Análisis coste-efectividad en la evaluación económica de intervenciones sanitarias

This systematic review was conducted to examine the cost-effectiveness of exercise interventions in community-dwelling older adults. A systematic search for articles published in English or Spanish was carried out in PubMed, Web of Science and Cochrane Library that covered the period from the respective start date of each database to October 2021. Methodological quality was assessed with the Physiotherapy Evidence Database scale and quality of economic evaluation with the Quality of Health Economic Studies and Consolidated Health Economic Evaluation Reporting Standards. A total of 12 out of 15 studies on exercise programmes for older adults reported cost-effective results. The most cost-effective training appears to be a multicomponent training programme, including aerobic exercise, muscle-strengthening of lower extremities, and balance and stretching training. The training methodology should be of progressive moderate or vigorous intensity performed at least twice per week with each session lasting 60 min for ≥6 months. The exercise programme should be delivered as a group-based intervention, doing extra exercise at home to increase the cost-effectiveness. These findings suggest that exercise interventions in non-institutionalized older people are a cost-effective tool. Sex, age, cognitive status, frailty, frequency and training duration could modify the cost-effectiveness of exercise interventions.

Systematic review registration. PROSPERO CRD42021231530 (date of registration: 20/02/2021).

The aim of this study was to do a cost-benefit analysis of myofascial release therapy (MRT) compared to manual therapy (MT) for treating occupational mechanical neck pain.

Variables regarding the outcomes of the intervention were intensity of neck pain, cervical disability, quality of life, craniovertebral angle, and ranges of cervical motion. Costs were assessed based on a social perspective using diary costs. Between-groups differences in average cost, cost-effectiveness, and cost-utility ratios were assessed using bootstrap parametric techniques. The economic cost-benefit evaluation was with regard to an experimental parallel group study design. There were 59 participants.

Myofascial released therapy showed significant improvement over MT for cervical mobility (side bending, rotation, and craniovertebral angle). The total cost of MRT was approximately 20% less (−$519.81; 95% confidence interval, −$1193.67 to $100.31) than that of MT, although this was not statistically significant. Cost-effectiveness and cost-utility ratios showed that MRT could be associated with lower economic costs.

With probabilities of 93.9% and 95.8%, MRT seems to be cost-effective for treating mechanical neck pain without the need to add any additional cost to obtain a better clinical benefit. Consequently, we believe it could be included in the clinical practice guidelines of different Spanish health care institutions.

Pregnancy-associated malaria (PAM) is a health problem with serious clinical, epidemiological and economic effects.

To analyze the microeconomic evaluations of PAM reported in the world scientific literature.

Systematic review with 15 different search strategies in PubMed, ScienceDirect, Scielo, Google Scholar and Malaria in Pregnancy (MiP) Library. A search, selection and extraction protocol was applied, which guaranteed completeness and reproducibility in accordance with preferred reporting items for systematic reviews and meta-analysis guidelines. The methodological quality was evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) guide. The analysis were based on frequencies, costs and average and incremental cost-effectiveness ratios in 2018 US dollars adjusted for purchasing power parity.

Twenty-two evaluations published between 1990 and 2018 were analyzed, of which 82% addressed cost-effectiveness in Africa. Twelve interventions were studied; of these, intermittent preventive treatment in pregnant women with sulfadoxine-pyrimethamine (IPTp-SP) was the most frequent strategy. The main outcomes were low birth weight, anaemia and DALYs avoided. The best average cost-effectiveness ratio was reported in IPTp-SP with a cost of US$ 2 per DALY avoided, followed by the administration of IPTp-SP in pregnant women with HIV (US$ 14.2).

The studies focus on Africa with a high heterogeneity in the interventions, outcomes, resources and populations studied. All the interventions were highly cost-effective, which demonstrates the importance of including prevention, care and control resources for PAM as a priority in health sector budgets. This is especially true considering the importance of its intervention for social progress and overcoming poverty in endemic areas.

El uso de ultrasonografía para la inserción de catéteres centrales ha mostrado ser coste-efectivo en adultos; en neonatos se desconoce esta información. El objetivo del estudio fue comparar el coste-efectividad de la cateterización venosa umbilical guiada por ultrasonografía con la cateterización convencional en un servicio de cuidados intensivos neonatales de un hospital universitario y público.

Estudio observacional retrospectivo en recién nacidos que requirieron catéter venoso umbilical antes de cumplir las primeras 24 h de vida extrauterina; se conformaron 2 cohortes históricas, una con cateterización guiada por ultrasonografía y otra con cateterización convencional. La efectividad se midió con 2 variables: colocación de posición ideal e inserción sin complicaciones. Se estimó el coste de recursos humanos y materiales (fungibles y no fungibles), la razón coste-efectividad y la razón coste-efectividad incremental; y se realizó análisis de sensibilidad.

La obstrucción del catéter fue más frecuente en la cateterización guiada que en la convencional (7,7 vs. 0%, p = 0,04) y la disfunción del catéter fue superior en esta última (79 vs. 3,8%, p < 0,0001). La razón coste-efectividad de la cateterización guiada fue 153,9 euros y de la convencional 484,6 euros; la razón coste-efectividad incremental fue 45,5 euros. El análisis de sensibilidad incrementó 2,6 euros en la razón coste-efectividad de la cateterización guiada y 47 euros, en la convencional.

El uso de la ultrasonografiacute;a para guiar la cateterización umbilical es más eficiente ya que, a pesar de suponer un mayor consumo de recursos económicos, ofreció una mayor efectividad.

Although the use of ultrasound for the insertion of central catheters has proven to be cost-effective in adults, it is not known if this is the case in the neonatal population. This study compared the cost-effectiveness of ultrasound-guided umbilical venous catheterisation with conventional catheterisation in a neonatal intensive care unit of a Public University Hospital.

A retrospective observational study was conducted on newborns that required an umbilical venous catheter before completing their first 24 hours of extra-uterine life. Two retrospective cohorts were formed, including one with ultrasound-guided catheterisation and the other with conventional catheterisation. The effectiveness was measured using 2 variables: placement of ideal position and insertion without complications. The cost of human and material resources (consumable and non-consumable), the cost-effectiveness ratio, and the incremental cost-effectiveness ratio were estimated, as well as carrying out a sensitivity analysis.

Catheter obstruction was more frequent in guided catheterisation than in conventional catheterisation (7.7% vs. 0%, p = .04) and catheter dysfunction was higher in the latter (79% vs. 3.8%, p < .0001). The cost-effectiveness ratio of the guided catheterisation was €153.9, and €484.6 for the conventional one. The incremental cost-effectiveness ratio was €45.5. The sensitivity analysis showed a €2.6 increase in the cost-effectiveness ratio of the guided catheterisation and €47 in the conventional one.

The use of ultrasound to guide umbilical catheterisation is more efficient than conventional catheterisation since, despite using more economic resources, it offers greater effectiveness.

Classical Markov models are defined through a stochastic transition matrix, i.e., a matrix whose columns (or rows) are deterministic values representing transition probabilities. However, in practice these quantities could often not be known in a deterministic manner, therefore, it is more realistic to consider them as random variables. Following this approach, this paper is aimed to give a technical generalization of classical Markov methodology in order to improve modelling of stroke disease when dealing with real data. With this goal, we randomize the entries of the transition matrix of a Markov chain with three states (susceptible, reliant and deceased) that has been previously proposed to model the stroke disease. This randomization of the classical Markov model permits the computation of the first probability density function of the solution stochastic process taking advantage of the so-called Random Variable Transformation technique. Afterwards, punctual and probabilistic predictions are computed from the first probability density function. In addition, the probability density functions of the time instants until a certain proportion of the total population remains susceptible, reliant and deceased are also computed. The study is completed showing the usefulness of our computational approach to determine, from a probabilistic point of view, key quantities in medical decision making, such as the cost-effectiveness ratio.

La hipertensión arterial constituye uno de los principales factores de riesgo por su elevada prevalencia y riesgo de complicaciones. Se ha progresado en la inercia clínica de la enfermedad, aunque el control de la presión arterial sigue siendo mejorable en colectivos específicos. La farmacoeconomía es una aplicación de la economía de la salud que nos permite conocer cuál es la eficiencia de las diferentes alternativas terapéuticas utilizables para tratar la hipertensión. Los antagonistas de los receptores de la angiotensina II (ARA II) han demostrado ser fármacos antihipertensivos efectivos y seguros, aunque la comparación entre los diferentes ARA II presenta resultados contradictorios. Olmesartán medoxomilo es un fármaco eficaz y bien tolerado, similar o ligeramente más eficaz que otros ARA II, tanto en monoterapia como en combinación fija (doble o triple).

La hipertensión arterial no diagnosticada o no tratada es la principal causa de disminución de la efectividad y eficiencia en situación de práctica clínica habitual; su tratamiento requiere desarrollar estrategias basadas en análisis de coste-eficiencia, para reducir los costes sanitarios y maximizar los resultados. Los escasos estudios publicados sugieren que olmesartán en monoterapia, en comparación con otros ARA II, reduce de forma similar o superior el riesgo cardiovascular y las complicaciones a un menor coste. La terapia combinada con 2 o 3 antihipertensivos también parece tener un perfil de costeefectividad favorable, a pesar de que el coste del tratamiento es mayor. Cabe destacar la escasez de datos de coste-efectividad sobre el uso de dosis fijas de ARA II en general y de olmesartán en particular en terapias de combinación.

Hypertension is a major risk factor due to its high prevalence and the risk of complications. Clinical inertia has been reduced, although blood pressure control could still be improved in certain specific groups. Pharmacoeconomics is an application of health economics that can be used to determine the efficiency of the various therapeutic alternatives available to treat hypertension. Angiotensin II receptor antagonists (ARA II) have been shown to be safe and effective hypotensive drugs, although comparisons among the distinct ARA II have yielded contradictory results. Olmesartan medoxomil is an effective and welltolerated drug with similar or slightly superior efficacy to other ARA II, both in monotherapy and in fixed-dose double- or triple-combination therapy.

Undiagnosed or untreated hypertension is the main cause of reduced effectiveness and efficiency in routine clinical practice; treatment requires the development of strategies based on cost-efficiency analyses to reduce health costs and optimize results. The few published studies suggest that olmesartan monotherapy produces a similar or greater reduction in cardiovascular risk and complications than other ARA II and at a lower cost. Combination therapy with two or three antihypertensive agents also seems to have a favorable cost-effectiveness profile, even though the cost of treatment is higher. Importantly, in combination therapies, there is a scarcity of cost-effectiveness data on the use of fixed-doses of ARA II in general and of olmesartan in particular.