Cost-Effectiveness of Natalizumab Compared With Fingolimod for Relapsing-Remitting Multiple Sclerosis Treatment in Colombia.

OBJECTIVES: Multiple sclerosis (MS) is a degenerative neurological disorder. Treatment aims to avoid relapses and disability progression. The purpose of this study was to evaluate the cost-effectiveness of natalizumab compared with fingolimod for treating highly active relapsing-remitting MS (RRMS) patients from the Colombian third-party payer perspective. METHODS: We used a Markov economic model from the perspective of the Colombian healthcare system to estimate the cost-effectiveness of natalizumab compared with fingolimod for RRMS with high disease activity or failure of interferons as first-line therapy. This model was centered on disability progression and relapses. We considered a 5-year time horizon with a 5% discount rate. We included only direct medical costs. Local experts were consulted to obtain resource utilization estimates, and local standardized costing methodologies and sources were used. Outcome was considered in terms of quality-adjusted life-years (QALYs). Utilities were extracted or calculated from the literature. Transition probabilities were calculated from available efficacy and safety information (1 USD = 3050.98 COP). RESULTS: Natalizumab showed lower total costs (USD 80 024 vs USD 98 137) and higher QALY yield (3.01 vs 2.94) than fingolimod, dominating it (incremental cost-effectiveness ratio = -$1861). Univariate sensitivity analysis showcased the relevance of the measures of effect on disability progression for natalizumab on model results. Probabilistic sensitivity analysis replicated base-case results in most simulations. CONCLUSIONS: This study showed that natalizumab dominated fingolimod with lower costs and higher QALYs in patients with high-activity RRMS. These results are consistent with previous published international literature.

Quiloperitoneo en diálisis peritoneal: reporte de caso y revisión sistemática de la literatura / Chyloperitoneum in peritoneal dialysis: a case report and review of literature

El quiloperitoneo es una condición infrecuente que se asocia a diálisis peritoneal; en la mayoría de los casos se puede confundir con peritonitis bacteriana, aunque puede ser la consecuencia de esta infección. Se reporta el desarrollo espontáneo de quiloperitoneo en un paciente de 54 años con enfermedad renal crónica secundaria a nefropatía diabética, en diálisis peritoneal manual desde hacía 5 años. El tratamiento consistió en suspensión temporal de la diálisis peritoneal, reposo intestinal, suministro de una dieta con alto contenido de ácidos grasos de cadena media e infusión de octreotide, con lo cual a los 10 días el paciente mostró mejoría, y se reinició la diálisis peritoneal. Una búsqueda sistemática de la literatura encontró 16 casos publicados (11 mujeres), con edades desde neonato hasta 88 años.

Chyloperitoneum is a rare condition associated with peritoneal dialysis. In most cases it is misdiagnosed as bacterial peritonitis, but it can also be a consequence of this infection. We present the spontaneous development of chyloperitoneum in a 54 year old patient with chronic kidney disease secondary to diabetic nephropathy, in manual peritoneal dialysis for 5 years. The treatment consisted of temporary suspension of peritoneal dialysis, bowel rest, supply of a diet with a high content of medium chain fatty acids and infusion of octreotide. After 10 days the patient showed improvement, and peritoneal dialysis was restarted. A systematic search of the literature found 16 published cases (11 women), ranging in age from newborn to 88 years.

La fiebre amarilla en Colombia: de calamidad pública a enfermedad desatendida / Yellow fever in Colombia: from public calamity to neglected disease

Desde su llegada al país a mediados del siglo XVII, la fiebre amarilla jugó un papel importante en la historia patria, primero con epidemias en los puertos del Caribe, y luego, con la navegación a vapor, remontando los ríos principales, sobre todo el Magdalena. Tanto el descubrimiento de los vectores involucrados en la transmisión como el desarrollo de la vacuna delegaron la preocupación a un segundo plano. Los brotes epidémicos de fiebre amarilla, esporádicos y en regiones apartadas, siguieron ocurriendo, para recrudecerse en 2016, en paralelo con lo que ocurre en países vecinos como Perú y Brasil. El vector principal, el Aedes aegypti, involucrado en la transmisión de otros arbovirus, se adapta y se extiende en muchos entornos urbanos del continente. Se cuenta, sin embargo, con una vacuna de relativo bajo costo y de alta efectividad que podría contribuir a la erradicación de la enfermedad

Since its arrival to Colombia in the middle XVII century, yellow fever played an important role in its history; first with epidemics in the Caribbean ports, and later, when steamboats became available, by navigating upstream the Magdalena River. Both the discovery of the vectors involved in its transmission as well as the development of an effective vaccine led concerns about the disease to a secondary plane. Epidemic outbreaks of yellow fever continued occurring, particularly in very distant regions and also with prolonged time intervals. However, since 2016 there has been a recrudescence of such outbreaks, in parallel with what is going in our neighbor countries, Peru and Brazil. The main vector, Aedes aegypti, is also involved in the transmission of other arbovirus infections, and it is capable of adapting and extending its presence in many urban areas in South America. Nonetheless, a low-cost and highly effective vaccine is available, which may contribute to eradicate the disease