RESUMO
Shortages of essential supplies used to prevent, diagnose, and treat COVID-19 have been a global concern, and price speculation and hikes may have negatively influenced access. This study identifies variability in prices of products acquired through government-driven contracts in Ecuador during the early pandemic response, when the highest mortality rates were registered in a single day. Data were obtained from the National Public Procurement Service (SERCOP) database between March 1 and July 31, 2020. A statistical descriptive analysis was conducted to extract relevant measures for commonly purchased products, medical devices, pharmaceutical drugs, and other goods. Among the most frequently purchased products, the greatest amounts were spent on face masks (US$4.5 million), acetaminophen (US$2.2 million), and reverse transcriptase quantitative polymerase chain reaction assay kits (US$1.8 million). Prices varied greatly, depending on each individual contract and on the number of units purchased; some were exceptionally higher than their market value. Compared with 2019, the mean price of medical examination gloves increased up to 1,307%, acetaminophen 500 mg pills, up to 796%, and oxygen flasks, 30.8%. In a context of budgetary constraints that actually required an effective use of available funds, speculative price hikes may have limited patient access to health care and the protection of the general population and health care workers. COVID-19 vaccine allocations to privileged individuals have also been widely reported. Price caps and other forms of regulation, as well as greater scrutiny and transparency of government-driven purchases, and investment in local production, are warranted in Ecuador for improved infectious disease prevention.
Assuntos
Vacinas contra COVID-19/economia , COVID-19/economia , COVID-19/epidemiologia , Equipamento de Proteção Individual/economia , SARS-CoV-2 , Acetaminofen/economia , Analgésicos não Narcóticos/economia , Vacinas contra COVID-19/provisão & distribuição , Economia Hospitalar , Equador/epidemiologia , Pessoal de Saúde , Humanos , Máscaras/economia , Fatores de TempoRESUMO
Postoperative pain might be different after intravenous vs. oral paracetamol. We systematically reviewed randomised controlled trials in patients >15 years that compared intravenous with oral paracetamol for postoperative pain. We identified 14 trials with 1695 participants. There was inconclusive evidence for an effect of route of paracetamol administration on postoperative pain at 0-2 h (734 participants), 2-6 h (766 participants), 6-24 h (1115 participants) and >24 h (248 participants), with differences in standardised mean (95%CI) pain scores for intravenous vs. oral of -0.17 (-0.45 to 0.10), -0.09 (-0.24 to 0.06), 0.06 (-0.12 to 0.23) and 0.03 (-0.22 to 0.28), respectively. Trial sequential analyses suggested that a total of 3948 participants would be needed to demonstrate a meaningful difference in pain or its absence at 0-2 h. There were no differences in secondary outcomes. Intravenous paracetamol is more expensive than oral paracetamol. Substitution of oral paracetamol in half the patients given intravenous paracetamol in our hospital would save around £ 38,711 ( 43,960 or US$ 47,498) per annum.
Assuntos
Acetaminofen/administração & dosagem , Acetaminofen/uso terapêutico , Analgésicos não Narcóticos/administração & dosagem , Analgésicos não Narcóticos/uso terapêutico , Dor Pós-Operatória/prevenção & controle , Acetaminofen/economia , Administração Intravenosa/economia , Administração Oral , Analgésicos não Narcóticos/economia , Humanos , Dor Pós-Operatória/economiaRESUMO
BACKGROUND: The use of IV narcotic analgesics (IVNA) within the context of vascular procedures is not fully described. We sought to evaluate the burden of IVNA including narcotic analgesia-related adverse drug events (NARADE), associated mortality and hospitalization cost in open and endovascular vascular procedures, and to compare it with nonnarcotic analgesia (IVNNA). METHODS: Retrospective cross-sectional study in hospitals participating in Premier database (2009-2015). Logistic regression analysis was implemented to report the risks of NARADE and in-hospital mortality. Negative binomial regression was used to assess length of stay and generalized linear modeling was used to estimate the hospitalization cost. RESULTS: A total of 171,473 patients were identified. NARADE occurred in 6.2% of the cohort. NARADE group was similar in gender and race but was slightly older (median age 71 vs. 70; P < 0.001). After risk-adjustment, NARADE risk was higher in patients who received IVNA-alone in carotid and lower extremity revascularization (LER) [OR (odds ratio) (95% confidence interval [CI]): 1.17 (1.02-1.34) and 1.31 (1.14-1.50)] or combined with IVNNA [OR (95% CI): 1.34 (1.13-1.59) and 1.81 (1.54-2.13)], respectively. Patients receiving aortic repair benefited from the use of IVNA + IVNNA [OR (95% CI): 0.82 (0.69-0.98)]. Occurrence of NARADE doubled the LOS, amplified mortality risk and increased cost in all domains. NARADE increased the odds of mortality by 24.3, 6.5 (4.9-8.68) and 16.6 times and added $5,368, $12,737 and $11,349 to the cost of carotid, aortic and LER interventions, respectively. In contrast, IVNNA was not associated with NARADE risk, increased LOS or cost and showed a survival benefit in patients undergoing open aortic repair [aOR (95% CI): 0.52 (0.36-0.75)]. CONCLUSIONS AND RELEVANCE: The use of opioid-based narcotics had increased the risk of NARADE, resources utilization and NARADE-related mortality. Yet the use of nonopioid-based analgesic was safe, did not increase the cost and reduced mortality in open AA repair. This entices shifting the paradigm toward exploring nonopioid-based analgesia options in order to replace or minimize opioid requirements.
Assuntos
Analgésicos não Narcóticos/administração & dosagem , Analgésicos não Narcóticos/economia , Custos de Medicamentos , Procedimentos Endovasculares/economia , Custos Hospitalares , Entorpecentes/administração & dosagem , Entorpecentes/economia , Manejo da Dor/economia , Procedimentos Cirúrgicos Vasculares/economia , Administração Intravenosa , Idoso , Analgésicos não Narcóticos/efeitos adversos , Análise Custo-Benefício , Estudos Transversais , Bases de Dados Factuais , Custos de Medicamentos/tendências , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Procedimentos Endovasculares/tendências , Feminino , Custos Hospitalares/tendências , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Modelos Econômicos , Entorpecentes/efeitos adversos , Manejo da Dor/efeitos adversos , Manejo da Dor/mortalidade , Manejo da Dor/tendências , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/mortalidade , Procedimentos Cirúrgicos Vasculares/tendênciasRESUMO
OBJECTIVE: To demonstrate that the application of etofenamate is effective in management of acute pain. MATERIAL AND METHODS: We conducted a prospective, longitudnal, 6 months trial, which included 22 women and 18 men with intense acute low back pain of mechanical or postural aetiology, patients who had pain of traumatic origin and needed radiographic studies by orthopaedic surgeon were excluded; the study subjects were treated with 1 g etofenamate intramuscularly and the analgesic effect was assessed by visual analog scale every 5 minutes for 30 minutes. RESULTS: Marked improvement in pain at 25 minutes in 35 subjects (87.5%). Pain did not improve in 5 subjects (four men, one woman, 12.5%) at 30 minutes. There were no adverse reactions to medication. DISCUSSION: The single dose of 1 g etofenamate is effective in the management of acute pain. Its use prevented 35 admissions with a cost savings of $70,000 pesos. Applying etofenamate caused satisfaction of the beneficiaries and emergency personnel, this drug could be an alternative treatment in medical services and first-level emergency.
Assuntos
Analgésicos não Narcóticos/uso terapêutico , Dor nas Costas/tratamento farmacológico , Serviço Hospitalar de Emergência/estatística & dados numéricos , Ácido Flufenâmico/análogos & derivados , Doença Aguda , Adulto , Analgésicos não Narcóticos/administração & dosagem , Analgésicos não Narcóticos/economia , Dor nas Costas/economia , Serviço Hospitalar de Emergência/economia , Feminino , Ácido Flufenâmico/administração & dosagem , Ácido Flufenâmico/economia , Ácido Flufenâmico/uso terapêutico , Humanos , Injeções Intramusculares , Masculino , Doenças Profissionais/tratamento farmacológico , Medição da Dor , Aceitação pelo Paciente de Cuidados de Saúde , Estudos ProspectivosRESUMO
OBJECTIVE: To evaluate the cost-effectiveness of samarium [153Sm-EDTMP] (Quadramet) compared to conventional therapy in the treatment of pain in patients with prostate cancer and bone metastases. METHOD: A decision tree model for the treatment of bone pain due to metastases was adapted to the Spanish context. The model represents the standard treatment patterns in Spain for the study population. The time-course of the model is 4 months and it computes an estimate for the cost of pain control per patient. The effectiveness data for the model derive from a randomised trial. The current treatment patterns have been established according to the consensus opinions of a group of medical experts. RESULTS: The cost of pain control per patient is euro 12,515.39 for conventional therapy and euro 5,595.52 for samarium-153 (Quadramet) therapy. The incremental cost-effectiveness analysis shows that samarium-153 (Quadramet) is a dominant therapy. It presents lower costs and higher efficacy than the conventional strategy. The sensitivity analyses showed these results to be robust. CONCLUSION: Samarium-153 (Quadramet) is cost-effective in treating pain in patients with prostate cancer and bone metastases.
Assuntos
Adenocarcinoma/economia , Analgésicos não Narcóticos/economia , Neoplasias Ósseas/economia , Compostos Organometálicos/economia , Compostos Organofosforados/economia , Neoplasias da Próstata/economia , Radioisótopos/economia , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/secundário , Analgésicos não Narcóticos/uso terapêutico , Neoplasias Ósseas/tratamento farmacológico , Neoplasias Ósseas/secundário , Análise Custo-Benefício , Custos de Medicamentos , Humanos , Masculino , Modelos Econômicos , Compostos Organometálicos/uso terapêutico , Compostos Organofosforados/uso terapêutico , Medição da Dor/métodos , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/patologia , Samário/economia , Resultado do TratamentoRESUMO
OBJECTIVE: To determine the incidence of side effects with the short-term use of intravenously administered ketorolac in children and the overall cost savings with a unit dosing system. STUDY DESIGN: We prospectively examined the incidence of complications arising from the intravenous administration of ketorolac to 1747 children (14,810 doses) during a 3-year, 3-month period and assessed cost savings resulting from dividing 60 mg syringes into 7.5, 15, 30, and 60 mg unit doses. Complications were recorded prospectively into a computerized database. Estimated drug costs to the pharmacy were calculated on the basis of the total numbers of each drug fraction administered, with allowance for 1O% wastage as a result of drug expiration. RESULTS: Side effects occurring with ketorolac administration were rare. Four patients (0.2%) had hypersensitivity reactions to the drug, two of them possibly on the basis of latex allergy. Two patients (O.1%) had renal complications but were subsequently found to have underlying causes that could account for their renal symptoms. One patient (0.05%) had massive gastrointestinal bleeding in the postoperative period. With fractionation of 60 mg syringes, total drug cost to the pharmacy was $34,786, rather than the $86,639 that would have been spent had a single syringe been used for each dose. CONCLUSION: Ketorolac proved safe for short-term intravenous use in children more than 1 year of age when patients with known contraindications to the use of non-steroidal antiinflammatory drugs were excluded. A considerable reduction in drug costs can be achieved with fractionation of premixed syringes into unit doses.