Economic burden of type-2 diabetes in Peru: a cost-of-illness study valuing cost differences associated with the level of glycemic control

OBJECTIVES

Type 2 diabetes mellitus (T2DM) represents an increasing public health problem in Peru. This study aims to estimate the national economic burden of this disease for the public funder, the social security, and private sector insurers.

METHODS

Direct healthcare costs were estimated for a cohort of 45-to-75-year-old adults diagnosed with T2DM in 2019, over a 20-year period. Disease progression was modeled using PROSIT Models and literature, including acute and chronic microvascular and macrovascular complications. Three scenarios of glycemic control were considered: current levels of 35.8% of the population controlled (HbA1c < 7%) (S1); 100% controlled (S2) and; 100% uncontrolled (S3). The impact of diabetes prevalence on overall costs was evaluated in sensitivity analysis.

RESULTS

Total national economic burden was estimated at $15,405,448,731; an annual average per patient of $2,158. Total costs would decrease to $12,853,113,596 (-16.6%) in S2 and increase to $16,828,713,495 (+9.2%) in S3. Treating patients with complications and risk factors could cost 6.5 times more, being stroke the complication with the highest impact. Up to a 67.6% increase in total costs was found when increasing T2DM prevalence.

CONCLUSIONS

T2DM places a heavy burden on the Peruvian healthcare budget that will be even greater if poor glycemic control is maintained.

Cost-effectiveness analysis of dupilumab versus omalizumab, mepolizumab, and benralizumab added to the standard of care in adults with severe asthma in Colombia

BACKGROUND

Cost-effectiveness studies evaluate health technologies and help choose treatments. The current study compared dupilumab to omalizumab, mepolizumab, and benralizumab in Colombian adults with severe uncontrolled type 2 asthma.

METHODS

Over a 5-year period, a Markov model was utilized to assess the costs of biological treatments and management of exacerbations, comparing various doses of exacerbations, comparing various doses of dupilumab, omalizumab, mepolizumab, and benralizumab as add-on treatments. It included a 5% annual discount rate per local HTA, and set willingness-to-pay at three times GDP per capita per quality-adjusted life year (QALY) in Colombia.

RESULTS

Dupilumab (200 mg) exhibited greater QALYs and reduced overall costs compared to mepolizumab (100 mg), benralizumab (30 mg), and omalizumab (450 mg and 600 mg), with the incremental cost-effectiveness ratio (ICER) per QALYgained being -$5.429, -$6.269, -$196.567 and -$991.007, respectively. Dupilumab had greater QALYs and costs versus omalizumab 300 mg (ICERof $200.653 per QALY, above the willingness-to-pay threshold of 3 × GDP per capita). Sensitivity analyses were consistent with base case results.

CONCLUSIONS

Dupilumab 200 mg was strongly dominant versus omalizumab 450 mg and 600 mg, mepolizumab 100 mg, and benralizumab 30 mg; however, cost-effectiveness was not demonstrated versus omalizumab 300 mg. These results could assist healthcare professionals in choosing an appropriate biologic for treating severe type 2 asthma.

[Baseline characterization of a cohort of colombian patients with chronic rhinosinusitis with nasal polyps]

OBJECTIVE

To present the baseline clinical and demographic characteristics of CRSwNP patients over the age of 18 enrolled in a Patient Support Program (PSP) prior to biologic treatment.

METHODS

Descriptive, cross-sectional study performed in a Colombian CRSwNP asthma PSP sponsored by Sanofi from Aug-2021 to Jul-2022. Data was collected from CRSwNP patients, prior to the start of Dupilumab treatment, who consented to the use of their data. The following information was reported: Age, reporting city, treating medical specialty, comorbidities, and persistence of treatment.

RESULTS

339 patients were included, 171 (50,4%) were women and 168 (49,6%) were men. The mean age at Dupilumab treatment initiation was 52,4 years. 62,8% began treatment during adulthood (26-59y), while 34.1% started at elderly (+60y) and 3.1% were young adults (18-25y). Most cases (29,7%) were included in Bogotá, followed by Antioquia (19%), Valle del Cauca (7,3%) and the remaining 44% nationwide. Comorbidities were present in 67,1% of the patients, with diagnosis of allergic rhinitis, atopic dermatitis, asthma, and other non-type 2 inflammatory diseases. Nasal surgical history was present in 89,6% of the patients, most of them with one to three previous surgeries. Continuous treatment was observed in 70,3% of patients for 6 to 12 months, in 21,3% for more than 12 months and in 8,4% for less than six months. The most frequently treating medical specialty was otorhinolaryngology (79,6%), followed by allergology (16%) and other medical professionals (4,4%).

CONCLUSIONS

There is concordance with the literature on a higher presentation of the disease in women than in men. There is a large proportion of patients with nasal surgical history and type 2 inflammatory comorbidities by the moment of biologic treatment initiation. The care and identification of CRSwNP colombian patients is mainly provided by otorhinolaryngologists, followed by allergologists.

Temporal Evaluation of the Surface Area of Treated Skin Ulcers Caused by Cutaneous Leishmaniasis and Relation with Optical Parameters in an Animal Model: A Proof of Concept

Cutaneous leishmaniasis (CL) is a neglected disease caused by an intracellular parasite of the Leishmania genus. CL lacks tools that allow its understanding and treatment follow-up. This article presents the use of metrical and optical tools for the analysis of the temporal evolution of treated skin ulcers caused by CL in an animal model. Leishmania braziliensis and L. panamensis were experimentally inoculated in golden hamsters, which were treated with experimental and commercial drugs. The temporal evolution was monitored by means of ulcers' surface areas, as well as absorption and scattering optical parameters. Ulcers' surface areas were obtained via photogrammetry, which is a procedure that allowed for 3D modeling of the ulcer using specialized software. Optical parameters were obtained from a spectroscopy study, representing the cutaneous tissue's biological components. A one-way ANOVA analysis was conducted to identify relationships between both the ulcers' areas and optical parameters. As a result, ulcers' surface areas were found to be related to the following optical parameters: epidermis thickness, collagen, keratinocytes, volume-fraction of blood, and oxygen saturation. This study is a proof of concept that shows that optical parameters could be associated with metrical ones, giving a more reliable concept during the assessment of a skin ulcer's healing.

MON-528 Hypoparathyroidism in a Medium-Income Country Shares Similar Clinical Profile to High Income Countries

Introduction Hypoparathyroidism is a rare disease. In low and medium-income countries there is limited data of clinical characteristics and patterns of clinical practice of patients with hypoparathyroidism. Methods Observational cross-sectional study in a tertiary care university hospital in Colombia. The clinical charts of adult patients with diagnosis of hypoparathyroidism were included. Inclusion criteria were a diagnosis of hypoparathyroidism with a PTH less than 20 pg/mL associated with hypocalcemia. Major results 108 patients fulfilled inclusion criteria. 91.7% (n=99) were women and 8.3% (n=9) were men. Mean age was 51.6 years (SD 15.5). 99.1% of patients were Hispanic and 0.9% were African American. Comorbidities were HTN in 42.6%, CAD in 3.7%, DM2 in 6.5%, dyslipidemia in 21.3%, PAD in 5.6%, Afib in 1.9%, stroke in 2.8%, valve heart disease in 0.9%, hypothyroidism in 88.9%, and thyroid cancer in 51.9% The etiology of hypoparathyroidism was postsurgical (93.5%), followed by idiopathic hypoparathyroidism (4.6%), post-radiation (0.9%), and unknown causes in (0.9%). Mental illness was found in 16.7% of cases, osteo-muscular compromise in 27.8%, carpo-pedal spam was referred by 15.7% of patients, and paresthesia in 35.2%. Seizures were reported by 9.3% of patients and basal ganglia calcification was found in 5.6% of cases. Trousseau sign was reported in 13% of cases and Chvostek in 6.5%. Initial calcium was 7.8 mg/dL (SD 1.8), the mean lowest calcium was 7.2 mg/dL SD 1.5, the last known urinary calcium was 237.4 mg/day (SD 48.08). However, it was only measured in 20 patients. The mean PTH level was 6.9 pg/ml (SD 0.54). Nephrocalcinosis was found in 2.8% of cases and nephrolithiasis in 3.7%. Patients required a mean of 0.7 emergency room consults, however, the range was wide from 0 to 21 consults. Median elemental calcium dose at last control was 960 mg/day (p25-p75 480-1440), median calcitriol dose was 0.5 ug/day (p25-p75 0.5-1.0). However, 13.8% of patients required more than 2000 mg/day of elemental calcium. PTH analogs were used in 1.9% of cases (n=2). Biochemical control of the disease was achieved in 50% of patients. Interpretation of the results and conclusions Our data suggest that patients with hypoparathyroidism from a medium income country share a similar clinical profile with patients from high-income countries. However, the biochemical control of the disease is low. Post-surgical hypoparathyroidism is the most common cause of hypoparathyroidism (93.6%) and its frequency is higher than other countries (75%), this suggests limitations in surgical performance or decreased detection of other rare etiologies. This study present for first time systematic data in Colombia and is one of the first studies in medium income countries.