RESUMO
RESUMO Objetivo: Identificar os custos não médicos diretos e indiretos em uma população de pacientes portadores de glaucoma primário de ângulo aberto (GPAA) em tratamento no Brasil. Métodos: A pesquisa dos custos neste estudo transversal foi realizada através de entrevista a uma população de pacientes portadores de GPAA em acompanhamento em um centro de referência para o tratamento do glaucoma na cidade de Juiz de Fora - MG. Para avaliação dos custos não médicos diretos, as seguintes variáveis foram investigadas: gasto com transporte, hospedagem, alimentação e acompanhante para cada consulta. Já na análise dos custos indiretos, avaliou-se: recebimento ou não de benefício social por causa do glaucoma (aposentadoria ou auxílio-doença) e qual o valor anual e perda de dias trabalhados pelo paciente e/ou pelo acompanhante. Os valores médios anuais foram calculados para todo o grupo e para cada estágio evolutivo do glaucoma. Resultados: Setenta e sete pacientes foram incluídos nesta análise (GPAA inicial: 26,0%; GPAA moderado: 24,7% e GPAA avançado: 49,3%). A média do custo não médico direto foi (em reais): 587,47; 660,52 e 708,54 para os glaucomas iniciais, moderados e avançados, respectivamente. Já a média do custo indireto foi: 20.156,75 (GPAA inicial); 26.988,16 (moderado) e 27.263,82 (avançado). Conclusão: Os custos não médicos diretos e indiretos relacionados ao GPAA no Brasil foram identificados. Os custos indiretos são superiores aos custos não médicos diretos e ambos tendem a aumentar com o avanço da doença.
ABSTRACT Objective: To identify direct and indirect non-medical costs in a population of patients with primary open-angle glaucoma (POAG) receiving treatment in Brazil. Methods: In this cross-sectional study, we obtained the costs through an interview with a population of patients with POAG at a glaucoma referral clinic in the city of Juiz de Fora - MG. In order to assess the direct non-medical costs, we investigated the following variables transportation expenses, lodging expenses, food and companion expenses for each visit. In the indirect costs analysis, we assessed the following variables: whether or not social benefits were received because of glaucoma (retirement or sickness benefit) and the annual value and loss of days worked by the patient and/or the companion. We calculated the mean annual values for the whole group and for each glaucoma stage. Results: Seventy-seven patients were included in this analysis (initial POAG: 26.0%, moderate POAG: 24.7% and advanced POAG 49.3%). The mean non-medical direct cost was (in reais): 587.47; 660.52 and 708.54 for the initial, moderate and advanced glaucomas, respectively. The mean indirect cost was: 20,156.75 (initial POAG); 26,988.16 (moderate POAG) and 27,263.82 (advanced POAG). Conclusion: We identified the direct and indirect non-medical costs related to POAG in Brazil. Indirect costs are higher than non-medical direct costs and both tend to increase with disease progression.
Assuntos
Humanos , Masculino , Feminino , Idoso , Glaucoma de Ângulo Aberto/economia , Gastos em Saúde , Efeitos Psicossociais da Doença , Financiamento Pessoal/economia , Visita a Consultório Médico/economia , Brasil , Glaucoma de Ângulo Aberto/terapia , Estudos Transversais , Custos de Cuidados de Saúde , Custos e Análise de CustoRESUMO
BACKGROUND: The competing choices of vaccination with either RV1 or RV5, the potential budget impact of vaccines on the EPI with different prices and new evidence make important an updated analysis for health decision makers in each country. The objective of this study is to assess cost-effectiveness of the monovalent and pentavalent rotavirus vaccines and impact on children deaths, inpatient and outpatient visits in 116 low and middle income countries that represent approximately 99% of rotavirus mortality. METHODS: A decision tree model followed hypothetical cohorts of children from birth up to 5 years of age for each country in 2010. Inputs were gathered from international databases and previous research on incidence and effectiveness of monovalent and pentavalent vaccines. Costs were expressed in 2010 international dollars. Outcomes were reported in terms of cost per disability-adjusted life-year averted, comparing no vaccination with either monovalent or pentavalent mass introduction. Vaccine price was assumed fixed for all world low-income and middle-income countries. RESULTS: Around 292,000 deaths, 3.34 million inpatient cases and 23.09 million outpatient cases would occur with no vaccination. In the base-case scenario, monovalent vaccination would prevent 54.7% of inpatient cases and 45.4% of deaths. Pentavalent vaccination would prevent 51.4% of inpatient cases and 41.1% of deaths. The vaccine was cost-effective in all world countries in the base-case scenario for both vaccines. Cost per disability-adjusted life-year averted in all selected countries was I$372 for monovalent, and I$453 for pentavalent vaccination. CONCLUSION: Rotavirus vaccine is cost-effective in most analyzed countries. Despite cost-effectiveness analysis is a useful tool for decision making in middle-income countries, for low-income countries health decision makers should also assess the impact of introducing either vaccine on local resources and budget impact analysis of vaccination.
Assuntos
Transmissão de Doença Infecciosa/economia , Transmissão de Doença Infecciosa/prevenção & controle , Infecções por Rotavirus/economia , Infecções por Rotavirus/epidemiologia , Vacinas contra Rotavirus/administração & dosagem , Vacinas contra Rotavirus/economia , Pré-Escolar , Análise Custo-Benefício , Países em Desenvolvimento , Hospitalização/economia , Humanos , Lactente , Recém-Nascido , Modelos Estatísticos , Visita a Consultório Médico/economia , Infecções por Rotavirus/mortalidade , Infecções por Rotavirus/prevenção & controle , Vacinas contra Rotavirus/imunologia , Análise de SobrevidaRESUMO
BACKGROUND: The elevated prevalence of osteoarthritis in Western countries, the high costs of hip and knee arthroplasty, and the wide variations in the clinical practice have generated considerable interest in comparing the associated costs before and after surgery. OBJECTIVE: To determine the influence of a number of variables on the costs of total knee and hip arthroplasty surgery during the hospital stay and during the one-year post-discharge. METHODS: A prospective multi-center study was performed in 15 hospitals from three Spanish regions. Relationships between the independent variables and the costs of hospital stay and postdischarge follow-up were analyzed by using multilevel models in which the "hospital" variable was used to group cases. Independent variables were: age, sex, body mass index, preoperative quality of life (SF-12, EQ-5 and Womac questionnaires), surgery (hip/knee), Charlson Index, general and local complications, number of beds and economic-institutional dependency of the hospital, the autonomous region to which it belongs, and the presence of a caregiver. RESULTS: The cost of hospital stay, excluding the cost of the prosthesis, was 4,734 Euros, and the post-discharge cost was 554 Euros. With regard to hospital stay costs, the variance among hospitals explained 44-46% of the total variance among the patients. With regard to the post-discharge costs, the variability among hospitals explained 7-9% of the variance among the patients. CONCLUSIONS: There is considerable potential for reducing the hospital stay costs of these patients, given that more than 44% of the observed variability was not determined by the clinical conditions of the patients but rather by the behavior of the hospitals.
antecedentes: la alta prevalencia de artrosis en los países occidentales, el elevado costo de las intervenciones de artroplastia de cadera y rodilla y las amplias variaciones en la práctica médica generan gran interés por comparar los costos asociados antes y después de la cirugía. Objetivo: conocer el costo de las intervenciones de reemplazo total de cadera y rodilla durante la estancia hospitalaria y al año de seguimiento posterior al alta. material y métodos: estudio multicéntrico y prospectivo efectuado en 15 hospitales de tres comunidades autónomas. La relación entre las variables independientes con el costo de la estancia y costo post-alta, se analizó con modelos multinivel y para agrupar los casos se utilizó la variable "hospital." Las variables independientes fueron: edad, sexo, índice de masa corporal, calidad de vida prequirúrgica (cuestionarios ED-5D, SF-12 y Womac), intervención (cadera-rodilla), índice Charlson, complicaciones, número de camas y dependencia económico-institucional del hospital, comunidad autó-noma y presencia de cuidador. Resultados: el costo promedio por paciente, sin incluir el costo de la prótesis, fue de 4,734 Euros ± 2,136 y el costo del seguimiento post alta de 554 Euros ± 509. Si se incluye el costo de la prótesis, al final del año el costo total asciende a 7,645 Euros ± 2,248. Conclusiones: existe un margen considerable en la reducción de los costos de estancia; más de 44% de la variabilidad observada no está determinada por las condiciones clínicas de los pacientes sino por el comportamiento de los centros hospitalarios.
Assuntos
Artroplastia de Quadril/economia , Artroplastia do Joelho/economia , Assistência ao Convalescente/economia , Idoso , Artroplastia de Quadril/reabilitação , Artroplastia do Joelho/reabilitação , Custos e Análise de Custo , Feminino , Seguimentos , Recursos em Saúde/economia , Recursos em Saúde/estatística & dados numéricos , Prótese de Quadril/economia , Custos Hospitalares/estatística & dados numéricos , Hospitais Universitários/economia , Humanos , Prótese do Joelho/economia , Tempo de Internação/economia , Masculino , Pessoa de Meia-Idade , Visita a Consultório Médico/economia , Estudos Prospectivos , EspanhaRESUMO
BACKGROUND: The Second Medicine, Angioplasty, or Surgery Study (MASS II) included patients with multivessel coronary artery disease and normal systolic ventricular function. Patients underwent coronary artery bypass graft surgery (CABG, n=203), percutaneous coronary intervention (PCI, n=205), or medical treatment alone (MT, n=203). This investigation compares the economic outcome at 5-year follow-up of the 3 therapeutic strategies. METHODS AND RESULTS: We analyzed cumulative costs during a 5-year follow-up period. To analyze the cost-effectiveness, adjustment was made on the cumulative costs for average event-free time and angina-free proportion. Respectively, for event-free survival and event plus angina-free survival, MT presented 3.79 quality-adjusted life-years and 2.07 quality-adjusted life-years; PCI presented 3.59 and 2.77 quality-adjusted life-years; and CABG demonstrated 4.4 and 2.81 quality-adjusted life-years. The event-free costs were $9071.00 for MT; $19,967.00 for PCI; and $18,263.00 for CABG. The paired comparison of the event-free costs showed that there was a significant difference favoring MT versus PCI (P<0.01) and versus CABG (P<0.01) and CABG versus PCI (P=0.01). The event-free plus angina-free costs were $16,553.00, $25,831.00, and $24,614.00, respectively. The paired comparison of the event-free plus angina-free costs showed that there was a significant difference favoring MT versus PCI (P=0.04), and versus CABG (P<0.001); there was no difference between CABG and PCI (P>0.05). CONCLUSIONS: In the long-term economic analysis, for the prevention of a composite primary end point, MT was more cost effective than CABG, and CABG was more cost-effective than PCI. CLINICAL TRIAL REGISTRATION INFORMATION: www.controlled-trials.com. REGISTRATION NUMBER: ISRCTN66068876.
Assuntos
Angioplastia Coronária com Balão/economia , Fármacos Cardiovasculares/economia , Ponte de Artéria Coronária/economia , Doença das Coronárias/economia , Estudos Multicêntricos como Assunto/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Idoso , Angina Pectoris/epidemiologia , Angioplastia Coronária com Balão/estatística & dados numéricos , Fármacos Cardiovasculares/uso terapêutico , Ponte de Artéria Coronária/estatística & dados numéricos , Doença das Coronárias/tratamento farmacológico , Doença das Coronárias/cirurgia , Doença das Coronárias/terapia , Análise Custo-Benefício , Técnicas de Diagnóstico Cardiovascular/economia , Intervalo Livre de Doença , Feminino , Seguimentos , Recursos em Saúde/economia , Recursos em Saúde/estatística & dados numéricos , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Visita a Consultório Médico/economia , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Anos de Vida Ajustados por Qualidade de Vida , Resultado do TratamentoRESUMO
OBJECTIVE: To assess the direct annual health care costs for children and adolescents with Down syndrome in Western Australia and to explore the variation in health care use including respite, according to age and disease profile. STUDY DESIGN: Population-based data were derived from a cross-sectional questionnaire that was distributed to all families who had a child with Down syndrome as old as 25 years of age in Western Australia. RESULTS: Seventy-three percent of families (363/500) responded to the survey. Mean annual cost was $4209 Australian dollars ($4287 US dollars) for direct health care including hospital, medical, pharmaceutical, respite and therapy, with a median cost of $1701. Overall, costs decreased with age. The decline in costs was a result of decreasing use of hospital, medical, and therapy costs with age. Conversely, respite increased with age and also with dependency. Health care costs were greater in all age groups with increasing dependency and for an earlier or current diagnosis of congenital heart disease. Annual health care costs did not vary with parental income, including cost of respite. CONCLUSIONS: Direct health care costs for children with Down syndrome decrease with age to approximate population costs, although costs of respite show an increasing trend.
Assuntos
Síndrome de Down/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Fatores Etários , Austrália/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Avaliação da Deficiência , Pessoas com Deficiência , Síndrome de Down/epidemiologia , Feminino , Cardiopatias Congênitas/economia , Cardiopatias Congênitas/epidemiologia , Humanos , Hidroterapia/economia , Lactente , Recém-Nascido , Masculino , Terapia Ocupacional/economia , Visita a Consultório Médico/economia , Visita a Consultório Médico/estatística & dados numéricos , Modalidades de Fisioterapia/economia , Cuidados Intermitentes/economia , Fonoterapia/economia , Inquéritos e Questionários , Natação/economia , Adulto JovemRESUMO
BACKGROUND: Rotavirus is the most common cause of severe diarrhea in infants. The economic costs of treating severe rotavirus can be quite significant and are important to include in any evaluation of prevention programs. The aim of this study was to determine utilization of health care resources and costs incurred due to severe diarrhea associated with rotavirus infection in Mexican children < 5 years of age. MATERIAL AND METHODS: The costs of rotavirus infection evaluated in this observational study consisted of hospital, emergency room care and out-patient visit expenses at three hospitals of the Mexican Institute of Social Security throughout 1999-2000. Service costs were estimated from costs of care for rotavirus versus non-rotavirus diarrhea obtained through a follow-up study data of 383 children and administrative records. RESULTS: Diarrhea cases due to rotavirus infection comprised 36% of the sample. Participants with rotavirus diarrhea spent an average of 3.2 days in the hospital, 5.9 hours in the emergency room, and had 1.3 visits to an outpatient physician's office. Some differences in the consumption of health care were found between rotavirus and non-rotavirus diarrhea cases, although the mean costs of rotavirus and nonrotavirus cases were not significantly different. The mean cost per case of severe rotavirus diarrhea was estimated to be US $936. The total cost of treating severe rotavirus diarrhea, including 5,955 rotavirus hospitalizations for 2004, was estimated at US $5.5 million. CONCLUSION: Health care costs due to treatment for severe rotavirus diarrhea are a significant economic burden to the Mexican Social Security system.
Assuntos
Diarreia/terapia , Custos de Cuidados de Saúde , Recursos em Saúde/estatística & dados numéricos , Infecções por Rotavirus/terapia , Antibacterianos/uso terapêutico , Antidiarreicos/economia , Antidiarreicos/uso terapêutico , Pré-Escolar , Países em Desenvolvimento , Diarreia/tratamento farmacológico , Diarreia/economia , Diarreia/epidemiologia , Diarreia/virologia , Diarreia Infantil/tratamento farmacológico , Diarreia Infantil/economia , Diarreia Infantil/epidemiologia , Diarreia Infantil/terapia , Diarreia Infantil/virologia , Custos de Medicamentos , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hidratação/economia , Hidratação/estatística & dados numéricos , Gastos em Saúde , Custos Hospitalares , Hospitalização/economia , Hospitais Urbanos/estatística & dados numéricos , Humanos , Lactente , Masculino , México/epidemiologia , Visita a Consultório Médico/economia , Infecções por Rotavirus/economia , Infecções por Rotavirus/epidemiologia , Infecções por Rotavirus/virologia , Índice de Gravidade de Doença , Previdência Social/economiaRESUMO
OBJECTIVE: To compare three antidepressant drugs from different classes used in treating moderate-to-severe major depressive disorder (MDD) in Colombian adults. METHODS: Based on expert input, a decision-tree model was adapted for Colombia to analyze data over 6 months from the government-payer perspective. The cost-effectiveness of amitriptyline, fluoxetine, and venlafaxine was determined. The clinical outcome was remission of depression (a score <7 on the Hamilton Depression [HAM-D] scale or <12 on the Montgomery-Åsberg Depression Rating Scale [MADRS]) after 8 weeks of treatment. Clinical data were obtained from the literature and costs from standard Colombian price lists. One-way and multivariate sensitivity analyses tested model robustness. RESULTS: Costs per patient (in 2007 US$) for treatment were: venlafaxine, $1 618; fluoxetine, $1 207; and amitriptyline, $1 068. Overall remission rates were 73.1 percent, 64.1 percent, and 71.3 percent, respectively. Amitriptyline dominated fluoxetine (i.e., it had lower costs and higher outcomes). The incremental cost-effectiveness ratio (ICER) of venlafaxine over amitriptyline was US$ 31 595. The acquisition price of venlafaxine was the model's cost driver, comprising 53.4 percent of the total cost/patient treated, compared with 18.5 percent and 24.8 percent for fluoxetine and amitriptyline, respectively. For the others, hospitalization comprised the major cost (72.1 percent and 65.2 percent, respectively). Probabilistic (Monte Carlo) sensitivity analysis confirmed the original findings of the pharmacoeconomic model. CONCLUSIONS: Amitriptyline is cost-effective in comparison to fluoxetine and venlafaxine in Colombia. However, the cost of venlafaxine was estimated for the brand-name product, as generics were not currently available. These cost-effectiveness results can be substantially affected by the presence of generics or drug cost regulations.
OBJETIVO: Comparar tres medicamentos antidepresivos de diferentes clases empleados para tratar trastornos depresivos mayores moderados e intensos en adultos colombianos. MÉTODOS: A partir de los aportes de expertos se adaptó un modelo de árbol de decisión para Colombia a fin de analizar los datos de seis meses desde la perspectiva del gobierno como pagador de los servicios. Se determinó la relación costo-efectividad de la amitriptilina, la fluoxetina y la venlafaxina. El desenlace clínico fue la remisión de la depresión (una puntuación <7 en la escala de depresión de Hamilton o <12 en la escala de valoración de la depresión de Montgomery-Åsberg) después de 8 semanas de tratamiento. Los datos clínicos se obtuvieron de la literatura especializada y los costos, de las listas habituales de precios de Colombia. Se realizaron análisis de sensibilidad simples y multifactoriales para probar la robustez de los modelos. RESULTADOS: Los costos del tratamiento por paciente (en dólares estadounidenses de 2007) fueron: US$ 1 618 para la venlafaxina, US$ 1 207 para la fluoxetina y US$ 1 068 para la amitriptilina. Las tasas de remisión general fueron 73,1 por ciento, 64,1 por ciento y 71,3 por ciento, respectivamente. La amitriptilina tuvo un menor costo y una mayor remisión que la fluoxetina. La razón de rentabilidad incremental de la venlafaxina sobre la amitriptilina fue de US$ 31 595. El inductor de costos (cost driver) del modelo fue el valor de adquisición de la venlafaxina, que representó 53,4 por ciento del total del costo por paciente tratado, en comparación con la fluoxetina (18,5 por ciento) y la amitriptilina (24,8 por ciento). En los otros casos, la hospitalización representó el mayor costo (72,1 por ciento y 65,2 por ciento, respectivamente). El análisis de sensibilidad probabilístico (Monte Carlo) confirmó los resultados preliminares del modelo farmacoeconómico. CONCLUSIONES: En Colombia, la amitriptilina es más efectiva en función del costo que la fluoxetina y la venlafaxina. No obstante, el costo de la venlafaxina se estimó a partir del medicamento de marca, ya que no había genéricos disponibles. Esta relación costo-efectividad puede variar considerablemente con la aparición de medicamentos genéricos o medidas regulatorias del costo de los medicamentos.
Assuntos
Humanos , Masculino , Feminino , Amitriptilina/economia , Antidepressivos/economia , Cicloexanóis/economia , Transtorno Depressivo/tratamento farmacológico , Fluoxetina/economia , Modelos Teóricos , Amitriptilina/uso terapêutico , Antidepressivos/uso terapêutico , Colômbia/epidemiologia , Convulsoterapia/economia , Análise Custo-Benefício , Cicloexanóis/uso terapêutico , Árvores de Decisões , Transtorno Depressivo/economia , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/terapia , Países em Desenvolvimento , Custos de Medicamentos , Fluoxetina/uso terapêutico , Gastos em Saúde/estatística & dados numéricos , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Método de Monte Carlo , Programas Nacionais de Saúde/economia , Visita a Consultório Médico/economia , Psicoterapia/economiaRESUMO
OBJECTIVE: To compare three antidepressant drugs from different classes used in treating moderate-to-severe major depressive disorder (MDD) in Colombian adults. METHODS: Based on expert input, a decision-tree model was adapted for Colombia to analyze data over 6 months from the government-payer perspective. The cost-effectiveness of amitriptyline, fluoxetine, and venlafaxine was determined. The clinical outcome was remission of depression (a score Assuntos
Amitriptilina/economia
, Antidepressivos/economia
, Cicloexanóis/economia
, Transtorno Depressivo/tratamento farmacológico
, Fluoxetina/economia
, Modelos Teóricos
, Amitriptilina/uso terapêutico
, Antidepressivos/uso terapêutico
, Colômbia/epidemiologia
, Convulsoterapia/economia
, Análise Custo-Benefício
, Cicloexanóis/uso terapêutico
, Árvores de Decisões
, Transtorno Depressivo/economia
, Transtorno Depressivo/epidemiologia
, Transtorno Depressivo/terapia
, Países em Desenvolvimento
, Custos de Medicamentos
, Feminino
, Fluoxetina/uso terapêutico
, Gastos em Saúde/estatística & dados numéricos
, Hospitalização/economia
, Hospitalização/estatística & dados numéricos
, Humanos
, Masculino
, Método de Monte Carlo
, Programas Nacionais de Saúde/economia
, Visita a Consultório Médico/economia
, Psicoterapia/economia
, Cloridrato de Venlafaxina
RESUMO
OBJECTIVE: To determine health care costs associated with pressure ulcers, ulcers of the lower limbs, other chronic ulcers, and venous leg ulcers from the New Mexico Medicaid fee-for-service program perspective. DESIGN: Retrospective analysis of claims database MAIN OUTCOME MEASURES: Physician visit, hospital, and prescription costs were determined for New Mexico Medicaid patients with a primary and/or secondary diagnosis of 1 of 4 identified categories of skin ulcers from January 1, 1994, through December 31, 1998. Costs were determined in terms of mean and median annual cost per patient and total costs per year. Zero dollar claims were included within the cost calculations. All costs are expressed in 2000-dollar values. MAIN RESULTS: Mean annual physician visit costs per patient ranged from $71 (standard deviation [SD] = $60) for venous leg ulcers in 1998 to $520 (SD = $1228) for pressure ulcers in 1996. Mean annual hospital costs per patient ranged from $266 (SD = $348) for other chronic ulcers in 1998 to $15,760 (SD = $30,706) for pressure ulcers in 1998. Mean annual prescription costs per patient ranged from $145 (SD = $282) for other chronic ulcers in 1998 to $654 (SD = $1488) for pressure ulcers in 1994. CONCLUSION: The New Mexico Medicaid fee-for-service system incurred a total cost of approximately $11.6 million (in 2000 dollars) from 1994 through 1998 for the treatment of the 4 categories of skin ulcers studied. The data showed that the majority of wounds were coded as pressure ulcers, which had the highest associated costs.
Assuntos
Custos Diretos de Serviços/estatística & dados numéricos , Planos de Pagamento por Serviço Prestado/economia , Medicaid/economia , Úlcera Cutânea/economia , Doença Crônica , Prescrições de Medicamentos/economia , Feminino , Pesquisa sobre Serviços de Saúde , Custos Hospitalares/estatística & dados numéricos , Humanos , Formulário de Reclamação de Seguro/economia , Tempo de Internação/economia , Masculino , Pessoa de Meia-Idade , New Mexico/epidemiologia , Visita a Consultório Médico/economia , Úlcera por Pressão/economia , Estudos Retrospectivos , Úlcera Cutânea/classificação , Úlcera Cutânea/epidemiologia , Úlcera Cutânea/terapia , Úlcera Varicosa/economiaRESUMO
This piece analyzes the funding of the public Unified Health System (UHS) in the state of Mato Grosso, Brazil, in order to identify the model of care that has been taking shape there since 1994. We studied 16 municipalities, selected according to their size, degree of involvement with the UHS, and socioeconomic and health conditions. We found that between 1994 and 1998 there were large increases in health spending, due to higher municipal expenditures and to rising intergovernmental transfers for outpatient care. However, the health care system taking shape in a large number of Mato Grosso municipalities is increasingly focused on an individual, curative, specialized, and highly technological type of care. Indicative of this trend is the fact that the biggest increases in spending for outpatient care--up to 300% in some municipalities--have come from diagnostic and therapeutic procedures that are of medium or high complexity. Since the resources for health care are limited, and since the model of care adopted by many municipalities continues to shift resources from primary health care to more complex procedures, we believe that the financial viability of the Unified Health System is coming into question. Although this study was limited to the state of Mato Grosso, other Brazilian municipalities are no doubt facing similar situations. The same is probably true for municipalities in other South American countries that have adopted decentralization of the health care system as one of the strategies for State reform.
Assuntos
Reforma dos Serviços de Saúde , Administração em Saúde Pública/economia , Assistência Ambulatorial/economia , Assistência Ambulatorial/organização & administração , Brasil , Bases de Dados Factuais , Odontologia/organização & administração , Países em Desenvolvimento/economia , Gastos em Saúde , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Programas de Imunização/economia , Programas de Imunização/organização & administração , Medicina , Modelos Teóricos , Visita a Consultório Médico/economia , Visita a Consultório Médico/estatística & dados numéricos , Vigilância da População , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/organização & administração , Especialização , Saúde da População UrbanaRESUMO
OBJECTIVE: Rheumatoid arthritis (RA) is a disease that often requires multiple drug treatment for long periods of time. The purpose of this study was to assess the direct costs of medical care for RA patients seen in a tertiary care center in Mexico City. METHODS: The clinical cases of 3 patients attending our Institution were studied. These represented: (i) one with a disease easily controlled with a disease modifying anti-rheumatic drug (DMARD) (mild disease), (ii) one adequately controlled with 2 or more DMARDs (moderate disease), and (iii) one poorly controlled in spite of multiple DMARDs (severe disease). The costs of the medical visits and of all laboratory and routine examinations during the last year were estimated according to local tabulators, considering the options of highest, intermediate and lowest costs. The costs of the prescribed medications were calculated from current price lists obtained from four drugstores near the Institution. RESULTS: Medical care to an RA patient costs between US $19 and US $221.70 monthly (US $228.08 and US $2,661.40 per year) depending on the socio-economic status of the patient and on variables related to the activity and severity of the disease in our setting. The number of medical visits represented 0.1% to 12.7% of the total costs, laboratory and routine examinations 0.1% to 7.1%, and medications 81.8% to 99.8%. For reference the minimum wage in Mexico is US $90.40 per month. CONCLUSIONS: The direct costs of medical care to RA patients in our setting can be high, and greatly depends on the prescribed medications.
Assuntos
Artrite Reumatoide/tratamento farmacológico , Custos Diretos de Serviços , Antirreumáticos/economia , Antirreumáticos/uso terapêutico , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/fisiopatologia , Custos de Medicamentos , Testes Hematológicos/economia , Humanos , México , Visita a Consultório Médico/economiaRESUMO
La prevención es importante para reducir la carga de las enfermedades crónicas. La consulta externa y el triaje deben ser factor de enlace entre el paciente y el entorno socio-cultural-geográfico. Se estudian 188 pacientes del triaje general del Hospital Rísquez en Cotiza, Caracas, por medio de una encuesta socio-económica. El 66% de los pacientes eran solteros. El 72,34% eran del sexo femenino. El 87,77% eran venezolanos por nacimiento y el 9,03% extranjeros. El 15,43% no ha completado los estudios de primaria (hasta 6 grado). El 35,64% no ha completado la educación secundaria y el 9,04% eran analfabetos. El 58,57% no trabajaban. El 86,77% acuden al hospital por referencia de un amigo o familiar. El 65,43% refiere no tener vivienda propia y el 85,64% no tenía vehiculo propio. El grupo familiar, sin incluir al paciente, lo forman entre 2 a 5 personas en el 60,64% de los casos; y trabajan entre 1 y 3 personas en el 81,93%. El 20,69% de los pacientes provenían de zonas foráneas a Caracas
Assuntos
Humanos , Visita a Consultório Médico/economiaRESUMO
Estudo descritivo transversal, sendo os dados coletados atraves de questionarios aplicados aos responsaveis por criancas que procuram o ambulatorio de pediatria geral do Hospital Universitario(HU) da Universidade Federal de Santa Catarina(UFSC).Os objetivos foram a verificacao da procedencia e o por que da procura dos responsaveis pelo ambulatorio, bem como dos gastos da consulta. Discutido o sistema de saude brasileiro e apresentacao de proposta para sua viabilizacao
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Visita a Consultório Médico/economia , Ambulatório Hospitalar/economia , Hospitais Universitários , Serviços de Saúde da CriançaRESUMO
A pilot study was undertaken to explore the effects of geographic migration and exposure to new cultural values and attitudes on rates of physician office visits in a Puerto Rican population in a major Northeastern urban area. A cross-sectional survey study of an immigrant community was performed, using a questionnaire developed to assess the degree of immigrants' adaptation to the dominant culture, self-perceived health status, levels of stress and social support, and attitudes toward Western medical care. A convenience sample of 93 respondents was obtained. Analysis of the data showed that adaptation to the dominant culture, as measured in this study, is as good an independent predictor of high levels of physician office visitation as self-reported health status. In addition, it has a small but significant effect on perceived health. These results suggest that further exploration of the effect of cultural adaptation on health behaviors would be productive for clinicians and health resource managers.