Background. Neuropathic pain has a prevalence of 2–17% in the general population. Diagnosis and treatment of neuropathic pain are not fully described in different populations. The aim was to determine the treatment patterns and direct costs of care associated with the management of neuropathic pain from the onset of the first symptom to up to two years after diagnosis. Methods. From a drug-claim database, a cohort of randomly selected outpatients diagnosed with neuropathic pain was obtained from an insurer in Colombia and followed up for two years after diagnosis. The clinical records were reviewed individually to identify the study variables, including the time needed to make the diagnosis, the medical and paraclinical resources used, the pharmacological therapy for pain management, and the direct costs associated with care. Results. We identified 624 patients in 49 cities, with a mean age of 50.3 ± 14.1 years, of which 324 were men (51.9%). An average of 90 days passed from the initial consultation until the diagnosis of neuropathic pain, the most frequent being lumbosacral radiculopathy (57.9%). 34.5% of the cohort had at least one diagnostic imaging procedure, and 16% had an electromyography. On average, they were treated by a general practitioner twice. 91.7% received initial treatment with tramadol, carbamazepine, amitriptyline, imipramine, or pregabalin, and 60.4% received combined therapy. The mean cost of care for two years for each patient was US$246.3. Conclusions. Patients with neuropathic pain in Colombia are being diagnosed late, are using therapeutic agents not recommended as first-line treatment by clinical practice guidelines, and are being treated for short periods of time.

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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 un árbol 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).

Conclusions: The current direct medical expenses of TB patients are relatively affordable, but for low-income patients and patients in severe condition, the financial burden is still heavy. Improved medical assistance policies are in need.

Abstract Background: Ceftazidime-Avibactam (CAZ-AVI) may offer a significant advance over previously antimicrobials against carbapenem-resistant Enterobacteriaceae (CRE). We evaluate the cost-effectiveness of CAZ-AVI compared to colistin-meropenem (COL+MEM) in the treatment of CRE infections in ColombiaMethods: A decision tree model was developed from healthcare system perspective assuming a 30-day time horizon. Inputs were derived from a published observational study. The clinical course was simulated based on treatment response between 48-72 hours, and the duration of the treatment was 7-14 days. The clinical failure was assumed as the addition of an antibiotic. The model considered that combination therapy of COL+MEM was not superior to monotherapy to reflect real clinical behavior. Cost inputs were extracted from a published Colombian manual tariffs and official databases, expressed in 2019 dollars (USD). Utility values were from published literature. The sensitivity analyses were performed.Results: In the base case analysis, CAZ-AVI was associated with reduced mortality, length of hospital stay and fewer add-on antibiotics, resulting in an increase of 1.76 QALYs per patient versus COL+MEM. and incremental costs associated in CAZ-AVI were $2,521 higher per patient compared to COL+MEM ($755 versus $3,276). The incremental costs were partially increased due to the lower mortality rate observed with CAZ-AVI. The incremental cost-effectiveness ratio was estimated to be $3,317 per QALY. In the probabilistic sensitivity analysis, with a willingness to pay above $2,438, CAZ-AVI has a higher probability of being cost-effective.Discussion: CAZ-AVI demonstrates cost-effectiveness as a treatment for CRE infections by reducing the number of deaths and increasing QALYs.