Análisis de costo-efectividad de la atención fonoaudiológica especializada en deglución en recién nacidos pretérmino en la Unidad de Cuidados Intensivos Neonatales en Colombia

dc.contributorAlvis-Guzmán, Nelson
dc.contributorJERVIS-JALABE, DAVID SCOTT
dc.contributorBeltrán Venegas, Tulia
dc.contributorVargas Moranth, Rusvelt
dc.contributorVargas García, Miguel Antonio
dc.creatorEusse Solano, Paola Andrea
dc.creatorBeleño Rico, Indira Paola
dc.date2022-10-18T13:44:02Z
dc.date2022-10-18T13:44:02Z
dc.date2022
dc.date.accessioned2023-10-03T19:54:53Z
dc.date.available2023-10-03T19:54:53Z
dc.identifierhttps://hdl.handle.net/11323/9569
dc.identifierCorporación Universidad de la Costa
dc.identifierREDICUC- Repositorio CUC
dc.identifierhttps://repositorio.cuc.edu.co/
dc.identifier.urihttps://repositorioslatinoamericanos.uchile.cl/handle/2250/9173267
dc.descriptionThe cost-effectiveness of AFAED in treating PTNB in the NICU is unknown. Of interest are the possible economic implications of using it as standard treatment. This study evaluated the costs and effectiveness of this care. Methods. A CEA of AFAED vs. traditional care was performed in a cohort of PTNBW infants treated in a NICU in Barranquilla (Colombia). Direct costs of care were estimated from a third-party payer perspective. Weight gain and hospital stay were the measures of effectiveness. CER for each alternative and ICER were estimated. Results. The average cost of stay with AFAED was COP $28,642,524 (SD: 21,515,021) and with traditional treatment, COP $41,532,597 (SD: 35,649,081). The average length of stay for AFAED was 20.55 days (SD: 13.31) versus 29.00 (SD: 22.73). The average weight gain was higher in those treated with AFAED (29.66 g - SD: 66.38 - vs. 23.06 - SD: 95.12). The RCEI was COP$ -93,585.60 per g-day of weight gained. Discussion. The effectiveness indicator (average weight gain) was higher, and the average costs per patient were slightly lower in patients with AFAED, ment a better cost-effectiveness ratio of this treatment strategy. Simulation of different scenarios in which the cost of professional fees and length of stay in the NICU increased or decreased by 15% and 30% showed that AFAED is the dominant alternative
dc.descriptionSe desconoce la relación costo-efectividad de la AFAED en el tratamiento de RNPT en la UCIN. Resultan interesantes las posibles implicaciones económicas de utilizarla como tratamiento estándar. Este estudio evaluó los costos y la efectividad de esta atención. Métodos. Se realizó un ACE de la AFAED vs atención tradicional de en una cohorte de RNPT atendidos en una UCIN de Barranquilla (Colombia). Se estimaron costos directos de atención desde la perspectiva del tercer pagador. La ganancia de peso y la estancia hospitalaria fueron las medidas de efectividad. Se estimaron las RCE para cada alternativa y la RCEI. Resultados. El costo promedio de la estancia con AFAED fue COP $28.642.524 (DE: 21.515.021) y con el tratamiento tradicional, COP $41.532.597 (DE: 35.649.081). La estancia promedio para AFAED fue 20,55 días (DE: 13,31) frente a 29,00 (DE: 22,73). El promedio de ganancia de peso fue mayor en los tratados con AFAED (29,66 g -DE: 66,38-, frente a 23,06 -DE: 95,12). El RCEI fue de COP$ -93.585,60 por gr-día de peso ganado. Discusión. El indicador de efectividad (promedio de ganancia de peso) fue mayor y los costos promedio por paciente fueron ligeramente inferiores en los pacientes con AFAED, lo que significa una mejor relación costo-efectividad de esta estrategia de tratamiento. La simulación de diferentes escenarios en los que el costo de los honorarios profesionales y la duración de la estancia en la UCIN se incrementaba o disminuía en un 15% y 30%, demostró que la AFAED es la alternativa dominante
dc.descriptionProblema de investigación 14 -- Planteamiento del problema 14 -- Pregunta o problema de investigación 15 -- Hipótesis 15 -- Objetivos 15 -- Objetivo general 15 -- Objetivos específicos 15 -- Marco referencial 16 -- Delimitación de la investigación 16 -- Marco teórico 16 -- Deglución en el RNPT 17 Evaluación Clínica de la Alimentación 21 -- Importancia clínica de la alimentación oral de los recién nacidos prematuros 21 -- Los problemas de alimentación como causa de aumento de los costos de atención en los recién nacidos prematuros 23 -- Atención fonoaudiológica especializada en deglución 24 -- Cobertura del aseguramiento en salud para la atención del RNPT 25 -- Evaluaciones económicas de las intervenciones en salud 26 -- Principios generales de las evaluaciones económicas en salud 29 -- Marco legal 31 -- Antecedentes de la investigación 32 -- Justificación 35 -- Diseño metodológico 35 -- Diseño de la investigación 35 -- Población y muestra 35 -- Técnicas e instrumentos de recolección de información 36 -- Medidas de efectividad 36 -- Perspectiva 36 -- Costos 36 -- Procedimiento 37 -- Análisis estadísticos 38 -- Consideraciones éticas 39 -- Resultados 40 -- Costos 41 -- Costo-efectividad 42 -- Análisis de sensibilidad 42 -- Discusión 44 -- Conclusiones 46 -- Recomendaciones 46 -- Anexos 47 -- Referencias 49 --
dc.descriptionMagíster en Gestión de Servicios de Salud
dc.descriptionMaestría
dc.format58 páginas
dc.formatapplication/pdf
dc.formatapplication/pdf
dc.languagespa
dc.publisherCorporación Universidad de la Costa
dc.publisherCiencias de la Salud
dc.publisherBarranquilla, Colombia
dc.publisherMaestría en Gestión de Servicios de Salud
dc.relationAguilar-Rodríguez M, León-Castro JC, Álvarez-Cerezo M, Aledón-Andújar N, Escrig-Fernández R, Rodriguez de Dios-Benlloch JL, et al. The effectiveness of an oral sensorimotor stimulation protocol for the early achievement of exclusive oral feeding in premature infants. A randomized, controlled trial. Physical & Occupational Therapy in Pediatrics. 2020;40(4):371–83.
dc.relationThakkar PA, Rohit HR, Ranjan Das R, Thakkar UP, Singh A. Effect of oral stimulation on feeding performance and weight gain in preterm neonates: a randomised controlled trial. Paediatrics and international child health. 2018;38(3):181–6.
dc.relationGrassi A, Sgherri G, Chorna O, Marchi V, Gagliardi L, Cecchi F, et al. Early intervention to improve sucking in preterm newborns: a systematic review of quantitative studies. Advances in Neonatal Care. 2019;19(2):97–109.
dc.relationChen D, Yang Z, Chen C, Wang P. Effect of Oral Motor Intervention on Oral Feeding in Preterm Infants: A Systematic Review and Meta-Analysis. American Journal of Speech-Language Pathology. 2021;30(5):2318–28.
dc.relationThabet AM, Sayed ZA. Effectiveness of the Premature Infant Oral Motor Intervention on Feeding Performance, Duration of Hospital Stay, and Weight of Preterm Neonates in Neonatal Intensive Care Unit: Results From a Randomized Controlled Trial. Dimensions of Critical Care Nursing. 2021;40(4):257–65.
dc.relationFoster JP, Psaila K, Patterson T. Non‐nutritive sucking for increasing physiologic stability and nutrition in preterm infants. Cochrane Database of Systematic Reviews. 2016;(10).
dc.relationMyrhaug HT, Brurberg KG, Hov L, Markestad T. Survival and impairment of extremely premature infants: a meta-analysis. Pediatrics. 2019;143(2).
dc.relationMinisterio de Salud y Protección Social, Colciencias. Guía de práctica clínica del recién nacido prematuro. Vol. 1. Bogotá D.C.: Ministerio de Salud y Protección Social; 2013. 1–512 p.
dc.relationVogel JP, Chawanpaiboon S, Moller A-B, Watananirun K, Bonet M, Lumbiganon P. The global epidemiology of preterm birth. Best Practice & Research Clinical Obstetrics & Gynaecology. 2018;52:3–12.
dc.relationKramer MS, Papageorghiou A, Culhane J, Bhutta Z, Goldenberg RL, Gravett M, et al. Challenges in defining and classifying the preterm birth syndrome. American journal of obstetrics and gynecology. 2012;206(2):108–12.
dc.relationLawn JE, Gravett MG, Nunes TM, Rubens CE, Stanton C. Global report on preterm birth and stillbirth (1 of 7): definitions, description of the burden and opportunities to improve data. BMC pregnancy and childbirth. 2010;10(1):1–22.
dc.relationLawn JE, Blencowe H, Pattinson R, Cousens S, Kumar R, Ibiebele I, et al. Stillbirths: Where? When? Why? How to make the data count? The Lancet. 2011;377(9775):1448–63.
dc.relationde Mendonça ELSS, de Lima Macêna M, Bueno NB, de Oliveira ACM, Mello CS. Premature birth, low birth weight, small for gestational age and chronic non-communicable diseases in adult life: A systematic review with meta-analysis. Early Human Development. 2020;105154.
dc.relationQueiroz Marchezan I. Fundamentos de Fonoaudiología. Aspectos Clínicos de la Motricidad Orofacial. Editorial Médica Panamericana. Buenos Aires, Argentina; 2002. 126 p.
dc.relationGross RD, Trapani-Hanasewych M. Breathing and swallowing: the next frontier. In: Seminars in speech and language. Thieme Medical Publishers; 2017. p. 87–95.
dc.relationMayerl CJ, Edmonds CE, Catchpole EA, Myrla AM, Gould FDH, Bond LE, et al. Sucking versus swallowing coordination, integration, and performance in preterm and term infants. Journal of Applied Physiology. 2020;129(6):1383–92.
dc.relationBarlow SM. Oral and respiratory control for preterm feeding. Vol. 17, Current Opinion in Otolaryngology and Head and Neck Surgery. Curr Opin Otolaryngol Head Neck Surg; 2009. p. 179–86.
dc.relationLee KW, Kim SB, Lee JH, Kim H, Han DW, Kim J. Evaluating the Clinical Symptoms of Neonates with Suspected Dysphagia. Vol. 35, J Korean Acad Rehab Med. Korean Academy of Rehabilitation Medicine; 2011.
dc.relationvan den Engel-Hoek L, Harding C, van Gerven M, Cockerill H. Pediatric feeding and swallowing rehabilitation: An overview. Journal of pediatric rehabilitation medicine. 2017;10(2):95–105.
dc.relationSchwemmle C, Arens C. Feeding, eating, and swallowing disorders in infants and children: An overview. HNO. 2018;66(7):515–26.
dc.relationDedivitis RA, Santoro PP, Arakawa-Sugueno L. Manual práctico de la disfagia- diagnóstico e tratameto. Vol. 1, Journal of Chemical Information and Modeling. 2017. 1–277 p.
dc.relationChiavaro Norma. Funciones y disfunciones estomatognáticas. 1st ed. Buenos Aires: Librería AKADIA Editorial; 2011.
dc.relationDodrill P, McMahon S, Ward E, Weir K, Donovan T, Riddle B. Long-term oral sensitivity and feeding skills of low-risk pre-term infants. Early Human Development. 2004;76(1):23–37.
dc.relationHernandez AM, Marchesan I. ACTUACIÓN FONOAUDIOLÓGICA EN EL AMBIENTE HOSPITALAR. REVINTER, editor. Rio de Janeiro: REVINTER; 2001. 226 p.
dc.relationMinisterio de Salud y Protección Social. Guía de práctica clínica del recién acido prematuro. 2013.
dc.relationMinisterio de Salud y Protección Social. Plan de Beneficios en Salud 2021 - Resolución 2481 de 2020 - CONSULTORSALUD. Bogotá; 2020. 147 p.
dc.relationMinisterio de Salud y Proteccion Social. Guía de práctica clínica del recién nacido prematuro. Colciencias. 2013;
dc.relationMeacock R. Methods for the economic evaluation of changes to the organisation and delivery of health services: principal challenges and recommendations. Health Economics, Policy and Law. 2019;14(1):119–34.
dc.relationSutton M, Garfield-Birkbeck S, Martin G, Meacock R, Morris S, Sculpher M, et al. Economic analysis of service and delivery interventions in health care. 2018;
dc.relationMasters R, Anwar E, Collins B, Cookson R, Capewell S. Return on investment of public health interventions: a systematic review. J Epidemiol Community Health. 2017;71(8):827–34.
dc.relationBrown MM, Brown GC. How to interpret a healthcare economic analysis. Current opinion in ophthalmology. 2005;16(3):191–4.
dc.relationSen A, Deaton A, Besley T. Economics with a Moral Compass? Welfare Economics: Past, Present, and Future. Annual Review of Economics. 2020;12:1–21.
dc.relationYanovskiy M, Levy ON, Shaki YY, Zigdon A, Socol Y. Cost-Effectiveness Threshold for Healthcare and Safety: Justification and Quantification. medRxiv. 2021;
dc.relationSeixas BV. Welfarism and extra-welfarism: a critical overview. Cadernos de saude publica. 2017;33.
dc.relationSakowsky RA. Disentangling the welfarism/extra‐welfarism distinction: Towards a more fine‐grained categorization. Health Economics. 2021;30(9):2307–11.
dc.relationBrouwer W, van Baal P, van Exel J, Versteegh M. When is it too expensive? Cost-effectiveness thresholds and health care decision-making. Springer; 2019.
dc.relationJing L, Bethancourt C-N, McDonagh T. Assessing infant and maternal readiness for newborn discharge. Current opinion in pediatrics. 2017 Oct;29(5):598–605.
dc.relationGriffith TT, Bell AF, Vincent C, White-Traut R, Medoff-Cooper B, Rankin K. Oral Feeding Success: A Concept Analysis. Advances in neonatal care : official journal of the National Association of Neonatal Nurses. 2019 Feb;19(1):21–31.
dc.relationLemyre B, Jefferies AL, O’Flaherty P. Facilitating discharge from hospital of the healthy term infant. Paediatrics & child health. 2018 Dec;23(8):515–31.
dc.relationMayerl CJ, Edmonds CE, Catchpole EA, Myrla AM, Gould FDH, Bond LE, et al. Sucking versus swallowing coordination, integration, and performance in preterm and term infants. Journal of applied physiology (Bethesda, Md : 1985). 2020 Dec;129(6):1383–92.
dc.relationPineda R, Prince D, Reynolds J, Grabill M, Smith J. Preterm infant feeding performance at term equivalent age differs from that of full-term infants. Journal of perinatology : official journal of the California Perinatal Association. 2020 Apr;40(4):646–54.
dc.relationReam MA, Lehwald L. Neurologic consequences of preterm birth. Current neurology and neuroscience reports. 2018;18(8):1–10.
dc.relationOrtinau C, Neil J. The neuroanatomy of prematurity: normal brain development and the impact of preterm birth. Clinical Anatomy. 2015;28(2):168–83.
dc.relationWoythaler M. Neurodevelopmental outcomes of the late preterm infant. In: Seminars in Fetal and Neonatal Medicine. Elsevier; 2019. p. 54–9.
dc.relationAllotey J, Zamora J, Cheong‐See F, Kalidindi M, Arroyo‐Manzano D, Asztalos E, et al. Cognitive, motor, behavioural and academic performances of children born preterm: a meta‐analysis and systematic review involving 64 061 children. BJOG: An International Journal of Obstetrics & Gynaecology. 2018;125(1):16–25.
dc.relationDuncan AF, Matthews MA. Neurodevelopmental outcomes in early childhood. Clinics in perinatology. 2018;45(3):377–92.
dc.relationOttolini KM, Andescavage N, Keller S, Limperopoulos C. Nutrition and the developing brain: the road to optimizing early neurodevelopment: a systematic review. Pediatric research. 2020;87(2):194–201.
dc.relationKwon J, Kellner P, Wallendorf M, Smith J, Pineda R. Neonatal feeding performance is related to feeding outcomes in childhood. Early Human Development. 2020;151:105202.
dc.relationZhang X, Donnelly B, Thomas J, Sams L, O’Brien K, Taylor SN, et al. Growth in the High‐Risk Newborn Infant Post‐Discharge: Results from a Neonatal Intensive Care Unit Nutrition Follow‐up Clinic. Nutrition in Clinical Practice. 2020;35(4):738–44.
dc.relationLainwala S, Kosyakova N, Power K, Hussain N, Moore JE, Hagadorn JI, et al. Delayed achievement of oral feedings is associated with adverse neurodevelopmental outcomes at 18 to 26 months follow-up in preterm infants. American journal of perinatology. 2020;37(05):483–90.
dc.relationYi YG, Oh B-M, Shin SH, Shin JY, Kim E-K, Shin H-I. Association of uncoordinated sucking pattern with developmental outcome in premature infants: a retrospective analysis. BMC pediatrics. 2019;19(1):1–7.
dc.relationAykanat Girgin B, Cimete G. Rehospitalization of preterm infants according to the discharge risk level. Journal for Specialists in Pediatric Nursing. 2017;22(1):e12165.
dc.relationHannan KE, Hwang SS, Bourque SL. Readmissions among NICU graduates: Who, when and why? In: Seminars in perinatology. Elsevier; 2020. p. 151245.
dc.relationHumberg A, Fortmann I, Siller B, Kopp MV, Herting E, Göpel W, et al. Preterm birth and sustained inflammation: consequences for the neonate. In: Seminars in immunopathology. Springer; 2020. p. 1–18.
dc.relationHan C, Shin J, Jeon GW. Development of swallowing function in infants with oral feeding difficulties. International journal of pediatrics. 2020;2020.
dc.relationMayerl CJ, Gould FDH, Bond LE, Stricklen BM, Buddington RK, German RZ. Preterm birth disrupts the development of feeding and breathing coordination. Journal of Applied Physiology. 2019;126(6):1681–6.
dc.relationZahedpasha Y, Hasanpour M, Tilaki KH, Zarkesh MR, Arzani A, Als H. Cue-Based Feeding and Short-Term Health Outcomes of Premature Infants in Newborn Intensive Care Units (NICU): A None-Randomized Trial. 2021;
dc.relationLessen BS. Effect of the premature infant oral motor intervention on feeding progression and length of stay in preterm infants. Advances in Neonatal care. 2011;11(2):129–39.
dc.relationLessen BS, Morello CA, Williams LJ. Establishing intervention fidelity of an oral motor intervention for preterm infants. Neonatal Network. 2015;34(2):72–82.
dc.relationKhurana S, Kane AE, Brown SE, Tarver T, Dusing SC. Effect of neonatal therapy on the motor, cognitive, and behavioral development of infants born preterm: a systematic review. Developmental Medicine & Child Neurology. 2020;62(6):684–92.
dc.relationChen D, Yang Z, Chen C, Wang P. Effect of Oral Motor Intervention on Oral Feeding in Preterm Infants: A Systematic Review and Meta-Analysis. American Journal of Speech-Language Pathology. 2021;30(5):2318–28.
dc.relationDrummond MF, Sculpher MJ, Claxton K, Stoddart GL, Torrance GW. Methods for the economic evaluation of health care programmes. Oxford university press; 2015.
dc.relationThakkar PA, Rohit HR, Ranjan Das R, Thakkar UP, Singh A. Effect of oral stimulation on feeding performance and weight gain in preterm neonates: a randomised controlled trial. Paediatrics and international child health. 2018;38(3):181–6.
dc.relationThabet AM, Sayed ZA. Effectiveness of the Premature Infant Oral Motor Intervention on Feeding Performance, Duration of Hospital Stay, and Weight of Preterm Neonates in Neonatal Intensive Care Unit: Results From a Randomized Controlled Trial. Dimensions of Critical Care Nursing. 2021;40(4):257–65.
dc.relationGhomi H, Yadegari F, Soleimani F, Knoll BL, Noroozi M, Mazouri A. The effects of premature infant oral motor intervention (PIOMI) on oral feeding of preterm infants: A randomized clinical trial. International journal of pediatric otorhinolaryngology. 2019;120:202–9.
dc.relationMajoli M, de Angelis LC, Panella M, Calevo MG, Serveli S, Knoll BL, et al. Parent-Administered Oral Stimulation in Preterm Infants: A Randomized, Controlled, Open-Label Pilot Study. American Journal of Perinatology. 2021;
dc.relationAlvarado J, Guerra SP, Marín DC, Ortíz LA. Percepción sobre el rol del fonoaudiólogo en el área de motricidad oral en la unidad de cuidados intensivos neonatal. Pediatría. 2020;53(1):23–9.
dc.relationMahmoodi N, Lessen Knoll B, Keykha R, Jalalodini A, Ghaljaei F. The effect of oral motor intervention on oral feeding readiness and feeding progression in preterm infants. Iranian Journal of Neonatology IJN. 2019;10(3):58–63.
dc.relationOstadi M, Armanian A-M, Namnabati M, Kazemi Y, Poorjavad M. The effects of swallowing exercise and non-nutritive sucking exercise on oral feeding readiness in preterm infants: A randomized controlled trial. International Journal of Pediatric Otorhinolaryngology. 2021;142:110602.
dc.relationTahir W, Monahan M, Dorling J, Hewer O, Bowler U, Linsell L, et al. Economic evaluation alongside the Speed of Increasing milk Feeds Trial (SIFT). Archives of Disease in Childhood-Fetal and Neonatal Edition. 2020;105(6):587–92.
dc.relationNg VKY, Cribbie RA. Using the gamma generalized linear model for modeling continuous, skewed and heteroscedastic outcomes in psychology. Current Psychology. 2017;36(2):225–35.
dc.relationKan HJ, Kharrazi H, Chang H-Y, Bodycombe D, Lemke K, Weiner JP. Exploring the use of machine learning for risk adjustment: A comparison of standard and penalized linear regression models in predicting health care costs in older adults. PloS one. 2019;14(3):e0213258.
dc.relationRamsey SD, Willke RJ, Glick H, Reed SD, Augustovski F, Jonsson B, et al. Cost-effectiveness analysis alongside clinical trials II—an ISPOR Good Research Practices Task Force report. Value in Health. 2015;18(2):161–72.
dc.relationDrummond MF, Sculpher MJ, Claxton K, Stoddart GL, Torrance GW. Methods for the economic evaluation of health care programmes. Oxford university press; 2015.
dc.relationWakker P, Klaassen MP. Confidence intervals for cost/effectiveness ratios. Health Economics. 1995;4(5):373–81.
dc.rightsAtribución-NoComercial-CompartirIgual 4.0 Internacional (CC BY-NC-SA 4.0)
dc.rightshttps://creativecommons.org/licenses/by-nc-sa/4.0/
dc.rightsinfo:eu-repo/semantics/openAccess
dc.rightshttp://purl.org/coar/access_right/c_abf2
dc.subjectIntensive Care Units
dc.subjectNeonatal
dc.subjectCost-effectiveness analysis
dc.subjectInfant
dc.subjectPremature
dc.subjectFeeding behavior
dc.subjectPhysical stimulation / methods
dc.subjectSpeech therapy
dc.subjectWeight gain
dc.subjectLength of stay
dc.subjectCuidado Intensivo Neonatal
dc.subjectEstimulación física
dc.subjectFonoaudiología
dc.subjectAumento de peso
dc.subjectEvaluación de costo-efectividad
dc.subjectRecién nacido prematuro
dc.subjectConducta alimentaria
dc.subjectTiempo de internación
dc.titleAnálisis de costo-efectividad de la atención fonoaudiológica especializada en deglución en recién nacidos pretérmino en la Unidad de Cuidados Intensivos Neonatales en Colombia
dc.typeTrabajo de grado - Maestría
dc.typehttp://purl.org/coar/resource_type/c_bdcc
dc.typeText
dc.typeinfo:eu-repo/semantics/masterThesis
dc.typehttp://purl.org/redcol/resource_type/TM
dc.typeinfo:eu-repo/semantics/acceptedVersion
dc.typehttp://purl.org/coar/version/c_ab4af688f83e57aa
dc.coverageColombia


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