RESUMEN
OBJECTIVES: Because of the lack of evidence regarding long-term effectiveness and cost-effectiveness of first-generation direct-acting antivirals for chronic hepatitis C (CHC) treatment in Brazil, we performed a cost-utility analysis comparing standard dual therapy (peginterferon plus ribavirin [pegIFN/RBV]), boceprevir, and telaprevir for CHC patients. METHODS: We developed a state-transition Markov model simulating the progression of CHC. Long-term outcomes included remaining life expectancy in life-years (LYs), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER). Short-term outcomes included sustained virological response rates (SVR). Direct medical costs were obtained from Brazilian databases. A lifelong time horizon was considered and a 5% annual discount rate was applied for costs and clinical outcomes. A willingness-to-pay threshold of approximately $20 000 per QALY was used. We performed multiple sensitivity analyses. RESULTS: For short- and long-term scenarios, therapy with boceprevir was dominated by telaprevir, which was more effective than standard dual therapy (75.0% vs 40.4% SVR rate, 13.47 vs 12.59 LYs, and 9.74 vs 8.49 QALYs, respectively) and was also more expensive ($15 742 vs $5413). The corresponding ICERs were $29 854/SVR, $11 803/LY, and $8277/QALY. Based on our model, triple therapy with telaprevir was the most cost-effective treatment for the Brazilian health system. Despite a lack of data regarding the Brazilian population, we incorporated as many applicable parameters as possible. CONCLUSIONS: Telaprevir is more effective and cost-effective than boceprevir. Our model may be applied for other settings with a few adjustments in the input parameters.
Asunto(s)
Antivirales/uso terapéutico , Hepatitis C Crónica/tratamiento farmacológico , Oligopéptidos/uso terapéutico , Prolina/análogos & derivados , Antivirales/administración & dosificación , Antivirales/efectos adversos , Brasil , Análisis Costo-Beneficio , Costos de los Medicamentos , Quimioterapia Combinada , Femenino , Costos de la Atención en Salud/estadística & datos numéricos , Hepatitis C Crónica/economía , Humanos , Interferón-alfa/administración & dosificación , Interferón-alfa/economía , Interferón-alfa/uso terapéutico , Masculino , Cadenas de Markov , Persona de Mediana Edad , Oligopéptidos/administración & dosificación , Oligopéptidos/economía , Prolina/administración & dosificación , Prolina/economía , Prolina/uso terapéutico , Práctica de Salud Pública/economía , Práctica de Salud Pública/estadística & datos numéricos , Años de Vida Ajustados por Calidad de Vida , Ribavirina/administración & dosificación , Ribavirina/economía , Ribavirina/uso terapéutico , Resultado del TratamientoRESUMEN
BACKGROUND: Studies on dengue related to the cost of illness and cost of the program are factors to describe the economic burden of dengue, a neglected disease that has global importance in public health. These studies are often used by health managers in optimizing financial resources. A systematic review of studies estimating the cost of dengue was carried out, comparing the costs between the studies and examining the cost drivers regarding the methodological choices. METHODS: This study was done according to the guidelines of the Centre for Reviews and Dissemination (CRD). Several databases were searched: Medline, Virtual Health Library and CRD. Two researchers, working independently, selected the studies and extracted the data. The quality of the methodology of the individual studies was achieved by a checklist of 29 items based on protocols proposed by the British Medical Journal and Consolidated Health Economic Evaluation Reporting Standards. A qualitative and quantitative narrative synthesis was performed. RESULTS: A literature search yielded 665 publications. Of these, 22 studies are in accordance with previously established inclusion criteria. The cost estimates were compared amongst the studies, highlighting the study design, included population and comparators used (study methodology). The component costs included in the economic evaluation were based on direct and indirect costs, wherein twelve studies included both costs, twelve studies adopted the societal perspective and ten studies used the perspective of the public health service provider, or of a private budget holder. CONCLUSION: This study showed that the cost of dengue in 18 countries generated approximately US$ 3.3 billion Purchasing Power Parity (PPP) in 2015. This confirms that the burden of dengue has a great economic impact on countries with common socioeconomic characteristics and similarities in health systems, particularly developing countries, indicating a need for further studies in these countries.
Asunto(s)
Dengue/economía , Costo de Enfermedad , Humanos , Salud Pública/economía , Práctica de Salud Pública/economíaRESUMEN
The universal access to a health care system for the Brazilian population was established in 1990. Brazil is a country with no tradition in the production and use of health economic evaluation (HEE) to guide decision making in the public health system. It is only within the last two decades that HEEs using a microeconomic approach have appeared in the academic field. On a national level, HEE and Health Technology Assessment (HTA), in a wider sense, were first taken into account in 2003. Two policies deserve to be mentioned - (i) the regulation of medicines in the Brazilian market, and (ii) science, technology and innovation policy. The latter required the fostering of applied research to encourage the application of methods which employ systematic reviews and economic analyses of cost-effectiveness to guide the incorporation of technologies in the Brazilian health care system. The Ministry of Health has initiated the process of incorporating these new technologies on a federal level during the last ten years. In spite of the improvement of HEE methods at Brazilian universities and research institutes, these technologies have not yet reached the governmental bodies. In Brazil, the main challenge lies in the production, interpretation and application of HEE to all technologies within the access scheme(s), and there is limited capacity building. Setting priorities can be the solution for Brazil to be able to perform HEE for relevant technologies within the access scheme(s) while the universal coverage system struggles with a triple burden of disease.
Asunto(s)
Análisis Costo-Beneficio , Comparación Transcultural , Toma de Decisiones en la Organización , Programas Nacionales de Salud/economía , Práctica de Salud Pública/economía , Brasil , Accesibilidad a los Servicios de Salud/economía , Humanos , Invenciones/economía , Evaluación de la Tecnología Biomédica/economía , Cobertura Universal del Seguro de Salud/economíaRESUMEN
Indicators for Stress Adaptation Analytics (ISAAC) is a protocol to measure the emergency response behavior of organizations within local public health systems. We used ISAAC measurements to analyze how funding and structural changes may have affected the emergency response capacity of a local health agency. We developed ISAAC profiles for an agency's consecutive fiscal years 2013 and 2014, during which funding cuts and organizational restructuring had occurred. ISAAC uses descriptive and categorical response data to obtain a function stress score and a weighted contribution score to the agency's total response. In the absence of an emergency, we simulated one by assuming that each function was stressed at an equal rate for each of the two years and then we compared the differences between the two years. The simulations revealed that seemingly minor personnel or budget changes in health departments can mask considerable variation in change at the internal function level.
Asunto(s)
Planificación en Desastres/normas , Urgencias Médicas , Práctica de Salud Pública/normas , Análisis y Desempeño de Tareas , Toma de Decisiones , Planificación en Desastres/economía , Humanos , Gobierno Local , Modelos Organizacionales , Evaluación de Programas y Proyectos de Salud , Práctica de Salud Pública/economía , Estados UnidosRESUMEN
During the 1990s, Cuba was able to overcome a severe crisis, almost without negative health impacts. This national retrospective study covering the years 1989-2000 analyses the country's strategy through essential social, demographic, health process and health outcome indicators. Gross domestic product (GDP) diminished by 34.76% between 1989 and 1993. In 1994 slow recuperation started. During the crisis, public health expenses increased. The number of family doctors rose from 9.22 to 27.03 per 104 inhabitants between 1989 and 2000. Infant mortality rate and life expectancy exemplify a series of health indicators that continued to improve during the crisis years, whereas low birth weight and tuberculosis incidence are among the few indicators that suffered deterioration. GDP is inversely related to tuberculosis incidence, whereas the average salary is inversely related to low birth weight. Infant mortality rate has a strong negative correlation with the health expenses per inhabitant, the number of maternal homes, the number of family doctors and the proportion of pregnant women receiving care in maternal homes. Life expectancy has a strong positive correlation with health expenses, the number of nursing personnel and the number of medical contacts per inhabitant. The Cuban strategy effectively resolved health risks during the crisis. In times of serious socio-economic constraints, a well conceptualized public health policy can play an important role in maintaining the overall well-being of a population.
Asunto(s)
Atención a la Salud/organización & administración , Recesión Económica , Medicina Familiar y Comunitaria/estadística & datos numéricos , Reforma de la Atención de Salud/organización & administración , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Programas Nacionales de Salud/organización & administración , Práctica de Salud Pública/estadística & datos numéricos , Adolescente , Adulto , Anciano , Niño , Preescolar , Cuba/epidemiología , Atención a la Salud/economía , Países en Desarrollo , Femenino , Reforma de la Atención de Salud/economía , Indicadores de Salud , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Programas Nacionales de Salud/economía , Dinámica Poblacional , Embarazo , Práctica de Salud Pública/economía , Estudios Retrospectivos , Factores Socioeconómicos , Adulto JovenRESUMEN
O objetivo do artigo consiste em apresentar e discutir um modelo compreensivo/explicativo, de caráter ecossistêmico, sobre o processo de transmissão da dengue nos níveis de micro e macrocontexto, a partir da identificação das situações de riscos envolvidas. Considerou-se a dengue como doença infecciosa viral de transmissão vetorial que traz, na sua dinâmica de transmissão, elementos das dimensões biológicas, de conduta, ecológicas, políticas e econômicas, o que a caracteriza como um problema complexo e exige um enfoque sistêmico para seu controle. Assim, para a construção da modelagem, utilizaram-se o enfoque teórico da reprodução social de Juan Samaja e seus condicionantes de macro e microcontexto, e o enfoque operativo ecossistêmico, que buscou responder à pergunta condutora desta construção: quais são as situações de risco para transmissão da dengue, considerando as diversas dimensões da "reprodução social da saúde" no nível local? A visão ampliada das inter-relações entre as diversas situações de risco envolvidas na determinação multidimensional da dengue poderá servir como eixo direcionador para uma gestão integrada das ações do programa de controle da doença, articuladas entre os diversos setores envolvidos.
This paper aims to present and discuss a comprehensive / explanatory model, of ecosystem approach, on the process of transmission of dengue in the levels of micro and macro context, from the identification of the risks involved. Dengue was considered a viral infectious disease of vectorial transmission that carries on its transmission dynamics, elements of the biological, behavioral, ecological, political and economic dimensions, that make it a complex problem and require a systemic approach to its control. Thus, for the construction of modeling, we used the theoretical framework of social reproduction of Juan Samaja and its conditions of macro and micro-context, and the operating ecosystem approach, which sought to answer the question driving this construction: what are the risk situations for the transmission of dengue, considering the different dimensions of "social reproduction of health" at the local level? The enlarged view of the interrelationships among the various risk situations involved in determining multidimensional dengue could guide the integrated management of actions of a disease control program, coordinated by the several sectors involved.
Asunto(s)
Humanos , Masculino , Femenino , Control Biológico de Vectores/economía , Control Biológico de Vectores/métodos , Control Biológico de Vectores/organización & administración , Dengue/diagnóstico , Dengue/epidemiología , Dengue/prevención & control , Salud Pública/economía , Salud Pública/métodos , Salud Pública , Riesgos Ambientales , Gestión en Salud , Impactos de la Polución en la Salud/métodos , Impactos de la Polución en la Salud/políticas , Impactos de la Polución en la Salud/prevención & control , Larvicidas/prevención & control , Práctica de Salud Pública/economía , Práctica de Salud Pública/ética , Práctica de Salud Pública/normasAsunto(s)
Atención a la Salud , Costos de la Atención en Salud , Asistencia Pública , Salud Pública , Clase Social , Factores Socioeconómicos , Brasil/etnología , Diversidad Cultural , Atención a la Salud/historia , Agencias Gubernamentales/economía , Agencias Gubernamentales/historia , Agencias Gubernamentales/legislación & jurisprudencia , Costos de la Atención en Salud/historia , Costos de la Atención en Salud/legislación & jurisprudencia , Gastos en Salud/historia , Gastos en Salud/legislación & jurisprudencia , Política de Salud/historia , Historia del Siglo XXI , Asistencia Pública/economía , Asistencia Pública/historia , Asistencia Pública/legislación & jurisprudencia , Salud Pública/economía , Salud Pública/educación , Salud Pública/historia , Salud Pública/legislación & jurisprudencia , Práctica de Salud Pública/economía , Práctica de Salud Pública/historia , Práctica de Salud Pública/legislación & jurisprudencia , Política Pública/economía , Política Pública/historia , Política Pública/legislación & jurisprudencia , Clase Social/historia , Condiciones Sociales/economía , Condiciones Sociales/historia , Condiciones Sociales/legislación & jurisprudenciaRESUMEN
This article analyzes Cuba's medical role in Haiti since Hurricane Georges in 1998, with particular emphasis on the Cuban government's response to the 2010 earthquake. The article examines two central themes. First, it assesses the enormous impact on public health that Cuba has made since 1998, and second, it provides a comparative analysis of Cuba's medical role since the earthquake.
Asunto(s)
Medicina de Desastres , Desastres , Cuerpo Médico , Práctica de Salud Pública , Sistemas de Socorro , Cuba/etnología , Tormentas Ciclónicas/economía , Tormentas Ciclónicas/historia , Medicina de Desastres/economía , Medicina de Desastres/educación , Medicina de Desastres/historia , Medicina de Desastres/legislación & jurisprudencia , Planificación en Desastres/economía , Planificación en Desastres/historia , Planificación en Desastres/legislación & jurisprudencia , Desastres/economía , Desastres/historia , Terremotos/economía , Terremotos/historia , Haití/etnología , Historia del Siglo XX , Historia del Siglo XXI , Cuerpo Médico/economía , Cuerpo Médico/educación , Cuerpo Médico/historia , Cuerpo Médico/legislación & jurisprudencia , Cuerpo Médico/psicología , Médicos/economía , Médicos/historia , Médicos/legislación & jurisprudencia , Médicos/psicología , Salud Pública/economía , Salud Pública/educación , Salud Pública/historia , Salud Pública/legislación & jurisprudencia , Práctica de Salud Pública/economía , Práctica de Salud Pública/historia , Práctica de Salud Pública/legislación & jurisprudencia , Sistemas de Socorro/economía , Sistemas de Socorro/historia , Sistemas de Socorro/legislación & jurisprudenciaRESUMEN
This article intends to examine the conditions of the city of Rio de Janeiro, regarding the city's health safety of the living and housing condition of its workers, which helped bringing about the spread of tuberculosis in the end of the 19th century and beginning of the 20th century. Evidencing the high incidence of tuberculosis at this time, it intends to verify the reasons for creating the Brazilian League Against Tuberculosis and its purpose, analyzing its project of assistance to children's health and its intervention to discipline, which resulted in the creation of the Dona Amélia Queen Reformatory.