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INTRODUCTION: Health technology assessment (HTA) is a standardized methodology that allows the assessment technologies' value. By incorporating the perspective of stakeholders in a public consultation process, transparency and quality of decisions can be improved. OBJECTIVE: To describe the active stakeholder consultation process for rapid HTAs in an Argentinean, independent, academic, non-profit HTA agency, assessing its initial five years. METHODS: Since 2017, we have been conducting an active public consultation process for rapid HTA documents, inviting producers, healthcare professionals, and patient organizations to provide comments, and their input may lead to changes in the HTA documents. Changes were classified as major (changes to the coverage recommendation), intermediate (changes in efficacy, net benefit, or cost-effectiveness that did not change coverage recommendations), and minor modifications (other changes). RESULTS: From May 2017-August 2022, 308 rapid HTA (rHTA) reports were published, and 3,438 invitations were sent. 140 rHTA (45.5%) received a total of 228 comments. Comments came from producers in 53% (n = 112) and healthcare professional organizations in 31.2% (n = 66). Technologies evaluated were drugs in 37% (n = 114), procedures in 35.5% (n = 109), diagnostic methods in 15.3% (n = 47), and devices in 12.2% (n = 38). Out of 308 rHTA documents, 120 (39%) were modified-mostly minor adjustments (n = 100; 80%), followed by major (n = 12; 10%) and intermediate modifications (n = 8; 6.4%). CONCLUSION: Implementing an active stakeholder involvement process in HTA is feasible in a low- to middle-income country context and strengthens and improves the HTA process.
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The medical profession faces multiple challenges worldwide in the 21st century. This integrative review of the literature published between 2014 to 2018 on supply and demand in the health care labor market was based on a search of the SciELO, Biblioteca Virtual em Saúde (Virtual Health Library), and MEDLINE databases, in addition to specific periodicals in the area of Health Economics. The final sample included 21 studies, 13 of which were related to workforce supply and 8 to demand. Physicians reported that work satisfaction was an important factor in accepting a job offer, including being close to their family, working with colleagues in the same specialty, and the possibility of career advancement. For health system users, a fundamental question is how to resolve the unequal distribution of physicians.
A profissão médica se defronta globalmente com múltiplos desafios no século XXI, entre os quais podem-se destacar o crescimento populacional e a inovação tecnológica e a sua implementação na medicina. Este artigo buscou identificar na literatura científica aspectos relevantes acerca do mundo do trabalho para a profissão médica. Trata-se de uma revisão integrativa, que considerou as publicações do quinquênio de 2014 a 2018. A seleção dos artigos para o presente estudo foi realizada nas bases de dados Scientific Electronic Library Online, Biblioteca Virtual em Saúde, Medical Literature Analysis and Retrieval System Online, além de periódicos específicos da área de economia e saúde. Como resultado desta revisão, foram selecionados 21 artigos, sendo identificados 13 com temáticas referentes à oferta da força de trabalho médico e 8 com temáticas referentes à demanda da força de trabalho, de acordo com a classificação que emergiu pelos critérios adotados. Para os profissionais médicos, um aspecto que surge durante a decisão de escolher uma vaga é a satisfação pessoal no emprego, no sentido de estar perto da família, trabalhar com colegas da mesma especialidade e poder avançar na profissão. Já com relação à demanda da força de trabalho, ou seja, para quem busca os serviços de tais profissionais, uma questão fundamental é como resolver problemas de escassez de profissionais médicos que estão relacionados a uma distribuição desigual em determinados locais.
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Araucaria angustifolia is a species known for its valuable wood and nuts, but it is threatened with extinction. The plantation of forests for genetic resource conservation is a complementary strategy designed to reduce the species' genetic variability loss. This study aimed to evaluate the technical and economic viability of A. angustifolia for genetic conservation through use. The analyzed provenance and progeny trial was established in 1982 in Itapeva, Brazil. It was structured using a compact family blocks design with 110 open-pollinated progenies from five natural populations, three replicates, ten plants per subplot, and 3.0 m × 2.0 m spacing. After 33 years, the trial was evaluated for total height, diameter at breast height, wood volume, and survival. The variance components and genetic parameter estimates were performed using Restricted Maximum Likelihood/Best Linear Unbiased Prediction methods (REML/BLUP) methods with the Selegen software (version 2014). The production and management scenarios were obtained using the SisAraucaria software (version 2003). Sensitivity analysis and economic parameter estimates were obtained through various economic evaluation methods using the Planin software (version 1995). In general, the genetic parameters indicated that the population has enough variability for both conservation and breeding purposes, suggesting technical viability for the establishment of a seed orchard. The economic parameters indicated that the commercialization of wood and araucaria nuts proved to be more profitable than wood production by itself. In conclusion, araucaria genetic conservation through use is a technically and economically viable ex situ conservation strategy.
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The study examines the interaction between social capital, education, and subjective well-being in Ecuador, highlighting its impact on economic development. The study aims to understand the situation of social capital and subjective well-being and how the identified factors explain the impact on subjective well-being in the Ecuadorian population, using a descriptive and analytical approach with information from the World Value Survey database of waves 6 and 7. The main results show a significant relationship between social capital and subjective well-being, with positive influences such as justice and union membership, and negative effects of public administration and media. In conclusion, the importance of strengthening social capital and improving public services and communication to promote the well-being of the Ecuadorian population is emphasized.
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Countries in the Americas play a vital role in global livestock and aquaculture production. With international trade of livestock and aquaculture products becoming an important source of income for countries, there has been an increased interest in using animal health economics for advocacy and allocation of resources. This article discusses the development of a new Collaborating Centre for the Economics of Animal Health and the applications of the Global Burden of Animal Diseases (GBADs) framework in the Americas region. Incentives for the increased use of economics in animal health decision-making and examples from the Americas region are examined. The article then discusses the newly formed World Organisation for Animal Health Collaborating Centre in the Americas region. Finally, it reviews two ongoing case studies that are implementing the GBADs framework in Peru and the United States of America.
Les pays des Amériques jouent un rôle crucial dans la production mondiale d'animaux d'élevage, qu'il s'agisse d'espèces terrestres ou aquatiques. Le commerce international des produits issus de l'élevage et de l'aquaculture étant désormais une source importante de revenus pour les pays, la possibilité d'utiliser les concepts de l'économie de la santé animale à des fins de plaidoyer et d'allocation des ressources suscite un intérêt croissant. Les auteurs abordent la désignation d'un nouveau Centre collaborateur pour l'économie de la santé animale ainsi que les applications du programme " Impact mondial des maladies animales " (GBADs) dans la région des Amériques. Ils examinent les avantages d'une meilleure prise en compte de l'économie dans les prises de décision en matière de santé animale, illustrés par quelques exemples concrets relevés dans la région. Ils décrivent ensuite la création du nouveau Centre collaborateur de l'Organisation mondiale de la santé animale dans la région des Amériques. Enfin, ils présentent deux études de cas menées actuellement concernant la mise en oeuvre du programme GBADs respectivement au Pérou et aux Etats-Unis d'Amérique.
Los países de las Américas desempeñan un papel fundamental en la producción ganadera y acuícola mundial. Dado que el comercio internacional de productos ganaderos y acuícolas se ha convertido en una importante fuente de ingresos para los países, el interés por utilizar la economía de la sanidad animal en favor de la promoción y la asignación de recursos ha ido en aumento. En este artículo se analiza la creación de un nuevo Centro colaborador para la economía de la sanidad animal y las aplicaciones del marco del impacto global de las enfermedades animales (GBADs) en la región de las Américas. Se examinan los incentivos para un mayor uso de la economía en la toma de decisiones sobre sanidad animal, así como ejemplos de la región. A continuación, en el artículo se presenta el recién creado Centro colaborador de la Organización Mundial de Sanidad Animal en la región de las Américas. Por último, se examinan dos estudios de casos en los que se está poniendo en práctica el marco del GBADs en Perú y los Estados Unidos de América.
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Enfermedades de los Animales , Cooperación Internacional , Animales , Enfermedades de los Animales/economía , Enfermedades de los Animales/prevención & control , Américas , Acuicultura/economía , Perú , Estados UnidosRESUMEN
Background: Huntington's disease (HD) exerts significant impacts on individuals and families worldwide. Nevertheless, data on its economic burden in Brazil are scarce, revealing a critical gap in understanding the associated healthcare costs. Objective: This study was conducted at a tertiary neurology outpatient clinic in Brazil with the aim of assessing annual healthcare service utilization and associated costs for HD patients. Methods: We conducted a cross-sectional observational study involving 34 HD patients. A structured questionnaire was applied to collect data on direct medical costs (outpatient services, medications), non-medical direct costs (complementary therapies, mobility aids, home adaptations), and indirect costs (lost productivity, caregiver costs, government benefits) over one year. Results: Significant economic impacts were observed, with average annual direct medical costs of $4686.82 per HD patient. Non-medical direct and indirect costs increased the financial burden, highlighting extensive resource utilization beyond healthcare services. Thirty-three out of 34 HD patients were unemployed or retired, and 16 relied on government benefits, reflecting broader socioeconomic implications. Despite the dataset's limitations, it provides crucial insights into the economic impact of HD on patients and the Brazilian public health system. Conclusions: The findings underscore the urgent need for a more comprehensive evaluation of the costs to inform governmental policies related to HD. Future research is needed to expand the data pool and develop a nuanced understanding of the economic burdens of HD to help formulate effective healthcare strategies for patients.
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Costo de Enfermedad , Costos de la Atención en Salud , Enfermedad de Huntington , Humanos , Enfermedad de Huntington/economía , Enfermedad de Huntington/terapia , Brasil , Masculino , Femenino , Estudios Transversales , Persona de Mediana Edad , Costos de la Atención en Salud/estadística & datos numéricos , Adulto , Atención Terciaria de Salud/economía , AncianoRESUMEN
INTRODUCTION: In high-income countries, quality improvement interventions and research are usually guided by trauma registries. In low- and middle-income countries, the implementation of trauma registries has been limited mainly for cost reasons. OBJECTIVE: To analyze the budgetary impact of the implementation of trauma registries in Argentina. METHODS: We estimated direct costs of implementing trauma registries in public hospitals located in cities with a population over 50,000 inhabitants. In large urban areas, we selected hospitals by estimating a minimum volume of 240 severe trauma admissions/year and using the NBATS-2 instrument with geolocation techniques. We estimated costs based on a micro-costing approach of a trauma registry developed by Fundación Trauma. Scenario analysis was carried out restricting the population to hospitals from bigger cities and/or with higher concentration of trauma patients' care. For the high budget impact threshold, we used the total health spending estimation, and alternatively the health spending of the public sector. RESULTS: For the base case, 139 hospitals from 104 cities were included, comprising 175,605 injury-related discharges and 13,707 severely injured patients/year. The average cost for the initial three years was USD 3,753,085 (21.4 USD/per patient), falling below the high budget impact thresholds. The scenarios analysis showed a significantly costs reduction. CONCLUSIONS: The implementation of trauma registries in Argentina would be affordable, and in consequence, it would improve the coordination, management and quality of care for this great public health issue.
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Hospitales Públicos , Sistema de Registros , Heridas y Lesiones , Humanos , Argentina/epidemiología , Heridas y Lesiones/economía , Heridas y Lesiones/terapia , Heridas y Lesiones/epidemiología , Hospitales Públicos/economía , Presupuestos , Centros Traumatológicos/economía , Mejoramiento de la Calidad/economía , Análisis Costo-Beneficio , Costos de la Atención en Salud/estadística & datos numéricosRESUMEN
Objectives: In many countries, obesity treatments are not fully reimbursed by healthcare systems. People living with obesity (PwO) often pay out-of-pocket (OOP) for pharmacological and non-pharmacological interventions, placing them in a position of financial risk to manage their condition. This study sought to understand the OOP expenditures and non-financial costs incurred by PwO to manage weight. Methods: A 25-min cross-sectional online survey was conducted with PwO between ages 18-60 in Italy, Japan, India, Brazil, Spain and South Korea. Respondents were recruited using proprietary vendor panels and non-probability sampling. N = 600 participants completed the survey (n = 100 per country). Results: The mean annual OOP expenditure related to weight loss/management was $7,351, accounting for nearly 17% of annual household income. Costs generally increased by BMI. Half or more of the respondents agreed that obesity affected multiple aspects of their lives (outside activities, running a household, social life, work, family life, traveling). 46% agreed that obesity limited their job prospects. Conclusion: PwO spend a notable amount of their income paying OOP expenditures related to managing their weight. Quantifying the individual economic burden of living with obesity can inform the understanding of the resources required and policy changes needed to treat obesity as a disease.
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Understanding health-seeking behaviors and their drivers is key for governments to manage health policies. A growing body of research explores the role of cognitive biases and heuristics in health and care-seeking behaviors, but little is known about how a context of heightened anxiety and uncertainty might influence these behavioral drivers. This study analyzes the association between four behavioral predictors-internal locus of control, impatience, optimism bias, and aspirations-and healthcare decisions among low-income women in El Salvador, controlling for other factors. We find positive associations between internal locus of control and preventive health behaviors during the COVID-19 pandemic. For instance, a one standard deviation increase in locus of control is associated with a 10% increase in an index measuring the use of masks, distancing, hand washing, and vaccination. Locus of control was also associated with women's use of preventive health services (one standard deviation improves the likelihood of having a hypertension test in the last six months by 5.8 percentage points). In a sub-sample of mothers, we find significant relationships between the four behavioral drivers and the decisions the mothers make for their children. However, we find these associations are less robust compared to the decisions they make for themselves. Some associations were stronger during the pandemic, suggesting that feelings of uncertainty and stress could amplify behavioral drivers' influence on health-related behaviors. This novel finding is relevant for designing policy responses for future shocks. JEL CODES: I12, D10, D91, I30.
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COVID-19 , Toma de Decisiones , Aceptación de la Atención de Salud , Pobreza , Humanos , COVID-19/prevención & control , COVID-19/epidemiología , COVID-19/psicología , Femenino , Adulto , El Salvador , Aceptación de la Atención de Salud/psicología , Aceptación de la Atención de Salud/estadística & datos numéricos , Control Interno-Externo , Pandemias/prevención & control , Persona de Mediana Edad , Adulto Joven , Madres/psicología , Madres/estadística & datos numéricos , SARS-CoV-2 , Conductas Relacionadas con la SaludRESUMEN
BACKGROUND: The management of febrile neutropenia (FN) in pediatric cancer patients has traditionally been conducted in a hospital setting. However, recent evidence has indicated that outpatient management of FN can be equally effective compared to inpatient care. Based on this evidence, we conducted a cost-minimization analysis (CMA) specifically focused on pediatric cancer patients in Mexico. METHODS: A piggy-back study was conducted during the execution of a non-inferiority clinical trial that compared outpatient treatment to inpatient treatment for FN in children with cancer. A CMA was performed from a societal perspective using patient-level data. In the previous study, we observed that step-down oral outpatient management of low-risk FN was as safe and effective as inpatient intravenous management. Direct and indirect costs were collected prospectively. The costs were adjusted for inflation and converted to US dollars, with values standardized to July 2022 costs. Statistical analysis using bootstrap methods was employed to obtain robust estimations for decision-making within the Mexican public health care system. RESULTS: A total of 117 FN episodes were analyzed, with 60 in the outpatient group and 57 in the inpatient group; however, complete cost data were available for only 115 FN episodes. The analysis revealed an average savings of $1,087 per FN episode managed on an outpatient basis, representing a significant 92% reduction in total cost per FN episode compared to inpatient treatment. Length of hospital stay and inpatient consultations emerged as the primary cost drivers within the inpatient care group. CONCLUSION: This CMA demonstrates that the step-down outpatient management approach is cost-saving when compared to inpatient management of FN in pediatric cancer patients. The mean difference observed between the treatment groups provides support for decision-making within the public health care system, as outpatient management of FN allows for substantial cost savings without compromising patient health.
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Atención Ambulatoria , Neoplasias , Humanos , Neoplasias/terapia , Neoplasias/complicaciones , Niño , Atención Ambulatoria/economía , México , Femenino , Masculino , Preescolar , Adolescente , Fiebre/terapia , Fiebre/economía , Neutropenia Febril/terapia , Neutropenia Febril/economía , Análisis Costo-BeneficioRESUMEN
AВSTRACТ From a macroeconomic viewpoint, development theories have ranged from those that privilege international cooperation to those that maintain that the alternative for overcoming poverty is sustainable economic growth. In the middle has been development economics, whose studies have moved away from fieldwork as a modality for empirical research. The purpose of this article is to reflect on the central arguments of the experimental approach proposed by Esther Duflo and Abhijit Banerjee, applied from the perspective of economics, to understand and combat poverty. The main ideas, criticisms, and debates suggested by both the academic field and public management are presented. The epistemological scope of this theory will be relevant if it stimulates an interdisciplinary approach to poverty where the poor are considered as subjects and not as agents of an analytical model. JEL CLASSIFICATION A12, C90, 010, 130, 131, 138, 139
RESUMO Do ponto de vista macroeconômico, as teorias do desenvolvimento têm variado entre as que privilegiam a cooperação internacional e as que defendem que a alternativa à superação da pobreza é o crescimento econômico sustentável. A economia do desenvolvimento, cujos estudos se têm afastado do trabalho de campo como modalidade de investigação empírica, tem estado numa posição intermédia. O objectivo deste artigo é reflectir sobre os princípios centrais da abordagem experimental proposta por Esther Duflo e Abhijit Banerjee, aplicada a partir da perspectiva da economia, para compreender e combater a pobreza. São apresentadas as principais ideias, críticas e debates propostos tanto ao campo académico como à administração pública. O alcance epistemológico desta teoria será relevante na medida em que estimula uma visão interdisciplinar da pobreza, onde os pobres são considerados como sujeitos e não como agentes de um modelo analítico. CLASSIFICAÇÃO JEL A12, C90, 010, 130, 131, 138, 139
RESUMEN Desde una visión macroeconómica, las teorías de desarrollo han oscilado desde las visiones que privilegian la cooperación internacional, hasta las que sostienen que la alternativa para superar la pobreza es el crecimiento económico sostenible. En medio ha quedado la economía del desarrollo cuyos estudios se han alejado del trabajo de campo como modalidad para la investigación empírica. El objetivo de este artículo es reflexionar sobre los planteamientos centrales del enfoque experimental propuesto por Esther Duflo y Abhijit Banerjee, aplicado desde la economía, para entender y combatir la pobreza. Se da cuenta de sus principales ideas, críticas y debates propuestos tanto al campo académico como a la gestión pública. Los alcances epistemológicos de esta teoría serán relevantes en la medida que estimulen una lectura interdisciplinar de la pobreza, donde se considere a los pobres como sujetos y no como agentes de un modelo analítico. CLASIFICACIÓN JEL: A12, C90, 010, 130, 131, 138, 139
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Abstract During the past three decades the world has been witness to an alarming increase in the shortage of drugs and biomedical products in the field of anesthesia and surgical care. This situation can be particularly challenging when there are no therapeutic alternatives available, as is the case with some supplies and drugs for perioperative use. Anesthesiologists, who play a crucial role in the preparation of the drugs they administer, are particularly aware of these shortages. The reasons for these shortages are diverse and involve problems in supply, demand and government regulation. Among the causes identified are the increase in demand, bidding systems and the sustainability challenges faced by pharmaceutical companies. It is essential to understand these causes in order to seek strategies to reduce the risk of shortages of medicines and supplies. Addressing this challenge requires improving supply chain management, fostering transparency in information on stock-outs, promoting local production of medicines, and strengthening procurement and distribution regulations and policies. The solution to this problem requires a comprehensive and collaborative approach, with multiple stakeholders working together to ensure adequate access to needed medications in the anesthesia and surgical care setting.
Resumen Durante las últimas tres décadas, en el mundo se ha observado un alarmante aumento en el desabastecimiento de medicamentos y productos biomédicos en el ámbito de la atención anestésica y quirúrgica. Esta situación puede resultar especialmente problemática cuando no existen alternativas terapéuticas disponibles, como ocurre en algunos casos de insumos y medicamentos de uso perioperatorio. Los anestesiólogos, quienes desempeñan un papel crucial en la preparación de los medicamentos que administran, son particularmente conscientes de estos fenómenos de desabastecimiento. Las causas de estos desabastecimientos son diversas e involucran problemas en la oferta, la demanda y la regulación estatal. Entre las causas identificadas se encuentran el aumento en la demanda, los sistemas de licitación y los desafíos de sostenibilidad que enfrentan las empresas farmacéuticas. Es fundamental comprender estas causas para buscar estrategias que reduzcan el riesgo de desabastecimiento de medicamentos e insumos. Para abordar este desafío se requiere mejorar la gestión de la cadena de suministro, fomentar la transparencia en la información sobre desabastecimientos, promover la producción local de medicamentos y fortalecer las regulaciones y políticas de adquisición y distribución. La solución a este problema exige un enfoque integral y colaborativo, en el que múltiples partes interesadas trabajen conjuntamente para garantizar un acceso adecuado a los medicamentos necesarios en el ámbito de la atención anestésica y quirúrgica.
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INTRODUCTION: Considering the prospects of increased prevalence and disability due to neck and low back pain, it is relevant to investigate the care processes adopted, to assist future public policies and decision-making for a better allocation of resources. Objective: the aim of this study was to estimate the costs arising from inpatient and outpatient care of individuals with Neck Pain (NP) and Low Back Pain (LBP) in Brazil, between 2010 and 2019. METHODS: This is a cost-of-illness study from the perspective of the Brazilian public health system, based on health conditions with high prevalence (neck and low back pain). Data were presented descriptively using absolute and relative values. RESULTS: Between 2010 and 2019, the health system spent more than $600 million (R$ 2.3 billion) to treat NP and LBP in adults, and LBP accounted for most of the expenses. Female had higher absolute expenses in inpatient care and in the outpatient system. CONCLUSION: Our study showed that the costs with NP and LBP in Brazil were considerable. Female patients had higher outpatient costs and male patients had higher hospitalization costs. Healthcare expenses were concentrated for individuals between 34 and 63 years of age.
This study focused on understanding how much it cost to treat neck pain (NP) and low back pain (LBP) in Brazil between 2010 and 2019, from the point of view of the public health system (i.e. Unified Health System SUS). The idea was to find out how much money was spent and where. It turned out that the SUS spent, in total, more than US$600 million (R$2.3 billion) with LBP responsible for most of these expenses. Furthermore, we noted that women had higher outpatient care costs, while men had higher hospitalization costs. Those costs were more concentrated in people aged between 34 and 63 years.
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Atención Ambulatoria , Costo de Enfermedad , Costos de la Atención en Salud , Hospitalización , Dolor de la Región Lumbar , Dolor de Cuello , Humanos , Brasil , Dolor de la Región Lumbar/economía , Dolor de la Región Lumbar/terapia , Femenino , Masculino , Adulto , Persona de Mediana Edad , Dolor de Cuello/terapia , Dolor de Cuello/economía , Costos de la Atención en Salud/estadística & datos numéricos , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Atención Ambulatoria/economía , Prevalencia , Adulto Joven , Salud Pública/economía , Anciano , Factores Sexuales , Adolescente , Factores de EdadRESUMEN
BACKGROUND: Telemedicine, a method of healthcare service delivery bridging geographic distances between patients and providers, has gained prominence. This modality is particularly advantageous for outpatient consultations, addressing inherent barriers of travel time and cost. OBJECTIVE: We aim to describe economical outcomes towards the implementation of a multidisciplinary telemedicine service in a high-complexity hospital in Latin America, from the perspective of patients. DESIGN: A cross-sectional study was conducted, analysing the institutional data obtained over a period of 9 months, between April 2020 and December 2020. SETTING: A high-complexity teaching hospital located in Cali, Colombia. PARTICIPANTS: Individuals who received care via telemedicine. The population was categorised into three groups based on their place of residence: Cali, Valle del Cauca excluding Cali and Outside of Valle del Cauca. OUTCOME MEASURES: Travel distance, time, fuel and public round-trip cost savings, and potential loss of productivity were estimated from the patient's perspective. RESULTS: A total of 62 258 teleconsultations were analysed. Telemedicine led to a total distance savings of 4 514 903 km, and 132 886 hours. The estimated cost savings were US$680 822 for private transportation and US$1 087 821 for public transportation. Patients in the Outside of Valle del Cauca group experienced an estimated average time savings of 21.2 hours, translating to an average fuel savings of US$149.02 or an average savings of US$156.62 in public transportation costs. Areas with exclusive air access achieved a mean cost savings of US$362.9 per teleconsultation, specifically related to transportation costs. CONCLUSION: Telemedicine emerges as a powerful tool for achieving substantial travel savings for patients, especially in regions confronting geographical and socioeconomic obstacles. These findings underscore the potential of telemedicine to bridge healthcare accessibility gaps in low-income and middle-income countries, calling for further investment and expansion of telemedicine services in such areas.
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Hospitales de Enseñanza , Telemedicina , Humanos , Colombia , Estudios Transversales , Telemedicina/economía , Telemedicina/métodos , Femenino , Masculino , Persona de Mediana Edad , Adulto , Anciano , Ahorro de Costo , Accesibilidad a los Servicios de Salud/economía , Adolescente , Adulto Joven , Viaje/economíaRESUMEN
Objetivo: Analisar custos diretos da assistência de enfermagem ao cliente com insuficiência venosa crônica atendidos por profissional liberal. Métodos: Estudo transversal realizado em consultório particular de enfermagem. Observou-se 131 consultas de enfermagem para 15 pacientes. Calculou-se o custo a partir dos valores da assistência por tabela de honorários padronizadas, adicionada aos custos dos materiais e soluções consumidos nos atendimentos. Resultados: Constatou-se custo médio de US$ 77,91 por consulta de enfermagem associada aos procedimentos. Houve uma variação de 4 a 15 atendimentos a cliente. O custo total da assistência variou de US$ 311,64 a US$ 1.168.65, com média de US$ 680,15. Destaca-se o hidrogel como cobertura mais utilizada e tempo médio de 21 minutos por consulta. Conclusão: Os gastos com o tratamento de úlceras venosas colaboram com conhecimento monetário da terapêutica. Revela-se a importância de analisar custos como ferramenta para subsidiar ações que beneficiem a sustentabilidade empresarial da consulta de enfermagem. (AU)
Objective: To analyze the direct costs of nursing care for clients with chronic venous insufficiency assisted by liberal professionals. Methods: Cross-sectional study carried out in a private nursing office. There were 131 nursing consultations for 15 patients. The cost was calculated from the values of assistance using a standardized fee table, added to the costs of materials and solutions consumed in the assistance. Results: There was an average cost of US$ 77.91 per nursing consultation associated with the procedures. There was a range of 4 to 15 customer service calls. The total cost of assistance ranged from $311.64 to $1,168.65, averaging $680.15. Hydrogel stands out as the most used coverage and average time of 21 minutes per consultation. Conclusion: Expenses with the treatment of venous ulcers collaborate with monetary knowledge of the therapy. It reveals the importance of analyzing costs as a tool to support actions that benefit the corporate sustainability of nursing consultations. (AU)
Objetivo: Analizar los costos directos del cuidado de enfermería para clientes con insuficiencia venosa crónica asistidos por profesionales liberales. Métodos: Estudio transversal realizado en un consultorio privado de enfermería. Hubo 131 consultas de enfermería para 15 pacientes. El costo se calculó a partir de los valores de la asistencia utilizando una tabla de tarifas estandarizada, sumada a los costos de los materiales y soluciones consumidos en la asistencia. Resultados: Hubo un costo promedio de US $ 77,91 por consulta de enfermería asociada a los procedimientos. Hubo un rango de 4 a 15 llamadas de servicio al cliente. El costo total de la asistencia osciló entre $ 311.64 y $ 1,168.65, con un promedio de $ 680.15. El hidrogel destaca como la cobertura más utilizada y el tiempo medio de 21 minutos por consulta. Conclusion: Los gastos con el tratamiento de las úlceras venosas colaboran con el conocimiento monetario de la terapia. Revela la importancia del análisis de costos como herramienta de apoyo a acciones que beneficien la sustentabilidad corporativa de las consultas de enfermería. (AU)
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Atención de Enfermería , Enfermería de Consulta , Economía de la EnfermeríaRESUMEN
Despite the health, societal, and economic benefits of immunization, many countries focus primarily on childhood immunizations and lack robust policies and sufficient resources for immunizations that can benefit populations across the life course. While the benefits of childhood vaccination are well documented, there is limited evidence on the financial and social return on investment that policymakers can use to inform decisions around administering a life-course immunization program. We developed a cost-benefit model from a societal perspective to evaluate the inclusion of 5 vaccines across the life course in Colombia's national immunization program. This model estimated a return of US$1.3 per US$1.0 invested in the first 2 decades, increasing to US$3.9 after 60 years. Primary benefits were productivity gains, followed by fiscal savings and household averted expenditure on health care. Furthermore, vulnerable households are predicted to receive 3.2 times greater income protection than formally employed households under a life-course immunization program. Consequently, there is a potential to reduce Colombia's income inequality and poverty rate by increasing access to immunization for all ages.
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INTRODUCTION AND OBJECTIVES: Treatment of chronic hepatitis B (CHB) with nucelos(t)ide analogues (NA) can improve outcomes, but NA treatment is expensive for insurance plans. MATERIALS AND METHODS: The Centers for Medicare & Medicaid Services database was assessed from 2012 to 2021 to assess the use of NA for CHB in patients on Medicaid. Data extracted included the number of claims, units, and costs of each agent stratified by originator and generic. RESULTS: Over the study period, 1.9 billion USD was spent on NA, with spending peaking in 2016 at $289 million US, which has subsequently decreased. Lower expenditures since 2016 have been associated with increased use of generics. The use of generic tenofovir or entecavir led to savings of $669 million US over the study period. CONCLUSIONS: Increased generic use has significantly reduced expenditures for NA drugs; policy shifts towards generic drug use may help with sustainability.
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Antivirales , Costos de los Medicamentos , Medicamentos Genéricos , Gastos en Salud , Hepatitis B Crónica , Medicaid , Humanos , Estados Unidos , Medicaid/economía , Antivirales/uso terapéutico , Antivirales/economía , Hepatitis B Crónica/tratamiento farmacológico , Hepatitis B Crónica/economía , Medicamentos Genéricos/economía , Medicamentos Genéricos/uso terapéutico , Nucleósidos/uso terapéutico , Nucleósidos/economía , Tenofovir/uso terapéutico , Tenofovir/economía , Guanina/análogos & derivados , Guanina/uso terapéutico , Guanina/economíaRESUMEN
Up to 25% of pediatric cataract cases are inherited. There is sparse information in the literature regarding the cost of whole-exome sequencing (WES) for suspected hereditary pediatric cataracts. Molecular diagnosis of suspected hereditary pediatric cataracts is important for comprehensive genetic counseling. We performed a partial economic evaluation with a mixed costing analysis, using reimbursement data and microcosting approach with a bottom-up technique to estimate the cost of using WES for genetic diagnosis of suspected hereditary pediatric cataracts from the perspective of the Brazilian governmental health care system. One hundred and ten participants from twenty-nine families in Rio de Janeiro (RJ) were included. Costs of consumables, staff and equipment were calculated. Two scenarios were created: (1) The reference scenario included patients from RJ with suspected hereditary pediatric cataracts plus two family members. (2) The alternative scenario considered other genetic diseases, resulting in 5,280 exams per month. Sensitivity analysis was also performed. In the reference scenario, the total cost per exam was 700.09 United States dollars (USD), and in the alternative scenario, the total cost was 559.23 USD. The cost of WES alone was 527.85 USD in the reference scenario and 386.98 USD in the alternative scenario. Sensitivity analysis revealed that the largest costs were associated with consumables in both scenarios. Economic evaluations can help inform policy decisions, especially in middle-income countries such as Brazil.
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BACKGROUND: The diagnostic and prognostic relevance of Human Leukocyte Antigen B-27 (HLA-B27) in Axial Spondyloarthritis (AxSpA) is undeniable, with 70% of Ankylosing Spondylitis (AS) patients carrying the B27 gene, contrasted with a mere 4.35% in the general population. Flow cytometry (FC) and Polymerase Chain Reaction (PCR) have emerged as the predominant techniques for routine HLA-B27 typing. While various studies have compared these methods, none have catered to the unique characteristics of the Brazilian demographic. Therefore, this research aims to compare FC and PCR in a Brazilian cohort diagnosed with AxSpA. METHODS: An analytical cross-sectional study was undertaken involving 62 AxSpA outpatients from a Brazilian University Hospital. Both FC and PCR-SSP assays were utilized to ascertain HLA-B27 typing. The outcomes (either confirming or refuting the allele's presence) underwent rigorous scrutiny. Agreement between the methodologies was assessed using the kappa statistic. A p-value of < 0.05 was deemed statistically significant. RESULTS: Of the participants, 90.3% (n = 56) were HLA-B27 positive according to FC, while 79% (n = 49) were identified as positive using the PCR method. FC exhibited a sensitivity rate of 98% paired with a specificity of 38.5%. The Positive Predictive Value for FC stood at 85.7%, and the Negative Predictive Value was 83.5%. Consequently, the overall accuracy of the FC method was gauged at 85.5%. A kappa coefficient of κ = 0.454 was derived. CONCLUSIONS: FC demonstrated noteworthy sensitivity and satisfactory accuracy in HLA-B27 detection, albeit with a reduced specificity when contrasted with PCR-SSP. Nevertheless, given its cost-effectiveness and streamlined operation relative to PCR, FC remains a pragmatic option for preliminary screening in clinical practice, especially in low-income regions. To optimize resource allocation, we advocate for a refined algorithm that initiates by assessing the relevance of HLA-B27 typing based on Choosing Wisely recommendations. It then leans on FC, and, if results are negative yet clinical suspicion persists, advances to PCR. This approach aims to balance diagnostic accuracy and financial prudence, particularly in regions contending with escalating medical costs.
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Citometría de Flujo , Antígeno HLA-B27 , Reacción en Cadena de la Polimerasa , Humanos , Antígeno HLA-B27/genética , Antígeno HLA-B27/sangre , Antígeno HLA-B27/análisis , Estudios Transversales , Masculino , Femenino , Adulto , Espondiloartritis Axial/diagnóstico , Brasil , Persona de Mediana Edad , Sensibilidad y Especificidad , Espondilitis Anquilosante/diagnóstico , Espondilitis Anquilosante/genéticaRESUMEN
OBJECTIVES: Evaluate the cost of advanced ovarian cancer, using the microcosting technique, based on real-world evidence from the perspective of a reference Brazilian public hospital. METHODS: Retrospective cohort study of patients newly diagnosed with advanced ovarian cancer in 2017 and followed-up for up to 5 years. A bottom-up microcosting method was applied, using the activity-based cost approach, which evaluates service costs based on activity consumption throughout patients' journey. RESULTS: The results indicate a median overall survival of 35.3 months and a median age of 57 years (33-80 years old). The average cost per patient was USD 34 991.595 over a period of 35.3 months, with admissions because of the disease progression and end-of-life care being the most relevant. CONCLUSIONS: The results show that the costs of activities currently involved in the treatment of advanced ovarian cancer represent an important economic impact for the public health system. These data can support future analyses on the impact of incorporating new technologies for the treatment of ovarian cancer and on the financing and sustainability of the Brazilian public healthcare system.