Cost-utility analysis of genomic profiling in early breast cancer in Colombia.

BACKGROUND: In Colombia, the best strategy to establish indication for adjuvant chemotherapy in early breast cancer (EBC) remains unknown. This study aimed to identify the cost-utility of Oncotype DX™ (ODX) or Mammaprint™ (MMP) tests to establish the necessity of adjuvant chemotherapy. METHODS: This study used an adapted decision-analytic model to compare cost and outcomes of care between ODX or MMP tests and routine care without ODX or MMP tests (adjuvant chemotherapy for all patients) over a 5-year time horizon from the perspective of the Colombian National Health System (NHS; payer). Inputs were obtained from national unit cost tariffs, published literature, and clinical trial database. The study population comprised women with hormone-receptor-positive (HR +), HER2-negative, lymph-node-negative (LN0) EBC with high-risk clinical criteria for recurrence. The outcome measures were discounted incremental cost-utility ratio (ICUR; 2021 United States dollar per quality-adjusted life-year [QALY] gained) and net monetary benefit (NMB). Probabilistic (PSA) and deterministic sensitivity analysis (DSA) were performed. RESULTS: ODX increases QALYs by 0.05 and MMP by 0.03 with savings of $2374 and $554 compared with the standard strategy, respectively, and were cost-saving in cost-utility plane. NMB for ODX was $2203 and for MMP was $416. Both tests dominate the standard strategy. Sensitivity analysis revealed that with a threshold of 1 gross domestic product per capita, ODX will be cost-effective in 95.5% of the cases compared with 70.2% cases involving MMP.DSA showed that the variable with significant influence was the monthly cost of adjuvant chemotherapy. PSA revealed that ODX was a consistently superior strategy. CONCLUSIONS: Genomic profiling using ODX or MMP tests to define the need of adjuvant chemotherapy treatment in patients with HR + and HER2 -EBC is a cost-effective strategy that allows Colombian NHS to maintain budget.

Premezclados como alternativa para el uso seguro de medicamentos intravenosos en escenarios de atención en salud / Premixed products, an alternative for safe intravenous medications use in health care settings / As pré-misturas como alternativa para o uso seguro de drogas intravenosas em ambientes de saúde

RESUMEN Objetivo: presentar el panorama de errores de medicación, los recursos asociados a la preparación de medicamentos intravenosos y el uso de premezclados en la aten ción en salud. Metodología: se realizaron búsquedas en diferentes bases de datos, sin límite de fecha o tipo de estudio. Adicionalmente se realizó un análisis para estimar los costos, validando con expertos los recursos en central de mezclas. Resultados: los errores de medicación son un error médico común a nivel global. Los datos disponi bles son heterogéneos, pero sugieren que los errores de medicación pueden ser una causa considerable de morbilidad y mortalidad en ciertas poblaciones y contextos, con intervenciones adicionales, estancias hospitalarias prolongadas, mayores costos de atención y reducción en la probabilidad de que el tratamiento sea oportuno y eficaz. En medicinas intravenosas resultan escenarios de mayor gravedad y mayor nivel de costos. Los costos laborales anuales para una central de mezclas en Colombia se estiman entre 281,5 y 422,3 millones de pesos. La estandarización, como parte de los fármacos premezclados proporciona menor riesgo de contaminación, menor posibilidad de error en la preparación, menor incidencia de complicaciones rela cionadas con la terapia, disminución del desperdicio, mejora en la oportunidad de dispensación, optimización en el trabajo de los equipos de farmacia y reducción de costos asociados con este proceso. Conclusiones: el uso de premezclados, como parte de un programa de reducción de errores de medicación, puede mejorar los indicadores de calidad en administración de medicamentos y garantizar un uso más seguro de la terapia intravenosa.

SUMMARY Objective: To present an overview of medication preparation and administration errors, the resources implied in the preparation of intravenous medications, and the use of premixed drugs in healthcare settings. Methodology: We performed a litera ture review without limits by date or type of study. Additionally, analysis and vali dation by pharmaceutical experts were carried out to estimate the use of resources and related costs. Results: The available heterogeneous data suggest that medication errors are a significant cause of morbidity and mortality in specific populations and settings. Error medications cause additional interventions, prolonged hospitalization, higher costs of care, and a reduction in the treatment probability of success. Errors involving intravenously administered drugs have more severe consequences and generate higher costs. Annual labor costs for centralized medication mixing in Colombia are estimated between $281.5 and $422.3 million. Premixed drugs decrease the risk of contamination, the possibility of error in the preparation, and the incidence of complications related to therapy. Also, its use is related to the reduc tion of waste, improvement in the timing of dispensing, optimizing the pharmacy team, and reducing costs associated with this process. Conclusions: The use of premixes as part of a program to reduce medication errors can improve the quality indicators in drug administration and guarantee a safer use of intravenous therapy.

RESUMO Objetivo: apresentar o panorama dos erros de medicação, os recursos associados ao preparo de medicamentos intravenosos e o uso de pré-misturas na assistência à saúde. Metodologia: as buscas foram realizadas em diferentes bases de dados, sem limite de data ou tipo de estudo. Além disso, foi realizada uma análise para estimar os custos, validando com especialistas os recursos no centro de mistura. Resultados: erros de medicação são um erro médico comum globalmente. Os dados disponíveis são heterogêneos, mas sugerem que os erros de medicação podem ser uma causa significativa de morbidade e mortalidade em certas populações e contextos, com intervenções adicionais, internações hospitalares mais longas, custos mais altos de atendimento e probabilidade reduzida de que o tratamento seja oportuno e eficaz. Nos medicamentos intravenosos, resultam cenários de maior gravidade e maior nível de custos. Os custos anuais de mão de obra para uma usina de mistura na Colômbia são estimados entre 281,5 e 422,3 milhões de pesos. A padronização, como parte dos medicamentos pré-misturados, proporciona menor risco de contaminação, menor possibilidade de erro no preparo, menor incidência de complicações relacionadas à terapêutica, redução de desperdícios, melhoria na oportunidade de dispensação, otimização no trabalho das equipes. da farmácia e redução dos custos associados a este processo. Conclusões: o uso de pré-misturas, como parte de um programa de redução de erros de medicação, pode melhorar os indicadores de qualidade na admi nistração de medicamentos e garantir um uso mais seguro da terapia intravenosa.

Inmunonutrición, cirugía y oncología: un modelo de atenciónnutricional basado en la evidencia / Immunonutrition, surgery and oncology: an evidence-based model of nutritional care

Introducción: La presente revisión de literatura permiteproponer un modelo de acción para identificar oportunamentelos pacientes que requieren cirugía mayor y que puedan be-neficiarse de intervenciones nutricionales como la inmunonu-trición a partir de la evidencia científica. Objetivo: El propósito de esta revisión y síntesis es pro-poner un modelo intervención nutricional en el manejo nutri-cional de los pacientes en el perioperatorio.Material y métodos: Se realizó una revisión rápida de laliteratura, a partir de la consulta en las siguientes fuentes dedatos,EMBASE, MEDLINE (Pubmed), Cochrane Database ofSystematic Reviews (Wiley), LILACS (BVS, interfaz iAHx) y elmotor de búsqueda Google Académico. Resultados: Se identificaron 40 artículos, que cumplieroncon los parámetros establecidos para la revisión sistemática ylos criterios de calidad, que permitieron establecer cuatro fa-ses para la propuesta de intervención nutricional en el manejonutricional perioperatorio, tamización nutricional de rutina enconsulta externa, suplementación preoperatoria con dosis te-rapéutica de inmunonutrición, intervención nutricional intra-hospitalaria y seguimiento nutricional postoperatorio.(AU)

Background: The present literature review allows us topropose a model of action for the timely identification of pa-tients who require major surgery and who may benefit fromnutritional interventions such as immunonutrition based onscientific evidence. Objective: The purpose of this review and synthesis is topropose a nutritional intervention model in the nutritionalmanagement of perioperative patients. Material and methods: A quick review of the literaturewas carried out, based on consultation of the following datasources, EMBASE, MEDLINE (Pubmed), Cochrane Database ofSystematic Reviews (Wiley), LILACS (BVS, iAHx interface) andthe Google Scholar search engine. Results: As a result, 40 articles were identified, which metthe parameters established for the systematic review and the quality criteria, which allowed establishing four phases for theproposal of nutritional intervention 360 in perioperative nutri-tional management, routine nutritional screening in outpa-tient clinic, preoperative supplementation with therapeuticdoses of immunonutrition, in-hospital nutritional interventionand postoperative nutritional follow-up. Conclusion: A nutritional intervention model that includesa nutritional contribution with a formula of amino acids (argi-nine and/or glutamine), polyunsaturated fatty acids (omega-3fatty acid) and a mixture of nucleotides or RNA, is a cost-ef-fective strategy in elective surgery patients for gastrointestinalcancer (stomach and colon cancer), head and neck surgery,patients over 18 years of age.(AU)

[Pharmacoeconomics and outcome research on Irritable Bowel Syndrome review of findings using Tegaserod]. / Farmacoeconomía e investigación de resultados en el Síndrome de Intestino Irritable: revisión de la evidencia con Tegaserod.

Irritable Bowel Syndrome (IBS) is a chronic and episodic disease that affects 14.5% of females in the United States, and its impact decreases the quality of life. On the other hand, IBS consumes a great part of the health budget and develops indirect costs by loss of work productivity. Currently Tagaserod an agonist of the number 4 serotonin receptors (5-HT4), indicated for IBS-Constipation treatment, has demonstrated savings while optimizing health resources and improving the quality of life of patients and their work productivity.