RESUMO
OBJECTIVE: Evaluating the relative cost-effectiveness of using vitamin A in children aged less than 5-years-old regarding the reduction of events involving diarrhoea, malaria and mortality from the Colombian health-related social security system (CHSSS). MATERIALS AND METHODS: A decision tree was constructed, using deaths averted as outcome. Probabilities were taken from the pertinent literature and costs from official sources. The cost-effectiveness threshold was three times greater than the per capita Colombian gross domestic product (GDP) in 2012. Probabilistic and deterministic sensitivity analyses were made and cost effectiveness acceptability curves were drawn. RESULTS: Providing a cohort of 100,000 children with vitamin A (as opposed to not doing so) would represent a saving regarding medical attention costs of $ 340,306,917 due to the number of events involving diarrhea (4,268) and malaria (76), having become reduced, as well as cases requiring hospitalization. A saving for the CHSSS was consistently obtained in sensitivity analysis. CONCLUSION: Providing vitamin supplements for children aged less than 5 years-old would seem to be the least costly and most effective (dominant) strategy for the CHSSS, i.e. compared to not doing so).
Assuntos
Análise Custo-Benefício , Diarreia/prevenção & controle , Suplementos Nutricionais , Malária/prevenção & controle , Deficiência de Vitamina A/prevenção & controle , Vitamina A/uso terapêutico , Vitaminas/uso terapêutico , Pré-Escolar , Colômbia/epidemiologia , Árvores de Decisões , Diarreia/economia , Diarreia/etiologia , Diarreia/mortalidade , Suplementos Nutricionais/economia , Custos de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Malária/economia , Malária/etiologia , Malária/mortalidade , Masculino , Programas Nacionais de Saúde/economia , Resultado do Tratamento , Vitamina A/economia , Deficiência de Vitamina A/economia , Deficiência de Vitamina A/etiologia , Vitaminas/economiaRESUMO
Objetivo evaluar la costo-efectividad relativa del uso de vitamina a en los niños menores de 5 años en la disminución de eventos de diarrea, malaria y la mortalidad, bajo la perspectiva del sistema de salud colombiano (SGSSS). Materiales y Métodos se construyó unárbol de decisión con muertes evitadas como desenlace. Las probabilidades se extrajeron de la literatura y los costos de fuentes oficiales. El umbral de costo-efectividad fue tres veces el producto interno bruto (PIB) per cápita colombiano de 2012. Se realizaron análisis de sensibilidad determinísticos, probabilísticos y curva de aceptabilidad. Resultados En una cohorte de cien mil niños, la administración de vitamina a, frente no hacerlo, representaría un ahorro en costos de atención médica de $ 340.306.917, debido a que reduce el número de eventos de diarrea (4.268) y de malaria (76), así como los casos en los que se requiere hospitalización. En todos los análisis de sensibilidad se obtuvo un ahorro para el sistema. Conclusión Dentro del sistema de salud colombiano, la suplementación con vitamina a para niños menores de 5 años, comparado con no hacerlo, es la estrategia menos costosa y más efectiva (dominante).
Objective Evaluating the relative cost-effectiveness of using vitamin A in children aged less than 5-years-old regarding the reduction of events involving diarrhoea, malaria and mortality from the Colombian health-related social security system (CHSSS). Materials and Methods A decision tree was constructed, using deaths averted as outcome. Probabilities were taken from the pertinent literature and costs from official sources. The cost-effectiveness threshold was three times greater than the per capita Colombian gross domestic product (GDP) in 2012. Probabilistic and deterministic sensitivity analyses were made and cost effectiveness acceptability curves were drawn. Results Providing a cohort of 100,000 children with vitamin A (as opposed to not doing so) would represent a saving regarding medical attention costs of $ 340,306,917 due to the number of events involving diarrhea (4,268) and malaria (76), having become reduced, as well as cases requiring hospitalization. A saving for the CHSSS was consistently obtained in sensitivity analysis. Conclusion Providing vitamin supplements for children aged less than 5 years-old would seem to be the least costly and most effective (dominant) strategy for the CHSSS, i.e. compared to not doing so).
Assuntos
Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Análise Custo-Benefício , Diarreia/prevenção & controle , Suplementos Nutricionais , Malária/prevenção & controle , Deficiência de Vitamina A/prevenção & controle , Vitamina A/uso terapêutico , Vitaminas/uso terapêutico , Colômbia/epidemiologia , Árvores de Decisões , Diarreia/economia , Diarreia/etiologia , Diarreia/mortalidade , Suplementos Nutricionais/economia , Custos de Medicamentos/estatística & dados numéricos , Malária/economia , Malária/etiologia , Malária/mortalidade , Programas Nacionais de Saúde/economia , Resultado do Tratamento , Deficiência de Vitamina A/economia , Deficiência de Vitamina A/etiologia , Vitamina A/economia , Vitaminas/economiaRESUMO
Neural tube defects (NTDs) are serious birth defects of the brain and spine that affect approximately 3,000 pregnancies in the United States each year and affected 404 pregnancies in Puerto Rico from 1996 to 2002. Consuming the B vitamin folic acid can reduce the incidence of NTDs 50%-70%, and recent efforts to reduce NTD rates have focused on increasing the number of childbearing-aged women who take a vitamin containing folic acid every day. As the first stage of formative research in campaign planning, two exploratory, qualitative studies were conducted in order to (a) understand the complexity of vitamin use among women in the United States and Puerto Rico and (b) serve as a foundation on which to develop national communication and education interventions. Also, this information shed light on theories that might be used to guide campaign development. Results indicated that campaign messages designed to increase folic acid use through multivitamin supplementation in the United States must address women's barriers to vitamin use (e.g., cost, time), increase women's perceived need for multivitamins (e.g., identify immediate, tangible results from taking a daily multivitamin), and address the relationship between daily food choices and the need for supplementation. Future campaign messages in Puerto Rico must focus on many of these same issues, in addition to increasing women's knowledge about when folic acid should be taken in relation to pregnancy and addressing women's perceptions that vitamins cause weight gain (an undesirable outcome for most participants). The practical and theoretical implications of these results are discussed in terms of their contribution to the development of a creative new approach to increase multivitamin consumption among women of childbearing age in the United States and Puerto Rico.