[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.

Epidemiology and Control of Hypertension and Diabetes in Costa Rica

Costa Rica is one of the countries that make up Central America, neighboring Nicaragua and Panama. Costa Rica shares with its neighbors the social and economic problems characteristic of developing countries; however, one difference is that Costa Rica can derive a great part of its budget and expense to health and education, as it had abolished the army in 1948. It is for this reason that Costa Rica shares diseases characteristic of their region like the Dengue, yet at the same time have a true explosion in the fields of hypertension (HTA), diabetes (DM), and cardiovascular disease. The health system of Costa Rica has nearly universal coverage, reaching 98% of the population with primary and secondary diverse levels of attention that give appropriate and satisfactory treatment to all hypertensive and diabetic patients. The HTA and the DM are true public health problems; however, before 2004, there weren't appropriate data on their prevalence and management. Small studies showed an increase in the prevalence of HTA from 9 to 24%, though no data on the prevalence of DM were available. In 2004, the Multinational Survey of Diabetes and Hypertension and Other Factors of Risk carried out in San José, Costa Rica, determined a prevalence of HTA of 25% and of DM of 8%. Likewise, the methodology of the survey allowed an evaluation of the quality of the attention of the HTA (Tracer of Arterial Hypertension) and, consequently, appropriate control of hypertensive patients in Costa Rica; through it, it was determined that greater effort was required for earlier detection and resource optimization to better handle hypertensive and diabetic patients and thus reduce cardiovascular morbidity-mortality and chronic renal disease.

Chronic kidney disease in Costa Rica

Costa Rica is one of the Central American countries, located between Nicaragua to the north and Panama to the south. Like other Latin American countries, Costa Rica deals with social and economic problems associated with poverty, except for one significant difference-Costa Rica has not had an army since 1948, and so the people and government can spend more money on education and health. For this reason, Costa Rica is very different from other Latin American countries. We do not need weapons, and we have had a democratic tradition for 100 years. Despite our economic and social limitations, Costa Ricans have universal access to a health system that covers 98% of the inhabitants. Renal replacement therapy (RRT) is accessible to all who need it. In the last 5 years, Costa Rica has doubled the number of patients on hemodialysis, and has the highest number of kidney transplants per million population (pmp) in Latin America, with 20.63 transplants pmp in 2000, 27.25 transplants pmp in 2001, and 24.81 transplants pmp in 2002. However, the prevalence of all forms of RRT in Costa Rica is currently 193 pmp. This suggests that end-stage renal disease is underdiagnosed in Costa Rica as it is in many other Latin American countries. Greater research efforts are needed to determine the true extent of renal disease in Costa Rica and to optimize the use of health-sector resources to provide a better and more robust program of RRT for patients with end-stage renal disease.