RESUMO
AIM: To verify if the guidelines are being followed for the treatment of patients with type 1 diabetes mellitus (T1DM) who receive insulin by lawsuits. METHODS: A descriptive study was conducted with secondary data of these patients in a Brazilian city. RESULTS: 53.9% acquired insulin by lawsuits without previously registered use of another insulin in the Public Health System (SUS). CONCLUSION: The guidelines are not being followed for most patients analyzed, which may result in unnecessary expenses for the SUS. Therefore, this data can support the awareness of prescribers in relation to the savings generated for municipalities through the follow-up of the guidelines.
Assuntos
Diabetes Mellitus Tipo 1/tratamento farmacológico , Fidelidade a Diretrizes/legislação & jurisprudência , Insulina/economia , Adolescente , Adulto , Brasil , Feminino , Fidelidade a Diretrizes/economia , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Insulina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
CONTEXT AND OBJECTIVE:: In 2004, the Brazilian National Health Surveillance Agency (Agência Nacional de Vigilância Sanitária, ANVISA) published a resolution establishing guidelines for albumin use. Although the published data do not indicate any definitive conclusions about the benefits of albumin use in patients with nephrotic syndrome (NS), the guidelines recommend this procedure only in cases of edema that is refractory to use of diuretics. The aim here was to analyze albumin use among patients with nephrotic syndrome. DESIGN AND SETTING:: Pharmacoeconomic study conducted in four large public referral hospitals for nephrology services in northeastern Brazil. METHOD:: Cost-effectiveness and cost-utility economic evaluations were performed on a concurrent cohort of patients with nephrotic syndrome, who were divided into two groups according to compliance or noncompliance with the guidelines. Quality-of-life data were obtained from the SF36 and CHQ-PF50 questionnaires. RESULTS:: This study enrolled 109 patients (60% adults and 56% women); 41.3% were using albumin in accordance with the guidelines. The weight, diuresis and fluid balance parameters were more cost-effective for patients who adhered to the guidelines. Regarding days of hospitalization avoided, the incremental ratio showed a daily cost of R$ 55.33, and guideline-compliant patients were hospitalized for five days or fewer. The quality of life improved by 8%, and savings of R$ 3,458.13/QALY (quality-adjusted life year) for the healthcare system were generated through guideline compliance. CONCLUSION:: The economic analyses of this study demonstrated that there were greater cost benefits for patients whose treatment followed the guidelines.
Assuntos
Albuminas/uso terapêutico , Análise Custo-Benefício/economia , Farmacoeconomia , Fidelidade a Diretrizes/economia , Síndrome Nefrótica/tratamento farmacológico , Síndrome Nefrótica/economia , Adolescente , Adulto , Brasil , Criança , Estudos de Coortes , Feminino , Hospitalização/economia , Hospitais Públicos , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Adulto JovemRESUMO
ABSTRACT CONTEXT AND OBJECTIVE: In 2004, the Brazilian National Health Surveillance Agency (Agência Nacional de Vigilância Sanitária, ANVISA) published a resolution establishing guidelines for albumin use. Although the published data do not indicate any definitive conclusions about the benefits of albumin use in patients with nephrotic syndrome (NS), the guidelines recommend this procedure only in cases of edema that is refractory to use of diuretics. The aim here was to analyze albumin use among patients with nephrotic syndrome. DESIGN AND SETTING: Pharmacoeconomic study conducted in four large public referral hospitals for nephrology services in northeastern Brazil. METHOD: Cost-effectiveness and cost-utility economic evaluations were performed on a concurrent cohort of patients with nephrotic syndrome, who were divided into two groups according to compliance or noncompliance with the guidelines. Quality-of-life data were obtained from the SF36 and CHQ-PF50 questionnaires. RESULTS: This study enrolled 109 patients (60% adults and 56% women); 41.3% were using albumin in accordance with the guidelines. The weight, diuresis and fluid balance parameters were more cost-effective for patients who adhered to the guidelines. Regarding days of hospitalization avoided, the incremental ratio showed a daily cost of R$ 55.33, and guideline-compliant patients were hospitalized for five days or fewer. The quality of life improved by 8%, and savings of R$ 3,458.13/QALY (quality-adjusted life year) for the healthcare system were generated through guideline compliance. CONCLUSION: The economic analyses of this study demonstrated that there were greater cost benefits for patients whose treatment followed the guidelines.
RESUMO CONTEXTO E OBJETIVO: Em 2004, a Agência Nacional de Vigilância Sanitária (ANVISA) publicou uma resolução que estabelece diretrizes para o uso de albumina. Embora os dados publicados não indiquem conclusões definitivas sobre os benefícios do uso de albumina em pacientes com síndrome nefrótica (SN), a diretriz recomenda o procedimento apenas em casos de edema refratário ao uso de diuréticos. O objetivo aqui foi analisar o uso de albumina em pacientes com síndrome nefrótica. TIPO DE ESTUDO E LOCAL: Estudo farmacoeconômico realizado em quatro grandes hospitais públicos de referência em serviços de nefrologia no nordeste do Brasil. MÉTODO: Foram realizadas avaliações econômicas do tipo custo-efetividade e custo-utilidade em uma coorte concorrente de pacientes com síndrome nefrótica, divididos em dois grupos de acordo com o cumprimento ou descumprimento das diretrizes. Dados de qualidade de vida foram obtidos a partir dos questionários SF36 e CHQ-PF50. RESULTADOS: Este estudo incluiu 109 pacientes (60% adultos e 56% mulheres); 41,3% estavam usando albumina conforme as diretrizes. Os parâmetros de peso, diurese e balanço hídrico foram mais custo-efetivos para pacientes que aderiram às diretrizes. Quanto a dias de internação evitados, a razão incremental mostrou um custo diário de R$ 55,33, sendo que os pacientes que seguiram as diretrizes ficaram cinco dias a menos internados. A qualidade de vida melhorou 8%, gerando economia de R$ 3,458.13/QALY (quality-adjusted life year) para o sistema de saúde por meio do cumprimento das diretrizes. CONCLUSÃO: As análises econômicas deste estudo demonstraram maiores benefícios em termos de custo para os pacientes cujo tratamento seguiu as diretrizes.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Análise Custo-Benefício/economia , Farmacoeconomia , Fidelidade a Diretrizes/economia , Albuminas/uso terapêutico , Síndrome Nefrótica/economia , Síndrome Nefrótica/tratamento farmacológico , Qualidade de Vida , Brasil , Estudos de Coortes , Hospitalização/economia , Hospitais PúblicosRESUMO
Myocardial perfusion imaging is widely used for the risk stratification of coronary artery disease. In view of its cost, besides radiation issues, judicious evaluation of the appropriateness of its indications is essential to prevent an unnecessary economic burden on the health system. We evaluated, at a tertiary-care, public Brazilian hospital, the appropriateness of myocardial perfusion scintigraphy indications, and estimated the budget impact of applying appropriateness criteria. An observational, cross-sectional study of 190 patients with suspected or known coronary artery disease referred for myocardial perfusion imaging was conducted. The appropriateness of myocardial perfusion imaging indications was evaluated with the Appropriate Use Criteria for Cardiac Radionuclide Imaging published in 2009. Budget impact analysis was performed with a deterministic model. The prevalence of appropriate requests was 78%; of inappropriate indications, 12%; and of uncertain indications, 10%. Budget impact analysis showed that the use of appropriateness criteria, applied to the population referred to myocardial perfusion scintigraphy within 1 year, could generate savings of $ 64,252.04 dollars. The 12% inappropriate requests for myocardial perfusion scintigraphy at a tertiary-care hospital suggest that a reappraisal of MPI indications is needed. Budget impact analysis estimated resource savings of 18.6% with the establishment of appropriateness criteria for MPI.
Assuntos
Orçamentos/estatística & dados numéricos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/economia , Fidelidade a Diretrizes/economia , Imagem de Perfusão do Miocárdio/economia , Tomografia Computadorizada de Emissão de Fóton Único/economia , Brasil/epidemiologia , Doença da Artéria Coronariana/epidemiologia , Estudos Transversais , Países em Desenvolvimento , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Imagem de Perfusão do Miocárdio/normas , Imagem de Perfusão do Miocárdio/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Prevalência , Tomografia Computadorizada de Emissão de Fóton Único/estatística & dados numéricos , Revisão da Utilização de Recursos de SaúdeRESUMO
OBJECTIVE: To demonstrate the effectiveness of quality improvement methods to monitor and improve administration of cotrimoxazole (CTX) prophylaxis to improve health outcomes among adults living with HIV/AIDS in low resource countries. DESIGN: Program evaluation. SETTING: HIV/AIDS health care facilities in Uganda, Mozambique, Namibia and Haiti. INTERVENTION: Performance measures based on national guidelines are developed in each country. These may include CD4 monitoring, ART adherence and uptake of CTX prophylaxis. CTX prophylaxis is routinely selected, because it has been shown to reduce HIV-related morbidity and mortality. Patient records are sampled using a standard statistical table to achieve a minimum confidence interval of 90% with a spread of ±8% in participating clinics. If an electronic medical record is available, all patients are reviewed. Routine review of performance measures, usually every 6 months, is conducted to identify gaps in care. Improvement interventions are developed and implemented at health facilities, informed by performance results, and local/national public health priorities. MAIN OUTCOME MEASURE: Median clinic rates of CTX prophylaxis. RESULTS: Median performance rates of CTX prophylaxis generally improved for adult HIV+ patients between 2006 and 2013 across countries, with median clinic rates higher than baseline at follow-up in 16 of 18 groups of clinics implementing CTX -focused improvement projects. CONCLUSIONS: Quality management offers a data-driven method to improve the quality of HIV care in low resource countries. Application of improvement principles has been shown to be effective to increase the rates of CTX prophylaxis in national HIV programs in multiple countries.
Assuntos
Antibacterianos/uso terapêutico , Antibioticoprofilaxia/métodos , Infecções por HIV/tratamento farmacológico , Melhoria de Qualidade/organização & administração , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , África Subsaariana , Antibacterianos/economia , Antibioticoprofilaxia/economia , Países em Desenvolvimento , Fidelidade a Diretrizes/economia , Fidelidade a Diretrizes/estatística & dados numéricos , Haiti , Humanos , Guias de Prática Clínica como Assunto , Melhoria de Qualidade/economia , Combinação Trimetoprima e Sulfametoxazol/economiaRESUMO
In this study, 20 Brazilian public schools have been assessed regarding good manufacturing practices and standard sanitation operating procedures implementation. We used a checklist comprised of 10 parts (facilities and installations, water supply, equipments and tools, pest control, waste management, personal hygiene, sanitation, storage, documentation, and training), making a total of 69 questions. The implementing modification cost to the found nonconformities was also determined so that it could work with technical data as a based decision-making prioritization. The average nonconformity percentage at schools concerning to prerequisite program was 36%, from which 66% of them own inadequate installations, 65% waste management, 44% regarding documentation, and 35% water supply and sanitation. The initial estimated cost for changing has been U.S.$24,438 and monthly investments of 1.55% on the currently needed invested values. This would result in U.S.$0.015 increase on each served meal cost over the investment replacement within a year. Thus, we have concluded that such modifications are economically feasible and will be considered on technical requirements when prerequisite program implementation priorities are established.
Assuntos
Inocuidade dos Alimentos , Serviços de Alimentação/economia , Serviços de Alimentação/organização & administração , Saneamento/economia , Saneamento/métodos , Instituições Acadêmicas , Brasil , Custos e Análise de Custo , Documentação , Manipulação de Alimentos/instrumentação , Manipulação de Alimentos/métodos , Serviços de Alimentação/legislação & jurisprudência , Fidelidade a Diretrizes/economia , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Higiene/educação , Capacitação em Serviço , Controle de Pragas , Saneamento/legislação & jurisprudência , Gerenciamento de Resíduos , Abastecimento de ÁguaRESUMO
OBJECTIVE: We examined the impact of patient adherence and screening test performance on the cost-effectiveness of visual inspection with acetic acid (VIA) and Pap smears when used with colposcopy for diagnosis. MATERIALS AND METHODS: Cost-effectiveness analysis was performed using computer modeling. The primary outcome was cancer prevalence in the 10 years after screening. Three hypothetical populations of 35-year-old women were compared: never-screened women, women screened with VIA, and women screened with Pap smears. We used community-based data from our screening program in Honduras to estimate screening test sensitivity and specificity, adherence to follow-up, and costs of screening and colposcopy services. Published data were used to model disease outcomes. RESULTS: VIA was more sensitive than Pap smears (70% vs. 4%), less expensive (U.S. 0.23 dollars vs. 3.17 dollars), and the 2-vist VIA system had a higher rate of adherence to follow-up than the 3-visit Pap smear system (84% vs. 38%). VIA had a higher false-positive rate than Pap smears resulting in higher colposcopy referral rates, but more dysplasia was detected and treated. Cost-effectiveness analysis revealed that screening with VIA would cost U.S. 3,198 dollars per cancer case avoided and reduce cancer cases by 42%, versus U.S. 36,802 dollars and 2% for Pap screening. Although Pap smear quality was low in Honduras, sensitivity analysis showed that VIA was more cost-effective than Pap smears, even when test accuracy was equivalent. CONCLUSION: In developing countries, systems barriers can limit the cost-effectiveness of Pap smears. VIA may be a cost-effective alternative for some resource-poor settings, although systems barriers, quality control, and feasibility issues must be considered.
Assuntos
Detecção Precoce de Câncer/economia , Programas de Rastreamento/economia , Teste de Papanicolaou , Cooperação do Paciente/estatística & dados numéricos , Displasia do Colo do Útero/prevenção & controle , Neoplasias do Colo do Útero/prevenção & controle , Esfregaço Vaginal/economia , Ácido Acético , Adulto , Análise Custo-Benefício , Países em Desenvolvimento , Feminino , Fidelidade a Diretrizes/economia , Honduras , Humanos , Inquéritos e Questionários , Neoplasias do Colo do Útero/economia , Displasia do Colo do Útero/economiaRESUMO
Despite recognition of the importance of posttrial access to antiretroviral therapy (ART), the implementation process has not been studied. We examined whether the National Institutes of Health (NIH) guidance document was being implemented in NIH-funded ART trials conducted in developing countries between July 2005 and June 2007. All of the 18 studies we identified had posttrial access plans for trial participants. More than 70% had specific mechanisms for posttrial access, but none guaranteed long-term sponsor funding after the trials. The plans reflected variation in local contexts and the uncertainty of predicting local conditions in the long term. The strength of the NIH guidance document may be that it encourages investigators to formulate plans in advance and to work with other stakeholders to provide access to ART.
Assuntos
Antirretrovirais/uso terapêutico , Ensaios Clínicos como Assunto/normas , Continuidade da Assistência ao Paciente/normas , Infecções por HIV/tratamento farmacológico , Acessibilidade aos Serviços de Saúde/normas , Adulto , África , Antirretrovirais/economia , Ásia , Criança , Pré-Escolar , Continuidade da Assistência ao Paciente/economia , Custos e Análise de Custo , Países em Desenvolvimento , Fidelidade a Diretrizes/economia , Guias como Assunto , Haiti , Acessibilidade aos Serviços de Saúde/economia , Humanos , National Institutes of Health (U.S.)/normas , Sujeitos da Pesquisa , América do Sul , Estados Unidos , Adulto JovemRESUMO
Substantial research has documented pervasive disparities in the prevalence, severity, and morbidity of asthma among minority populations compared with non-Latino white subjects. The underlying causes of these disparities are not well understood, and as a result, the leverage points to address them remain unclear. A multilevel framework for integrating research in asthma health disparities is proposed to advance both future research and clinical practice. The components of the proposed model include health care policies and regulations, operation of the health care system, provider/clinician-level factors, social/environmental factors, and individual/family attitudes and behaviors. The body of research suggests that asthma disparities have multiple, complex, and interrelated sources. Disparities occur when individual, environmental, health system, and provider factors interact with one another over time. Given that the causes of asthma disparities are complex and multilevel, clinical strategies to address these disparities must therefore be comparably multilevel and target many aspects of asthma care. Several strategies that could be applied in clinical settings to reduce asthma disparities are described, including the need for routine assessment of the patient's beliefs, financial barriers to disease management, and health literacy and the provision of cultural competence training and communication skills to health care provider groups.