Hepatitis B infection control in Colombian Amazon after 15 years of hepatitis B vaccination. Effectiveness of birth dose and current prevalence.

BACKGROUND: Hepatitis B virus (HBV) infection is highly endemic in the Colombian Amazon basin. In Colombia, the universal hepatitis B vaccination in that area has been active since 1993. The program targets children aged under five years. Newborns receive at least three doses, and in 2001, HBV vaccine birth dose was included. This study aimed to evaluate the advances on HBV control in the Colombian Amazon. METHODS: A population-based cross-sectional study was conducted in children less than 11 years old in rural areas of the Colombian Amazon, in order to assess the current levels of HBV prevalence and evaluate the effectiveness of HBV vaccination. Participants were selected from villages scattered along the Amazon, Putumayo and Loretoyaco Rivers. Blood samples were taken from children. All the samples were examined for surface antigen (HBsAg) and IgG antibodies against core antigen (AntiHBc) of HBV. Data on HBV vaccination status and other risk factors were also collected. RESULTS: Blood samples from 1275 children were included in the study. The positivity for IgG AntiHBC and HBsAg was 3.8% and 0.5%, respectively. It was observed that receiving a dose of HBV vaccine within 48 h after birth decreased the risk of HBV infection and carriage by 95%. Being born to an AntiHBc positive mother increased 8 times the risk of HBV infection (OR = 7.8 CI 95% 3.3-10.2) and 7 times the risk of HBsAg carriage (OR = 6.6 CI 95% 2.1-10.1). CONCLUSION: The prevalence of HBV infection and HBsAg carriage continues to decrease among children living in the Colombian Amazon. The high protective effectiveness of an HBV birth does suggest that perinatal transmission is important in endemic areas of Latin America, an aspect that has not been fully studied in the region.

[Costs of Chagas' disease screening test in blood donors in two Colombian blood banks, 2015].

INTRODUCTION: Transfusion is a mechanism of transmission of Chagas' disease. There are no studies on the costs of the screening test in Colombian blood banks. OBJECTIVE: To estimate the costs of the screening test for Chagas' disease among blood donors in two Colombian blood banks, 2015. MATERIALS AND METHODS: We conducted a micro-costing study from the perspective of the health care provider to estimate the cost of Chagas' disease testing in two blood banks, Banco de Sangre de la Cruz Roja, Seccional Bolívar, and Banco de Sangre del Hospital de Yopal, Casanare, taking into account four cost categories: 1) Administrative costs: public services and insurance costs were calculated based on the blood bank area in square meters; 2) capital costs: building and equipment costs that were annualized using a 3% discount rate and a lifespan of 20 years for building and five for equipment; 3) costs of Chagas' disease test materials and reagents adjusted by blood bank production level, and 4) costs of staff in charge of Chagas' disease test processing. The costs of transfusion bagsand immunohematology tests are also reported. RESULTS: The cost of Chagas' disease test in the blood bank of Seccional Bolívar was COP$ 37,804 (USD$ 12), and the blood bag and immunohematology test costs were COP$ 25,941 (USD$ 8.2) and COP$ 6,800 (USD$ 2.2), respectively. In the blood bank of Yopal, Casanare, the costs were COP$ 77,384 (USD$ 24.6), COP$ 30,141 (USD$ 9.6) and COP$ 12,627 (USD$ 4), respectively. Personnel cost accounted for the highest percentage of the total cost for both blood banks (47.5% in Seccional Bolívar, and 55.7% in Yopal, Casanare). CONCLUSION: Our results are an important input for the planning of services and cost-effectiveness studies for screening tests for Chagas' disease in Colombian blood banks.

Costos de la prueba de tamización para la enfermedad de Chagas en donantes de dos bancos de sangre de Colombia, 2015 / Costs of Chagas' disease screening test in blood donors in two Colombian blood banks, 2015

Resumen Introducción . La transfusión es un mecanismo de transmisión de la enfermedad de Chagas. No se han hecho estudios de costos de la prueba de tamización en bancos de sangre de Colombia. Objetivo. Estimar los costos de la prueba de tamización para la enfermedad de Chagas en donantes de bancos de sangre de Colombia, 2015. Materiales y métodos. Se hizo un estudio de costos desde la perspectiva del prestador de servicios en los bancos de sangre de la Cruz Roja, seccional Bolívar, y del Hospital de Yopal, Casanare, que incluyó: 1) gastos administrativos, es decir, costos de servicios públicos y seguros asignados según los metros cuadrados de las instalaciones del banco de sangre; 2) costos de capital, es decir, edificación y equipos, anualizados con una tasa de descuento de 3 % y considerando una vida útil de 20 y cinco años, respectivamente; 3) costos de insumos y materiales ajustados al nivel de producción, y 4) costos del recurso humano encargado del procesamiento de las pruebas. Se reportó, asimismo, el costo de las bolsas y de las pruebas de inmunohematología. Resultados. En el banco de sangre de la Cruz Roja, seccional Bolívar, el costo de la prueba fue de COP$ 37.804 (USD$ 12), mientras que la bolsa y la prueba de inmunohematología costaron COP$ 25.942 (USD$ 8,2) y COP$ 6.800 (USD$ 2,2), respectivamente. En el banco de sangre del Hospital de Yopal, los costos ascendieron a COP$ 77.384 (USD$ 24,6), COP$ 30.141 (USD$ 9,6) y COP$ 12.627 (USD$ 4), respectivamente. La mayor participación en el costo de la prueba correspondió al recurso humano (47,5 % en Cartagena y 55,7 % en Yopal). Conclusiones. Estos resultados son importantes para la planificación de los servicios y los análisis de costo-efectividad de la prueba de tamización para la enfermedad de Chagas en los bancos de sangre.

Abstract Introduction: Transfusion is a mechanism of transmission of Chagas' disease. There are no studies on the costs of the screening test in Colombian blood banks. Objective: To estimate the costs of the screening test for Chagas' disease among blood donors in two Colombian blood banks, 2015. Materials and methods: We conducted a micro-costing study from the perspective of the health care provider to estimate the cost of Chagas' disease testing in two blood banks, Banco de Sangre de la Cruz Roja, Seccional Bolívar, and Banco de Sangre del Hospital de Yopal, Casanare, taking into account four cost categories: 1) Administrative costs: public services and insurance costs were calculated based on the blood bank area in square meters; 2) capital costs: building and equipment costs that were annualized using a 3% discount rate and a lifespan of 20 years for building and five for equipment; 3) costs of Chagas' disease test materials and reagents adjusted by blood bank production level, and 4) costs of staff in charge of Chagas' disease test processing. The costs of transfusion bags and immunohematology tests are also reported. Results: The cost of Chagas' disease test in the blood bank of Seccional Bolívar was COP$ 37,804 (USD$ 12), and the blood bag and immunohematology test costs were COP$ 25,941 (USD$ 8.2) and COP$ 6,800 (USD$ 2.2), respectively. In the blood bank of Yopal, Casanare, the costs were COP$ 77,384 (USD$ 24.6), COP$ 30,141 (USD$ 9.6) and COP$ 12,627 (USD$ 4), respectively. Personnel cost accounted for the highest percentage of the total cost for both blood banks (47.5% in Seccional Bolívar, and 55.7% in Yopal, Casanare). Conclusion: Our results are an important input for the planning of services and cost-effectiveness studies for screening tests for Chagas' disease in Colombian blood banks.

¿Existen ventajas clínicas al evaluar el estado de los genes KRAS, NRAS, BRAF, PIK3CA, PTEN y HER2 en pacientes con cáncer colorrectal? / Is it clinically worthwhile to evaluate the state of the KRAS, NRAS, BRAF, PTEN, and HER2 genes in patients with colorectal cancer?

En la última década han surgido los tratamientos guiados por el perfil molecular del tumor, con beneficio clínico para los pacientes con cáncer colorrectal avanzado o metastásico. Esta estratificación molecular permite agrupar o individualizar a los pacientes para un óptimo tratamiento de su enfermedad. Basada en información relevante y actualizada, se presenta una revisión de genes y biomoléculas de las vías de señalización intracelular del receptor del factor de crecimiento epidérmico, involucradas en la carcinogénesis del cáncer colorrectal. Además, se pretende identificar evidencia que soporte el beneficio de utilizar biomarcadores en pacientes con cáncer colorrectal, como factores pronósticos o predictivos para tratamientos biológicos. Se concluye que existe evidencia científica y, además, aceptación por parte de asociaciones internacionales de oncología clínica, para utilizar la evaluación del estado de los genes KRAS y BRAF en la práctica clínica, por su valor predictivo en el tratamiento del cáncer colorrectal avanzado; mientras que, para los genes NRAS, PIK3CA, PETEN y HER2, la aceptación por consenso de expertos de Europa y Estados Unidos aún no es unánime, para recomendar la evaluación rutinaria de estos biomarcadores predictivos en el cáncer colorrectal avanzado

Therapies guided by the molecular profile of the tumor have emerged in the last decade, with clinical benefit for patients with advanced or metastatic colorectal cancer. This molecular stratification allows patients to be grouped or individualized for optimal treatment of their disease. Based on relevant and up-to-date information, a mini-review of genes and biomolecules of epidermal growth factor receptor intracellular signaling pathways involved in the carcinogenesis of colorectal cancer is presented. In addition, we intend to identify evidence supporting the benefit of using biomarkers in clinical scenarios of colorectal cancer as prognostic or predictive factors for biological therapies. It is concluded that there is scientific evidence and also acceptance by international associations of clinical oncology to use the evaluation of the state of the KRAS and BRAF genes in clinical scenarios because of its predictive value in the treatment of advanced colorectal cancer, while for the NRAS, PIK3CA, PETEN and HER2 genes the consensus of experts from Europe and the United States of America to recommend the routine evaluation of these predictive biomarkers in advanced colorectal cancer has not yet been unanimous

Análisis de impacto presupuestal del uso de inmunoglobulina humana normal para los pacientes con deficiencia inmune primaria en Colombia / Análisis de impacto presupuestal del uso de inmunoglobulina humana normal para los pacientes con deficiencia inmune primaria en Colombia

Tecnologías Evaluadas: Inmunoglobulina humana normal. Población: Pacientes con inmunodeficiencia primaria. Perspectiva: La perspectiva del presente AIP corresponde al tercero pagador, que en este caso es el Sistema General de Seguridad Social en Salud (SGSSS) en Colombia. Horizonte Temporal: El horizonte temporal de este AIP en el caso base corresponde a un año. Adicionalmente se reportan las estimaciones del impacto presupuestal para los años 2 y 3, bajo el supuesto de la inclusión en el POS en el año 1. Costos incluidos: El costo anual de la inmunoglobulina humana normal es de $41.883.552,73 pesos colombianos. Fuentes de costos: Dado que se estimó el costo de medicamentos, se utilizó la información de sistema deI nformación de Precios de Medicamentos y Dispositivos Médicos para el año 2014. Escenarios: Se plantearon los siguientes escenarios: adopción del 100% a su ingreso al plan de beneficios y un segundo escenario donde la adopción para el año uno es del 50%, hasta alcanzar el 100% al tercer año comparadora. Resultados: Debido a que no existe tecnología comparador dentro del análisis, se evidencia para el primer escenario donde la adopción es del 100%, se estima un impacto presupuestal por $185.125.303.066,60 pesos colombianos y para el escenario en el que comienza con el 50% y creciendo se evidencia un impacto de $92.562.651.533,3 pesos colombianos.(AU)

Costos en pacientes con infección por Acinetobacter baumanniien Colombia / Healthcare costs in Colombian patients infected with Acinetobacter baumannii

Objetivo: Determinar el impacto económico como resultado de la adquisición de una infección por A. baumannii en Colombia. Métodos: Se consideró la información de un estudio previo de cohorte prospectivo, multicéntrico. Se incluyeron 165 pacientes ingresados en las Unidades de Cuidados Intensivos (UCIs) participantes entre abril de 2006 y abril de 2010. Se cuantificaron los costos directos e indirectos de la atención desde la perspectiva de la sociedad utilizando la técnica de microcosteo, y se realizaron modelos uni y multivariados. Resultados: La mayoría de los pacientes eran menores de 65 años de edad (75%), hombres (64%) y una tercera parte (32%) estaban infectados por un A. baumannii resistente (resistencia a 5 o más familias de antimicrobianos). El costo total hospitalario en la población de pacientes del estudio fue de US $ 10.180 (Costos directos US $ 10.105 SD ± 6.671 y costos indirectos US $ 75 ± 106 por paciente). El costo de los antimicrobianos fue de US $ 3.497 ± 3.510 por paciente. Conclusiones: Los pacientes con A. baumannii que fueron ingresados en la UCI son altamente costosos para el sistema de salud Colombiano. Aunque el costo principal estuvo asociado directamente a la atención en salud, cada paciente y su familia también asumieron costos, que se estimaron aproximadamente en 30% del salario mensual mínimo legal vigente para el año 2012.

Objective: The purpose of the study was to determine the healthcare costs among patients infected with A. baumannii in intensive care units (ICUs) in Colombia. Methods: We reviewed information from a previous prospective, observational, and multicenter study that included 165 patients admitted to Critical Care Units (ICUs) between April 2006 and April 2010. Direct and indirect health care costs were estimated from the societal perspective using micro-costing, and uni- and multivariate models were constructed. Results: The majority of patients (64%) were male; most (75%) were under 65 years of age, and 32% were infected with a pathogen resistant to 5 or more antimicrobial families. Overall, the healthcare cost in our sample was US $10,180 (The total direct cost (SD) was US $10,105±$6671 and the indirect cost was US $75±$106 per patient). The antimicrobia cost was US $3,497±$3,510 per patient and indirect costs represented <1% of the total cost. Conclusions: High costs were observed in patients with A. baumannii who were admitted to the ICU. The main cost was the direct cost of care, but patients and their families assumed out-of-pocket costs as a consequence of the infection that represented nearly 30% of the legal minimum wage for Colombia in 2012.

[Acinetobacter baumannii - related mortality in intensive care units in Colombia]. / Mortalidad por Acinetobacter baumannii en unidades de cuidados intensivos en Colombia.

OBJECTIVE: Compare mortality in multidrug-susceptible Acinetobacter baumannii infected patients and multidrug-resistant A. baumannii-infected patients hospitalized in intensive care units (ICUs) in Colombia. METHODS: A prospective, observational, and multicenter study. A total of 165 patients admitted to the participating ICUs from April 2006 to April 2010 were included. On day 14 and day 30 of hospitalization, mortality in multidrug-resistant patients with clinical isolates of A. baumannii was compared with that in multidrug-susceptible patients. RESULTS: Of the 165 adult patients who had health care-associated infections (HAI) caused by A. baumannii, multidrug-susceptible bacteria were found in 62 patients and multidrug-resistant bacteria in 103. Statistically significant differences in mortality on day 14 of hospitalization in the ICU were not found. On the other hand, significant differences (P < 0.05) in mortality on day 30 of hospitalization were observed between patients with multidrug-resistant isolates and those with multidrug-susceptible isolates. This difference was maintained when the patients' risk factors were evaluated by multivariate analysis. CONCLUSIONS: The presence of multidrug resistance is the primary risk factor for mortality in patients with HAI caused by A. baumannii in Colombian ICUs.

[Epidemiological and economic impact of tetanus vaccination in Colombian adults]. / Impacto epidemiológico y económico de la vacunación contra el tétanos en adultos de Colombia.

OBJECTIVE: Assess the potential epidemiological and economic impact of vaccinating the over-15 Colombian population against tetanus with a booster dose every 10 years. METHODS: A cost-effectiveness analysis of tetanus vaccination with a booster dose every 10 years was conducted in Colombia and compared with the current strategy (2, 4, 6, 18, and 60 months). Estimates of the burden of disease were based on three official data sources. A Markov model from the perspective of the third party payer was developed. The time horizon was the lifetime of a person. Deterministic and probabilistic sensitivity analyses were conducted. RESULTS: In Colombia, 30 to 48 cases of tetanus resulting in 9.6 to 10.1 deaths are reported each year. Although booster vaccination for the entire population was cost-effective (the cost per disability-adjusted life year [DALY] avoided was US$ 11,314 in the entire population), gender-based differentiation of the results showed that it would not be cost-effective in women (cost per DALY avoided was US$ 4,903 in men and US$ 22,332 in women). CONCLUSIONS: This is the first study that evaluates the cost-effectiveness of a tetanus vaccine booster dose every 10 years in a developing country. Use of this measure would be cost-effective in Colombia, especially for men. As a result of the gender-based differences in the results, any decision about its use in women of childbearing age should take current vaccination into account.

Mortalidad por Acinetobacter baumannii en unidades de cuidados intensivos en Colombia / Acinetobacter baumannii - related mortality in intensive care units in Colombia

OBJETIVO: Comparar la mortalidad en pacientes infectados por Acinetobacter baumannii multisensibles con pacientes infectados por A. baumannii multirresistentes hospitalizados en unidades de cuidados intensivos (UCI) de Colombia. MÉTODOS: Estudio prospectivo, observacional y multicéntrico. Se incluyó a 165 pacientes ingresados en las UCIs participantes entre abril de 2006 y abril de 2010. Se comparó la mortalidad de los pacientes con aislamientos clínicos de A. baumannii multirresistentes frente a aquellos multisensibles al día 14 y 30 de hospitalización. RESULTADOS: De los 165 pacientes adultos que presentaron infecciones asociadas al cuidado en salud (IACS) por A. baumannii, en 62 se encontraron bacterias multisensibles y en 103, multirresistentes. No se hallaron diferencias estadísticamente significativas en la mortalidad al día 14 de hospitalización en UCI. Sí se observaron en cambio diferencias significativas (P < 0,05) para mortalidad al día 30 de hospitalización entre los pacientes con aislamientos multirresistentes y multisensibles, y esta diferencia se mantuvo al controlar los factores de riesgo de los pacientes con análisis multivariado. CONCLUSIONES: La presencia de multirresistencia es el principal factor de riesgo para la mortalidad entre los pacientes con IACS por A. baumannii en las UCI de Colombia.

OBJECTIVE: Compare mortality in multidrug-susceptible Acinetobacter baumannii infected patients and multidrug-resistant A. baumannii-infected patients hospitalized in intensive care units (ICUs) in Colombia. METHODS: A prospective, observational, and multicenter study. A total of 165 patients admitted to the participating ICUs from April 2006 to April 2010 were included. On day 14 and day 30 of hospitalization, mortality in multidrug-resistant patients with clinical isolates of A. baumannii was compared with that in multidrug-susceptible patients. RESULTS: Of the 165 adult patients who had health care-associated infections (HAI) caused by A. baumannii, multidrug-susceptible bacteria were found in 62 patients and multidrug-resistant bacteria in 103. Statistically significant differences in mortality on day 14 of hospitalization in the ICU were not found. On the other hand, significant differences (P < 0.05) in mortality on day 30 of hospitalization were observed between patients with multidrug-resistant isolates and those with multidrug-susceptible isolates. This difference was maintained when the patients' risk factors were evaluated by multivariate analysis. CONCLUSIONS: The presence of multidrug resistance is the primary risk factor for mortality in patients with HAI caused by A. baumannii in Colombian ICUs.

Impacto epidemiológico y económico de la vacunación contra el tétanos en adultos de Colombia / Epidemiological and economic impact of tetanus vaccination in Colombian adults

OBJETIVO: Evaluar el potencial impacto epidemiológico y económico de la vacunación antitetánica en la población colombiana mayor de 15 años de edad, con dosis de refuerzo cada 10 años. MÉTODOS: Se realizó un análisis de costo-efectividad de la vacunación con refuerzo cada 10 años contra el tétanos en Colombia, comparándola con la actual estrategia (2, 4, 6, 18 y 60 meses). La carga de enfermedad se estimó con base en tres fuentes oficiales de datos. Se realizó un modelo de Markov desde la perspectiva del tercer pagador. El horizonte temporal fue el tiempo de vida de una persona. Se realizaron análisis de sensibilidad determinístico y probabilístico. RESULTADOS: En Colombia se notifican anualmente entre 30 y 48 casos de tétanos que ocasionan entre 9,6 y 10,1 muertes. Si bien la vacunación con refuerzo resultó costo-efectiva para toda la población (el costo por año de vida ajustado por discapacidad [AVAD] evitado fue de US$ 11 314 en toda la población), al discriminar los resultados por género no sería costoefectiva en las mujeres (el costo por AVAD evitado en hombres fue de US$ 4 903, y en mujeres de US$ 22 332). CONCLUSIONES: Este es el primer estudio que evalúa la costo- efectividad de una dosis de refuerzo cada 10 años de la vacuna contra el tétanos en un país en desarrollo. La aplicación de esta medida sería costo-efectiva en Colombia, especialmente para los hombres. Las diferencias en los resultados por género obliga a que cualquier decisión de implementación deba tener en cuenta la vacunación actual en mujeres en edad fértil.

OBJECTIVE: Assess the potential epidemiological and economic impact of vaccinating the over-15 Colombian population against tetanus with a booster dose every 10 years. METHODS: A cost-effectiveness analysis of tetanus vaccination with a booster dose every 10 years was conducted in Colombia and compared with the current strategy (2, 4, 6, 18, and 60 months). Estimates of the burden of disease were based on three official data sources. A Markov model from the perspective of the third party payer was developed. The time horizon was the lifetime of a person. Deterministic and probabilistic sensitivity analyses were conducted. RESULTS: In Colombia, 30 to 48 cases of tetanus resulting in 9.6 to 10.1 deaths are reported each year. Although booster vaccination for the entire population was cost-effective (the cost per disability-adjusted life year [DALY] avoided was US$ 11,314 in the entire population), gender-based differentiation of the results showed that it would not be cost-effective in women (cost per DALY avoided was US$ 4,903 in men and US$ 22,332 in women). CONCLUSIONS: This is the first study that evaluates the cost-effectiveness of a tetanus vaccine booster dose every 10 years in a developing country. Use of this measure would be cost-effective in Colombia, especially for men. As a result of the gender-based differences in the results, any decision about its use in women of childbearing age should take current vaccination into account.

[The cost of treatment of multiple sclerosis in Colombia]. / Costos de la esclerosis múltiple en Colombia.

OBJECTIVE: To estimate, according to the states of disease (remission or relapse) and her level of progression (EDSS), the cost of treatment of Multiple Sclerosis (MS) in Colombia. METHODS: From the perspective of the third payer, a cost study of MS was performed using two-way estimation techniques: a) "Top down" to estimate the costs during relapses from clinical registers of 304 patients; b) "bottom-up" to estimate the cost in remission from a questionnaire (Kobelt 2006) applied to 137 patients, located in different regions of Colombia. RESULTS: The mean of patient's age was 43,7 years and 73% of those were women. The mean annual cost per patient varied according to the disease phase, finding the highest value in Phase II (EDSS 3 - 5,5) with $ 50.581.216 COP (US$ 25.713) and the lowest one in Phase IV (EDSS 8 - 9,5) with $20.738.845 COP (US$ 10.543). The cost of Disease Modifier Drugs (DMD) represented 91.5% from the medial total annual cost of 1,2 and 3 phases. The participation of DMD was 58%.in the 4 phase. Indirect costs are minimal participation in all phases, except for 4 where increases at the expense of reduced consumption of DMD. Costs associated with the period of relapses of MS are low against the total cost, with an average cost of $ 2,433,182 COP ($ 1.237 USD). DISCUSSION: MS in Colombia is a disease with a behavioral pathology "high cost " to the social security system (SGSSS), generated mainly at the expense of their direct costs, which, even without including relapses, an aggregate amount of more than 75 times the annual premium cost of health insurance for Colombia ($ 430,488 COP) in the year under review (2008).

[Theoretical estimation of the epidemiological impact of hepatitis A infection in Colombia]. / Estimación del impacto de la infección por Hepatitis A en zonas urbanas de Colombia 2008: Un análisis a partir de datos secundarios.

BACKGROUND: Hepatitis A vaccination is justified in areas with an intermediate endemicity of the infection. AIM: To estimate the epidemiological impact of hepatitis A infection in Colombia. MATERIAL AND METHODS: Epidemiological indicators of hepatitis A infection prevalence by age, morbidity by age, and lethality by age were estimated from a literature search. These measures were projected on a hypothetical cohort of children followed from birth until 15 years of age. The number of cases of infection, jaundice, hepatic failure, hospitalizations and deaths were estimated. RESULTS: From birth to adolescence, a cohort of 872 923 urban children in Colombia would generate between 312,331 and 598,591 infections, between 13,586 and 25,960 hospitalizations, between 213 and 407 hepatic failures and between 107 and 204 deaths. CONCLUSIONS: The impact of hepatitis A infection in Colombia, is important. Introducing hepatitis A vaccination would reduce a substantial number of severe hepatitis A cases.

Los QALYs y DALYs como indicadores sintéticos de salud / QALYs and DALYs as synthetic indicators of health

This article is a revision of the genesis and use of the health synthetic indicators QALYs and DALYs. The chronology of their appearance is shown and similarities and differences between them stated. DALYs (Disability-Adjusted Life-Years) correspond to years of life that are adjusted by a certain level of disability experienced during a particular period of time. DALYs, by studying disease burden, summarize the impact of mortality and disability related to specific disease in different communities. On the other hand, QALYs (Quality-Adjusted Life-Years) summarize health results in an indicator that combines the number of years lived with the quality of life experienced over those years. QALYs and DALYs play a crucial role as results measures in economic evaluation studies (cost-effectiveness and cost-utility analysis) measuring the impact of actions or specific interventions in the reversion of disease burden (DALYs) and/ or the improvement of the quality of life and life expectancy of patients (QALYs). Their generic character allows the comparison of the impact of health interventions for different diseases.

En el presente artículo se revisa la génesis y uso de los indicadores sintéticos de salud QALYs y DALYs. Se muestra la cronología de su aparición y se establecen las semejanzas y diferencias entre los mismos. Los DALYs (Disability Adjusted Life Years) corresponden a los años de vida ajustados por la Discapacidad o AVADs por su sigla en español. Los DALYs resumen, mediante estudios de carga de la enfermedad, el impacto de la mortalidad y discapacidad asociada a enfermedades especificas, en distintas comunidades; en cambio los QALYs (Quality Adjusted Life Years) sintetizan los resultados de salud en un indicador que combina el número de años vividos con la calidad de vida experimentada durante esos años. QALYs y DALYs cumplen hoy un papel esencial como medidas de resultado en los estudios de evaluación económica (análisis de costo efectividad y costo utilidad) midiendo el impacto de acciones o intervenciones especificas para revertir la carga de la enfermedad (DALYs) y/o mejorar la calidad y esperanza de vida de pacientes (QALYs). Su carácter genérico permite comparar el impacto de intervenciones de salud entre diferentes enfermedades.

Estimación del impacto de la infección por Hepatitis A en zonas urbanas de Colombia 2008: Un análisis a partir de datos secundarios / Theoretical estimation of the epidemiological impact of hepatitis A infection in Colombia

Background: Hepatitis A vaccination is justified in areas with an intermediate endemicity of the infection. Aim: To estimate the epidemiological impact of hepatitis A infection in Colombia. Material and Methods: Epidemiological indicators of hepatitis A infection prevalence by age, morbidity by age, and lethality by age were estimated from a literature search. These measures were projected on a hypothetical cohort of children followed from birth until 15 years of age. The number of cases of infection, jaundice, hepatic failure, hospitalizations and deaths were estimated. Results: From birth to adolescence, a cohort of 872 923 urban children in Colombia would generate between 312,331 and 598,591 infections, between 13,586 and 25,960 hospitalizations, between 213 and 407 hepatic failures and between 107 and 204 deaths. Conclusions: The impact of hepatitis A infection in Colombia, is important. Introducing hepatitis A vaccination would reduce a substantial number of severe hepatitis A cases.

[Economic impact of introducing the injectable inactivated polio vaccine in Colombia]. / Impacto económico de la introducción de la vacuna inactivada inyectable contra la poliomielitis en Colombia.

OBJECTIVE: Evaluate the cost-effectiveness of introducing the injectable inactivated polio vaccine (IPV) in Colombia versus the current system based on the use of the oral vaccine (OPV). METHODS: A Markov model was designed, based on a hypothetical cohort of newborns that would receive the IPV or the OPV vaccine, with a two-year follow-up and monthly estimates of the number of cases of vaccine-associated paralytic poliomyelitis (VAPP) that would emerge. The cost was analyzed from the perspective of the insurer (costs throughout life) and society (cases of VAPP and disability-adjusted life years [DALYs] prevented). RESULTS: From 1988 to 1998, some 22.5 million doses of OVP were administered in Colombia and nine cases of VAPP were detected, for a rate of 4.0 yen 10-7 dose. According to the model, 2 to 4 cases of VAPP could be anticipated in the following two years. The cost of treating the VAPP cases would total US$302,008, with the cost of vaccination with OPV coming to US$737,037 and with IPV, US$5,527,777. Vaccination with IPV would prevent 64 DALYs, at a cost of US$71,062 per DALY prevented; preventing one case of VAPP by substituting OPV with IPV would cost between US$1.8 and US$2.2 million. CONCLUSIONS: Substituting OPV with IPV is not a cost-effective measure in Colombia, even if the cellular vaccine against whooping cough currently in use were replaced with an acellular vaccine combined with an IPV.

Impacto económico de la introducción de la vacuna inactivada inyectable contra la poliomielitis en Colombia / Economic impact of introducing the injectable inactivated polio vaccine in Colombia

OBJETIVOS: Evaluar la relación costo-efectividad de la introducción de la vacuna inyectable contra la poliomielitis (VIP) en Colombia con respecto al sistema actual basado en el empleo de la vacuna oral (VOP). MÉTODOS: Se diseñó un modelo de Markov basado en una cohorte hipotética de recién nacidos que recibiría la VIP o la VOP con un seguimiento de dos años y estimaciones mensuales del número de casos de poliomielitis paralítica asociada con la vacuna (PPAV). El análisis del costo se realizó desde la perspectiva del asegurador (costos a lo largo de la vida) y la sociedad (casos de PPAV evitados y años de vida ajustados por discapacidad [AVAD] evitados). RESULTADOS: Entre 1988 y 1998 se aplicaron en Colombia 22,5 millones de dosis de la VOP y se detectaron nueve casos de PPAV, para una tasa de 4,0 ¥ 10-7 por dosis. Según el modelo, se podrían esperar entre 2 y 4 casos de PPAV en los dos años de seguimiento. El costo de tratar los casos de PPAV sería de US$ 302 008, con costos de vacunación con la VOP de US$ 737 037 y de US$ 5 527 777 con la VIP. La vacunación con la VIP permitiría evitar 64 AVAD con un costo de US$ 71 062 por AVAD evitado; evitar un caso de PPAV mediante la sustitución de la VOP por la VIP costaría entre US$ 1,8 millones y US$ 2,2 millones. CONCLUSIONES: La sustitución de la VOP por la VIP no es una medida efectiva en función del costo en Colombia, incluso si se sustituyera la vacuna celular contra la tos ferina, actualmente en uso, por una vacuna acelular combinada con una VIP.

OBJECTIVE: Evaluate the cost-effectiveness of introducing the injectable inactivated polio vaccine (IPV) in Colombia versus the current system based on the use of the oral vaccine (OPV). METHODS: A Markov model was designed, based on a hypothetical cohort of newborns that would receive the IPV or the OPV vaccine, with a two-year follow-up and monthly estimates of the number of cases of vaccine-associated paralytic poliomyelitis (VAPP) that would emerge. The cost was analyzed from the perspective of the insurer (costs throughout life) and society (cases of VAPP and disability-adjusted life years [DALYs] prevented). RESULTS: From 1988 to 1998, some 22.5 million doses of OVP were administered in Colombia and nine cases of VAPP were detected, for a rate of 4.0 ¥ 10-7 dose. According to the model, 2 to 4 cases of VAPP could be anticipated in the following two years. The cost of treating the VAPP cases would total US$302 008, with the cost of vaccination with OPV coming to US$737 037 and with IPV, US$5 527 777. Vaccination with IPV would prevent 64 DALYs, at a cost of US$71 062 per DALY prevented; preventing one case of VAPP by substituting OPV with IPV would cost between US$1.8 and US$2.2 million. CONCLUSIONS: Substituting OPV with IPV is not a cost-effective measure in Colombia, even if the cellular vaccine against whooping cough currently in use were replaced with an acellular vaccine combined with an IPV.