Costo-efectividad de un programa prototipo de gestión de la enfermedad para la insuficiencia cardiaca en el ámbito colombiano

Beltrán Martínez, Diego Alfonso

Costo-efectividad de un programa prototipo de gestión de la enfermedad para la insuficiencia cardiaca en el ámbito colombiano

dc.contributor.advisor	Porras Ramirez, Alexandra
dc.contributor.author	Beltrán Martínez, Diego Alfonso
dc.contributor.orcid	Beltrán Martínez, Diego Alfonso [0000-0002-0357-8874]
dc.date.accessioned	2024-08-16T16:25:52Z
dc.date.available	2024-08-16T16:25:52Z
dc.date.issued	2024-06
dc.description.abstract	Introducción: La insuficiencia cardíaca (IC) es una patología que afecta a millones de personas, generando complicaciones clínicas, hospitalizaciones frecuentes y una reducción de la calidad de vida. Los programas de gestión de la enfermedad (PGE) se proponen como una solución para mejorar los resultados clínicos y optimizar los recursos. Métodos: Este estudio realizó un análisis de costo-efectividad retrospectivo comparando un programa prototipo de gestión de IC con la atención clínica habitual en Colombia. Los costos de las intervenciones se obtuvieron de fuentes nacionales y se modelaron los costos asociados a desenlaces clínicos. Se utilizaron datos de estudios observacionales y revisiones de literatura sobre la efectividad de los PGE. Resultados: El costo promedio del programa prototipo fue de 2.565,60 USD, comparado con 1.545,13 USD para la atención base. Los costos de atención a desenlaces oscilan desde 1.124,98 USD hasta 6.220,60 USD. Los PGE demostraron una reducción promedio del 39\% en el riesgo de uso de servicios de urgencias. El costo final ajustado por persona fue de 3.346,04 USD para el programa prototipo y 4.197,76 USD para la atención base. La razón costo-efectividad (RCE) indicó que cada punto porcentual de disminución del riesgo de desenlace costaba 21,83 USD. Discusión: Este estudio demuestra que un programa integral de atención a la insuficiencia cardíaca crónica en el sistema de salud colombiano, con un enfoque en acciones diagnósticas y terapéuticas, es costo-efectivo y mejora los desenlaces clínicos. A diferencia de otros estudios que se basan en la educación del paciente y el seguimiento por enfermería, este enfoque multidisciplinario aborda de manera más completa las necesidades de los pacientes. Aunque presenta limitaciones como la falta de datos de gasto real, el estudio ofrece una perspectiva clara sobre el impacto financiero y clínico en entornos con recursos limitados, siendo aplicable a países en desarrollo
dc.description.abstractenglish	Introduction: Heart failure (HF) is a pathology that affects millions of people, generating clinical complications, frequent hospitalizations and reduced quality of life. Disease management programs (DMPs) are proposed as a solution to improve clinical outcomes and optimize resources. Methods: The present study performed a retrospective cost-effectiveness analysis comparing a prototype HF management program with usual clinical care in Colombia. Intervention costs were obtained from national sources and costs associated with clinical outcomes were modeled. Data from observational studies and literature reviews on the effectiveness of DMPs were used. Results: The average cost of the prototype program was \$2,565.60, compared with \$1,545.13 for baseline care. Outcome care costs ranged from \$1,124.98 to \$6,220.60. The DMPs demonstrated an average 39\% reduction in the risk of ED use. The final adjusted cost per person was \$3,346.04 for the prototype program and \$4,197.76 for baseline care. The cost-effectiveness ratio (CER) indicated that each percentage point decrease in risk of outcome cost \$21.83. Discussion: This study shows that a comprehensive program of care for chronic heart failure in the Colombian health system, with a focus on diagnostic and therapeutic actions, is cost-effective and improves clinical outcomes. Unlike other studies that are based on patient education and nursing follow-up, this multidisciplinary approach addresses patients' needs in a more comprehensive manner. Although it has limitations such as the lack of actual expenditure data, the study provides a clear perspective on the financial and clinical impact in resource-limited settings that are applicable to developing countries.
dc.description.degreelevel	Maestría	spa
dc.description.degreename	Magíster en Epidemiología	spa
dc.format.mimetype	application/pdf
dc.identifier.instname	instname:Universidad El Bosque	spa
dc.identifier.reponame	reponame:Repositorio Institucional Universidad El Bosque	spa
dc.identifier.repourl	repourl:https://repositorio.unbosque.edu.co
dc.identifier.uri	https://hdl.handle.net/20.500.12495/12886
dc.language.iso	es
dc.publisher.faculty	Facultad de Medicina	spa
dc.publisher.grantor	Universidad El Bosque	spa
dc.publisher.program	Maestría en Epidemiología	spa
dc.relation.references	Agbor VN, Ntusi NAB, and Noubiap JJ. An overview of heart failure in low- and middle-income countries. en. Cardiovascular Diagnosis and Therapy 2020 Apr; 10:24451–251. DOI: 10.21037/cdt.2019.08.03. Available from: https://cdt.amegroups.org/article/view/28316 [Accessed on: 2024 Jul 14]
dc.relation.references	Akosah KO, Schaper AM, Haus LM, Mathiason MA, Barnhart SI, and McHugh VL. Improving Outcomes in Heart Failure in the Community. en. Chest 2005 Jun; 127:2042–8. DOI: 10.1378/chest.127.6.2042. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0012369215498071 [Accessed on: 2024 Jul 23]
dc.relation.references	Alcocer Gamba MA, Borrayo Sánchez G, Gutiérrez Fajardo P, Tepayotl Aponte A, Ruiz Ruiz VE, Castán Flores D, Herrera Garza EH, Araiza Garaygordobil D, Gúızar Sánchez CA, Á lvarez Á lvarez RJ, Á lvarez San Gabriel A, Hernández Rendón E, González J, Mariona Montero VA, Coutiño HE, De León Larios G, Pacheco Bouthillier AD, Pombo Bartelt E, Aceves Garc´ıa M, Fernández Muñoz MDJ, Olalde Román MJ, Chávez Leal S, Olmos Dominguez L, Mendoza Zavala GH, Mendez Machado GF, Rascón Sabido R, Ivey Miranda JB, Aguilera Mora LF, Galván Oseguera H, Rayo Chávez J, Chávez Mendoza A, Cigarroa López JÁ , and Magaña Serrano JA. Primera declaración Mexicana en materia de Insuficiencia Cardiaca. es. Cardiovascular and Metabolic Science 2021; 32:8–85. DOI: 10.35366/98870. Available from: https://www.medigraphic.com/cgi-bin/new/resumen.cgi? IDARTICULO=98870 [Accessed on: 2023 Dec 9]
dc.relation.references	AlHabeeb W. Heart failure disease management program: A review. Medicine 2022 Aug; 101:e29805. DOI: 10 . 1097 / MD . 0000000000029805. Available from: https : / / www . ncbi . nlm . nih . gov / pmc / articles/PMC9351896/ [Accessed on: 2024 Feb 24]
dc.relation.references	Banco de la República de Colombia. Tasa Representativa del Mercado (TRM - Peso por dólar). Available from:https://www.banrep.gov.co/es/estadisticas/trm [Accessed on: 2024 Jul 14]
dc.relation.references	Bhatnagar R, Fonarow GC, Heidenreich PA, and Ziaeian B. Expenditure on Heart Failure in the United States. JACC. Heart failure 2022 Aug; 10:571–80. DOI: 10.1016/j.jchf.2022.05.006. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9680004/ [Accessed on: 2024 Feb 24]
dc.relation.references	Bocchi EA, Da Cruz FDD, BrandA˜ o SM, Issa V, Ayub-Ferreira SM, Brunner La Rocca HP, and Wijk SSv. Cost- Effectiveness Benefits of a Disease Management Program:The REMADHE Trial Results. en. Journal of Cardiac Failure 2018 Oct; 24:627–37. DOI: 10 . 1016 / j . cardfail . 2018 . 04 . 008. Available from: https ://linkinghub.elsevier.com/retrieve/pii/S1071916418301684 [Accessed on: 2024 Jul 19]
dc.relation.references	Bragazzi NL, Zhong W, Shu J, Abu Much A, Lotan D, Grupper A, Younis A, and Dai H. Burden of heart failure and underlying causes in 195 countries and territories from 1990 to 2017. European Journal of Preventive Cardiology 2021 Dec; 28:1682–90. DOI: 10.1093/eurjpc/zwaa147. Available from: https://doi.org/10.1093/eurjpc/zwaa147 [Accessed on: 2024 Jul 15]
dc.relation.references	Callender T, Woodward M, Roth G, Farzadfar F, Lemarie JC, Gicquel S, Atherton J, Rahimzadeh S, Ghaziani M, Shaikh M, Bennett D, Patel A, Lam CSP, Sliwa K, Barretto A, Siswanto BB, Diaz A, Herpin D, Krum H, Eliasz T, Forbes A, Kiszely A, Khosla R, Petrinic T, Praveen D, Shrivastava R, Xin D, MacMahon S, McMurray J, and Rahimi K. Heart Failure Care in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis. PLOS Medicine 2014 Aug; 11:e1001699. DOI: 10.1371/journal.pmed.1001699. Available from: https:/ / journals . plos . org / plosmedicine / article ? id = 10 . 1371 / journal. pmed. 1001699 [Accessed on: 2024 Jul 15]
dc.relation.references	Carbajosa V. Tiempo de estancia hospitalaria en pacientes ingresados por insuficiencia cardiaca aguda. Factores asociados. es. Pages: 1. PhD thesis. Universidad de Valladolid, 2019. Available from: https:// dialnet. unirioja.es/servlet/tesis?codigo=296040 [Accessed on: 2024 Jul 14]
dc.relation.references	Chan DC, Heidenreich PA, Weinstein MC, and Fonarow GC. Heart failure disease management programs: A cost- effectiveness analysis. en. American Heart Journal 2008 Feb; 155:332–8. DOI: 10.1016/j.ahj.2007.10.001. Available from: https : / / linkinghub . elsevier . com / retrieve / pii / S000287030700779X [Accessed on: 2024 Jul 18]
dc.relation.references	Cook C, Cole G, Asaria P, Jabbour R, and Francis DP. The annual global economic burden of heart failure. eng. International Journal of Cardiology 2014 Feb; 171:368–76. DOI: 10.1016/j.ijcard.2013.12.028
dc.relation.references	Dang W, Yi A, Jhamnani S, and Wang SY. Cost-Effectiveness of Multidisciplinary Management Program and Exercise Training Program in Heart Failure. en. The American Journal of Cardiology 2017 Oct; 120:1338–43. DOI: 10.1016/j.amjcard.2017.06.071. Available from: https://linkinghub.elsevier.com/ retrieve/pii/S0002914917311645 [Accessed on: 2024 Jul 19]
dc.relation.references	Del Sindaco D, Pulignano G, Minardi G, Apostoli A, Guerrieri L, Rotoloni M, Petri G, Fabrizi L, Caroselli A, Venusti R, Chiantera A, Giulivi A, Giovannini E, and Leggio F. Two-year outcome of a prospective, controlled study of a disease management programme for elderly patients with heart failure: en. Journal of Cardiovascular Medicine 2007 May; 8:324–9. DOI: 10.2459/JCM.0b013e32801164cb. Available from: http://journals.lww.com/ 01244665-200705000-00004 [Accessed on: 2024 Jul 23]
dc.relation.references	Egelseer-Bruendl T, Jahn B, Arvandi M, Puntscher S, Santamaria J, Brunelli L, Weissenegger K, Pfeifer B, Neururer S, Rissbacher C, Huber A, Fetz B, Kleinheinz C, Modre-Osprian R, Kreiner K, Siebert U, and Poelzl G. Cost-effectiveness of a multidimensional post-discharge disease management program for heart failure patients—economic evaluation along a one-year observation period. en. Clinical Research in Cardiology 2024 Feb. DOI: 10.1007/s00392- 024- 02395- 5. Available from: https://doi.org/10.1007/s00392- 024- 02395- 5 [Accessed on: 2024 Jul 18]
dc.relation.references	Fonseca AF, Lahoz R, Proudfoot C, Corda S, Loefroth E, Jackson J, Cotton S, and Studer R. Burden and Quality of Life Among Female and Male Patients with Heart Failure in Europe: A Real-World Cross-Sectional Study. Patient preference and adherence 2021 Jul; 15:1693–706. DOI: 10 . 2147 / PPA. S312200. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8331086/ [Accessed on: 2024 Feb 24]
dc.relation.references	Hebert K, Quevedo HC, Gogichaishvili I, Nozadze N, Sagirashvili E, Trahan P, Kipshidze N, and Arcement LM. Feasibility of a Heart Failure Disease Management Program in Eastern Europe: Tbilisi, Georgia. en. Circulation: Heart Failure 2011 Nov; 4:763–9. DOI: 10 . 1161 / CIRCHEARTFAILURE. 111 . 962431. Available from: https://www.ahajournals.org/doi/10.1161/CIRCHEARTFAILURE.111.962431 [Accessed on: 2024 Jul 23]
dc.relation.references	Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, and Yancy CW. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. en. Circulation 2022 May; 145. DOI: 10.1161/ CIR.0000000000001063. Available from: https://www.ahajournals.org/doi/10.1161/CIR. 0000000000001063 [Accessed on: 2023 Dec 9]
dc.relation.references	Hershberger RE, Ni H, Nauman DJ, Burgess D, Toy W, Wise K, Dutton D, Crispell K, Vossler M, and Everett J. Prospective evaluation of an outpatient heart failure management program. en. Journal of Cardiac Failure 2001 Mar; 7:64–74. DOI: 10.1054/jcaf.2001.21677. Available from: https://linkinghub.elsevier.com/ retrieve/pii/S1071916401797138 [Accessed on: 2024 Jul 23]
dc.relation.references	Kebede B, Dessie B, Getachew M, Molla Y, Bahiru B, and Amha H. Clinical Characteristics, Management, and Length of Hospital Stay Between Patients with New-Onset and Acute Decompensated Chronic Heart Failure: A Prospective Cohort Study in Ethiopia. English. Research Reports in Clinical Cardiology 2021 Nov; 12. Publisher: Dove Press:57-66. DOI: 10 .2147 / RRCC . S337047. Available from: https : / / www . dovepress . com / clinical - characteristics-management-and-length-of-hospital-stay-betwee-peer-reviewed- fulltext-article-RRCC [Accessed on: 2024 Jul 14]
dc.relation.references	Luk A, Wang VN, Almazroa L, Foroutan F, Huebener N, Hillyer AG, Billia F, Ross H, and Overgaard CB. Management of Acute Decompensated Heart Failure in the Cardiac Intensive Care Unit: The Importance of Co-management With a Heart Failure Specialist. English. CJC Open 2020 Jul; 2. Publisher: Elsevier:229–35. DOI: 10.1016/j.cjco. 2020 . 02 . 010. Available from: https:// www.cjcopen.ca/article/S2589- 790X(20 ) 30024 - X/fulltext [Accessed on: 2024 Jul 14]
dc.relation.references	McAlister FA, Lawson FM, Teo KK, and Armstrong PW. A systematic review of randomized trials of disease management programs in heart failure. en. The American Journal of Medicine 2001 Apr; 110:378–84. DOI: 10 . 1016 / S0002 - 9343(00 ) 00743 - 9. Available from: https:// linkinghub. elsevier. com/ retrieve/pii/S0002934300007439 [Accessed on: 2024 Jul 23]
dc.relation.references	McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Bo¨hm M, Burri H, Butler J, Cˇ elutkiene˙ J, Chioncel O, Cleland JG, Coats AJ, Crespo-Leiro MG, Farmakis D, Gilard M, Heyman S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CS, Lyon AR, McMurray JJ, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GM, Ruschitzka F, and Skibelund AK. Gúıa ESC 2021 sobre el diagnóstico y tratamiento de la insuficiencia cardiaca aguda y crónica. en. Revista Española de Cardiolog´ıa 2022 Jun; 75:523.e1–523.e114. DOI: 10.1016/j.recesp.2021.11.027. Available from: https://linkinghub.elsevier.com/ retrieve/pii/S0300893221005236 [Accessed on: 2023 Dec 9]
dc.relation.references	Ministerio de Salud y Protección Social. Anexo técnico No. 1 del Decreto 780 de 2016. 2016
dc.relation.references	Ministerio de Salud y Protección Social. Decreto 2423 de 1996: Por el cual se determina la nomenclatura y clasificación de los procedimientos médicos, quirúrgicos y hospitalarios del Manual Tarifario y se dictan otras disposiciones. 1996
dc.relation.references	Ministerio de Salud y Protección Social. Decreto 780 de 2016: Por medio del cual se expide el Decreto Único Reglamentario del Sector Salud y Protección Social. 2016
dc.relation.references	Ministerio de Salud y Protección Social. Gúıa de Práctica Cl´ınica para la prevención, diagnóstico, tratamiento y rehabilitación de la falla cardiaca en población mayor de 18 años, clasificación B, C y D. 2016
dc.relation.references	O’Meara E, McDonald M, Chan M, Ducharme A, Ezekowitz JA, Giannetti N, Grzeslo A, Heckman GA, Howlett JG, Koshman SL, Lepage S, Mielniczuk LM, Moe GW, Swiggum E, Toma M, Virani SA, Zieroth S, De S, Matteau S, Parent MC, Asgar AW, Cohen G, Fine N, Davis M, Verma S, Cherney D, Abrams H, Al-Hesayen A, Cohen-Solal A, D’Astous M, Delgado DH, Desplantie O, Estrella-Holder E, Green L, Haddad H, Harkness K, Hernandez AF, Kouz S, LeBlanc MH, Lee D, Masoudi FA, McKelvie RS, Rajda M, Ross HJ, and Sussex B. CCS/CHFS Heart Failure Guidelines: Clinical Trial Update on Functional Mitral Regurgitation, SGLT2 Inhibitors, ARNI in HFpEF, and Tafamidis in Amyloidosis. en. Canadian Journal of Cardiology 2020 Feb; 36:159–69. DOI: 10.1016/j. cjca . 2019 . 11 . 036. Available from: https : / / linkinghub . elsevier . com / retrieve / pii / S0828282X19315144 [Accessed on: 2023 Dec 9]
dc.relation.references	Oyanguren J, Latorre Garc´ıa PM, Torcal Laguna J, Lekuona Goya I, Rubio Mart´ın S, Maull Lafuente E, and Grandes G. Effectiveness and Factors Determining the Success of Management Programs for Patients With Heart Failure: A Systematic Review and Meta-analysis. en. Revista Española de Cardiolog´ıa (English Edition) 2016 Oct; 69:900–14. DOI: 10 . 1016 / j. rec. 2016 . 05 . 012. Available from: https:// linkinghub. elsevier. com/ retrieve/pii/S1885585716301542 [Accessed on: 2024 Jul 23]
dc.relation.references	Piña IL, Allen LA, and Desai NR. Managing the economic challenges in the treatment of heart failure. BMC Cardiovascular Disorders 2021 Dec; 21:612. DOI: 10 . 1186 / s12872 - 021 - 02408 - 5. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8710027/ [Accessed on: 2024 Feb 24]
dc.relation.references	Prasad D, Kabir Z, Dash A, and Das B. Cardiovascular risk factors in developing countries: A review of clinico- epidemiological evidence. en. Global Heart 2010 Dec; 5:115. DOI: 10 . 1016 / j. cvdpc. 2010 . 09 . 001. Available from: https://globalheartjournal.com/article/10.1016/j.cvdpc.2010.09.001/ [Accessed on: 2024 Jul 21]
dc.relation.references	Roccaforte R, Demers C, Baldassarre F, K. Teo K, and Yusuf S. Effectiveness of comprehensive disease management programmes in improving clinical outcomes in heart failure patients. A meta-analysis. en. European Journal of Heart Failure 2005 Dec; 7:1133–44. DOI: 10.1016/j.ejheart.2005.08.005. Available from: https://onlinelibrary.wiley.com/doi/10.1016/j.ejheart.2005.08.005 [Accessed on: 2024 Jul 23]
dc.relation.references	Safavi KC, Dharmarajan K, Kim N, Strait KM, Li SX, Chen SI, Lagu T, and Krumholz HM. Variation Exists in Rates of Admission to Intensive Care Units for Heart Failure Patients Across Hospitals in the United States. Circulation 2013; 127:923–9. DOI: 10. 1161/ CIRCULATIONAHA. 112. 001088. eprint: https:// www. ahajournals. org/ doi/ pdf/ 10. 1161/ CIRCULATIONAHA. 112. 001088. Available from: https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.112.001088
dc.relation.references	Savarese G and Lund LH. Global Public Health Burden of Heart Failure. Cardiac Failure Review 2017 Apr; 3:7–11. DOI: 10.15420/cfr.2016:25:2. Available from: https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC5494150/ [Accessed on: 2024 Feb 24]
dc.relation.references	Savarese G, Becher PM, Lund LH, Seferovic P, Rosano GMC, and Coats AJS. Global burden of heart failure: a comprehensive and updated review of epidemiology. eng. Cardiovascular Research 2023 Jan; 118:3272–87. DOI: 10.1093/cvr/cvac013
dc.relation.references	Siddique A, Otaibi FM, and Khan SF. Heart Failure Management in Developing Countries. en. Handbook of Medical and Health Sciences in Developing Countries. Ed. by Al-Worafi YM. Cham: Springer International Publishing, 2023:1–28. DOI: 10.1007/978-3-030-74786-2_6-1. Available from: https://link.springer.com/10. 1007/978-3-030-74786-2_6-1 [Accessed on: 2024 Jul 21]
dc.relation.references	SISPRO. Consulta Pública de Precios de Medicamentos en la Cadena de Comercialización - Circular 2 de 2012. Available from: https://web.sispro.gov.co/WebPublico/Consultas/ConsultarCNPMCadenaComercializacio 028_2_2.aspx [Accessed on: 2024 Mar 12]
dc.relation.references	Smith B, Hughes-Cromwick PF, Forkner E, and Galbreath AD. Cost-effectiveness of telephonic disease management in heart failure. eng. The American Journal of Managed Care 2008 Feb; 14:106–15
dc.relation.references	SOCIEDAD ARGENTINA DE CARDIOLOGIA. Consenso de Insuficiencia Cardıaca. Revista Argentina de Cardiologıa. 91
dc.relation.references	Takeda A, Martin N, Taylor RS, and Taylor SJ. Disease management interventions for heart failure. The Cochrane Database of Systematic Reviews 2019 Jan; 2019:CD002752. DOI: 10.1002/14651858.CD002752.pub4. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6492456/ [Accessed on: 2024 Feb 24]
dc.relation.references	Turner DA, Paul S, Stone MA, Juarez-Garcia A, Squire I, and Khunti K. Cost-effectiveness of a disease management programme for secondary prevention of coronary heart disease and heart failure in primary care. en. Heart 2008 Dec; 94:1601–6. DOI: 10.1136/hrt.2007.125708. Available from: https://heart.bmj.com/lookup/ doi/10.1136/hrt.2007.125708 [Accessed on: 2024 Jul 18]
dc.relation.references	Urbich M, Globe G, Pantiri K, Heisen M, Bennison C, Wirtz HS, and Di Tanna GL. A Systematic Review of Medical Costs Associated with Heart Failure in the USA (2014–2020). Pharmacoeconomics 2020; 38:1219–36. DOI: 10.1007/s40273- 020- 00952- 0. Available from: https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC7546989/ [Accessed on: 2024 Feb 24]
dc.relation.references	Watson RDS, Gibbs CR, and Lip GYH. Clinical features and complications. BMJ : British Medical Journal 2000 Jan; 320:236–9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1117436/ [Accessed on: 2024 Feb 24]
dc.relation.references	Yu DS, Thompson DR, and Lee DT. Disease management programmes for older people with heart failure: crucial characteristics which improve post-discharge outcomes. en. European Heart Journal 2006 Mar; 27:596–612. DOI: 10.1093/eurheartj/ehi656. Available from: http://academic.oup.com/eurheartj/article/ 27/5/596/539781/Disease-management-programmes-for-older-people [Accessed on: 2024 Jul 23]
dc.rights	Attribution-NonCommercial-NoDerivatives 4.0 International	en
dc.rights.accessrights	info:eu-repo/semantics/openAccess
dc.rights.accessrights	https://purl.org/coar/access_right/c_abf2
dc.rights.local	Acceso abierto	spa
dc.rights.uri	http://creativecommons.org/licenses/by-nc-nd/4.0/
dc.subject	Insuficiencia cardíaca
dc.subject	Gestión de la enfermedad
dc.subject	Análisis coste-beneficio
dc.subject	Colombia
dc.subject.keywords	Heart Failure
dc.subject.keywords	Disease Management
dc.subject.keywords	Cost-Effectiveness Analysis
dc.subject.keywords	Colombia
dc.subject.nlm	WA 105
dc.title	Costo-efectividad de un programa prototipo de gestión de la enfermedad para la insuficiencia cardiaca en el ámbito colombiano
dc.title.translated	Cost-effectiveness of a prototype disease management program for heart failure in the Colombian setting
dc.type.coar	https://purl.org/coar/resource_type/c_bdcc
dc.type.coarversion	https://purl.org/coar/version/c_ab4af688f83e57aa
dc.type.driver	info:eu-repo/semantics/masterThesis
dc.type.hasversion	info:eu-repo/semantics/acceptedVersion
dc.type.local	Tesis/Trabajo de grado - Monografía - Maestría	spa