Impacto de diferentes métodos de asignación de costos indirectos estructurales de hospitales públicos, en el ranking costo-efectividad de 47 intervenciones en salud / Impact of different overhead cost allocation methods of public hospitals on the cost-effectiveness ranking of 47 health programs

Background: Costs allocation methods are important for economic evaluation of health care. Aim: To evaluate the impact of overhead costs rates of different hospitals on the cost-effectiveness rankings of health programs. Material and Methods: Using the cost reports from eight hospitals, a Montecarlo simulation was implemented, programming the complete micro-costing algorithm to calculate the final cost of 47 health care interventions, from the health sector perspective. The independent variables considered were the overhead cost rates per establishment and the actual overhead costs. Changing these variables, resulted in changes of the final cost of interventions and cost-effectiveness ratios. Finally the probabilities of changes in the cost-effectiveness ranking of each intervention were calculated. Results: Thirteen programs did not change their ranking order. However, 34 interventions modified their position with different occurrence probabilities. In the new proposed ranking, 21 programs changed their position from one to six places. Conclusions: Different overhead cost rates, representing different assignation forms, have a relative impact in the cost-effectiveness order. Montecarlo simulation can help to improve the accuracy of ranking assignment.

Automedicación en individuos de la Región de la Araucanía con problemas musculoesqueléticos / Self medication among patients with musculoskeletal symptoms in Región de la Araucanía

Background Self-medication is a common behavior in the general population, specially among those suffering from chronic pain. Aim: To study the prevalence and characteristics of self medication. Subjects and Methods: Aiming to know the prevalence and features of self medication, a structured interview was applied to 272 out of 419 individuals from the general population, that reported musculoskeletal symptoms. Results: Sixty five percent of those interviewed recognised self medication. No gender differences were observed and there was a trend towards a higher frequency of self medication among older individuals. The frequency of self-medication was higher in low socioeconomic groups, subjects with long lasting pain, those with more severe pain and among subjects with a previous prescription. The drugs more frequently used were dipyrone, piroxicam and aspirin. The average daily piroxicam dose reported was 27 mg. Self medication was not associated with the labor condition of the subjects or the time of occurrence of symptoms. Conclusions: Self medication is a frequent behavior, particularly among low socio-economic groups and those with long lasting and more severe pain

CA 19-9 y antígeno carcino-embrionario en cáncer de la vesícula biliar / CA 19-9 and carcinoembryonic antigen in gallbladder cancer

The aim of this work was to assess the diagnostic yield of serum tumoral markers, Ca 19-9 and carcinoembryonic antigen, in patients with gallbladder cancer. We studied 54 patients of whom 33 had gallbladder cancer and in 21 the tumor was removed previously and were presently free of disease. Twenty one patients with cholelithiasis were used as controls. Ca 19-9 was over 37 U/ml in 22 (65 percent) patients with cancer, in two patients free of disease and two controls. The sensitivity and specificity of Ca 19-9 was 0.66 and 0.90 respectively. Carcinoembryonic antigen was over 2.5 ng/ml in 25 patients with cancer (56 percent) and in sensitivity and specificity was 0.75 and 0.71 respectively. Using a cutoff point of 4 ng/ml, these figures were 0.51 and 0.9 respectively. The better predictive capacity was given by Ca 19-9 over 37 U/ml or a carcinoembryonic antigen over 4 ng/ml. It is concluded that, although the sensitivity and specificity of these markers was adequate in this work, one must hear in mind that studied patients had advanced tumors