Características clínicas, recursos utilizados y costos de la psoriasis en pacientes de una IPS de referencia del Valle de Aburrá, 2014

Volumen 24 Numero 4 Octubre-Noviembre 2016

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Artículo de investigación

Rev Asoc Colomb Dermatol. 2016; 24: 4 (Octubre-Diciembre), 253-263

Características clínicas, recursos utilizados y costos de la psoriasis en pacientes de una IPS de referencia del Valle de Aburrá, 2014

Autor(es):

Uriel Palacios-Barahona

apalacios@ces.edu.co

Médico investigador, Universidad CES, Centro de Evaluación de Tecnologías en Salud, Medellín, Colombia.

Sol Beatriz Jiménez

Médica dermatóloga; coordinadora, Programa de Dermatología, Universidad CES, Medellín, Colombia.

John Jairo Orozco

Médico investigador, Universidad CES, Centro de Evaluación de Tecnologías en Salud, Medellín, Colombia.

Resumen:

Introducción. La caracterización de los pacientes con psoriasis es importante porque permite conocer las formas clínicas más frecuentes y la gravedad de la enfermedad, y además, determinar su impacto en los costos para el sector salud. Objetivo. Determinar las características clínicas, los recursos utilizados y los costos de los pacientes con psoriasis atendidos en un centro de referencia del área metropolitana del Valle de Aburrá en el 2014. Metodología. Se llevó a cabo un estudio descriptivo de pacientes con psoriasis que asistieron al Centro Dermatológico CES, Sabaneta, entre el 1° de enero y el 30 de noviembre de 2014. Los recursos utilizados, como citas, tratamientos, exámenes paraclínicos y procedimientos, se consultaron en las historias clínicas. Para calcular las tarifas de consultas y procedimientos, se usaron las establecidas en el manual tarifario ISS 2001 más el 30 % y en el Seguro Obligatorio de Accidentes de Tránsito (SOAT) 2014; en medicamentos, se utilizó el sistema de información de precios de medicamentos (SISMED). Resultados. Se incluyeron 95 pacientes, cuya media de edad fue de 47,2 años (desviación estándar, DE=15,5 años); el 47 eran mujeres. El promedio del índice DLQI (Dermatology Life Quality Index) fue de 8,2 (DE=7,2) y el del PASI (Psoriasis Area and Severity Index) fue de 5,7 (DE=4,7). Los costos mínimo y máximo, según el manual ISS + 30 %, fueron de COP$ 21.710 y COP$ 13’803.505 para la psoriasis leve, y de COP$ 402.610 y COP$ 36’643.757 para la moderada a grave; cuando se utilizó terapia biológica, fueron de COP$ 15’608.272 y COP$ 36’643.757. Según el manual SOAT, los costos oscilaron entre COP$ 536.987 y COP$ 39’312.273 en casos de psoriasis entre moderada a grave y, entre COP$ 17’286.259 y COP$ 39’312.272, cuando se utilizó terapia biológica. Conclusión. La psoriasis es una enfermedad que acarrea costos elevados de tratamiento en relación con su gravedad y la eficacia del tratamiento.

Palabras clave:

psoriasis, costos y análisis de costos, terapia biológica, terapia combinada, estudio observacional, costos de la atención en salud, costo de enfermedad.

Summary:

Introduction: The characterization of patients with psoriasis is important because it allows an approach to the most frequent clinical forms and the severity of the illness; besides, it enables the possibility of determining the impact of said illness in terms of cost towards the health system. Objective: To determine the clinical characteristics, supplies needed and cost of patients with psoriasis that received medical attention in a referral center of the metropolitan area in Valle de Aburrá. Methodology: A descriptive study in patients with psoriasis that attended the Centro Dermatológico CES, Sabaneta, between the January 1st and November 30th, 2014, was carried out. The clinical history was used to consult the utilization of appointments, treatments, lab tests, and procedures; the ISS 2001 rates manual plus 30 % and the SOAT 2014 rates manual were used. To estimate the price of drugs a drug information system (SISMED) was used. Results: Ninety five patients were analyzed. The average age was 47.2 years (SD=15.5); 47 of the patients analyzed were women. The average DLQI was 8.2 (SD=7.2), and the PASI was 5.7 (SD=4.7). The manual cost ISS + 30% for mild psoriasis presented a minimum value of COP$ 21,710 and a maximum value of COP$ 13,803,505; moderate to severe psoriasis was between COP$ 402,610 and COP$ 36,643,757; for patients using biological therapy was between COP$ 15,608,272 and COP$ 36,643,757. According to the SOAT manual, the cost of moderate to severe psoriasis was between COP$ 536,987 and COP$ 39,312,273 and for those who used biological therapy was between COP$ 17,286,259 and COP$ 39,312,272. Conclusion: Psoriasis is an illness that represents an elevated cost in treatment in relation to the severity and efficiency of the treatment received.

Key words:

Psoriasis, costs and cost analysis, biological therapy, combined modality therapy, observational study, health care costs, cost of illness.

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Pasquini M, Wang Z, Horowitz MM, Gale RP. 2013 report from the Center for International Blood and Marrow Transplant Research (CIBMTR): Current uses and outcomes of hematopoietic cell transplants for blood and bone marrow disorders. Clin Transpl. 2013;187-97.
Enfermedad injerto contra huésped en el trasplante hematopoyético. Piel. 2004;19:431-41. Fecha de consulta: 16 de febrero de 2015. Disponible en: http://www.carmenbrufau.es/images/EICH.pdf.
Hymes SR, Alousi AM, Cowen EW. Graft-versus-host disease: part I. Pathogenesis and clinical manifestations of graft-versus-host disease. J Am Acad Dermatol. 2012;66:515.e1-18.
Peñas PF, Zaman S. Many faces of graft-versus-host disease. Australas J Dermatol. 2010;51:1-10.
Billingham RE. The biology of graft-versus-host reactions. Harvey Lect. 1966-1967;62:21-78.
Jagasia M, Giglia J, Chinratanalab W, Dixon S, Chen H, Frangoul H, et al. Incidence and outcome of chronic graft-versus-host disease using National Institutes of Health consensus criteria. Biol Blood Marrow Transplant. 2007;13:1207-15. Fecha de consulta: 16 de febrero de 2015. http://www.bbmt.org/article/S1083-8791(07)00338-2/pdf.
Flowers MED, Inamoto Y, Carpenter PA, Lee SJ, Kiem H-P, Petersdorf EW, et al. Comparative analysis of risk factors for acute graft-versus-host disease and for chronic graft-versus-host disease according to National Institutes of Health consensus criteria. Blood. 2011;117:3214-9. Fecha de consulta: 16 de febrero de 2015. Disponible en: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3062319/.
Vigorito AC, Campregher P V, Storer BE, Carpenter PA, Moravec CK, Kiem H-P, et al. Evaluation of NIH consensus criteria for classification of late acute and chronic GVHD. Blood. 2009;114:702-8. Fecha de consulta: 16 de febrero de 2015. Disponible en: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2713471/.
Filipovich AH, Weisdorf D, Pavletic S, Socie G, Wingard JR, Lee SJ, et al. National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. Diagnosis and staging working group report. Biol Blood Marrow Transplant. 2005;11:945-55. Fecha de consulta: 19 de septiembre de 2014. Disponible en: http://www.bbmt.org/article/S1083-8791(05)00631-2/pdf.
Velásquez M. Enfermedad injerto contra huésped. Rev Asoc Colomb Alerg Asma Inmunol. 2001;10:110-9.
Jacobsohn DA, Vogelsang GB. Acute graft versus host disease. Orphanet J Rare Dis. 2007;2-35. Fecha de consulta: 7 de enero de 2015. Disponible en: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2018687/.
Szydlo R, Goldman JM, Klein JP, Gale RP, Ash RC, Bach FH, et al. Results of allogeneic bone marrow transplants for leukemia using donors other than HLA-identical siblings. J Clin Oncol. 1997;15:1767-77. Fecha de consulta: 16 de febrero de 2015. Disponible en: http://web.b.ebscohost.com.bdigital.ces.edu.co:2048/ehost/pdfviewer/pdfv....
Beatty PG, Clift RA, Mickelson EM, Nisperos BB, Flournoy N, Martin PJ, et al. Marrow transplantation from related donors other than HLA-identical siblings. N Eng J Med. 1985:313:765-71.
Murashige N, Kami M, Mori SI, Katayama Y, Kobayashi K, Onishi Y, et al. Characterization of acute graft-versus-host disease following reduced-intensity stem-cell transplantation from an HLA-identical related donor. Am J Hematol. 2008;83:630-4.
Flomenberg N, Baxter-Lowe LA, Confer D, Fernández-Vina M, Filipovich A, Horowitz M, et al. Impact of HLA class I and class II high-resolution matching on outcomes of unrelated donor bone marrow transplantation: HLA-C mismatching is associated with a strong adverse effect on transplantation outcome. Blood. 2004;104:1923-30. Fecha de consulta: 16 de febrero de 2015. Disponible en: http://www.bloodjournal.org/content/104/7/1923.long?sso-checked=true.
Petersdorf EW, Kollman C, Hurley CK, Dupont B, Nademanee A, Begovich AB, et al. Effect of HLA class II gene disparity on clinical outcome in unrelated donor hematopoietic cell transplantation for chronic myeloid leukemia: The US National Marrow Donor Program Experience. Blood. 2001;98:2922-9. Fecha de consulta: 20 de febrero de 2015. Disponible en: http://www.bloodjournal.org/content/98/10/2922.long.
Przepiorka D, Weisdorf D, Martin P, Klingemann HG, Beatty P, Hows J, et al. 1994 Consensus Conference on Acute GVHD Grading. Bone Marrow Transplant. 1995;15:825-8.
Shulman HM, Cardona DM, Greenson JK, Hingorani S, Horn T, Huber E, et al. NIH Consensus development project on criteria for clinical trials in chronic graft-versus-host disease: II. The 2014 Pathology Working Group Report. Biol Blood Marrow Transplant. 2015;21:589-603. Fecha de consulta: 22 de julio de 2015. Disponible en: http://www-ncbi-nlm-nih-gov.bdigital.ces.edu.co:2048/pmc/articles/PMC435....
Imanguli M, Alevizos I, Brown R, Pavletic S, Atkinson J. Oral graft-versus-host disease. Oral Dis. 2008;14:396-412. Fecha de consulta: 3 de marzo de 2015. Disponible en: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2565862/.
Vargas-Díez E, García-Díez A, Marín A, Fernández-Herrera J. Life-threatening graft-vs-host disease. Clin Dermatol. 2005;23:285-300.
Levy-Polack MP, Sebelli P, Polack NL. Incidence of oral complications and application of a preventive protocol in children with acute leukemia. Spec Care Dentist.1998;18:189-93.
Reyes AD, Martín TA, Leache EB, Suárez C. Manifestaciones orales en la enfermedad injerto contra huésped (EICH). Presentación de un caso. Med Oral. 2003;8: 361-5. Fecha de consulta: 5 de febrero de 2016. Disponible en: http://www.medicinaoral.com/pubmed/medoralv8_i5_p361.pdf.
Mays JW, Fassil H, Edwards DA, Pavletic SZ, Bassim CW. Oral chronic graft-versus-host disease: Current pathogenesis, therapy, and research. Oral Dis. 2013;19:327-46. Fecha de consulta: 5 de febrero de 2016. Disponible en: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3561479/?tool=pmcentrez.
Mays SR, Kunishige JH, Truong E, Kontoyiannis DP, Hymes SR. Approach to the morbilliform eruption in the hematopoietic transplant patient. Semin Cutan Med Surg. 2007;26:155-62.
Lützow-Holm C, Rønnevig JR. Cutaneous drug reactions. Tidsskr Nor Laegeforen. 2005;125:2483-7.
Byun HJ, Yang JI, Kim BK, Cho KH. Clinical differentiation of acute cutaneous graft-versus-host disease from drug hypersensitivity reactions. J Am Acad Dermatol. 2011;65:726-32.
Horn TD, Redd J V, Karp JE, Beschorner WE, Burke PJ, Hood AF. Cutaneous eruptions of lymphocyte recovery. Arch Dermatol. 1989;125:1512-7.
Martín PJ, Rizzo JD, Wingard JR, Ballen K, Curtin PT, Cutler C, et al. First- and second-line systemic treatment of acute graft-versus-host disease: Recommendations of the American Society of Blood and Marrow Transplantation. Biol Blood Marrow Transplant. 2012;18:1150-63. Fecha de consulta: 10 de marzo de 2015. Disponible en: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3404151/.
Hymes SR, Alousi AM, Cowen EW. Graft-versus-host disease: part II. Management of cutaneous graft-versus-host disease. J Am Acad Dermatol. 2012;66:535.e1-16.
Ratanatharathorn V, Nash RA, Przepiorka D, Devine SM, Klein JL, Weisdorf D, et al. Phase III study comparing methotrexate and tacrolimus (prograf, FK506) with methotrexate and cyclosporine for graft-versus-host disease prophylaxis after HLA-identical sibling bone marrow transplantation. Blood. 1998;92:2303-14. Fecha de consulta: 10 de marzo de 2015. Disponible en: http://www.bloodjournal.org/content/92/7/2303.long?sso-checked=true.
Klassen J. The role of photopheresis in the treatment of graft-versus-host disease. Curr Oncol. 2010;17:55-8.
Calore E, Marson P, Pillon M, Tumino M, Tison T, Mainardi C, et al. Treatment of acute GVHD in childhood with extracorporeal photochemotherapy/phofotopheresis: The Padova experience. Biol Blood Marrow Transplant. 2015;21:1963-72.
Greinix HT, Worel N, Just U, Knobler R. Extracorporeal photopheresis in acute and chronic graft-versus-host disease. Transfus Apher Sci. 2014;50:349-57. Fecha de consulta: 25 de julio de 2015. Disponible en: https://www-clinicalkey-com.bdigital.ces.edu.co:2443/service/content/pdf....
Gómez-Almaguer D, Ruiz-Argüelles GJ, del Carmen Tarín-Arzaga L, González-Llano O, Gutiérrez-Aguirre H, Cantú-Rodríguez O, et al. Alemtuzumab for the treatment of steroid-refractory acute graft-versus-host disease. Biol Blood Marrow Transplant. 2008;14:10-5.
Teshima T, Maeda Y, Ozaki K. Regulatory T cells and IL-17-producing cells in graft-versus-host disease. Immunotherapy. 2011;3:833-52.
Pidala J, Anasetti C. Glucocorticoid-refractory acute graft-versus-host disease. Biol Blood Marrow Transplant. 2010;16:1504-18. Disponible en: http://www.bbmt.org/article/S1083-8791(10)00012-1/pdf.
Lee SJ, Vogelsang G, Flowers MED. Chronic graft-versus-host disease. Biol Blood Marrow Transplant. 2003;9:215-33.
Horwitz ME, Sullivan KM. Chronic graft-versus-host disease. Blood Reviews. 2006;20:15-27.
Wojnar J, Giebel S, Holowiecka-Goral A, Krawczyk-Kulis M, Markiewicz M, Wozniczka K, et al. The incidence and risk factors for chronic graft-versus-host-disease. Ann Transplant. 2006;11:14-20.
Storb R, Prentice RL, Sullivan KM, Shulman HM, Deeg HJ, Doney KC, et al. Predictive factors in chronic graft-versus-host disease in patients with aplastic anemia treated by marrow transplantation from HLA-identical siblings. Ann Intern Med. 1983;98:461-6. Fecha de consulta: 22 de febrero de 2015. Disponible en: http://web.a.ebscohost.com.bdigital.ces.edu.co:2048/ehost/pdfviewer/pdfv....
Lee SJ, Flowers MED. Recognizing and managing chronic graft-versus-host disease. Hematology Am Soc Hematol Educ Program. 2008:134-41. Fecha de consulta: 22 de febrero de 2015. Disponible en: http://asheducationbook.hematologylibrary.org/content/2008/1/134.long.
Lee SJ, Klein JP, Barrett AJ, Ringden O, Antin JH, Cahn J-Y, et al. Severity of chronic graft-versus-host disease: Association with treatment-related mortality and relapse. Blood. 2002;100:406-14. Fecha de consulta: 15 de julio de 2015. Disponible en: http://www.bloodjournal.org/content/100/2/406.long?sso-checked=true.
Martin PJ. Biology of chronic graft-versus-host disease: Implications for a future therapeutic approach. Keio J Med. 2008;57:177-83.
Wei J, Zhang Y, Xu H, Jin J, Zhang J. Atopic dermatitis-like presentation of graft-versus-host disease: A novel form of chronic cutaneous graft-versus-host disease. J Am Acad Dermatol. 2013;69:34-9.
Cornejo CM, Kim EJ, Rosenbach M, Micheletti RG. Atypical manifestations of graft-versus-host disease. J Am Acad Dermatol. 2015;72:690-5.
Carpenter PA, Kitko CL, Elad S, Flowers MED, Gea-Banacloche JC, Halter JP, et al. National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: V. The 2014 Ancillary Therapy and Supportive Care Working Group Report. Biol Blood Marrow Transplant. 2015;21:1167-87. Fecha de consulta: 5 de febrero de 2016. Disponible en: http://www.sciencedirect.com/science/article/pii/S1083879115002244
Hashemi A, Bahrololoumi Z, Khaksar Y, Saffarzadeh N, Neamatzade H, Foroughi E. Mouth-rinses for the prevention of chemotherapy induced oral mucositis in children: A systematic review. Iran J Pediatr Hematol Oncol. 2015;5:106-12. Fecha de consulta: 20 de febrero de 2016. Disponible en: http://www-ncbi-nlm-nih-gov.bdigital.ces.edu.co:2048/pmc/articles/PMC447....
Dignan FL, Scarisbrick JJ, Cornish J, Clark A, Amrolia P, Jackson G, et al. Organ-specific management and supportive care in chronic graft-versus-host disease. Br J Haematol. 2012;158:62-78. Fecha de consulta: 22 de marzo de 2015. Disponible en: http://web.b.ebscohost.com.bdigital.ces.edu.co:2048/ehost/pdfviewer/pdfv....
Flowers MED, Martin PJ. How we treat chronic graft-versus-host disease. Blood. 2015;125:606-15. Fecha de consulta: 29 de junio de 2015. Disponible en: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4304105/.
Ballester-Sánchez R, Navarro-Mira MÁ, de Unamuno-Bustos B, Pujol-Marco C, Sanz-Caballer J, Botella-Estrada R. The role of phototherapy in cutaneous chronic graft-vs-host disease: A retrospective study and review of the literature. Actas Dermosifiliogr. 2015;106:651-7. Fecha de consulta: 24 de julio de 2015. Disponible en: http://www.actasdermo.org/en/the-role-phototherapy-in-cutaneous/articulo....
Ratcliffe N, Dunbar NM, Adamski J, Couriel D, Edelson R, Kitko CL, et al. National Institutes of Health State of the Science Symposium in Therapeutic Apheresis: Scientific opportunities in extracorporeal photopheresis. Transfus Med Rev. 2015;29:62-70.
Zhu L, Couriel DR, Chang C-H. The effect of extracorporeal photopheresis on T cell response in chronic graft-versus-host disease. Leuk Lymphoma. 2015;18:1-9.
Velásquez MM. Inmunointervención: fotoféresis, radioféresis, vacunas con células dendríticas. Rev Asoc Colomb Alerg Asma Inmunol. 2001;10:77-84.
Peñas PF, Fernández-Herrera J, García-Diez A. Dermatologic treatment of cutaneous graft versus host disease. Am J Clin Dermatol. 2004;5:403-16.
Kim SJ, Lee JW, Jung CW, Min CK, Cho B, Shin HJ, et al. Weekly rituximab followed by monthly rituximab treatment for steroid-refractory chronic graft-versus-host disease: Results from a prospective, multicenter, phase II study. Haematologica. 2010;95:1935-42.
Baird K, Comis LE, Joe GO, Steinberg SM, Hakim FT, Rose JJ, et al. Imatinib mesylate for the treatment of steroid-refractory sclerotic-type cutaneous chronic graft-versus-host disease. Biol Blood Marrow Transplant. 2015;21(6):1083-90.