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1.
Dermatol Ther ; : e14135, 2020 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-32761749

RESUMO

The current systematic review aimed to evaluate the efficacy and safety of dabrafenib plus trametinib (dabrafenib-trametinib) with those of other therapeutic alternatives in the treatment of patients with BRAF V600 mutation unresectable or metastatic melanoma. The search was carried out on four databases up to July-2018. Two separate network meta-analyses (NMA) were performed using the frequentist method (random effects): one with an exclusive population with BRAF V600 mutation (NMA-pBRAFV600) and another with a mixed population (with or without the mutation: NMA-pMixed). An evidence profile was included using the GRADE method for NMA. The validity of the final estimator in the NMA-pMixed was assessed via sensitivity analysis. Five clinical trials were included in the NMA-pBRAFV600. In the NMA-pBRAFV600 population, dabrafenib-trametinib had a favorable effect on overall survival (OS) and progression-free survival (PFS) compared with dabrafenib, vemurafenib, and dacarbazine, and on partial response rate (PRR) and overall response rate (ORR) compared with dacarbazine and vemurafenib. In the NMA-pMixed population, dabrafenib-trametinib had a positive effect on OS vs ipilimumab 3 mg/kg and on PFS and PRR vs ipilimumab (3 and 10 mg/kg), nivolumab, and pembrolizumab. However, dabrafenib-trametinib, and vemurafenib-cobimetinib were comparable in terms of clinical efficacy. In addition, dabrafenib-trametinib was associated with less grades 3 and 4 adverse events.

2.
Value Health Reg Issues ; 23: 37-48, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32688214

RESUMO

OBJECTIVES: To characterize at a global level the concept of therapeutic value (TV) and describe the experience of value-based pricing (VBP) policies in 6 reference countries. METHODS: We conducted a rapid review of the literature that addressed 2 exploratory research questions. A systematic and exhaustive search was carried out up to July 2018 in MEDLINE (Ovid), Embase, Scopus, and Web of Science. RESULTS: The concepts of TV and VBP are related; value frameworks for medicines should include social preferences, comparative effectiveness, safety, adoption viability, social impact, high quality of evidence, severity of illness, and innovation. The added therapeutic value (ATV) is the manner of measuring the therapeutic advantages of new medicines compared with existing ones in terms of comparative effectiveness and safety. There are variations in the mechanisms of reimbursement and drug pricing regulation between the countries of study. CONCLUSION: In a VBP system it is essential to establish the TV and ATV of a new medicine. Although there are no methodological guidelines for the implementation of VBP policies, the process implies from the beginning the definition of TV categories that will be included in the drug pricing and reimbursement systems. Agreements between the pharmaceutical industry and governments have become a useful tool as a negotiating mechanism in most countries.

3.
Iatreia ; 33(2): 167-176, abr.-jun. 2020. tab
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1114788

RESUMO

SUMMARY Epilepsy is a common neurological disorder that affects approximately 1% of the world's pop7u-lation. About one third of those patients suffer from treatment-resistant epilepsy (TRE8), defined as failure to stop seizures despite adequate trials of at least two medications at therapeutic dosa-ges. There has been a growing interest in the development of novel antiepileptic drugs with diffe-rent mechanisms of action. This narrative review, based on 42 references retrieved from Scopus and Medline, discusses the scientific data from human and animal studies regarding the efficacy of cannabis-based treatment for epilepsy. Benefits have been described in preclinical and cli-nical studies in children, but ongoing research will clarify the real role of cannabinoids in TRE.


RESUMEN La epilepsia es un desorden neurológico común que afecta aproximadamente al 1% de la pobla-ción mundial. Alrededor de un tercio de los pacientes sufren de epilepsia resistente al tratamiento, que se define como la falla de parar las crisis epilépticas a pesar de haber recibido tratamiento con dos medicamentos a dosis terapéuticas. Se ha visto interés en el desarrollo de medicamentos antiepilépticos con dife-rentes mecanismos de acción. Esta revisión narrativa se basó en 42 referencias extraídas de Scopus y Medli-ne, que discuten hallazgos científicos sobre estudios en humanos y animales acerca de la eficacia del cannabis para el tratamiento de epilepsia. Los beneficios se des-cribieron en estudios preclínicos y clínicos en niños, sin embargo investigaciones en curso clarificarán el papel real de los cannabinoides para la epilepsia resistente al tratamiento.

4.
Infectio ; 24(1): 9-14, ene.-mar. 2020. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1090537

RESUMO

Abstract Objective: To evaluate the cost-effectiveness of ceftolozane/tazobactam + metronidazole (C/T+M) and ceftolozane/tazobactam (C/T) compared with 8 alternatives used in the treatment of complicated intraabdominal infection (cIAI) and complicated urinary tract infection (cUTI) respectively. Methods: A Monte Carlo simulation decision model was used for the estimation and comparison of treatment-related costs, and quality adjusted life years for patients with cIAI treated with C/T+M in comparison with cefepime + metronidazole, ciprofloxacin + metronidazole, doripenem, levofloxacin + metronidazole, meropenem, piperacillin/tazobactam, ceftazidime + metronidazole or imipenem/cilastatin and patients with cUTI treated with C/T in comparison with cefepime, ciprofloxacin, doripenem, levofloxacin, meropenem, piperacillin/tazobactam, ceftazidime or imipenem/cilastatin. Local costs were estimated using base cases identified by experts and consulting local databases. Sensitivity values of the PACTS (Program to Assess Ceftolozane/Tazobactam Susceptibility) study in Latin America were used in the model. Results: C/T+M and C/T obtained incremental cost-effectiveness ratios (ICER) that were below the Colombian cost-effectiveness threshold (3 GDP per capita) in most comparisons, and were dominated by meropenem, considering only gram-negative microorganisms. Sensitivity assessments were also carried out, in which only the population with P. aeruginosa infections was considered, showing positive results for C/T+M and C/T (cost-effective or dominant with regards to all comparators). Conclusions: C/T+M and C/T could be cost-effective alternatives in the treatment of CIAI and CUTI in Colombia, when there is an adequate and rational use of antibiotics. The results of the sensitivity analyses showed dominance and cost-effectiveness with regards to every comparator in patients infected with P. aeruginosa


Resumen Objetivo: Evaluar la costo-efectividad de ceftolozano/tazobactam + metronidazol (C/T + M) y ceftolozano/tazobactam (C/T) en comparación con 8 alternativas utilizadas en el tratamiento de las infecciones intraabdominales complicadas (IAAc) e infecciones del tracto urinario complicadas (ITUc) respectivamente. Métodos: Se usó un modelo de decisión de simulación de Monte Carlo para la estimación y comparación de los costos relacionados con el tratamiento y los años de vida ajustados por calidad para pacientes con IAAc tratados con C/T + M, en comparación con cefepima + metronidazol, ciprofloxacina + metronidazol, doripenem , levofloxacina + metronidazol, meropenem, piperacilina / tazobactam, ceftazidima + metronidazol o imipenem/cilastatina, y pacientes con ITUc tratados con C/T en comparación con cefepime, ciprofloxacina, doripenem, levofloxacina, meropenem, piperacilina / tazobactam, ceftazidima o imipenem/cilastatina . Los costos locales se estimaron por medio de casos base identificados por expertos y consultando bases de datos locales. Se utilizaron los valores de sensibilidad bacteriana del estudio PACTS (Programa para evaluar la susceptibilidad al ceftolozano/tazobactam) en América Latina para poblar el modelo. Resultados: C/T + M y C/T obtuvieron razones de costo-efectividad incrementales (RCEI) que estaban por debajo del umbral de costo-efectividad colombiano (3 PIB per cápita) en la mayoría de las comparaciones, y fueron dominados por meropenem, considerando solo microorganismos gran-negativos También se llevaron a cabo análisis de sensibilidad, en los que solo se consideró la población con infecciones por P. aeruginosa, mostrando resultados positivos para C/T + M y C/T (costo efectivo o dominante con respecto a todos los comparadores). Conclusiones: C/T + M y C/T podrían ser alternativas costo efectivas en el tratamiento de IAAc e ITUc en Colombia, cuando existe un uso adecuado y racional de antibióticos. Los resultados de los análisis de sensibilidad mostraron dominio y costo-efectividad en relación con todos los comparadores en pacientes infectados con P. aeruginosa.

5.
Value Health Reg Issues ; 23: 13-18, 2020 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-31999987

RESUMO

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.

6.
Dermatol Ther ; 33(2): e13145, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31664762

RESUMO

The current systematic review aimed to evaluate and compare the efficacy and safety of dabrafenib-trametinib with those of other therapeutic alternatives in the treatment of patients with unresectable advanced/metastatic melanoma with BRAF-V600 mutation. The search was carried out on four databases up to July 2018. Two separate network meta-analyses (NMA) were performed using the frequentist method (random effects): one with an exclusive population with BRAF-V600 mutation (NMA-pBRAFV600) and another with mixed population (with or without the mutation: NMA-pMixed). An evidence profile was included using the GRADE method for NMA. The validity of the final estimator in the NMA-pMixed was assessed via a sensitivity analysis. Nine clinical trials were included in the NMA-pBRAFV600. Dabrafenib-trametinib was found to have a favorable effect on overall survival (OS) and progression-free survival (PFS) compared with dabrafenib, vemurafenib, and dacarbazine and on partial response rate (PRR) and overall response rate compared with dacarbazine and vemurafenib. In the NMA-pMixed, dabrafenib-trametinib was found to have a positive effect on OS versus ipilimumab 3 mg/kg and on PFS and PRR versus ipilimumab, nivolumab, and pembrolizumab. However, dabrafenib-trametinib and vemurafenib-cobimetinib significantly differed in terms of efficacy. In addition, dabrafenib-trametinib has a favorable effect on Grades 3 and 4 adverse events.

7.
Rev. colomb. gastroenterol ; 35(1): 104-113, 2020.
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1115605

RESUMO

Resumen Introducción: si bien los cannabinoides se han utilizado durante varios años, apenas recientemente se han descrito los descubrimientos sobre sus mecanismos de acción y blancos terapéuticos, así como las alteraciones en el sistema endocannabinoide, observadas en diversas enfermedades y condiciones que se manifiestan con dolor, inflamación, patologías autoinmunes y distintos desórdenes específicos de los órganos. La enfermedad inflamatoria intestinal (EII) agrupa dos condiciones idiopáticas crónicas con patogénesis incierta, en las que se ha identificado que una desregulación del sistema inmune desempeña un papel importante. Así, pues se necesita desarrollar tratamientos alternativos para estos pacientes, ya que solo una minoría de ellos alcanza una remisión de la enfermedad. Nuestro objetivo es revisar las evidencias recientes relacionadas con el uso de cánnabis en la colitis ulcerativa (CU) y en la enfermedad de Crohn (EC). Métodos: se realizó una revisión narrativa focalizada, a partir de las bases de datos de búsqueda de Pubmed y Embase. Los artículos pertinentes fueron revisados y resumidos en forma narrativa. Resultados: los dos componentes principales del cannabis, el cannabidiol (CBD) y el tetrahidrocannabinol (THC), han sido estudiados extensivamente y han probado causar efectos antiinflamatorios y antinociceptivos. Se han descrito ampliamente las propiedades de estos componentes en el control sintomático de la CU y de la EC. No obstante, se sugieren estudios de alta calidad para seguir evaluando la eficacia y la seguridad del uso del cannabis en pacientes con la EII.


Abstract Introduction: Although cannabinoids have been used for several years, only recently have their mechanisms of action and therapeutic targets been described. Alterations in the endocannabinoid system have been observed in various diseases and conditions such as pain, inflammation, autoimmune diseases and various specific disorders. Inflammatory bowel disease groups two chronic idiopathic conditions with uncertain pathogeneses in which deregulation of the immune system plays an important role. Alternative treatments need to be developed for these patients since only a minority of patients achieve disease remission. Our goal is to review recent evidence related to the use of cannabis to treat ulcerative colitis and Crohn's disease. Methods: This is a focused narrative review based on searches of Pubmed and Embase. Relevant articles have been reviewed and summarized in narrative form. Results: The two main components of cannabis, CBD and THC, have been extensively studied, and their anti-inflammatory and antinociceptive effects have been tested. The effects of these components for control of the symptoms of ulcerative colitis and Crohn's disease have been widely described. However, high quality studies are needed to continue evaluating the efficacy and safety of cannabis use in patients with inflammatory bowel disease.

8.
Value Health Reg Issues ; 20: 79-85, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31082638

RESUMO

BACKGROUND: The increase in obesity prevalence and its relationship with multiple cardiovascular complications have raised the burden of obesity in the general population. Bariatric surgery has shown to be more effective in reducing weight than the traditional pharmacologic and nonpharmacologic treatments. OBJECTIVE: To evaluate the cost-effectiveness of this alternative compared with standard treatment in the Colombian context. METHODS: A Markov single cohort model was used to simulate the incremental cost per quality-adjusted life-year (QALY) gained every year over a base-case 5-year time horizon. The model considers 5 health states: comorbidity, remission, acute myocardial infarction, stroke, and death. Four comorbidity conditions were evaluated separately: diabetes, hypertension, dyslipidemia, and sleep apnea. The model was evaluated from a third-payer perspective. All costs were expressed in 2016 Colombian pesos ($1.00 = 3051 COP). A 5% annual discount rate was applied to both costs and outcomes. RESULTS: In baseline analysis, bariatric surgery was a cost-effective alternative compared with nonsurgical treatment in the diabetes and hypertension cohort with an incremental cost-effectiveness ratio of $6 194 899 and $43 689 527 per QALY gained, respectively. In the sleep apnea cohort, surgery has greater effectiveness and lower costs, which is why it is a dominant strategy. In the dyslipidemia cohort, bariatric surgery is dominated by the nonsurgical approach. CONCLUSION: The current study provides evidence that bariatric surgery is a cost-effective alternative among some cohorts in the Colombian setting. For obese patients with sleep apnea or diabetes, bariatric surgery is a recommendable alternative (dominant and cost-effective, respectively) for the Colombian healthcare system.

9.
Value Health Reg Issues ; 20: 66-72, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31035116

RESUMO

OBJECTIVES: To estimate the burden of disease attributable to obesity and overweight conditions using disability-adjusted life-years (DALYs) in Colombia. METHODS: The burden of disease was estimated following an adapted methodology published by the World Health Organization. A selection of diseases was performed in which overweight and obesity are risk factors. DALYs were calculated by obtaining the proportion of cases and deaths of every disease that can be attributable to obesity and overweight conditions. The economic impact of obesity was calculated by multiplying the cost of care per patient for each comorbidity by the number of cases attributable exclusively to obesity. RESULTS: A total of 997 371 DALYs were estimated, 45% of which corresponded to men; 81% of DALYs corresponded to years lived with disability. Conditions with greater attributable DALYs are, in order, hypertension (31.6% of the total DALYs), type 2 diabetes mellitus (28.0%), cardiac ischemic disease (14.6%), and lower back pain (11.2%). An estimation of 20.5 DALYs per 1000 inhabitants was made. The economic impact of care for comorbidities associated with obesity could amount to $2158 million. CONCLUSIONS: Obesity and overweight conditions are related to higher mortality and disability than previously estimated; effective interventions aimed at prevention and treatment will have a high impact on quality of life.

10.
Value Health Reg Issues ; 20: 60-65, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30974312

RESUMO

OBJECTIVES: To evaluate the public health benefits and economic value of live-attenuated yellow fever (YF) 17D vaccine in Colombia. METHODS: A decision tree model was used to assess the theoretical impact of routine YF vaccination of 1-year-olds (no "catch-up") during the interepidemic period from 1980 to 2002, avoiding capturing the impact of YF vaccine introduction in 2003. The vaccine was assumed to be 99% effective, to provide lifetime protection, and to cover 85% of the target population. Costs per disability-adjusted life-year (DALY) averted were computed from payer and societal perspectives. Univariate sensitivity analyses were performed. RESULTS: During the interepidemic period, routine YF vaccination would have averted 2223 nonfatal cases of YF and 65 deaths, leading to an overall reduction of 1365 DALYs. The net cost of this vaccination would have been $25 964 813 (payer's perspective) and $16 535 465 (societal perspective). Cost per DALY averted was $19 022 and $12 114 from payer and societal perspectives, respectively (all costs in 2015 US dollars). Vaccination was considered cost-effective from both perspectives (ie, between 1- and 3-fold the gross domestic product per capita, $7158) and remains so if price per dose was $2.75 or less and $4.66 from payer and societal perspectives, respectively. Underreporting had the largest impact on the results. CONCLUSIONS: Routine toddler YF vaccination in Colombia would have been considered cost-effective in the prevaccination era. This study provides insights on the value of vaccination in an upper middle-income country.

11.
Rev. colomb. obstet. ginecol ; 69(4): 270-302, Oct.-Dec. 2018. tab, graf
Artigo em Inglês | LILACS | ID: biblio-985512

RESUMO

ABSTRACT Objective: To assess the efficacy and safety of atosiban in pregnant women with risk of preterm delivery as compared to nifedipine, indomethacin, terbutaline, fenoterol and placebo. Materials and methods: A systematic literature review was carried out in eight electronic databases, including Medline, Central, and Embase, using free and standardized search terms. Outcomes assessment included time delay until delivery, neonatal mortality, ratio of adverse maternal events, and ratio of neonatal complications. The quality of the evidence was evaluated per study and for the body of evidence and, whenever feasible, the information was synthesized into a meta-analysis. Alternatively, a narrative summary was presented. Results: Eleven studies were included. Atosiban did not show any statistically significant differences in terms of delaying delivery versus other uterine contraction inhibitors. The neonatal mortality was lower compared to indomethacin (RR = 0.21; 95% CI: 0.05 to 0.92), and the percentage of total maternal adverse events was lower compared to fenoterol (RR = 0.16; 95% CI: 0.08 to 0.31), nifedipine (RR = 0.48; 95% CI: 0.3 to 0.78), and terbutaline (RR = 0.44; 95% CI: 0.28 to 0.71). Conclusions: Atosiban has similar efficacy for delivery delay in patients with risk of preterm delivery as compared to other agents (moderate certainty), showing some advantages regarding neonatal mortality (low certainty) versus indomethacin, and compared to fenoterol, nifedipine and terbutaline in terms of maternal adverse events (moderate certainty).


RESUMEN Objetivo: evaluar la eficacia y seguridad de atosiban en gestantes con amenaza de parto pretérmino comparado con nifedipino, indometacina, terbutalina, fenoterol y placebo. Materiales y métodos: se realizó una revisión sistemática de la literatura en ocho bases de datos electrónicas (Medline, Central, Embase, entre otras), mediante términos de búsqueda libres y estandarizados. Los desenlaces evaluados incluyeron tiempo de retardo del parto, mortalidad neonatal, proporción de eventos adversos maternos y proporción de complicaciones neonatales. Se evaluó la calidad de la evidencia por estudio y para el cuerpo de evidencia, y se sintetizó la información mediante metaanálisis, cuando fue posible; de lo contrario, se resumió de forma narrativa. Resultados: se incluyeron once estudios. Atosiban no mostró diferencias estadísticamente significativas en retardo del parto contra otros uteroinhibidores. Mostró menor mortalidad neonatal que la indometacina (RR = 0,21; IC 95 %: 0,05 a 0,92), y menor proporción de eventos adversos maternos totales que el fenoterol (RR = 0,16; IC 95 %: 0,08 a 0,31), el nifedipino (RR = 0,48; IC 95 %: 0,3 a 0,78) y la terbutalina (RR = 0,44; IC 95 %: 0,28 a 0,71). Conclusiones: atosiban tiene una eficacia similar para retardar el parto ante la amenaza de un parto pretérmino con otros comparadores (certeza moderada), con ventajas frente a indometacina en mortalidad neonatal (certeza baja) y frente a fenoterol, nifedipino y terbutalina en eventos adversos maternos (certeza moderada).


Assuntos
Humanos , Trabalho de Parto Prematuro , Placebos , Terbutalina , Nifedipino , Indometacina , Metanálise , Fenoterol
12.
Rev. colomb. cardiol ; 25(5): 297-304, sep.-oct. 2018. tab, graf
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1042766

RESUMO

Resumen Objetivo: Evaluar la costo-efectividad del acceso arterial radial comparado con el femoral en la realización tanto de arteriografía coronaria diagnóstica como de angioplastia coronaria transluminal percutánea. Métodos: Se construyó un modelo de árbol de decisión para determinar costos de las dos intervenciones en pacientes adultos con sospecha de enfermedad cardiovascular. Para el análisis de efectividad se evaluó la frecuencia de complicaciones mayores y menores en ambos abordajes. La perspectiva para los costos fue la del tercero pagador (sistema de salud colombiano); se incluyeron solo costos médicos directos asociados a los procedimientos y las complicaciones, expresados en pesos colombianos de 2016 (1 USD = COP 3.051). Resultados: El costo promedio estimado de la arteriografía coronaria con abordaje radial fue $1.384.945 y el femoral de $1.474.543. En angioplastia coronaria transluminal percutánea se estimó un costo ponderado de $8.037.743 en el abordaje radial y $8.319.178 en el femoral. El abordaje radial fue dominante para los eventos adversos cardiovasculares mayores respecto al femoral. Tanto en angiografía diagnóstica como en intervención el abordaje radial evita 0,9% de los eventos adversos cardiovasculares mayores y 1,6% de los sangrados mayores, pero presenta más complicaciones menores que el abordaje femoral. Conclusiones: El abordaje radial en arteriografía coronaria diagnóstica y en angioplastia coronaria transluminal percutánea mostró ser una estrategia dominante, al tener un menor costo y menos eventos adversos cardiovasculares mayores.


Abstract Objective: To evaluate the cost-effectiveness of radial artery access compared with that of femoral in the performing of diagnostic coronary angiography, as well as percutaneous transluminal coronary angioplasty. Methods: A decision tree model was constructed in order to determine the costs of two interventions in adult patients with a suspicion of cardiovascular disease. For the effectiveness analysis, an evaluation was made of the major and minor complications in both approaches. The perspective for the costs was the ``third party payer'' (Colombian health system), and included the medical costs associated with the procedure and the complications, expressed in Colombian pesos (2016, 1 US$ = COP 3.051) Results: The estimated mean cost of the coronary angiography using a radial approach was $1,384,945 and $1,474,543 by the femoral approach. In percutaneous transluminal coronary angioplasty the weighted cost was $8,037,743 in the radial approach and $8,319,178 in the femoral approach. The radial approach was dominant for major adverse cardiovascular events compared to the femoral one. In both diagnostic and interventionist angiography, the radial approach avoided 0.9% of the major cardiovascular events and 1.6% of major bleeds, but had more minor complications than the femoral approach. Conclusions: The radial artery approach in diagnostic coronary angiography and percutaneous transluminal coronary angioplasty is shown to be a dominant strategy, on being less costly and having less major cardiovascular adverse events.

13.
Artigo em Inglês | PAHO-IRIS | ID: phr-49454

RESUMO

[ABSTRACT]. Objectives. To assess the economic impact of dengue in Latin America and the Caribbean using a systematic review that includes studies not previously considered by other reviews. Methods. Cochrane methodology was used to conduct a systematic review of the cost of dengue in Latin America. PubMed Central, EMBASE, and the Biblioteca Virtual en Salud— which includes scientific, peer-reviewed journals not indexed by other databases—were searched from inception through August 2016. All articles that reported cost of illness data for countries in Latin America were included. Included studies underwent a methodological appraisal using a seven-question instrument designed for cost of illness studies. Extracted data were direct and indirect costs for outpatient and hospitalized cases and total cost of the disease. Values were adjusted to 2015 US dollars using the consumer price index. Results. From a total of 848 initial references, 17 studies were included, mainly from Brazil, Colombia, Cuba, Mexico, and Puerto Rico; costs were available for 39 countries. The methodological appraisal showed that 70% of the studies met more than 70% of the evaluated items. The main economic impact of dengue was due to productivity costs. Average annual cost was more than US$ 3 billion. Direct costs represented over 70% of the total share for hospitalized cases. For outpatients, direct medical costs were low, but social costs were significant since indirect costs may account for up to 80% of the total cost. Conclusions. Dengue fever has a significant economic impact in Latin America. It is essential to develop new public health interventions, such as dengue vaccination, to decrease the propagation of the disease and its total cost.


[RESUMEN]. Objetivos. Evaluar las repercusiones económicas del dengue en América Latina y el Caribe mediante una revisión sistemática que abarcó estudios no considerados en otras revisiones anteriores. Métodos. Se usó la metodología de Cochrane para hacer una revisión sistemática del costo del dengue en América Latina. Se hizo una búsqueda en PubMed Central, EMBASE y la Biblioteca Virtual en Salud, que incluyen revistas científicas arbitradas no indizadas por otras bases de datos, desde su aparición hasta agosto del 2016. Se incluyeron todos los artículos que contenían datos sobre el costo de la enfermedad para los países de América Latina. Los estudios incluidos se sometieron a una evaluación metodológica para la cual se usó un instrumento de siete preguntas diseñado para los estudios sobre los costos de las enfermedades. Los datos extraídos fueron los costos directos e indirectos para los casos de pacientes ambulatorios y hospitalizados y el costo total de la enfermedad. Los valores se ajustaron a dólares de los Estados Unidos del 2015 con base en el índice de precios al consumidor. Resultados. De un total de 848 referencias iniciales, se incluyeron 17 estudios, principalmente de Brasil, Colombia, Cuba, México y Puerto Rico; se encontraron datos sobre los costos en 39 países. La evaluación metodológica indicó que 70% de los estudios reunían más de 70% de los puntos evaluados. La principal repercusión económica del dengue se debió a los costos por pérdida en la productividad. El costo anual promedio fue de más de USD 3.000 millones. Los costos directos representaron más de 70% del total para los casos de pacientes hospitalizados. En cuanto a los pacientes ambulatorios, los costos médicos directos fueron bajos, pero los costos sociales fueron considerables, ya que los costos indirectos pueden representar hasta 80% del costo total. Conclusiones. El dengue tiene importantes repercusiones económicas en América Latina. Es fundamental elaborar nuevas intervenciones en materia de salud pública, como la vacunación contra el dengue, para reducir la propagación de la enfermedad y su costo total.


[RESUMO]. Objetivos. Avaliar o impacto econômico da dengue na América Latina e o Caribe por meio de uma revisão sistemática que incluiu estudos não considerados anteriormente por outras revisões. Métodos. Utilizou-se a metodologia Cochrane para realizar uma revisão sistemática do custo da dengue na América Latina. Foi realizada uma busca dos bancos de dados PubMed Central, EMBASE e Biblioteca Virtual em Saúde— a qual inclui periódicos científicos com avaliação por pares não indexados por outros repositórios— desde sua criação até agosto de 2016. Todos os artigos que relataram dados de custo de doença para países da América Latina foram incluídos. Os estudos incluídos foram submetidos a uma avaliação metodológica usando um instrumento de sete perguntas desenvolvido para estudos de custo de doença. Os dados extraídos foram os custos diretos e indiretos para casos ambulatoriais e hospitalizados e o custo total da doença. Os valores foram ajustados para dólares de 2015, usando-se o índice de preços ao consumidor. Resultados. De 848 referências inicialmente identificadas, 17 estudos foram incluídos, principalmente do Brasil, Colômbia, Cuba, México e Porto Rico; dados sobre custos estavam disponíveis para 39 países. A avaliação metodológica demonstrou que 70% dos estudos apresentavam mais de 70% dos itens avaliados. O principal impacto econômico da dengue foi devido aos custos de produtividade. O custo médio anual foi superior a US$3 bilhões. Para casos que exigiram hospitalização, os custos diretos representaram mais de 70% do custo total. Para pacientes ambulatoriais, os custos médicos diretos foram baixos, mas os custos sociais foram significativos, pois os custos indiretos podem representar até 80% do custo total. Conclusões. A dengue tem impacto econômico considerável na América Latina. É essencial desenvolver novas intervenções de saúde pública, como a vacinação contra a dengue, para diminuir a propagação da doença e seu custo total.


Assuntos
Dengue , Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde , América Latina , Região do Caribe , Efeitos Psicossociais da Doença , América Latina , Região do Caribe , Custos de Cuidados de Saúde , Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde , Região do Caribe
14.
Rev. cienc. salud (Bogotá) ; 16(2): 219-236, abr.-ago. 2018. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-959695

RESUMO

Abstract Introduction: The aim of this project is to estimate the costs to society of training a doctor at either a public or a private university in Colombia. Materials and methods: Direct and indirect costs were estimated in 2016 Colombian pesos (average exchange rate 3051 COP per US dollar), as was the return on investment, expressed as net present value, return on investment, and internal rate of return. The time required to recover the investment in studying medicine was also determined, and this was contrasted with the counterfactual of studying in another academic program. A discount rate of 12 % was used. A sensitivity analysis was performed with several alternative scenarios. Results: In the baseline scenario, the total cost of training a physician in Colombia is US $80, 971.80 at a private university and US $54, 971.79 at a public university (of which $14, 436.57 is contributed by the State in the latter case). The time to return of investment is 3 years 6 months for study at a public university and 7 years 3 months for study at a public university. Applying discount rates of 5 %, 7.5 %, and 12 %, studying medicine presents a higher return than that obtained by studying in another academic program. Conclusions: The cost of training a medical doctor in Colombia is 70 % higher than the cost of training other professionals, but returns are greater due to subsequent higher income. Net returns are higher for graduates of public universities because their initial investment is smaller and their incomes are similar.


Resumen Introducción: este estudio busca estimar los costos de formar un médico en Colombia, tanto en una universidad pública como privada, desde la perspectiva de la sociedad. Materiales y métodos: se calcularon los costos directos e indirectos en pesos colombianos de 2016 (tasa de cambio promedio 3051 COP por USD), así como el retorno a la inversión, expresado en valor actual neto, retorno sobre la inversión, y tasa interna de retorno y, el periodo de recuperación de la inversión de estudiar medicina frente al contrafactual de estudiar otra carrera. Se empleó una tasa de descuento de 12 %. Se realizó un análisis de sensibilidad con varios escenarios. Resultados: en el escenario base, el costo total de la formación de un médico en Colombia es de $80971.80 USD en una universidad privada y de $54971.79 USD en una pública (de los cuales $14436.57 USD son aportados por el Estado). El tiempo de retorno de la inversión es de 3 años y 6 meses en una universidad pública y 7 años y 3 meses en una privada. Aplicando tasas de descuento de 5 %, 7,5 % y 12 %, estudiar medicina presenta mayor retorno que el obtenido con otra carrera. Conclusiones: el costo de formación de un médico en Colombia es un 70 % mayor al requerido para la formación de otro profesional; sin embargo, los retornos son mayores debido los mayores ingresos percibidos. Los retornos son mayores en los egresados de universidades públicas, debido a que la inversión es menor y los ingresos percibidos son similares.


Resumo Introdução: o objetivo deste trabalho é estimar os custos de formar um médico na Colômbia, tanto em uma universidade pública quanto privada, desde a perspectiva da sociedade. Materiais e métodos: calcularam-se os custos diretos e indiretos em pesos colombianos de 2016 (taxa de câmbio médio 3051 COP por USD) assim como o retorno ao investimento, expressado em valor atual neto, retorno sobre o investimento, e taxa interna de retorno e, o período de recuperação do investimento de estudar medicina frente ao contrafactual de estudar outra carreira. Empregou-se uma taxa de desconto de 12 %. Se realizou uma análise de sensibilidade com vários cenários. Resultados: no cenário base, o custo total da formação de um médico na Colômbia é de $80971.80 USD em uma universidade privada e $54971.79 USD em uma pública (dos quais $14436.57 USD são aportados pelo Estado). O tempo de retorno do investimento é de 3 anos e 6 meses em uma universidade pública e 7 anos e 3 meses em uma privada. Aplicando taxas de desconto de 5 %, 7.5 % e 12 %, estudar medicina apresenta maior retorno que o obtido com outro curso. Conclusões: o custo de formação de um médico na Colômbia é um 70 % maior ao requerido para a formação de outro profissional, no entanto, os retornos são maiores devido aos maiores ingressos percebidos. Os retornos são maiores nos formados de universidades públicas, devido a que o investimento é menor e os ingressos percebidos são similares.

15.
Rev Bras Ginecol Obstet ; 40(5): 242-250, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29913541

RESUMO

OBJECTIVE: To assess the cost-effectiveness of carbetocin versus oxytocin for prevention of postpartum hemorrhage (PPH) due to uterine atony after vaginal delivery/cesarean section in women with risk factors for bleeding. METHODS: A decision tree was developed for vaginal delivery and another one for cesarean, in which a sequential analysis of the results was obtained with the use of carbetocin and oxytocin for prevention of PPH and related consequences. A third-party payer perspective was used; only direct medical costs were considered. Incremental costs and effectiveness in terms of quality-adjusted life years (QALYs) were evaluated for a one-year time horizon. The costs were expressed in 2016 Colombian pesos (1 USD = 3,051 Col$). RESULTS: In the vaginal delivery model, the average cost of care for a patient receiving prophylaxis with uterotonic agents was Col$ 347,750 with carbetocin and Col$ 262,491 with oxytocin, while the QALYs were 0.9980 and 0.9979, respectively. The incremental cost-effectiveness ratio is above the cost-effectiveness threshold adopted by Colombia. In the model developed for cesarean section, the average cost of a patient receiving prophylaxis with uterotonics was Col$ 461,750 with carbetocin, and Col$ 481,866 with oxytocin, and the QALYs were 0.9959 and 0.9926, respectively. Carbetocin has lower cost and is more effective, with a saving of Col$ 94,887 per avoided hemorrhagic event. CONCLUSION: In case of elective cesarean delivery, carbetocin is a dominant alternative in the prevention of PPH compared with oxytocin; however, it presents higher costs than oxytocin, with similar effectiveness, in cases of vaginal delivery.


Assuntos
Análise Custo-Benefício , Ocitócicos/economia , Ocitócicos/uso terapêutico , Ocitocina/análogos & derivados , Ocitocina/economia , Ocitocina/uso terapêutico , Hemorragia Pós-Parto/prevenção & controle , Colômbia , Técnicas de Apoio para a Decisão , Feminino , Humanos , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/etiologia , Gravidez , Medição de Risco , Inércia Uterina
16.
Rev. gerenc. políticas salud ; 17(34): 112-118, ene.-jun. 2018. tab, graf
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-978527

RESUMO

Resumen Las enfermedades de baja prevalencia requieren modelos de gestión diferentes a los de otras condiciones. Este trabajo buscó recoger las experiencias internacionales. Se realizaron búsquedas en numerosas bases de datos de literatura indexada y de documentos grises. Un panel de expertos de diferentes disciplinas revisó los resúmenes de la literatura y su posible adaptación al contexto colombiano. La búsqueda inicial arrojó 5604 referencias; la búsqueda manual adicionó 31 referencias, finalmente 78 artículos aportaron información útil para el análisis. Los resultados permiten afirmar que existen varios componentes de un modelo de gestión, estos son: políticas, legislación y aspectos administrativos; definición y codificación de enfermedades; investigación y educación; centros especializados, centros de excelencia y redes de atención; diagnóstico, tamizaje, prevención y promoción; inclusión de medicamentos huérfanos; rehabilitación y manejo paliativo; organizaciones de pacientes, grupos o redes de apoyo; y apoyo sociosanitario (inclusión laboral y educativa).


Abstract Low prevalence diseases require management models different from those used in other conditions. This work was intended to gather international experiences on this issue. Searches were made in many indexed literature databases as well as in those with gray literature. A panel of experts from different disciplines checked the abstracts and their potential adaptation into the Colombian context. The initial search retrieved 5604 references and the manual search added other 31 references. At the end, 78 articles provided useful information for the analysis. The results allow to state that a management model consists of several components, to wit: policies, legislation and administrative aspects; definition and coding of the diseases; research and education; specialized centers; excellence centers and service networks; diagnosis, screening, prevention, and promotion; orphan drug inclusion; rehabilitation and palliative care; organizations of patients and support groups or networks; and social-sanitary support (labor and educational inclusion).


Resumo As doenças de baixa prevalência requerem modelos de gestão diferentes aos de outras condições. Este trabalho visou coletar experiências internacionais. Realizaram-se pesquisas em numerosos bancos de dados de literatura indexada e documentos cinza. Um painel de expertos de diferentes disciplinas revisou os resumos da literatura e sua possível adaptação no contexto colombiano. A procura inicial resultou em 5604 referências; a procura manual adicionou 31 referências, por fim 78 artigos forneceram informações úteis para a análise. Os resultados permitem afirmar que existem vários componentes de um modelo de gestão, quais são: políticas, legislações e aspetos administrativos; definição e codificação de doenças; pesquisa e ensino; centros especializados, centros de excelência e redes de atendimento; diagnóstico, triagem, prevenção e promoção; inclusão de medicamentos órfãos; reabilitação e cuidados paliativos; organizações de pacientes, grupos ou redes de apoio; e apoio sócio-sanitário (inclusão laboral e educativa).


Assuntos
Humanos , Administração Hospitalar , Organizações de Serviços Gerenciais , Doenças Raras , Medicamentos do Componente Especializado da Assistência Farmacêutica
17.
Rev. bras. ginecol. obstet ; 40(5): 242-250, May 2018. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-958989

RESUMO

Abstract Objective To assess the cost-effectiveness of carbetocin versus oxytocin for prevention of postpartum hemorrhage (PPH) due to uterine atony after vaginal delivery/ cesarean section in women with risk factors for bleeding. Methods A decision treewas developed for vaginal delivery andanother one for cesarean, in which a sequential analysis of the results was obtained with the use of carbetocin and oxytocin for prevention of PPH and related consequences. A third-party payer perspective was used; only directmedical costs were considered. Incremental costs and effectiveness in terms of quality-adjusted life years (QALYs) were evaluated for a one-year timehorizon. The costs were expressed in 2016 Colombian pesos (1 USD = 3,051 Col$). Results In the vaginal delivery model, the average cost of care for a patient receiving prophylaxis with uterotonic agents was Col$ 347,750 with carbetocin and Col$ 262,491 with oxytocin,while theQALYs were 0.9980 and 0.9979, respectively. The incremental costeffectiveness ratio is above the cost-effectiveness threshold adopted by Colombia. In the model developed for cesarean section, the average cost of a patient receiving prophylaxis with uterotonics was Col$ 461,750 with carbetocin, and Col$ 481,866 with oxytocin, and the QALYs were 0.9959 and 0.9926, respectively. Carbetocin has lower cost and is more effective, with a saving of Col$ 94,887 per avoided hemorrhagic event. Conclusion In case of elective cesarean delivery, carbetocin is a dominant alternative in the prevention of PPH compared with oxytocin; however, it presents higher costs than oxytocin, with similar effectiveness, in cases of vaginal delivery.


Resumo Objetivo Avaliar a relação custo-eficácia da carbetocina versus oxitocina para prevenção de hemorragia pós-parto (HPP) vaginal e cesariana devido à atonia uterina em mulheres com fatores de risco para desenvolver sangramento. Métodos Foram desenvolvidos protocolos de manejo para parto vaginal e outra para parto por cesárea e analisados resultados obtidos com carbetocina e oxitocina na prevenção de HPP, assim como, consequências relacionadas à ocorrência do evento hemorrágico. A perspectiva utilizada foi a do terceiro pagador, portanto, apenas os custos médicos diretos foram levados em consideração. Os custos incrementais e a eficácia em termos de anos de vida ajustados pela qualidade (QALY) foram avaliados para um horizonte de tempo de um ano. Os custos foram expressos em pesos colombianos de 2016 (1 USD = 3.051 Col$). Resultados No modelo de parto vaginal, o customédio de cuidados para um paciente que recebeu profilaxia com agentes uterotônicos foi de Col$ 347.750 com carbetocina e Col$ 262.491 com oxitocina, enquanto os QALYs foram 0,9980 e 0,9979, respectivamente. O índice incremental de custo-efetividade está acima do limite de custoefetividade adotado pela Colômbia. No modelo desenvolvido para parto por cesárea, o custo médio do paciente que recebeu profilaxia com terapia uterotônica foi de Col$ 461.750 com carbetocina e Col$ 481.866 com oxitocina e os QALYs foram 0,9959 e 0,9926, respectivamente. A carbetocina foi a alternativa com menor custo e maior efetividade com uma economia de $94.887 por evento hemorrágico evitado. Conclusão A carbetocina no parto eletivo por cesárea é uma alternativa dominante na prevenção da PPH em relação à oxitocina; porém representa custos mais altos com uma eficácia similar à da oxitocina no caso de parto vaginal.

18.
Biomedica ; 38(1): 77-85, 2018 Mar 15.
Artigo em Espanhol | MEDLINE | ID: mdl-29668137

RESUMO

Introducción. El citomegalovirus es la causa más frecuente de infección en pacientes con trasplante renal. Existen dos estrategias de similar efectividad para prevenirlo: la profilaxis universal con valganciclovir durante 90 días o el tratamiento anticipado verificando la carga viral semanal y aplicándolo solo si esta es positiva.Objetivo. Determinar cuál de estas dos estrategias sería más costo-efectiva en pacientes de riesgo intermedio en Colombia.Materiales y métodos. Se diseñó un árbol de decisiones bajo la perspectiva del tercer pagador considerando únicamente los costos médicos directos en pesos colombianos (COP) del 2014 durante un periodo de un año en una población de pacientes con riesgo intermedio para citomegalovirus (donante positivo y receptor positivo, o donante negativo y receptor positivo). Las probabilidades de transición se extrajeron de los estudios clínicos y se validaron con expertos mediante el método Delphi.Los costos de los procedimientos se basaron en el manual tarifario ISS 2001, con un incremento del 33 % a partir del índice de precios al consumidor (IPC) en salud de 2014, en tanto que los de los medicamentos se extrajeron de las circulares del Ministerio de Salud y del Sistema de Información de Medicamentos (Sismed).Resultados. La profilaxis universal con valganciclovir resultó ser menos costosa y se asoció con una menor probabilidad de infección. El costo promedio del primer año de tratamiento anticipado sería de COP$ 30'961.290, mientras que el universal sería de COP$ 29'967.834, es decir, un costo 'incremental' de COP$ 993.456.Conclusiones. Para los pacientes de riesgo intermedio con trasplante renal en Colombia, la profilaxis universal es la mejor estrategia por ser menos costosa y reducir el riesgo de infección.


Assuntos
Análise Custo-Benefício , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/virologia , Colômbia , Transplante de Rim
19.
Biomédica (Bogotá) ; 38(1): 77-85, ene.-mar. 2018. tab, graf
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-888550

RESUMO

Resumen Introducción. El citomegalovirus es la causa más frecuente de infección en pacientes con trasplante renal. Existen dos estrategias de similar efectividad para prevenirlo: la profilaxis universal con valganciclovir durante 90 días o el tratamiento anticipado verificando la carga viral semanal y aplicándolo solo si esta es positiva. Objetivo. Determinar cuál de estas dos estrategias sería más costo-efectiva en pacientes de riesgo intermedio en Colombia. Materiales y métodos. Se diseñó un árbol de decisiones bajo la perspectiva del tercer pagador considerando únicamente los costos médicos directos en pesos colombianos (COP) del 2014 durante un periodo de un año en una población de pacientes con riesgo intermedio para citomegalovirus (donante positivo y receptor positivo, o donante negativo y receptor positivo). Las probabilidades de transición se extrajeron de los estudios clínicos y se validaron con expertos mediante el método Delphi. Los costos de los procedimientos se basaron en el manual tarifario ISS 2001, con un incremento del 33 % a partir del índice de precios al consumidor (IPC) en salud de 2014, en tanto que los de los medicamentos se extrajeron de las circulares del Ministerio de Salud y del Sistema de Información de Medicamentos (Sismed). Resultados. La profilaxis universal con valganciclovir resultó ser menos costosa y se asoció con una menor probabilidad de infección. El costo promedio del primer año de tratamiento anticipado sería de COP$ 30'961.290, mientras que el universal sería de COP$ 29'967.834, es decir, un costo 'incremental' de COP$ 993.456. Conclusiones. Para los pacientes de riesgo intermedio con trasplante renal en Colombia, la profilaxis universal es la mejor estrategia por ser menos costosa y reducir el riesgo de infección.


Abstract Introduction: Cytomegalovirus (CMV) is the most frequent opportunistic infection after renal transplantation. There are two strategies for its prevention: Universal prophylaxis, with valganciclovir for 90 days, and anticipated therapy, using weekly viral load surveillance, and therapy only if positive. Meta-analysis directly comparing both strategies have shown them to have similar effectiveness. Objective: To determine which strategy is more cost-effective in intermediate risk patients in Colombia. Materials and methods: We designed a third-party payer perspective decision tree, considering only direct medical costs in 2014 Colombian pesos (COP) (USD$ 1=COP$ 2,000) and a time horizon of one year. The target population was intermediate CMV risk patients (positive receptor). Transition probabilities were extracted from clinical studies, validated with a Delphi expert panel method; procedural costs were obtained from the ISS 2001 manual with a 33% increment based on the Consumer Price Index for 2014, while medication costs were obtained from the official Ministry of Health information system. Results: Universal prophylaxis with valganciclovir was dominant, with lower costs and less probability of infection. The average cost of the first year in anticipated therapy would be COP$ 30,961,290, whereas in the case of universal therapy the cost would be COP$ 29,967,834 (incremental cost of COP$ 993,456). Conclusions: For Colombian renal transplant patients at intermediate risk for CMV infection, universal prophylaxis strategy is the best option.

20.
Acta méd. peru ; 35(1): 55-59, ene. 2018. ilus
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1010886

RESUMO

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

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