RESUMO
We present an overview of rheumatology practices in Mexico, describing the national health care system as segmented and fragmentary, with a population separated into 3 main categories, according to employment-based coverage and income level: (1) private sector, (2) Social Security System, and (3) public insurance subsector.The rheumatology practice in the public and private sectors are described. We estimate that between 85%-90% of Mexican rheumatologists have a mixed (public and private)-type practice. Payments to rheumatologists are not currently affected by quality and value metrics, with low penetrance of electronic health records. Recent changes and challenges to health insurance coverage are illustrated.
Assuntos
Atenção à Saúde , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Avaliação das Necessidades , Doenças Reumáticas , Atenção à Saúde/métodos , Atenção à Saúde/organização & administração , Registros Eletrônicos de Saúde/estatística & dados numéricos , Humanos , Seguro Saúde/organização & administração , México/epidemiologia , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Garantia da Qualidade dos Cuidados de Saúde , Doenças Reumáticas/economia , Doenças Reumáticas/epidemiologia , Doenças Reumáticas/terapiaRESUMO
INTRODUCTION: Tumor necrosis factor-alpha antagonists (anti-TNFα) have shown an increasing consumption and generate a significant economic burden on health systems. OBJECTIVES: The prescribing patterns of tumor necrosis factor-alpha antagonists were determined in a patient population associated with the Sistema General de Seguridad Social en Salud in Colombia. MATERIALS AND METHODS: A descriptive observational study was conducted in 316 patients with respect to use of tumor necrosis factor-alpha antagonists during a treatment period from January 2008 to June 2009. The database examined contained indications of use, inclusion criteria to medication, duration of illness, co-morbidities and adverse reactions. The data were retrieved from the clinical histories. Student's t test was used for the comparison of quantitative variables, and the chi-square test was used to establish associations between categorical variables and multivariate analysis were used. RESULTS: Mean age was 44.613.9 years; 63.9% of participants were female. Of the 316 patients, 17.1% received monotherapy. The order of prescription drugs was as follows: adalimumab (37.3%), infliximab (37.3%) and etanercept (25.4%), all were prescribed in appropriately defined daily doses. Co-medication drugs most frequently prescribed were: disease-modifying anti-rheumatic (82.9%), NSAIDs (29.1%), omeprazole (22.5%), antihypertensives (21.2%), folic acid (19.9%) calcium plus vitamin D (9.8%), calcitriol (6.0%). 10.4% of patients had a record of some adverse drug reaction. The average cost of therapy per patient per year was US$23,464. CONCLUSIONS: Anti-TNFα are being used at recommended doses, particularly in rheumatoid arthritis and in combination with other anti-rheumatic drugs. The direct cost of therapy was high for the country's health system.
Assuntos
Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adalimumab , Adulto , Anticorpos Monoclonais/economia , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Humanizados/economia , Anticorpos Monoclonais Humanizados/uso terapêutico , Antirreumáticos/economia , Antirreumáticos/uso terapêutico , Colômbia , Análise Custo-Benefício , Etanercepte , Feminino , Humanos , Imunoglobulina G/economia , Imunoglobulina G/uso terapêutico , Infliximab , Masculino , Pessoa de Meia-Idade , Receptores do Fator de Necrose Tumoral/uso terapêutico , Doenças Reumáticas/tratamento farmacológico , Doenças Reumáticas/economia , Resultado do TratamentoAssuntos
Antirreumáticos/economia , Padrões de Prática Médica/economia , Doenças Reumáticas/economia , Doenças Reumáticas/terapia , Antirreumáticos/uso terapêutico , Atitude do Pessoal de Saúde , Brasil , Feminino , Humanos , Masculino , Doenças Reumáticas/tratamento farmacológico , Fatores SocioeconômicosRESUMO
INTRODUCTION: The relationship between the effectiveness of health care interventions and their costs is of increasing interest. The goal of the present study was to summarize the economic evaluations (EEs) published in the field of rheumatology and related disciplines, and to focus in particular on methodologic issues. METHODS: MEDLINE was searched in order to identify all relevant EEs published between 1966 and February 1995. Titles and abstracts of 1,435 articles were retrieved and independently reviewed by 2 assessors. Overall, 63 articles were identified by either assessor as being definite or possible full EEs (defined as an analysis comparing 2 or more strategies involving the assessment of both costs and consequences), and were assessed independently. RESULTS: Thirty-six articles were determined to be full EEs (33 cost-effectiveness and 3 cost-utility analyses). Most were published in the periods 1984-1990 (31%) and 1991-1995 (61%). Main areas covered were methods of prevention (44%), treatment (31%), and treatment-prevention (22%). Disorders most frequently studied were osteoarthritis (36%), osteoporosis (22%), and rheumatoid arthritis (14%). Direct and indirect costs were measured or estimated in 100% and 28% of the EEs, respectively. The viewpoint of the analysis was stated explicitly in 12 studies (33%). Incremental and sensitivity analyses were presented in 17 (47%) and 23 (64%), respectively. Inadequate use of economic terms was also documented. CONCLUSION: The EE articles reviewed adhered partially to basic analytic methods. Economic evaluations in the field of rheumatology need to be improved to comply with current standards for the evaluation of health care interventions.
Assuntos
Pesquisa sobre Serviços de Saúde/economia , Pesquisa sobre Serviços de Saúde/métodos , Doenças Reumáticas/economia , Reumatologia/economia , Análise Custo-Benefício , Custos de Cuidados de Saúde , Humanos , MEDLINE , Qualidade da Assistência à Saúde , Doenças Reumáticas/terapiaRESUMO
Evaluamos 160 pacientes vistos por un reumatólogo, 100 de los cuales fueron de la consulta del Servicio de Reumatología de un Hospital Universitario de tercer nivel (Secretaria de Salud) y 60 de la práctica privada, con el objetivo de evaluar ciertos aspectos de la calidad de vida de los pacientes reumatológicos a quienes se les solicitó contestar un cuestionario en donde se les preguntaron algunos conceptos e ideas acerca de su enfermedad, tipo y frecuencia de atención que recibieron, tratamientos alternativos, ingresos mensuales y costo de la enfermedad, así como ayudas alternativas para abatir el costo de su padecimiento. El padecimiento más frecuentemente visto fue artritis reumatoide (54.3 por ciento), seguido de osteoartrosis (11.8 por ciento), fibromialgia (11.8 por ciento) y lupus eritematoso generalizado (10 por ciento). El concepto acerca de la etiología fue: ambiental 25.2 por ciento, física 23.1 por ciento y desconocida 19.6 por ciento. En cuanto a la escolaridad 13.7 por ciento tenían secundaria completa, 22.5 por ciento primaria completa y 10 por ciento se refirieron analfabetas. El 47.5 por ciento de nuestros pacientes eran derechohabientes de otra institución de salud. El promedio de ingreso mensual familiar referido por paciente fue de $1,137.00 ($142 USD) y los gastos por enfermedad fueron de $ 293.00 ($36.6 USD). El gasto por concepto de enfermedad resultó porcentualmente mayor en aquellos pacientes que fueron atendidos en el hospital universitario. Concluimos que el paciente reumatológico en nuestro medio desvía por lo menos el 25 por ciento del ingreso familiar para la atención de su enfermedad, a pesar de que casi el 50 por ciento de nuestro pacientes son derechohabientes de otra institución, lo que disminuye el costo de su enfermedad dado que obtienen de ésta manera medicamentos, exámenes de laboratorio y gabinete