BoletínDE PRENSA

www.cuentadealtocosto.org

Boletín de Prensa de la Cuenta de Alto CostoVolumen 2, Número 42 de Agosto de 2016

CUENTA DE ALTO COSTO

Lizbeth Acuña MerchánDirectora Ejecutiva

Patricia Sánchez QuinteroCoordinadora Gestión del Conocimiento

Lina Piñeros RubianoCoordinadora de Gestión de la

Información

Luis Alberto Soler VanoyCoordinador de Gestión del Riesgo

Para obtener más información sobre la CAC y las patologías de alto costo en

Colombia, puede contactarse con:

Alejandro Niño BogoyaCommunications Chief Officer

Unidad de Comunicación y Difusiónalejandro.nino@cuentadealtocosto.org

Carrera 45 # 103-34 Oficina 802PBX (+571) 6021820

Bogotá D.C., Colombia

Entidades de salud del país, comprometidas con la gestión del riesgo

Con el objetivo de fortalecer la gestión del riesgo en las patologías incluidas en la Cuenta de Alto Costo, durante los meses de mayo y junio de 2016, se realizaron siete (7) visitas de asistencia técnica a entidades de diferentes latitudes del país, las cuales pertenecen en su mayoría al régimen subsidiado.

Esta experiencia de trabajo colaborativo permitió identificar diversas estrategias que han sido implementadas para impactar positivamente en la captación de personas con Hipertensión Arterial o Diabetes Mellitus; en el diagnóstico oportuno del VIH, el Cáncer, la Hemofilia y la Artritis Reumatoide. También se evidenciaron esfuerzos importantes para ofrecen un manejo adecuado y oportuno de cada patología de alto costo, evitando

así la aparición de lesiones y otras afectaciones a la salud que estas pueden causar.

En cada entidad y de acuerdo con sus particularidades, se plantearon estrategias para potenciar el impacto obtenido hasta el momento y se presentaron nuevas perspectivas para abordar la problemática desde diferentes frentes, teniendo como marco de referencia la Política de Atención Integral en Salud (PAIS), la necesidad de generar sinergias con los demás actores del Sistema y la importancia de tener procesos centrados en los usuarios para lograr resultados eficientes en salud que conlleven hacia la estabilización de la carga de enfermedad y por consiguiente la sostenibilidad financiera en salud para el país.

Las entidades que participaron en este primer ejercicio (Saludvida, Coosalud, Comfacor, Ambuq, Comparta, Mallamas, Dusakawi) agrupan cerca de 7 millones de usuarios, que son el 16% de la población afiliada al POS, y están comprometidas con la gestión del riesgo de esta población.

BOLETÍN DE PRENSA DE LA CUENTA DE ALTO COSTO

www.cuentadealtocosto.org

CONSENSO BASADO EN EVIDENCIA

(Actualización)Indicadores mínimos para evaluar los

resultados clínicos en pacientes con

diagnóstico Enfermedad Renal Crónica

estadificada en 1 - 4 y 5 sin diálisis,

Hipertensión Arterial y Diabetes Mellitus

Bogotá D.C., ColombiaOctubre de 2015

Nuevas publicaciones de la Cuenta de Alto Costo

En su trabajo constante por generar conocimiento científico para el país, la Cuenta de Alto Costo ha desarrollado, además de los importantes procesos de capacitación, la producción de 6 pósters, un artículo científico y un libro respecto a las patologías de alto costo y a la gestión del riesgo de estas enfermedades en Colombia.

Este libro es la actualización más reciente de los indicadores mínimos para evaluar los resultados clínicos en pacientes con diagnóstico de Enfermedad Renal Crónica estadificada en 1-4 y 5 sin diálisis, hipertensión arterial y diabetes mellitus.

La versión digital está disponible en la página web de la Cuenta de Alto Costo, o puede seguir este enlace goo.gl/DoQia5. La edición impresa será distribuida de manera directa por la CAC.

Es importante anotar que todas las publicaciones de la Cuenta de Alto Costo son completamente gratuitas y las puede descargar desde nuestra página web www.cuentadealtocosto.org.

Una de las publicaciones más importantes de la región, la Revista Panamericana de Salud Pública, presentó en su edición mas reciente un artículo original sometido por el equipo técnico de la Cuenta de Alto Costo: Enfermedad renal en Colombia: prioridad para la gestión de riesgo [Kidney disease in Colombia: Priority for risk management].

Los autores de la publicación son: Lizbeth Acuña, Directora Ejecutiva de la CAC, Patricia Sánchez, Coordinadora de Gestión del Conocimiento, Luis Alberto Soler, Coordinador de Gestión del Riesgo y la epidemióloga Luisa Alvis de la Coordinación de Gestión del Conocimiento de la Cuenta de Alto Costo. Este documento está disponible de manera gratuita en la página web de la revista o a través del siguiente enlace http :// i r i s .paho.org/xmlu i/b i ts t ream/handle/123456789/28575/v40n1a3_16-22.pdf?sequence=1&isAllowed=y

El equipo técnico de la Cuenta de Alto Costo presentó en los últimos meses, 6 trabajos en eventos internacionales en Francia, Alemania y Estados Unidos. En junio se presentaron dos trabajos en el evento conmemorativo por los 50 años de la Agencia Internacional para la Investigación en Cáncer (IARC por sus siglas en inglés) en Lyón Francia.

Otros dos posters fueron presentados en EUHEA CONFERENCE 2016 Know the Ropes – Balancing Costs and Quality in Health Care, en la Universidad de Hamburgo en Alemania, y dos más en el Congreso Mundial de la Federación Mundial de Hemofilia en Orlando Florida.

Indicadores mínimos para evaluar los resultados

clínicos en pacientes con diagnóstico de Enfermedad

Renal Crónica estadificada en 1 - 4 y 5 sin diálisis,

Hipertensión Arterial y Diabetes Mellitus

2016

Consenso basado en evidencia

Actualización 2016

LIB

ROAR

TÍCU

LOPO

STER

S

16

Rev Panam Salud Publica 40(1), 2016

Enfermedad renal en Colombia:

prioridad para la gestión de riesgo

Lizbeth Acuña,1 Patricia Sánchez,1 Luis Alberto Soler1 y Luisa Fernanda Alvis1

Pan American Journal

of Public Health

Investigación original

Forma de citar Acuña L, Sánchez P, Soler LA, Alvis LF. Enfermedad renal crónica en Colombia: prioridad para la

gestión de riesgo. Rev Panam Salud Publica. 2016;40(1):16–22.

La enfermedad renal crónica (ERC) es

considerada hoy en día un problema de

salud pública en el ámbito mundial

debido a su prevalencia e incidencia

creciente en la población, su importancia

relativa en la carga de enfermedad, su

comportamiento crónico o permanente,

su potencial letal y porque representa un

importante gasto en salud para el sistema

dado que requiere una alta complejidad

técnica en su manejo.

En Colombia, en el año 2008, la enfer-

medad renal crónica estadio 5 (ERC5)

con necesidad de terapia de sustitución o

reemplazo renal (diálisis peritoneal,

hemodiálisis o trasplante) fue estableci-

da como enfermedad de alto costo (1).

A partir de ese momento, la gestión

del riesgo se instauró como una de las

prioridades para asegurar no solo el

equilibrio del sistema de salud, sino

como estrategia para optimizar la

atención y propender por la calidad de

vida de las personas.

De esta manera, la gestión del riesgo

para esta patología en Colombia se

ha abordado desde dos perspectivas:

por un lado desde las patologías que se

han identificado como posibles “precur-

soras” o potenciales causas de la ERC,

como son la hipertensión arterial y la

diabetes mellitus, para evitar que se

desarrolle la ERC y que son prevenibles,

intervenibles y tratables; y por otro, para

evitar la progresión desde la enfermedad

RESUMEN Objetivo. El objetivo de este estudio fue describir las características demográficas y

clínicas de los pacientes con enfermedad renal crónica (ERC), hipertensión arterial o dia-

betes mellitus y encontrar la asociación entre la presencia de estas patologías y el desarro-

llo de ERC.

Métodos. Estudio analítico y de corte transversal. La información procede de la base de

datos única de ERC y de pacientes con hipertensión arterial y diabetes, que las entidades obli-

gadas a compensar suministraron a la Cuenta de Alto Costo, reportada con corte al 30 de junio

de 2013. Se realizó un análisis descriptivo y se determinó la prevalencia de ERC y enfermedad

renal crónica en estadio 5 (ERC5). Se determinó la asociación entre ERC y edad, sexo y la dia-

betes mediante odds ratio (OR) crudos.

Resultados. Se analizaron 2 599 419 registros, de los cuales 40% correspondían a

personas con ERC. El 74,9% de la población tenía hipertensión y 6,4% tenía diabetes.

La prevalencia de ERC fue de 2,81%, y 94,3% de los pacientes se encontraba en estadios 1

a 3. El riesgo de presentar ERC en los pacientes con diabetes es 1,03 (intervalo de confianza

de 95% [IC95%] 1,016 – 1,043). En los mayores de 60 años, el riesgo de ERC es 2,15 (IC95%

2,140 – 2,167).

Conclusiones. El 33,4% de pacientes con hipertensión o diabetes no han sido estudiados

para determinar la presencia o ausencia de ERC. Es prioritario aplicar estrategias de preven-

ción secundaria y primaria, para evitar la progresión de ERC y reducir la prevalencia de facto-

res de riesgo como hipertensión y diabetes.

Palabras clave Prevalencia; enfermedad renal crónica; hipertensión; diabetes mellitus; Colombia.

1 Cuenta de Alto Costo, Colombia. La correspon-

dencia se debe dirigir a Luisa Fernanda Alvis.

Correo electrónico: lalvis@cuentadealtocosto.org

Pay for performance as a strategy that addresses the Risk Sharing Agreements in Colombia:A possible option!

ObjectiveTo emphasize the importance of information systems as a policy led by the ministries of health to building trust between stakeholders in the sector with the aim of creating joint venture agreements which require measurement bases and indicators record as accurately and possible reliability.

MethodologyThe information being provided High Cost Diseases Fund in Colombia is reported by the country’s insurers through regulations issued by the Ministry of Health. This information is reported by an information system designed for each disease: chronic kidney disease , hypertension , diabetes, cancer , rheumatoid arthritis , HIV/AIDS , epilepsy and haemophilia, which is verified and validated in order to ensure high reliability and a transparent flow of resources that are made.

ResultsAdvances driven from insurers and providers are: 1 Colombia has the best record date for chronic kidney disease (CKD), high blood pressure (hypertension) and diabetes mellitus (DM) in Latin America; 2. Colombia is the pioneer country in the region to promote and strengthen risk management payment by results between the actors system 3. It is the country with the largest decrease in the incidence of ESRD from 2006 to 2012 at 31.8 points percentage, as published by United States Renal Data System (USRDS) in the 2013 report; 4. Lowering the cost of treatment per patient dialysis therapy, with a saving in 5 years (US $ 360 million) to the health system; 5. In four years is estimated to have prevented the entrance Renal Replacement Therapy (RRT) in about 5,169 cases, which represents savings for the health system of approximately US $ 240 million) and 6. This coupled with an institutional genetic leadership and strengthening support networks seeking the support of the Pan American Health Organization (PAHO) and the Ministries of Latin Health to launch the International Network for the Prevention in Chronic Kidney Disease (RIPERC) which has been defined as a thematic network for knowledge transfer between different health institutions linked to governments, private sector actors and scientific associations to strengthen knowledge management and the generation of public policies through its three basic areas: training, research and the information system.

ConclusionsThe information obtained, is considered essential to establish risk-sharing agreements: Administrative demographic, clinical , and provide insight into the epidemiological situation, aspects of the process of care and the cost of illness to implement risk adjustment models with Incentive management and disease control, evaluation and monitoring by health outcomes and thus encourage competition among insurers and providers which allows the insurer to have tools to consider shared with suppliers venture.

Lizbeth Acuña Merchán1, Patricia Sánchez1, Luis Soler1, Alejandro Bryón2

1. High Cost Disease Fund - 2. HEORT

Benefits adjustment for risk management incentives: Payment by results

ObjectiveThe risk adjustment models are applied to adjust the risk premium based prediction is to increase levels of costs and use of services for financial resources that insurers are really suffice according to their population. The model in Colombia was designed based on prevalence and incorporating indicators of management in prevention and control of the ERC and HIV for the purpose of a transfer of resources between insurers to minimize the inequitable distribution of health cost insurers as a result of Concentration risk of high-cost diseases, adverse selection and risk selection of users.

MethodologyThe risk adjustment is from the collection of information and CKD patients with HIV / AIDS in the country. The concentration of insurance risk in each group was determined by age. Prevalence deviation regarding the country for economic redistribution between insurers as each force is calculated. Indicators are determined to assess the management eralizan aseguradoreas for the prevention and control of these diseases and based on a weighting amount is calculated for each receive or provide insurance and then distributed in which health indicators get better.

ResultsThe deviation of prevalence shows that 39% of insurers had higher concentration of epidemiological risk in CKD according to their performance in relation to the country and therefore were redistributed in 2015 US $$ 36,759,117.11, while HIV / AIDS US $ 9,578,595.01 . the evaluation results are evaluated in 4 ERC: cpatacion with hypertension and diabetes, study to rule out or confirm ERC, ERCterminal incidence and variation in incidence, a variation among insurers as to the results obtained in the country is presented however, 82% (42/50) receives resources to meet the goal or overcome particular country. HIV / AIDS of the 4 indicators: prevalence of HIV / AIDS screening in pregnant, HIV tempana detecccion and adequate viral load in people living with HIV receive antiretroviral therapy, 86% (43/50) of insurers.

ConclusionsThe applied model risk adjustment is the first held in Colombia with high reliability of the information and has not only performed epidemiology and risk adjustment between insurers analysis but has created a space for dialogue between all actors in the system to standardize measurements that help reduce clinical variability , reestrucuturacion of supply and demand for services , implementation of programs with risk approach to setting and implementing public policies to benefit and improve the quality of patient care and has It has been considered a breakthrough for the health system of the country and an example in Latin America.

Lizbeth Acuña Merchán1, Patricia Sánchez1, Luis Soler1.

1. High Cost Disease Fund

Opportunity in diagnosis of Breast Cancer in Colombian women

To describe the time between different stages for diagnosis of breast cancer in women attending in health care services.

Acuña, Lizbeth1; Sánchez, Patricia1; Alvis, Luisa1; Soler Luis1

1 High Cost Diseases Fund. Bogotá - Colombia

Objective

Results

Methods

Descriptive, longitudinal and retrospective study. The information was reported to High Cost Diseases Fund in 2015. Women with diagnosis of malignant breast tumor considering the International Classification of Diseases -ICD-10 (C500, C501, C502, C503, C504, C505, C506, C508, C509), aged between 18 and 80 years and women who were in treatment (radiation therapy, systemic therapy, surgery or a combination of these) in time data recollection were included. 3 opportunities were measured by determining the time between 1) the first symptoms and admission to the health care institution for making the diagnosis, 2) time from the histopathology and the result of the histopathological study and 3) result of the histopathological report and consultation with the attending physician of the disease. Opportunities with some demographic and clinical variables (age at diagnosis, stage) through statistical analysis were related.

Results: 13.691 women diagnosed with breast cancer were included. The average time for first opportunity was 95.9 days (3.2 months), for the second time opportunity was 27.5 days and for the third 76 days (2.6 months). In women aged 18 to 34 years at diagnosis, the time between the first symptoms and admission to health care institution for diagnosis was lower than women over 65 years.

Conclusions

In Colombia, women with breast cancer have a diagnostic process with multiple stages due to operation of the health care system, the implementation of actions for the reduction in the time between each of these, are stages is essential to ensure the timely access, quality of care and a better prognosis.

Figure 1. Opportunity between referral and admission to the HSP (Health Service Provider) to make the diagnosis

2,9

3,3

3,1

3,2

2,7

2,8

2,9

3,0

3,1

3,2

3,3

3,4

18-34 35-49 50-64 >65

Lapseoftime(inm

onths)

Ageofwomenatdiagnosis

Figure 2. Average days between taking the sample and the valid

22,223,4

25,3

38,3

0

5

10

15

20

25

30

35

40

45

18-34 35-49 50-64 >65

Lapseo

ftim

e(indays)

Ageofwomenatdiagnosis

Figure 3. Average months between the result of the histopathological report

3,9

4,4

4,7

5,4

0

1

2

3

4

5

6

18-34 35-49 50-64 >65

Lapseoftime(in

months)

Ageofwomenatdiagnosis

Funding: No funding

Cancer Registry: information as a tool for disease control in Colombia

Acuña, Lizbeth1; Sánchez, Patricia1; Alvis, Luisa1; Soler Luis1

1 High Cost Diseases Fund. Bogotá - Colombia

According to the national regulatory framework, an information registry was defined in order to know the cancer situation from the needs of the health care system, clinical interests and decision makers.

A comprehensive literature review was performed to identify relevant variables to determine monitoring indicators used by insurers and providers in the attention of patients with cancer. Variables were selected and defined by a consensual work with clinical experts, thematic and methodological experts, then these variables were evaluated by the Ministry of Health in order to review and approve the structure to collect the information.

Variable group Number of variables

Variables disaggregated

Demographic variables 16Diagnosis and staging variables 25Variables related to medical history 3

Variables related to chemotherapy 29 101 variables disaggregated

Variables related to surgery 12Variables related to radiotherapy 20Variables related to transplant 5 Variables related to complementary treatment 14 20 variables

disaggregatedVariables related to the final situation of the oncological treatment 8

Objective

Methods

Results

A structure of 132 variables were developed and expressed in a resolution (law) that requires all entities with populations under their charge, to report annually to the High Cost Diseases Fund all the patients with a diagnosis of cancer, describing clinical and demographic characteristics and the process of health care, among others. In 2015 a total of 166,224 records were reported, corresponding to 165,125 patients living with a diagnosis of cancer. Different indicators were compared with some estimations for the country to identify existing gaps.

Conclusion

The implementation of a mandatory information registry as a public policy, allows the country to obtain real information for data analysis to know the situation of the disease, standardizing the reporting methodology and encouraging the culture of information registration not only for quality analysis but to obtain indicators for decision making.

Funding: No funding

BreastCancer (Women)40%

BreastCancer (Men)0,3%

Prostate18%

Cervix16%

Colorectal11%

Stomach5%

Non-Hodgkin'sLymphoma5,2%

HodgkinLymphoma3,2%

AcuteLymphocyticLeukemia2,1%

AcuteMyeloidLeukemia0,5%

Othertypes10%

Table 1. Description of registry variables

Figure 1. Percentage distribution of different types of cancer considered as high-cost diseases, reported to the High Cost Diseases Fund in 2014.

Table 2. Incidence, Prevalence and Mortality. Types of cancer Prioritized by the High Cost Disease Fund Report of Insurance Companies -2015 -

Type of CancerIncidence

per 100,000 inhabitants

Prevalence per 100,000 inhabitants

Mortality per 100,000 inhabitants

Breast cancer (Women) 17,7 154,7 5,7Breast cancer (Men) 0,2 0,9 0,1Cervix 8 46,2 2,9Prostate 8,9 73,3 3,8Hodgkin lymphoma 0,5 3,8 0,2Non-Hodgkin lymphoma 2 14,2 0,9Gastric 3,3 12,9 2,4Colorectal 4,2 22 2,3Acute Lymphocytic Leukemia 0,7 4,1 0,3Acute myeloid leukemia 0,2 1,2 0,2Lung 1,9 5,8 1,4Melanoma 0,9 4,7 0,4

TOTAL 31,3 207,2 14,3

Results of a national registry for hemophilia A and B: Situation of the disease in Colombia

INTRODUCTION AND OBJECTIVETo understand the situation of hemophilia by determining the characteristics of the disease which allows presenting those responsible for the care of these patients the results of their actions and expand the landscape of the disease at national and international level. The objective of this study was to analyze demographic and clinical variables in the national registry of information reported to the High Cost Account.

MATERIALS AND METHODSRetrospective observational study. All reported patients diagnosed with hemophilia A or B were included, univariate and bivariate analysis were carried out of the 64 variables defined in the information registry.

RESULTS1,832 patients were reported with hemophilia. The prevalence in men and women was 3.8 *100.000, being 6.28*100.000 for men with hemophilia A and 1.24 for men with hemophilia B; the Adjusted Prevalence for men was 7.55*100.000. The age group with the highest concentration of hemophiliacs is between 10 to 19 years old (26.4 %); 56.5 % of patients with hemophilia A are severe versus 41.7 % of patients with hemophilia B. 59.7 % of hemophiliacs are in prophylaxis, 36.6 % in on demand and 3.7 % being in prophylaxis required additional doses of factor demand. 20 % of hemophiliacs with inhibitors which 29 % are high responders, 34 % of patients have chronic hemophilic arthropathy, 4.9 % hepatitis C, 0.6 % hepatitis B and 0.7 % HIV infection.

CONCLUSIONSData from the first record in Colombia at a national level allows sizing disease´s current state for both governmental decision makers and those who take action for the patient. These results are comparable with estimates for the country made by other authors and they are the base line founded on real data for health care planning and for the implementation of actions for approaching and care of this population in the health care system of Colombia

Pathology Adjusted rate IC (95%)

Hemophilia A Women 0,12 0,05 0,19Man 6,13 5,82 6,47Total 3,12 2,94 3,29

Hemophilia BWomen 0,05 0 0,09Man 1,22 1,08 1,39Total 0,63 0,54 0,74

Table 1 : Prevalence of hemophilia in Colombia per 100,000 people

Table 2: Presence of some complications in hemophilia population

Illustration 1: Distribution of cases according to severity of haemophilia

Illustration 2: Distribution of cases according to the presence of inhibitors

Source : Resolution 0123 CAC: Database 2015. Information date: January 2015. DANE Population database: 31 June 30, 2015

Source : Resolution 0123 CAC: Database 2015. Information date: January 2015. DANE Population database: 31 June 30, 201

21,1 19,8

56,5

2,6

21,232,6

41,7

4,6

0,0

20,0

40,0

60,0

80,0

100,0

120,0

Mild Moderate Severe Unknown

Percentage%

Severityofthedeficiency

HemophiliaA HemophiliaB

14,5

6,0

62,0

17,6

0,0 10,0 20,0 30,0 40,0 50,0 60,0 70,0

Highresponse

lowresponse

Noinhibitors

Unknown

Percentage

Presen

ceofinh

ibito

r

Illustration 3: Distribution interdisciplinary team care for hemophilia population

52,5

40,042,2

38,2

19,2

50,4

10,4

37,4

43,947,5

60,057,8

61,8

80,8

49,6

89,6

62,6

56,1

0,0

10,0

20,0

30,0

40,0

50,0

60,0

70,0

80,0

90,0

100,0

Orthopedics Odontology Nutrition SocialWork Physiatry Psychology Pharmaceuticalchemist

Physiotherapy Nursing

Percentage%

Specialist

YES NO

Complications Hemophilia A (N=1.527) Hemophilia B (N=307)Hemophilia

(N=1.832)n % n % n %

Chronic hemophilic arthropathy No 984 64,5 216 70,4 1.200 65,5Yes 541 35,5 91 29,6 632 34,5

Infection Hepatitis C virus No 1.445 94,8 297 96,7 1.742 95,1Yes 80 5,3 10 3,3 90 4,9

Infection Hepatitis B virus No 1.518 99,5 304 99 1.822 99,5Yes 7 0,5 3 1 10 0,6

HIV infection No 1.514 99,3 306 99,7 1.82 99,3Yes 11 0,7 1 0,3 12 0,7

Results of a national registry for hemophilia A and B: Situation of the disease in Colombia

INTRODUCTION AND OBJECTIVETo understand the situation of hemophilia by determining the characteristics of the disease which allows presenting those responsible for the care of these patients the results of their actions and expand the landscape of the disease at national and international level. The objective of this study was to analyze demographic and clinical variables in the national registry of information reported to the High Cost Account.

MATERIALS AND METHODSRetrospective observational study. All reported patients diagnosed with hemophilia A or B were included, univariate and bivariate analysis were carried out of the 64 variables defined in the information registry.

RESULTS1,832 patients were reported with hemophilia. The prevalence in men and women was 3.8 *100.000, being 6.28*100.000 for men with hemophilia A and 1.24 for men with hemophilia B; the Adjusted Prevalence for men was 7.55*100.000. The age group with the highest concentration of hemophiliacs is between 10 to 19 years old (26.4 %); 56.5 % of patients with hemophilia A are severe versus 41.7 % of patients with hemophilia B. 59.7 % of hemophiliacs are in prophylaxis, 36.6 % in on demand and 3.7 % being in prophylaxis required additional doses of factor demand. 20 % of hemophiliacs with inhibitors which 29 % are high responders, 34 % of patients have chronic hemophilic arthropathy, 4.9 % hepatitis C, 0.6 % hepatitis B and 0.7 % HIV infection.

CONCLUSIONSData from the first record in Colombia at a national level allows sizing disease´s current state for both governmental decision makers and those who take action for the patient. These results are comparable with estimates for the country made by other authors and they are the base line founded on real data for health care planning and for the implementation of actions for approaching and care of this population in the health care system of Colombia

Pathology Adjusted rate IC (95%)

Hemophilia A Women 0,12 0,05 0,19Man 6,13 5,82 6,47Total 3,12 2,94 3,29

Hemophilia BWomen 0,05 0 0,09Man 1,22 1,08 1,39Total 0,63 0,54 0,74

Table 1 : Prevalence of hemophilia in Colombia per 100,000 people

Table 2: Presence of some complications in hemophilia population

Illustration 1: Distribution of cases according to severity of haemophilia

Illustration 2: Distribution of cases according to the presence of inhibitors

Source : Resolution 0123 CAC: Database 2015. Information date: January 2015. DANE Population database: 31 June 30, 2015

Source : Resolution 0123 CAC: Database 2015. Information date: January 2015. DANE Population database: 31 June 30, 201

21,1 19,8

56,5

2,6

21,232,6

41,7

4,6

0,0

20,0

40,0

60,0

80,0

100,0

120,0

Mild Moderate Severe Unknown

Percentage%

Severityofthedeficiency

HemophiliaA HemophiliaB

14,5

6,0

62,0

17,6

0,0 10,0 20,0 30,0 40,0 50,0 60,0 70,0

Highresponse

lowresponse

Noinhibitors

Unknown

Percentage

Presen

ceofinh

ibito

r

Illustration 3: Distribution interdisciplinary team care for hemophilia population

52,5

40,042,2

38,2

19,2

50,4

10,4

37,4

43,947,5

60,057,8

61,8

80,8

49,6

89,6

62,6

56,1

0,0

10,0

20,0

30,0

40,0

50,0

60,0

70,0

80,0

90,0

100,0

Orthopedics Odontology Nutrition SocialWork Physiatry Psychology Pharmaceuticalchemist

Physiotherapy Nursing

Percentage%

Specialist

YES NO

Complications Hemophilia A (N=1.527) Hemophilia B (N=307)Hemophilia

(N=1.832)n % n % n %

Chronic hemophilic arthropathy No 984 64,5 216 70,4 1.200 65,5Yes 541 35,5 91 29,6 632 34,5

Infection Hepatitis C virus No 1.445 94,8 297 96,7 1.742 95,1Yes 80 5,3 10 3,3 90 4,9

Infection Hepatitis B virus No 1.518 99,5 304 99 1.822 99,5Yes 7 0,5 3 1 10 0,6

HIV infection No 1.514 99,3 306 99,7 1.82 99,3Yes 11 0,7 1 0,3 12 0,7