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Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

2007, Number 3

Rev Invest Clin 2007; 59 (3)

Cost-efectiveness of the treatment of acute and chronic rhinosinusitis at the IMSS

Muñoz-Carlin ML, Nevárez-Sida A, García-Contreras F, Mendieta-Sevilla SR, Constantino-Casas P

Language: Spanish
References: 18
Page: 197-205
PDF size: 85.06 Kb.


ABSTRACT

Introduction. Rhinosinusitis is one of the more common diseases encountered in outpatient visits to health care. The objective of this study was to determine the most cost-effective antibiotic treatment for patients with acute (RSA) and chronic rhinosinusitis (RSC) that is available at the Mexican Institute of Social Security (IMSS). Methods. Cost-effectiveness analysis of RSA and RSC treatment from an institutional perspective. Effectiveness outcome was defined as the percentage of cure. A decision tree with a Bayesian approach included the following therapeutic alternatives: ciprofloxacin, gatifloxacin, trimetoprim/sulfametoxazol (TMP/SMX), amoxicilin/clavulanic acid (AAC) and clindamicin. Results. Treatment for RSA with AAC showed a mean cost per cured patient of $ 878 pesos. The remaining antibiotics had a higher cost per unit of success, and therefore the results showed that AAC was the best alternative considering this criterion. The therapy that showed a larger percentage of cured patients in RSC was clindamicin; however, the therapeutic alternative with the lowest cost per successful unit was the one based on ciprofloxacin, which dominates gatifloxacin and AAC. Conclusions. The most cost-effective alternative in the antibiotic treatment of patients with RSA was ACC while for RSC it was ciprofloxacin; sensitivity analysis showed the strength of the base study results.


REFERENCES

  1. Anzai Y, Weymuller EA, Yueh B, Maronian N, Jarvik JG. The impact of sinus computed tomography on treatment decisions for Chronic Rhinosinusitis. Arch Otolaryngol Head Neck Surg 2004; 130: 423-8.

  2. Adult chronic rhinorinosinusitis: Definitions, diagnosis, epidemiology and pathophysiology. Otolaryngology, Head and Neck Surgery 2003; 129(Suppl.): S1-S32.

  3. Cauwenberge PV, Watelet JB. Epidemiology of chronic rhinosinusitis. Thorax 2000; 55: S20-S21.

  4. Ragab SM, Lund VJ, Scadding G. Evaluation of the Medical and Surgical treatment of chronic rhinosinusitis: a prospective, randomised, controlled trial. Laryngoscope 2004; 114: 923-30.

  5. López LJ. Epidemiología de alergia pediátrica en el Hospital General de México OD. Alergia, asma e inmunología pediátricas 1999; 8: 17-20.

  6. Boletín Epidemiológico del Instituto Mexicano del Seguro Social, 1996.

  7. Murphy M, Fishman P, Short S, Sullivan S, Yueh B, Weymuller E. Health care utilization and cost among adults with chronic rhinosinusitis enrolled in a health maintenance organization. Otolaryngol Head Neck Surg 2002; 127: 367-76.

  8. Fajardo-Dolci G, Chavolla-Magaña R, La Madrid-Bautista E. Rinosinusitis crónica y cirugía endoscópica funcional de senos paranasales. Revista Médica del Hospital General 1998; 61(1): 37-40.

  9. Benninger MS, Anon J, Mabry RL. The medical management of rhinosinusitis. Otolaryngol Head Neck Surg 1997; 117(3 part 2): S41-S49.

  10. The International Conference on Sinus Disease: Quantification for staging sinusitis. July 17-21, 1993.

  11. Anand VK. Epidemiology and Economic Impact of Rhinosinusitis. Ann Otol Rhinol Laryngol 2004; 113: 3-5.

  12. Bhattacharyya N. The Economic Burden and Symptom Manifestations of Chronic Rhinosinusisits. American Journal of Rhinol 2003; 17: 27-32.

  13. Stankiewicz JA, Chow JM. Cost Analysis in the diagnosis of chronic rhinosinusitis. Am J Rhinol 2003; 17: 139-42.

  14. http://transparencia.imss.gob.mx/html/imss%20va%20a% 20comprar%20imss%20compro.htm (Accesada enero 2006).

  15. Balk EM, Zucker DR, Engels EA, Wong JB, Williams JW, Lau J. Strategies for Diagnosis and treating Suspected Acute Bacterial Sinusitis. A cost-effectiveness Analysis. J Gen Intern Med 2001; 16: 701-11.

  16. Snow V, Mottur-Pilson C, Hickner JM. Principles of Appropriate Antibiotic Use for Acute Sinusitis in Adults. Ann Intern Med 2001; 134: 495-7.

  17. Diagnosis and Treatment of Acute Bacterial Rhinosinusitis Agency for Health Care Policy and Research (AHCPR) U.S. Department of health and human services, Public Health Service. Pub, Nº 99-E015, March 1999.

  18. American Academy of Paediatrics. Clinical Practice Guideline: Management of Sinusitis. Memorias del Congreso Red de Sociedades Científicas-RSCMV, V Encuentro, 13, 14 y 15 de julio.




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