). A análise univariável revelou correlação entre a realimentação plena e o jejum abreviado [HR 0,29 (IC95%: 0,12-0,68] e com a distensão abdominal [HR 0,12(IC95%: 0,01-0,94)]. Após análise multivariável, o jejum abreviado apresentou menor tempo para realimentação plena [HR 0,39(IC95%: 0,16-0,92]. Conclusão: o jejum pré-operatório abreviado favorece a recuperação metabólico-nutricional, diminuindo o tempo para realimentação plena. A implantação do protocolo de abreviação do jejum reduz custos de internação hospitalar.

ABSTRACT Objective: to evaluate the feasibility of abbreviated fasting in oncologic colorectal surgeries, as well as the impact on the surgical outcome of the patients. Methods: prospective randomized comparative study with patients undergoing elective colorectal cancer surgeries from May to September 2017. Patients were randomized electronically into two groups according to the preoperative fast to be adopted: conventional or abbreviated. Results: of the 33 patients included, 15 followed the abbreviated fasting protocol and 18 the conventional fasting. Both groups had comparable profiles. No patient underwent mechanical preparation of the colon. In 69.7% of the cases, surgery involved low rectal dissection. The procedures were equivalent in relation to intraoperative variables and severe complications. The time to achieve complete oral intake was shorter for abbreviated fasting (10 versus 16 days, p=0.001), as well as the length of inhospital stay (2 versus 4 days, p=0.009). Hospital costs were lower in the abbreviated fasting (331 versus 682 reais, p<0.001). The univariable analysis revealed a correlation between complete oral intake and abbreviated fasting [HR 0.29 (IC95%: 0.12-0.68] and abdominal distension [HR 0.12 (IC95% 0.01-0.94)]. After multivariable analysis, abbreviated fasting presented a lower time for complete oral intake [HR 0.39 (IC95%: 0.16-0.92]. Conclusion: the abbreviated preoperative fasting favors the metabolic-nutritional recovery, reducing the time for complete oral intake. The implementation of the abbreviation protocol reduces hospital admission costs.

Optimización de recursos para determinar la carga viral de HIV-1 en un país con pocos recursos / Optimizing resources to reduce costs to determine HIV viral load in limited resources settings

Resumen Introducción. Las metas globales para controlar la epidemia de HIV contemplan que la carga viral sea indetectable en 90 % de las personas en tratamiento. El costo de la medición de la carga viral en lotes de muestras puede reducirse y, así, aumentar la cobertura cuando los recursos son limitados; sin embargo, su eficacia disminuye al aumentar la prevalencia del fracaso del tratamiento antirretroviral. Objetivo. Evaluar estrategias para disminuir la proporción de pacientes con fracaso del tratamiento antirretroviral en los lotes de muestras y, de esta manera, aumentar el ahorro en las pruebas de carga viral. Materiales y métodos. Las estrategias evaluadas fueron: a) la organización de los lotes de muestras según el esquema de tratamiento antirretroviral, y b) la exclusión de aquellos pacientes con antecedente reciente de fracaso del tratamiento antirretroviral, aquellos con menos de 12 meses de tratamiento antirretroviral y aquellos sin tratamiento antirretroviral previo. Los resultados de los lotes se compararon con los resultados individuales. Resultados. El valor diagnóstico negativo fue similar para los pacientes con esquema de primera línea (100,0 %; IC95% 99,5-100,0) o de segunda línea de tratamiento (99,4 %; IC95% 96,9-99,9). La incidencia del fracaso del tratamiento antirretroviral fue menor en los pacientes con tratamiento de primera línea (p<0,01), lo cual permitió un mayor ahorro en las pruebas de laboratorio en este grupo (74,0 %; IC95% 71,0-76,7) que en los pacientes con tratamiento de segunda línea (50,9 %; IC95% 44,4-57,3) (p<0,01). Conclusión. La selección de las muestras que se incluyeron en los lotes para determinar la carga viral del HIV según el tipo de esquema de tratamiento, permitió maximizar el porcentaje de ahorro en pruebas de laboratorio.

Abstract Introduction: HIV viral load testing is a key factor to evaluate the accomplishment of the UNAIDS target of 90% of viral suppression among people receiving antiretroviral therapy. Pooled samples are a potentially accurate and economic approach in resource-constrained settings, but efficiency can be negatively affected by high prevalence rates of virological failure. Objective: Strategies were assessed to increase the relative efficiency of pooled HIV viral load testing in resource-constrained settings. Materials and methods: We evaluated two strategies: a) plasma samples were not included in pools if patients had <12 months on antiretroviral therapy, patients had previous viral load >1,000 copies/ml, or were antiretroviral therapy naïve patients, and b) plasma pools were organized separately for first and second-line antiretroviral therapy regimens. Individual viral load tests were used to compare pooled results. Results: Negative predictive values were similar for patients on first (100.0%; 95% CI 99.5 to 100.0) and second-line antiretroviral therapy regimens (99.4%; 95% CI 96.9 to 99.9). However, the incidence of virological failure among individuals on first-line antiretroviral therapy was lower than second-line antiretroviral therapypatients (p <0.01), resulting in greater savings in laboratory tests in patients on first-line antiretroviral therapy (74.0%; 95% CI 71.0 to 76.7) compared with the group of patients on second-line antiretroviral therapy (50.9%; 95% CI 44.4 to 57.3) (p<0.01). Conclusion: Selecting the samples to be included in the pools and selecting the pools according to ART regimens are criteria that could lead to decreased spending on laboratory tests for HIV viral load determination in resource-constrained settings.

Custo-efetividade do uso do curativo de colágeno e alginato no tratamento de áreas doadoras de enxerto de pele de espessura parcial / Cost-effectiveness of collagen wound dressing with alginate for the treatment of split-thickness skin graft donor sites / El costo-efectividad de la utilización del apósito de colágeno con alginato en el tratamiento de las áreas donadoras de injerto de espesor parcial de la piel

OBJETIVO: Avaliar a utilização do curativo de colágeno e alginato de cálcio em áreas doadoras de enxerto de pele parcial em relação ao curativo com gaze tipo rayon. MÉTODO: Foi realizado estudo clínico prospectivo na Divisão de Cirurgia Plástica e Queimaduras do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, no período de 2010 a 2015. Os pacientes foram selecionados de forma consecutiva e distribuídos de forma randomizada em três grupos de acordo com o tratamento usado na área doadora: rayon exposto, embebido em soro fisiológico 0,9%; rayon coberto por gaze de algodão estéril e atadura; curativo formado por 90% de colágeno bovino associado a 10% de alginato de cálcio. Foram analisados comparativamente os seguintes parâmetros: dor, tempo para epitelização, tempo de internação e custos. RESULTADOS: Foram estudados 30 pacientes, com idade variando de 12 e 60 anos. Quinze desses pacientes tiveram suas áreas doadoras cobertas com o curativo de colágeno e alginato de cálcio, os quais apresentaram redução dos níveis álgicos em 79,5% (p<0,01), menor tempo de internação e epitelização, média de 5,8 dias (p<0,01) e redução dos custos hospitalares em cerca de 47% (p<0,01) em comparação com o curativo de rayon. Nenhum apresentou infecção na área doadora. CONCLUSÃO: O curativo de colágeno e alginato apresentou melhor custo-benefício em relação ao rayon para cobertura de áreas doadoras, com importante redução da dor, do tempo de epitelização e de internação e dos custos.

OBJECTIVE: To evaluate the use of collagen calcium-alginate dressing for split-thickness skin graft donor sites in comparison with rayon dressing. METHODS: A prospective clinical study was conducted at Divisão de Cirurgia Plástica e Queimaduras do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo from 2010 to 2015. Patients were selected consecutively and randomly allocated into three groups according to the treatment used on the donor site: rayon soaked in 0.9% saline; rayon covered with sterile cotton gauze and bandage; 90% bovine collagen with 10% calcium-alginate dressing covered with transparent polyurethane film. Following parameters was comparatively analyzed: pain, time to epithelialization, length of stay and costs. RESULTS: We studied 30 patients, ranging from 12 to 60 years of age. Fifteen of these patients had their donor sites covered with collagen calcium-alginate dressing, which showed pain reduction of 79.5% (p<0.01), shorter hospital stay and epithelialization, average of 5.8 days (p<0.01) and reduction in hospital costs about 47% (p<0.01) in comparison with rayon dressing. None presented infection in the donor site. CONCLUSION: Collagen calcium-alginate dressing showed better cost-benefit than rayon to cover donor sites, with significant reduction of pain, epithelialization time, length of stay and costs.

Objetivo: Evaluar la utilización del apósito de colágeno con alginato de calcio en áreas donadoras de injerto de espesor parcial de la piel en relación a la curación con gasa tipo rayón. Método: Se realizó un estudio clínico prospectivo en la División de Cirugía Plástica y Quemadura, del Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo en el período de 2010 a 2015. Los pacientes fueron seleccionados de forma consecutiva y distribuida de forma aleatorizada en tres grupos de acuerdo con el tratamiento utilizado en la área donadora: rayón expuesto, embebido en suero fisiológico 0,9%; Rayón cubierto por gasa de algodón estéril y vendaje; apósito formado por un 90% de colágeno bovino asociado al 10% de alginato de calcio. Se analizaron comparativamente los siguientes parámetros: dolor, tiempo para epitelización, tiempo de internación y costos. Resultados: Se estudiaron 30 pacientes, con edad variando de 12 a 60 años. Quince de estos pacientes tuvieron sus áreas donantes cubiertas con el apósito de colágeno con alginato de calcio, los cuales presentaron reducción de los niveles álgicos en el 79,5% (p<0,01), menor tiempo de internación y epitelización, media de 5.8 (p<0,01) y reducción de los costos hospitalarios en 47% (p<0,01) en comparación con el apósito de rayón. Ninguno presentó infección en el área donante. Conclusión: El apósito de colágeno con alginato presentó mejor costo-efectividad en relación al rayón para cobertura de áreas donantes, con importante reducción del dolor, del tiempo de epitelización, de internación y de los costos

Resultados a corto plazo de la artroplastia total de cadera cementada / Short-term outcome after cemented totalhip replacement

Fundamento: a lo largo de los años la artroplastia total de cadera ha demostrado ser una de las cirugías más costo-efectivas, ya que permite restablecer el nivel de actividad física previa, lo que evita la morbilidad importante asociada con la falta de movilidad en pacientes con alteraciones en la cadera. Objetivo: evaluar los resultados a corto plazo de la artroplastia total de cadera cementada. Métodos: se realizó un estudio descriptivo prospectivo a un grupo de pacientes operados mediante la artroplastia total de cadera cementada, en el Hospital Militar Universitario Octavio de la Concepción y de la Pedraja de Camagüey, durante 24 meses desde enero de 2014 hasta diciembre de 2015 y el tiempo promedio de seguimiento de los pacientes fue de 10 meses (con un rango de seis a 24 meses). El universo y la muestra lo conformaron 24 pacientes con el diagnóstico de osteoartritis primaria de cadera u otra afección de la cadera operados mediante la artroplastia total cementada. Las variables de estudio fueron edad, sexo, diagnóstico previo a la intervención, las complicaciones posoperatorias y la evaluación según las dos escalas evaluativas utilizadas. Resultados: predominó el grupo de edades entre 70 y 80 años para un promedio de edad de 68 años (con rango de 42 a 80 años); el sexo más afectado fue el femenino, el diagnóstico preoperatorio más frecuente fue la osteoartritis primaria de cadera que se presentó una sola complicación, una infección superficial de la herida para un 4,10; al finalizar el trabajó se logró disminuir la Visual Analogue Scale 8,4 puntos como promedio y la Harris Hip Score mejoró 39 puntos; y los resultados de la artroplastia total de cadera cementada fueron excelentes y buenos en la totalidad de los pacientes. Conclusiones: el estudio concluyó que la artroplastia total de cadera cementada es un procedimiento seguro y con excelentes resultados.

Background: the total hip arthroplasty is one of the most effective orthopaedic surgeries that has been used for decades, is one of the most successful operations in medicine. The clinical result after surgery and compliance during rehabilitation are influenced by the patient's expectations. Objective: the aim of this study was to evaluate the results after cemented total hip arthroplasty in a short-term. Methods: a study was conducted on 24 patients who had cemented total hip arthroplasty primary, attended at Octavio of the Concepción and of the Pedraja Military Teaching Hospital of Camagüey, the patients were followed-up for a mean of 10 months (range, 6 to 24 months), from january 2014 to december 2015. Parameters, such as age, sex, reasons for the surgery, complications, and pre-operative and post-operative functional scores were recorded. Results: the most frequent group of age was from 70 to 80 years old for a 41,60 percent, with a mean of 68 years (range, 42 to 80 years); females with 58, 30 percent were more affected than males; only one case was recorded superficial infection for a 4,10 percent; the average Visual Analogue Scale improved from 9,5 points preoperatively to 1,1 points and the average Harris Hip Score was from 56 points preoperatively to 95 points at the final follow-up; and the results of the cemented total hip arthroplasty were excellent and goods in a 95,90 percent. Conclusions: The study concluded that cemented total hip arthroplasty is a secure procedure with excellent benefits.

[Optimizing resources to reduce costs to determine HIV viral load in limited resources settings].

INTRODUCTION: HIV viral load testing is a key factor to evaluate the accomplishment of the UNAIDS target of 90% of viral suppression among people receiving antiretroviral therapy. Pooled samples are a potentially accurate and economic approach in resource-constrained settings, but efficiency can be negatively affected by high prevalence rates of virological failure. OBJECTIVE: Strategies were assessed to increase the relative efficiency of pooled HIV viral load testing in resource-constrained settings. MATERIALS AND METHODS: We evaluated two strategies: a) plasma samples were not included in pools if patients had <12 months on antiretroviral therapy, patients had previous viral load >1,000 copies/ml, or were antiretroviral therapy naïve patients, and b) plasma pools were organized separately for first and second-line antiretroviral therapy regimens. Individual viral load tests were used to compare pooled results. RESULTS: Negative predictive values were similar for patients on first (100.0%; 95% CI 99.5 to 100.0) and second-line antiretroviral therapy regimens (99.4%; 95% CI 96.9 to 99.9). However, the incidence of virological failure among individuals on first-line antiretroviral therapy was lower than second-line antiretroviral therapy patients (p <0.01), resulting in greater savings in laboratory tests in patients on first-line antiretroviral therapy (74.0%; 95% CI 71.0 to 76.7) compared with the group of patients on second-line antiretroviral therapy (50.9%; 95% CI 44.4 to 57.3) (p<0.01). CONCLUSION: Selecting the samples to be included in the pools and selecting the pools according to ART regimens are criteria that could lead to decreased spending on laboratory tests for HIV viral load determination in resource-constrained settings.

Pacientes con leishmaniasis cutánea tratados con antimoniato de meglumina en 2 municipios de Boyacá, Colombia 2013-2014 / Patients with Tegumentary Leishmaniasis Treated with Meglumine Antimoniate in 2 Municipalities of Boyaca, Colombia from 2013 to 2014 / Pacientes com leishmaniose cutânea tratados com antimonato de meglumina em 2 municípios de Boyacá, Colômbia 2013-2014

Introducción: La leishmaniasis es una de las enfermedades reemergentes de mayor importancia en salud pública, causa grandes costos y puede generar discapacidad. Objetivo: Evaluar el costo y la efectividad obtenida con el tratamiento de primera línea para leishmaniasis cutánea en los municipios de Otanche y Puerto Boyacá, Boyacá durante 2013-2014. Metodología: Estudio longitudinal retrospectivo de tipo descriptivo, se tomaron 86 pacientes que cumplían con los criterios de inclusión; se realizó un análisis de las características sociodemográficas, la efectividad del manejo de la patología con antimoniato de meglumina, los efectos adversos y los costos institucionales de los pacientes. Resultados: Se observó que los más afectados fueron los pacientes de 0 a 14 años, de género masculino (57%) y procedentes de zonas rurales. Las zonas corporales más comprometidas fueron los miembros superiores. El municipio de Otanche atendió el 86% de los pacientes reportados y en promedio el costo por paciente fue de 258,664 pesos. El municipio de Puerto Boyacá reportó el 14% de los casos y el costo promedio por paciente fue de 290,307 pesos; con una diferencia en costos por paciente de 31,643 entre los municipios. Conclusiones: Cuando la administración del medicamento se hace siguiendo las dosis recomendadas, la efectividad se encuentra alrededor del 90%. Los pacientes que recibieron dosis superiores a la indicada obtuvieron un mayor porcentaje de curación, sin embargo, no es necesario sobredosificar a los pacientes y elevar los costos para mejorar la curación. Los pacientes que recibieron dosis subterapéuticas generaron más costos debido a que es necesario brindarles servicios médicos de mayor complejidad. [Abril-Sánchez LR, Pachón-Abril E, Picón-Jaimes YA. Pacientes con leishmaniasis cutánea tratados con antimoniato de meglumina en 2 municipios de Boyacá, Colombia 2013-2014. MedUNAB 2017; 20(2): 165-173].

Introduction: Leishmaniasis is one of the most important reemerging diseases in public health and causes great costs and may generate a disability. Objective: To evaluate the cost and effectiveness obtained with the first line treatment for tegumentary leishmaniasis in the municipalities of Otanche and Puerto Boyaca, Boyaca during 2013 and 2014. Methodology: This is a retrospective longitudinal study of descriptive type. 86 patients who fulfilled the inclusion criteria were taken into account. Ananalys is of the sociodemographic characteristics, the effectiveness of the management of the pathology with meglumine antimoniate, the adverse effects and the institutional costs of the patients was carried out. Results: It was observed that the most affected with this disease were male patients (57%) from 0 to 14 years old and from rural areas. The most compromised body areas were the superior limbs. The municipality of Otanche treated 86% of the patients who were reported, and on average the cost per patient was $258,664 (Colombian pesos). The municipality of Puerto Boyacá reported 14% of the cases and the average cost per patient was 290,307 pesos; the difference in cost among the municipalities per patient was 31,643 pesos. Conclusions: The effectiveness rate when the administration of the drug is done following the recommended doses is around 90%. Patients who were treated with a higher dose than the indicated one obtained a higher percentage of curing; however, it is not necessary to dose patients and raise costs to improve curing. Patients who were treated with subtherapeutic doses generated more costs due to the need to provide them with more complex medical services. [Abril-Sánchez LR, Pachón-Abril E, Picón- Jaimes YA. Patients with Tegumentary Leishmaniasis Treated with Meglumine Antimoniate in 2 Municipalities of Boyaca, Colombia from 2013 to 2014. MedUNAB 2017; 20(2): 165-173].

Introdução: A leishmaniose é uma das doenças de maior importância que ressurge em saúde pública, causa grandes custos e pode gerar incapacidade. Objetivo: Avaliar o custo e a eficácia obtidos com o tratamento de primeira linha para leishmaniose cutânea nos municípios de Otanche e Puerto Boyacá, Boyacá, durante 2013-2014. Metodologia: Estudo longitudinal retrospectivo de tipo descritivo, foram atendidos 86 pacientes que preencheram aos critérios de inclusão; para o estudo se fez uma análise das características socio demográficas, da efetividade do manejo da patologia com antimonato de meglumina, dos efeitos adversos e os custos institucionais dos pacientes. Resultados: Observou-se que os mais afetados foram os pacientes de 0 a 14 anos de idade, masculino (57%) e os das áreas rurais. As áreas do corpo mais comprometidas foram os membros superiores. O município de Otanche tratou 86% dos pacientes relatados e, em média, o custo por paciente foi de 258.664 pesos. O município de Puerto Boyacá reportou 14% dos casos e o custo médio por paciente foi de 290.307 pesos; com uma diferença de custos por paciente de 31.643 entre os municípios. Conclusões: Quando a administração da medicação é feita seguindo as doses recomendadas, a eficácia aproximada é de 90%. O paciente que receberam maior dosagem que a indicada obtiveram maior porcentagem de cura, no entanto, não é necessário administrar maiores quantidades e aumentar os custos para melhorar a cicatrização. Os pacientes que receberam doses subterapêuticas geraram mais custos devido à necessidade de fornecer serviços médicos muito mais complexos. [Abril-Sánchez LR, Pachón-Abril E, Picón-Jaimes YA. Pacientes com leishmaniose cutânea tratados com antimonato de meglumina em 2 municípios de Boyacá, Colômbia 2013-2014. MedUNAB 2017; 20(2): 165-173].

Effectiveness and Efficiency of Improving HIV Service Provision for Key Populations in Nicaragua.

OBJECTIVE: HIV in Nicaragua is concentrated among key populations (KPs) - men who have sex with men, female sex workers, and female transgender - in whom prevalence is 600-4,000 times higher than the general population. The United States Agency for International Development PrevenSida project is aimed at increasing healthy behavior among KPs and people with HIV and improving testing, counseling, and continuity of prevention and treatment by building capacity and improving performance of non-governmental organizations (NGOs) providing services to KPs. We evaluated the cost-effectiveness of PrevenSida's activities. METHODS: This retrospective observational evaluation used individuals in KPs covered by NGOs receiving assistance from PrevenSida from 2012 to 2014. Cost-effectiveness analysis compared PrevenSida's intervention with business-as-usual. Model inputs were generated from epidemiological modeling and PrevenSida's records. RESULTS: By 2014, 24 NGOs received grants and technical assistance from PrevenSida with 72,955 people in KPs served at $11.32/person ($9.39-$16.55/person, depending on region). The estimated incremental cost-effectiveness ratio was $50,700/HIV case averted or $2,600/Disability-adjusted Life Year (DALY) averted (95% CI: $1,000-$99,000 and $50-$5,100, respectively). CONCLUSION: PrevenSida distributed about $600,000 in grants and used $230,000 to support 24 NGOs in 2014. Cost-effectiveness from the program perspective compared to no program was slightly over half of GDP per capita per DALY averted, considered highly cost-effective by WHO criteria. Cost and efficiency varied by region, reflecting the number of people in KPs receiving services. Cost-sharing by NGOs improved cost-effectiveness from the program perspective and likely promotes sustainability. Focused interventions for KP service provision organizations can be acceptably efficient in this setting.

Costo-efectividad de los tratamientos de consolidación para la leucemia mieloide aguda en niños en riesgo alto en el sistema de salud colombiano / Cost-effectiveness of consolidation treatments for acute myeloid leukemia in high-risk pediatric patients within the Colombian healthcare system

Introducción. La leucemia mieloide aguda representa alrededor del 20 % de las leucemias en menores de 18 años. Actualmente, solo existen dos alternativas de tratamiento de consolidación: la quimioterapia y el trasplante con progenitores hematopoyéticos. Objeti vo. Evaluar el costo-efectividad del trasplante alogénico con progenitores hematopoyéticos de donantes emparentados o no emparentados, en comparación con la quimioterapia de consolidación en niños de alto riesgo con leucemia mieloide aguda. Materiales y métodos. Se construyó un árbol de decisiones utilizando los años de vida ganados como resultado. Los costos y probabilidades se extrajeron de estudios y reportes que se encuentran en la literatura científica. El umbral de costo-efectividad fue tres veces el producto interno bruto per cápita de 2010. Se hicieron análisis de sensibilidad univariados y probabilísticos, así como una curva de aceptabilidad. Resultados. Al comparar el trasplante de donante emparentado o no emparentado con los ciclos de quimioterapia, se obtuvieron tasas de costo-efectividad incremental de COP$ 9´226.421 (USD$ 4.820) y COP$ 6´544.116 (USD$ 3.419), respectivamente, cifras estas inferiores al producto interno bruto per cápita: COP$ 12´047.418 (USD$ 6.294). El trasplante resultó ser costo-efectivo en 70 % de las simulaciones y con mayor probabilidad de serlo cuando había disposición a pagar cantidades superiores a COP$ 7´200.000 (USD$ 3.762). Conclusión. El trasplante alogénico (emparentado o no) en Colombia resultó ser costo-efectivo frente al tratamiento de consolidación en niños de alto riesgo con leucemia mieloide aguda.

Introduction: Acute myeloid leukemia represents about 20% of leukemias in minors under 18 years old. At present, there are only two consolidation treatment alternatives: Chemotherapy and stem-cell transplantation. Objective: To evaluate the cost-effectiveness of unrelated and related hematopoietic stem cell transplantations, versus chemotherapy consolidation in pediatric patients with high-risk acute myeloid leukemia. Materials and methods: A decision tree was constructed with life-years gained as the outcome. Costs and probabilities were extracted from the literature. Probabilistic sensitivity analyses and acceptability curves were computed. The cost-effectiveness threshold was three times the 2010 per capita gross domestic product. Results: When compared to consolidation chemotherapy cycles, related and unrelated hematopoietic stem-cell transplantation had incremental cost-effectiveness ratios of COP$ 9,226,421 (USD$ 4,820) and COP$ 6,544,116 (USD$ 3,419) respectively, which are lower than the per capita gross domestic product (COP$ 12,047,418, USD$ 6,294). Transplant proved to be cost-effective in 70% of the simulations and had a higher probability of the willingness to pay being over than COP$ 7,200,000 (USD$ 3,762). Conclusion: In Colombia, related and unrelated hematopoietic stem-cell transplants are cost-effective alternatives to consolidation treatment for high-risk acute myeloid leukemia in pediatric patients.

Costo utilidad de profilaxis con palivizumab versus no profilaxis en niños con riesgo de infección de virus sincitial respiratorio en Colombia / Cost utility of prophylaxis with palivizumab versus no prophylaxis in children with risk of infection of syncitial respiratory virus in Colombia

Objetivo: determinar la costo utilidad de la profilaxis del palivizumab en niños con factores de riesgo para infección por virus sincitial respiratorio. Materiales y métodos: fue realizado un árbol de decisión, desde la perspectiva del pagador, en niños pretérmino (menores de 35 semanas) o con enfermedad cardiaca congénita, usando datos de costos locales y datos de efectividad para el cálculo de años de vida ajustado a calidad (AVAC) provenientes de estudios clínicos controlados con un horizonte temporal de toda la expectativa de vida. Los costos fueron reportados en pesos colombianos (ColP$) y se aplicó una tasa de descuento de 3,5 %. El modelo se evaluó usando una simulación de Monte Carlo. Resultados: en el grupo pretérmino los costos de palivizumab fueron $8 944 789 y en el grupo de no palivizumab $1 846 634. Los AVAC en estos grupos fueron de 72,28 y 72,17, respectivamente. La razón de costo utilidad incremental fue de $ 65 528 681/AVAC adicional. En el grupo de niños con enfermedad cardiaca congénita los costos de palivizumab fueron de $15 191 700 y de $4 657 187 en el grupo de no palivizumab. Los AVAC en estos grupos fueron de 72,16, respectivamente. La razón de costo utilidad incremental fue de $47 884 150/AVAC adicional. Existe una probabilidad mayor del 50 % de ser costo útil con una disposición a pagar mayor de $60 000 000. Conclusión: palivizumab es una alternativa costo útil en niños con riesgo de infección por virus sincitial respiratorio.

ABSTRACT Objective: To determine the incremental cost utility ratio (ICUR) of prophylaxis with palivizumab in children with risk factors for infection by respiratory syncytial virus (RSV). Material and methods: A decision tree using the perspective of the Colombian health sector was conducted in preterm infants (<35weeks) and children with congenital heart disease (CHD) using local data on costs and effectiveness data for the calculation of quality adjusted life years (QALYs) from randomized clinical trials with a time horizon of their life expectancy. Costs were reported in Colombian pesos ($ ColP) and a discount rate of 3.5 % was applied. The model was evaluated using a Monte Carlo simulation. Results: The costs of palivizumab in the preterm group were $8'944.789 and the group of non palivizumab $1'846.634. The QALY in these groups were 72.28 and 72.17 respectively. The ICUR was $65'528.681/QALY additional. In the group of children with CHD the costs of palivizumab were $15'191.700 and $4'657.187 in no palivizumab group. The QALYs in these groups were 72.16 and 71.94, respectively. The ICUR was $47'884.150/QALY. There is a probability greater than 50 % of being cost-effective with a willingness to pay of $60'000.000. Conclusions: Palivizumab provides a costeffective alternative of prophylaxis against RSV infection.

Costo-utilidad de prednisolona y aciclovir en pacientes con parálisis deBell en Colombia / Cost-utility of prednisolone and acyclovir in patients with Bell’s palsy in Colombia

Existen múltiples alternativas terapéuticas para pacientes con parálisis de Bell; sin embargo, sedesconoce la eficiencia de estas en el sistema de salud colombiano. El objetivo del presente estudio es determinarla razón de costo utilidad incremental (RCUI) y el valor esperado de información perfecta (VEIP) delos diferentes tratamientos para esta condición.Materiales y métodos: Se realizó un estudio de costo utilidad desde la perspectiva del pagador usando unárbol de decisión con un horizonte temporal menor de un año que evaluó: a. prednisolona sola, b. antiviralessolos, c. combinación prednisolona y antivirales, y d. observación. Se obtuvieron los costos directos del tarifarioISS+30%. Se calcularon los años de vida ajustados a calidad (AVAC) usando los datos de utilidad de fuentessecundarias. Se realizó una simulación de Monte Carlo con 10.000 iteraciones y 1.000 microsimulaciones.Resultados: Los costos totales esperados fueron prednisolona sola: $COP 48,315 (95%IC: 16,434-84,252);observación: $COP 49,868 (95%IC: 22,760-84,540); esteroides y antivirales $COP 62,237 (95%IC: 32,112-96,750) y antivirales solos $COP: 96,402 (95%IC: 56,372-139,926). Todas las alternativas obtuvieron 0.72 AVAC(95%IC: 0.68-0.75). La prednisolona sola fue la alternativa dominante para todos los valores de la disposición apagar. El VEIP para las disposiciones a pagar de $COP 47’512,194 y 222’802,847 fueron de $COP: 32’623,700y 134’383,920 respectivamente.Conclusión: La prednisolona sola es la estrategia dominante para cualquier disposición a pagar. El VEIP enColombia para la mayor disposición a pagar fue de $COP: 134’383,920...

There are multiple therapeutic alternatives for patients with Bell’s palsy, however their efficiencywithin the Colombian health system is unknown. The objective of this study is to determine the incrementalcost-utility ratio (ICUR) and the expected value of perfect information (EVPI) of different treatments forthis condition.Materials and methods: A cost-utility analysis was conducted from the perspective of the payer using adecision tree with a time horizon of less than one year. This model evaluated the following alternatives: a.prednisolone only, b. antivirals only, c. a combination of prednisolone and antivirals; d. observation. Directcosts were obtained from national tariff (ISS+30%). Quality adjusted life-years (QALYs) using utility data fromsecondary sources were calculated. Monte Carlo simulation with 10,000 iterations and 1,000 microsimulationwas performe...