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"descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Cost-effectiveness plan for the early phase and the established phase.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease that, untreated, leads to disability, pain, reduced quality of life, and premature mortality.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> According to the Colombian Fund for High-Cost Diseases (CAC by its acronym in Spanish), even though the global prevalence of RA is low (ranges from 0.2% to 5%), Colombia reported a prevalence of 0.23 cases per 100 inhabitants and an incidence of 13.78 per 100,000 inhabitants in 2018. The regions with the highest prevalence included Bogotá DC, Risaralda, Caldas, and Antioquia. The average age of reported patients was 57.8 years, with a male-to-female ratio of 1:5, and the mean age range at RA diagnosis was 36–64 years.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Patients with RA can be classified into early or established phases.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–7</span></a> The early phase refers to ≤12 months from symptom onset to starting treatment with disease-modifying drugs (DMARDs), while, in the established phase, this time is longer than 12 months.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> These phases are mutually exclusive and not consecutive and occur only once in a patient's lifetime.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,5,7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">However, in the early course of the disease, RA presents a phenotype with immunoregulatory alterations that can be temporarily or permanently blocked; thus, early treatment of RA is crucial due to its potential to prevent long-term joint damage and improve cumulative quality of life.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Concerningly, the 2018 CAC report highlighted low compliance with opportunity indicators such as time of onset of symptoms to specialist care, diagnosis, and DMARD treatment initiation.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Also, it is important to address RA activity levels, assessed by Disease Activity Score-28 (DAS28), categorizing subjects into remission (<2.4), low (2.4–3.6), moderate (3.6–5.5), and severe activity (≥5.5).<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Achieving remission or low activity is an international therapeutic target, including Colombia, to prevent complications, disability, and improve patient quality of life.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,10</span></a> Furthermore, this is a therapeutic goal that can be achieved in the short-term; therefore, after six months, the patient can be classified as target or non-target (moderate or severe activity).<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> However, the 2018 CAC report indicated that only 44% of patients initially in high activity achieved remission, with 69% remaining in high activity, underscoring the need for improved therapeutic outcomes.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">RA is categorized as a high-cost disease due to its impact on productivity, medical expenses, out-of-pocket costs, medications, hospitalizations, surgeries, and interdisciplinary care due to the high consumption of resources.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,5,8</span></a> Thus, based on the 2018 CAC report, the estimated average six-month cost per patient in remission was $15,885,885 Colombian pesos in current currency (COP<span class="elsevierStyleInf">cte</span>). Extrapolating this to the entire cohort evaluated in the report (79,199 patients) <span class="elsevierStyleSup">2</span> that had reached remission would suggest management costs of approximately 1.2 billion COP. This prompts the question: how can pharmacoeconomics help Colombia ensure most patients achieve treatment goals at a lower cost?</p><p id="par0030" class="elsevierStylePara elsevierViewall">Similarly, the question arose: is there a cost-effectiveness analysis that compares the clinical approach to RA in the early vs. established phases in Colombia? At the University Hospital of the Fundacion Santa Fe de Bogotá (HUFSFB), a quaternary health service institution in Colombia, many patients are referred by the Health Promotion Entity (EPS for its acronym in Spanish) after 12 months of symptoms, classifying them in the established phase. The lack of cost-effectiveness studies comparing early versus established phase approaches in Colombia in a real cohort of patients with the relevance of providing viability to developing health programs that promote the early diagnosis and treatment of RA prompted this research.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The purpose of this research was to conduct an economic evaluation answering how costly and effective is treating early-phase RA patients compared to those in the established phase. The study aimed to identify costs, compare effectiveness, and estimate the incremental cost-effectiveness ratio (ICER) of these approaches.</p><p id="par0040" class="elsevierStylePara elsevierViewall">This research contributes new insights into RA management in Colombia, informing health policies by the entities administering benefit plans, according to the incremental cost per unit of effectiveness, based on real cohort data rather than simulations. It provides a foundational basis for further research into the national budgetary impacts of early versus established phase approaches, aiming to enhance RA management programs across the country.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Delimitation of the population under study and research problem</span><p id="par0045" class="elsevierStylePara elsevierViewall">Following the PICOT question format—Patient, Intervention, Comparison, Outcome, and Time—this study focused on adult patients diagnosed with RA. The intervention of interest was the early-phase approach, defined as the initial clinical management upon RA diagnosis, compared to the established-phase approach. The primary outcome evaluated was disease level categorized as “target”,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> with a follow-up period of six months ± one month for both cost and effectiveness assessments. Regarding the time horizon, exactly six months was not chosen, because not all patients attended follow-up during their first six months of treatment.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10–15</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Information collection</span><p id="par0050" class="elsevierStylePara elsevierViewall">Clinical approach data for patients were extracted from medical records at HUFSFB and validated through meticulous data mining processes.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The study ensured consistency in clinical approaches across early and established phases at HUFSFB, minimizing bias in approach variability, and making it possible to analyze whether there is a discrepancy in the costs and effectiveness due to the phase of disease. The institution's standardized care model adheres closely to national clinical guidelines, ensuring uniformity in patient management protocols, from referral criteria by the EPS, admission, physical examination, and tests; the latter are taken and analyzed in the same center.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Moreover, internal monitoring of this model guarantees adherence by healthcare professionals to defined care protocols.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The comprehensive nature of this model allows direct comparison between early and established phases, mitigating potential biases arising from different care pathways based on disease phase.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Importantly, resource prescription at HUFSFB is unrestricted, ensuring patients receive necessary treatments irrespective of disease phase.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Therefore, the HUFSFB comprehensive care model is essential, since it allows us to assess whether the cost differential is due to the phase in which the patient is located.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Cohort description and sample design</span><p id="par0060" class="elsevierStylePara elsevierViewall">The study utilized data from HUFSFB spanning May 2013 to December 2018, comprising 971 subjects (181 in the early phase, 790 in the established phase). A non-probabilistic inclusion method encompassed patients meeting specific criteria<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>:</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Inclusion criteria</span><p id="par0065" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">a)</span><p id="par0070" class="elsevierStylePara elsevierViewall">Complete and consistent data with medical records</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">b)</span><p id="par0075" class="elsevierStylePara elsevierViewall">Confirmed RA diagnosis</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">c)</span><p id="par0080" class="elsevierStylePara elsevierViewall">At least one follow-up</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">d)</span><p id="par0085" class="elsevierStylePara elsevierViewall">Age over 18</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">e)</span><p id="par0090" class="elsevierStylePara elsevierViewall">Absence of other immunological disorders.</p></li></ul></p><p id="par0095" class="elsevierStylePara elsevierViewall">Exclusion criteria included duplicate follow-ups.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Subsequent univariate analysis and Propensity Score matching were employed,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> and subjects within the six months ± one month follow-up timeframe were selected.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Costs</span><p id="par0105" class="elsevierStylePara elsevierViewall">Direct medical costs over six-month periods were estimated based on PICOT parameters. Thus, given that the database did not contain the cost of the approach, identification, quantification, and assessment of cost-generating events were conducted under the assumption that prescribed medications were dispensed and consumed by patients, without applying a discount rate.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16,17</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">About the directionality of costs, the compilation of the use of cost-generating events used a bottom-up approach, until the total cost of the intervention for patients in each phase was obtained according to its final effectiveness (target or non-target)<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> detailing expenditures related to medications, clinical laboratories, hospitalizations, and consultations.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> Costs were measured in COP<span class="elsevierStyleInf">cte</span>.</p><p id="par0115" class="elsevierStylePara elsevierViewall">For medication costs, the Anatomical Therapeutic Chemical Classification Code (ATC) was used, while other cost-generating events employed the Mandatory Traffic Accident Insurance (SOAT) code.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> Data sources included the Drug Price Information System 2018,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> SOAT Tariff Manual,<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> and National Commission for Prices of Drugs and Medical Devices Circular 04 of 2018.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> Unit values from 2018 were applied uniformly across the study period, regardless of the period they had their six ± one month follow-up.</p><p id="par0120" class="elsevierStylePara elsevierViewall">Regarding adverse drug reactions,<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> the number of patients on target in both phases was compared and p-values were calculated, yet no difference was found in the proportion of subjects who presented them. Thus, these probabilities were not included in the model. In the database delivered and authorized for this assessment, there was only data on the number of subjects with adverse drug events, and it was specified which medication it was associated with, but detailed information about the type of event was missing; however, the HUFSFB explained that, according to confidential medical records, minor events were managed by reducing the medication dose or withdrawing it.</p><p id="par0125" class="elsevierStylePara elsevierViewall">For the costing that will be presented in the analysis, the average semiannual cost of a patient per cost-generating event was calculated among the subjects who used the event, as follows: the amount of the event was multiplied by its unit value and divided between the number of patients who used the event; these results were then totaled by corresponding activity (medications, clinical laboratories, hospital admissions, and consultations). The costs that entered the model were calculated with the following difference: the amount was multiplied by the unit value of each cost-generating event, totaled, and then divided by the total number of patients in the corresponding subgroup (understood as target early phase, non-target early phase, target established phase, and non-target established phase) so that the cost was jointly assumed among all patients in the subgroup. This was determined in such a way the effectiveness probabilities used in the model were unique per subgroup.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Effectiveness</span><p id="par0130" class="elsevierStylePara elsevierViewall">Effectiveness was assessed by the proportion of patients achieving treatment goals<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> within the initial six months ± one month follow-up period.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> The minimum and maximum effectiveness were calculated by adjusting base case effectiveness data, subtracting and adding 10%, respectively.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Model</span><p id="par0135" class="elsevierStylePara elsevierViewall">An analytical decision tree model was developed in Excel® to assess costs and effectiveness between early-phase and established-phase RA approaches, reflecting the study's defined time horizon and outcomes. Based on the time horizon defined for the study and the type of outcome, this was considered the best model following good modeling practices.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22–25</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Incremental cost-effectiveness ratio (ICER)</span><p id="par0140" class="elsevierStylePara elsevierViewall">ICER calculations were performed in Excel®.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a></p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Sensitivity analysis</span><p id="par0145" class="elsevierStylePara elsevierViewall">Deterministic and probabilistic sensitivity analyses in Excel® assessed the impact of variable uncertainties on ICER outcomes.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">27–29</span></a></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Error and bias control strategies</span><p id="par0150" class="elsevierStylePara elsevierViewall">All patients were included regardless of initial activity level, considering potential changes by the study's time horizon. Activity level was factored into matching processes to balance target and non-target subjects at baseline.</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Results</span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Descriptive statistical analysis</span><p id="par0155" class="elsevierStylePara elsevierViewall">To characterize the population (971 patients: 181 in the early phase and 790 in the established phase), the database was reviewed for sociodemographic and clinical variables. Sociodemographic variables included age, education, marital status, population group, and gender. Clinical variables included body mass index (BMI), smoking (SMK), rheumatoid factor (RF), cyclic citrullinated peptide (CCP) antibodies, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), DAS28 (to determine RA activity level), Health Assessment Questionnaire (HAQ), and active alcohol consumption.</p><p id="par0160" class="elsevierStylePara elsevierViewall">The inclusion and exclusion criteria described in the methodology were applied to the patient records, resulting in 128 patients in the early phase and 551 in the established phase. Univariate analysis revealed significant differences between the phases for age, SMK, HAQ, disease activity levels (in goals and non-goals), and active alcohol consumption, with <span class="elsevierStyleItalic">P</span>-values below .05 (see <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Pairing</span><p id="par0165" class="elsevierStylePara elsevierViewall">Given the observed differences in variables, the nearest neighbor Propensity Score method was used for matching to ensure homogeneity between the early and established phase patients.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> Variables showing statistical differences, as per literatura,<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">31–37</span></a> were included in the matching process to correlate with the effectiveness outcome (disease activity).</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Propensity score matching method</span><p id="par0170" class="elsevierStylePara elsevierViewall">Cases consisted of patients from the early phase, while controls were from the established phase, since the first is the one of interest and with the smallest number of people, with two controls per case for increased robustness.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> This resulted in 128 trios: 128 subjects in the early phase (cases) and 256 in the established phase (controls). Matching reduced mean differences between early and established phase groups by 81% to 17% compared to unmatching (see <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Post-matching univariate analysis</span><p id="par0175" class="elsevierStylePara elsevierViewall">No significant differences were found between early and established phases for age, SMK, HAQ, and disease activity levels in goals and non-goals. The p-value for active alcoholism was not corrected due to low numbers (nine individuals in the early phase and five in the established phase), which may not influence study outcomes significantly (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Application of time horizon</span><p id="par0180" class="elsevierStylePara elsevierViewall">Applying the time horizon to matched patients with a follow-up of six months (±1 month), there were 103 trios, resulting in 103 patients in the early phase and 206 in the established phase, given the 2:1 ratio.</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Costs</span><p id="par0185" class="elsevierStylePara elsevierViewall">As shown in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>, costs in the early phase for targeted goals were higher in medications by 36%, followed by hospitalizations (32%), clinical laboratories (23%), and consultations (9%). Average six-month costs per patient in targeted goals were $3,565,017 COP <span class="elsevierStyleInf">cte</span>. Conversely, in the early non-target phase, costs were highest in medications (41%), followed by hospitalizations (24%), clinical laboratories (21%), and consultations (14%), with an average six-month cost per patient of $4,141,960 COP<span class="elsevierStyleInf">cte</span>.</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0190" class="elsevierStylePara elsevierViewall">Therefore, the difference in average semiannual cost per person when comparing the early phase between goals and non-goals is 14 percentage points less in goals, equivalent to $576,943 COP<span class="elsevierStyleInf">cte</span>. This indicates that costs were higher for non-goals, reflecting a higher percentage of medication use during the early phase without goals. Notably, neither targets nor non-targets received biological DMARDs during this period. Non-biological medications used included prednisolone, folic acid, methotrexate, chloroquine, sulfasalazine, leflunomide, azathioprine, and cyclosporine.</p><p id="par0195" class="elsevierStylePara elsevierViewall">In the established goals phase, medication costs accounted for 96%, followed by clinical laboratories (3%), consultations (1%), and hospitalizations (0%), with an average six-monthly patient cost of $23,911,480 COP<span class="elsevierStyleInf">cte</span>. Conversely, in the established non-goal phase, medication costs were 91%, clinical laboratories 4%, hospitalizations 3%, and consultations 2%, with an average cost of $18,353,624 COP<span class="elsevierStyleInf">cte</span> per patient. This resulted in a 23.2 percentage points higher average semiannual cost per person in goals compared to non-goals, totaling $5,557,856 COP<span class="elsevierStyleInf">cte,</span> highlighting higher expenses in the goals group due to increased biological DMARDs use (etanercept 2.29% and adalimumab 0.76%).</p><p id="par0200" class="elsevierStylePara elsevierViewall">Considering the above analysis, the difference in average semiannual cost per patient between the early and established phases was significant: the cost was 85% higher in the established phase for goals compared to early phase goals, indicating higher expenses per patient in the established phase for goals. Similarly, for non-goals, the average cost increased by 77% in the established phase compared to the early phase, showing increased expenses in the established phase. Thus, subjects in the early phase were generally less expensive compared to those in the established phase, regardless of goal achievement (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Effectiveness</span><p id="par0205" class="elsevierStylePara elsevierViewall">As shown in <a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>, at the six-month follow-up, 75.7% of patients in the early phase achieved goals compared to 63.6% in the established phase, with a statistically significant difference (<span class="elsevierStyleItalic">P</span> = .043) at a significance level of 0.05, indicating effectiveness variations.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Model</span><p id="par0210" class="elsevierStylePara elsevierViewall">A decision tree<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24,25</span></a> (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) was designed for RA, assuming no interaction between individuals, mutually exclusive phases, and it is not a contagious disease. Likewise, for this case, it was required to compare two cohorts and it was assumed that there is no resource restriction for patient care. The model incorporated data on goal effectiveness probabilities and associated costs to derive ICER results.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0180">Incremental cost-effectiveness ratio (ICER)</span><p id="par0215" class="elsevierStylePara elsevierViewall">The cost-effectiveness plane (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>) revealed a dominant ICER of −$2,326,389 COP<span class="elsevierStyleInf">cte</span> (savings) per patient in goals addressed in the early versus the established phase in the base case scenario.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0185">Deterministic sensitivity analysis</span><p id="par0220" class="elsevierStylePara elsevierViewall">The tornado diagram (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>) identified “cost of early goals,” “cost of established goals,” and “cost of early non-goals” as the top contributors to model uncertainty. The only variables affecting the ICER conclusion were “cost of early goals” and “cost of non-early goals” (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>); when the cost exceeded approximately $1,500,000 COP<span class="elsevierStyleInf">cte</span> for early goals or $2,650,000 COP<span class="elsevierStyleInf">cte</span> for non-early goals, the ICER turned positive.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a></p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0190">Probabilistic sensitivity analysis</span><p id="par0225" class="elsevierStylePara elsevierViewall">To analyze the behavior of the ICER around a willingness to pay, the CAC reported that the annual cost of DMARDs not in the Basic Health Plan (PBS by its acronym in Spanish) was $5,783,292 COP<span class="elsevierStyleInf">cte</span>, and the annual cost of care was $2,585. 497 COP<span class="elsevierStyleInf">cte</span>. Considering a willingness to pay would be the semiannual cost of $4,184,395 COPcte (threshold). Thus, according to <a class="elsevierStyleCrossRef" href="#fig0030">Fig. 6</a>, for the first quadrant, 1.2% of the ICER were above the threshold (non-cost-effective) and 9.2% were below (cost-effective). Secondly, 88.6% are in the fourth quadrant; hence, addressing a patient in the early phase is dominant in 88.6% (less expensive and more effective) over the established phase. Additionally, 0.1% of the calculated ICERs are in the second quadrant. In that sense, in 0.1% of the results, the early phase is dominated by the established phase. Consequently, 97.8% of the RICE is below the chosen willingness to pay, being cost-effective in favor of the early phase.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><elsevierMultimedia ident="fig0030"></elsevierMultimedia></span><span id="sec0125" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0195">Acceptability curve</span><p id="par0230" class="elsevierStylePara elsevierViewall">According to <a class="elsevierStyleCrossRef" href="#fig0035">Fig. 7</a>, at zero willingness to pay, there was an 88.7% probability that the early phase approach was cost-effective, compared to 11.3% for the established phase. Likewise, the acceptability curve allows us to infer that, with a willingness to pay of $4,184,395 COP<span class="elsevierStyleInf">cte</span>, (threshold - red dot), the probability of cost-effectiveness for the early phase approach rose to 98.7%.</p><elsevierMultimedia ident="fig0035"></elsevierMultimedia></span></span><span id="sec0130" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0200">Discussion</span><p id="par0235" class="elsevierStylePara elsevierViewall">In this research, a comprehensive cost-effectiveness analysis was conducted, revealing that the early phase approach is both less costly and more effective compared to the established phase. However, due to the absence of prior cost-effectiveness studies directly comparing these phases, the results cannot be directly contrasted with similar investigations. Nevertheless, our chosen economic assessment method was ideal, since enabled us to evaluate differential costs and effectiveness, calculating the incremental cost-effectiveness ratio and aligning it with willingness-to-pay thresholds.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a></p><p id="par0240" class="elsevierStylePara elsevierViewall">Moreover, we assert the relevance of this research to national health policies, underscoring the importance of implementing strategies that ensure timely access to specialized services for managing RA during its early stages. Furthermore, it holds significant implications for clinical practice, as early intervention improves patient prognosis. Clinical experience at HUFSFB suggests that some patients can achieve sustained remission without requiring biological DMARDs, a benefit less observed in the established phase.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,40</span></a> The standardized comprehensive care model at HUFSFB<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> likely contributes to these positive outcomes and should be promoted alongside protocols prioritizing timely care.</p><p id="par0245" class="elsevierStylePara elsevierViewall">Additionally, the potential long-term return on investment in early intervention may pique the interest of decision-makers, given the savings to third-party payers.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,41,42</span></a> While the findings are specific to the context of the third payer, the cohort, and the care model at HUFSFB, it is important to think that, if the average semiannual cost per patient in remission goes from $15,885,885 COP<span class="elsevierStyleInf">cte</span><a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> to $3,565,017 (calculated in this research), and all the prevalence in 2018 would have reached goals, the total cost could be reduced from $1.2 trillion to $282,345 million COP<span class="elsevierStyleInf">cte</span>, broadly speaking. All of this would indicate that prioritizing care in the early phase could make a difference in cost issues for the treatment of RA in Colombia.</p></span><span id="sec0135" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0205">Conclusion</span><p id="par0250" class="elsevierStylePara elsevierViewall">The average semiannual costs per patient achieving goals were as follows: $3,565,017 COP<span class="elsevierStyleInf">cte</span> for target early phase, $4,141,960 COP<span class="elsevierStyleInf">cte</span> for non-target early phase, $23,911,480 COP<span class="elsevierStyleInf">cte</span> for target established phase, and $18,353,624 COP<span class="elsevierStyleInf">cte</span> for non-target established phase. Effectiveness, measured by the proportion of patients achieving goals at six months, was 75.7% in the early phase and 63.6% in the established phase.</p><p id="par0255" class="elsevierStylePara elsevierViewall">The clinical approach to RA in the early phase proves to be less expensive and more effective compared to the established phase. In the base case, the research indicates that the ICER resulted in cost savings of −$2,326,389 COP<span class="elsevierStyleInf">cte</span> per patient achieving goals in the early phase compared to the established phase costs in 2018, over a six-month ± one-month follow-up in the cohorts. It is important to note that the model does not include probabilities of adverse events due to their similarity between cohorts, and the small sample size did not allow correction of the p-value for active alcoholism.</p><span id="sec0140" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0210">Previous cost-effectiveness studies</span><p id="par0260" class="elsevierStylePara elsevierViewall">A literature review was conducted across several databases (LILACS, SCIELO, Redalyc, Web of Science, Google Scholar, PubMed, and SCOPUS), in which the search terms: “cost-effectiveness”, “early arthritis”, “established arthritis” were introduced, and the Boolean term “AND” focusing on studies comparing early and established phases of arthritis in terms of cost-effectiveness. The search encompassed articles and clinical cohort studies published in English and Spanish up until 2018, reflecting the data analyzed for this study. Additionally, recent studies from 2022 to 2023 were considered for comparative purposes in this publication.</p></span></span><span id="sec0145" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0215">Ethical considerations</span><p id="par0265" class="elsevierStylePara elsevierViewall">The study obtained informed consent from patients at HUFSFB and adhered to bioethical research regulations, receiving approval from both the HUFSFB and Universidad Nacional de Colombia ethics committees.</p></span><span id="sec0150" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0220">Financing</span><p id="par0270" class="elsevierStylePara elsevierViewall">The study was conducted with data collection supported by HUFSFB. The study design, analysis, interpretation, article writing, and the decision to submit the article for publication were performed by the authors independently under a master's thesis in pharmacology at the Universidad Nacional de Colombia.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> While the research did not receive direct funding during its execution, it was recognized with the 2020 National Rheumatology Award, securing second place and an associated financial award from the Colombian Association of Rheumatology Congress.</p></span><span id="sec0155" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0225">Conflict of interests</span><p id="par0275" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:14 [ 0 => array:3 [ "identificador" => "xres2246686" "titulo" => "Abstract" 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"xpalclavsec1879167" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:10 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Delimitation of the population under study and research problem" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Information collection" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Cohort description and sample design" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Inclusion criteria" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Costs" ] 5 => array:2 [ "identificador" => "sec0040" "titulo" => "Effectiveness" ] 6 => array:2 [ "identificador" => "sec0045" "titulo" => "Model" ] 7 => array:2 [ "identificador" => "sec0050" "titulo" => "Incremental cost-effectiveness ratio (ICER)" ] 8 => array:2 [ "identificador" => "sec0055" "titulo" => "Sensitivity analysis" ] 9 => array:2 [ "identificador" => "sec0060" "titulo" => "Error and bias control strategies" ] ] ] 6 => array:3 [ "identificador" => "sec0065" "titulo" => "Results" "secciones" => array:12 [ 0 => array:2 [ "identificador" => "sec0070" "titulo" => "Descriptive statistical analysis" ] 1 => array:2 [ "identificador" => "sec0075" "titulo" => "Pairing" ] 2 => array:2 [ "identificador" => "sec0080" "titulo" => "Propensity score matching method" ] 3 => array:2 [ "identificador" => "sec0085" "titulo" => "Post-matching univariate analysis" ] 4 => array:2 [ "identificador" => "sec0090" "titulo" => "Application of time horizon" ] 5 => array:2 [ "identificador" => "sec0095" "titulo" => "Costs" ] 6 => array:2 [ "identificador" => "sec0100" "titulo" => "Effectiveness" ] 7 => array:2 [ "identificador" => "sec0105" "titulo" => "Model" ] 8 => array:2 [ "identificador" => "sec0110" "titulo" => "Incremental cost-effectiveness ratio (ICER)" ] 9 => array:2 [ "identificador" => "sec0115" "titulo" => "Deterministic sensitivity analysis" ] 10 => array:2 [ "identificador" => "sec0120" "titulo" => "Probabilistic sensitivity analysis" ] 11 => array:2 [ "identificador" => "sec0125" "titulo" => "Acceptability curve" ] ] ] 7 => array:2 [ "identificador" => "sec0130" "titulo" => "Discussion" ] 8 => array:3 [ "identificador" => "sec0135" "titulo" => "Conclusion" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0140" "titulo" => "Previous cost-effectiveness studies" ] ] ] 9 => array:2 [ "identificador" => "sec0145" "titulo" => "Ethical considerations" ] 10 => array:2 [ "identificador" => "sec0150" "titulo" => "Financing" ] 11 => array:2 [ "identificador" => "sec0155" "titulo" => "Conflict of interests" ] 12 => array:2 [ "identificador" => "xack775173" "titulo" => "Acknowledgments" ] 13 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-08-15" "fechaAceptado" => "2023-06-27" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1879166" "palabras" => array:5 [ 0 => "Rheumatoid arthritis" 1 => "Cost" 2 => "Effectiveness" 3 => "Early phase" 4 => "Established phase" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1879167" "palabras" => array:5 [ 0 => "Artritis reumatoide" 1 => "Costo" 2 => "Efectividad" 3 => "Fase temprana" 4 => "Fase establecida" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Rheumatoid arthritis (RA) is a high-cost disease, which allows patients to be classified into early or established phase approaches.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">The purpose of this work was to perform a cost-effectiveness analysis comparing both phases with patient data at a 6-month time horizon from a third-party payer perspective.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Materials and methods</span><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">The population was delimited. The costs and effectiveness of each of the phases were estimated. A decision tree-type economic evaluation model was developed, and the Incremental Cost-Effectiveness Ratio (ICER) was calculated with the respective sensitivity analyses, both deterministic and probabilistic.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">In terms of costs, it was found that for effectiveness in goals, the cost was 85% higher in the established than in the early phase. Similarly, for non-target effectiveness, the cost was 77% higher in the established than in the early phase. On the other hand, the effectiveness results were better in the early phase compared to the established phase. Regarding the ICER, it was determined that the early phase approach saves $2,326,389 COP<span class="elsevierStyleInf">cte</span> (colombian pesos current currency) per patient in goals at 6 months of treatment, compared to the established phase approach.</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusion</span><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">The clinical approach to early-stage rheumatoid arthritis is a less costly and more effective alternative vs. the established phase, as it generates savings for the third-party payer over a 6-month time horizon, from a third-party payer perspective.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Materials and methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducción</span><p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">La artritis reumatoide (AR) es una enfermedad de alto costo, que permite clasificar a los pacientes en fase temprana o establecida.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">El propósito de este trabajo fue hacer un análisis de costoefectividad, comparando ambas fases con datos de pacientes a un horizonte temporal de 6 meses, desde la perspectiva del tercer pagador.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Materiales y métodos</span><p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">Se delimitó la población. Se estimaron los costos y las efectividades de cada una de las fases. Se desarrolló un modelo de evaluación económica de tipo árbol de decisión y se calculó la razón incremental costoefectividad (RICE) con sus respectivos análisis de sensibilidad, tanto determinístico como probabilístico.</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0130" class="elsevierStyleSimplePara elsevierViewall">En términos de costos, se encontró que para una efectividad en metas el costo fue un 85% mayor en fase establecida que en fase temprana. Igualmente, para una efectividad en no metas, el costo fue un 77% mayor en fase establecida que en fase temprana. Por otra parte, los resultados de efectividad salieron a favor de la fase temprana en comparación con la fase establecida. Con respecto a la RICE, se determinó que el abordaje en fase temprana ahorra $2.326.389 COP<span class="elsevierStyleInf">cte</span> (pesos colombianos moneda corriente) por paciente en metas a los 6 meses de tratamiento, en comparación con el abordaje en fase establecida.</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusión</span><p id="spar0135" class="elsevierStyleSimplePara elsevierViewall">El abordaje clínico de la artritis reumatoide en fase temprana es una alternativa menos costosa y más efectiva vs. la fase establecida, ya que genera ahorros para el tercer pagador en un horizonte temporal de 6 meses, desde la perspectiva del tercer pagador.</p></span>" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Materiales y métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusión" ] ] ] ] "multimedia" => array:12 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1228 "Ancho" => 2925 "Tamanyo" => 142218 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Comparison of the average six-monthly cost per patient between the early and established phases.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1456 "Ancho" => 1675 "Tamanyo" => 107303 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Decision tree model.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1292 "Ancho" => 2925 "Tamanyo" => 170809 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Cost-effectiveness plan for the early phase and the established phase.</p>" ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Fig. 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1433 "Ancho" => 3341 "Tamanyo" => 279655 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Tornado diagram.</p>" ] ] 4 => array:8 [ "identificador" => "fig0025" "etiqueta" => "Fig. 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1684 "Ancho" => 2925 "Tamanyo" => 231558 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">One-way deterministic sensitivity analysis.</p>" ] ] 5 => array:8 [ "identificador" => "fig0030" "etiqueta" => "Fig. 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 1916 "Ancho" => 2925 "Tamanyo" => 394217 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Scatter diagram.</p>" ] ] 6 => array:8 [ "identificador" => "fig0035" "etiqueta" => "Fig. 7" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr7.jpeg" "Alto" => 1924 "Ancho" => 2925 "Tamanyo" => 301309 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0035" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Acceptability curve.</p>" ] ] 7 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0040" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">HAQ: <span class="elsevierStyleItalic">Health Assessment Questionnaire</span>; SMK: smoking.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>-value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SMK \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HAQ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Activity level: goals \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.032 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Alcoholism \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.000 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3661598.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Summary of statistical differences before pairing.</p>" ] ] 8 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0045" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">HAQ: <span class="elsevierStyleItalic">Health Assessment Questionnaire</span>; SMK: smoking.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Reduction \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Age</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">81.1% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">HAQ</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80.3% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">SMK</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Stop smoking \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80.2% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Never smoked \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">79.9% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Smoker \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">78.5% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Activity level: goals</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">73.9% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Alcoholism</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17.1% \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3661599.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Pairing results.</p>" ] ] 9 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0050" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">HAQ: <span class="elsevierStyleItalic">Health Assessment Questionnaire</span>; SMK: smoking.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>-value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.395 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SMK \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.361 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HAQ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.184 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Activity level: goals \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.687 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Alcoholism \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">.019 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3661597.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Summary of statistical differences after pairing.</p>" ] ] 10 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0055" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">COP<span class="elsevierStyleInf">cte</span>: Colombian pesos current currency.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Phase \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Effectiveness \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Cost-generating event \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Base case semiannual average cost per patient (COPcte) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Base case percentages \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Early \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Target \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Medicines \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">$1,268,537 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hospitalizations \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">$1,139,227 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Clinical laboratories \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">$823,609 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Consultations \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">$333,645 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total early goals \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">$3,565,017 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Early \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Non-target \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Medicines \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">$1,652,835 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hospitalizations \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">$1,005,200 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Clinical laboratories \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">$889,714 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Consultations \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">$594,212 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total early no goals \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">$4,141,960 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Established \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Target \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Medicines \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">$22,827,068 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">96% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hospitalizations \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Clinical laboratories \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">$779,029 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Consultations \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">$305,382 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total established goals \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">$23,911,480 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Established \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Non-target \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Medicines \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">$16,681,794 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">91% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hospitalizations \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">$469,093 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Clinical laboratories \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">$750,087 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Consultations \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">$452,649 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total established non-goals \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">$18,353,624 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100% \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3661595.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Cost Summary.</p>" ] ] 11 => array:8 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0060" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">RA: Rheumatoid Arthritis.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Goals \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Early % \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Established % \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24.3 (25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36.4(75) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75.7 (78) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">63.6 (131) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3661596.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Effectiveness in RA patients approach.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:42 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Indicadores de gestión del riesgo en pacientes con artritis reumatoide en Colombia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Fondo Colombiano de Enfermedades de Alto Costo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:5 [ "fecha" => "2018" "paginaInicial" => "21" "paginaFinal" => "69" "editorial" => "Fondo Colombiano de Enfermedades de Alto Costo Colombia" "editorialLocalizacion" => "Bogotá" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Situación de la artritis reumatoide en Colombia 2018" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Fondo Colombiano de Enfermedades de Alto Costo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:5 [ "fecha" => "2019" "paginaInicial" => "74" "paginaFinal" => "82" "editorial" => "Fondo Colombiano de Enfermedades de Alto Costo Colombia" "editorialLocalizacion" => "Bogotá" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Artritis reumatoide temprana: resultados clínicos y funcionales de una cohorte en un centro de alta complejidad, Cali-Colombia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.L. 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Original Investigation
Cost-effectiveness analysis of the early versus established phase clinical approach in a cohort of patients with rheumatoid arthritis in a fourth level health care institution in Colombia
Análisis de costo-efectividad del abordaje clínico en fase temprana vs. fase establecida en una cohorte de pacientes con artritis reumatoide de una institución prestadora de servicios de salud de cuarto nivel en Colombia
a Grupo de Investigación Reumavance, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia
b Departamento de Medicina Interna, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia
c Hospital Universitario Fundación Santa Fe (HUFSFB), Bogotá, Colombia
d Grupo de Investigación Reumavance, Departamento de Medicina Interna, Universidad de Los Andes, Bogotá, Colombia