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Background: The medical care paradigm is face-to-face; however, technological development has led to the digital modality. Objective: To determine cost-effectiveness of digital care and face-to-face care at the first level of care. Material and methods: Cost-effectiveness study. 2 groups were integrated: the digital service and the face-to-face service. The sample size was calculated with the percentage formula for 2 groups, and the result was 217 per group. The effectiveness was evaluated in 3 dimensions: the satisfaction of the patient, of the doctor and of the medical assistant. In all 3 cases the Visual analogue scale was used. The cost corresponded to the fixed unit cost estimated with the technique of times and movements adjusted for the duration of care. The statistical analysis included averages, percentages and cost-effectiveness ratio. Results: The cost of digital attention is $343.83 and face-to-face attention is $171.91 (all estimated in Mexican pesos). From the patient's perspective, the effectiveness in digital care is $9.47 and in face-to-face is $9.25. The cost to reach effectiveness of 10 in face-to-face care is $185.85 and in digital care $363.20. From the physician's perspective, the cost to achieve effectiveness of 10 is $419.13 in digital care and $184.52 in face-to-face care. From the perspective of the medical assistant, to achieve effectiveness of 10, the cost in digital care is $468.43 and in face-to-face $179.83. Conclusions: Currently, the best cost-effectiveness ratio corresponds to face-to-face care; however, digital care is an option that will have to evolve.
Introducción: el paradigma de atención médica es presencial; sin embargo, el desarrollo tecnológico ha propiciado la modalidad digital. Objetivo: determinar el costo-efectividad de la atención digital y la atención presencial en primer nivel. Material y métodos: estudio de costo-efectividad. Se integraron 2 grupos: el de atención digital y el de atención presencial. El tamaño de muestra se calculó con la fórmula de porcentajes para 2 grupos y el resultado fue 217 por grupo. La efectividad se evaluó en 3 dimensiones: la satisfacción del paciente, del médico y de la asistente médica. En los 3 casos se utilizó la Escala visual analógica. El costo correspondió al costo unitario fijo estimado con la técnica de tiempos y movimientos ajustado por la duración de la atención. El análisis estadístico incluyó promedios, porcentajes y relación costo-efectividad. Resultados: el costo de la atención digital es $343.83 y la atención presencial $171.91. Desde la perspectiva del paciente, la efectividad en atención digital es 9.47 y en presencial 9.25. El costo para alcanzar una efectividad de 10 en la atención presencial es $185.85 y en la atención digital $363.20. Desde la perspectiva del médico, el costo para alcanzar una efectividad de 10 es $419.13 en la atención digital y $184.52 en la atención presencial. Desde la perspectiva de la asistente médica, para alcanzar una efectividad de 10 el costo en la atención digital es $468.43 y en la presencial $179.83. Conclusiones: actualmente la mejor relación costo-efectividad corresponde a la atención presencial; sin embargo, la atención digital es una opción que tendrá que evolucionar.
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Análise Custo-Benefício , Satisfação do Paciente , Humanos , México , Telemedicina/economia , Feminino , MasculinoRESUMO
The aim of this study was to shed light on a crucial issue through a comprehensive evaluation of the cost-effectiveness and cost-utility of a cutting-edge web-based foot-ankle therapeutic exercise program (SOPeD) designed for treating modifiable risk factors for ulcer prevention in individuals with diabetes-related peripheral neuropathy (DPN). In this randomized controlled trial, 62 participants diagnosed with DPN were assigned to the SOPeD software or received usual care for diabetic foot. Primary outcomes were DPN symptoms and severity, foot pain and function, and quality-adjusted life years (QALYs). Between-group comparisons provided 95% confidence intervals. The study also calculated incremental cost-effectiveness and cost-utility ratios (ICERs), analyzed direct costs from a healthcare perspective, and performed a sensitivity analysis to assess uncertainty. The web-based intervention effectively reduced foot pain, improved foot function and showed favorable cost-effectiveness, with ICERs ranging from (USD) $5.37-$148.71 per improvement in different outcomes. There is a high likelihood of cost-effectiveness for improving DPN symptoms and severity, foot pain, and function, even when the minimum willingness-to-pay threshold was set at $1000.00 USD. However, the intervention did not prove to be cost-effective in terms of QALYs. This study reveals SOPeD's effectiveness in reducing foot pain, improving foot function, and demonstrating cost-effectiveness in enhancing functional and clinical outcomes. SOPeD stands as a potential game-changer for modifiable risk factors for ulcers, with our findings indicating a feasible and balanced integration into public health systems. Further studies and considerations are vital for informed decisions to stakeholders and the successful implementation of this preventive program on a larger scale.Trial Registration: ClinicalTrials.gov, NCT04011267. Registered on 8 July 2019.
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Análise Custo-Benefício , Pé Diabético , Terapia por Exercício , Humanos , Pé Diabético/prevenção & controle , Pé Diabético/terapia , Feminino , Masculino , Pessoa de Meia-Idade , Terapia por Exercício/métodos , Terapia por Exercício/economia , Idoso , Anos de Vida Ajustados por Qualidade de Vida , Tornozelo/fisiopatologia , Internet , Resultado do Tratamento , Pé/fisiopatologiaRESUMO
BACKGROUND: The DAPA-CKD study showed that dapagliflozin added to standard treatment reduced the risk of chronic kidney disease progression, and death from renal or cardiovascular causes compared to placebo. OBJECTIVE: Assess the cost-effectiveness of dapagliflozin and standard treatment versus standard treatment alone for chronic kidney disease within the Colombian health system. METHODS: We employed a Markov model based on the DAPA-CKD study, tailored to the Colombian scenario. The model forecasted hospitalizations for heart failure, overall and cardiovascular mortality, and chronic kidney disease progression over a 10-year horizon with a 5% discount rate. RESULTS: Dapagliflozin combined with standard treatment is a cost-effective intervention in treating stage 2-4 CKD. In the base case, the ICER was US $5,366, below 1 GDP (US $6.558) per capita. This was consistent in the sensitivity analyses. CONCLUSION: Our study showed that dapagliflozin, when combined with standard treatment, is cost-effective against standard treatment alone, aligning with Colombia's willingness-to-pay threshold.
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A maternal vaccine to protect newborns against invasive Streptococcus agalactiae infection is a developing medical need. The vaccine should be offered during the third trimester of pregnancy and induce strong immune responses and placental transfer of protective antibodies. Polysaccharide vaccines against S. agalactiae conjugated to protein carriers are in advanced stages of development. Additionally, protein-based vaccines are also in development, showing great promise as they can provide protection regardless of serotype. Furthermore, safety concerns regarding a new vaccine are the main barriers identified. Here, we present vaccines in development and identified safety, cost, and efficacy concerns, especially in high-need, low-income countries.
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Infecções Estreptocócicas , Vacinas Estreptocócicas , Streptococcus agalactiae , Streptococcus agalactiae/imunologia , Humanos , Infecções Estreptocócicas/imunologia , Infecções Estreptocócicas/prevenção & controle , Infecções Estreptocócicas/microbiologia , Vacinas Estreptocócicas/imunologia , Gravidez , Feminino , Animais , Complicações Infecciosas na Gravidez/imunologia , Complicações Infecciosas na Gravidez/prevenção & controle , Complicações Infecciosas na Gravidez/microbiologia , Desenvolvimento de Vacinas , Recém-Nascido , Anticorpos Antibacterianos/imunologiaRESUMO
Objetivo: analisar efetividade e custos de modelos de cuidados transitórios em atenção domiciliar de pacientes com condições agudas e crônicas comparados a outras modalidades. Método: revisão integrativa de uma amostra de 18 artigos dentre os 278 pesquisados em sete bases de dados. Resultados: Destacaram-se, em 15 modelos de cuidados transitórios, os de: reabilitação; terapêuticas parenterais; acompanhamento de doenças crônicas; pós-operatórios e internação domiciliar. Foram efetivos para tratar condições agudas ou crônicas agudizadas; simplificar acesso a hospital; prevenir readmissões; reduzir tempo de internação; ampliar adesão em reabilitação ambulatorial, reduzir mortalidade e melhorar estado emocional/sobrecarga do cuidador. O principal componente de custo foi os valores de diárias. Em nove estudos, os modelos significaram quedas no custo geral com internação. Conclusão: Cuidados transitórios em Atenção Domiciliar possibilitam a continuidade do tratamento com efetividade e economia para provedores e sistemas de saúde
Objective: to analyze the effectiveness and costs of transitional care models in home care of patients with acute and chronic conditions compared with other modalities. Method:integrative review of a sample of 18 articles among the 278 searched in seven databases. Results: among 15 transitional care models, the following stood out: rehabilitation; parenteral therapies; chronic disease follow-up; postoperative care; and home hospitalization. They were effective in treating acute or chronic conditions; simplifying access to hospital; preventing readmissions; reducing length of stay; increasing adherence to outpatient rehabilitation, reducing mortality, and improving emotional status/caregiver burden. The main cost component was per diem rates. In nine studies, the models meant decreases in overall hospitalization costs. Conclusion: transitional care in home care enables effective and cost-efficient continuity of care for providers and health systems.
Objetivo: analizar la efectividad y los costes de los modelos de cuidados transitorios en la atención domiciliaria de pacientes con patologías agudas y crónicas en comparación con otras modalidades. Método: revisión integradora en una muestra de 18 artículos, entre 278 encontrados en siete bases de datos. Resultados: Entre los 15 modelos de cuidados transitorios destacaron los siguientes: rehabilitación; terapias parenterales; seguimiento de enfermedades crónicas; cuidados postoperatorios; y hospitalización a domicilio. Los modelos fueron eficaces para tratar enfermedades agudas o crónicas; simplificar el acceso al hospital; prevenir los reingresos; reducir la duración de la estancia; aumentar la adherencia a la rehabilitación ambulatoria; reducir la mortalidad; y mejorar el estado emocional/la carga para los cuidadores. El principal componente de coste fueron las tarifas diarias. En nueve estudios, los modelos resultaron en una disminución de los costes generales de hospitalización. Conclusión: Los cuidados de transición en la atención domiciliaria permiten una continuidad asistencial eficaz y rentable para los proveedores y los sistemas sanitarios
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Humanos , Masculino , Feminino , Efetividade , Custos de Cuidados de Saúde , Cuidado Transicional , Análise de Custo-Efetividade , Assistência DomiciliarRESUMO
OBJECTIVES: The 13-valent pneumococcal conjugate vaccine (PCV13) has been recommended for infants in Argentina's national immunization program (NIP) in a 2 + 1 schedule since 2012. Licensure of the 15-valent vaccine (PCV15) is anticipated soon, and the 20-valent vaccine (PCV20) recently received regulatory approval. This cost-effectiveness analysis examined the public health and economic implications of transitioning from PCV13 to either PCV15 or PCV20 in Argentina's pediatric NIP. METHODS: A decision-analytic Markov model was used with a 10-year time horizon and a 3.0% annual discount rate for costs and benefits. Vaccine effectiveness estimates were derived from Argentinian surveillance data, PCV13 clinical effectiveness and impact studies, and PCV7 efficacy studies. Population, epidemiologic, and economic inputs were obtained from literature and Argentinian-specific data. The study adopted a healthcare system perspective; sensitivity and scenario analyses were conducted to assess input parameters and structural uncertainty. RESULTS: Compared with PCV13, PCV20 was estimated to avert an additional 7,378, 42,884, and 172,389 cases of invasive pneumococcal disease (IPD), all-cause pneumonia, and all-cause otitis media (OM), respectively, as well as 3,308 deaths, resulting in savings of United States Dollars (USD) 50,973,962 in direct medical costs. Compared with PCV15, PCV20 was also estimated to have greater benefit, averting an additional 6,140, 35,258, and 142,366 cases of IPD, pneumonia, and OM, respectively, as well as 2,624 deaths, resulting in savings of USD 37,697,868 in direct medical costs. PCV20 was associated with a higher quality-adjusted life year gain and a lower cost (i.e., dominance) versus both PCV13 and PCV15. Results remained robust in sensitivity analyses and scenario assessments. CONCLUSION: Over a 10-year horizon, vaccination with PCV20 was expected to be the dominant, cost-saving strategy versus PCV13 and PCV15 in children in Argentina. Policymakers should consider the PCV20 vaccination strategy to achieve the greatest clinical and economic benefit compared with lower-valent options.
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Análise Custo-Benefício , Infecções Pneumocócicas , Vacinas Pneumocócicas , Vacinas Conjugadas , Vacinas Pneumocócicas/economia , Vacinas Pneumocócicas/administração & dosagem , Vacinas Pneumocócicas/imunologia , Humanos , Argentina/epidemiologia , Infecções Pneumocócicas/prevenção & controle , Infecções Pneumocócicas/economia , Infecções Pneumocócicas/epidemiologia , Lactente , Vacinas Conjugadas/economia , Vacinas Conjugadas/administração & dosagem , Vacinas Conjugadas/imunologia , Pré-Escolar , Programas de Imunização/economia , Cadeias de Markov , Anos de Vida Ajustados por Qualidade de Vida , Criança , Feminino , Masculino , Análise de Custo-EfetividadeRESUMO
Background: Dengue virus (DENV) is an arbovirus transmitted by Aedes aegypti mosquitoes, which can cause severe conditions such as hemorrhagic fever and dengue shock syndrome. These conditions are associated with adverse social, clinical, and economic consequences in Brazil. Herein, the Wolbachia mosquito replacement method is a promising dengue control strategy. Methods: We estimated the economic impact of implementing the Wolbachia mosquito replacement method in seven Brazilian cities. A mathematical microsimulation model tracked nearly 23 million inhabitants over a 20-year period, considering the transitions between five different health states (susceptible, inapparent, outpatient, hospitalised and death). Direct costs included local dengue control programs, Wolbachia implementation and dengue care. Indirect costs related to death and productivity loss, as well as disability-adjusted life-years (DALY) averted were also considered. Findings: Without Wolbachia, the model projected 1,762,688 reported dengue cases over 20 years. Implementing the Wolbachia method would avert at least 1,295,566 dengue cases, resulting in lower costs and greater effectiveness in all simulated cities. On average, for every 1000 inhabitants followed for 20 years, the Wolbachia method yielded a cost difference of USD 538,233.68 (BRL 2,691,168.40) and averted 5.56 DALYs. Net monetary benefits (NMB) were positive in all seven cities, ranging from USD 110.72 (BRL 553.59) to USD 1399.19 (BRL 6995.95) per inhabitant. Alternative scenarios have also shown a favourable return on investment with a positive benefit-cost ratio (BCR). Interpretation: Wolbachia is likely a cost-effective strategy in the Brazilian context, consistent with international studies. Sensitivity analysis and alternative scenarios confirmed the robustness of the results. Funding: This study was funded by the Wellcome Trust under a grant (224459/Z/21/Z).
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OBJECTIVES: To undertake a cost-effectiveness analysis of restorative treatments for a first permanent molar with severe molar incisor hypomineralization from the perspective of the Brazilian public system. MATERIALS AND METHODS: Two models were constructed: a one-year decision tree and a ten-year Markov model, each based on a hypothetical cohort of one thousand individuals through Monte Carlo simulation. Eight restorative strategies were evaluated: high viscosity glass ionomer cement (HVGIC); encapsulated GIC; etch and rinse adhesive + composite; self-etch adhesive + composite; preformed stainless steel crown; HVGIC + etch and rinse adhesive + composite; HVGIC + self-etch adhesive + composite, and encapsulated GIC + etch and rinse adhesive + composite. Effectiveness data were sourced from the literature. Micro-costing was applied using 2022 USD market averages with a 5% variation. Incremental cost-effectiveness ratio (ICER), net monetary benefit (%NMB), and the budgetary impact were obtained. RESULTS: Cost-effective treatments included HVGIC (%NMB = 0%/ 0%), encapsulated GIC (%NMB = 19.4%/ 19.7%), and encapsulated GIC + etch and rinse adhesive + composite (%NMB = 23.4%/ 24.5%) at 1 year and 10 years, respectively. The benefit gain of encapsulated GIC + etch and rinse adhesive + composite in relation to encapsulated GIC was small when compared to the cost increase at 1 year (gain of 3.28% and increase of USD 24.26) and 10 years (gain of 4% and increase of USD 15.54). CONCLUSION: Within the horizon and perspective analyzed, the most cost-effective treatment was encapsulated GIC restoration. CLINICAL RELEVANCE: This study can provide information for decision-making.
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Hipoplasia do Esmalte Dentário , Restauração Dentária Permanente , Cimentos de Ionômeros de Vidro , Humanos , Brasil , Árvores de Decisões , Hipoplasia do Esmalte Dentário/terapia , Restauração Dentária Permanente/métodos , Restauração Dentária Permanente/economia , Cimentos de Ionômeros de Vidro/uso terapêutico , Cadeias de Markov , Dente Molar , Hipomineralização Molar , Método de Monte CarloRESUMO
INTRODUCTION: In Argentina, vaccination with 13-valent pneumococcal conjugate vaccine (PCV13) followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23; PCV13 â PPSV23) has been recommended for all adults aged ≥ 65 years and younger adults with chronic medical ("moderate-risk") or immunocompromising ("high-risk") conditions since 2017. With the approval of a 20-valent PCV (PCV20), we evaluated the cost-effectiveness of PCV20 versus current recommendations for moderate-/high-risk adults aged 18-64 years and all adults 65-99 years. METHODS: A probabilistic cohort model was used to project lifetime outcomes and costs associated with invasive pneumococcal disease (IPD) and all-cause non-bacteremic pneumonia (NBP), and the expected impact of vaccination. Clinical outcomes were projected annually based on Argentinean data. Economic costs were estimated based on cases and corresponding medical costs (adjusted to 2023 USD) and costs of vaccine and administration. Cost-effectiveness of PCV20 was evaluated versus the current strategy, PCV13 â PPSV23, and alternatively, versus sequentially administered 15-valent PCV and PPSV23 (PCV15 â PPSV23), and presented as cost per quality-adjusted life year gained; a healthcare system perspective was used. Costs and benefits were discounted at 3%/year. RESULTS: PCV20 in lieu of PCV13 â PPSV23 among moderate-/high-risk adults aged 18-64 years and all adults 65-99 years (N = 13.4M) prevented 3838 IPD, 4377 inpatient NBP, and 6003 outpatient NBP cases, and 1865 disease-related deaths; relative to PCV15 â PPSV23 the corresponding reductions were 2775, 3285, 4518, and 1348. PCV20 was projected to be the dominant strategy versus PCV13 â PPSV23 and PCV15 â PPSV23 as overall costs were lower by $87.6M and $80.8M, respectively. In probabilistic sensitivity analyses, PCV20 was dominant (i.e., more effective, less costly) in 100% of 1000 simulations. CONCLUSIONS: Analyses suggest implementing a PCV20 vaccination program in moderate-/high-risk adults aged 18-64 years and all adults ≥ 65 years-in lieu of PCV13 â PPSV23-would yield substantial reductions in pneumococcal disease and would be cost saving to the Argentinean healthcare system.
Pneumococcal pneumonia has a high disease burden in both children and adults. Older adults and those with certain underlying conditions are more susceptible to severe pneumococcal disease resulting in considerable economic burden on the healthcare system. In Argentina, vaccination with 13-valent pneumococcal conjugate vaccine (PCV13) followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23) a year later is recommended for all adults aged ≥ 65 years and adults aged 1864 years with underlying risk conditions. Despite vaccination efforts, prevalence of pneumococcal disease remains high. Two higher-valent PCVs15-valent PCV (PCV15) and 20-valent PCV (PCV20)are available for use in adults with PCV20 offering additional serotype coverage. This study assessed the cost-effectiveness of replacing current (PCV13 â PPSV23) and alternative (PCV15 â PPSV23) vaccination strategies with PCV20 alone. The use of PCV20 was evaluated among Argentinean adults aged 1864 years with underlying risk conditions and all adults aged 6599 years (N = 13 million). Over a lifetime time horizon, compared to PCV13 â PPSV23, PCV20 use would avert 14,218 cases and 1865 deaths, and increase quality-adjusted life years by 8655. Compared to PCV15 â PPSV23, PCV20 reduced cases and deaths by 10,578 and 1348, respectively, and increased quality-adjusted life years by 6341. In both comparisons, PCV20 use was cost saving with $87.6 million and $80.8 million lower costs compared to PCV13 â PPSV23 and PCV15 â PPSV23, respectively. Results of the cost-effectiveness analyses suggest that the use of PCV20 is a cost-saving strategy, reducing overall costs to the healthcare system and improving public health.
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PURPOSE: 5-aminolevulinic acid (5-ALA) fluorescence-guided resection (FGR) has been an essential tool in the 'standard of care' of malignant gliomas. Over the last two decades, its indications have been extended to other neoplasms, such as metastases and meningiomas. However, its availability and cost-benefit still pose a challenge for widespread use. The present article reports a retrospective series of 707 cases of central nervous system (CNS) tumors submitted to FGR with pharmacological equivalent 5-ALA and discusses financial implications, feasibility and safeness. METHODS: From December 2015 to February 2024, a retrospective single institution series of 707 cases of 5-ALA FGR were analyzed. Age, gender, 5-ALA dosage, intraoperative fluorescence finding, diagnosis and adverse effects were recorded. Financial impact in the surgical treatment cost were also reported. RESULTS: there was an additional cost estimated in $300 dollars for each case, increasing from 2,37 to 3,28% of the total hospitalization cost. There were 19 (2,69%) cases of asymptomatic photosensitive reaction and 2 (0,28%) cases of photosensitive reaction requiring symptomatic treatment. 1 (0,14%) patient had a cutaneous rash sustained for up to 10 days. No other complications related to the method were evident. In 3 (0,42%) cases of patients with intracranial hypertension, there was vomiting after administration. CONCLUSION: FGR with pharmacological equivalent 5-ALA can be considered safe and efficient and incorporates a small increase in hospital expenses. It constitutes a reliable solution in avoiding prohibitive costs worldwide, especially in countries where commercial 5-ALA is unavailable.