RESUMO
BACKGROUND: Despite the high prevalence of chronic otitis media (COM) in low to middle-income countries, there are few studies regarding its associated factors, health-related quality of life, and treatment costs. This study aimed to identify associated factors of COM, assess its impact on the quality of life as well as estimate the patients' reported costs of COM treatment in Colombia. METHODS: Cross-sectional study. Two otology-referral centers in Bogotá (Colombia) were included. Questionnaires focusing on sociodemographic and clinical associated factors, quality of life, and patients' reported costs were administered to 200 adults with COM diagnosis and 144 control adults. Otoscopic evaluation and audiometric data were collected. RESULTS: The mean age was 42.2 years (SD: 14.44). The median length of COM was 26.13 years (SD: 17.06), and 79.5% of the COM patients reported otorrhea during childhood (P-value: 0.01). The most frequently reported allergic disease among our study population was allergic rhinitis (26.5%). COM was less frequent in patients with a medium-high socioeconomic status (PR: 0.54; 95% CI: 0.39-0.72), and more frequent in patients who reported increased ear discharge due to upper respiratory tract infections (PR: 1.69; 95% CI: 1.68-1.70). The global score of the "Chronic Suppurative Otitis Media Questionnaire-12" showed a difference of 9 points between patients with active and inactive COM (P < 0.001). Patients spent between 12.07% to 60.37% of their household income on expenses related to COM. CONCLUSIONS: Associated factors found in this study are consistent with previous reports. COM has a significant financial impact and affects patients' quality of life. Worldwide research addressing these issues in poor-resource countries is scarce, further studies are needed.
Assuntos
Otite Média/diagnóstico , Qualidade de Vida/psicologia , Adulto , Doença Crônica/economia , Doença Crônica/psicologia , Colômbia , Efeitos Psicossociais da Doença , Estudos Transversais , Feminino , Gastos em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Otite Média/economia , Otite Média/psicologia , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: Acute otitis media is the main cause of consultation, antibiotic use, and ambulatory surgery in developed countries; besides, it is associated with an important economic burden. However, non-medical indirect costs of acute otitis media, which are relevant in this pathology, have been underestimated. OBJECTIVE: To estimate the costs of acute otitis media in pediatric patients in Cartagena, Colombia. MATERIALS AND METHODS: We conducted a prospective study of micro-costing between 2014 and 2015. The direct and indirect costs of acute otitis media were determined through forms applied to parents or caregivers. Loss of productivity was estimated based on the monthly legal minimum wage of 2014 (COP $616.000) (USD $308). RESULTS: A total of 62 episodes of acute otitis media occurred. The total economic costs attributed per episode was COP $358,954 (standard deviation: SD ± COP $254,903, i.e., USD $179). The total economic burden was COP $22,503,141 (USD $11,250), the indirect costs per episode were COP $101,402 (USD $51), and the average care time spent by parents was 3.7 days. CONCLUSION: The estimated costs of acute otitis media in this study were lower than the costs estimated in a review of high-income countries and similar to those of low-income countries such as Nigeria. Information on total costs (direct and indirect) of acute otitis media is necessary for public health decision-making and for full cost-effectiveness assessments.
Introducción. La otitis media aguda es la principal causa de consultas médicas, de uso de antibióticos y de cirugías ambulatorias en los países desarrollados. Está asociada con una significativa carga económica, pero sus costos indirectos no médicos, los cuales son relevantes en esta enfermedad, se han subestimado. Objetivo. Estimar los costos de la otitis media aguda en pacientes pediátricos en Cartagena, Colombia. Materiales y métodos: Se hizo un estudio prospectivo de microcosteo entre el 2014 y el 2015. Se determinaron los costos directos e indirectos de la otitis media aguda mediante encuestas a los padres o cuidadores. La pérdida de productividad se estimó con base en el salario mínimo legal vigente mensual del 2014 (COP $616.000) (USD $308). Resultados. Se presentaron 62 episodios de otitis media aguda. Los costos económicos totales por episodio fueron de COP $358.954 (desviación estándar, DE: ± $254.903) (USD $179). La carga económica total fue de COP $22'503.141 (USD $11.250), los costos indirectos por episodio fueron de COP $101.402 (USD $51) y el tiempo promedio empleado por los padres en el cuidado fue de 3,7 días. Conclusiones. Los costos estimados de la otitis media aguda en el presente estudio fueron menores a los estimados en países con ingresos altos y similares a los de países con ingresos bajos como Nigeria, según una revisión bibliográfica. La información sobre los costos totales directos e indirectos de la otitis es necesaria para la adopción de decisiones en salud pública y para hacer evaluaciones económicas completas de costo-efectividad.
Assuntos
Efeitos Psicossociais da Doença , Otite Média/economia , Otite Média/terapia , Doença Aguda , Região do Caribe , Colômbia , Feminino , Humanos , Lactente , Masculino , Estudos Prospectivos , Saúde da População UrbanaRESUMO
Abstract Introduction: Acute otitis media is the main cause of consultation, antibiotic use, and ambulatory surgery in developed countries; besides, it is associated with an important economic burden. However, non-medical indirect costs of acute otitis media, which are relevant in this pathology, have been underestimated. Objective: To estimate the costs of acute otitis media in pediatric patients in Cartagena, Colombia. Materials and methods: We conducted a prospective study of micro-costing between 2014 and 2015. The direct and indirect costs of acute otitis media were determined through forms applied to parents or caregivers. Loss of productivity was estimated based on the monthly legal minimum wage of 2014 (COP $616.000) (USD $308). Results: A total of 62 episodes of acute otitis media occurred. The total economic costs attributed per episode was COP $358,954 (standard deviation: SD ± COP $254,903, i.e., USD $179). The total economic burden was COP $22,503,141 (USD $11,250), the indirect costs per episode were COP $101,402 (USD $51), and the average care time spent by parents was 3.7 days. Conclusion: The estimated costs of acute otitis media in this study were lower than the costs estimated in a review of high-income countries and similar to those of low-income countries such as Nigeria. Information on total costs (direct and indirect) of acute otitis media is necessary for public health decision-making and for full cost-effectiveness assessments.
Resumen Introducción. La otitis media aguda es la principal causa de consultas médicas, de uso de antibióticos y de cirugías ambulatorias en los países desarrollados. Está asociada con una significativa carga económica, pero sus costos indirectos no médicos, los cuales son relevantes en esta enfermedad, se han subestimado. Objetivo. Estimar los costos de la otitis media aguda en pacientes pediátricos en Cartagena, Colombia. Materiales y métodos: Se hizo un estudio prospectivo de microcosteo entre el 2014 y el 2015. Se determinaron los costos directos e indirectos de la otitis media aguda mediante encuestas a los padres o cuidadores. La pérdida de productividad se estimó con base en el salario mínimo legal vigente mensual del 2014(COP$616.000) (USD$308). Resultados. Se presentaron 62 episodios de otitis media aguda. Los costos económicos totales por episodio fueron de COP $358.954 (desviación estándar, DE: ± $254.903) (USD $179). La carga económica total fue de COP $22'503.141 (USD $11.250), los costos indirectos por episodio fueron de COP $101.402 (USD $51) y el tiempo promedio empleado por los padres en el cuidado fue de 3,7 días. Conclusiones. Los costos estimados de la otitis media aguda en el presente estudio fueron menores a los estimados en países con ingresos altos y similares a los de países con ingresos bajos como Nigeria, según una revisión bibliográfica. La información sobre los costos totales directos e indirectos de la otitis es necesaria para la adopción de decisiones en salud pública y para hacer evaluaciones económicas completas de costo-efectividad.
Assuntos
Feminino , Humanos , Lactente , Masculino , Otite Média/economia , Otite Média/terapia , Efeitos Psicossociais da Doença , Saúde da População Urbana , Doença Aguda , Estudos Prospectivos , Colômbia , Região do CaribeRESUMO
OBJECTIVE: To assess whether antimicrobial therapy in young children with acute otitis media reduces time to resolution of symptoms, overall symptom burden, and persistence of otoscopic evidence of infection. We used a cost-utility model to evaluate whether immediate antimicrobial treatment seems to be worthwhile, and if so, which antimicrobial agent is most cost effective. STUDY DESIGN: We compared the cost per quality-adjusted life-day of 5 treatment regimens in children younger than 2 years of age with acute otitis media: immediate amoxicillin/clavulanate, immediate amoxicillin, immediate cefdinir, watchful waiting, and delayed prescription (DP) for antibiotic. RESULTS: The 5 treatment regimens, listed in order from least effective to most effective were DP, watchful waiting, immediate cefdinir, immediate amoxicillin, and immediate amoxicillin/clavulanate. Listed in order from least costly to most costly, the regimens were DP, immediate amoxicillin, watchful waiting, immediate amoxicillin/clavulanate, and immediate cefdinir. The incremental cost-utility ratio of immediate amoxicillin compared with DP was $101.07 per quality-adjusted life-day gained. The incremental cost-utility ratio of immediate amoxicillin/clavulanate compared with amoxicillin was $2331.28 per quality-adjusted life-day gained. CONCLUSIONS: In children younger than 2 years of age with acute otitis media and no recent antibiotic exposure, immediate amoxicillin seems to be the most cost-effective initial treatment.
Assuntos
Anti-Infecciosos/uso terapêutico , Otite Média/tratamento farmacológico , Doença Aguda , Anti-Infecciosos/economia , Criança , Pré-Escolar , Análise Custo-Benefício , Humanos , Lactente , Otite Média/economia , Resultado do TratamentoRESUMO
BACKGROUND: Breastfeeding is vital for child survival, health, and development. Mexico has very low rates of breastfeeding and experienced a severe decrease in the prevalence of exclusive breastfeeding from 21% in 2006 to 14% in 2012. OBJECTIVE: The objective of the article was to estimate the pediatric costs of inadequate breastfeeding in Mexico associated with the following acute health conditions: respiratory infections, otitis media, gastroenteritis, necrotizing enterocolitis (NEC), and sudden infant death syndrome (SIDS). DESIGN: The authors estimated the economic costs of inadequate breastfeeding as follows: the sum of direct health care costs for diseases whose risk increases when infants are non-exclusively breastfed <6 mo or are not breastfed from ages 6 to <11 mo, lost future earnings due to premature infant death, and the costs of purchasing infant formula. Incidence cases were retrieved from national surveillance systems, except for NEC and SIDS, which were estimated from the literature. A sensitivity analysis was carried out to provide a range of costs based on different assumptions of the number of incident cases of all infant health outcomes examined. The model applied to the cohort of 1-y-old children born in 2012. RESULTS: The total annual costs of inadequate breastfeeding in Mexico for the studied cohort ranged from $745.6 million to $2416.5 million, where the costs of infant formula accounted for 11-38% of total costs. A range of 1.1-3.8 million reported cases of disease and from 933 to 5796 infant deaths per year for the diseases under study are attributed to inadequate infant breastfeeding practices; altogether these represent nearly 27% of the absolute number of episodes of such diseases. CONCLUSIONS: This study provides costs of inadequate breastfeeding that had not been quantified in Mexico. The costs presented in this article provide the minimum amount that the country should invest to achieve better breastfeeding practices.
Assuntos
Aleitamento Materno , Desenvolvimento Infantil , Promoção da Saúde , Política Nutricional , Cooperação do Paciente , Adulto , Aleitamento Materno/economia , Estudos de Coortes , Efeitos Psicossociais da Doença , Enterocolite Necrosante/economia , Enterocolite Necrosante/epidemiologia , Enterocolite Necrosante/mortalidade , Enterocolite Necrosante/terapia , Monitoramento Epidemiológico , Feminino , Gastroenterite/economia , Gastroenterite/epidemiologia , Gastroenterite/mortalidade , Gastroenterite/terapia , Custos de Cuidados de Saúde , Humanos , Incidência , Lactente , Fórmulas Infantis/economia , Mortalidade Infantil , Masculino , México/epidemiologia , Inquéritos Nutricionais , Otite Média/economia , Otite Média/epidemiologia , Otite Média/mortalidade , Otite Média/terapia , Infecções Respiratórias/economia , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/mortalidade , Infecções Respiratórias/terapia , Morte Súbita do Lactente/epidemiologiaRESUMO
BACKGROUND: Health service utilization (HSU) is an essential component of economic evaluations of health initiatives. Defining HSU for cases of pneumococcal disease (PD) is particularly complex considering the varying clinical manifestations and diverse severity. OBJECTIVE: We describe the process of developing estimates of HSU for PD as part of an economic evaluation of the introduction of pneumococcal conjugate vaccine in Brazil. METHODS: Nationwide inpatient and outpatient HSU by children under-5 years with meningitis (PM), sepsis (PS), non-meningitis non-sepsis invasive PD (NMNS), pneumonia, and acute otitis media (AOM) was estimated. We assumed that all cases of invasive PD (PM, PS, and NMNS) required hospitalization. The study perspective was the health system, including both the public and private sectors. Data sources were obtained from national health information systems, including the Hospital Information System (SIH/SUS) and the Notifiable Diseases Information System (SINAN); surveys; and community-based and health care facility-based studies. RESULTS: We estimated hospitalization rates of 7.69 per 100,000 children under-5 years for PM (21.4 for children <1 years of age and 4.3 for children aged 1-4 years), 5.89 for PS (20.94 and 2.17), and 4.01 for NMNS (5.5 and 3.64) in 2004, with an overall hospitalization rate of 17.59 for all invasive PD (47.27 and 10.11). The estimated incidence rate of all-cause pneumonia was 93.4 per 1000 children under-5 (142.8 for children <1 years of age and 81.2 for children aged 1-4 years), considering both hospital and outpatient care. DISCUSSION: Secondary data derived from health information systems and the available literature enabled the development of national HSU estimates for PD in Brazil. Estimating HSU for noninvasive disease was challenging, particularly in the case of outpatient care, for which secondary data are scarce. Information for the private sector is lacking in Brazil, but estimates were possible with data from the public sector and national population surveys.
Assuntos
Serviços de Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Infecções Pneumocócicas/economia , Assistência Ambulatorial/estatística & dados numéricos , Brasil/epidemiologia , Pré-Escolar , Humanos , Lactente , Meningite Pneumocócica/economia , Meningite Pneumocócica/epidemiologia , Otite Média/economia , Otite Média/epidemiologia , Infecções Pneumocócicas/epidemiologia , Vacinas Pneumocócicas/economia , Pneumonia/economia , Pneumonia/epidemiologia , Sepse/economia , Sepse/epidemiologia , Vacinas Conjugadas/economiaRESUMO
BACKGROUND: Streptococcus pneumoniae causes community-acquired pneumonia, otitis media and meningitis, with higher incidences at the extremes of life. PPV-23 vaccine is widely used in prevention of pneumonia and invasive pneumococcal disease in older adults in developed countries. We developed an evaluation of cost-effectiveness of implementing PPV-23 in Colombian population over 60 years. METHODS: The number of cases of pneumonia and meningitis in patients over 60 years and the proportion by S. pneumoniae was estimated based on a review of literature. A decision tree model with a 5-year time horizon was built to evaluate the cost-effectiveness of the implementation of the PPV-23 in this population. Direct health care costs of out- and in-patients were calculated based on expenditure records from the Bogota public health system. Incremental cost-effectiveness ratios per life saved and per year of life gained were estimated based on the decision tree model. Deterministic and probabilistic sensitivity analyses were performed. RESULTS: Without vaccination 4460 (range 2384-8162) bacteremic pneumococcal pneumonias and 141 (range 73-183) pneumococcal meningitis would occur among people over 60 years old in Colombia. In the first year, vaccination with PPV-23 at US$8/dose would save 480 (range 100-1753) deaths due to Invasive and non-invasive pneumococcal disease. Vaccination would results in US$3400/deaths averted (range US$1028-10,862) and US$1514/life years gained (range US$408-5404). CONCLUSION: Vaccination with PPV-23 in over 60 years is a highly cost-effective public health measure in Colombia. Despite some limitations, the results are robust, and may help developing countries to perform informed decisions about the introduction of the vaccine.
Assuntos
Infecções Pneumocócicas/economia , Infecções Pneumocócicas/epidemiologia , Vacinas Pneumocócicas/administração & dosagem , Vacinas Pneumocócicas/economia , Idoso , Idoso de 80 Anos ou mais , Colômbia/epidemiologia , Infecções Comunitárias Adquiridas/economia , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/prevenção & controle , Análise Custo-Benefício , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Masculino , Meningites Bacterianas/economia , Meningites Bacterianas/epidemiologia , Meningites Bacterianas/prevenção & controle , Pessoa de Meia-Idade , Modelos Estatísticos , Otite Média/economia , Otite Média/epidemiologia , Otite Média/prevenção & controle , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/imunologia , Pneumonia Bacteriana/economia , Pneumonia Bacteriana/epidemiologia , Pneumonia Bacteriana/prevenção & controleAssuntos
Técnicas de Apoio para a Decisão , Nível de Saúde , Avaliação de Resultados em Cuidados de Saúde , Anos de Vida Ajustados por Qualidade de Vida , Asma/economia , Transtorno do Deficit de Atenção com Hiperatividade/economia , Cegueira/economia , Paralisia Cerebral/economia , Criança , Epilepsia/economia , Perda Auditiva/economia , Humanos , Hipersensibilidade/economia , Deficiência Intelectual/economia , Otite Média/economia , PaisRESUMO
OBJECTIVE: To gather and calculate utilities for a wide range of health states in the pediatric population. STUDY DESIGN: The study subjects, parents or guardians at least 18 years of age with at least 1 child under age 18 years, were recruited through our Pediatric Research Network (PResNet). Recruitment locations included pediatric clinics, the Indiana State Fair, and public and private conventions. Each subject's utilities were assessed on 3 random health states out of 29 chosen for the study. Both the time trade-off and standard gamble methods were used to measure utilities. RESULTS: Utilities were assessed in a total of 4016 participants (a recruitment rate of 88%). Utility values ranged from a high for acute otitis media (0.96 by standard gamble; 0.97 by time trade-off) to a low for severe mental retardation (0.59 by standard gamble; 0.51 by time trade-off). CONCLUSIONS: Our extensive data set of utility assessments for a wide range of disease states can aid future economic evaluations of pediatric health care.
Assuntos
Técnicas de Apoio para a Decisão , Nível de Saúde , Avaliação de Resultados em Cuidados de Saúde , Pais , Anos de Vida Ajustados por Qualidade de Vida , Adulto , Asma/economia , Transtorno do Deficit de Atenção com Hiperatividade/economia , Cegueira/economia , Paralisia Cerebral/economia , Criança , Epilepsia/economia , Feminino , Gastroenterite/economia , Perda Auditiva/economia , Hospitalização , Humanos , Hipersensibilidade/economia , Deficiência Intelectual/economia , Masculino , Otite Média/economia , Qualidade de Vida , Índice de Gravidade de DoençaAssuntos
Imunoglobulinas Intravenosas/uso terapêutico , Otite Média/prevenção & controle , Infecções por Vírus Respiratório Sincicial/prevenção & controle , Vírus Sinciciais Respiratórios/imunologia , Doença Aguda , Infecções por Haemophilus/prevenção & controle , Haemophilus influenzae , Humanos , Hospedeiro Imunocomprometido , Imunoglobulinas Intravenosas/administração & dosagem , Imunoglobulinas Intravenosas/economia , Lactente , Otite Média/diagnóstico , Otite Média/economia , Otite Média/microbiologia , Infecções Pneumocócicas/prevenção & controleRESUMO
If the initial use of amoxicillin fails to cure otitis media, a family will be burdened with medical costs for a second medication, additional office visit fees and time lost from employment. For some families the initial choice of a more expensive but more effective antibiotic may be more cost effective. Using a decision analysis approach we compared the cost effectiveness of amoxicillin and cefaclor. As the amoxicillin efficacy rate decreases or as parental salaries are increased, the cost-effective advantage moves towards cefaclor. With the decision analysis method described, a practitioner can use costs and efficacy rates relevant to his or her practice to determine the most cost-effective initial antibiotic for a child with otitis media.