RESUMO
Background: Inflammatory bowel disease (IBD) has a major economic impact on healthcare costs. Objectives: The aim of this study was to evaluate the current healthcare expenditure associated with IBD in a population-wide study in Catalonia. Design: Retrospective observational study. Methods: All patients with IBD included in the Catalan Health Surveillance System (CHSS) were considered eligible. The CHSS compiles data on more than 7 million individuals in 2020 (34,823 with IBD). Data on the use of healthcare resources and its economic impact were extracted applying the International Classification of Diseases, 10th revision, Clinical Modification codes (ICD-10-CM codes). Health expenditure, comorbidities, and hospitalization were calculated according to the standard costs of each service provided by the Department of Health of the Catalan government. The data on the IBD population were compared with non-IBD population adjusted for age, sex, and income level. IBD costs were recorded separately for Crohn's disease (CD) and ulcerative colitis (UC). Results: Prevalence of comorbidities was higher in patients with IBD than in those without. The risk of hospitalization was twice as high in the IBD population. The overall healthcare expenditure on IBD patients amounted to 164M. The pharmacy cost represents the 60%. The average annual per capita expenditure on IBD patients was more than 3.4-fold higher (IBD 4200, non-IBD 1200). Average costs of UC were 3400 and 5700 for CD. Conclusion: The risk of comorbidities was twice as high in patients with IBD and their use of healthcare resources was also higher than that of their non-IBD counterparts. Per capita healthcare expenditure was approximately 3.4 times higher in the population with IBD. Trial registration: The study was not previously registered.
Economic impact of inflammatory bowel disease in Catalonia The manuscript includes data of the most recent epidemiologic data about the high economic impact of IBD in Catalonia.
RESUMO
BACKGROUND: At present only monoclonal EIA (enzyme-immunoassay) stool antigen-tests have obtained optimal accuracy in the diagnosis of Helicobacter pylori. Our aim was to evaluate the accuracy of two stool antigen-tests, the validated Premier Platinum HpSA PLUS (EIA test) and the newly available ImmunoCard STAT! HpSA HD (rapid test) for the initial diagnosis and the confirmation of eradication of H. pylori infection. PATIENTS AND METHODS: Patients with indication of H. pylori diagnosis, or confirmation after treatment were included. Data were coded to protect personal data and ensure blindness between tests. Accuracy was considered as coincident diagnosis with the gold standard (13C-urea breath test, UBT). The EIA was used as a bench standard. All stool tests were performed in duplicate. RESULTS: 264 patients completed the protocol (100 naïve, 164 post-eradication). Average age was 52 years, 61% women, 11% ulcer. Positive diagnoses by UBT were 41% for naïve and 17% for post-eradication. Overall ImmunoCard and EIA accuracies were respectively 91% (95%C. I. =88-94%) and 89% (86-93%), sensitivities 72% (67-78%) and 72% (67-78%), and specificities 98% (96-100%), and 95% (92-97%). Concordance between ImmunoCard and EIA was 95% (93-98%). DISCUSSION: Our results indicate that the newly available ImmunoCard rapid stool antigen-test achieves 90% accuracy, with high specificity but suboptimal sensitivity. The ImmunoCard attained equivalent accuracies as the EIA bench standard, with 95% concordance
ANTECEDENTES: En la actualidad, únicamente los métodos de detección de antígenos en heces monoclonales basados en enzimoinmunoanálisis (ELISA) han obtenido una adecuada precisión para el diagnóstico de la infección por Helicobacter pylori. Nuestro objetivo fue evaluar la exactitud (sensibilidad y especificidad) de 2 métodos de antígenos en las heces, el previamente validado Premier Platinum HpSA® PLUS (ELISA) y el nuevo ImmunoCard® STAT! HpSA® HD (test rápido), para el diagnóstico inicial y la confirmación de la erradicación de la infección por H. pylori. PACIENTES Y MÉTODOS: Se incluyeron pacientes en los que estaba indicado el diagnóstico inicial de la infección por H. pylori o su confirmación tras el tratamiento. Los datos fueron codificados y los evaluadores de ambos test fueron ciegos para los resultados de las pruebas diagnósticas. El resultado principal fue la coincidencia con el resultado del patrón oro (prueba del aliento con 13C-urea). Los test en heces se realizaron por duplicado. RESULTADOS: Doscientos sesenta y cuatro pacientes completaron el protocolo (100 naïve, 164 posterradicación). La edad media fue de 52 años, el 61% fueron mujeres y el 11% tenían úlcera péptica. La prueba del aliento fue positiva en el 41% de los pacientes naïve y en el 17% posterradicación. La exactitud global del método rápido y del ELISA fue, respectivamente, 91% (IC 95%: 88-94%) y 89% (86-93%), la sensibilidad 72% (67-78%) y 72% (67-78%), y la especificidad 98% (96-100%) y 95% (92-97%). La concordancia entre el método ImmunoCard® y ELISA fue del 95% (93-98%). DISCUSIÓN: El nuevo método rápido de antígenos en heces (ImmunoCard® STAT! HpSA® HD) tiene una exactitud diagnóstica del 90%, con una elevada especificidad, pero una sensibilidad insuficiente. El método ImmunoCard® tiene una exactitud equivalente al método ELISA estándar, con una concordancia del 95%
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Antígenos Virais/análise , Helicobacter pylori/isolamento & purificação , Infecções por Helicobacter/diagnóstico , Fezes/química , Helicobacter pylori/imunologia , Ensaio de Imunoadsorção Enzimática , Testes Respiratórios , Curva ROC , Sensibilidade e Especificidade , Estudos ProspectivosRESUMO
Objetivo: El factor transformador del crecimiento Beta1 (TGF-Beta1) es uno de los mediadores fibrogénicos con más relevancia en la patogenia de la fibrosis pulmonar idiopática (FPI). El objetivo del estudio ha sido investigar el valor pronóstico de la determinación en plasma del TGF-Beta1 en la FPI. Pacientes y métodos: Se ha realizado un estudio prospectivo en el que se incluyó a 29 pacientes con FPI y 27 controles sanos. La determinación del TGF-Beta1 se realizó mediante enzimoinmunoanálisis. Resultados: La concentración de TGF-Beta1 fue significativamente mayor en los pacientes con FPI que en los controles (media +/- desviación estándar: 11,1 +/- 7,5 frente a 4 +/- 2,4 ng/ml; p < 0,01). Se observó una débil relación inversa de la concentración del TGF-Beta1 con los valores de la capacidad vital forzada y de la capacidad pulmonar total. Se evaluó a 13 pacientes con FPI a los 8 +/- 1,2 meses (rango: 5-9 meses). La concentración de TGF-Beta1 fue de 18,2 +/- 15 ng/ml, sin diferencias significativas respecto a la primera determinación (11,1 +/- 7,5 ng/ml). No se observó ninguna relación entre los cambios evolutivos en la exploración funcional respiratoria y los cambios en la concentración de TGF-Beta1. Conclusiones: Aunque la concentración plasmática de TGF-Beta1 está elevada en los pacientes con FPI, este parámetro no parece ser útil como marcador del pronóstico de la enfermedad ni de la respuesta terapéutica
Objective: Transforming growth factor Beta1 (TGF-Beta1) is one of the key profibrotic mediators in the pathogenesis of idiopathic pulmonary fibrosis (IPF). The purpose of this study was to investigate the prognostic value of quantifying TGF-Beta1 levels in patients with IPF. Patients and methods: We conducted a prospective study of 29 IPF patients and 27 healthy controls. Enzyme-linked immunosorbent assays were used to quantify TGF-Beta1 levels. Results: Mean (SD) TGF-Beta1 levels were significantly higher in the IPF patients than in the control subjects (11.1 [7.5] ng/mL vs 4 [2.4] ng/mL; P<.01). Weak inverse correlations were observed between TGF-Beta1 levels and both forced vital capacity and total lung capacity. Thirteen IPF patients were evaluated at 8 (1.2) months (range, 5-9 months). The mean TGF-Beta1 level was 18.2 (15) ng/mL and there were no significant differences with respect to the initial measurement of 11.1 (7.5) ng/mL. No correlation was observed between changes in respiratory function and changes in TGF-Beta1 levels. Conclusions: Although plasma levels of TGF-Beta1 were high in the patients with IPF, they do not appear to be a useful prognostic marker of disease activity or therapeutic response