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6. Medication review with follow-up for cardiovascular outcomes: a trial based cost-utility analysis

Author

Ahumada-Canale, A, Vargas, C, Balmaceda, C, Martinez-Mardones, F, Plaza-Plaza, JC, Benrimoj, S, and Garcia-Cardenas, V

Subjects
Primary Health Care, Cost-Benefit Analysis, Quality of Life, Humans, Quality-Adjusted Life Years, Aged, Follow-Up Studies
Abstract

Aim: To assess the trial-based cost–effectiveness of medication review with follow-up compared with usual care in primary care. Materials & methods: A cluster randomized controlled trial included patients if they were independent older adults, receiving five or more prescriptions, with moderate or high cardiovascular risk. Costs were estimated from the public healthcare sector perspective, and health benefits were measured as quality-adjusted life years. Both of which were used to calculate the incremental cost–effectiveness ratio. Results: Twelve centers completed the study, six (146 patients) in the intervention group and six (145 patients) in the control group. The base-case analysis showed an incremental cost–effectiveness ratio of US$ (2019) 434.4/quality-adjusted life year (95% CI 64.20–996.03). Conclusion: The intervention was cost-effective in the public primary care setting.

Published
2021

7. Different Alternatives to Assess the Burden of Disease Using Attributable Fraction on a Disability Variable: The Case of Pain and Chronic Musculoskeletal Disorders in Chile.

Author

Zitko, P, Bilbeny, N, Vargas, C, Balmaceda, C, Eberhard, ME, Ahumada, M, Rodríguez, MF, Flores, J, Markkula, N, Espinoza, MA, Zitko, P, Bilbeny, N, Vargas, C, Balmaceda, C, Eberhard, ME, Ahumada, M, Rodríguez, MF, Flores, J, Markkula, N, and Espinoza, MA

Abstract

Objectives

To estimate the burden of disease through 4 complementary procedures to years lived with disability (YLDs) using the concept of attributable fraction and including analysis of subdomains of disability.

Methods

We explored the burden on disability for 7 common musculoskeletal disorders (CMD) using the 2009 to 2010 Chilean National Health Survey, which included the Community Oriented Programme for the Control of Rheumatic Disease Core Questionnaire to identify cases with CMD, and an 8-domain questionnaire for health state descriptions. We calculated the proportion of disability attributable to pain in the general population and people with CMD. We also estimated the burden of CMD expressed as YLD and as the proportion of the disability in the general population attributable to people with CMD, with a particular focus in the pain domain of disability. Second order of uncertainty around point estimations was also characterized.

Results

Pain domain of disability accounted for 23.4% of the total disability in the general population, and between 20% (fibromyalgia) to 27.1% (osteoarthritis of the hip) in people with some of the selected CMD. People with chronic musculoskeletal pain accounted for 21.2% of total disability from general population, which generated 1.2 million of YLD (6679 YLD/100 000 inhabitants). Chronic low back pain and osteoarthritis of the knee were in the top position of specific CMDs, explaining the highest national burden.

Conclusion

Pain is an essential component of disability in people with CMD and also in the general population. The approach used can be easily applied to other health conditions and other domains of disability.

Published
2021

20. Economic evaluation of sunitinib versus pazopanib and best supportive care for the treatment of metastatic renal cell carcinoma in Chile: cost-effectiveness analysis and a mixed treatment comparison

Author

Vargas, C, Balmaceda, C, Rodríguez, F, Rojas, R, Giglio, A, and Espinoza, MA

Subjects
Sulfonamides, Evidence-Based Medicine, Health Status, Cost-Benefit Analysis, Decision Making, Angiogenesis Inhibitors, Antineoplastic Agents, Kidney Neoplasms, Markov Chains, Drug Costs, Pyrimidines, Models, Economic, Health Policy & Services, Sunitinib, Humans, Quality-Adjusted Life Years, Neoplasm Metastasis, Chile, Carcinoma, Renal Cell
Abstract

© 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group. Background: Sunitinib and Pazopanib are two metastatic renal cell carcinoma (MRCC) treatment alternatives, however the health system in Chile does not consider coverage for any. The cost-effectiveness versus relevant comparator was assessed to support evidence-based decision making. Methods: A four health states Markov model was built: first, second line treatments, BSC and death. Benefits were measured in QALYs, and efficacy estimates were obtained from an indirect treatment comparison. A 10-year time horizon and a 3% undifferentiated discount rate were considered. Deterministic and probabilistic sensitivity analyses were performed. Results: The costs of treating MRCC with Sunitinib were higher than Pazopanib and BSC. When comparing Sunitinib versus Pazopanib, the incremental benefit is small favoring Sunitinib (0.03 QALYs). The base case scenario shows an average ICER of PA versus BSC of US$62,327.11/QALY and of US$85,885/QALY for Sunitinib versus Pazopanib. The ICER was most sensitive to the OS relative to BSC, where evidence was associated to important bias. Conclusions: Sunitinib or Pazopanib can be considered cost-effective if a 3 GDP per-capita threshold is assumed. The decision between SU or PA is highly sensitive to the price of the drugs, rather than the outcomes. Therefore, the decision might be made based on cost-minimization exercise.

Published
2019

21. Abstracts for the Tenth International Conference on Brain Tumour Research and Therapy: Stalheim Hotel, Voss, Norway, September 6–9, 1993

Author

Abrahamsen, Tore G., Wesenberg, Finn, Mørk, Sverre, Allen, Jeffrey, Hayes, Roberta, DaRosso, Robert, Nirenberg, Anita, Ali-Osman, Francis, Akande, Nike, Amberger, V., Seulberger, H., Paganetti, P. A., Schwab, M. E., Schwab, M. E., Arita N., Ohnishi T., Hiraga S., Yamamoto H., Taki T., Izumoto S., Higuchi M., Hayakawa T., Kusakabe M., Sakakura T., Baldwin, N. G., Rice, C. D., Merchant, R. E., Ashmore, Sally M., Darling, J. L., Bailey, C. C., Balmaceda C., Diez B., Villablanca J., Walker R., Finlay J., Bergenheim, A. Tommy, Hartman, Magdalena, Bergh, Jonas, Ridderheim, PerÅke, Henriksson, Roger, Berens, Michael E., Rief, Monique D., Giese, Alf, Zackrisson, Björn, Elfversson, Jörgen, Bernstein, Mark, Cabantog, Alberto, Glen, Jennifer, Mikulis, David, Bjerkvig, Rolf, Pedersen, Paal-Henning, Mathisen, Berit, Mahesparan, Rupavathana, Haugland, Hans Kristian, Bernstein, Mark, Laperriere, Normand, Thomason, Cindy, Leung, Phil, Bobola M. S., Berger M. S., Silber J. R., Bongcam-Rudloff, Erik, Wang, Jia-Lun, Nistér, Monica, Westermark, Bengt, Brem, Steven, Breslow, Gary, Ho, Jason, Gately, Stephen, Takano, Shingo, Ward, William, Brada, M., Laing, R., Warrington, J., Brem, Steven, Engelhard, Herbert, Takano, Shingo, Gately, Stephen, Brem, Steven, Landau, Barry, Kwaan, Hau, Verrusio, Elaine, Buckner, J. C., Cascino, T. L., Schomberg, P. S., O'Fallon, J. R., Dinapoli, R. P., Burch, P. A., Shaw, E. G., Broaddus, William C., Hager-Loudon, Kathryn, Merchant, Randall E., Loudon, William, Couldwell, William T., Jiang, Jack B., Burns, David, Couldwell, William T., Weiss, Martin H., Apuzzo, Michael L. J., Desbaillets I., Tada M., de Tribolet N., Van Meir, E., Davis, R. L., Onda, K., Prados, M. D., Dolan, M. Eileen, Fleig, Matthew J., Friedman, Henry S., Ekstrand, A. Jonas, Longo, Nicola, James, C. David, Chou, D., Wijnhoven, B., Bellinzona, M., Nakagawa, M., Feuerstein B. G., Basu H. S., Dolan M. E., Bergeron C., Pellarm M., Deen D. F., Marton L. J., Finlay, Jonathan, Fulton D. S., Urtasun R. C., Giese, Alf, Scheck, Adrienne C., Geddes, J., Vowles, G. M., Ashmore, S. M., Gillespie, G. Y., Goldman, C. K., Tucker, M. T., Lyon, E., Tsai, J. -C., Gobbel, G. T., Chan, P. H., Greenberg, Hairy S., Chandler, W. F., Ensminger, W. D., Junck, L., Sandler, H., Bromberg, J., McKeever, P., Gonzalez G. G., Sarkar A., Basu H., Feuerstein B. G., Deen D. F., Haugland, Kr., Tysnes, Ole-Bjørn, Hiraga, Shoju, Arita, Norio, Ohnishi, Takanori, Taki, Takuyu, Yamamoto, Hiroshi, Higuchi, Masahide, Hayakawa, Toru, Isern, Erik, Unsgaard, Geirmund, Marthinsen, Anne Beate Langeland, Strickert, Trond, Helseth, Eirik, Hochberg F., Cosgrove R., Valenzuela R., Pardo F., Zervas N., Jenkins, Robert B., Ritland, Steven R., Hailing, Kevin C., Thibodeau, Stephen N., Juillerat L., Darekar P., Janzer R. C., Hamou M. F., Kato, Tsutomu, Sawamura, Yutaka, Tada, Mitsuhiro, Sakuma, Shirou, Sudo, Masako, Abe, Hiroshi, Kallio M., Leppää J., Nikula T., Nikkinen P., Gylling H., Färkkilä M., Hiltunen J., Jääskeläinen J., Liewendahl K., Keles, G. Evren, Berger, Mitchel S., Deliganis, Anna, Kellie S. J., De Graaf S. S. N., Bloemhof H., Johnston I., Uges D. D. R., Besser M., Chaseling R. W., Ouvrier R. A., Kitchen, N. D., Hughes, S., Beaney, R., Thomas, D. G. T., Kim D. H., Maeda T., Mohapatra G., Park S., Waldman F. W., Gray J. W., Koala, D., Silber, J., Berger, M., Krauseneck P., Müller B., Strik H., Warmuth-Metz M., Kuratsu, Jun-ichi, Takeshima, Hideo, Ushio, Yukitaka, Kretschmar, C., Grodman, H., Linggood, R., Kyritsis, A. P., Bondy, M., Cunningham, J., Xiao, M., Levin, V., Leeds, N., Bruner, J., Yung, W. K. A., Saya, H., Lampson, L. A., Nichols, M. R., Lampson, M. A., Dunne, A. D., Li, Hong, Hamou, Marie-France, Jaufeerally, Rehana, Diserens, Annie-Claire, Van Meir, Erwin, de Tribolet, Nicolas, Levin, V. A., Maor, M., Sawaya, R., Leavens, M., Woo, S., Thall, P., Gleason, M. J., Liang, Bertrand C., Ross, D. A., Meltzer, P. S., Trent, J. M., Greenberg, H. S., Lillehei K. O., Kong Q., DeMasters B. K., Withrow S. J., Macdonald D. R., Cairncross J. G., Ludwin S., Lee D., Cascino T., Buckner J., Dropcho E., Fulton D., Stewart D., Schold C., Wainman N., Eisenhauer E., Kirby S., Fisher B. J., Magrassi, L., Butti, G., Pezzotta, S., Milanesi∘, G., Matsutani, Masao, Marienhagen, Kirsten, Laerum, Ole Didrik, Baldwin, N. G., Merzak, Abderrahim, Koocheckpour, Shahriar, Roxanis, Yannis, Pilktngton, Geoffrey J., Nagai, Masakatsu, Watanabe, Kunihiko, Narita, Jun-ichi, Hagiwara, Hideaki, Noble, Mark, Nomura, K., Oyama, H., Motoo, M., Shibui, S., Tokuue, K., Akine, Y., Ohnishi, T., Arita, N., Hiraga, S., Hayakawa, T., Nygaard, Svein J. Tjoflaat, Tysnes, Ole-Bjørn, Pardo, F. S., Hsu, D. W., Hedley-Whyte, E. T., Efird, J., Schmidt, E. V., Marienhagen, Paal-Henning Pedersenl Kirsten, Pilkington, Geoffrey J., Clarke, Tracey M., Yu, Hui Tian, Rogers, Joan P., Stern, Robert, Phuphanich, Surasak, Greenberg, Harvey, Murtagh, R., Viloria, Jesus, Ransohoff, Joseph, Martin, Kimberly, Hatva, V. Erika, Rao, Jasti S., Mohanam, S., Rempel, Sandra A., Schwechheimer, Karl, Davis, Richard L., Cavenee, Webster K., Rosenblum, Mark L., Reifenberger, Guido, Liu, Lu, Ichimura, Koichi, Schmidt, Esther E., Collins, V. Peter, Revesz T., Scaravilli F., Cockburn H., Thomas D. G. T., Rice, C. D., Biron, R. T., Merchant, R. E., McKerrow, James, Sloane, Bonnie, Mikkelsen, Tom, Roosen, Norbert, Coopersmith, Peter, Smith, Robert, Rooprai, Harcharan Kaur, Maidment, Steven, Rucklidge, Garry, Volovsek, Anton, Rutka J. T., Smith S. L., Matsuzawa K., Sankar, A. A., Darling, J. L., Williams, S. R., Fukuyama K., Marton L. J., Ikeda, Jun, Selker, R. G., Vertosick, F. T., Goldenberg, M. T., Bindal, R., Diez B., Taratuto A., Picco P., Monges J., Martinez M., Pacheco G., Gamboni M., Schultz M., Silber J. R., Mueller B. A., Ewers T. G., Berger M. S., Shiraishi, T., Tabuchi, K., Nakagawa, S., Kihara, S., Stewart, D. J., Eapen, L., Agboola, O., Popovic, P., Goel, R., Raaphorst, P., Wong, P. T. T., Shimokawa, S., Oh-uchida, M., Hori, K., Markert C., Pflughaupt K. -W., Tada M., Diserens A. -C., Jauferrally R., Desbaillets I., Hamou M. -F., de Tribolet N., Takeshima H., Mochizuki H., Clifford J. L., Nishi T., Levin V. A., Lotan R., Saya H., Terzis, A. J. A., Arnold, H., Laerum, O. D., Bjerkvig, R., Taratuto A. L., Sevlever G., Diaz D., Di Tella M., Cuccia V., Pomata H., Gallo G., Dietze, A., Knopp, U., Thomas, R., Brada, M., Carnochan, P., Flux, G., Kitchen, N., Thomas, D., Zalutsky, M., Bigner, D., Tofilon, Philip, Borchardt, Paul, Torp, Sverre H., Dalen, Are, Tohyama, Takashi, Kubo, Osami, Takakura, Kintomo, Lee, Virginia M. -Y., Trojanowski, John Q., Nygaard, Svein, Urtasun, R. C., Parliament, M. B., McEwan, A. J., Mannan, R. H., Weibe, L. I., Unsgårp, G., Sonnewald, U., Gribbestad, I., Isern, E., Petersen, S. B., Wang J., Delgado D. A., Warr, Tracy J., Sheer, Denise, Gorman, Pat, Yamaguchi, F., Westphal, M., Anker, L., Hamel, W., Lücke, M., Shepard, M., Kleihues, P., Herrmann, H. D., Yung, W. K. Alfred, Taylor, Scott, and Steck, Peter A.

Published
1993
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31. Costs and consequences of chronic pain due to musculoskeletal disorders from a health system perspective in Chile

Author

Vargas, C, Bilbeny, N, Balmaceda, C, Rodríguez, MF, Zitko, P, Rojas, R, Eberhard, ME, Ahumada, M, Espinoza, MA, Vargas, C, Bilbeny, N, Balmaceda, C, Rodríguez, MF, Zitko, P, Rojas, R, Eberhard, ME, Ahumada, M, and Espinoza, MA

Abstract

Copyright © 2018 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The International Association for the Study of Pain. Background: Chronic pain is a prevalent and distressing condition caused by an unceasing pain lasting more than 3 months or a pain that persists beyond the normal healing time. There is evidence of inadequate management partly explained by the unawareness regarding the magnitude of the problem. Objectives: To estimate the annual expected costs and consequences of chronic pain caused by musculoskeletal diseases from the health system perspective in Chile. Methods: A Markov cohort model was built to represent chronic pain and estimate expected costs and consequences over 1-year time horizon. Transition probabilities were obtained through expert elicitation. Consequences examined were: years lost to disability (YLD), depression, anxiety, and productivity losses. Direct health care costs were estimated using local sources. Probabilistic sensitivity analysis was performed to characterize second-order uncertainty. Results: The annual expected cost due to musculoskeletal chronic pain was estimated in USD $1387.2 million, equivalent to 0.417% of the national GDP. Lower back pain and osteoarthritis of the knee explained the larger proportion of the total cost, 31.8% and 27.1%, respectively. Depression attributed to chronic pain is another important consequence accounting for USD $94 million (Bayesian credibility interval 95% $49.1-$156.26). Productivity losses were also important cost, although early retirement and presenteeism were not measured. Chronic pain causes 137,037 YLDs. Conclusion: Chronic pain is not only an important cause of disability but also responsible for high social and financial burden in Chile. Public health programs focused on managing chronic pain may decrease burden of disease and possibly reduce costs. ©

Published
2018

33. Identifying Romanness

Author

Balmaceda, C and Clarke, K

Subjects
Virtue in literature, In literature, Rome, Virtus (The Latin word), Historiography
Abstract

This thesis deals with the role of the concept of virtus in Roman historiography of the late Republic and early Empire. I shall argue throughout the study that analysing and tracing this concept in the works of the historians of this period take us to the very heart of the question of their appraisal both of political change and Roman identity. Understanding this moral appraisal does not mean just a better comprehension of their concept of virtus, but a new approach to their concept of history as magistra vitae. In the first chapter, I shall introduce some characteristics of the nature of historical writing and the approaches of ancient and modern historians. I shall be challenging some currents views on the complexity of evaluating ancient history by rhetorical and moral standards. In chapter II, I shall consider the concept of virtus in terms of its etymology and usage; I will then attempt to show the particular connection between virtus and Romanness. I will also develop and explain the concepts of virilis-virtus and humana-virtus and place them in their philosophical context. Chapters III, IV, V and VI will form part of what I have called 'Virtus in History', and in these chapters I shall deal with four historians. The first section is dedicated to Sallust and his analysis of political decline in relation to virtus. I shall attempt to assess Sallust's influential creation of moral language in the writing of history. Then, I will consider the connection of virtus as a means to preserve libertas in Livy's work, especially considering the author's time. Chapter V is concerned with Velleius' history and his view that the principate has re-established virtus in Rome. I shall concentrate on Tiberius for my analysis of virtus and challenge some traditional approaches to this author and his prince. Finally, in chapter VI, I will examine Tacitus' perception of the nature of the political change that Rome has undergone. I will show how the transformations in politics have a deep influence on the very idea of Romanness and how the disturbance of this concept leads to a more profound and internal interpretation of it.

Published
2016

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