Análisis de costo-utilidad en Colombia del tratamiento integral del carcinoma de seno con reconstrucción inmediata frente a la reconstrucción diferida

Ana Helena Perea, Diego Rosselli, .

Palabras clave: neoplasias de la mama, mastectomía radical modificada, mamoplastia, análisis costobeneficio, calidad de vida, Colombia.

Resumen

Introducción. La reconstrucción mamaria inmediata o diferida hace parte del tratamiento del cáncer de mama. Cada país y sistema de salud costea y evalúa estos procedimientos de forma diferente. Es importante determinar cuál estrategia resulta de mayor costo-utilidad en Colombia.
Objetivo. Evaluar la costo-utilidad del tratamiento del cáncer de mama con reconstrucción inmediata, comparada con la reconstrucción diferida.
Materiales y métodos. Se utilizó un modelo de árbol de decisiones con un plazo previsto de un año desde la perspectiva del tercer pagador. Los datos de costos se tomaron del manual tarifario del Instituto de Seguros Sociales de 2001 más un ajuste del 30 % según la metodología del Instituto de Evaluación Tecnológica en Salud y el modelo de facturación del Centro Javeriano de Oncología del Hospital Universitario San Ignacio. Las probabilidades de transición y las utilidades se obtuvieron de
médicos especialistas, de las pacientes y de la literatura médica. Se hicieron los análisis univariado y probabilístico de sensibilidad.
Resultados. Los costos esperados per cápita fueron de COP$ 26’710.605 (USD$ 11.165) para la reconstrucción inmediata y de COP$ 6’459.557 (USD$ 11.060) para la diferida. La reconstrucción inmediata generó un costo incremental de COP$ 251.049 (USD$ 105), así como 0,75 años de vida ajustados por calidad (AVAC), en tanto que la diferida generó 0,63 AVAC, con una relación de costoutilidad incremental de COP $2’154.675 por AVAC (USD$ 901).
Conclusiones. El costo por AVAC no superó el umbral de aceptabilidad del producto interno bruto (PIB) per cápita. Los costos durante el primer año resultaron similares y ambas técnicas son favorables para el sistema de salud colombiano, pero la utilidad de la reconstrucción inmediata reportada por los pacientes y en la literatura médica, es mayor.

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  • Ana Helena Perea Servicio de Anestesiología, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, D.C., Colombia
  • Diego Rosselli Departamento de Epidemiología Clínica, Pontificia Universidad Javeriana, Bogotá, D.C., Colombia

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Cómo citar
Perea, A. H., & Rosselli, D. (2018). Análisis de costo-utilidad en Colombia del tratamiento integral del carcinoma de seno con reconstrucción inmediata frente a la reconstrucción diferida. Biomédica, 38(3), 363-378. https://doi.org/10.7705/biomedica.v38i3.3705
Publicado
2018-09-01
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