Cost-effectiveness analysis of 10- and 13-valent pneumococcal conjugate vaccines in Peru

Objective To evaluate the cost-effectiveness of introducing the 10-valent pneumococcal conjugate vaccine (PCV10) versus the 13-valent PCV (PCV13) to the National Immunization Schedule in Peru for prevention of pneumococcal disease (PD) in children <5 years of age. Methods The integrated TRIVAC vaccine cost-effectiveness model from the Pan American Health Organization's ProVac Initiative (version 2.0) was applied from the perspective of the Government of Peru. Twenty successive cohorts of children from birth to 5 years were evaluated. Clinical outcomes were pneumococcal pneumonia (PP), pneumococcal meningitis (PM), pneumococcal sepsis (PS) and acute otitis media from any causes (AOM). Measures included prevention of cases, neurological sequelae (NS), auditory sequelae (AS), deaths and disability adjusted life years (DALYs). A sensitivity analyses was also performed. Findings For the 20 cohorts, net costs with PCV10 and PCV13 were US$ 363.26 million and US$ 408.26 million, respectively. PCV10 prevented 570,273 AOM; 79,937 PP; 2217 PM; 3049 PS; 282 NS; 173 AS; and 7512 deaths. PCV13 prevented 419,815 AOM; 112,331 PN; 3116 PM; 4285 PS; 404 NS; 248 AS; and 10,386 deaths. Avoided DALYs were 226,370 with PCV10 and 313,119 with PCV13. Saved treatment costs were US$ 37.39 million with PCV10 and US$ 47.22 million with PCV13. Costs per DALY averted were US$ 1605 for PCV10, and US$ 1304 for PCV13. Sensitivity analyses showed similar results. PCV13 has an extended dominance over PCV10. Conclusion Both pneumococcal vaccines are cost effective in the Peruvian context. Although the net cost of vaccination with PCV10 is lower, PCV13 prevented more deaths, pneumococcal complications and sequelae. Costs per each prevented DALY were lower with PCV13. Thus, PCV13 would be the preferred policy; PCV10 would also be reasonable (and cost-saving relative to the status quo) if for some reason 13-valent were not feasible.; This study was presented at 9th International Symposium of Pneumococci and Pneumococcal Diseases, Hyderabad, India, March 2014, and supported by the National Council of Science, Technology and Technological Innovation of Peru (CONCYTEC) and International Clinical Epidemiology Network (INCLEN Trust).

Author(s): Mezones Holguin, Edward; Canelo Aybara, Carlos; David Clark, Andrew; Bess Janusz, Cara; Jaúregui, Bárbara;Escobedo Palza, Seimer; Hernandez, Adrian V.; Berhane, Yemane; Vega Porras, Denhiking; González, Marco;Fiestas, Fabián; Toledo , Washington; Michele, Fabiana; Suárez, Víctor J.
Source: Vaccine
URL: http://hdl.handle.net/10757/582635

Insulin resistance and endometrial cancer risk: A systematic review and meta-analysis

Abstract Aim: It has been suggested that chronic hyperinsulinemia from insulin resistance is involved in the etiology of endometrial cancer (EC). We performed a systematic review and meta-analysis to assess whether insulin resistance is associated with the risk of EC. Methods: We searched PubMed-Medline, Embase, Scopus, and Web of Science for articles published from database inception through 30th September 2014. We included all observational studies evaluating components defining insulin resistance in women with and without EC. Quality of the included studies was assessed by NewcastleeOttawa scale. Randomeffects models and inverse variance method were used to meta-analyze the association between insulin resistance components and EC. Results: Twenty-five studies satisfied our inclusion criteria. Fasting insulin levels (13 studies, n Z 4088) were higher in women with EC (mean difference [MD] 33.94 pmol/L, 95% confi- dence interval [CI] 15.04e52.85, p Z 0.0004). No differences were seen in postmenopausal versus pre- and postmenopausal subgroup analysis. Similarly, non-fasting/fasting C-peptide levels (five studies, n Z 1938) were also higher in women with EC (MD 0.14 nmol/L, 95% CI 0.08e0.21, p < 0.00001). Homeostatic model assessment - insulin resistance (HOMA-IR) values (six studies, n Z 1859) in EC patients were significantly higher than in women without EC (MD 1.13, 95% CI 0.20e2.06, p Z 0.02). There was moderate-to-high heterogeneity among the included studies. Conclusion: Currently available epidemiologic evidence is suggestive of significantly higher risk of EC in women with high fasting insulin, non-fasting/fasting C-peptide and HOMAIR values.

Author(s): Hernandez, Adrian V.; Pasupuleti, Vinay; Benites Zapata, Vicente A.; Thota, Priyaleela; Deshpande, Abhishek;Perez Lopez, Faustino R.
Source: European Journal of Cancer
URL: http://hdl.handle.net/10757/582697

Are medical students able to perform multicenter studies?

Are medical students able to perform multicenter studies? This question goes far beyond what the scientific environment could imagine even a few years ago. Medical students, particularly in Latin America, have progressively incremented their research productivity[1],[2]. This is due to the strategies developed —such as the creation of medical students’ scientific societies— in response to the lack of a culture of research and publishing in the continent [3],[4]. As these improvements have been rising, new research challenging opportunities have emerged. Multicenter studies are an example. We would like to relate the experience of a project we ran in 85 universities of 17 Latin American countries in which the main local researchers were medical students, conforming then the Collaborative Working Group for the Research of Human Resources for Health (Red-LIRHUS) [5]. In order to do so, we will mention the main advantages and complications in carrying out a multicenter study with medical students as investigators.

Author(s): Pereyra Elías, Reneé; Montenegro Idrogo, Juan José; Mayta Tristán, Percy ( 0000-0002-0861-6606 ) 
Source: Medwave (Medwave)
URL: http://hdl.handle.net/10757/579916

Dispositivo intrauterino parcialmente migrado e incrustado en serosa de rectosigmoides tras 8 años de inserción

Se presenta el caso clínico de un dispositivo intrauterino parcialmente migrado a cavidad pélvica e incrustado en serosa de rectosigmoides luego de 8 años de su inserción. El diagnóstico se realizó mediante ecografía transvaginal y retiro del dispositivo por laparoscopia. Se realizó rafia de serosa rectal y de útero. La paciente tuvo un postoperatorio sin complicaciones.

Autor(es): Bernuy P., Sandra; Rivera N., María Cristina; Salazar L., Carmen; Ramírez C., Fernando
Fuente: Revista Chilena de Obstetrica y Ginecología (Rev. Chil. Obstet. Ginecol.)
URL: http://hdl.handle.net/10757/582068

Perception of physicians about medical education received during their Nephrology residency

Introduction: In Peru there are different hospitals and university programs for training of specialists in nephrology. Objective: To assess the perception of physicians who attend such programs. Methods: We carried out a descriptive cross-sectional national-level study in physicians who were in the last two years of nephrology training during February 2012 and who had graduated from it in 2010 and 2011. A self-applied questionnaire was developed along with the Peruvian Society of Nephrology based on international standards. The questionnaire evaluated: mentoring, clinical training, procedures, external rotations, research and global perception. Results: Forty doctors were surveyed nationwide. 82.5% had tutors, 22.5% of them said their support was poor. A 27.5% described their theoretical formation as deficient. The practical training was perceived as acceptable globally; however, improvements in training on peritoneal dialysis and reading kidney transplant biopsies are necessary. A 90% have national external rotations and 65% reported to have an international rotation. In the assessment of research, 77.5% thought this is deficient. In addition, 82.5% believed that residency should last four years. However, 60% reported that their residency training was good. There is a decrease in the positive perception of the aspects studied among residents regarding graduates. Conclusion: The overall perception of nephrology residency training was considered good; however, areas of tutoring, and academic and research activities on average were deficient.

Author(s): Herrera Añazco, Percy; Bonilla Vargas, Luis; Hernandez, Adrian V.; Silveira Chau, Manuela
Source: Jornal Brasileiro de Nefrologia (J. Bras. Nefrol)

URL: http://hdl.handle.net/10757/579609