ABSTRACT
Objetivo: Estimar o impacto orçamentário em cinco anos da incorporação da técnica de SET (single embryo transfer) sequencial no Sistema de Saúde Suplementar brasileiro (SSSB). Métodos: Foram consideradas taxas de nascidos vivos de 41% e de gemelaridade de 2% e 30% para SET e DET (double transfer embryo), respectivamente. Os custos dos procedimentos foram, em sua maioria, obtidos das tabelas SIMPRO, CBHPM e CMED. Para a estimativa da população elegível, foram consideradas mulheres de 20 a 35 anos registradas no Datasus e taxas de infertilidade e de uso de fertilização in vitro (FIV) da literatura. Estimou-se em 20% e 80% o uso de SET sequencial e DET, respectivamente, com incorporação da primeira em 45%, 50%, 55%, 65% e 75% dos casos nos cinco anos subsequentes. Resultados: Considerando cenários com reembolso de um a dois ciclos de SET sequencial e inclusão ou não do valor dos medicamentos, o impacto orçamentário em cinco anos seria entre R$ 10.231.387 e R$ 16.123.874 em operadoras de grande porte, R$ 1.054.174 e R$ 1.661.297 em operadoras de médio porte e R$ 173.700 e R$ 273.738 em operadoras de pequeno porte. Em cenário com aumento progressivo do uso de SET sequencial sem alteração no modelo de reembolso atual, foi estimada economia de R$ 59.319.276 para o SSSB em cinco anos. Conclusões: O uso de SET sequencial (vs. DET) em procedimentos de FIV é potencialmente menos oneroso para o SSSB referente a custos de pré-natal, parto e complicações. Em cenário de incorporação progressiva, o custo incremental foi estimado em R$ 8-13 mil/paciente.
Objective: To estimate the five-year budget impact of incorporating the sequential single embryo transfer (SET) technique into the Brazilian Supplementary Healthcare System (BSHS). Methods: Live birth rates of 41% and multiple pregnancy rates of 2% and 30% were considered for SET and DET (double transfer embryo), respectively. The costs of the procedures were mostly obtained from e SIMPRO, CBHPM and CMED tables. To estimate the eligible population, we considered women aged 20-35 years registered in DATASUS, and infertility and in vitro fertilization (IVF) rates from the literature. The use of sequential SET and DET was estimated as 20% and 80%, respectively, with incorporation of the first in 45%, 50%, 55%, 65% and 75% of cases in the subsequent five years. Results: Considering scenarios with reimbursement of 1 to 2 cycles of sequential SET and inclusion or not of the drugs in the reimbursement, the budget impact in five years would be between BRL 10,231,387-16,123,874 in large operators, BRL 1,054,174-1,661,297 in midsize operators and BRL 173,700-273,738 in small operators. In a scenario of progressive increase of the use of sequential SET with no change in the current reimbursement model, we estimated a saving of BRL 59,319,276 for the BSHS in five years. Conclusions: The use of sequential SET (vs. DET) in IVF procedures is potentially less costly for BSHS for prenatal, child-birth and complication costs. In the scenario of progressive incorporation and full reimbursement of the procedure, the incremental cost was estimated at BRL 8-13 thousands/patient.
Subject(s)
Costs and Cost Analysis , Supplemental Health , Single Embryo Transfer , InfertilityABSTRACT
OBJECTIVE: To evaluate the influence of estrogen therapy and estrogen-progestin therapy on homocysteine and C-reactive protein levels in postmenopausal women. METHODS: In total, 99 postmenopausal women were included in this double-blind, randomized clinical trial and divided into three groups: Group A used estrogen therapy alone (2.0 mg of 17β-estradiol), Group B received estrogen-progestin therapy (2.0 mg of 17 β-estradiol +1.0 mg of norethisterone acetate) and Group C received a placebo (control). The length of treatment was six months. Serum measurements of homocysteine and C-reactive protein were carried out prior to the onset of treatment and following six months of therapy. RESULTS: After six months of treatment, there was a 20.7% reduction in homocysteine levels and a 100.5% increase in C-reactive protein levels in the group of women who used estrogen therapy. With respect to the estrogen-progestin group, there was a 12.2% decrease in homocysteine levels and a 93.5% increase in C-reactive protein levels. CONCLUSION: Our data suggested that hormone therapy (unopposed estrogen or estrogen associated with progestin) may have a positive influence on decreasing cardiovascular risk due to a significant reduction in homocysteine levels. .
Subject(s)
Female , Humans , Middle Aged , C-Reactive Protein/metabolism , Estrogen Replacement Therapy/methods , Estrogens/therapeutic use , Homocysteine/blood , Postmenopause/blood , Progestins/therapeutic use , Age Factors , Brazil , Cardiovascular Diseases/prevention & control , Double-Blind Method , Drug Combinations , Estradiol/administration & dosage , Follow-Up Studies , Longitudinal Studies , Norethindrone/administration & dosage , Norethindrone/analogs & derivatives , Patient Dropouts , Prospective StudiesSubject(s)
Humans , Female , Adult , Middle Aged , Climacteric , Bone Density , Drug Combinations , Estradiol , Norethindrone , Hormone Replacement Therapy , Combined Modality Therapy , Endometrial Hyperplasia , Estrogens, Conjugated (USP) , LipidsABSTRACT
O hirsutismo representa uma patologia de grande importância para os médicos ginecologistas, näo só pela sua expressiva incidência e pelo aspecto emocional que envolve as pacientes, mas também pela baixa aderência ao tratamento que deve ser a longo prazo.