Cost-effectiveness analysis of pneumococcal conjugate vaccines in preventing pneumonia in Peruvian children

Introduction: Pneumococcal pneumonia (PP) has a high burden of morbimortality in children. Use of pneumococcal conjugate vaccines (PCVs) is an effective preventive measure. After PCV 7-valent (PCV7) withdrawal, PCV 10-valent (PCV10) and PCV 13-valent (PCV13) are the alternatives in Peru. This study aimed to evaluate cost effectiveness of these vaccines in preventing PP in Peruvian children <5 yearsold. Methodology: A cost-effectiveness analysis was developed in three phases: a systematic evidence search for calculating effectiveness; a cost analysis for vaccine strategies and outcome management; and an economic model based on decision tree analysis, including deterministic and probabilistic sensitivity analysis using acceptability curves, tornado diagram, and Monte Carlo simulation. A hypothetic 100 vaccinated children/vaccine cohort was built. An incremental cost-effectiveness ratio (ICER) was calculated. Results: The isolation probability for all serotypes in each vaccine was estimated: 38% for PCV7, 41% PCV10, and 17% PCV13. Avoided hospitalization was found to be the best effectiveness model measure. Estimated costs for PCV7, PCV10, and PCV13 cohorts were USD13,761, 11,895, and 12,499, respectively. Costs per avoided hospitalization were USD718 for PCV7, USD333 for PCV10, andUSD 162 for PCV13. At ICER, PCV7 was dominated by the other PCVs. Eliminating PCV7, PCV13 was more cost effective than PCV10 (confirmed in sensitivity analysis). Conclusions: PCV10 and PCV13 are more cost effective than PCV7 in prevention of pneumonia in children <5 years-old in Peru. PCV13 prevents more hospitalizations and is more cost-effective than PCV10. These results should be considered when making decisions about the Peruvian National Inmunizations Schedule.
Authors: Mezones Holguin, Edward; Bolaños Díaz, Rafael; Fiestas, Víctor; Sanabria, César; Gutiérrez Aguado, Alfonso; Fiestas, Fabián; Suárez, Víctor J.; Rodríguez Morales, Alfonso J.; Hernandez, Adrian V.
Source: The Journal of Infection in Developing Countries

URL:  http://hdl.handle.net/10757/337985

Differences in survival between patients with systemic lupus erythematosus from a public and a private center

Sr. Editor:
Hemos leído con atención el artículo publicado por el servicio de Reumatología del Hospital José María Cullen de Santa Fe, Argentina1. Nos parece relevante la comparación de la evolución del lupus eritematoso sistémico (LES) en un centro privado y uno público, ya que el desenlace de esta enfermedad se podría ver afectado por diversos factores que involucran estar en cualquiera de los centros mencionados, como el tratamiento farmacológico brindado y las características demográficas de la persona que acude a un centro público y uno privado. Estos factores influyen en la calidad de vida y el grado de actividad de la enfermedad en el paciente2. Sin embargo, el estudio presentado tiene algunas limitaciones que ponen en tela de juicio los resultados reportados. En primer lugar, no se define el momento en que los autores inician el seguimiento de enfermedad de los pacientes. Esto podría sesgar el estudio ya que el pronóstico de supervivencia de LES varía de acuerdo con varios factores, como el grado de actividad de la enfermedad en la que se encuentra la persona, la edad y las comorbilidades en el momento de diagnóstico, entre otras3. Segundo, no se determina si los pacientes son usuarios exclusivos de uno de los sistemas de salud (público o privado), si tienen ambos sistemas de salud o si durante los anos ˜ de seguimiento cambiaron de un sistema a otro. Esto generaría que los pacientes reciban más de un tratamiento simultáneamente o tratamientos distintos por cada centro en diversos periodos
Authors: Godoy Carrillo, Maria Claudia; Meneses Saco, Alejandra
Source: Reumatología Clinica (Reumatol Clin)
URL:  http://hdl.handle.net/10757/337884

Low adherence to hemodialysis regime in patients with chronic renal disease in a Peruvian Ministry of Health reference hospital

Objectives: To describe the frequency and perceived causes of non-adherence to dialysis in a Peruvian national reference public hospital. Design: Descriptive study. Setting: Nephrology department, Hospital Nacional 2 de Mayo, Lima, Peru. Participants: Patients with more than one year on dialysis. Interventions: The number of absences to appointed sessions was determined and a validated questionnaire was used to describe perceptions regarding the causes of absences. Main outcomes measures: Low adherence to dialysis defined as patients with more than one absence per month or more than 12 absences between July 2012 and July 2013. Results: The study included 54 patients, of which 27 were male. Average age was 57 ± 16.4 years and average time on dialysis was 40.6 ± 11.5 months. Only 7 patients had higher education. There were 504 absences (5.45%). The second day of the weekly schedule was the day with more absences (292), followed by the third day (145). Overall 13 patients showed low adherence. Main causes of absence reported included a remote residence (6/13), feeling good (6/13), and insufficient financial resources to cover transportation costs (5/13). Conclusions: A quarter of patients had low adherence, and main factors were distance to health facility and wellbeing self-perception.
Authors: Herrera Añazco, Percy; Palacios Guillen, Melissa; Mezones Holguin, Edward; Hernandez, Adrian V.; Chipayo Gonzales, David
Source:  Anales de la Facultad de Medicina

URL:  http://hdl.handle.net/10757/336754

Validation of a scale to assess contamination at home, study in rural Peru

Objectives: To validate a scale to assess contamination of food at home and measure the validity and reliability. Methods: mothers or caregivers with children under 5 years were surveyed in San Juan de Lurigancho in Lima Peru. The scale was previously subject to a rating of expert judges. Factor analysis with principal components was performed; the internal consistency was measured with Kuder-Richardson Formula 20 (KR-20) and the validity of the test with the coefficient Kaiser-Meyer-Olkin (KMO) and the sphericity test Barlet. Results: The sample was 194 caregivers. Three components (Practices cleaning, storage practices and pollution of the child) with a total of 10 items were identified. The item Cleaning Practices had a KR-20 = 0.722 storage practices and food contamination 0.518 and 0.5 respectively. The validity of the test was KMO = 0.549 and 591,678. Barlet test, df = 136, (p <0.05). Conclusions: This scale can contribute to the planning of interventions in the aspect of pollution in the home and thus reduce episodes of infections in children.
Authors: Lozada Urbano, Michelle; Rivera, Roger; Miranda, Doris; Gallegos Vergara, Clara; Reyes Villegas, María Ysabel; Xirinachs Salazar, Yanira
Source: Arch Med

URL:  http://hdl.handle.net/10757/336526

Mandatory requirement of social health service in Peru: Discriminatory and unconstitutional

The rural and urban-edge health service (SERUMS) is an activity that only health professionals perform for the Peruvian government, as it is a mandatory requirement to qualify for a second specialty or to work in public hospitals and public health care facilities, and obtain government scholarships for future training. The few legal changes in the rules of this social program and the focus of “service” restricted to health professionals lead to a perception of this policy as discriminatory and unconstitutional because it violates the right to education and work. There is no scientific evidence that supports the usefulness and effectiveness of this program in terms of quality of service and health indicator improvement, as well as in adequate distribution and retention of health professionals. We suggest to abolish the compulsory requirement and to reformulate a political strategy to help attract and retain health professionals in vulnerable areas of Peru.
Authors: Mayta Tristán, Percy; Poterico, Julio A.; Galán Rodas, Edén; Raa Ortiz, Daniel
Source: Rev Peru Med Exp Salud Publica
URL:  http://hdl.handle.net/10757/336532