Assuntos

Fatores Socioeconômicos , Humanos , Criança , América Latina/epidemiologia , Dinâmica Populacional

RESUMO

Background: Quadrivalent cell-based influenza vaccines (QIVc) avoid egg-adaptive mutations and can be more effective than traditional quadrivalent egg-based influenza vaccines (QIVe). This analysis compared the cost-effectiveness of QIVc and QIVe in Argentinian populations < 65 years old from the payer and societal perspectives. Methods: A static decision tree model compared the costs and health benefits of vaccination with QIVc vs. QIVe using a one-year time horizon. The relative vaccine effectiveness of QIVc vs. QIVe was assumed to be 8.1% for children and 11.4% for adults. An alternative high egg-adaptation scenario was also assessed. Model inputs were sourced from Argentina or the international literature. Deterministic and probabilistic sensitivity analyses were performed. Results: Compared to QIVe, QIVc would prevent 17,857 general practitioner visits, 2418 complications, 816 hospitalizations, and 12 deaths per year. From the payers' perspective, the incremental cost-effectiveness ratio per quality-adjusted life years gained was USD12,214 in the base case and USD2311 in the high egg-adaptation scenario. QIVc was cost-saving from the societal perspective in both scenarios. Conclusions: QIVc in Argentina would be cost-effective relative to QIVe. The potential health benefits and savings would be even higher in high egg-adaptation seasons.

RESUMO

Objetivos: Este estudo teve como objetivo avaliar desfechos clínico-econômicos associados à vacina contra influenza quadrivalente baseada em células (QIVc) versus a vacina trivalente atualmente utilizada (TIVe) para prevenção sazonal de influenza no Programa Nacional de Imunizações (PNI) brasileiro. Métodos: Um modelo estático de árvore de decisão foi usado. Considerou-se um total de 54.071.642 indivíduos vacinados em 2019; a circulação de influenza por subtipo foi baseada em dados de vigilância epidemiológica. A efetividade da vacina (EV) TIVe foi extraída de metanálises publicadas; já a EV relativa da QIVc foi retirada de um estudo observacional retrospectivo. A incompatibilidade antigênica da vacina com vírus circulantes foi baseada em fontes retrospectivas internacionais. O uso de recursos baseou-se em estudos do mundo real. Custos unitários foram retirados de tabelas-padrão publicados em 2019 em reais (BRL). Resultados: Substituir a TIVe pela QIVc pode evitar, anualmente, casos sintomáticos (452.065) e reduzir visitas ambulatoriais (118.735), hospitalizações (15.466), mortes (2.753), custos médicos (-BRL 46.677.357) e custos indiretos (-BRL 59.962.135). O número anual de anos de vida ajustados por qualidade de vida (QALYs) pode aumentar em 96.129. Resultados de base a partir da perspectiva do pagador mostram uma razão de custo-efetividade incremental (RCEI) de BRL 17.293/QALY e, da perspectiva da sociedade, o RCEI obtido foi de um ganho de BRL 16.669/QALY. Usando o Produto Interno Bruto (PIB) brasileiro como um limiar (BRL 34.533/QALY), trocar a TIVe pela QIVc no PNI pode ser uma estratégia altamente custo-efetiva. Conclusões: O uso da QIVc pelo PNI tem potencial para ser altamente custo-efetivo tanto da perspectiva do pagador quanto da sociedade

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Objectives: This study aimed to estimate health and economic outcomes associated to cell-based quadrivalent influenza vaccine (QIVc) versus current trivalent influenza vaccines (TIVe) for seasonal influenza prevention in the Brazilian National Immunization Program (NIP), from the societal and public payer perspectives. Methods: A 1-year static decision-tree model based on literature was used. 54,071,642 total vaccinated individuals in 2019 were considered; influenza subtype circulation was based on Brazilian epidemiologic data (2009-2019). TIVe vaccine effectiveness (VE) was extracted from a published meta-analysis and QIVc relative VE from an international retrospective observational study. A/H3N2 egg-adaptation and B mismatch to recommended strain were gathered from international retrospective sources. Resource use was obtained from real-world studies. Inputs were adjusted to influenza subtype and multiple age groups with Brazilian literature. Unit costs were retrieved from published standard tables in 2019 Brazilian Reais (BRL). Results: Replacing TIVe with QIVc, can annually avert symptomatic cases (452,065) and reduce outpatient visits (118,735); hospitalizations (15,466), deaths (2,753), overall medical direct costs (-BRL 46,677,357) and indirect costs (-BRL 59,962,135). The annual number of quality-adjusted life-years (QALYs) could be increased by 96,129. Base case results from the payer perspective show an incremental cost-effectiveness ratio (ICER) of BRL 17,293/QALY gained and from the societal perspective the ICER obtained was BRL 16,669/QALY gained. Using the Brazilian Gross Domestic Product (GDP) as a threshold (BRL 34,533/QALY) switching TIVe with QIVc in the NIP can be a highly cost-effective strategy, leading to a high QALY increment and preventing medical and indirect costs. Conclusions: The use of QIVc by the NIP has the potential to be highly cost-effective in the payer and society perspective

Assuntos

Vacinas contra Influenza , Programas de Imunização , Análise de Custo-Efetividade

RESUMO

The burden of seasonal influenza disease in Argentina is considerable. The cost-effectiveness of trivalent (TIV) versus quadrivalent influenza vaccine (QIV) in Argentina was assessed. An age-stratified, static, decision-tree model compared the costs and benefits of vaccination for an average influenza season. Main outcomes included: numbers of influenza cases; general practitioner (GP) visits; complicated ambulatory cases; hospitalizations; deaths averted; and costs per quality-adjusted life years (QALYs) gained. Epidemiological data from Argentina for 2014-2019 were used to determine the proportion of A and B strain cases, and the frequency of mismatch between vaccine and circulating B strains. To manage uncertainty, one-way and probabilistic sensitivity analyses were performed. Switching from TIV to QIV would prevent 19,128 influenza cases, 16,164 GP visits, 2440 complicated ambulatory cases, 524 hospitalizations, and 82 deaths. Incremental cost-effectiveness ratios (ICERs) per QALY were 13,590 and 11,678 USD from the payer's and societal perspectives, respectively. The greatest health benefits and direct medical cost savings would occur in ≥ 65-year-olds. One-way sensitivity analyses demonstrated the principal drivers of ICER to be vaccine acquisition costs, environmental B strain predominance, and B strain mismatch. Introducing QIV in Argentina would be beneficial and cost-effective relative to TIV, particularly in older adults.

RESUMO

BACKGROUND: Latin America has witnessed a marked increase in cardiovascular (CV) disease, the leading cause of death in many countries. The benefits of lipid-lowering therapy to reduce CV-related events are widely accepted. Clinical evidence suggests that rosuvastatin is associated with slightly greater reductions in low-density lipoprotein cholesterol levels than is atorvastatin at comparable doses. Rosuvastatin, however, is often priced at a premium. OBJECTIVE: Our objective was to examine the cost-effectiveness of using atorvastatin versus rosuvastatin in reducing CV events in Brazil and Colombia using real-world prices. METHODS: A global Markov cohort model of primary and secondary CV prevention was developed and adapted to Brazilian and Colombian settings. The risks and costs of major CV events and efficacy, adherence, and costs of statins were considered. Total gains in life-years, quality-adjusted life-years, major CV events avoided, and costs over the lifetime horizon were estimated. Several dose comparisons were considered. RESULTS: In the Colombian analyses, differences in drug costs between therapies were considerable while outcomes were similar. The incremental cost per quality-adjusted life-year gained for rosuvastatin versus atorvastatin was more than $700,000 and $200,000 in primary and secondary prevention, respectively. Brazilian analyses found lower incremental cost-effectiveness ratios for rosuvastatin at some dose comparisons due to similar pricing between statins. Sensitivity analyses revealed that changes in treatment efficacy and adherence had the largest impact on results. CONCLUSIONS: In primary and secondary CV prevention, the efficacy advantage of rosuvastatin was minimal, while its acquisition cost was higher, particularly in Colombia. The incremental cost-effectiveness ratios were, therefore, generally in favor of atorvastatin being the cost-effective option.

RESUMO

BACKGROUND AND OBJECTIVES: Pain is a prevalent clinical condition causing tremendous humanistic and economic burden worldwide. With limited research into the impact of pain on health related outcomes in Brazil, the current study examined prevalence of pain conditions, rate of diagnosis and treatment, and potential impact on health outcomes among Brazilian adults. METHOD: Data were collected from the stratified random sample of adults (n = 12,000) in thecross-sectional 2011 National Health and Wellness Survey (NHWS) in Brazil. Respondents reported on sociodemographic information, health-related quality of life (SF-12v2), work productivity and activity impairment (WPAI), comorbid conditions, and healthcare resource use. Comparisons between those reporting pain and no pain (i.e.,neuropathic pain, fibromyalgia, surgery/medical procedure-related pain, or back pain, versus controls without the respective condition; or arthritis, with vs. without experiencing pain) were conducted using Chi-square and t-tests for categorical and continuous variables, respectively. RESULTS: Back pain was the most commonly reported pain condition (12%), followed by fibromyalgia. Among those experiencing the condition neuropathic pain was the most, and back pain the least, commonly diagnosed and treated. Across conditions, to varying degrees, pain vs. no pain was associated with greater comorbid burden, higher resource utilization, and greater impairments in health status and work productivity, with few differences in sociodemographic factors. CONCLUSION: Pain-related conditions were associated with varying awareness and treatment rates among Brazilian adults. Consistent with previous US and European studies, pain was associated with various negative health outcomes. These findings highlight the under-treatment and range of potential sources of pain burden in Brazil.

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JUSTIFICATIVA E OBJETIVOS: A dor é uma condição clínica prevalente que gera um fardo humanístico e econômico tremendo em todo o mundo. Tendo em vista os poucos estudos sobre o impacto da dor em resultados de saúde no Brasil, este estudo avaliou a prevalência de condições dolorosas, a taxa de diagnóstico e tratamento, e o possível impacto nos resultados de saúde entre adultos brasileiros. MÉTODO: Os dados foram coletados de uma amostra estratificada e aleatória de adultos (n = 12.000) da pesquisa transversal National Health and Wellness Survey de 2011 feita no Brasil. Os entrevistados deram informações sociodemográficas, sobre qualidade de vida relacionada à saúde (SF-12v2), produtividade no trabalho e prejuízo de suas atividades (WPAI), condições comórbidas e uso de recursos de assistência à saúde. As comparações entre os indivíduos com e sem dor (isto é, dor neuropática, fibromialgia, dor relacionada a procedimentos cirúrgicos/médicos, ou lombalgia, versus os controles sem a respectiva condição; ou artrite, com versus sem dor) foram realizadas pelos testes Qui-quadrado e t para variáveis categóricas e contínuas, respectivamente. RESULTADOS: Lombalgia foi a condição dolorosa mais comum (12%), seguida de fibromialgia. Entre os incluídos nessa condição, a dor neuropática foi a mais comumente diagnosticada e tratada, e a lombalgia foi a menos diagnosticada e tratada. Nas diferentes condições, em graus variáveis, dor versus sem dor foi associada a maior fardo comórbido, maior utilização de recursos, e maiores prejuízos ao estado de saúde e à produtividade no trabalho, com poucas diferenças nos fatores sociodemográficos. CONCLUSÃO: As condições dolorosas foram associadas a diferentes percepções e taxas de tratamento entre adultos brasileiros. Corroborando estudos anteriores norte-americanos e europeus, a dor foi associada a vários resultados negativos para a saúde. Esses achados destacam o subtratamento e uma gama de fontes potenciais de fardo da dor no Brasil.

Assuntos

Efeitos Psicossociais da Doença , Eficiência Organizacional , Dor Lombar , Qualidade de Vida

RESUMO

Background. Respiratory syncytial virus (RSV) is the most frequent etiologic agent causing lower respiratory tract infection in children <2 years of age. Between 0.5 and 3% of patients will require hospitalization. The aim of this study was to estimate the direct medical cost of treating children <2 years old with suspicion of RSV at the Instituto Mexicano del Seguro Social (IMSS). Methods. Direct medical costs were estimated from an institutional perspective. Medical records were reviewed from patients <2 years of age who attended emergency services in second-level hospitals including subjects who required hospitalization. Estimated costs were obtained with the microcosting technique using the institutional costs from IMSS (year 2010). Costs were reported in USD (year 2011). Results. When analyzing total medical costs, outpatient management yielded a cost of $230.0 ± $10.30 U.S. dollars (USD), whereas hospitalized patients exhibited an average cost of $8,313.20 ± $595.30 USD. The main components of outpatient management costs were emergency visits, specialist consultations and diagnostic testing (41.6%, 32.7% and 10.7% of the total cost, respectively). In the case of hospitalized patients, intensive care unit cost (89.3%) and overall hospitalization cost (6.5%) represented 95.7% of the total cost. Conclusions. RSV is a disease that represents a significant economic burden for health care institutions, although most patients are treated on an outpatient basis.

RESUMO

OBJECTIVE: To identify, from the Mexican Public Health System perspective, which would be the most cost-effective treatment for patients with Fibromyalgia (FM). MATERIAL AND METHODS: A Markov model including three health states, divided by pain intensity (absence or presence of mild, moderate or severe pain) and considering three-month cycles; costs and effectiveness were estimated for amitriptyline (50mg/day), fluoxetine (80 mg/day), duloxetine (120 mg/day), gabapentin (900 mg/day), pregabalin (450 mg/day), tramadol/acetaminophen (150 mg/1300 mg/día) and amitriptyline/fluoxetine (50mg/80 mg/día) for the treatment of FM. The clinical outcome considered was the annual rate of pain control. Probabilities assigned to the model were collected from published literature. Direct medical costs for FM treatment were retrieved from the 2006 data of the Mexican Institute of Social Security (IMSS) databases and were expressed in 2010 Mexican Pesos. Probabilistic Sensitivity Analyses were conducted. RESULTS: The best pain control rate was obtained with pregabalin (44.8%), followed by gabapentin (38.1%) and duloxetine (34.2%). The lowest treatment costs was for amitriptyline ($ 9047.01), followed by fluoxetine ($ 10,183.89) and amitriptyline/fluoxetine ($ 10,866.01). By comparing pregabalin vs amitriptyline, additional annual cost per patient for pain control would be around $ 50.000 and $ 75.000 and would result cost-effective in 70% and 80% of all cases. CONCLUSIONS: Among all treatment options for FM, pregabalin achieved the highest pain control and was cost-effective in 80% of patients of the Mexican Public Health System.

Assuntos

Analgésicos/economia , Antidepressivos Tricíclicos/economia , Custos de Medicamentos , Fibromialgia/tratamento farmacológico , Acetaminofen/economia , Acetaminofen/uso terapêutico , Aminas/economia , Aminas/uso terapêutico , Amitriptilina/economia , Amitriptilina/uso terapêutico , Analgésicos/uso terapêutico , Antidepressivos Tricíclicos/uso terapêutico , Análise Custo-Benefício , Ácidos Cicloexanocarboxílicos/economia , Ácidos Cicloexanocarboxílicos/uso terapêutico , Esquema de Medicação , Quimioterapia Combinada , Cloridrato de Duloxetina , Fibromialgia/economia , Fluoxetina/economia , Fluoxetina/uso terapêutico , Gabapentina , Humanos , Cadeias de Markov , México , Modelos Biológicos , Modelos Econômicos , Pregabalina , Tiofenos/economia , Tiofenos/uso terapêutico , Tramadol/economia , Tramadol/uso terapêutico , Resultado do Tratamento , Ácido gama-Aminobutírico/análogos & derivados , Ácido gama-Aminobutírico/economia , Ácido gama-Aminobutírico/uso terapêutico

RESUMO

BACKGROUND: Knee surgery is a risk factor for thromboembolic disease. Prophylaxis reduces the risk of this condition. METHODS: Economic and health consequences of drugs preventing and treating thromboembolic disease in patients undergoing knee surgery from the institutional perspective (time horizon: 1 year) were estimated. The measures of effectiveness were: reduction in the number of cases (per 1,000 patients) of deep vein thrombosis, pulmonary embolism, hospital admissions and deaths. Transition probabilities were estimated by meta-analysis. The alternatives were: warfarin (reference), dalteparin, enoxaparin, nadroparin, unfractionated heparin + warfarin, and non-prophylaxis. Data on resources use and costs corresponds to the Instituto Mexicano del Seguro Social (IMSS). Acceptability curves were constructed. RESULTS: No prophylaxis implied three times higher cost ($18,835.10 versus $5,967.10) and less effectiveness in comparison with warfarin. The incremental cost-effectiveness ratios for enoxaparin were $3, $13, $17 and $3 per each additional case of deep vein thrombosis, pulmonary embolism, death and hospital admission avoided. Results of nadroparin and unfractionated heparin were inferior to warfarin (59.1% and 72.9% more costly and less effective in three measures of effectiveness, respectively). Dalteparin showed higher health outcomes and lower cost compared with warfarin (-20.6%). Dalteparin had a higher probability of being cost-effective than enoxaparin. DISCUSSION: thromboprophylaxis is a clinically and economically favorable alternative. The identification of a pharmacoeconomic profile of alternatives to perform it becomes relevant given the increasing pressure on institutional budgets. CONCLUSIONS: Dalteparin would be a cost-saving alternative in thromboprophylaxis of patients undergoing knee surgery at IMSS.

Assuntos

Anticoagulantes/economia , Artroplastia do Joelho/economia , Dalteparina/economia , Complicações Pós-Operatórias/prevenção & controle , Trombofilia/tratamento farmacológico , Academias e Institutos/economia , Anticoagulantes/efeitos adversos , Anticoagulantes/uso terapêutico , Artroplastia do Joelho/estatística & dados numéricos , Redução de Custos , Análise Custo-Benefício , Dalteparina/efeitos adversos , Dalteparina/uso terapêutico , Diagnóstico por Imagem/economia , Custos de Medicamentos , Heparina/efeitos adversos , Heparina/economia , Heparina/uso terapêutico , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Cadeias de Markov , México , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/etiologia , Hemorragia Pós-Operatória/induzido quimicamente , Embolia Pulmonar/economia , Embolia Pulmonar/etiologia , Embolia Pulmonar/prevenção & controle , Estudos Retrospectivos , Previdência Social/economia , Trombofilia/economia , Trombofilia/etiologia , Trombofilia/prevenção & controle , Trombose Venosa/economia , Trombose Venosa/etiologia , Trombose Venosa/prevenção & controle , Varfarina/efeitos adversos , Varfarina/economia , Varfarina/uso terapêutico

RESUMO

OBJECTIVE: Major depressive disorder (MDD) is often underdiagnosed, undertreated, and associated with negative health outcomes. The current study examined the prevalence of MDD signs and symptoms in Brazil, including awareness, diagnosis, treatment, and the association of MDD with health outcomes. METHODS: Data were collected from the 2011 National Health and Wellness Survey in Brazil (N = 12,000). Excluding those with bipolar disorder, respondents who met Patient Health Questionnaire-9 criteria for MDD (n = 1105) were compared with those not qualifying as having MDD or any depressive symptoms (n = 8684), analyzing separately those currently taking (n = 184) or not taking (n = 155) prescription medication for depression. Sociodemographics and health status, symptoms, experience of depression, diagnosis, MDD severity, pharmacotherapy, productivity impairment (Work Productivity and Activity Impairment questionnaire), health status (Short-Form 12, version 2), and health care resource use were measured. Results were weighted and projected to the Brazil adult population. Differences were measured with column proportion and mean tests for categorical and continuous outcomes, respectively. RESULTS: MDD prevalence was 10.2%, with only 28.1% of the individuals with MDD diagnosed and 15.6% currently using prescription medication for depression. Males were especially likely to be unaware of MDD. Compared with non-MDD controls, patients with MDD (treated or untreated) reported significantly greater overall work impairment, worse mental and physical health status, and greater health care resource utilization (all P<0.05). There was a trend for worsening health outcomes with increasing MDD severity. CONCLUSIONS: These findings suggest that Brazilians may be underdiagnosed and undertreated for MDD. Individuals with MDD reported substantially poorer health outcomes, suggesting the need to increase MDD awareness, especially among males, and provide better access to treatment.

RESUMO

INTRODUCTION: In Mexico during 2008, were reported 127,604 new cancer cases, 6,347 of them were colorectal cancer cases and 4,276 non-Hodgkin lymphoma (NHL) cases. OBJECTIVE: To evaluate health related quality of life in non-Hodgkin lymphoma and colorectal cancer cases in different clinical stages, attended in a High Specialty Medical facility at the Instituto Mexicano del Seguro Social, during a 13 month period. RESULTS: 162 patients were included, 56.8% (n=92) with NHL and 43.2% (n=70) with colorectal cancer. The scores obtained in the NHL group were: Global health status/QoL: 67.75 (± 27.55), physical functioning 69.64 (± 29.98), role functioning 71.38 (± 33.73), emotional functioning 69.7 (± 26.57), cognitive functioning 75.36 (± 28.01), social functioning 79.35 (± 29.38), fatigue 35.27 (± 28.27), nausea and vomiting 13.41 (± 21.85), pain 28.08 (± 30.25), dyspnea 19.20 (± 32.11), insomnia 30.80 (± 38.03), appetite lost 26.45 (± 36.16), constipation 19.20 (± 32.11), diarrhea 12.32 (± 26.48), financial difficulties 26.09 (± 35.57). In colorectal cancer patients the scores were: Global health status/QoL: 68.21 (± 24.46), physical functioning 67.38 (± 30.45), role functioning 65.48 (± 35.70), emotional functioning 66.43 (± 26.84), cognitive functioning 78.57 (± 26.49), social functioning 75.24 (± 31.05), fatigue 37.78 (± 31.62), nausea and vomiting 20.00 (± 28.32), pain 37.38 (± 34.45), dyspnea 11.90 (± 26.64), insomnia 28.09 (± 35.73), appetite lost 23.81 (± 36.40), constipation 19.05 (± 32.88), diarrhea 20.95 (± 31.17), financial difficulties 34.76 (± 38.67). CONCLUSIONS: With these basal results is important a follow-up with special attention to the treatment and attendance processes, in patients with this neoplasms and their impact on the quality of life.

Assuntos

Academias e Institutos , Neoplasias Colorretais/terapia , Linfoma não Hodgkin/terapia , Programas Nacionais de Saúde , Qualidade de Vida , Previdência Social , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/patologia , Neoplasias Colorretais/fisiopatologia , Neoplasias Colorretais/psicologia , Nível de Saúde , Indicadores Básicos de Saúde , Humanos , Linfoma não Hodgkin/diagnóstico , Linfoma não Hodgkin/patologia , Linfoma não Hodgkin/fisiopatologia , Linfoma não Hodgkin/psicologia , México , Estadiamento de Neoplasias , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento

RESUMO

INTRODUCTION: Quality of life is the most studied PRO (patient reported outcome) in cancer patients. With early diagnosis and better treatments in breast cancer, this entity has been transformed in a chronic disease with longer survival. The joint effects of diseases and treatment on quality of life are each day more important to consider in survival patients. OBJECTIVE: To evaluate quality of life, socioeconomic factors, co-morbidities, and the attendance process impact on quality of life in breast cancer women with different clinical stages attending at the Instituto Mexicano del Seguro Social using the EORCT QLQ-C30 RESULTS: The scores of EORTC QLQ-C30 (v3) were: Global health status / QoL: 73.47 (± 20.81), physical functioning 76.98 (± 20.85), role functioning 76.60 (± 27.57), emotional functioning 64.53 (± 26.81), cognitive functioning 74.47 (± 26.02), social functioning 84.96 (± 23.20), fatigue 31.94 (± 25.45), nausea and vomiting 19.49 (± 26.93), pain 28.95 (± 27.27), dyspnea 15.29 (± 24.62), insomnia 35.13 (± 32.10), appetite lost 18.04 (± 28.75), 18.04 (± 28.75), constipation 19.20 (± 32.11), diarrhea 12.9 (± 24.25), financial difficulties 40.57 (± 37.26). The scores with EORTC QLQ-BR23 were: body image 74.84 (± 31.69), sexual functioning 13.73 (± 22.55), sexual enjoyment 32.86 (± 36.17), future perspectives 51.69 (± 38.00), systemic therapy side effects 30.82 (± 20.71), breast symptoms 22.85 (± 23.49), arm symptoms 27.53 (± 24.75), upset by hair loss 43.80 (± 44.01). CONCLUSIONS: Clinical stage in breast cancer is associated with differences in the scores from fatigue, nausea and vomiting and financial difficulties according to the evolution of the disease and the physical detriment associated. Socio-demographic features were related role functioning, fatigue and pain in single women with higher scores.

Assuntos

Academias e Institutos , Neoplasias da Mama/terapia , Programas Nacionais de Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Qualidade de Vida , Previdência Social , Fatores Socioeconômicos , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/patologia , Neoplasias da Mama/fisiopatologia , Neoplasias da Mama/psicologia , Comorbidade , Feminino , Humanos , México , Estadiamento de Neoplasias , Inquéritos e Questionários , Resultado do Tratamento

RESUMO

OBJECTIVES: Vaccination is an effective intervention for reduce child morbidity and mortality associated to pneumococcus. The availability of new anti-pneumococcal vaccines makes it necessary to evaluate its potential impact on public health and costs related to their implementation. The aim of this study was to estimate the cost-effectiveness and cost-utility of immunization strategies based on pneumococcal conjugated vaccines (PCV's) currently available in Mexico from a third payer perspective. MATERIAL AND METHODS: A decision tree model was developed to assess both, economic and health impact, of anti-pneumococcal vaccination in children <2 years (lifetime time horizon, discount rate: 5% annual). Comparators were: no-vaccination (reference) and strategies based on 7, 10 and 13-valent PCV's. Effectiveness measures were: child deaths avoided, life-years gained (LYG) and quality adjusted life years (QALY's) gained. Effectiveness, utility, local epidemiology and cost of treating pneumococcal diseases were extracted from published sources. Univariate sensitivity analysis were performed. RESULTS: Immunization dominates no-vaccination: strategy based on 13-valent vaccine prevented 16.205 deaths, gained 331.230 LY's and 332.006 QALY's and saved US$1.307/child vaccinated. Strategies based on 7 and 10-valent PCV's prevented 13.806 and 5.589 deaths, gained 282.193 and 114.251 LY's, 282.969 and 114.972 QALY's and saved US$1.084 and US$731/child vaccinated, respectively. These results were robust to variations in herd immunity and lower immunogenicity of 10-valent vaccine. CONCLUSIONS: In Mexico, immunization strategies based on 7, 10 and 13-valent PCV's would be cost-saving interventions, however, health outcomes and savings of the strategy based on 13-valent vaccine are greater than those estimated for 7 and 10-valent PCV's.

Assuntos

Custos de Medicamentos , Programas de Imunização/economia , Programas Nacionais de Saúde/economia , Infecções Pneumocócicas/economia , Vacinas Pneumocócicas/economia , Análise Custo-Benefício , Técnicas de Apoio para a Decisão , Árvores de Decisões , Vacina Pneumocócica Conjugada Heptavalente , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Reembolso de Seguro de Saúde , México , Modelos Econômicos , Infecções Pneumocócicas/microbiologia , Infecções Pneumocócicas/mortalidade , Infecções Pneumocócicas/prevenção & controle , Anos de Vida Ajustados por Qualidade de Vida , Fatores de Tempo , Resultado do Tratamento , Vacinas Conjugadas/economia

RESUMO

INTRODUCTION: In Mexico cancer is a public health burden. Nowadays the health care systems pay special attention to patient's perception and satisfaction of the health care received. Satisfaction with quality of health care has an impact in the adherence to the treatment. OBJECTIVE: To evaluate the satisfaction with the quality of health care received at the IMSS in a group of cancer patients [non Hodgkin lymphoma (NHL), breast and colorectal cancer]. Socio-demographic features, co-morbid diseases, and attendance processes impact on satisfaction are also evaluated. RESULTS: 476 cancer patients were studied: 314 with breast cancer, 92 with NHL and 70 with colorectal cancer. In women with breast cancer the mean score to nurses' interpersonal skills in non-classified disease group and clinical stage III group were: 73.64 ± 32.53, 90.00 ± 18.25 respectively (p=0.005), nurses' availability in non-classified and clinical stage III group were: 69.71 ± 30.25, 89.21 ± 19.00 respectively (p=0.003). In subjects with NHL the mean scores for doctors' technical skills in clinical stage I and III groups, were: 63.69 ± 37.78, 80.30 ± 18.46 respectively (p=0.017), doctors' information provision scores in subject in clinical stage I and IV were: 49.40 ± 40.75, 79.49 ± 24.63 respectively (p=0.043). In the group of colorectal cancer patients the mean of the score to exchange of information between clinical stage II and clinical stage III group were 50.00 ± 41.83, 84.21 ± 22.37 respectively (p=0.036). Were not observed association between attendance processes features and general satisfaction. CONCLUSIONS: In Mexico 50% of cancer patients are attended at the IMSS. The continued evaluation of the satisfaction with health care received by the health care service users is important to enhance attention's quality.

Assuntos

Academias e Institutos , Neoplasias da Mama/tratamento farmacológico , Neoplasias Colorretais/tratamento farmacológico , Linfoma não Hodgkin/terapia , Programas Nacionais de Saúde , Satisfação do Paciente , Qualidade da Assistência à Saúde , Previdência Social , Inquéritos e Questionários , Academias e Institutos/estatística & dados numéricos , Adulto , Idoso , Atitude do Pessoal de Saúde , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/patologia , Competência Clínica , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/patologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Pesquisa sobre Serviços de Saúde , Humanos , Linfoma não Hodgkin/epidemiologia , Linfoma não Hodgkin/patologia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Programas Nacionais de Saúde/estatística & dados numéricos , Estadiamento de Neoplasias , Relações Enfermeiro-Paciente , Educação de Pacientes como Assunto , Satisfação do Paciente/estatística & dados numéricos , Percepção , Relações Médico-Paciente , Previdência Social/estatística & dados numéricos

RESUMO

OBJECTIVE: Maraviroc is the first approved drug in a new class of antiretrovirals, the CCR5 antagonists. The objective of this study was to predict the long-term clinical impact and cost-effectiveness of maraviroc in treatment-experienced adults with HIV/AIDS in Mexico. METHODS: The AntiRetroviral Analysis by Monte Carlo Individual Simulation (ARAMIS) model was adapted to the Mexican context to predict clinical and economic outcomes of treating with optimized background therapy (OBT) versus testing for viral tropism status and treating with OBT ± maraviroc accordingly in treatment-experienced adults in Mexico. Baseline characteristics and efficacy were from the MOTIVATE trials' screening cohort. Costs and population mortality data were specific to Mexico. Results were reported from the perspective of health care payers in 2008 Mexican pesos (converted to 2008 US$ in parentheses). RESULTS: Compared to treatment with OBT alone, treatment with OBT ± maraviroc contingent on tropism test result increased projected undiscounted life expectancy and discounted quality-adjusted life expectancy from 7.54 to 8.71 years and 4.42 to 4.92 quality-adjusted life years (QALYs), respectively, at an incremental cost of $228,215 (US$21,329). The resultant incremental cost-effectiveness ratio (ICER) was $453,978 (US$42,429) per QALY gained. The ICER was somewhat lower when maraviroc was modeled in individuals susceptible to ≤ 2 components of OBT ($407,329; US$38,069), while the ICER was higher in individuals susceptible to ≥3 OBT components ($718,718; US$67,171). CONCLUSION: In treatment-experienced individuals with HIV/AIDS in Mexico, maraviroc may be cost-effective, particularly in individuals with limited options for active antiretroviral therapy (ART).

Assuntos

Cicloexanos/economia , Inibidores da Fusão de HIV/economia , Infecções por HIV/economia , Triazóis/economia , Simulação por Computador , Análise Custo-Benefício , Cicloexanos/uso terapêutico , Feminino , Inibidores da Fusão de HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Maraviroc , México , Pessoa de Meia-Idade , Modelos Biológicos , Anos de Vida Ajustados por Qualidade de Vida , Triazóis/uso terapêutico

RESUMO

BACKGROUND: Ageing of Mexican population implies greater demand of hospital services. Nevertheless, the available resources are used inadequately. In this study, the direct medical costs associated with the appropriateness of elderly populations hospital stay are estimated. METHODS: Appropriateness of hospital stay was evaluated with the Appropriateness Evaluation Protocol (AEP). Direct medical costs associated with hospital stay under the third-party payer's institutional perspective were estimated, using as information source the clinical files of 60 years of age and older patients, hospitalized during year 2004 in a Regional Hospital from the Mexican Social Security Institute (IMSS), in Mexico City. RESULTS: The sample consisted of 724 clinical files, with a mean of 5.3 days (95% CI = 4.9-5.8) of hospital stay, of which 12.4% (n = 90) were classified with at least one inappropriate patient day, with a mean of 2.2 days (95% CI = 1.6-2.7). The main cause of inappropriateness days was the inexistence of a diagnostic and/or treatment plan, 98.9% (n = 89). The mean cost for an appropriate hospitalization per patient resulted in US$1,497.2 (95% CI = US$323.2-US$4,931.4), while the corresponding mean cost for an inappropriate hospitalization per patient resulted in US$2,323.3 (95% CI = US$471.7-US$6,198.3), (p < 0.001). CONCLUSION: Elderly patients who were inappropriately hospitalized had a higher rate of inappropriate patient days. The average of inappropriate patient days cost is considerably higher than appropriate days. In this study, inappropriate hospital-stay causes could be attributable to physicians and current organizational management.

Assuntos

Gastos em Saúde , Hospitalização , Tempo de Internação/economia , Idoso , Idoso de 80 Anos ou mais , Bases de Dados como Assunto , Feminino , Humanos , Reembolso de Seguro de Saúde , Tempo de Internação/estatística & dados numéricos , Masculino , México , Pessoa de Meia-Idade , Estudos Retrospectivos

RESUMO

Introducción. Las micosis sistémicas generan un gran incremento en los costos de la atención médica. Se evaluó el medicamento más costo-efectivo para el tratamiento empírico de aspergilosis sistémica entre la anfotericina B, caspofungina y voriconazol en pacientes con fiebre persistente y neutropenia. Métodos. Modelo tipo árbol de decisiones para estimar los resultados clínicos esperados y los costos asociados del tratamiento de la aspergilosis sistémica. La perspectiva del estudio fue la del proveedor de servicios públicos de salud (Instituto Mexicano del Seguro Social [IMSS]). Temporalidad: 12 semanas. Medida de efectividad: tasa de remisión completa de la infección micótica. Se desarrollaron análisis de sensibilidad univaridos y probabilísticos. Resultados. Los costos totales promedio por paciente esperados para el tratamiento empírico de aspergilosis resultaron convoriconazol en $57 378.58 US; $72 833.96 US con anfotericina B, y de $49 962.37 US con caspofungina. La tasa de remisión total sin eventos adversos fue de 37% para caspofungina, 43.6% para voriconazol y de 51.1% para anfotericina B. El análisis de sensibilidad probabilístico muestra que voriconazol sería el tratamiento más costo-efectivo en 65% de los casos, independientemente de la disposición a pagar por el IMSS. Conclusiones. Los resultados presentados concuerdan con la afirmación de que el tratamiento estándar de primera línea recientemente propuesto para el tratamiento empírico de aspergilosis sistémica debe ser voriconazol.

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Introduction. Systemic mycosis has a great impact on medical care costs. The objective of this study was to assess the most cost-effective empirical treatment for systemic aspergillosis, evaluating amphotericin B, caspofungin and voriconazole in patients with persistent fever and neutropenia. Methods. A decision-tree model was used to estimate expected clinical results and costs associated with the treatment for systemic aspergillosis. The study used a healthcare payer's perspective (Mexican Institute of Social Security, IMSS). Time frame was 12 weeks. Effectiveness measure was complete remission of mycotic infection. One-way and probabilistic sensitivity analyses were performed. Results. Average total expected costs per patient for the voriconazole treatment were US $57 378.58, for amphotericin B US $72 833.96, and for caspofungin were US $49 962.37. Thetotal expected remission rate without any adverse events was 37% for caspofungin, 43.6% for voriconazole and 51.1% for amphotericin B. Probabilistic sensitivity analysis showed that voriconazole would be a cost-effective treatment with 65% confidence, regardless of the willingness to pay the IMSS. Conclusions. The results of the study agree with the recommendation that voriconazole must be the empirical treatment for systemic aspergillosis, proposed as a standard first-line antifungal drug.

RESUMO

La idoneidad del concepto de willingness to pay (disponibilidad a pagar) es revisado en las evaluaciones económicas que se realizan en el campo de la salud. Por un lado, existe dentro de la literatura económica un número importante de investigadores que señalan los múltiples problemas metodológicos que entrañan las estimaciones de willingness to pay. Por otro lado, aún el debate teórico-conceptual acerca de la agregación de las preferencias individuales dentro de una demanda agregada no ésta del todo resuelto. Sin embargo, durante los últimos 20 años la estimación de la disponibilidad a pagar dentro de las investigaciones económicas ha aumentado de forma significativa, siendo en muchos casos uno de los principales factores de la toma de decisión en políticas de salud. Plantease alguna de las limitaciones de esta técnica, así como el posible efecto distorsionador que podría tener sobre las evaluaciones económicas que se realizan en el área de la economía de la salud.

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The adequacy of the concept of willingness to pay within health economics evaluations is reviewed. A considerable number of researchers in the literature have pointed out multiple methodological issues involving willingness-to-pay estimates. On the other hand, the theoretical discussion about the aggregation of individual preferences within an aggregate demand remains open. However, over the last 20 years, willingness-to-pay estimates alongside health economics research significantly increased and in many cases they are one of the key factors for decision making on issues of health policies. The article describes some limitations of this approach as well as the potential distorting effect that it might have on health economics evaluations.

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São revisadas as limitações do uso do conceito de willingness to pay (disposição a pagar) nas avaliações econômicas que se realizam no campo da saúde. Há na literatura econômica muitos investigadores que assinalam os múltiplos problemas metodológicos inerentes às estimações de willingness to pay. Por outro lado, o debate teórico-conceitual acerca da agregação das preferências individuais dentro de uma demanda agregada não está totalmente resolvido. Contudo, durante os últimos 20 anos, a estimação da disposição a pagar calculada pelos estudos tem aumentado de forma significativa, sendo em muitos casos um dos principais fatores de tomada de decisão em políticas de saúde. São apresentadas algumas das limitações desta técnica, assim como o possível efeito de distorção que poderia ter sobre as avaliações econômicas em saúde.

Assuntos

Humanos , Alocação de Recursos para a Atenção à Saúde/economia , Necessidades e Demandas de Serviços de Saúde/economia , Satisfação do Paciente , Comportamento de Escolha , Análise Custo-Benefício/métodos , Financiamento Pessoal

RESUMO

The adequacy of the concept of willingness to pay within health economics evaluations is reviewed. A considerable number of researchers in the literature have pointed out multiple methodological issues involving willingness-to-pay estimates. On the other hand, the theoretical discussion about the aggregation of individual preferences within an aggregate demand remains open. However, over the last 20 years, willingness-to-pay estimates alongside health economics research significantly increased and in many cases they are one of the key factors for decision making on issues of health policies. The article describes some limitations of this approach as well as the potential distorting effect that it might have on health economics evaluations.

Assuntos

Alocação de Recursos para a Atenção à Saúde/economia , Necessidades e Demandas de Serviços de Saúde/economia , Satisfação do Paciente , Comportamento de Escolha , Análise Custo-Benefício/métodos , Financiamento Pessoal , Humanos

RESUMO

INTRODUCTION: Estimation of the economic costs of schizophrenia is a fundamental tool for a better understanding of the magnitude of this health problem. The aim of this study was to estimate the costs and effectiveness of five antipsychotic treatments (ziprasidone, olanzapine, risperidone, haloperidol and clozapine), which are included in the national formulary at the Instituto Mexicano del Seguro Social, through a simulation model. METHODS: Type of economic evaluation: complete economic evaluation of cost-effectiveness. STUDY PERSPECTIVE: direct medical costs. TIME HORIZON: 1 year. Effectiveness measure: number of months free of psychotic symptoms. ANALYSIS: to estimate cost-effectiveness, a Markov model was constructed and a Monte Carlo simulation was carried out. RESULTS: Effectiveness: the results of the Markov model showed that the antipsychotic with the highest number months free of psychotic symptoms was ziprasidone (mean 9.2 months). The median annual costs for patients using ziprasidone included in the hypothetical cohort was 194,766.6 Mexican pesos (MXP) (95% CI, 26,515.6-363,017.6 MXP), with an exchange rate of 1 € = 17.36 MXP. The highest costs in the probabilistic analysis were estimated for clozapine treatment (260,236.9 MXP). CONCLUSIONS: Through a probabilistic analysis, ziprasidone showed the lowest costs and the highest number of months free of psychotic symptoms and was also the most costeffective antipsychotic observed in acceptability curves and net monetary benefits.