RESUMO
OBJECTIVE: To examine direct and indirect costs incurred by new, retreatment, and multidrug-resistant (MDR) tuberculosis (TB) patients in the Dominican Republic before and during diagnosis, and during treatment, to generate an evidence base and formulate recommendations. METHODS: The "Tool to Estimate Patients' Costs" was adapted to the local setting, translated into Spanish, and pretested. Patients attending 32 randomly selected health facilities in six chosen study areas on the study days were interviewed. Responses from patients 18-65 years old who had received treatment for at least one month and provided signed informed consent were collected, entered into a database, and analyzed. RESULTS: A total of 200 patients were interviewed. For most respondents, direct and indirect costs increased while income decreased. Total costs amounted to a median of US$ 908 for new patients, US$ 432 for retreatment patients, and US$ 3 557 for MDR-TB patients. The proportion of patients without a regular income increased from 1% to 54% because of falling ill with TB. Following its review of the study results the Ministry of Health has made efforts to allocate public funds for food supplements and to include in- and outpatient TB services in the national health insurance schemes. CONCLUSIONS: Free TB diagnosis and treatment are not enough to alleviate the financial constraints experienced by vulnerable groups as a result of the illness. Health insurance covering TB in- and outpatient costs is critical to prevent TB-related financial hardship.
Assuntos
Efeitos Psicossociais da Doença , Política Pública , Tuberculose/tratamento farmacológico , Tuberculose/economia , Adolescente , Adulto , Idoso , Estudos Transversais , República Dominicana , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
OBJECTIVE: To examine direct and indirect costs incurred by new, retreatment, and multidrug-resistant (MDR) tuberculosis (TB) patients in the Dominican Republic before and during diagnosis, and during treatment, to generate an evidence base and formulate recommendations. METHODS: The "Tool to Estimate Patients' Costs" was adapted to the local setting, translated into Spanish, and pretested. Patients attending 32 randomly selected health facilities in six chosen study areas on the study days were interviewed. Responses from patients 18-65 years old who had received treatment for at least one month and provided signed informed consent were collected, entered into a database, and analyzed. RESULTS: A total of 200 patients were interviewed. For most respondents, direct and indirect costs increased while income decreased. Total costs amounted to a median of US$ 908 for new patients, US$ 432 for retreatment patients, and US$ 3 557 for MDR-TB patients. The proportion of patients without a regular income increased from 1% to 54% because of falling ill with TB. Following its review of the study results the Ministry of Health has made efforts to allocate public funds for food supplements and to include in- and outpatient TB services in the national health insurance schemes. CONCLUSIONS: Free TB diagnosis and treatment are not enough to alleviate the financial constraints experienced by vulnerable groups as a result of the illness. Health insurance covering TB in- and outpatient costs is critical to prevent TB-related financial hardship.
OBJETIVO: Examinar los costos directos e indirectos afrontados por los pacientes con tuberculosis en la República Dominicana, ya sea por un tratamiento nuevo, por retratamiento, o por una tuberculosis multirresistente (MR), antes y a lo largo del proceso diagnóstico y durante el tratamiento, con objeto de generar una base de datos probatorios y formular recomendaciones. MÉTODOS: El "Instrumento de cálculo de los costos afrontados por los pacientes" ("Tool to Estimate Patients' Costs") se adaptó al entorno local, se tradujo al español y se sometió a una prueba preliminar. Durante los días en que se llevó a cabo el estudio, se entrevistó a los pacientes que acudían a 32 establecimientos de salud seleccionados aleatoriamente en seis zonas elegidas para ello. Se recopilaron las respuestas de los pacientes de 18 a 65 años de edad que habían recibido tratamiento durante al menos un mes y que habían prestado su consentimiento por escrito. Las respuestas se introdujeron en una base de datos y se analizaron. RESULTADOS: Se entrevistó a 200 pacientes. Para la mayoría de los entrevistados, los costos directos e indirectos aumentaban a medida que se reducían sus ingresos. Los costos totales ascendieron a una mediana de US$ 908 para los nuevos pacientes, US$ 432 para los pacientes en retratamiento y US$ 3 557 para los pacientes con tuberculosis multirresistente. La proporción de pacientes sin ingresos regulares aumentó de 1 a 54% como consecuencia de haber contraído la tuberculosis. Después de examinar los resultados del estudio, el Ministerio de Salud ha llevado a cabo iniciativas con objeto de asignar fondos públicos para suplementos alimentarios y para incluir los servicios de atención hospitalaria y ambulatoria de la tuberculosis en los programas del seguro nacional de enfermedad. CONCLUSIONES: El diagnóstico y el tratamiento gratuitos de la tuberculosis no son suficientes para mitigar las limitaciones financieras afrontadas por los grupos vulnerables como consecuencia de la enfermedad. Es esencial que el seguro de enfermedad cubra los costos de la atención hospitalaria y ambulatoria de la tuberculosis para paliar las dificultades financieras relacionadas con la enfermedad.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Efeitos Psicossociais da Doença , Política Pública , Tuberculose/tratamento farmacológico , Tuberculose/economia , Estudos Transversais , República DominicanaAssuntos
Tuberculose , Tuberculose Resistente a Múltiplos Medicamentos , Efeitos Psicossociais da Doença , República Dominicana , Tuberculose Resistente a Múltiplos Medicamentos , Efeitos Psicossociais da Doença , República Dominicana , Política Pública , Efeitos Psicossociais da Doença , Tuberculose , Estudos TransversaisRESUMO
BACKGROUND: We hypothesized that investments to improve the control of tuberculosis in selected high-incidence countries would prove to be cost saving for the United States by reducing the incidence of the disease among migrants. METHODS: Using decision analysis, we estimated tuberculosis-related morbidity, mortality, and costs among legal immigrants and refugees, undocumented migrants, and temporary visitors from Mexico after their entry into the United States. We assessed the current strategy of radiographic screening of legal immigrants plus current tuberculosis-control programs alone and with the addition of either U.S.-funded expansion of the strategy of directly observed treatment, short course (DOTS), in Mexico or tuberculin skin testing to screen legal immigrants from Mexico. We also examined tuberculosis-related outcomes among migrants from Haiti and the Dominican Republic using the same three strategies. RESULTS: As compared with the current strategy, expanding the DOTS program in Mexico at a cost to the United States of 34.9 million dollars would result in 2591 fewer cases of tuberculosis in the United States, with 349 fewer deaths from the disease and net discounted savings of 108 million dollars over a 20-year period. Adding tuberculin skin testing to radiographic screening of legal immigrants from Mexico would result in 401 fewer cases of tuberculosis in the United States but would cost an additional 329 million dollars. Expansion of the DOTS program would remain cost saving even if the initial investment were doubled, if the United States paid for all antituberculosis drugs in Mexico, or if the decline in the incidence of tuberculosis in Mexico was less than projected. A 9.4 million dollars investment to expand the DOTS program in Haiti and the Dominican Republic would result in net U.S. savings of 20 million dollars over a 20-year period. CONCLUSIONS: U.S.-funded efforts to expand the DOTS program in Mexico, Haiti, and the Dominican Republic could reduce tuberculosis-related morbidity and mortality among migrants to the United States, producing net cost savings for the United States.
Assuntos
Terapia Diretamente Observada/economia , Emigração e Imigração , Cooperação Internacional , Pulmão/diagnóstico por imagem , Programas de Rastreamento , Teste Tuberculínico/economia , Tuberculose Pulmonar/prevenção & controle , Antituberculosos/economia , Antituberculosos/uso terapêutico , Redução de Custos , Técnicas de Apoio para a Decisão , República Dominicana , Haiti , Custos de Cuidados de Saúde , Humanos , Incidência , Investimentos em Saúde , Cadeias de Markov , México/epidemiologia , Modelos Econômicos , Radiografia Torácica/economia , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/economia , Tuberculose Pulmonar/mortalidade , Estados Unidos/epidemiologiaRESUMO
OBJECTIVE: To estimate the prevalence and to describe the clinical characteristics of gestational diabetes mellitus (GDM) in pregnant women receiving health care services at the Puerto Rico University Hospital from 1997 to 1998. METHODS: The study design was cross-sectional. All medical records available of pregnant women diagnosed with GDM were retrospectively reviewed. Descriptive statistics such as frequency distributions and summary measures (mean and standard deviation) were used. Annual and 18-month period prevalences of GDM were calculated. Fisher's exact test was used to compare proportions. RESULTS: A total of 78 medical records were available during the 18-month study period (June 1997 to December 1998). The estimated prevalence of GDM was 2 for the total study period (18-month) as well as for the year 1998. The highest proportion (52.3) of GDM cases was found in the 30 years or less age group. Forty-eight percent had a body mass index (BMI) > or = 30 m/kg2 (obese) before pregnancy; however, the weight gained during the last pregnancy was higher than 15 pounds (57). Sixty-four percent of the cases had a family history of diabetes, meanwhile, 34.7 reported a history of GDM during previous pregnancies. During the first prenatal visit, 80.5 reflected glucose levels higher than 110 mg/ml. Preeclampsia (6.4) and macrosomia (14) were the most frequent complications for the mother and the fetus, respectively. DISCUSSION: More epidemiological studies about GMD in Puerto Rico need to be performed to better describe the prevalence of the condition in the island.