Health System In Mexico Research Articles

Abstract PO4-10-06: Cost-effectiveness analysis of ribociclib in the treatment for premenopausal or perimenopausal women with HR+/HER2− advanced breast cancer: a public health care system perspective in Mexico

Abstract BACKGROUND: Ribociclib (RIB) an inhibitor of cyclin-dependent kinase 4 and 6 for the treatment of advanced breast cancer (ABC), has demonstrated significant efficacy in prolonging progression-free survival and overall survival when added to endocrine therapy (ET). Because of the high-cost perception of this therapeutic class, it is crucial to assess their relative value compared to existing standards of care in the local setting. Chemotherapy is used as the first line of treatment in a conservative case in almost three-quarters of ABC patients with positive hormone receptors in the Public Health System in Mexico. Additionally, the high use of chemotherapy presents additional clinical and economic challenges for the Institute. Among the clinical challenges, the toxicity associated with chemotherapy regimens stands out. We evaluated the cost-effectiveness of the inclusion of RIB+ ET to usual care in the treatment of premenopausal or perimenopausal ABC from the perspective of the Public Health System in Mexico. Direct medical costs were considered. METHODS: We developed a partitioned survival model to simulate time to cancer progression and to compare lifetime clinical benefit and cost of standard alternative treatment strategies for patients with metastatic disease. Per approved indication, endocrine treatment-naive patients were assigned to RI plus ET or usual care (different chemotherapy schemes). Costs in Mexican Pesos (MXN) were estimated from the perspective of the Public Health System in Mexico. Costs and clinical benefits were discounted at 5% annually. The model assumptions were informed based on published clinical trial data from the randomized Phase III MONALEESA-7 trial and other peer-reviewed studies and indirect treatment comparisons. We carried out one-way and probabilistic sensitivity analyses to assess the robustness of our results to the changes in model assumptions. RESULTS: Ribociclib reduced monthly direct medical costs associated with the administration of breast cancer treatment and the management of adverse events. Direct drug acquisition costs per month of ribociclib were in the range of the cost of current available and used therapies. Indirect treatment comparisons did not show statistical significance of the benefit of ribociclib vs. standard of care, primarily due to heterogeneity leading to a mixed evaluation vs. two comparator groups according to the statistical significance of the survival improvement. Ribociclib is a 100% oral therapy with a manageable safety profile with dosage adjustments, so it does not require institutional resources for its administration or for managing adverse events. Its consolidated cost at 28 days of treatment is up to 40% less than combined chemotherapy regimens and up to 30% less than monotherapy schemes. Average cost-effectiveness for progression-free survival for ribociclib is among the lowest considering chemotherapy options even though generic versions are available for many of them. For the comparators with comparable efficacy, ribociclib was cost-saving at current public market prices. For the comparators where ribociclib showed a significant benefit, the incremental cost-effectiveness ratio of ribociclib vs. standard of care is also below the threshold of 3 GDPs per capita vs. most options, leading to cost-effectiveness. A longer treatment duration due to progression delay was a main driver of incremental cost. CONCLUSIONS: Ribociclib is cost-saving or cost-effective vs. standard of care in the Public Health System in Mexico. Other variables must be considered to inform clinical and funding decisions, such as disease burden and humanistic impact on this young, economically active population. Citation Format: Saúl Campos-Gomez, Christian Pichardo Piña. Cost-effectiveness analysis of ribociclib in the treatment for premenopausal or perimenopausal women with HR+/HER2− advanced breast cancer: a public health care system perspective in Mexico [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-10-06.

Hybrid optimization and discrete-event simulation model to reduce waiting times in a primary health center

In the early stages of health attention, such as in the examination rooms, patients are generally treated using a First In First Treat (FIFT) logic. This treatment style is inefficient from an operational view as it leads to long waiting times for critical patients. Based on optimization and discrete-event simulation, this paper introduces a hybrid model to assign patients priorities and exam rooms. Patients arrive to the system following a probability function, and for every discrete interval, a mixed-integer linear optimization model is used to allocate patients, considering health priority, preparation times, and availability of time and resources. Instances of the problem are defined using information from a health system in Mexico. Additional to the linear model, a heuristic algorithm is proposed, composed of two phases and aims to provide good, feasible, and fast solutions without ensuring optimality. Computational experiments showed that the linear model is more appropriate for small instances since the heuristic is faster and the relative deviations with respect to the linear model are below five percent. Finally, the discrete-event simulation is run for two cases: (1) with a FIFT logic and (2) using the optimization model. The hybrid model reduces the global waiting times up to 90% and the number of high health priority patients who are not treated up to 100%.

Out of pocket and catastrophic health spending in Mexico in the face of the COVID-19 pandemic

INTRODUCTION: The measurement of the financial coverage of a health system uses key indicators such as household out-of-pocket spending as well as catastrophic health spending. Said indicators depend on the financing structure of the health system as well as quality criteria and efficiency of the system in patient care. In the case of Mexico, in recent years there have been important changes in the structure of the health system in addition to suffering from the COVID-19 pandemic events that have significantly impacted the access to health of patients. Therefore, it is relevant to quantify the impact of these events on out-of-pocket spending and catastrophic spending on health in Mexico and have a robust diagnosis of the financial coverage of the system public health in Mexico.OBJECTIVES: The main objective of this study is to quantify out-of-pocket spending and catastrophic spending on health in Mexican households for the year 2020. Comparing these estimates with previous years given the recent changes in the Mexican health system as well as the effect of the COVID-19 pandemic in these indicators.METHODS: Based on the information available in the 2020 National Household Income and Expenditure Survey (ENIGH), out-of-pocket and catastrophic spending on health were estimated following the methodology proposed by the World Health Organization. A quantile regression was estimated to assess the effect of income distribution on out-of-pocket spending.RESULTS: In Mexico in 2020, 67.7% (24.2 million) of households had an out-of-pocket health expenditure (OOHE) and 6% of these households had a catastrophic health expenditure (CHE), with respect to all households this percentage represents 4.04%. According to the classification stipulated by the World Health Organization, healthcare has six expenditure components: orthopedics, medicines, maternity, hospital, alternative medicines, and ambulatory expenses. The three main expenditure was attributable to drugs (39.9%), ambulatory (25.3%), and hospital costs (20.3%).CONCLUSION: The effect of recent modifications to the public health system in Mexico in addition to the COVID-19 pandemic has been reflected in an increase in the percentage of households with out-of-pocket spending in Mexico, as well as the percentage of households with catastrophic spending in health. The main expense item is made in medicines, ambulatory care follow-up and hospitalization. It is a priority to establish efficient financial protection schemes that allow reversing this situation in terms of efficient access to health in Mexico.

Impact of a multicomponent integrated care delivery program on diabetes care goals achievement: a primary care quality improvement initiative

AimTo evaluate the impact of multicomponent integrated care (MIC) delivery program in a primary care real-life setting on diabetes care goals. MethodsPatients with T2D and usual primary care from the public health system in Mexico were invited to participate in a five-month ambulatory MIC quality initiative (DIAbetes Empowerment and Improvement of Care program, DIABEMPIC). Results841 patients who finished the program and with complete data were analyzed. The patients had a mean decrease in hemoglobin A1c, systolic and diastolic pressure, and LDL-cholesterol of 2.4%, 9 mmHg, 3 mmHg, and 22.5 mg/dL, respectively (p < 0.001). The achievement of the optimal triple target goal increased from 1.8% to 26.7% (p < 0.001). In the adjusted analysis, the diabetes knowledge and global self-care behavior score post-intervention, as well as the increment of global self-care behavior score were associated with the optimal composite risk factor control achievement. ConclusionThe incorporation of diabetes therapeutic education interventions to improve self-care behaviors along with adequate treatment intensification in diabetes care are fundamental to attaining optimal risk factor control and attenuating disease burden.

The health system and access to treatment in patients with cervical cancer in Mexico.

Cervical cancer (CC) is tightly related to a low Human Development Index. Mexico is an upper-middle-income country with 126 million inhabitants, and its public health system aims to provide universal health coverage. Currently, employment-based social insurance covers approximately 60% of the population, and the scope of the remaining 40% is on course via the "IMSS-Bienestar" Institute. However, the annual government spending on health remains at 3% of the Gross Domestic Product, which is well below the 6% recommended by the Organization for Economic Cooperation and Development. CC is the second in incidence and mortality among women. Regarding primary prevention with the Human Papilloma Virus-vaccine, the current coverage for girls aged 9 to 14 years is only around 7%. Among secondary prevention with screening, the program is yet to cover the total number of women at risk; nevertheless, the age-standardized CC mortality rate has decreased from 12 per 100,000 women in 1979 to 5.7 per 100,000 women in 2020 due in part to increased screening coverage. Still, around two-thirds of patients present with locally advanced disease at diagnosis. Data from our country demonstrate that even socially disadvantaged CC patients achieve "standard" survival outcomes if treatment is granted. Nevertheless, there is a shortage in almost every aspect regarding CC treatment, including oncologists, chemotherapy units, medical physicists, radiation technicians, and both teletherapy and brachytherapy facilities. In conclusion, advances in the public health system in Mexico are urgently required to achieve CC control and reduce the mortality from this neoplasia that mainly targets socially disadvantaged women.

Waning immunity to SARS-CoV-2 following vaccination or infection.

We use survival analysis to analyze the decay in the protection induced by eight SARS-CoV-2 vaccines using data from 33,418 fully anonymized patients from the IMSS public health system in Mexico, including only previously vaccinated, confirmed SARS-CoV-2 positive with a PCR test. We analyze the waning effect in those with complete vs. incomplete dose fitting a Weibull distribution. We compare these results with an estimate of the waning effect due to active infection. In two-dose vaccines, we found that the average protection time of a complete dose increases 2.6 times compared to that of an incomplete dose. All analyzed vaccines provided a protection that lasted longer than the protection due to active infection, except in those patients that did not fulfilled the complete dose. The average protection of a full dose is 2.2 times larger than that provided by active infection. The average protection of active infection is about the same as the average protection of an incomplete dose. All evaluated vaccines had lost most of their protective effect between 8 and 11 months of application of first shot. Our results highly correlate with NT50 and other estimates of vaccine efficacy. We found that on average, vaccination increases Age50, the age at which there is a 50% probability of severe disease if infected, in 15 years. We also found that Age50 increases with mean protection time.

Treatment Adherence Issues for Adolescents and Young Adults with Testicular Cancer Due to Changes in the Public Health System in Mexico

Treatment Adherence Issues for Adolescents and Young Adults with Testicular Cancer Due to Changes in the Public Health System in Mexico

Vulnerability of access to health services for informal workers in Mexico in the face of the SARS-CoV-2 pandemic.

This critical-reflective essay problematizes the labor dynamics in the framework of informality considered as a determinant for access to the health system in Mexico and discusses the vulnerability of workers to the pandemic caused by the SARS-CoV-2 virus. This analysis aims to contribute to the construction of proposals aimed at improving the lives of male and female workers by guaranteeing their right to health.

Knowledge, Emotions and Stressors in Front-Line Healthcare Workers during the COVID-19 Outbreak in Mexico.

The aim of this study was to explore the knowledge, emotions and perceived stressors by healthcare workers who were in contact with infected patients during the COVID-19 outbreak. An online cross-sectional survey was applied. Data were collected from N = 263 healthcare workers in Tabasco State, Mexico. We developed and administered a questionnaire, which consisted of sociodemographic characteristics, plus four sections. The sections evaluated were (1) knowledge of COVID-19; (2) feelings/emotions during the COVID-19 outbreak; (3) factors that caused stress and (4) factors that helped to reduce stress. Surveyed individuals were divided into three groups: physicians, nurses and other healthcare workers. When we evaluated their knowledge of COVID-19 we observed that the majority of healthcare workers in the three groups reported that they knew about COVID-19. Physicians indicated that they felt insecure about practicing their profession (62.5%) due to the high risk of being in contact with SARS-CoV-2. With regards to stressor factors, the risk of transmitting COVID-19 to their families was the main factor causing moderate to high stress (95.4%). Finally, we found that “your profession puts your life at risk” was the only factor associated with feeling nervous and scared (PR: 3.15; 95% CI: 1.54–6.43). We recommended health education campaigns, introductory courses on COVID-19 and other infectious diseases, management protocols and the provision of protection equipment to health workers in order to reduce personal and professional fears of contagion and to improve the health system in Mexico when facing epidemics.

Visualizing complex healthcare disparities: proof of concept for representing a cyclical continuum of care model for a retrospective cohort of patients with musculoskeletal infections

BackgroundCare continuum models (also known as care cascade models) are used by researchers and health system planners to identify potential gaps or disparities in healthcare, but these models have limited applications to complex or chronic clinical conditions. Cyclical continuum models that integrate more complex clinical information and that are displayed using circular data visualization tools may help to overcome these limitations. We performed proof-of-concept cyclical continuum modeling for one such group of conditions—musculoskeletal infections—and assessed for racial and ethnic disparities across the complex care process related to these infections.MethodsCyclical continuum modeling was performed in a diverse, retrospective cohort of 1648 patients with musculoskeletal infections, including osteomyelitis, septic arthritis, and/or infectious myositis, in the University of New Mexico Health System. Logistic regression was used to estimate the relative odds of each element or outcome of care in the continuum. Results were visualized using circularized, map-like images depicting the continuum of care.ResultsRacial and ethnic disparities differed at various phases in the care process. Hispanic/Latinx patients had evidence of healthcare disparities across the continuum, including diabetes mellitus [odds ratio (OR) 2.04, 95% confidence interval (CI): 1.61, 2.60 compared to a white non-Hispanic reference category]; osteomyelitis (OR 1.28, 95% CI: 1.01, 1.63); and amputation (OR 1.48; 95% CI: 1.10, 2.00). Native American patients had evidence of disparities early in the continuum (diabetes mellitus OR 3.59, 95% CI: 2.63, 4.89; peripheral vascular disease OR 2.50; 95% CI: 1.45, 4.30; osteomyelitis OR 1.43; 95% CI: 1.05, 1.95) yet lower odds of later-stage complications (amputation OR 1.02; 95% CI: 0.69, 1.52). African American/Black non-Hispanic patients had higher odds of primary risk factors (diabetes mellitus OR 2.70; 95% CI: 1.41, 5.19; peripheral vascular disease OR 4.96; 95% CI: 2.06, 11.94) and later-stage outcomes (amputation OR 2.74; 95% CI: 1.38, 5.45) but not intervening, secondary risk factors (osteomyelitis OR 0.79; 95% CI: 0.42, 1.48).ConclusionsBy identifying different structural and clinical barriers to care that may be experienced by groups of patients interacting with the healthcare system, cyclical continuum modeling may be useful for the study of healthcare disparities.

Trends in dementia consultations in two psychiatric hospitals in Mexico City: 2010‐2018

AbstractBackgroundThe analysis of the information about the use of health services is a key input for understanding infrastructure and planning requirements, as well as for contributing to the identification of deficiencies and opportunities aimed at improving the provision of services. Dementia is a condition that is increasing in Mexico; however, the health system lacks long‐term care services, being psychiatric hospitals one of the main centers for providing services to the population affected by this disease. That is why this research aims to identify trends in dementia care for adults over 60 years who were attended in two psychiatric hospitals in Mexico City between 2010–2018.MethodWe used records of the psychiatric hospitals "Fray Bernardino Álvarez" and "Samuel Ramírez Moreno", during the period 2010‐2018. The annual proportion of first and subsequent consultations for dementia (according to ICD‐10, code F00) in both men and women was estimated. The Joinpoint Trend Analysis Software version 4.1.0 was used to explore the change in time trends of care. Trend changes are presented as Annual Percent Change (APC) and was considered statistically significant when p&lt;0.05.ResultOn average, both psychiatric hospitals recorded 9000 dementia consultations per year. Statistically significant increases are observed by sex. Among women, first‐time consultations were recorded with a 16.8% (CI: 5.5‐29.4) and subsequent consultations (APC: 13.4%, CI: 6.2‐21.2). And in men it is only significant in subsequent consultations (APC: 19.5%, CI: 6.6‐34.1).ConclusionThe number of hospital consultations for dementia has increased significantly; however, the health system in Mexico is limited in resources and infrastructure that could guarantee long‐term care services, so it should restructure services and promote other instances that would allow for quality care to be provided to people affected by the disease, as well as their caregivers.

Adverse drug reactions' reporting in a Mexican hospital.

To summarize the procedure for reporting adverse drug reactions (ADRs) in a Mexican hospital, with the purpose of promoting and facilitating the report of ADRs by the heath team. We outline the relevance of pharmacists in performing these activities in Mexican hospitals. A pharmacovigilance study was carried out following the establishment of the Pharmacovigilance Unit of a Mexican hospital on January 2014 through March 2019. There is an undernotification rate of ADRs, since only 137 ADRs were notified in a five-year period, mostly by biopharmaceutical chemists holding bachelor's degrees that were acting as pharmacists. To improve the safety of medications, it is necessary to improve ADR notifications in Mexico's health system. One important step in this direction is to establish a Pharmacy degree with training for promoting and performing ADR notifications.

Treatment modalities and outcomes in patients with rectal cancer (RC) in a referral center in Mexico.

e16105 Background: Regarding cancer care, health system in Mexico is characterized by heterogeneous medical and technical infrastructure among institutions. Limited access to specialized surgeons, radiation therapy and medications may differ and affect survival. Our institution has surgeons, medical oncologists and radiation therapy for the treatment of uninsured low-income patients with RC. The institution does not provide chemotherapy or biologic therapy. Our aim was to describe treatment modalities and outcomes in patients (pts) with RC treated in a referral center in Mexico. Methods: A retrospective database of all consecutive pts with histological diagnosis of rectal adenocarcinoma evaluated at our institution from January 2010 to December 2016 was created. Clinical and pathological variables at diagnosis and treatment modalities were recorded. Overall survival (OS) was estimated using Kaplan-Meier method and compared by log rank test. Results: 99 pts were included, 61.6% male gender. Median age was 61 y/o (range 19 – 97). EGOG PS 0 – 1: 86%. 69% were moderately differentiated. Tumor location: lower (25%), middle (57%), and upper third (18%). Clinical stage (CS) was localized (T1-2, N0 M0) 5%, locally advanced (T3-4, or N+) 71% and advanced (M1) 24%. Treatment modalities (TM) by stage are presented in the Table. For those with advanced disease, 58% had metastasis in one site. RAS and BRAF mutation determination was performed in 21%. 5-year survival rate: 56%. Median OS (months): 25.3 for localized, 103.1 for locally advanced and 18.6 for advanced disease (P = 0.001). Conclusions: In our center, pts with local and regional RC had treatment according to international guidelines and survival was not compromised. On the contrary, limited access to systemic therapy affected patients with advanced disease and decreased survival was documented. To improve survival in patients with advanced disease, health policy adjustments to incorporate systemic treatment coverage are required. [Table: see text]

Formas de malnutrición regional en México en el marco de un desarrollo sostenible

Objetivo: cuantificar indicadores de formas de malnutrición de la población en México para su seguimiento y evaluación en el marco del cumplimiento de los Objetivos de Desarrollo Sostenible (ODS) al año 2030. Metodología: se cuantifican los indicadores de malnutrición por grupos de población, zonas y género en cuatro regiones de México. Se utiliza información de los años 2012 y 2016 de la Encuesta Nacional de Salud y Nutrición (Ensanut). Resultados: se observó disparidades en los indicadores a nivel territorial, las entidades de la región Sur-Sureste, que presentan el mayor rezago social del país, registraron el mayor porcentaje de población preescolar con problemas de retraso en crecimiento (16.6 % en 2016), mientras que las entidades de la región Centro y Norte exhibieron un mayor porcentaje de personas adultas con problemas de sobrepeso y obesidad (77 % y 75 % respectivamente en 2016). Limitaciones: la Ensanut a Medio Camino 2016 no tiene representatividad a nivel entidad federativa, en consecuencia, los resultados de escolares y jóvenes no son robustos y comparables respecto a los datos de 2012. Conclusiones: hay una doble carga para el sistema de salud en México; por un lado, en 2016, el 12.51 % de los niños en edad preescolar mostraron retraso en el crecimiento, por el otro, el 73.6 % de la población adulta tenía problemas de sobrepeso y obesidad. La política de salud pública debe prevenir la desnutrición infantil, el sobrepeso y la obesidad en adultos, así como establecer prioridades para eliminar las formas de malnutrición a nivel territorial y cumplir efectivamente con los objetivos globales de la Agenda 2030, con un impacto en la cultura alimentaria de las familias.

Factors associated with positive user experience with primary healthcare providers in Mexico: a multilevel modelling approach using national cross-sectional data

ObjectiveThis study aimed to investigate factors associated with patient experience with primary care in a large public health system in Mexico and determine the amount of variability in experience attributable...

Cost and time savings of subcutaneous trastuzumab (SC-T) in a public health system in Mexico.

e18387 Background: The subcutaneous presentation of trastuzumab has been recently incorporated into the treatment regimen of HER2-positive breast cancer (BC). Its use has been associated with cost savings and reduced chair time, being especially suitable for public health systems. Aim: To estimate the cost savings of the use of SC-T compared to intravenous trastuzumab (IV-T) according to patient weight, and calculate the infusion time of SC-T in a tertiary healthcare facility at TecSalud from Feb 2018 - Jan 2019. Methods: From a total of 2068 oncological treatments, 756 corresponded to SC-T, either alone or concomitantly with chemotherapy (CT). For cost estimation, we considered $1,103 USD per SC-T vial, $1,162 USD per IV-T vial and $2.6 USD per mg of IV-T, as per governmental rates. We compared the actual treatment cost of 600 mg fixed SC-T dose with the hypothetical cost of administering IV-T at a dose of 6 mg/kg, considering its price per vial and per mg. The total time of SC-T infusion was reported. Results: Median patient weight for the 756 reported SC-T treatments was 72 kg (45 - 127 kg). Of these, 561 consisted of SC-T alone; and 56% had adjuvant, 34% neoadjuvant and 10% palliative intent. The estimated cost of the 756 doses of SC-T was $833,500 USD. Considering patients’ weight, 46% of the infusion treatments would have required 2 IV-T vials, with a total of 1105 vials and an absolute cost of $1,282,374 USD. Likewise, if cost per mg of IV-T is examined, we would have used 338,744 mg of IV-T, with an estimated cost of $894,284 USD. Approximate savings of SC-T use would reach $448,874 USD per vial payment and $60,784 USD per mg payment. The median time of SC-T only infusion was of 3 minutes (1 - 20 minutes); and no adverse effects were documented during its administration. Conclusions: The SC-T fixed dose (irrespectively of patients’ weight) results in significant practical and financial advantages as weight-adjusted dosing is not required. This is specially relevant in countries like Mexico, where &gt; 70% of BC patients are overweight/obese, requiring higher doses of IV-T and resulting in greater expenses. Thus, the use of SC-T not only offers greater convenience to patients, but also reduces overall healthcare costs compared to standard IV infusion.

PCN132 ECONOMIC EVALUATION AND BUDGET IMPACT OF FULVESTRANT (FASLODEX®) IN THE TREATMENT OF LOCALLY ADVANCED OR METASTATIC BREAST CANCER IN POSTMENOPAUSAL WOMEN WHO HAVE NOT RECEIVED PRIOR ENDOCRINE THERAPY FROM THE PERSPECTIVE OF THE PUBLIC HEALTHCARE SYSTEM IN MEXICO

Estimate the cost-effectiveness and budget impact of fulvestrant for locally advanced or metastatic breast cancer in postmenopausal women who have not received prior endocrine therapy in comparison with currently used aromatase inhibitors (AI) and cyclin-dependent kinase (CDK) 4/6 inhibitors in the public health system in Mexico. Cost-effectiveness and budget impact analyses were conducted from the perspective of the public health system in Mexico, as payer. The interventions included fulvestrant, anastrozole, letrozole, exemestane, tamoxifen, palbociclib-letrozole and ribociclib-letrozole. Due to the lack of head to head trials, a network metanalysis was performed. The decision model was a partitioned survival model with 3 health states: progression free survival, post-progression survival and death. A 4-week cycle length over a 20-year time horizon was applied to the model. Only direct medical costs were included. All costs are expressed in 2018 US dollars. Effectiveness was measured as expected life years. A discount rate of 5% was used. Probabilistic and deterministic sensitivity analyses were also conducted. The budget impact analysis comprehended a 5-year period with a penetration rate of fulvestrant ranging from 10% to 30%. Fulvestrant was associated with the highest life expectation within monotherapies, but also the highest cost, resulting in ICERs between $13,277 (vs exemestane) and $25,338 (vs letrozole). The CDK 4/6-letrozole schemes had a higher effectiveness than fulvestrant, but increased the cost to almost the double, with ICERs of $79,574 and $273,416. Sensitivity analyses demonstrated model results are robust to uncertainty of model inputs. According to the penetration rate of fulvestrant, the net impact in the health federal budget would be $13.68 million. This analysis suggests that, according to internationally accepted criteria, fulvestrant constitutes a cost-effective alternative for locally advanced or metastatic breast cancer in postmenopausal women who have not received prior endocrine therapy, with a low budget impact.

The Importance of Mental Health in the Mexican Public Health System

The concept of mental illness has been hidden behind a curtain of stigma and dislike for a long time. The magnitude, suffering and burden in terms of disability and costs for individuals, families and society in general are overwhelming and do not correspond with the resources devoted to their research and attention. This document refers the importance of mental health within public health in Mexico. The presence of these mental disorders in society is reaching alarming figures and the forecasts indicate that they will increase. It is vital to highlight three main axes in the development of strategies that seek direct intervention in the population: prevention, hospitalization and social reintegration. It requires a great human and political will along with a great commitment of all health professionals to achieve a real change within the health system in Mexico regarding mental health.

Racial and ethnic disparities in surgical amputations following serious musculoskeletal infections in a diverse New Mexico cohort

Patients with serious musculoskeletal infections may encounter health disparities across multiple phases of prevention and treatment, including surgical intervention. The purpose of this study was to identify and compare the predictors of surgical intervention and surgical amputation among patients with septic arthritis, osteomyelitis, and infectious myositis in a diverse cohort of patients from New Mexico. A retrospective cohort from the University of New Mexico Health System was formed. Patients with septic arthritis, osteomyelitis, and/or infectious myositis who underwent surgical procedures or amputations were compared with those who did not, using predictive multivariable logistic regression modeling. The impact of diabetes mellitus (DM) as a predictor of surgical outcomes was evaluated. DM was a predictor of both surgical procedures and amputations in a diverse cohort of patients (n = 1694). Diabetes was more common in American Indian/Alaskan Native (AI/AN) patients. However, Black non-Hispanic/African American and Hispanic patients were more likely to undergo amputations, compared to AI/AN patients, even after adjustment for diabetes severity. Racial and ethnic disparities in infection-related amputation may differ from those observed for diabetes or for general access to surgical management. Interventions intended to prevent or treat serious musculoskeletal infections should consider health disparities that differ across the clinical care process.

2156. Cyclical Continuum Modeling: A Process-Based Approach to Identifying and Quantifying Health Disparities in Patients with Serious Musculoskeletal Infections

BackgroundComplex infectious disease processes, including serious musculoskeletal infections, may result in differential health disparities at successive phases in a clinical course. Previously, our group proposed the application of cyclical continuum modeling to the study of these complex clinical processes.MethodsUsing a retrospective cohort of over 1,600 adult patients in the University of New Mexico Health System with serious musculoskeletal infections, including septic arthritis, osteomyelitis, and/or infectious myositis, we performed preliminary proof-of-concept cyclical continuum modeling analyses. The experiences of patients in different racial/ethnic groups were compared using a logistic regression model adjusted for age and sex. Outcomes in multiple categories were reviewed—primary risk factors for limb loss (e.g., diabetes mellitus and peripheral vascular disease), secondary risk factors for limb loss (e.g., osteomyelitis and multiple musculoskeletal infection types), and outcomes or complications of infection (e.g., sepsis, antibiotic use, and amputation). Preliminary cyclical visualization tools were used to demonstrate differences in health outcomes across racial/ethnic groups.ResultsAlthough significantly younger than other members of the cohort, American Indian/Alaskan Native patients (17.7% of cohort) had high odds of primary and secondary risk factors yet low odds of amputation. Hispanic patients (40.2% of cohort) tended to have high odds of primary and secondary factors as well as amputation. Black non-Hispanic patients (2.6% of cohort) had high odds of primary risk factors and low odds of osteomyelitis, yet Black non-Hispanic patients were most likely to undergo an amputation. Initial cyclical visualization techniques showed promise for comparing the relative distribution of racial/ethnic disparities across the clinical course.ConclusionHealth disparities encountered by patients with serious musculoskeletal infections may be studied using a process-based approach. Future development of cyclical continuum modeling methods should focus on applications of both relative and absolute epidemiological measures and cyclical visualization methods.Disclosures All authors: No reported disclosures.