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Óscar Gamboa

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Linda Mileshkin

University of Melbourne

University of Belgrade

Hospital Israelita Albert Einstein

Dimitrios Zardavas

Gunter Von Minckwitz

Goethe-Universität Frankfurt am Main

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Papers by Óscar Gamboa

ErbB2+ metastatic breast cancer treatment after progression on trastuzumab: a cost-effectiveness analysis for a developing country

Revista de salud pública (Bogotá, Colombia)

Breast cancer (BC) and metastatic breast cancer (MBC) are significant causes of deaths amongst wo... more Breast cancer (BC) and metastatic breast cancer (MBC) are significant causes of deaths amongst women worldwide, including developing countries. The cost of treatment in the latter is even more of an issue than in higher income countries. ErbB2 overexpression is a marker of poor prognosis and the goal for targeted therapy. This study was aimed at evaluating the cost-effectiveness in Colombia of ErbB2+ MBC treatment after progression on trastuzumab. A decision analytic model was constructed for evaluating such treatment in a hypothetical cohort of ErbB2+MBC patients who progressed after a first scheme involving trastuzumab. The alternatives compared were lapatinib+capecitabine (L+C), and trastuzumab+a chemotherapy agent (capecitabine, vinorelbine or a taxane). Markov models were used for calculating progression-free time and the associated costs. Effectiveness estimators for such therapy were identified from primary studies; all direct medical costs based on national fees-guidelines w...

Efectos de edad, periodo y cohorte en la mortalidad por cáncer de pulmón, próstata, mama y gástrico en colombia entre 1985 y 2009

NUESTRA PRODUCCION

by Óscar Gamboa and Colposcopia Digital

NUESTRA PRODUCCION Gamboa, O.; Chicaiza, L; Molina, M.; Díaz, J.; González, M.; Murillo, R.; Ball... more NUESTRA PRODUCCION Gamboa, O.; Chicaiza, L; Molina, M.; Díaz, J.; González, M.; Murillo, R.; Ballesteros, M.; Sánchez, R. "Cost-effectiveness of conventional cytology and HPV DNA testing for cervical cancer screening in Colombia", "Costo-efectividad de la citología y tamización con pruebas de ADN-VHP para cáncer de cuello uterino en Colombia". Salud Pública, Mex 2008; 50: 276-285. Sandoval, G.; Vacca, C.; Olarte, J. "Medicamentos Vitales no disponibles: análisis de reglamentación nacional e internacional propuesta de actualización del listado nacional". Vitae 2008, 15: 77-90, N°1. Garavito, G.; Bertani, S.; Deharo, E.; "Hallazgos complementarios sobre la actividad antimalárica del azul de metileno y su toxicidad", Vitae 2008, 15: 91-95, N°1.

PCN35 COST-EFFECTIVENESS OF HUMAN PAPILLOMAVIRUS VACCINE IN COLOMBIA IN 2007

Value in Health, 2009

PIN25 COST-EFFECTIVENESS ANALYSIS OF THE INTRODUCTION OF THE VARICELLA VACCINE IN COLOMBIA

by Óscar Gamboa and C. Castañeda

Value in Health, 2011

the model is robust to a wide range of parameter estimates. CONCLUSIONS: This analysis suggests t... more

EVALUACIÓN DE COSTO-EFECTIVIDAD DE LA ADICIÓN DE LA RESONANCIA MAGNÉTICA A LA RADIOGRAFÍA CONVENCIONAL EN LA EVALUACIÓN DE PACIENTES CON PIE DIABÉTICO

En personas con diabetes, una infección en el pie frecuentemente conduce a amputación. La radiogr... more En personas con diabetes, una infección en el pie frecuentemente conduce a amputación. La radiografía plana es el método tradicionalmente usado en la evaluación de las infeccionas óseas del pie, pero comparada con ella, la resonancia magnética es más sensible y específica. Se realiza aquí una evaluación de costo efectividad usando un modelo de Markov para comparar la radiografía convencional

Resultados a largo plazo en una cohorte de mujeres con cáncer de mama de bogotá colombia

by Pedro Ramos and Óscar Gamboa

Revista Colombiana de Cancerología, 2013

Actividad de la telomerasa e infección por VPH en raspados cervicales de mujeres que desarrollaron lesiones escamosas intraepiteliales de alto grado. Un estudio de seguimiento

Revista Colombiana de Cancerología, 2012

Resumen La actividad de la telomerasa (AT) es detectada en altos niveles en líneas celulares inmo... more

Análisis de costo-efectividad en Colombia de anastrazol Vs. tamoxifeno como terapia inicial en mujeres con cáncer temprano de mama y receptor hormonal positivo

Biomédica, 2010

Costo-efectividad de medios de contraste isoosmolales e hiposmolales en pacientes con alto riesgo de nefropatía inducida por medio de contraste

Biomédica, 2012

Introduction. Contrast media can cause acute renal failure by direct toxic effects on the tubular... more Introduction. Contrast media can cause acute renal failure by direct toxic effects on the tubular cells and kidney ischemia. Diabetics and hospitalized patients have a greater risk of developing contrastinduced nephropathy than the general population. Objective. The cost effectiveness of iso and low-osmolality contrast media was assessed in high risk outpatients. Materials and methods. The analysis was based on a systematic literature review comparing the nephrotoxic effects of iso-to low-osmolality contrast media. Only direct costs were considered; these were obtained from the official tariff manual. Incremental cost-effectiveness ratios, efficiency curves and acceptability curves were calculated. Univariate sensitivity analyses were performed for costs and effects, as well as probabilistic analyses. Zero and 3% discounts were applied to results. The costeffectiveness threshold was equal to the per capita GDP per life-year gained. Results. Alternatives with Iopamidol and Iodixanol are preferable to the others, because both reduce risk of contrast-induced nephropathy and are less costly. The incremental cost-effectiveness of the Iodixanol alternative compared to the Iopamidol alternative is US$ 14,660 per additional life year gained; this is more than twice the threshold. Conclusion. The low-osmolality contrast medium, Iopamidol, appears to be cost-effective when compared with Iohexol or other low-osmolality contrast media (Iopromide, Iobitridol, Iomeprol, Iopentol and Ioxilan) in contrast-induced nephropathy, high-risk outpatients. The choice of the iso-osmolality contrast medium, Iodixanol, depends on its cost per vial and on the willingness to pay.

Abandono del tratamiento: una causa de muerte evitable en el niño con cáncer

Revista Colombiana de Cancerología, 2011

Fecha de recepción: 17 de noviembre del 2010. Fecha de aprobación: 15 de marzo del 2011

Impacto Económico de la Vacuna contra el Neumococo en Pacientes Oncológicos

Revista de Salud Pública, 2007

Modelos empleados para la Toma de Decisiones en el Cuidado de la Salud

Revista de Salud Pública, 2008

Barreras para la implementación de la prueba ADN-VPH como técnica de tamización primaria para cáncer de cuello uterino en un área demostrativa en Colombia

Revista Colombiana de Cancerología, 2013

Estudio de costo-efectividad de la tamización en cáncer de próstata para colombia

Revista Colombiana de Cancerología, 2013

Objetivo: Describir el riesgo nutricional de pacientes que ingresaron al Instituto Nacional de Ca... more Objetivo: Describir el riesgo nutricional de pacientes que ingresaron al Instituto Nacional de Cancerología (INC) durante el año 2012. Materiales y métodos: Se realizó una revisión de historias clínicas de pacientes mayores de 18 años que ingresaron a los servicios de urgencias, hemato-oncología y cirugía del INC durante 2012, en las cuales se extrajeron los datos de la historia nutricional para obtener las variables clínicas (cambios en el peso, consumo de alimentos, síntomas gastrointestinales y en la capacidad funcional) y en el examen físico (pérdida de grasa subcutánea y muscular, además de edema). Finalmente fue cali cado en tres categorías: bien nutrido, riesgo de desnutrición y desnutrición severa. Se realizó un análisis descriptivo de las variables. Resultados: Se encontraron 159 registros completos. El 63% eran mujeres y presentaban un similar riesgo de desnutrición que los hombres (50 vs 47%, respectivamente). El 15% tenían desnutrición severa y a su vez eran mayores en edad (57 años, en promedio) y tenían la mayor pérdida de peso (37% en promedio) en los últimos 6 meses. Muchos de los pacientes disminuyen la ingesta de alimentos (65%) pero sin cambiar totalmente la consistencia de los mismos. El síntoma gastrointestinal más frecuente fueron las náuseas (38%) seguido de emesis (35%). El 32% presentaban dé cit de reserva grasa y 28% de masa muscular, siendo mayores en los desnutridos severos (92% y 92%, respectivamente). Conclusiones: Son escasos los pacientes tamizados nutricionalmente al momento de hospitalización en el INC. La mayoría de los pacientes se encuentran en riesgo de desnutrición y la desnutrición severa es más común en pacientes mayores. Es necesario establecer una política interna de tamización nutricional que contribuya a evitar la desnutrición y a tratarla tempranamente.

Guía de práctica clínica para el diagnóstico y el tratamiento de las infecciones bacterianas y micóticas en pacientes oncológicos mayores de 15 años con neutropenia febril posquimioterapia de alto riesgo

by Leonardo Enciso and Óscar Gamboa

Revista Colombiana de Cancerología, 2014

PCN16 THE COST AND HEALTH CONSEQUENCES OF DIFFERENT BREAST CANCER SCREENING STRATEGIES IN COLOMBIA

Value in Health, 2009

PUK13 COST-EFFECTIVENESS ANALYSIS OF THE EARLY CONVERSION OF TACROLIMUS TO MTOR INHIBITORS IN PATIENTS WITH RENAL TRANSPLANTATION

by Óscar Gamboa and C. Montero

Value in Health, 2011

The objective of this study is to analyze the relationship between 12-month renal function and co... more The objective of this study is to analyze the relationship between 12-month renal function and costs in post-kidney transplant patients from the Brazilian Public Health System (SUS) perspective. METHODS: Non-interventional, multicenter, retrospective medical chart review of patients that underwent kidney transplantation. Three years follow-up data on resource use and associated costs from adults (ageՆ18 years-old at time of transplantation), single kidney only transplants from Jan/2004 to Jan/2005 were collected from 7 transplant centers in Brazilian hospitals. Data were censored on graft loss. Estimated glomerular filtration rates (eGFR) at 12-month post-transplantation were calculated using the abbreviated Modification of Diet in Renal Disease equation and stratified according to the National Kidney Foundation K/Kidney Disease Outcomes Quality Initiative renal function categories. Costs were adjusted to year 2004 at an annual discount rate of 5% and converted to 2010 USD. Case mix group costing approach was used to determine average cost per day of hospitalization, stratified by cause (surgical or clinical complication) and type (general ward, ICU). RESULTS: 498 subjects were eligible for the analysis. Outpatient care resource use and associated costs (excluding costs with immunosuppressive therapy) did not significantly vary among patients in different eGFR categories, with average annual costs ranging from 664 and 921USD in the first year, 194 and 245USD in the second and 129 and 165USD in the third year post-transplantation. However, a trend towards of increasing inpatient costs (pϽ0.001) and incidence of hospitalization per year with declining of renal function was observed. After 3 years post-transplant, 41% of stage 1 Chronic Kidney Disease (CKD) and 91% of stage 4 patients were re-admited to the hospital at least once incurring an estimated average cost of 1,239 and 3,654USD, respectively. CONCLUSIONS: Renal function, measured by 12-month post-transplant eGFR, is an important determinant of costs of hospitalization in kidney graft recipients.

Cervical Cancer Screening Programs in Latin America and the Caribbean

by Jose Jeronimo and Óscar Gamboa

Vaccine, 2008

Latin America and the Caribbean (LAC) have a significant burden of cervical cancer. Prophylactic ... more Latin America and the Caribbean (LAC) have a significant burden of cervical cancer. Prophylactic human papillomavirus (HPV) vaccines are an opportunity for primary prevention and new screening methods, such as new HPV DNA testing, are promising alternatives to cytology screening that should be analyzed in the context of regional preventive programs. Cytology-based screening programs have not fulfilled their expectations and coverage does not sufficiently explain the lack of impact on screening in LAC. While improved evaluation of screening programs is necessary to increase the impact of screening on the reduction of incidence and mortality, other programmatic aspects will need to be addressed such as follow-up of positive tests and quality control. The implementation of new technologies might enhance screening performance and reduce mortality in the region. The characteristics, performance and impact of cervical cancer screening programs in LAC are reviewed in this article.

Cervical cancer screening with naked-eye visual inspection in Colombia

by Ricardo Cendales, Joaquin Luna, Óscar Gamboa, and violeta cobo

International Journal of Gynecology & Obstetrics, 2010

Objective: To assess the accuracy of visual inspection provided by nurses through combining aceti... more Objective: To assess the accuracy of visual inspection provided by nurses through combining acetic acid (VIA) and Lugol's iodine (VILI) in a low-resource region of Colombia. Methods: A cross-sectional study with 4957 women was conducted to evaluate visual inspection techniques as the basis for see-and-treat approaches in cervical cancer control. All women underwent conventional cytology, VIA performed by nurses, and a combination of VIA and VILI. All women underwent colposcopy and biopsies were obtained for any positive test. Results: A total of 762 women underwent biopsy, 4945 women were included in the analysis of conventional cytology, and 4957 were included in the analysis of VIA and VIA-VILI. Positivity rates were 1.3% and 4.3% for HSIL and LSIL cytology, 7.4% for VIA, and 10.1% for VIA-VILI. Sensitivity for cytology was 52.9% and 36.8% for LSIL and HSIL thresholds, 53.6% for VIA, and 68.1% for VIA-VILI. The corresponding specificity was 95.0%, 99.2%, 93.2%, and 90.8% respectively. The parallel combination of VIA-VILI and cytology LSILthreshold revealed the best performance as a screening strategy. Conclusion: The use of VIA-VILI simulating colposcopic procedures and provided by nurses represents a good alternative for implementing see-andtreat programs in Latin America. Program constraints should be taken into account.

ErbB2+ metastatic breast cancer treatment after progression on trastuzumab: a cost-effectiveness analysis for a developing country

Revista de salud pública (Bogotá, Colombia)

Breast cancer (BC) and metastatic breast cancer (MBC) are significant causes of deaths amongst wo... more Breast cancer (BC) and metastatic breast cancer (MBC) are significant causes of deaths amongst women worldwide, including developing countries. The cost of treatment in the latter is even more of an issue than in higher income countries. ErbB2 overexpression is a marker of poor prognosis and the goal for targeted therapy. This study was aimed at evaluating the cost-effectiveness in Colombia of ErbB2+ MBC treatment after progression on trastuzumab. A decision analytic model was constructed for evaluating such treatment in a hypothetical cohort of ErbB2+MBC patients who progressed after a first scheme involving trastuzumab. The alternatives compared were lapatinib+capecitabine (L+C), and trastuzumab+a chemotherapy agent (capecitabine, vinorelbine or a taxane). Markov models were used for calculating progression-free time and the associated costs. Effectiveness estimators for such therapy were identified from primary studies; all direct medical costs based on national fees-guidelines w...

Efectos de edad, periodo y cohorte en la mortalidad por cáncer de pulmón, próstata, mama y gástrico en colombia entre 1985 y 2009

NUESTRA PRODUCCION

by Óscar Gamboa and Colposcopia Digital

NUESTRA PRODUCCION Gamboa, O.; Chicaiza, L; Molina, M.; Díaz, J.; González, M.; Murillo, R.; Ball... more NUESTRA PRODUCCION Gamboa, O.; Chicaiza, L; Molina, M.; Díaz, J.; González, M.; Murillo, R.; Ballesteros, M.; Sánchez, R. "Cost-effectiveness of conventional cytology and HPV DNA testing for cervical cancer screening in Colombia", "Costo-efectividad de la citología y tamización con pruebas de ADN-VHP para cáncer de cuello uterino en Colombia". Salud Pública, Mex 2008; 50: 276-285. Sandoval, G.; Vacca, C.; Olarte, J. "Medicamentos Vitales no disponibles: análisis de reglamentación nacional e internacional propuesta de actualización del listado nacional". Vitae 2008, 15: 77-90, N°1. Garavito, G.; Bertani, S.; Deharo, E.; "Hallazgos complementarios sobre la actividad antimalárica del azul de metileno y su toxicidad", Vitae 2008, 15: 91-95, N°1.

PCN35 COST-EFFECTIVENESS OF HUMAN PAPILLOMAVIRUS VACCINE IN COLOMBIA IN 2007

Value in Health, 2009

PIN25 COST-EFFECTIVENESS ANALYSIS OF THE INTRODUCTION OF THE VARICELLA VACCINE IN COLOMBIA

by Óscar Gamboa and C. Castañeda

Value in Health, 2011

the model is robust to a wide range of parameter estimates. CONCLUSIONS: This analysis suggests t... more

EVALUACIÓN DE COSTO-EFECTIVIDAD DE LA ADICIÓN DE LA RESONANCIA MAGNÉTICA A LA RADIOGRAFÍA CONVENCIONAL EN LA EVALUACIÓN DE PACIENTES CON PIE DIABÉTICO

En personas con diabetes, una infección en el pie frecuentemente conduce a amputación. La radiogr... more En personas con diabetes, una infección en el pie frecuentemente conduce a amputación. La radiografía plana es el método tradicionalmente usado en la evaluación de las infeccionas óseas del pie, pero comparada con ella, la resonancia magnética es más sensible y específica. Se realiza aquí una evaluación de costo efectividad usando un modelo de Markov para comparar la radiografía convencional

Resultados a largo plazo en una cohorte de mujeres con cáncer de mama de bogotá colombia

by Pedro Ramos and Óscar Gamboa

Revista Colombiana de Cancerología, 2013

Actividad de la telomerasa e infección por VPH en raspados cervicales de mujeres que desarrollaron lesiones escamosas intraepiteliales de alto grado. Un estudio de seguimiento

Revista Colombiana de Cancerología, 2012

Resumen La actividad de la telomerasa (AT) es detectada en altos niveles en líneas celulares inmo... more

Análisis de costo-efectividad en Colombia de anastrazol Vs. tamoxifeno como terapia inicial en mujeres con cáncer temprano de mama y receptor hormonal positivo

Biomédica, 2010

Costo-efectividad de medios de contraste isoosmolales e hiposmolales en pacientes con alto riesgo de nefropatía inducida por medio de contraste

Biomédica, 2012

Introduction. Contrast media can cause acute renal failure by direct toxic effects on the tubular... more Introduction. Contrast media can cause acute renal failure by direct toxic effects on the tubular cells and kidney ischemia. Diabetics and hospitalized patients have a greater risk of developing contrastinduced nephropathy than the general population. Objective. The cost effectiveness of iso and low-osmolality contrast media was assessed in high risk outpatients. Materials and methods. The analysis was based on a systematic literature review comparing the nephrotoxic effects of iso-to low-osmolality contrast media. Only direct costs were considered; these were obtained from the official tariff manual. Incremental cost-effectiveness ratios, efficiency curves and acceptability curves were calculated. Univariate sensitivity analyses were performed for costs and effects, as well as probabilistic analyses. Zero and 3% discounts were applied to results. The costeffectiveness threshold was equal to the per capita GDP per life-year gained. Results. Alternatives with Iopamidol and Iodixanol are preferable to the others, because both reduce risk of contrast-induced nephropathy and are less costly. The incremental cost-effectiveness of the Iodixanol alternative compared to the Iopamidol alternative is US$ 14,660 per additional life year gained; this is more than twice the threshold. Conclusion. The low-osmolality contrast medium, Iopamidol, appears to be cost-effective when compared with Iohexol or other low-osmolality contrast media (Iopromide, Iobitridol, Iomeprol, Iopentol and Ioxilan) in contrast-induced nephropathy, high-risk outpatients. The choice of the iso-osmolality contrast medium, Iodixanol, depends on its cost per vial and on the willingness to pay.

Abandono del tratamiento: una causa de muerte evitable en el niño con cáncer

Revista Colombiana de Cancerología, 2011

Fecha de recepción: 17 de noviembre del 2010. Fecha de aprobación: 15 de marzo del 2011

Impacto Económico de la Vacuna contra el Neumococo en Pacientes Oncológicos

Revista de Salud Pública, 2007

Modelos empleados para la Toma de Decisiones en el Cuidado de la Salud

Revista de Salud Pública, 2008

Barreras para la implementación de la prueba ADN-VPH como técnica de tamización primaria para cáncer de cuello uterino en un área demostrativa en Colombia

Revista Colombiana de Cancerología, 2013

Estudio de costo-efectividad de la tamización en cáncer de próstata para colombia

Revista Colombiana de Cancerología, 2013

Objetivo: Describir el riesgo nutricional de pacientes que ingresaron al Instituto Nacional de Ca... more Objetivo: Describir el riesgo nutricional de pacientes que ingresaron al Instituto Nacional de Cancerología (INC) durante el año 2012. Materiales y métodos: Se realizó una revisión de historias clínicas de pacientes mayores de 18 años que ingresaron a los servicios de urgencias, hemato-oncología y cirugía del INC durante 2012, en las cuales se extrajeron los datos de la historia nutricional para obtener las variables clínicas (cambios en el peso, consumo de alimentos, síntomas gastrointestinales y en la capacidad funcional) y en el examen físico (pérdida de grasa subcutánea y muscular, además de edema). Finalmente fue cali cado en tres categorías: bien nutrido, riesgo de desnutrición y desnutrición severa. Se realizó un análisis descriptivo de las variables. Resultados: Se encontraron 159 registros completos. El 63% eran mujeres y presentaban un similar riesgo de desnutrición que los hombres (50 vs 47%, respectivamente). El 15% tenían desnutrición severa y a su vez eran mayores en edad (57 años, en promedio) y tenían la mayor pérdida de peso (37% en promedio) en los últimos 6 meses. Muchos de los pacientes disminuyen la ingesta de alimentos (65%) pero sin cambiar totalmente la consistencia de los mismos. El síntoma gastrointestinal más frecuente fueron las náuseas (38%) seguido de emesis (35%). El 32% presentaban dé cit de reserva grasa y 28% de masa muscular, siendo mayores en los desnutridos severos (92% y 92%, respectivamente). Conclusiones: Son escasos los pacientes tamizados nutricionalmente al momento de hospitalización en el INC. La mayoría de los pacientes se encuentran en riesgo de desnutrición y la desnutrición severa es más común en pacientes mayores. Es necesario establecer una política interna de tamización nutricional que contribuya a evitar la desnutrición y a tratarla tempranamente.

Guía de práctica clínica para el diagnóstico y el tratamiento de las infecciones bacterianas y micóticas en pacientes oncológicos mayores de 15 años con neutropenia febril posquimioterapia de alto riesgo

by Leonardo Enciso and Óscar Gamboa

Revista Colombiana de Cancerología, 2014

PCN16 THE COST AND HEALTH CONSEQUENCES OF DIFFERENT BREAST CANCER SCREENING STRATEGIES IN COLOMBIA

Value in Health, 2009

PUK13 COST-EFFECTIVENESS ANALYSIS OF THE EARLY CONVERSION OF TACROLIMUS TO MTOR INHIBITORS IN PATIENTS WITH RENAL TRANSPLANTATION

by Óscar Gamboa and C. Montero

Value in Health, 2011

The objective of this study is to analyze the relationship between 12-month renal function and co... more The objective of this study is to analyze the relationship between 12-month renal function and costs in post-kidney transplant patients from the Brazilian Public Health System (SUS) perspective. METHODS: Non-interventional, multicenter, retrospective medical chart review of patients that underwent kidney transplantation. Three years follow-up data on resource use and associated costs from adults (ageՆ18 years-old at time of transplantation), single kidney only transplants from Jan/2004 to Jan/2005 were collected from 7 transplant centers in Brazilian hospitals. Data were censored on graft loss. Estimated glomerular filtration rates (eGFR) at 12-month post-transplantation were calculated using the abbreviated Modification of Diet in Renal Disease equation and stratified according to the National Kidney Foundation K/Kidney Disease Outcomes Quality Initiative renal function categories. Costs were adjusted to year 2004 at an annual discount rate of 5% and converted to 2010 USD. Case mix group costing approach was used to determine average cost per day of hospitalization, stratified by cause (surgical or clinical complication) and type (general ward, ICU). RESULTS: 498 subjects were eligible for the analysis. Outpatient care resource use and associated costs (excluding costs with immunosuppressive therapy) did not significantly vary among patients in different eGFR categories, with average annual costs ranging from 664 and 921USD in the first year, 194 and 245USD in the second and 129 and 165USD in the third year post-transplantation. However, a trend towards of increasing inpatient costs (pϽ0.001) and incidence of hospitalization per year with declining of renal function was observed. After 3 years post-transplant, 41% of stage 1 Chronic Kidney Disease (CKD) and 91% of stage 4 patients were re-admited to the hospital at least once incurring an estimated average cost of 1,239 and 3,654USD, respectively. CONCLUSIONS: Renal function, measured by 12-month post-transplant eGFR, is an important determinant of costs of hospitalization in kidney graft recipients.

Cervical Cancer Screening Programs in Latin America and the Caribbean

by Jose Jeronimo and Óscar Gamboa

Vaccine, 2008

Latin America and the Caribbean (LAC) have a significant burden of cervical cancer. Prophylactic ... more Latin America and the Caribbean (LAC) have a significant burden of cervical cancer. Prophylactic human papillomavirus (HPV) vaccines are an opportunity for primary prevention and new screening methods, such as new HPV DNA testing, are promising alternatives to cytology screening that should be analyzed in the context of regional preventive programs. Cytology-based screening programs have not fulfilled their expectations and coverage does not sufficiently explain the lack of impact on screening in LAC. While improved evaluation of screening programs is necessary to increase the impact of screening on the reduction of incidence and mortality, other programmatic aspects will need to be addressed such as follow-up of positive tests and quality control. The implementation of new technologies might enhance screening performance and reduce mortality in the region. The characteristics, performance and impact of cervical cancer screening programs in LAC are reviewed in this article.

Cervical cancer screening with naked-eye visual inspection in Colombia

by Ricardo Cendales, Joaquin Luna, Óscar Gamboa, and violeta cobo

International Journal of Gynecology & Obstetrics, 2010

Objective: To assess the accuracy of visual inspection provided by nurses through combining aceti... more Objective: To assess the accuracy of visual inspection provided by nurses through combining acetic acid (VIA) and Lugol's iodine (VILI) in a low-resource region of Colombia. Methods: A cross-sectional study with 4957 women was conducted to evaluate visual inspection techniques as the basis for see-and-treat approaches in cervical cancer control. All women underwent conventional cytology, VIA performed by nurses, and a combination of VIA and VILI. All women underwent colposcopy and biopsies were obtained for any positive test. Results: A total of 762 women underwent biopsy, 4945 women were included in the analysis of conventional cytology, and 4957 were included in the analysis of VIA and VIA-VILI. Positivity rates were 1.3% and 4.3% for HSIL and LSIL cytology, 7.4% for VIA, and 10.1% for VIA-VILI. Sensitivity for cytology was 52.9% and 36.8% for LSIL and HSIL thresholds, 53.6% for VIA, and 68.1% for VIA-VILI. The corresponding specificity was 95.0%, 99.2%, 93.2%, and 90.8% respectively. The parallel combination of VIA-VILI and cytology LSILthreshold revealed the best performance as a screening strategy. Conclusion: The use of VIA-VILI simulating colposcopic procedures and provided by nurses represents a good alternative for implementing see-andtreat programs in Latin America. Program constraints should be taken into account.