[Evidence synthesis for COVID-19 interventions: update reports from Argentina's National Commission for Health Technology AssessmentSíntese de evidências para intervenções em COVID-19: relatórios de atualização da Comissão Nacional de Avaliação de Tecnologias em Saúde da Argentina]

This report presents the work done on the design, publication, and impact of updates on evidence-based COVID-19 interventions, in order to support decision-making with updated evidence syntheses based on living systematic reviews of therapeutic interventions. To this end, a specific working group was created within the National Commission for Health Technology Assessment (CONETEC) of the Ministry of Health of Argentina, in collaboration with the Pan American Health Organization (PAHO). A methodology was designed to develop and publish assessment documents aimed at supporting decision-making. These update reports were based on the exploration of three areas: health effects, feasibility of implementation, and evidence-based recommendations. A color-coded system was used to present the conclusions according to the balance between their positive and negative effects in different clinical scenarios, in order to improve their interpretation and implementation. In 2021, 16 evidence synthesis reports were published (13 original reports and three full updates). These were downloaded many times from the CONETEC website and the Regional Database of Health Technology Assessment Reports of the Americas (BRISA), highlighting the need for robust, up-to-date, reliable evidence summaries adapted for implementation in the country's health system. Other challenges include constant updating of information, appropriate dissemination, and sustained rigorous preparation of the reports.

[Comparative economic evaluation of renal replacement therapies in Argentina, Costa Rica, and UruguayAvaliação econômica comparativa de terapias de substituição renal na Argentina, na Costa Rica e no Uruguai]

Objetivo.

Evaluar las diferencias de costos y prevalencia de las terapias de remplazo renal (TRR) como el trasplante, la diálisis peritoneal y la hemodiálisis en Argentina, Costa Rica y Uruguay, mediante estrategias costo-efectivas de difusión.

Métodos.

Costos y prevalencia de principales financiadores y prestadores por país, y análisis de costo-efectividad mediante modelo de Markov a 5 años, evaluando estrategias de asignación de recursos expresadas por razón incremental de costo-efectividad en costo por año de vida ajustado por calidad.

Resultados.

Se observa dispersión entre los países en el acceso y los valores prestacionales de TRR, que afectan su prevalencia y el punto de equilibrio monetario. Desde el punto de vista de los costos, es más eficiente promover la realización de trasplantes y de diálisis peritoneal, y desalentar la indicación de hemodiálisis, aunque la disponibilidad de cada TRR por país requirió evaluaciones particulares.

Conclusiones.

Promover la realización de trasplantes ahorra costos, aunque los puntos de equilibrio variables requieren determinar diferentes umbrales de costo-efectividad por país. En Argentina y Uruguay, la administración de TRR mejoraría su eficiencia si se aumentan la cantidad de pacientes en diálisis peritoneal y las tasas de donación para trasplantes. En Costa Rica (donde hay tasas elevadas de trasplantes y margen presupuestario), la incorporación de técnicas dialíticas se ajusta por demanda e incidencia de pacientes con ERCT.

Abstract P304: Motivia®, a Cardiovascular Disease Prevention Program, Decreases Hospitalization Length in Patients With High Risk for Developing Cardiovascular Event. Retrospective Analysis From 2010-2015

Objective: Cardiovascular events (CE) due to atherosclerosis are preventable but the identification of adults at high risk (HR) is required. Burden of atherosclerosis is not considered for categorization of HR patients (HRPts), even though only fractions of CE are predicted by Framingham risk factors (FRS). Our objective was to investigate the effectiveness of a program (Motivia®) designed for detection and monitoring of HRPts in a health insurance program.

Design and Method: Motivia® is a program where patients are categorized based on the cardiovascular risk score using our previously reported algorithm, FRS combined with the Total Plaque Area (TPA) determination, and treatment is based on the post-test score. In this retrospective analysis (2010-2015) only HRPtes (based on TPA+FRS) were included. After categorization, Pts were referred to Motivia® high risk medical attention physician (MHP) or primary attention physician (PP) to perform evaluation and monitoring. Each Pt was seen at least each 3 months to achieve control of risk factors. The outcome measured were, time to first hospitalization for acute ischemic syndrome, coronary revascularization procedure, stroke, diabetes complication, and heart failure. We used models of survival (Log Rank test and Cox proportional hazards model) for the analysis. Outcome of these 2 groups were compared. Pts signed informed consent and the study was approved by the Blossom DMO Argentina ethics committee.

Results: The analysis showed a significant reduction in the overall rate of CVE from 1.37% to 1.03% in both groups while in > 64 years old the reduction was greater (from 4.51% to 2.45%). However, after age, sex and pretreatment risk correction, we did not observe difference in the likelihood to have a cardiovascular event. Nevertheless, interms of hospitality length, patients under MHP had shorter stay than PP (2.3 vs. 3.5 days/bed).

Conclusions: Motivia® program, based on intensive treatment using TPA determination may benefit patients and health insurance by decreasing hospitality length.

Clinical features of the hospitalized patients with 2009 pandemic influenza A (H1N1) in Santa Fe, Argentina

Background  During 2009 occurred the emergence and global spread of a novel influenza A (H1N1) virus. We describe the clinical and epidemiologic features of hospitalized patients who survived and patients who died because of pandemic 2009 influenza A (H1N1) infection reported in Santa Fe, Argentina, from May to July 2009.

Methods  Using medical charts, we collected data on 242 patients who were hospitalized with confirmed laboratory results (defined as positive by specific PCR for pandemic 2009 influenza A H1N1).

Results  During the study period, there were 242 cases of hospitalization or death. Of the 242, 46% were admitted to an intensive care unit (ICU) and 33·5% died. The mean age was 27·8 years for surviving and 39·6 for those who died. Twenty‐eight percent of hospitalizations involved persons under the age of 15 years; 33% of the patients were between the age of 15 and 44 years; and only 3·3% were 65 years of age or older. Sixty‐seven percent had an underlying medical conditions, including diabetes, obesity, heart and lung diseases, and pregnancy. Of the 242 patients, 68% had findings consistent with pneumonia. Treatment with oseltamivir was administered to 227 (93·8%) patients from which 38 received oseltamivir within 48 hours after the onset of symptoms.

Conclusions  The pandemic strain caused severe illness, including pneumonia and acute respiratory distress syndrome, and resulted in ICU admissions in 46% of patients and death in 33·5%. The mean age of hospitalized infected cases was lower than is common with seasonal influenza. Underlying medical conditions were common in the 67% the evaluated patients. Patients who died had a higher prevalence of comorbidities (86·4%) than those who survived (57%), suggesting that the presence of chronic illness may increase the likelihood of death. However, the severe illness was also identified among young, healthy persons.