Browsing by Author "Espinoza Sepúlveda, Manuel Antonio"

Now showing 1 - 20 of 36
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    Did socioeconomic inequality in self-reported health in Chile fall after the equity-based healthcare reform of 2005? A concentration index decomposition analysis
    (2015) Cabieses Valdez, Báltica Beatriz; Cookson, R.; Espinoza Sepúlveda, Manuel Antonio; Santorelli, G.; Delgado, I.
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    Diferencia de costos intrahospitalarios entre pacientes de muy bajo peso al nacer con y sin displasia broncopulmonar en 14 centros de Chile
    (2022) Pettinelli Díaz, Gonzalo Alfredo; Espinoza Sepúlveda, Manuel Antonio; Pontificia Universidad Católica de Chile. Escuela de Medicina
    El análisis de costos permite conocer cuánto se gasta y cómo se invierten los recursos para determinar la eficiencia del sistema. En este sentido, el análisis de costos ofrece grandes posibilidades para la gestión hospitalaria y la toma de decisiones. Por su parte, la displasia broncopulmonar es una enfermedad asociada a múltiples factores de riesgo, siendo además la morbimortalidad más frecuente en prematuros de muy bajo peso. Si bien el porcentaje de prematuros de muy bajo peso es bajo, los costos de esta población son los más elevados de las unidades de neonatología. El costo de los problemas de salud en Chi le han sido históricamente considerados al momento de definir las prioridades de la agenda de políticas públicas, pero desconocemos la magnitud atribuible a la DBP. Por esto, el objetivo de esta tesis es determinar cuál es la diferencia de costos intrahospitalarios en pacientes con y sin DBP en neonatos menores a 1.500 gramos en Chile. Para esto se llevó a cabo un estudio de costos de la enfermedad de la base de datos de la Red NEOCOSUR en 5.016 pacientes. Como resultados se demostró que el costo promedio intrahospitalario de los pacientes con DBP es 2.2 veces superior al de los pacientes sin DBP. Además se demostró que el costo aumenta a medida que la severidad de la DBP es mayor, y disminuye a medida que l a edad gestacional es mayor.
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    Differential Effects of a Telemonitoring Platform in the Development of Chemotherapy-Associated Toxicity: A Randomized Trial Protocol
    (2024) Martínez, Felipe; Taramasco, Carla; Espinoza Sepúlveda, Manuel Antonio; Acevedo, Johanna; Goic Boroevic, Carolina; Nervi Nattero, Bruno
    Chemotherapy requires careful monitoring, but traditional follow-up approaches face significant challenges that were highlighted by the COVID-19 pandemic. Hence, exploration into telemonitoring as an alternative emerged. The objective is to assess the impact of a telemonitoring platform that provides clinical data to physicians overseeing solid tumor patients, aiming to enhance the care experience. The methodology outlines a parallel-group randomized clinical trial involving recently diagnosed patients with solid carcinomas preparing for curative intent chemotherapy. Eligible adult patients diagnosed with specific carcinoma types and proficient in Spanish, possessing smartphones, will be invited to participate. They will be randomized using concealed allocation sequences into two groups: one utilizing a specialized smartphone application called Contigo for monitoring chemotherapy toxicity symptoms and accessing educational content, while the other receives standard care. Primary outcome assessment involves patient experience during chemotherapy using a standardized questionnaire. Secondary outcomes include evaluating severe chemotherapy-associated toxicity, assessing quality of life, and determining user satisfaction with the application. The research will adhere to intention-to-treat principles. This study has been registered at ClinicalTrials.gov (NCT06077123)
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    Early versus deferred anti-SARS-CoV-2 convalescent plasma in patients admitted for COVID-19: A randomized phase II clinical trial
    (2021) Balcells Marty, Maria Elvira; Rojas Orellana, Luis Esteban; Martínez Valdebenito, Constanza Pamela; Ceballos Valdivielso, María Elena Andrea; Ferrés Garrido, Marcela Viviana; Chang Rathkamp, Mayling Raquel; Vizcaya Altamirano, María Cecilia; Mondaca Contreras, Sebastián Patricio; Huete Garín, Isidro Álvaro; Castro López, Ricardo Adolfo; Sarmiento Maldonado, Mauricio; Villarroel Del Pino, Luis Antonio; Pizarro Ibáñez, Alejandra Valentina; Ross Pérez, Patricio Daniel; Santander Toro, Jaime Andrés; Lara Hernández, Bárbara Alejandra; Ferrada Koch, Marcela Patricia; Vargas Salas, Sergio Sebastián; Beltrán Pávez, Carolina; Soto Rifo, Ricardo; Valiente Echeverria, Fernando Andrés; Caglevic, Christian; Mahave, Mauricio; Selman Bravo, Carolina Antoniett; Gazitúa, Raimundo; Briones, José Luis; Villarroel Espíndola, Franz; Balmaceda Araque, Carlos Felipe; Espinoza Sepúlveda, Manuel Antonio; Pereira Garces, Jaime; Nervi Nattero, Bruno; Le Corre Perez, Monique Nicole
    Background: Convalescent plasma (CP), despite limited evidence on its efficacy, is being widely used as a compassionate therapy for hospitalized patients with COVID-19. We aimed to evaluate the efficacy and safety of early CP therapy in COVID-19 progression.", "Methods and findings", "The study was an open-label, single-center randomized clinical trial performed in an academic medical center in Santiago, Chile, from May 10, 2020, to July 18, 2020, with final follow-up until August 17, 2020. The trial included patients hospitalized within the first 7 days of COVID-19 symptom onset, presenting risk factors for illness progression and not on mechanical ventilation. The intervention consisted of immediate CP (early plasma group) versus no CP unless developing prespecified criteria of deterioration (deferred plasma group). Additional standard treatment was allowed in both arms. The primary outcome was a composite of mechanical ventilation, hospitalization for >14 days, or death. The key secondary outcomes included time to respiratory failure, days of mechanical ventilation, hospital length of stay, mortality at 30 days, and SARS-CoV-2 real-time PCR clearance rate. Of 58 randomized patients (mean age, 65.8 years; 50% male), 57 (98.3%) completed the trial. A total of 13 (43.3%) participants from the deferred group received plasma based on clinical aggravation. We failed to find benefit in the primary outcome (32.1% versus 33.3%, odds ratio [OR] 0.95, 95% CI 0.32-2.84, p > 0.999) in the early versus deferred CP group. The in-hospital mortality rate was 17.9% versus 6.7% (OR 3.04, 95% CI 0.54-17.17 p = 0.246), mechanical ventilation 17.9% versus 6.7% (OR 3.04, 95% CI 0.54-17.17, p = 0.246), and prolonged hospitalization 21.4% versus 30.0% (OR 0.64, 95% CI, 0.19-2.10, p = 0.554) in the early versus deferred CP group, respectively. The viral clearance rate on day 3 (26% versus 8%, p = 0.204) and day 7 (38% versus 19%, p = 0.374) did not differ between groups. Two patients experienced serious adverse events within 6 hours after plasma transfusion. The main limitation of this study is the lack of statistical power to detect a smaller but clinically relevant therapeutic effect of CP, as well as not having confirmed neutralizing antibodies in donor before plasma infusion.", "Conclusions", "In the present study, we failed to find evidence of benefit in mortality, length of hospitalization, or mechanical ventilation requirement by immediate addition of CP therapy in the early stages of COVID-19 compared to its use only in case of patient deterioration.
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    Economic evaluation of a multimorbidity patient centered care model implemented in the Chilean public health system
    (2023) Zamorano Pichard, Paula Francisca; Espinoza Sepúlveda, Manuel Antonio; Varela, Teresita; Abbott, Tomás; Tellez, Alvaro; Armijo Escalona, Nicolás Andrés; Suarez, Francisco
    Multimorbidity and patient-centered care approaches are growing challenges for health systems and patients. The cost of multimorbidity patients and the transition to a new care strategy is still sightly explored. In Chile, more than 70% of the adult population suffer from multimorbidity, opening an opportunity to implement a Multimorbidity patient-centered care model. The objective of this study was to perform an economic evaluation of the model from the public health system perspective. The methodology used a cost-consequence evaluation comparing seven exposed with seven unexposed primary care centers, and their reference hospitals. It followed three steps. First, we performed a Time-Driven Activity-Based Costing with routinely collected data routinely collected. Second, we run a comparative analysis through a propensity score matching and an estimation of the attributable costs to health services utilization at primary, secondary and tertiary care and health outcomes. Third, we estimated implementation and transaction costs. Results showed savings in aggregate costs of the total population (-0.12 (0.03) p?
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    Effects on Quality of Life of a Telemonitoring Platform amongst Patients with Cancer (EQUALITE) A Randomized Trial Protocol
    (2024) Martínez, Felipe; Taramasco Toro, Carla; Espinoza Sepúlveda, Manuel Antonio; Acevedo, Johanna; Goic Boroevic, Carolina; Nervi Nattero, Bruno
    Cancer, a pervasive global health challenge, necessitates chemotherapy or radiotherapy treatments for many prevalent forms. However, traditional follow-up approaches encounter limitations, exacerbated by the recent COVID-19 pandemic. Consequently, telemonitoring has emerged as a promising solution, although its clinical implementation lacks comprehensive evidence. This report depicts the methodology of a randomized trial which aims to investigate whether leveraging a smartphone app called Contigo for disease monitoring enhances self-reported quality of life among patients with various solid cancers compared to standard care. Secondary objectives encompass evaluating the app’s impact on depressive symptoms and assessing adherence to in-person appointments. Randomization will be performed independently using an allocation sequence that will be kept concealed from clinical investigators. Contigo offers two primary functions: monitoring cancer patients’ progress and providing educational content to assist patients in managing common clinical situations related to their disease. The study will assess outcomes such as quality of life changes and depressive symptom development using validated scales, and adherence to in-person appointments. Specific scales include the EuroQol Group’s EQ-5D questionnaire and the Patient Health Questionnaire (PHQ-9). We hypothesize that the use of Contigo will assist and empower patients receiving cancer treatment, which will translate to better quality of life scores and a reduced incidence of depressive symptoms. All analyses will be undertaken with the intention-to-treat principle by a statistician unaware of treatment allocation. This trial is registered in ClinicalTrials under the registration number NCT06086990
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    Eficacia y seguridad de tratamientos hipoglicemiantes orales en el manejo de pacientes con diabetes mellitus 2 refractarios a la monoterapia con metformina : revisión de la literatura
    (2021) Meza Vásquez, Francisco Javier; Espinoza Sepúlveda, Manuel Antonio; Pontificia Universidad Católica de Chile. Facultad de Medicina
    Introducción: La Diabetes es una enfermedad crónica no transmisible que afecta a un gran porcentaje de la población mundial, lo que la convierte en un problema de salud pública. Esta se caracteriza por una baja producción de insulina por parte del páncreas , o bien, cuando el organismo es incapaz de utilizar eficazmente la insulina que produce. En Chile según la última encuesta nacional de salud de los años 2016- 2017(ENS), la prevalencia de la enfermedad es de un 12.3%. Los usuarios Diabéticos del sistema público de salud se controlan, en su gran mayoría, en la atención primaria de salud (APS). En este estudio se presentan los resultados de una revisión de la literatura sobre cuales son los fármacos más utilizados como segunda línea de tratamiento farmacológico contra la diabetes mellitus tipo 2. Su objetivo es entregar información relevante a los tomadores de decisiones en temas de cobertura en salud. Preguntas / Objetivos de la investigación: Preguntas: a) ¿Siguen siendo las sulfonilureas la mejor opción costo-efectiva como segunda línea de tratamiento de la diabetes mellitus tipo 2 en Chile? b) ¿Existe evidencia para cambiar a las sulfonilureas como fármacos de elección en la segunda línea de tratamiento de la diabetes mellitus tipo 2 en Chile? Objetivos: a) Obtener información robusta sobre la eficacia de los fármacos hipoglicemiantes orales utilizados como segunda línea de tratamiento en diferentes outcomes para poder compararlos con las sulfonilureas en base a una revisión de la literatura. b) Generar recomendaciones en base a evidencia científica de calidad, sobre qué fármacos son más indicados como segunda línea de tratamiento en base a los resultados del estudio. c) Generar una discusión sobre como la elección de compra por parte del estado de ciertos fármacos puede expandir las brechas en salud, perpetuando las desigualdades e inequidades que en salud se generan en este ámbito. 8 Método: El método de esta investigación consistirá en una revisión sistemática de la literatura. Resultados esperados: Se espera obtener información relevante sobre diferentes hipoglicemiantes orales que presentan una mayor eficacia en los distintos outcomes medidos en comparación a las sulfonilureas para ser adicionados a la metformina como segunda línea de tratamiento farmacológico. Discusión y conclusiones: La evidencia científica no es concluyente sobre cuál medicamento es el más adecuado para acompañar a la metformina cuando la monoterapia falla en pacientes con DM2. Existen múltiples estudios que han intentado dilucidar una respuesta a esta interrogante, no obteniendo resultados positivos ya que dicha respuesta va más allá de una problemática de farmacología, existen otros factores que entran en juego, como temas culturales, económicos, el lobby generado por las empresas farmacéuticas, entre otras, que no permiten entregar una única respuesta correcta. Como conclusión, se debe trabajar desde el contexto en que está inmersa la investigación, para poder obtener resultados que sean posibles de aplicar en el caso necesitado. Se espera que este estudio contribuya a disminuir las desigualdades e inequidades que en salud se generan por temas de cobertura en salud.
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    Equidad en salud y evaluación de tecnologías sanitarias en Chile
    (2014) Espinoza Sepúlveda, Manuel Antonio; Cabieses Valdez, Báltica Beatriz
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    Estimation of the demand for palliative care in non-oncologic patients in Chile
    (2023) Armijo Escalona, Nicolás Andrés; Abbot, Tomás; Espinoza Sepúlveda, Manuel Antonio; Neculhueque, Ximena; Balmaceda, Carlos
    Background: Access to palliative care is an emerging global public health challenge. In Chile, a palliative care law was recently enacted to extend palliative care coverage to the non-oncologic population. Thus, a reliable and legitimate estimate of the demand for palliative care is needed for proper health policy planning. Objective: To estimate the demand for Palliative Care in Chile. Methodology: Diseases likely to require palliative care were identified according to literature and expert judgement. Annual deaths of diseases identified were estimated for the periods 2018–2020. Demand estimation corresponds to the identification of the proportion of deceased patients requiring palliative care based on the burden of severe health-related suffering. Finally, patient-years were estimated based on the expected survival adjustment. Results: The estimated demand for palliative care varies between 25,650 and 21,679 patients depending on the approximation used. In terms of annual demand, this varies between 1,442 and 10,964 patient-years. The estimated need has a minor variation between 2018 and 2019 of 0.85% on average, while 2020 shows a slightly higher decrease (7.26%). Conclusion: This is a replicable method for estimating the demand of palliative care in other jurisdictions. Future studies could approach the demand based on the decedent population and living one for a more precise estimation and better-informed health planning. It is hoped that our methodological approach will serve as an input for implementing the palliative care law in Chile, and as an example of estimating the demand for palliative care in other jurisdictions.
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    Estudio de impacto presupuestal de Daclatasvir asociado a Asunaprevir desde la perspectiva del sistema de salud público chileno
    (2017) Vargas, C.; Espinoza Sepúlveda, Manuel Antonio; Giglio, A.; Soza, Alejandro
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    Evaluación de tecnologías sanitarias (ETESA) aplicada a los dispositivos médicos : recomendaciones para Chile : un scoping review
    (2021) López Gutiérrez, María Cecilia; Espinoza Sepúlveda, Manuel Antonio; Pontificia Universidad Católica de Chile. Escuela de Medicina
    Introducción: En un contexto donde la cobertura universal en salud (CUS) se ha vuelto una prioridad y los recursos son limitados, la evaluación de tecnologías sanitarias (ETESA) se propone como una herramienta para generar decisiones de cobertura en salud más transparentes y basadas en la evidencia. Se define como un campo multidisciplinario de análisis que estudia las repercusiones técnicas, éticas, sociales y económicas de una tecnología determinada, como un dispositivo médico (DM) o un medicamento, así como su efectividad clínica. Aún cuando los medicamentos y los DMs poseen similitudes, se diferencian en varios aspectos, como la diversidad y constante innovación de estos últimos. Procesos de toma de decisiones de cobertura de DMs en Chile, que consideran algunos elementos de ETESA, como la evaluación de evidencia clínica, a través de la Ley Ricarte Soto, no consideran pautas específicas para este tipo de tecnologías. Consecuentemente, el objetivo de esta investigación fue proponer recomendaciones para una guía de ETESA aplicada a los DMs. Método: se realizó una investigación bibliográfica basada en la técnica de scoping review respecto a los aspectos clave de los métodos de la ETESA aplicada a los DMs. Resultados: dos aspectos clave, de amplio consenso en la literatura internacional, son la evidencia clínica limitada y la curva de aprendizaje de los DMs, que a su vez se identificaron como unos de los principales desafíos con respecto a la evidencia científica necesaria para la evaluación clínica y económica en la ETESA, y que también reflejan la necesidad de adaptar los marcos de valor existentes. Discusión y Conclusiones: la ETESA aplicada a los DMs constituye un desafío para las diferentes partes interesadas involucradas en el proceso de evaluación y de decisiones de cobertura de estas tecnologías. La evidencia clínica limitada de los DMs fue el principal aspecto discutido en la literatura, para lo cual se recomienda el uso de evidencia del mundo real y considerar opciones de cobertura condicional, como la cobertura con desarrollo de evidencia (CED). La falta de consideración de los desafíos planteados puede generar una estimación inadecuada de la eficacia, efectividad, seguridad y costo-efectividad del DM.
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    Evaluation of the Health Assessment Questionnaire Disability Index in Chilean patients with rheumatoid arthritis
    (2019) Durán, Josefina; Dominguez de Landa, Maria Angelica; Espinoza Sepúlveda, Manuel Antonio
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    Health and economic efects on patients with type 2 diabetes mellitus in the long run: predictions for the Chilean population
    (2022) Espinoza Sepúlveda, Manuel Antonio; Abbott, Tomás; Passi, Álvaro; Balmaceda, Carlos
    Background: Diabetes is associated to a high financial and disease burden, explaining a large proportion of expenditure of the health system in one year. The purpose of this study was to estimate long-term costs and health outcomes of recently diagnosed patients with type 2 diabetes in Chile. Methods: Cost and consequence study based on mathematical discrete event simulation (DES) model. We modelled expected costs (USD) and quality-adjusted life-years (QALYs) from diagnosis to death (or the age of 95) of a hypothetical cohort of 100,000 incident cases, simulated based on the Chilean National Health Survey 2018. The incidence of twelve complications was estimated assuming the hazard functions provided by the United Kingdom Prospective Diabetes Study. We explore heterogeneity across patients based on their baseline risk covariates and their impact on costs and QALYs. Results: The expected cost and QALY of a recently diagnosed type 2 diabetes patient in Chile were USD 8660 and 12.44 QALYs. Both costs and QALYs were independently determined by baseline risk and the patient's life expectancy from the diagnosis. Length of life since diagnosis showed the major impact on costs (5.2% increase for every additional year). Myocardial infarction was the most frequent complication (47.4%) and the most frequent cause of death. Conclusion Diabetes type 2 determines a significant expenditure of the health system and substantial health losses. Although the control of cardiovascular risk factors and the metabolic control of the disease, both have an important impact on costs and outcomes, the main impact is achieved by postponing the age of onset of the disease.
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    Health-related quality of life by household income in Chile: a concentration index decomposition analysis
    (2022) Severino Suarez Rodrigo Alfredo; Espinoza Sepúlveda, Manuel Antonio; Cabieses, Báltica
    Background: Health inequities have a profound impact on all dimensions of people’s lives, with invariably worse results among the most disadvantaged, transforming them into a more fragile and vulnerable population. These unfair inequalities also affect dimensions focused on subjectivity, such as health-related quality of life (HRQoL), which has been positioned, in recent decades, as an important outcome in health decision-making. The main objective of this study is to estimate socioeconomic inequality in HRQoL of Chilean by household income.  Methods: Secondary analysis of the National Health Survey (ENS 2016–2017, Chile). This survey includes a nationally representative, stratified, and multistage household sample of people aged 15 and above. Socioeconomic inequality in HRQoL (EQ5D) is estimated by the concentration index (CI) ranked by household income. Decomposition analysis is conducted to examine potential explanatory sociodemographic factors.  Results: The CI for household income inequality in HRQoL was -0.063. The lower the household income, the worse the HRQoL reported by in Chile. The decomposition analysis revealed that socioeconomic position contributes 75,7% to inequality in the quality of life, followed by educational level (21.8%), female gender (17.3%), and type of Health Insurance (15%), age (-19.7%) and residence (-10.8%). Less than 1% corresponds to the unexplained residual component. Conclusions: Our findings suggest the existence of a disproportionate concentration of worse HRQoL in the most disadvantaged socioeconomic groups in Chile. This inequality is largely, yet not completely, associated with household income. Other significant factors associated with this inequality are education, gender, and healthcare insurance. These results suggest the need of strengthening efforts to reducing socioeconomic gaps in health outcomes in Chile, as a means to achieve social justice and equity in health and healthcare.
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    Impacto de una Política de Equivalencia Terapéutica en el Precio de Medicamentos en Chile
    (2015) Balmaceda, Carlos; Espinoza Sepúlveda, Manuel Antonio; Diaz, Janepsy