Browsing by Author "Armijo Escalona, Nicolás Andrés"

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    Cost-effectiveness of dabigatran for thromboembolic events prevention in atrial fibrillation patients in Chile
    (Springer Nature, 2025) Abbot, Tomás; Armijo Escalona, Nicolás Andrés; Rojas Orellana, Luis; Giglio Jiménez, Andrés Enrique; Balmaceda, Carlos; Espinoza Sepúlveda, Manuel Antonio
    Background Atrial fibrillation (AF) is the most common sustained arrhythmia in adults, associated with significant morbidity, mortality, and economic burden due to thromboembolic events. In Chile, acenocoumarol is the most widely used anticoagulant, while access to direct oral anticoagulants (DOACs) such as dabigatran, rivaroxaban, and apixaban remains limited for AF patients. Among DOACs, dabigatran is the only one with an approved specific reversal agent (idarucizumab) available in the Chilean public system. Evaluating the cost-effectiveness of these alternatives is critical for informing resource allocation. Aims To evaluate the cost-effectiveness of dabigatran compared to acenocoumarol, rivaroxaban and apixaban, for thromboembolic events prevention in atrial fibrillation (AF) patients, from the Chilean public health payer perspective. Methods A Markov cohort model was used to represent the natural history of AF in terms of ischemic and hemorrhagic complications. Direct costs were obtained from local official sources and converted to US dollars (1 USD = 710.9 CLP at 2022). Data about major events and utilities were obtained from the literature. We applied an undifferentiated discount rate of 3% for costs and outcomes over a lifetime time horizon. Uncertainty was characterized through deterministic and probabilistic sensitivity analysis. We also examined the use of idarucizumab and prothrombin-complexes-concentrate (PCC) as reversal agents in an emergency setting as an additional scenario-analysis. Results Dabigatran was the most (cost-)effective among all alternatives (8.53 QALYs). Considering the Chilean cost-effectiveness threshold of USD 17,200 (1 GDP per capita), dabigatran was cost-effective (USD 11,042 per QALY gained), while both rivaroxaban and apixaban were dominated by dabigatran. Regarding the second-order uncertainty, at the suggested threshold, dabigatran exhibit the highest probability of being cost-effective (approximately 60%). In the reversal agent scenario, dabigatran plus idarucizumab was also found to be cost-effective in the Chilean context. Conclusion Dabigatran is cost-effective and dominates both rivaroxaban and apixaban at current publicly available prices in Chile. In addition, we expect dabigatran-idarucizumab is also expected to be cost-effective for Chilean health system when is compared against acenocoumarol-PCC as reversal agents.
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    Design of chitosan nanocapsules with compritol 888 ATO (R) for imiquimod transdermal administration. Evaluation of their skin absorption by raman microscopy
    (2020) Alvarez Figueroa, María Javiera; Narvaez Araya, D.; Armijo Escalona, Nicolás Andrés; Carrasco Flores, E. A.; González Aramundiz, José Vicente
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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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    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.