Browsing by Author "Passi, Álvaro"

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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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    Prevalence of anxiety disorders in Latin America: a systematic review and meta-analysis
    (Elsevier Ltd., 2025) Errázuriz Concha, Antonia; Avello Vega, Dalia de los Ángeles; Passi, Álvaro; Torres Barrenechea, Rafael; Bacigalupo Izquierdo, Félix; Crossley, Nicolás; Undurraga Fourcade, Eduardo Andrés; Jones, Peter B.
    Background The prevalence of anxiety disorders among the adult population in Latin America (LATAM) and its association with development indicators is insufficiently characterised. We estimated pooled regional, country, and sex-specific prevalence rates of anxiety disorders in LATAM based on International Classification of Diseases (ICD) or Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria. Additionally, we examined the association between its prevalence and four country-level development indicators: Human Development Index (HDI), income inequality (Gini coefficient), Gender Inequality Index (GII), and Intentional Homicide Rate (IHR). Methods We conducted a systematic review and meta-analysis of population-based studies on the prevalence of ICD/ DSM anxiety disorders in LATAM from 1990 to 2024, irrespective of language. We searched PubMed, PsycINFO, Cochrane Library, SciELO, LILACS, and grey literature. Study quality was assessed using JBI's critical appraisal tools. Pooled estimates were generated using random-effects meta-analysis, and heterogeneity was evaluated using the I-squared (I2) statistic. Meta-regression analyses were performed to examine the ecological association between anxiety disorders prevalence and four development indicators. The study was registered with PROSPERO (CRD42020190238). Findings Using data from 36 studies in LATAM, we calculated the lifetime, 12-month, and current prevalence of ICD/ DSM anxiety disorders at 14.55% (95% Confidence Interval 12.32%-17.11%; I2 = 97.9%); 6.61% (5.20-8.37; I2 = 98.1%), and 3.27% (2.34-4.56; I2 = 97.5%), respectively. Heterogeneity was high across prevalence periods, sexes, and countries (all I2 >= 91.4%), warranting caution in interpreting pooled estimates. Elevated 12-month and current prevalence rates of anxiety disorders were associated with higher Gini coefficients (p <= 0.0013). Additionally, higher current prevalence was associated with lower HDI (p = 0.0103) and higher GII (p = 0.0023), while elevated 12-month prevalence was associated with higher IHR (p = 0.011). Interpretation This study shows that approximately one in seven people in LATAM experience anxiety disorders at some point in their lives. These findings highlight the need to strengthen mental health systems in the region, and evidence the association between prevalence of anxiety disorders and development indicators. Our results can serve as a baseline for tracking anxiety disorders and for informed decision-making at the national and regional levels. The substantial heterogeneity between studies and the underrepresentation of some countries underscore the imperative for enhancing regional mental health capacities.