Latin American Clinical Epidemiology Network Research Articles

Latin American Clinical Epidemiology Network Series – Paper 4: Economic evaluation of Kangaroo Mother Care: cost utility analysis of results from a randomized controlled trial conducted in Bogotá

Background and ObjectiveAlthough kangaroo mother care (KMC) has been shown to be safe and effective in randomized controlled trials (RCTs), there are no published complete economic evaluations including the three components of the full intervention. MethodsA cost utility analysis performed on the results of an RCT conducted in Bogotá, Colombia between 1993 and 1996. Hospital and ambulatory costs were estimated by microcosting in a sample of preterm infants from a University Hospital in Bogotá in 2011 and at a KMC clinic in the same period. Utility scores were assigned by experts by means of (1) direct ordering and scoring discrete health states and (2) constructing a multi-attribute utility function. Ninety-five percent confidence intervals (CIs) for the incremental cost–utility ratios (ICURs) were computed by the Fiellers theorem method. One-way sensitivity analysis on price estimates for valuing costs was performed. ResultsICUR at 1 year of corrected age was $ −1,546 per extra quality-adjusted life year gained using the KMC method (95% CI $ −7,963 to $ 4,910). ConclusionIn Bogotá, the use of KMC is dominant: more effective and cost-saving. Although results from an economic analysis should not be extrapolated to different systems and communities, this dominant result suggests that KMC could be cost-effective in similar low and middle income countries settings.

Latin American Clinical Epidemiology Network Series – Paper 8: Ticagrelor was cost-effective vs. clopidogrel in acute coronary syndrome in Chile

ObjectiveTo evaluate the incremental cost-effectiveness ratio (ICER) of the use of ticagrelor as a substitute for clopidogrel for secondary prevention of acute coronary syndrome in Chile. Study Design and SettingCost-effectiveness analysis based on a Markov model: Safety and effectiveness data of ticagrelor were obtained from a systematic review of the literature. Costs are expressed in Chilean pesos (CLP) as of 2013. The evaluation was conducted from the payer standpoint. A probabilistic sensitivity analysis comprising discount rates and national cost variability was done. A budget impact analysis estimated for 2015 was conducted to calculate the total cost for both treatments. ResultsThe ICER with a discount rate of 6% for ticagrelor vs. clopidogrel was CLP 4,893,126 per quality-adjusted life-year (QALY) gained (=9,689 US$). In the budget impact analysis for the baseline scenario, considering 100% of treatment, coverage, and adherence, ticagrelor represented an additional cost of CLP 5,233,854,272, for 979 QALYs gained compared with clopidogrel. ConclusionsTicagrelor is cost-effective in comparison with clopidogrel for the secondary prevention of acute coronary syndrome. These findings are similar to those reported in other international cost-effectiveness studies.

Latin American Clinical Epidemiology Network Series – Paper 1: The Latin American Clinical Epidemiology Network “LatinCLEN”

The Latin American Clinical Epidemiology Network (LatinCLEN) was born in the 90s as a branch of the International Clinical Epidemiology Network. Clinical Epidemiology Units that made up this network in the region were initially composed of health professionals trained in Australia and North America. From these units, second- and third-generation training centers started to develop in the region, with the main purpose of introducing clinical research methodology and critical appraisal, as well as health economics and biostatistics. The field of Clinical Epidemiology has been introduced into health schools, and has had great influence on health policies and practices in Latin America. The articles in this series provide a bird's eye view of research development in the region which include, among others, the capacity to conduct clinical trials on innovative therapies, systematic reviews, economic analyses, as well as studies on risk factors and burden of illness.

Latin American Clinical Epidemiology Network Series – Paper 6: The influence of alcohol in traffic accidents and health care costs of it in Bogotá-Colombia

ObjectivesIn Colombia, some studies have estimated medical costs associated to traffic accidents. It is required to assess results by city or region and determine the influence of variables such as alcohol consumption. The main objective of this study was to identify health care costs associated to traffic accidents in Bogota and determine whether alcohol consumption can increase them. Study Design and SettingCross-sectional costs study conducted in patients over 18 years treated in the emergency rooms of six different hospitals in Bogota, Colombia. ResultsThe average total cost of medical care per patient was 628 USD, in Bogota-Colombia. The average cost per accident was estimated at 1,349 USD. On average, the total cost for health care for patients with positive blood alcohol level was 1.8 times higher than those who did not consume alcohol. The indirect costs were on average 115.3 USD per injured person. Numbers are expressed in 2011 U.S. dollars. ConclusionAlcohol consumption increases the risk of traffic accidents and direct medical health costs.

Latin American Clinical Epidemiology Network Series – Paper 5: Years of life lost due to premature death in traffic accidents in Bogota, Colombia

ObjectiveThis study aimed to quantify the number of years of life lost in traffic accidents in Bogota, Colombia. Study Design and SettingThe years of life lost were calculated using the ‘age-standardized expected years of life lost’ method, the table of Japanese adjusted life expectancy and the database of the Institute of Legal Medicine and Forensic Science between September 2012 and August 2013. ResultsDuring a period of 1 year, 430 people died and 10,056.3 years of life were lost in Bogota due to traffic accidents. ConclusionThe mortality burden of traffic accidents in Bogota is high. Further studies are required in order to characterize the accidents and develop effective policy decisions.

Latin American Clinical Epidemiology Network Series – Paper 7: Central obesity measurements better identified risk factors for coronary heart disease risk in the Chilean National Health Survey (2009–2010)

ObjectivesObesity is an important determinant of cardiovascular risk. However, the optimal measure and cutoffs in Latin America are not defined. We sought to assess the relationship between body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) with risk factor prevalence and estimated coronary heart disease (CHD) risk and to assess if recommended cutoffs apply to the Chilean population. Study Design and SettingData from 2,200 men and 3,216 women from the Chilean Health Survey 2009–2010 were analyzed. Receiver operator characteristic (ROC) curves were used to compare discrimination and estimate optimal cutoffs. Sensitivity, specificity, and net reclassification improvement (NRI) for these cutoffs were compared with values obtained applying international recommendations. ResultsWHtR and WC have a higher ROC area for risk factors and CHD risk. BMI and WC optimal cutoffs did not improve net reclassification when compared with international recommendations. A WHtR of 0.55 in men improves NRI compared with proposed values (P < 0.01). A WHtR of 0.6 in women improves NRI when compared with BMI (P > 0.01) but not when compared with WC. ConclusionCentral obesity measurements demonstrated the strongest associations with CV risk factors and estimated risk. Optimal cutoffs were similar to those recommended internationally with the exception of WHtR.

Latin American Clinical Epidemiology Network Series – Paper 9: The Kangaroo Mother Care Method: from scientific evidence generated in Colombia to worldwide practice

Kangaroo Mother Care (KMC) is a human-based care intervention devised to complement neonatal care for low birth weight and premature infants. Kangaroo position (skin-to-skin contact on the mother's chest) offers thermal regulation, physiological stability, appropriate stimulation, and enhances bonding and breastfeeding. Kangaroo nutrition is based on breastfeeding, and kangaroo discharge policy relies on family empowerment and early discharge in kangaroo position with close ambulatory follow-up. We describe how the evidence has been developed and how it has been put into practice by means of direct preterm infants care and dissemination of the method, including training of KMC excellence centers in many countries not only in Latin America but worldwide.

Latin American Clinical Epidemiology Network Series – Paper 2: Apixaban was cost-effective vs. acenocoumarol in patients with nonvalvular atrial fibrillation with moderate to severe risk of embolism in Chile

ObjectiveNonvalvular atrial fibrillation (NVAF) is a risk factor for ischemic stroke and systemic embolism. New oral anticoagulants are currently available. The objective of this study was to assess the incremental cost–utility ratio (ICUR) for apixaban vs. acenocoumarol in patients treated in Chile's public health system. Study Design and SettingWe assessed cost–utility from the payer perspective with a lifetime Markov model. Epidemiologic characteristics, costs, and utilities were obtained from a Chilean cohort; data were completed with information from international literature. ResultsIncremental costs when using apixaban vs. acenocoumarol over a lifetime are CH$2,108,600 with an incremental effectiveness of 0.173 years of life gained (YLG) and 0.182 quality-adjusted life-year (QALY). The ICUR of apixaban vs. acenocoumarol was CH$12,188,439 per YLG and CH$11,585,714 per QALY. One to 3 times gross domestic product (GDP) per capita threshold is acceptable based on World Health Organization (WHO) norms. Chilean GDP per capita was CH$7,797,021 in 2013. The sensitivity analysis shows that these results are sensitive to the ischemic stroke risk with apixaban, and the intracranial hemorrhage risk due to the use of acenocoumarol. ConclusionThe use of apixaban in patients with NVAF in moderate-to-high risk of stroke is cost-effective, considering the payment threshold suggested by WHO.

Latin American Clinical Epidemiology Network Series – Paper 3: Cochrane develops widely in Latin America and strengthens ties with LatinCLEN

Latin American Clinical Epidemiology Network Series – Paper 3: Cochrane develops widely in Latin America and strengthens ties with LatinCLEN