Costo-efectividad de la radiografía de tórax en lactantes con sospecha clínica de bronquiolitis viral en Colombia

Vista sencilla de ítem
dc.contributor.authorRodríguez-Martínez, Carlos E.
dc.contributor.authorSossa Briceño, Mónica P
dc.date.accessioned2020-05-14T19:33:59Z
dc.date.available2020-05-14T19:33:59Z
dc.date.issued2011
dc.description.abstractObjetivo. Estimar el costo-efectividad de no realizar radiografía de tórax a ningún lactante con sospecha clínica de bronquiolitis viral versus realizarla en todos estos pacientes de manera rutinaria, que es la práctica más utilizada hoy en Colombia. Métodos. Se realizó un estudio de costo-efectividad en el que se compararon las estrategias consistentes en tomar radiografía a todos y no tomar radiografía de tórax a ningún lactante con sospecha clínica de bronquiolitis viral. El desenlace principal fue la proporción de diagnósticos correctos. El horizonte temporal fue la evolución de la bronquiolitis. La perspectiva fue la del tercer pagador y los costos se obtuvieron de las tarifas vigentes en una clínica en la ciudad de Bogotá. Se realizaron análisis de sensibilidad determinísticos y probabilísticos. Resultados. La estrategia de no realizar radiografía de tórax a ningún paciente fue dominante en relación con realizarla en todos los casos de manera rutinaria, con un costo promedio de US$ 111,0 y una tasa de diagnósticos correctos de 0,8020, comparados con los valores correspondientes de US$ 129,0 y 0,7873 para la estrategia de tomar radiografía rutinaria a todos estos pacientes. La variable más influyente fue el costo hospitalario de la neumonía. En el análisis de sensibilidad probabilístico, la estrategia de no radiografiar a ningún lactante fue dominante en 61,1% de las simulaciones. Conclusiones. Los resultados sugieren que no realizar radiografía de tórax de rutina a lactantes con sospecha clínica de bronquiolitis viral es una estrategia costo-efectiva respecto a la práctica común de realizarla en todos estos casos, dado que arroja una mayor proporción de diagnósticos correctos a un menor costo promedio por paciente. No obstante, harán falta nuevos estudios con muestras más representativas de todos los establecimientos de salud e incluir la estrategia de tomar radiografía de tórax únicamente a pacientes que tengan predictores de anormalidades radiológicas.spa
dc.description.abstractenglishOBJECTIVE: Estimate the cost-effectiveness of not taking chest x-rays of any infant with clinically suspected viral bronchiolitis versus routinely taking them of all such patients, the most common practice today in Colombia. METHODS: A cost-effectiveness study was conducted, comparing strategies of taking chest x-rays of all infants with clinically suspected viral bronchiolitis and not x-raying any of these infants. The principal outcome was the proportion of correct diagnoses. The time horizon was the clinical course of the bronchiolitis. The perspective was that of the third-party payer, and the costs were obtained from the rates in effect in a clinic in Bogotá. Deterministic and probabilistic sensitivity analyses were performed. RESULTS: The strategy of not taking a chest x-ray of any patient prevailed over that of routinely taking one in all cases, with an average cost of US$ 111.00 and a correct diagnosis rate of 0.8020, versus the respective values of US$ 129.00 and 0.7873 for the strategy of routinely x-raying all of these patients. The most influential variable was pneumonia-related hospital costs. In the probabilistic sensitivity analysis, the strategy of not x-raying any infant prevailed in 61.1 percent of the simulations. CONCLUSIONS: The results suggest that not taking routine chest x-rays of infants with clinically suspected viral bronchiolitis is a cost-effective strategy compared with the common practice of taking them in all cases, since the former yields a greater proportion of correct diagnoses at a lower average cost per patient. Nevertheless, new studies will be needed that have more representative samples from all of the health facilities and include the strategy of taking chest x-rays only of patients with predictors of radiologic abnormalities.(AU)eng
dc.format.mimetypeapplication/pdf
dc.identifier.issn1680-5348
dc.identifier.urihttps://hdl.handle.net/20.500.12495/2788
dc.language.isospa
dc.publisherOrganización Panamericana de la Saludspa
dc.publisher.journalRevista Panamericana de Salud Publicaspa
dc.relation.ispartofseriesRevista Panamericana de Salud Publica, 1680-5348, Vol. 29, Nro. 3, 2011, p. 155-161spa
dc.relation.referencesShay DK, Holman RC, Newman RD, Liu LL, Stout JW, Anderson LJ. Bronchiolitis-associated hospitalizations among US children, 1980–1996. JAMA. 1999;282(15):1440–6spa
dc.relation.referencesBoyce TG, Mellen BG, Mitchel EF Jr., Wright PF, Griffin MR. Rates of hospitalization for respiratory syncytial virus infection among children in medicaid. J Pediatr. 2000;137(6): 865–70spa
dc.relation.referencesLeader S, Kohlhase K. Respiratory syncytial virus-coded pediatric hospitalizations, 1997 to 1999. Pediatr Infect Dis J. 2002;21(7):629–32.spa
dc.relation.referencesEverard ML. Bronchiolitis. Origins and optimal management. Drugs. 1995;49(6):885–96.spa
dc.relation.referencesChristakis DA, Cowan CA, Garrison MM, Molteni R, Marcuse E, Zerr DM. Variation in inpatient diagnostic testing and management of bronchiolitis. Pediatrics. 2005;115(4):878–84spa
dc.relation.referencesWalsh-Kelly CM, Kim MK, Hennes HM. Chest radiography in the initial episode of bronchospasm in children: can clinical variables predict pathologic findings? Ann Emerg Med. 1996;28(4):391–5.spa
dc.relation.referencesSchuh S, Lalani A, Allen U, Manson D, Babyn P, Stephens D, et al. Evaluation of the utility of radiography in acute bronchiolitis. J Pediatr. 2007;150(4):429–33spa
dc.relation.referencesFazel R, Krumholz HM, Wang Y, Ross JS, Chen J, Ting HH, et al. Exposure to low-dose ionizing radiation from medical imaging procedures. N Engl J Med. 2009;361(9):849–57.spa
dc.relation.referencesWillis CE, Slovis TL. The ALARA concept in pediatric CR and DR: dose reduction in pediatric radiographic exams—a white paper conference. AJR Am J Roentgenol. 2005;184:373–4.spa
dc.relation.referencesLittle P, Watson L, Morgan S, Williamson I. Antibiotic prescribing and admissions with major suppurative complications of respiratory tract infections: a data linkage study. Br J Gen Pract. 2002;52(476):187–90, 193.spa
dc.relation.referencesDrummond MF, O´Brien B, Stoddart GL, Sculpher MJ, Torrance GW. Methods for the economic evaluation of health care programmes. 2.a ed. New York (NY): Oxford University Press;1997.spa
dc.relation.referencesYong JH, Schuh S, Rashidi R, Vanderby S, Lau R, Laporte A, et al. A cost effectiveness analysis of omitting radiography in diagnosis of acute bronchiolitis. Pediatr Pulmonol. 2009; 44(2):122–7.spa
dc.relation.referencesDrummond MF, Iglesias CP, Cooper NJ. Systematic reviews and economic evaluations conducted for the National Institute for Health and Clinical Excellence in the United Kingdom: a game of two halves? Int J Technol Assess Health Care. 2008;24(2):146–50.spa
dc.relation.referencesMansbach JM, Emond JA, Camargo CA Jr. Bronchiolitis in US emergency departments 1992 to 2000: epidemiology and practice variation. Pediatr Emerg Care. 2005;21(4):242–7.spa
dc.relation.referencesDeeks JJ. Systematic reviews in health care: Systematic reviews of evaluations of diagnostic and screening tests. BMJ. 2001;323:157–62.spa
dc.relation.referencesBanco de la República, Colombia. Series estadísticas. Tasas de cambio. Santa Fe de Bogotá: Banco de la República; 2009. Disponible en: https://www.banrep.gov.co/series-estadisticas/ see_ts_cam.htm. Acceso el 12 de enero de 2011spa
dc.relation.referencesSehabiague G, Iraola I, Estevan M, Hortal M. Neumonía comunitaria: su impacto en la demanda asistencial del Departamento de Emergencia Pediátrica. Arch Pediatr Urug. 2006;77:355–60.spa
dc.relation.referencesCenters for Disease Control and Prevention (CDC). Bronchiolitis-associated outpatient visits and hospitalizations among American Indian and Alaska Native children—United States, 1990–2000. MMWR Morb Mortal Wkly Rep. 2003;52:707–10.spa
dc.relation.referencesAlbernaz EP, Menezes AM, Cesar JA, Victora CG, Barros FC, Halpern R. Fatores de risco associados à hospitalização por bronquiolite aguda no período pós-neonatal. Rev Saude Publica. 2003;37(4):485–93.spa
dc.relation.referencesBonillo Perales A, Díez-Delgado Rubio J, Ortega Montes A, Infante Márquez P, Jiménez Liria MR, Batlles Garrido J, et al. Antecedentes perinatales y hospitalización por bronquiolitis. Comparación con el Impact-RSV Study Group. An Esp Pediatr. 2000;53:527–32.spa
dc.relation.referencesCarroll KN, Gebretsadik T, Griffin MR, Dupont WD, Mitchel EF, Wu P, et al. Maternal asthma and maternal smoking are associated with increased risk of bronchiolitis during infancy. Pediatrics. 2007;119(6):1104–12.spa
dc.relation.referencesDiez DJ, Ridao LM, Ubeda SI, Ballester SA. Incidencia y costes de la hospitalización por bronquiolitis y de las infecciones por virus respiratorio sincitial en la Comunidad Valenciana. Años 2001 y 2002. An Pediatr (Barc). 2006;65:325–30.spa
dc.relation.referencesFarah MM, Padgett LB, McLario DJ, Sullivan KM, Simon HK. First-time wheezing in infants during respiratory syncytial virus season: chest radiograph findings. Pediatr Emerg Care. 2002;18(5):333–6.spa
dc.relation.references. Fjaerli HO, Farstad T, Bratlid D. Hospitalisations for respiratory syncytial virus bronchiolitis in Akershus, Norway, 1993–2000: a population-based retrospective study. BMC Pediatr. 2004;4(1):25.spa
dc.relation.referencesGarcia ML, Calvo RC, Quevedo TS, Martinez M, Sanchez F, Martin F, et al. Radiografía de tórax en la bronquiolitis: ¿es siempre necesaria?. An Pediatr (Barc). 2004;61:219–25.spa
dc.relation.referencesGonzalez GH, Garcia GF, Fernandez AJ, Izquierdo LB, Pino VA, Blanco QA. Estudio clínico epidemiológico de bronquiolitis aguda. An Esp Pediatr. 2000;53:520–6.spa
dc.relation.referencesMahabee-Gittens EM, Bachman DT, Shapiro ED, Dowd MD. Chest radiographs in the pediatric emergency department for children < or = 18 months of age with wheezing. Clin Pediatr (Phila). 1999;38(7):395–9.spa
dc.relation.referencesMansbach JM, Pelletier AJ, Camargo CA Jr. US outpatient office visits for bronchiolitis, 1993–2004. Ambul Pediatr. 2007;7(4):304–7.spa
dc.relation.referencesMargolis P, Gadomski A. The rational clinical examination. Does this infant have pneumonia? JAMA. 1998;279(4):308–13.spa
dc.relation.referencesNielsen HE, Siersma V, Andersen S, GahrnHansen B, Mordhorst CH, NørgaardPedersen B, et al. Respiratory syncytial virus infection—risk factors for hospital admission: a case-control study. Acta Paediatr. 2003; 92(11):1314–21.spa
dc.relation.referencesYorita KL, Holman RC, Steiner CA, Effler PV, Miyamura J, Forbes S, et al. Severe bronchiolitis and respiratory syncytial virus among young children in Hawaii. Pediatr Infect Dis J. 2007;26(12):1081–8.spa
dc.relation.referencesGreenes DS, Harper MB. Low risk of bacteremia in febrile children with recognizable viral syndromes. Pediatr Infect Dis J. 1999; 18(3):258–61.spa
dc.relation.referencesKuppermann N, Bank DE, Walton EA, Senac MO Jr, McCaslin I. Risks for bacteremia and urinary tract infections in young febrile children with bronchiolitis. Arch Pediatr Adolesc Med. 1997;151(12):1207–14.spa
dc.relation.referencesPurcell K, Fergie J. Concurrent serious bacterial infections in 2396 infants and children hospitalized with respiratory syncytial virus lower respiratory tract infections. Arch Pediatr Adolesc Med. 2002;156(4):322–4.spa
dc.relation.referencesKneyber MC, Moons KG, de Groot R, Moll HA. Predictors of a normal chest x-ray in respiratory syncytial virus infection. Pediatr Pulmonol. 2001;31(4):277–83spa
dc.relation.referencesAmerican Academy of Pediatrics Subcommittee on Diagnosis and Management of Bronchiolitis. Diagnosis and management of bronchiolitis. Pediatrics. 2006;118(4):1774–93spa
dc.relation.referencesvan Woensel JB, van Aalderen WM, Kimpen JL. Viral lower respiratory tract infection in infants and young children. BMJ. 2003;327(7405):36–40.spa
dc.relation.urihttps://iris.paho.org/xmlui/handle/123456789/9558
dc.rights.creativecommons2011
dc.rights.localAcceso cerradospa
dc.subjectBronquiolitisspa
dc.subjectNeumoníaspa
dc.subjectRadiografíaspa
dc.titleCosto-efectividad de la radiografía de tórax en lactantes con sospecha clínica de bronquiolitis viral en Colombiaspa
dc.title.translatedCost-effectiveness of chest x-rays in infants with clinically suspected viral bronchiolitis in Colombiaspa
dc.typearticlespa
dc.type.hasversioninfo:eu-repo/semantics/publishedVersion
dc.type.localartículospa

Archivos

Bloque original
Mostrando 1 - 1 de 1
No hay miniatura disponible
Nombre:
Martínez C.E.R., Briceño M.P.S._2011.pdf
Tamaño:
229.22 KB
Formato:
Adobe Portable Document Format
Descripción:
Descargar
Bloque de licencias
Mostrando 1 - 1 de 1
No hay miniatura disponible
Nombre:
license.txt
Tamaño:
1.71 KB
Formato:
Item-specific license agreed upon to submission
Descripción:
Descargar

Colecciones

Artículos