RESUMO
We conducted a 3-year cost-effectiveness analysis on the cavitated dentine carious lesion preventive capabilities of composite resin (CR) (reference group) and atraumatic restorative treatment (ART) high-viscosity glass-ionomer cement (HVGIC) sealants compared to supervised toothbrushing (STB) in high-risk first permanent molars. School children aged 6-7 years in 6 schools (2 per group) received CR and ART/HVGIC sealants or STB daily for 180 days each school year. Data were collected prospectively and cost estimates were made for sample data and a projection of 1,000 sealants/STB high-risk permanent molars. Although STB had the best outcome, its high implementation cost (95% of cost for supervisors visiting schools 180 days/school year) affected the results. ART/HVGIC was cost-effective compared to CR for the sample data (savings of USD 37 per cavitated dentine carious lesion prevented), while CR was cost-effective compared to ART/HVGIC for the projection (savings of USD 17 per cavitated dentine carious lesion prevented), and both were cost-saving compared to STB. Two STB scenarios were tested in sensitivity analyses with variations in caries incidence and number of supervision days; results showed STB had lower costs and higher savings per cavitated dentine carious lesion prevented than CR and ART/HVGIC. A major assumption is that both scenarios have the same high effectiveness rate experienced by STB under study conditions; however, they point to the value of further research on the benefits of adopting STB as a long-term venture in a general population of school children.
Assuntos
Resinas Compostas/uso terapêutico , Análise Custo-Benefício , Tratamento Dentário Restaurador sem Trauma/economia , Cárie Dentária/prevenção & controle , Dente Molar , Selantes de Fossas e Fissuras/uso terapêutico , Escovação Dentária , Brasil/epidemiologia , Criança , Cárie Dentária/epidemiologia , Dentifrícios/uso terapêutico , Dentição Permanente , Feminino , Cimentos de Ionômeros de Vidro/uso terapêutico , Humanos , Masculino , Estudos ProspectivosRESUMO
We conducted a cost analysis of Haiti's Ministry of Public Health and Population neglected tropical disease program, Projet des Maladies Tropicales Negligées and collected data for 9 of 55 communes participating in the May 2008-April 2009 mass drug administration (MDA). The Projet des Maladies Tropicales Negligées Program partnered with IMA World Health and Hôpital Ste. Croix to implement MDA for treatment of lymphatic filariasis and soil-transmitted helminthiasis by using once a year treatment with albendazole and diethylcarbamazine in a population of approximately 8 million persons. Methods included analyzing partner financial records and conducting retrospective surveys of personnel. In the nine communes, 633,261 persons were treated at a cost of U.S. $0.64 per person, which included the cost of donated drugs, and at a cost of U.S. $0.42 per person treated, when excluding donated drug costs. The MDA for lymphatic filariasis in Haiti began in 2000, with the treatment of 105,750 persons at a cost per person of U.S. $2.23. The decrease in cost per person treated is the result of cumulative implementation experience and economies of scale.
Assuntos
Albendazol/uso terapêutico , Anti-Helmínticos/uso terapêutico , Dietilcarbamazina/uso terapêutico , Filariose Linfática/tratamento farmacológico , Helmintíase/tratamento farmacológico , Doenças Negligenciadas/tratamento farmacológico , Albendazol/administração & dosagem , Albendazol/economia , Anti-Helmínticos/administração & dosagem , Anti-Helmínticos/economia , Custos e Análise de Custo , Dietilcarbamazina/administração & dosagem , Dietilcarbamazina/economia , Tratamento Farmacológico/economia , Tratamento Farmacológico/métodos , Filariose Linfática/economia , Filariose Linfática/epidemiologia , Haiti/epidemiologia , Helmintíase/economia , Helmintíase/epidemiologia , Humanos , Doenças Negligenciadas/economia , Doenças Negligenciadas/epidemiologia , PrevalênciaRESUMO
OBJECTIVE: Identify opioids prescribed, preferred routes, and doses among children with incurable cancer. STUDY DESIGN: Prospective survey with monthly questionnaires regarding patients 0 to 19 years old from oncology centers. Data were collected by professionals on each patient for 6 months or until death, and analyzed from patients who died. Impact of tumor was analyzed with Kruskal-Wallis and Mann-Whitney tests. Major opioid dosages are expressed as oral morphine equivalents. RESULTS: Of 185 children recruited, 164 (88 boys, 76 girls) died. Mean palliative care duration was 67 days. One hundred forty-seven (89.6%) received major opioids. Morphine, diamorphine, and fentanyl were prescribed in 75%, 57.9%, and 11.6%, respectively. Seventy-three (44.5%) received >1 major opioid. Median monthly maximum doses prescribed rose from 2.1 mg/kg/24 h (study entry) to 4.4 mg/kg/24 h (death) (P < .001); overall variable (0.09-1500 mg/kg/24 h, median 3.7 mg/kg/24 h). Opioids were given by the oral (117/164, 71.3%), intravenous (68/164, 41.5%), subcutaneous (40, 28%), rectal (20, 12.2%), and transdermal (18, 11%) routes. There was a shift to intravenous use as death approached. Numbers within each tumor group were too small to show significance. Children with solid tumors outside the central nervous system were likely to receive more opioids, be given multiple different opioids, and receive opioids in the last month. CONCLUSIONS: The study shows the United Kingdom practice of opioid use and provides comparator data for practice in children's palliative medicine.
Assuntos
Analgésicos Opioides/uso terapêutico , Neoplasias/complicações , Dor/tratamento farmacológico , Cuidados Paliativos/métodos , Administração Oral , Administração Retal , Adolescente , Adulto , Analgésicos Opioides/administração & dosagem , Criança , Pré-Escolar , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Fentanila/uso terapêutico , Heroína/uso terapêutico , Humanos , Lactente , Infusões Intravenosas , Injeções Subcutâneas , Masculino , Morfina/uso terapêutico , Dor/etiologia , Estudos Prospectivos , Projetos de Pesquisa , Inquéritos e Questionários , Equivalência Terapêutica , Reino UnidoRESUMO
BACKGROUND: Because lymphatic filariasis (LF) elimination efforts are hampered by a dearth of economic information about the cost of mass drug administration (MDA) programs (using either albendazole with diethylcarbamazine [DEC] or albendazole with ivermectin), a multicenter study was undertaken to determine the costs of MDA programs to interrupt transmission of infection with LF. Such results are particularly important because LF programs have the necessary diagnostic and treatment tools to eliminate the disease as a public health problem globally, and already by 2006, the Global Programme to Eliminate LF had initiated treatment programs covering over 400 million of the 1.3 billion people at risk. METHODOLOGY/PRINCIPAL FINDINGS: To obtain annual costs to carry out the MDA strategy, researchers from seven countries developed and followed a common cost analysis protocol designed to estimate 1) the total annual cost of the LF program, 2) the average cost per person treated, and 3) the relative contributions of the endemic countries and the external partners. Costs per person treated ranged from $0.06 to $2.23. Principal reasons for the variation were 1) the age (newness) of the MDA program, 2) the use of volunteers, and 3) the size of the population treated. Substantial contributions by governments were documented - generally 60%-90% of program operation costs, excluding costs of donated medications. CONCLUSIONS/SIGNIFICANCE: MDA for LF elimination is comparatively inexpensive in relation to most other public health programs. Governments and communities make the predominant financial contributions to actual MDA implementation, not counting the cost of the drugs themselves. The results highlight the impact of the use of volunteers on program costs and provide specific cost data for 7 different countries that can be used as a basis both for modifying current programs and for developing new ones.