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Everardo Álvarez-Hernández,
Ingris Peláez-Ballestas,
Annelies Boonen,
Janitzia Vázquez-Mellado,
Adolfo Hernández-Garduño,
Fernando Carlos Rivera,
Leobardo Teran-Estrada,
Lucio Ventura-Ríos, César Ramos-Remus,
Cassandra Skinner-Taylor,
Maria Victoria Goycochea-Robles,
Ana Guislaine Bernard-Medina,
Rubén Burgos-Vargas
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ABSTRACT: The cost of certain diseases may lead to catastrophic expenses and impoverishment of households without full financial support by the state and other organizations.
To determine the socioeconomic impact of the rheumatoid arthritis (RA) cost in the context of catastrophic expenses and impoverishment.
This is a cohort-nested cross-sectional multicenter study on the cost of RA in Mexican households with partial, full, or private health care coverage. Catastrophic expenses referred to health expenses totaling >30% of the total household income. Impoverishment defined those households that could not afford the Mexican basic food basket (BFB).
We included 262 patients with a mean monthly household income (US dollars) of $376 (0–18,890.63). In all, 50.8%, 35.5%, and 13.7% of the patients had partial, full, or private health care coverage, respectively. RA annual cost was $ 5534.8 per patient (65% direct cost, 35% indirect). RA cost caused catastrophic expenses in 46.9% of households, which in the logistic regression analysis were significantly associated with the type of health care coverage (OR 2.7, 95%CI 1.6–4.7) and disease duration (OR 1.024, 95%CI 1.002–1.046). Impoverishment occurred in 66.8% of households and was associated with catastrophic expenses (OR 3.6, 95%CI 1.04–14.1), high health assessment questionnaire scores (OR 4.84 95%CI 1.01–23.3), and low socioeconomic level (OR 4.66, 95%CI 1.37–15.87).
The cost of RA in Mexican households, particularly those lacking full health coverage leads to catastrophic expenses and impoverishment. These findings could be the same in countries with fragmented health care systems.
Reumatología clinica. 06/2012; 8(4):168-73.
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ABSTRACT: This study aims to measure the frequency of medication error (ME) in rheumatology outpatients of the Social Security System (SS) in Mexico and to measure the costs by comparing the days lost at work as direct consequence of the medication error against the theoretical cost of no error in the process. A prospective 6-month survey was conducted in a reference hospital in Guadalajara, Mexico. ME was defined as any discrepancy between the prescription and medicine taken by patients. The origin of the discrepancy was identified and registered. We present 381 patients: 292 with rheumatoid arthritis, 57 with ankylosing spondylitis, and 32 with systemic lupus erythematosus. One hundred twenty seven (33%) had medication errors. Ninety eight (77%) got worse in their condition due to ME. Forty percent of MEs were due to patients' decisions, 41% to a lack of availability of medication which should have been provided by SS, and 18% to a non-justified medical decision by primary-care providers. Patients lost in average 3 working days each month because of the ME. The cost of ME is high. In the case analyzed, opportune access to treatment represents a lower cost for the system, but it represents a significant loss of days at work each month. ME is a signal of a system failure. Inter-professional teamwork is needed to perfect the system.
Clinical Rheumatology 09/2011; 30(11):1421-4. · 2.00 Impact Factor
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Joaquín Mould-Quevedo,
Ingris Peláez-Ballestas,
Janitzia Vázquez-Mellado,
Leobardo Terán-Estrada,
Jorge Esquivel-Valerio,
Lucio Ventura-Ríos,
Francisco J Aceves-Ávila,
Ana G Bernard-Medina,
María V Goycochea-Robles,
Adolfo Hernández-Garduño, [......],
Grupo Reumaimpact,
Clara Shumski,
Mario Garza-Elizondo, César Ramos-Remus,
Jesús Espinoza-Villalpando,
Everardo Álvarez-Hernández,
Diana Flores-Alvarado,
Jaquelin Rodríguez-Amado,
Julio Casasola-Vargas,
Cassandra Skinner-Taylor
01/2008; 144.
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Reumatología Clínica 07/2006; 2(4):161-3.
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ABSTRACT: The aim of this study was to assess the sensitivity, specificity, positive and negative predictive values of the translation of a screening questionnaire for systemic lupus erythematosus (SLE) in Spanish-speaking populations. The questionnaire was applied to secondary-care outpatients in a rheumatology clinic. Sensitivity, specificity, predictive positive and negative values of the instrument, and the best cut-off point to discriminate between SLE patients and other conditions, were determined. Fifty-two subjects answered the questionnaire (21 patients with SLE, 15 with a possible diagnosis of SLE who eventually proved not to have the disease, and 16 healthy volunteers), which can be answered in 2 min. The best cut-off point was three affirmative answers (95% specificity, 84% sensitivity, 80% predictive positive and 96% predictive negative values). The questionnaire can discriminate between SLE cases and other conditions. Sensitivity and specificity are close to those of the original English version. Applying this instrument can help to acquire informed estimates of SLE prevalence.
Clinical Rheumatology 01/2004; 22(6):400-4. · 2.00 Impact Factor
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ABSTRACT: the aim of this study was to assess the sensitivity, specificity, positive and negative predictive values of the translation of a screening questionnaire for systemic lupus erythematosus (SLE) in Spanish-speaking populations. The questionnaire was applied to secondary-care outpatients in a rheumatology clinic. Sensitivity, specificity, predictive positive and negative values of the instrument, and the best cut-off point to discriminate between SLE patients and other conditions, were determined. Fifty-two subjects answered the questionnaire (21 patients with SLE, 15 with a possible diagnosis of SLE who eventually proved not to have the disease, and 16 healthy volunteers), which can be answered in 2min. The best cut-off point was three affirmative answers (95% specificity, 84% sensitivity, 80% predictive positive and 96% predictive negative values). The questionnaire can discriminate between SLE cases and other conditions. Sensitivity and specificity are close to those of the original English version. Applying this instrument can help to acquire informed estimates of SLE prevalence.
Clinical Rheumatology 11/2003; 22(6):400-404. · 2.00 Impact Factor
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ABSTRACT: High glucocorticoid serum levels and prednisone (PDN) therapy have been associated with depression, posttraumatic stress disorder, and some types of cognitive dysfunction in humans.
The aim of this study was to assess whether chronic (90 days) PDN administration produces disturbance in learning and memory retention associated with neuronal degeneration and cerebral glial changes.
Male Wistar rats were studied. Controls received 0.1 ml distilled water vehicle orally. The PDN group was treated orally with 5 mg/kg/d PDN, which is equivalent to moderate doses used in clinical settings. Learning and memory retention were assessed with the Morris water maze. The index of degenerated neurons as well as the number and cytoplasmic transformation of astrocytes and microglia cells were evaluated in the prefrontal cortex and the CA1 hippocampus.
PDN-treated rats showed a significant delay of 20% in learning and memory retention as compared with controls. In addition, in the PDN group, the neuronal degeneration index was two times higher in the prefrontal cortex, and approximately 10 times higher in the CA1 hippocampus, than in control animals. The number and cytoplasmic transformation of astrocytes were also significantly higher in the PDN group than in control animals. In the PDN-treated group, isolectin-B4-labeled microglia cells were higher in the prefrontal cortex but not in the hippocampus.
These results suggest that chronic exposure to PDN produces learning and memory impairment, reduces neural viability, and increases glial reactivity in cerebral regions with these cognitive functions.
Journal of Investigative Medicine 12/2002; 50(6):458-64. · 1.96 Impact Factor
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ABSTRACT: This longitudinal prospective study was designed to assess the effects of the angiotensin converting enzyme inhibitor (ACEI) ramipril on ventricular mass, left ventricle (LV) diastolic function and blood pressure in patients with mild to moderate essential hypertension and hyperinsulinemia. LV diastolic dysfunction is the first target organ alteration occurring in hypertensive patients, while ventricular hypertrophy is the most relevant predictive factor for cardiovascular morbility and mortality in systemic hypertension. Because several studies have demonstrated that there is no direct correlation between blood pressure values and the severity of LV hypertrophy or diastolic dysfunction, it is assumed that other factors are involved in the genesis of these functional alterations. Moreover, the hypertensive effect of insulin is caused by sympathetic stimulation, sodium and water renal retention and protooncogene stimulation leading to myocardial and vascular fibrosis and hypertrophy. We studied 24 hypertensive patients with hyperinsulinemia. All patients underwent an overall and cardiologic clinical evaluation, and electrocardiographic and ecocardiographic studies were performed at baseline and 6 months after being treated with 2.5 to 5 mg/day ramipril. Ramipril treatment significantly reduced systolic (12 mmHg) and diastolic (12 mmHg) pressure levels, basal insulin serum levels (23.62 pmol/dL vs 10.42 pmol/dL), and left ventricle mass index values (143.8 g/m2 vs 118.2 g/m2). Among the variables assessing LV diastolic function, only the transmitral flow E/A wave ratio showed significant differences in women. Ramipril was well tolerated and no significant adverse events were reported.
Archivos de cardiología de México 73(1):24-30.
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Joaquín Mould-Quevedo,
Ingris Peláez-Ballestas,
Janitzia Vázquez-Mellado,
Leobardo Terán-Estrada,
Jorge Esquivel-Valerio,
Lucio Ventura-Ríos,
Francisco J Aceves-Avila,
Ana G Bernard-Medina,
María V Goycochea-Robles,
Adolfo Hernández-Garduño,
Rubén Burgos-Vargas,
Clara Shumski,
Mario Garza-Elizondo, César Ramos-Remus,
Jesús Espinoza-Villalpando,
Everardo Alvarez-Hernández,
Diana Flores-Alvarado,
Jaquelin Rodríguez-Amado,
Julio Casasola-Vargas,
Cassandra Skinner-Taylor
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ABSTRACT: To estimate the social costs of rheumatoid arthritis (RA), ankylosing spondylitis (AS), and gout from the patient's perspective.
We carried out a cross-sectional analysis of the cost and resource utilization of 690 RA, AS, and gout patients from 10 medical centers and private facilities in five cities of Mexico. The information was obtained from the baseline of a dynamic cohort. We estimated out-of-pocket expenses, institutional direct costs, and direct medical costs.
The mean (SD) annual out-of-pocket expense (USD) was $610.0 ($302.2) for RA, $578.6 ($220.5) for AS, and $245.3 ($124.0) for gout. Figures correspond to 15%, 9.6%, and 2.5% of the family income. They also represented 26.1%, 25.3%, and 24.4% of the total annual cost per RA, AS, and gout patients, respectively. The expected direct institutional patient/year costs were 1,724.2 for RA, $1,710.8 for AS, and $760.7 for gout. The total patient annual costs were $2,334.3 for RA, $2,289.4 for AS, and $1,006.1 for gout. Most out-of-pocket expenses were used to purchase drugs, pay for laboratory tests, imaging studies, and alternative therapies.
From the patient's perspective, the cost of RA, AS, and gout represents 25% of direct medical costs. The cost of RA is higher than that for AS and gout.
Gaceta medica de Mexico 144(3):225-31. · 0.22 Impact Factor
