Search

Background: Knee surgery is a risk factor for thromboembolic disease. Prophylaxis reduces the risk of this condition., Methods: Economic and health consequences of drugs preventing and treating thromboembolic disease in patients undergoing knee surgery from the institutional perspective (time horizon: 1 year) were estimated. The measures of effectiveness were: reduction in the number of cases (per 1,000 patients) of deep vein thrombosis, pulmonary embolism, hospital admissions and deaths. Transition probabilities were estimated by meta-analysis. The alternatives were: warfarin (reference), dalteparin, enoxaparin, nadroparin, unfractionated heparin + warfarin, and non-prophylaxis. Data on resources use and costs corresponds to the Instituto Mexicano del Seguro Social (IMSS). Acceptability curves were constructed., Results: No prophylaxis implied three times higher cost ($18,835.10 versus $5,967.10) and less effectiveness in comparison with warfarin. The incremental cost-effectiveness ratios for enoxaparin were $3, $13, $17 and $3 per each additional case of deep vein thrombosis, pulmonary embolism, death and hospital admission avoided. Results of nadroparin and unfractionated heparin were inferior to warfarin (59.1% and 72.9% more costly and less effective in three measures of effectiveness, respectively). Dalteparin showed higher health outcomes and lower cost compared with warfarin (-20.6%). Dalteparin had a higher probability of being cost-effective than enoxaparin., Discussion: thromboprophylaxis is a clinically and economically favorable alternative. The identification of a pharmacoeconomic profile of alternatives to perform it becomes relevant given the increasing pressure on institutional budgets., Conclusions: Dalteparin would be a cost-saving alternative in thromboprophylaxis of patients undergoing knee surgery at IMSS.

Background: Medical care in a hospital under a socialized medicine system should be highly effective at the lowest expense possible. When myocardial perfusion studies are performed in well-selected patients, the costs decrease because of the need for fewer invasive studies. When patients are not selected properly, there is an increase-wasted resource, making it necessary to perform cost-effective studies. The goal of this study is to evaluate the economical impact of the diagnostic process in patients suspected of having coronary artery disease, referred to our service (Nuclear Medicine, Hospital de Cardiología CMN, IMSS) in 2002., Methods: We analyzed 1966 reports of myocardial gammagrams. Patient reports were stratified according to their referring unit. The sum of the unitary fixed cost was converted to the unitary cost for each reason for referral. Kappa was used to evaluate concordance., Results: Patients were 62 +/- 11.39 years old, 52% male. Concordance between the referring diagnosis and the myocardial gammagram was <1% (p <0.001). The cost of cardiac gammagrams varied between $2,613.11 and $3,306.77 (Mexican pesos). Waste was calculated at 30%, which represented $1.8 million (Mexican pesos)., Conclusions: Cost-effective studies are important tools in the administration of resources. In this particular case the results indicate the necessity for systematic registration of financial information, periodic review of operation costs by service, and criteria for use of high-cost services.