RESUMO
OBJECTIVE: To investigate, within a private health insurance, the ordering frequency and the costs related to inappropriate tumor markers test orders. METHODS: This study analyzed data regarding tumor markers requests within a private health insurance between 2010 and 2017. Patients included in this analysis were ≥ 50 years old, had available medical records, and had at least 1 tumor markers tested within the study period. Tests were considered inappropriate when tumor markers were used in screening for neoplasms, ie, when there was no previous diagnosis. We evaluated data regarding age, sex, the ordering physician's medical specialty, and test costs. RESULTS: Between 2010 and 2017, 1112 tumor markers tests were performed and increased from 52 to 262 per year. Our sample consisted mostly of women (69.50%) with a mean age of 59.40 (SD 8.20) years. Most orders were inappropriate (87.80%) and represented 79.40% of all expenses with tumor markers tests. Cardiology professionals were the medical specialty that requested the most tumor markers tests (23.90%), followed by internal medicine specialists (22.70%) and gynecologists (19.20%). CONCLUSIONS: We observed a high percentage of inappropriate test orders in the study period, resulting in elevated costs. Studies of this nature deserve the attention of health care managers, and interventions should be performed in order to reduce the inappropriate use of tumor markers tests in clinical practice.
OBJETIVO: investigar no âmbito de um plano de saúde privado a frequência de solicitação e os custos relacionados à solicitação inapropriada de marcadores tumorais. METODOLOGIA: Utilizou-se a base de dados de um plano de saúde privado entre os anos de 2010 a 2017. Foram incluídos na pesquisa, sujeitos com idade ≥ 50 anos, que apresentavam prontuários médicos acessíveis e que havia realizado a dosagem de algum marcadores tumorais no período. Considerou-se como "exame inapropriado" quando o marcador tumoral foi utilizado como rastreio de neoplasia, ou seja, quando não havia o diagnóstico prévio. Foram avaliados os dados referentes à idade, sexo, especialidade do médico solicitante e informações sobre os custos desses exames. RESULTADOS: Foram realizados um total 1.112 testes no período, representando um aumento de 52 para 262 exames/ano. A amostra foi composta na maioria pelo sexo feminino (69,50%), com média de idade de 59,40 ± 8,20 anos. A maioria das solicitações foram inapropriadas (87,80%). Notou-se que a solicitação desses exames, impactaram cerca de 79,40% dos gastos totais do plano de saúde com marcadores tumorais. Os cardiologistas foram a especialidade que mais solicitaram marcadores tumorais em 23,90% das ocasiões, seguidos pelos especialistas em clínica médica (22,70%) e ginecologistas (19,20%). CONCLUSÕES: Observamos um alto percentual de pedidos de exames inadequados no período do estudo, resultando em custos elevados. Estudos dessa natureza merecem a atenção dos gestores de saúde e intervenções devem ser realizadas a fim de reduzir o uso inadequado de testes de marcador tumoral na prática clínica.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Biomarcadores Tumorais/economia , Planos de Pré-Pagamento em Saúde/estatística & dados numéricos , Procedimentos Desnecessários/estatística & dados numéricos , Neoplasias/diagnóstico , Estudos Retrospectivos , Procedimentos Desnecessários/economia , Custos e Análise de CustoAssuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Neoplasias do Colo do Útero/diagnóstico , Programas de Rastreamento/efeitos adversos , Programas de Rastreamento/estatística & dados numéricos , Detecção Precoce de Câncer/efeitos adversos , Detecção Precoce de Câncer/estatística & dados numéricos , Argentina/epidemiologia , Fatores Socioeconômicos , Esfregaço Vaginal/estatística & dados numéricos , Saúde Pública/estatística & dados numéricos , Fatores de Risco , Fatores Etários , Guias de Prática Clínica como Assunto , Procedimentos Desnecessários/economia , Medicina Baseada em Evidências , Testes de DNA para Papilomavírus Humano/estatística & dados numéricos , Teste de Papanicolaou/estatística & dados numéricosRESUMO
INTRODUCTION: The Xpert® MTB/RIF assay is being implemented as a substitute for sputum smear microscopy (SSM) in many low and high tuberculosis (TB) burden countries, including Brazil, a country with low multidrug resistance and moderate human immunodeficiency virus co-infection rates. SETTING: Brazilian National TB Programme (NTP). OBJECTIVE AND DESIGN: We estimated the incremental cost-effectiveness ratio (ICER) of Xpert as a substitute for two SSM tests in the diagnosis of drug-susceptible TB. The costs for confirming each additional case and for avoiding treatment due to false-positive empirical diagnoses were estimated. RESULTS: The ICER was US$943 for each additional TB diagnosis and US$356 for each additional TB diagnosis with bacteriological confirmation, assuming 80% specificity of clinical diagnosis using both strategies. For every 100 000 patients with suspected TB, the NTP would spend an additional US$1.2 million per year to confirm 3344 more TB patients. The model was highly sensitive to specificity of clinical diagnosis after a negative test. CONCLUSION: Although the NTP has no threshold for cost-effectiveness, our model can provide support for decision makers in Brazil and other countries with a low prevalence of drug resistance among TB patients. Financial benefit can potentially be expected if physicians rely more on a negative Xpert result and empirical treatment is reduced.
Assuntos
DNA Bacteriano/genética , Farmacorresistência Bacteriana/genética , Custos de Cuidados de Saúde , Pulmão/microbiologia , Técnicas de Diagnóstico Molecular/economia , Mycobacterium tuberculosis/genética , Reação em Cadeia da Polimerase/economia , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/economia , Antibióticos Antituberculose/uso terapêutico , Automação Laboratorial , Brasil , Simulação por Computador , Análise Custo-Benefício , DNA Bacteriano/isolamento & purificação , Técnicas de Apoio para a Decisão , Árvores de Decisões , Reações Falso-Positivas , Humanos , Mycobacterium tuberculosis/efeitos dos fármacos , Mycobacterium tuberculosis/isolamento & purificação , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Rifampina/uso terapêutico , Escarro/microbiologia , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/microbiologia , Procedimentos Desnecessários/economiaRESUMO
A partir de uma campanha conduzida pela Fundação American Board of Internal Medicine (ABIM),teve início em 2011 a Iniciativa Choosing Wisely, quando várias associações norte-americanas de distintas especialidades médicas apresentaram listas de procedimentos utilizados de maneira excessiva e, consequentemente, inapropriada. Neste artigo, buscou-se destacar as relações entre a qualidade do cuidado, a variação injustificada na oferta de procedimentos e as iniciativas para redução da sobreutilização desses procedimentos. Além de uma metodologia adequada, alguns critérios devem ser levados em conta para se avaliar se o uso de determinados procedimentos é, ou não, recomendável. Entre os principais,encontram-se: a transparência e a participação de um grupo mais amplo de profissionais, incluindo diversas especialidades; a seleção de procedimentos de modo a evitar os que têm utilidade cientificamente questionável no tocante à melhora da saúde, além de custos impactantes, desproporcionais aos possíveis benefícios, para os serviços de saúde; a possibilidade de medir e avaliar esses procedimentos; ausência de conflito de interesses ou corporativismos...
From a campaign driven by the American Board of Internal Medicine (ABIM) Foundation, the ChoosingWisely Initiative began in 2011 when several US societies from different medical specialties presented listsof procedures that are used excessively and therefore inappropriate. In this article we sought to highlightthe relationship between healthcare quality, unjustified variation in supply of low-value procedures and theinitiatives to reduce the overuse of those procedures. In addition to appropriate methodology, one shouldtake account of criteria to evaluate whether or not the use of given procedures is recommended. The mostimportant criteria are: the transparency and participation of a broader group of professionals, includingdifferent specialties; selection of procedures whose utility with regard to improving health is scientificallyquestionable and its costs to health services are excessive relative to benefits; the possibilty to measure andevaluate these procedures; the absence of any conflict of interest or corporatism...
A partir de una campaña llevada a cabo por la Fundación American Board of Internal Medicine (ABIM),iniciada en 2011, la Iniciativa Choosing Wisely cuando distintas asociaciones norteamericanas dedistintas especialidades médicas presentaran listas de procedimientos utilizados de forma excessiva e, porconsiguiente, inapropriada. En este artículo hemos tratado de poner de relieve las relaciones entre la calidadde la atención, la variación injustificada en la oferta de los procedimientos y las iniciativas para reducir lasobreutilización de ellos. Además de una metodología adecuada, deben tenerse en cuenta ciertos criteriospara evaluar si es recomendado el uso de ciertos procedimientos. Entre los principales, están: la transparenciay la participación de un grupo más amplio de profesionales, incluyendo diversas especialidades; la selecciónde procedimientos con el fin de evitar aquellos que tienen utilidad científicamente cuestionable con relacióna la mejora de la salud, y los costes desproporcionados a los beneficios potenciales, impactantes para losservicios de salud; la posibilidad de mensurar y evaluar estos procedimentos; ausencia de conflicto deintereses o corporativismos...
Assuntos
Humanos , Mau Uso de Serviços de Saúde/prevenção & controle , Segurança do Paciente , Procedimentos Desnecessários/economia , Procedimentos Desnecessários/normas , Qualidade da Assistência à Saúde/economia , Qualidade da Assistência à Saúde/normas , Assistência Centrada no Paciente/normas , Gastos em Saúde , Relações Médico-PacienteRESUMO
Introduction: Thyroidectomy is a common surgery. Routine searching of the recurrent laryngeal nerve is the most important strategy to avoid palsy. Neuromonitoring has been recommended to decrease recurrent laryngeal nerve palsy. Objective: To assess if neuromonitoring of recurrent laryngeal nerve during thyroidectomy is cost-effective in a developing country. Materials and methods: We designed a decision analysis to assess the cost-effectiveness of recurrent laryngeal nerve neuromonitoring. For probabilities, we used data from a meta-analysis. Utility was measured using preference values. We considered direct costs. We conducted a deterministic and a probabilistic analysis. Results: We did not find differences in utility between arms. The frequency of recurrent laryngeal nerve injury was 1% in the neuromonitor group and 1.6% for the standard group. Thyroidectomy without monitoring was the less expensive alternative. The incremental cost-effectiveness ratio was COP$ 9,112,065. Conclusion: Routine neuromonitoring in total thyroidectomy with low risk of recurrent laryngeal nerve injury is neither cost-useful nor cost-effective in the Colombian health system.
Introducción. La tiroidectomía es una cirugía común. La búsqueda rutinaria del nervio laríngeo inferior es la estrategia más importante para evitar la parálisis. Objetivo. Evaluar el costo-efectividad en un país en desarrollo de la monitorización neurológica del nervio laríngeo inferior durante la tiroidectomía. Materiales y métodos. Se diseñó un análisis de decisiones para evaluar el costo-efectividad de la monitorización neurológica del nervio laríngeo inferior. Para las probabilidades se usaron datos de un meta-análisis. La utilidad se determinó con medidas de preferencia. Se incluyeron los costos directos. Se hizo un análisis determinístico y probabilístico. Resultados. No se encontraron diferencias en la utilidad entre las estrategias. La frecuencia de la lesión de este nervio fue de 1 % en el grupo bajo monitorización neurológica y de 1,6 % en el grupo de control. La tiroidectomía sin monitorización fue la alternativa menos costosa. La razón de costo-efectividad incremental fue de COP$ 9.112.065 Conclusión. La monitorización neurológica rutinaria en la tiroidectomía total con bajo riesgo de lesión del nervio laríngeo inferior, no es útil con relación a su costo ni costo-efectiva en el sistema de salud colombiano.
Assuntos
Humanos , Nervo Laríngeo Recorrente/fisiologia , Tireoidectomia/economia , Traumatismos do Nervo Laríngeo Recorrente/prevenção & controle , Monitorização Neurofisiológica Intraoperatória/economia , Complicações Intraoperatórias/prevenção & controle , Tireoidectomia/efeitos adversos , Traqueostomia/economia , Metanálise como Assunto , Probabilidade , Técnicas de Apoio para a Decisão , Análise Custo-Benefício , Colômbia , Procedimentos Desnecessários/economia , Países em Desenvolvimento , Estimulação Elétrica/instrumentação , Eletromiografia/economia , Eletromiografia/instrumentação , Eletromiografia/métodos , Monitorização Neurofisiológica Intraoperatória/instrumentação , Monitorização Neurofisiológica Intraoperatória/métodos , Intubação Intratraqueal/instrumentação , Tempo de Internação/economiaRESUMO
INTRODUCTION: Thyroidectomy is a common surgery. Routine searching of the recurrent laryngeal nerve is the most important strategy to avoid palsy. Neuromonitoring has been recommended to decrease recurrent laryngeal nerve palsy. OBJECTIVE: To assess if neuromonitoring of recurrent laryngeal nerve during thyroidectomy is cost-effective in a developing country. MATERIALS AND METHODS: We designed a decision analysis to assess the cost-effectiveness of recurrent laryngeal nerve neuromonitoring. For probabilities, we used data from a meta-analysis. Utility was measured using preference values. We considered direct costs. We conducted a deterministic and a probabilistic analysis. RESULTS: We did not find differences in utility between arms. The frequency of recurrent laryngeal nerve injury was 1% in the neuromonitor group and 1.6% for the standard group. Thyroidectomy without monitoring was the less expensive alternative. The incremental cost-effectiveness ratio was COP$ 9,112,065. CONCLUSION: Routine neuromonitoring in total thyroidectomy with low risk of recurrent laryngeal nerve injury is neither cost-useful nor cost-effective in the Colombian health system.
Assuntos
Complicações Intraoperatórias/prevenção & controle , Monitorização Neurofisiológica Intraoperatória/economia , Traumatismos do Nervo Laríngeo Recorrente/prevenção & controle , Nervo Laríngeo Recorrente/fisiologia , Tireoidectomia/economia , Colômbia , Análise Custo-Benefício , Técnicas de Apoio para a Decisão , Países em Desenvolvimento , Estimulação Elétrica/instrumentação , Eletromiografia/economia , Eletromiografia/instrumentação , Eletromiografia/métodos , Humanos , Monitorização Neurofisiológica Intraoperatória/instrumentação , Monitorização Neurofisiológica Intraoperatória/métodos , Intubação Intratraqueal/instrumentação , Tempo de Internação/economia , Metanálise como Assunto , Probabilidade , Tireoidectomia/efeitos adversos , Traqueostomia/economia , Procedimentos Desnecessários/economiaRESUMO
BACKGROUND: Radiographs are routinely obtained at postoperative visits during the first year after posterior spinal fusion (PSF) for idiopathic scoliosis (IS). The goal of this study was to determine how often radiographic findings change postoperative care. METHODS: A total of 227 consecutive patients aged 10 to 21 years who underwent surgery for IS at our institution from 2004 to 2010 were identified. Charts were reviewed to determine the frequency of the following clinical symptoms during the first year after surgery: pain greater than expected, implant prominence, and sensory/motor disturbance. Radiographs were reviewed to identify implant failure and curve change. Logistic regression analysis was used to identify clinical symptoms associated with treatment deviation. RESULTS: During the first year after surgery, an average of 6 (range, 2 to 12) radiographs were obtained from patients during an average of 3 (range, 2 to 10) follow-up visits. Pain (14%) was the most common symptom. Neurologic symptoms (13%) and implant prominence (4%) were less common. Implant failure was identified in 4 subjects (2%), of which 3 required revision surgery. The incidence of revision surgery was 2.9/1000 radiographs (95% confidence interval, 0.6-8.3). Curve progression >5 degrees in the uninstrumented curve occurred in 2 patients (0.9%). Curve progression did not result in a change in treatment for any of the patients. Pain was the only clinical symptom associated with implant failure (P=0.0047). 169/227 patients did not have any symptoms and only one of these underwent revision surgery. The sensitivity of a clinical test, which uses the presence of pain to guide the need for radiographic evaluation and rule out implant failure, was 75%, specificity 87%, positive predictive value 10%, and negative predictive value 99.5%. CONCLUSIONS: After obtaining baseline postoperative radiographs, additional radiographs during the first year after surgery for IS may not be required in the absence of clinical symptoms. Reducing the number of radiographs taken during the first year after surgery for IS in patients without symptoms can reduce radiation exposure to patients and health care costs without affecting treatment. LEVEL OF EVIDENCE: Level II, Diagnostic Study.
Assuntos
Dor Pós-Operatória/diagnóstico por imagem , Radiografia/estatística & dados numéricos , Reoperação/estatística & dados numéricos , Escoliose/cirurgia , Fusão Vertebral , Procedimentos Desnecessários , Adolescente , Criança , Estudos de Coortes , Redução de Custos , Análise de Falha de Equipamento/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Masculino , Cuidados Pós-Operatórios/economia , Cuidados Pós-Operatórios/métodos , Saúde Radiológica , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Fusão Vertebral/instrumentação , Fusão Vertebral/métodos , Resultado do Tratamento , Procedimentos Desnecessários/economia , Procedimentos Desnecessários/estatística & dados numéricosRESUMO
The aims of this study were to analyze unnecessary laboratory exams for patients with hypertension and diabetes and to check the expenditures involved. This is an exploratory-descriptive, cross-sectional study with a quantitative approach. We used data from medical records of 293 patients registered in primary units - the Family Health Center (NSF3); secondary: School Health Center (CSE); and tertiary: Hospital das Clínicas (HC) from 2006 to 2009 in a city in Southeastern Brazil. We identified a total of 9,522 laboratory tests, of which 5.97% were unnecessary. Of these, about 58% were requested by NSF3 and 42% by CSE. Results suggest there is a lack of integration among different levels of health care, which result in misallocation of resources and unnecessary spending.
El objetivo del estudio fue analizar la solicitación y los gastos con exámenes auxiliares innecesarios para pacientes con hipertensión y diabetes en los servicios de salud. Se trata de un estudio transversal retrospectivo, utilizando datos de las historias clínicas de 293 pacientes registrados en las unidades de niveles primario -el Núcleo de Salud de la Familia (NSF3), secundario- Centro de Salud de la Escuela (CSE) y terciario Hospital de Clínicas (HC), en el período de 2006 a 2009 en una ciudad del sudeste de Brasil. Hubo un total de 9.522 exámenes de laboratorio, de los cuales un 5,97% innecesarios. De estos, cerca del 58% fue solicita por el NSF3 y el 42% en el CSE. Los resultados sugieren que ocurre falta de integración entre los diferentes niveles de atención de salud, causando mala distribución de recursos y gastos innecesarios.
Este estudo objetivou analisar a solicitação e os gastos com exames complementares desnecessários para pacientes hipertensos e diabéticos nos serviços de saúde. Trata-se de estudo transversal retrospectivo, utilizando dados de prontuários de 293 pacientes cadastrados nas unidades de níveis primário - Núcleo de Saúde da Família (NSF3), secundário - Centro de Saúde Escola (CSE) e terciário - Hospital das Clínicas (HC), no período de 2006 a 2009 em um município da região sudeste do Brasil. Observou-se um total de 9.522 exames laboratoriais totalizando R$ 28.208,28, sendo 568 (5,97%) desnecessários - R$1.641,58. Destes, cerca de R$ 952,12 (58%) foram solicitados pela NSF3, e R$689,46(42%), pelo CSE. Os resultados sugerem que ocorre falta de integração nos diferentes níveis de atenção à saúde, acarretando má alocação de recursos e gastos desnecessários.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/economia , Gastos em Saúde , Hipertensão/diagnóstico , Hipertensão/economia , Procedimentos Desnecessários/economia , Estudos Transversais , Saúde da Família , Serviços de Saúde , Estudos RetrospectivosRESUMO
BACKGROUND: Preoperative medical testing in the United States is estimated at $3,000,000 USD per year. In an attempt to reduce this cost, some key points have been described with the purpose of promoting appropriate preoperative measurements with an adequate costObjective: To evaluate the utility of a preoperative standardized questionnaire in adult patients prior to elective surgery to detect which patients could be operated without laboratory testing. METHOD: An observational, prospective and analytic study was carried out. The questionnaire has been applied to 176 patients, all adults scheduled for elective surgery from April 2011 to March 2012. RESULTS: There were 57.4% females and 42.6% males. Ages varied between 18 and 85 years old, with a median of 46 years; 40.3% of the patients were > 50 years old and 59.7% were < 50 years old. The negative predictive value of the questionnaire is 95.88% (CI 95.34-96.42%). CONCLUSION: This questionnaire is a useful instrument to determinate the necessity of preoperative laboratory testing in young, clinical healthy and elective surgery patients in a general hospital.
Antecedentes: el costo de los exámenes preoperatorios en Estados Unidos se calcula en 3,000 millones de dólares anuales. Con la intención de disminuir este costo se han descrito algunos puntos clave que pueden promover una preparación preoperatoria con un adecuado costo-beneficio. Objetivo: evaluar la utilidad de la aplicación de un cuestionario estandarizado a pacientes adultos llevados a cirugía electiva para identificar a los que pudieran ser operados sin necesidad de estudios preoperatorios. Material y métodos: estudio observacional, prospectivo, analítico, en el que se aplicó un instrumento evaluador estandarizado a pacientes adultos para determinar la necesidad de realizar estudios preoperatorios programados para procedimientos electivos de cirugía general de abril de 2011 a marzo de 2012. Resultados: el cuestionario se aplicó a 176 pacientes, 57.4% mujeres y 42.6% hombres. La edad varió entre 18 y 85 años, con una media de 46 años. El 40.3% de los pacientes eran mayores de 50 años, y 59.7% menores de 50 años de edad. El valor predictivo negativo del cuestionario fue 95.8% (IC 95.34-96.42%). Conclusión: este cuestionario es una herramienta útil, que permite identificar a los pacientes jóvenes, clínicamente sanos, que no requieren estudios de laboratorio prequirúrgicos para cirugía electiva de cirugía general.
Assuntos
Testes Diagnósticos de Rotina , Procedimentos Cirúrgicos Eletivos , Cuidados Pré-Operatórios/métodos , Inquéritos e Questionários , Procedimentos Desnecessários , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Intervalos de Confiança , Redução de Custos , Grupos Diagnósticos Relacionados , Testes Diagnósticos de Rotina/economia , Testes Diagnósticos de Rotina/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/economia , Feminino , Humanos , Masculino , Anamnese , México , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Cuidados Pré-Operatórios/economia , Estudos Prospectivos , Sensibilidade e Especificidade , Procedimentos Desnecessários/economia , Adulto JovemRESUMO
The aims of this study were to analyze unnecessary laboratory exams for patients with hypertension and diabetes and to check the expenditures involved.This is an exploratory-descriptive, cross-sectional study with a quantitative approach.We used data from medical records of 293 patients registered in primary units - the Family Health Center (NSF3); secondary: School Health Center (CSE); and tertiary: Hospital das Clinicas (HC) from 2006 to 2009 in a city in Southeastern Brazil. We identified a total of 9,522 laboratory tests, of which 5.97% were unnecessary. Of these, about 58% were requested by NSF3 and 42% by CSE. Results suggest there is a lack of integration among different levels of health care, which result in misallocation of resources and unnecessary spending. Descriptors: Health expenditures. Hypertension. Diabetes mellitus. Family health. Health services.
Assuntos
Diabetes Mellitus/diagnóstico , Diabetes Mellitus/economia , Gastos em Saúde , Hipertensão/diagnóstico , Hipertensão/economia , Procedimentos Desnecessários/economia , Idoso , Estudos Transversais , Saúde da Família , Feminino , Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Objetivos Determinar la prevalencia de la solicitud del perfil lipídico como ayuda diagnóstica de primera línea en pacientes con impresión clínica de vértigo periférico, así como un análisis de la relación costo-beneficio de dicha solicitud. Métodos Estudio de tipo corte transversal retrospectivo. Revisión de 201 historias de pacientes atendidos en la consulta externa tanto de especialistas como de médicos generales de la Clínica Universitaria Teletón y Casa chía, con diagnóstico de vértigo periférico, en el periodo comprendido entre enero de 2005 y julio de 2008. Resultados Las edades de los pacientes oscilaron entre 6 y 87 años, el 36 % de sexo masculino y el 64 % femenino. El perfil lipídico fue solicitado como prueba diagnóstica inicial para el manejo de vértigo a un 76 % de los pacientes. Los perfiles lipídicos hallados fueron normales en el 80 % de los pacientes a quienes se les solicitó. Se presenta el análisis de la relación costo-beneficio de esta prueba. Conclusiones Existe una alta prevalencia de solicitud de perfil lipídico como estudio de primera línea en el abordaje de pacientes con vértigo periférico, aunque no existe evidencia que avale esta solicitud, se requiere retroalimentación al cuerpo médico tanto de atención primaria como especialistas.
Objective Determining the prevalence of requesting lipid profile as a first-line diagnostic method in patients having a clinical impression of peripheral vertigo and also determining such request's cost- benefit ratio. Methods This was a retrospective cross-sectional study of 201 clinical charts regarding patients diagnosed as having peripheral vertigo at the Teletón teaching hospital's outpatient services in Chía between January 2005 and July 2008. Clinical charts drawn up by both general practitioners and medical specialists at first-time visit were compiled and analyzed Results The patients were aged 6 to 87 years old; 36 % were males and 64 % females. Lipid profile was requested for 76 % of the patients as initial diagnostic method; it was found that 80 % of the results revealed no abnormality. Conclusion Although a high prevalence regarding a request for lipid profile first-line study was found for patients having peripheral vertigo, there was no scientific evidence supporting such requirement. Ordering this kind of study not only increases unnecessary costs concerning diagnostic methods but also involves unjustified treatment. Feedback is needed for both doctors and first attention staff to ensure that this type of practice becomes changed.
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Testes Diagnósticos de Rotina , Lipídeos/sangue , Padrões de Prática Médica , Procedimentos Desnecessários , Vertigem/sangue , Colômbia/epidemiologia , Comorbidade , Análise Custo-Benefício , Estudos Transversais , Testes Diagnósticos de Rotina/economia , Dislipidemias/sangue , Dislipidemias/diagnóstico , Dislipidemias/economia , Dislipidemias/epidemiologia , Medicina Geral , Hospitais Universitários/economia , Medicina , Ambulatório Hospitalar/economia , Padrões de Prática Médica/economia , Estudos Retrospectivos , Procedimentos Desnecessários/economia , Vertigem/economia , Vertigem/epidemiologiaRESUMO
OBJECTIVE: Estimate the cost-effectiveness of not taking chest x-rays of any infant with clinically suspected viral bronchiolitis versus routinely taking them of all such patients, the most common practice today in Colombia. METHODS: A cost-effectiveness study was conducted, comparing strategies of taking chest x-rays of all infants with clinically suspected viral bronchiolitis and not x-raying any of these infants. The principal outcome was the proportion of correct diagnoses. The time horizon was the clinical course of the bronchiolitis. The perspective was that of the third-party payer, and the costs were obtained from the rates in effect in a clinic in Bogotá. Deterministic and probabilistic sensitivity analyses were performed. RESULTS: The strategy of not taking a chest x-ray of any patient prevailed over that of routinely taking one in all cases, with an average cost of US$ 111.00 and a correct diagnosis rate of 0.8020, versus the respective values of US$ 129.00 and 0.7873 for the strategy of routinely x-raying all of these patients. The most influential variable was pneumonia-related hospital costs. In the probabilistic sensitivity analysis, the strategy of not x-raying any infant prevailed in 61.1% of the simulations. CONCLUSIONS: The results suggest that not taking routine chest x-rays of infants with clinically suspected viral bronchiolitis is a cost-effective strategy compared with the common practice of taking them in all cases, since the former yields a greater proportion of correct diagnoses at a lower average cost per patient. Nevertheless, new studies will be needed that have more representative samples from all of the health facilities and include the strategy of taking chest x-rays only of patients with predictors of radiologic abnormalities.
Assuntos
Bronquiolite Viral/diagnóstico , Técnicas de Apoio para a Decisão , Radiografia Torácica/economia , Procedimentos Desnecessários/economia , Bronquiolite Viral/diagnóstico por imagem , Bronquiolite Viral/economia , Colômbia , Análise Custo-Benefício , Custos e Análise de Custo , Árvores de Decisões , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Lactente , Reembolso de Seguro de Saúde/economia , Pneumonia/economia , Radiografia Torácica/estatística & dados numéricos , Sensibilidade e EspecificidadeRESUMO
OBJETIVO: Estimar el costo-efectividad de no realizar radiografía de tórax a ningún lactante con sospecha clínica de bronquiolitis viral versus realizarla en todos estos pacientes de manera rutinaria, que es la práctica más utilizada hoy en Colombia. MÉTODOS: Se realizó un estudio de costo-efectividad en el que se compararon las estrategias consistentes en tomar radiografía a todos y no tomar radiografía de tórax a ningún lactante con sospecha clínica de bronquiolitis viral. El desenlace principal fue la proporción de diagnósticos correctos. El horizonte temporal fue la evolución de la bronquiolitis. La perspectiva fue la del tercer pagador y los costos se obtuvieron de las tarifas vigentes en una clínica en la ciudad de Bogotá. Se realizaron análisis de sensibilidad determinísticos y probabilísticos. RESULTADOS: La estrategia de no realizar radiografía de tórax a ningún paciente fue dominante en relación con realizarla en todos los casos de manera rutinaria, con un costo promedio de US$ 111,0 y una tasa de diagnósticos correctos de 0,8020, comparados con los valores correspondientes de US$ 129,0 y 0,7873 para la estrategia de tomar radiografía rutinaria a todos estos pacientes. La variable más influyente fue el costo hospitalario de la neumonía. En el análisis de sensibilidad probabilístico, la estrategia de no radiografiar a ningún lactante fue dominante en 61,1 por ciento de las simulaciones. CONCLUSIONES: Los resultados sugieren que no realizar radiografía de tórax de rutina a lactantes con sospecha clínica de bronquiolitis viral es una estrategia costo-efectiva respecto a la práctica común de realizarla en todos estos casos, dado que arroja una mayor proporción de diagnósticos correctos a un menor costo promedio por paciente. No obstante, harán falta nuevos estudios con muestras más representativas de todos los establecimientos de salud e incluir la estrategia de tomar radiografía de tórax únicamente a pacientes que tengan predictores de anormalidades radiológicas.
OBJECTIVE: Estimate the cost-effectiveness of not taking chest x-rays of any infant with clinically suspected viral bronchiolitis versus routinely taking them of all such patients, the most common practice today in Colombia. METHODS: A cost-effectiveness study was conducted, comparing strategies of taking chest x-rays of all infants with clinically suspected viral bronchiolitis and not x-raying any of these infants. The principal outcome was the proportion of correct diagnoses. The time horizon was the clinical course of the bronchiolitis. The perspective was that of the third-party payer, and the costs were obtained from the rates in effect in a clinic in Bogotá. Deterministic and probabilistic sensitivity analyses were performed. RESULTS: The strategy of not taking a chest x-ray of any patient prevailed over that of routinely taking one in all cases, with an average cost of US$ 111.00 and a correct diagnosis rate of 0.8020, versus the respective values of US$ 129.00 and 0.7873 for the strategy of routinely x-raying all of these patients. The most influential variable was pneumonia-related hospital costs. In the probabilistic sensitivity analysis, the strategy of not x-raying any infant prevailed in 61.1 percent of the simulations. CONCLUSIONS: The results suggest that not taking routine chest x-rays of infants with clinically suspected viral bronchiolitis is a cost-effective strategy compared with the common practice of taking them in all cases, since the former yields a greater proportion of correct diagnoses at a lower average cost per patient. Nevertheless, new studies will be needed that have more representative samples from all of the health facilities and include the strategy of taking chest x-rays only of patients with predictors of radiologic abnormalities.
Assuntos
Humanos , Lactente , Bronquiolite Viral/diagnóstico , Técnicas de Apoio para a Decisão , Radiografia Torácica/economia , Procedimentos Desnecessários/economia , Bronquiolite Viral/economia , Bronquiolite Viral , Colômbia , Análise Custo-Benefício , Custos e Análise de Custo , Árvores de Decisões , Custos de Cuidados de Saúde/estatística & dados numéricos , Reembolso de Seguro de Saúde/economia , Pneumonia/economia , Radiografia Torácica , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: Determining the prevalence of requesting lipid profile as a first-line diagnostic method in patients having a clinical impression of peripheral vertigo and also determining such request's cost- benefit ratio. METHODS: This was a retrospective cross-sectional study of 201 clinical charts regarding patients diagnosed as having peripheral vertigo at the Teletón teaching hospital's outpatient services in Chía between January 2005 and July 2008. Clinical charts drawn up by both general practitioners and medical specialists at first-time visit were compiled and analyzed. RESULTS: The patients were aged 6 to 87 years old; 36 % were males and 64 % females. Lipid profile was requested for 76 % of the patients as initial diagnostic method; it was found that 80 % of the results revealed no abnormality. CONCLUSION: Although a high prevalence regarding a request for lipid profile first-line study was found for patients having peripheral vertigo, there was no scientific evidence supporting such requirement. Ordering this kind of study not only increases unnecessary costs concerning diagnostic methods but also involves unjustified treatment. Feedback is needed for both doctors and first attention staff to ensure that this type of practice becomes changed.
Assuntos
Testes Diagnósticos de Rotina/estatística & dados numéricos , Lipídeos/sangue , Padrões de Prática Médica/estatística & dados numéricos , Procedimentos Desnecessários/estatística & dados numéricos , Vertigem/sangue , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Colômbia/epidemiologia , Comorbidade , Análise Custo-Benefício , Estudos Transversais , Testes Diagnósticos de Rotina/economia , Dislipidemias/sangue , Dislipidemias/diagnóstico , Dislipidemias/economia , Dislipidemias/epidemiologia , Feminino , Medicina Geral , Hospitais Universitários/economia , Humanos , Masculino , Medicina , Pessoa de Meia-Idade , Ambulatório Hospitalar/economia , Padrões de Prática Médica/economia , Estudos Retrospectivos , Procedimentos Desnecessários/economia , Vertigem/economia , Vertigem/epidemiologia , Adulto JovemRESUMO
Background: The economic impact of irritable bowel syndrome (IBS) in México in terms of excessive diagnostic testing can be considerably reduced if the recommendations of the Latín American Consensus (LATAM) for IBS are followed. Aim: To estímate the economic impact of IBS in terms of excessive diagnostic testing. Material and Methods: Based on a previously published study the costs of diagnostic testing for IBS were compared to the theoretical costs according to the recommendations of the consensus. These costs were compared to estímate the economic impact of excessive diagnostic testing. A cost-minimization analysis was also done. Results: For the lowest socioeconomic level in academic medicine, the excessive diagnostic testing had an approximate cost of US$21.38, compared to US$1.72 if the LATAM Consensus recommendations would have been followed, representing a saving of 92.0 percent. The cost for the highest socioeconomic level in academic medicine was US$1080.36 versus US$103.60 (a saving of 90.4 percent) and for prívate medicine, the costs were US$3121.60 versus US$159.90 (a saving of 94.9 percent) if the recommendations would have been followed. Conclusions: Limited diagnostic testing recommended by the LATAM Consensus for IBS can significantly decrease the economic impact of this disease in México.
Assuntos
Humanos , Custos Diretos de Serviços/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Síndrome do Intestino Irritável/economia , Consenso , Técnicas de Diagnóstico do Sistema Digestório/economia , Síndrome do Intestino Irritável/diagnóstico , México , Guias de Prática Clínica como Assunto , Procedimentos Desnecessários/economiaRESUMO
BACKGROUND: The economic impact of irritable bowel syndrome (IBS) in Mexico in terms of excessive diagnostic testing can be considerably reduced if the recommendations of the Latin American Consensus (LATAM) for IBS are followed. AIM: To estimate the economic impact of IBS in terms of excessive diagnostic testing. MATERIAL AND METHODS: Based on a previously published study, the costs of diagnostic testing for IBS were compared to the theoretical costs according to the recommendations of the consensus. These costs were compared to estimate the economic impact of excessive diagnostic testing. A cost-minimization analysis was also done. RESULTS: For the lowest socioeconomic level in academic medicine, the excessive diagnostic testing had an approximate cost of U.S. $21.38, compared to U.S. $1.72 if the LATAM Consensus recommendations would have been followed, representing a saving of 92.0%. The cost for the highest socioeconomic level in academic medicine was U.S. $1080.36 versus U.S. $103.60 (a saving of 90.4%) and for private medicine, the costs were U.S. $3121.60 versus U.S. $159.90 (a saving of 94.9%) if the recommendations would have been followed. CONCLUSIONS: Limited diagnostic testing recommended by the LATAM Consensus for IBS can significantly decrease the economic impact of this disease in Mexico
Assuntos
Custos Diretos de Serviços/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Síndrome do Intestino Irritável/economia , Consenso , Técnicas de Diagnóstico do Sistema Digestório/economia , Humanos , Síndrome do Intestino Irritável/diagnóstico , México , Guias de Prática Clínica como Assunto , Procedimentos Desnecessários/economiaRESUMO
The objective of this clinical trial was to determine the frequency of medical tests considered unnecessary in routine preoperative evaluation for cataract surgery. Unnecessary costs with these tests were also evaluated. For patients assigned to the selective testing group, it was requested that no preoperative testing be performed unless the patient presented a new or worsening medical problem warranting medical evaluation with testing. For patients assigned to the routine testing group, three tests were requested: a 12-lead electrocardiogram, complete blood count, and serum glucose level. The costs of tests considered unnecessary were calculated. The sample of 1,025 patients consisted of 512 assigned to the routine testing group and 513 to the selective testing group. Cumulative rate of medical events was similar in the two groups (p=0.923). The selective group underwent 60.7% fewer tests. The results suggest that selective preoperative testing in cataract surgery does not harm patients in terms of peri-operative clinical complications and also represents a significant cost reduction compared to routine testing.
Assuntos
Extração de Catarata , Testes Diagnósticos de Rotina/estatística & dados numéricos , Cuidados Pré-Operatórios , Procedimentos Desnecessários , Adulto , Idoso , Idoso de 80 Anos ou mais , Extração de Catarata/economia , Custos e Análise de Custo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/economia , Procedimentos Desnecessários/economiaRESUMO
Unnecessary operations represent between 20 and 25% of total surgical practice. This article analyses causes, history, enormous economic effects and their consequences as an iatrogenic harm. Looking for a solution to the problem of unnecessary operations is urgent because these surgeries have a direct effect on the field of ethics and morality in the practice of surgery.