ABSTRACT
BACKGROUND: Cancer is a public health priority in Chile. AIM: To estimate the expected annual cost of cancer in Chile, due to direct costs of health services, working allowances and indirect costs for productivity losses. MATERIAL AND METHODS: We undertook an ascendent costing methodology to calculate direct costs. We built diagnostic, treatment and follow-up cost baskets for each cancer type. Further, we estimated the expenditure due to sick leave subsidies. Both estimates were performed either for the public or private sector. Costs related to productivity loss were estimated using the human capital approach, incorporating disease related absenteeism premature deaths. The time frame for all estimates was one year. RESULTS: The annual expected costs attributed to cancer was $1,557 billion of Chilean pesos. The health services expected annual costs were $1,436 billion, 67% of which are spent on five cancer groups (digestive, hematologic, respiratory, breast and urinary tract). The expected costs of sick leave subsidies and productivity loss were $48 and $71 billion, respectively. CONCLUSIONS: Cancer generates costs to the health system, which obliges health planners to allocate a significant proportion of the health budget to this disease. The expected costs estimated in this study are equivalent to 8.9% of all health expenditures and 0.69% of the Gross Domestic Product. This study provides an updated reference for future research, such as those aimed at evaluating the current health policies in cancer.
Subject(s)
Humans , Health Care Costs , Neoplasms/therapy , Chile/epidemiology , Health Expenditures , Cost of Illness , AbsenteeismABSTRACT
Background: The neutrophil/lymphocyte ratio is an effective marker of inflammation ana can have prognostic value in surgical patients. Aim: To evaluate the effect of an increased neutrophil/lymphocyte ratio (NLR) on perioperative complications ana overall ana disease-free survival in patients undergoing elective resection for stage II colon cancer. Material and Methods: Data was obtained from clinical charts, preoperative blood results and hospital records of all patients undergoing an elective curative resection for colon cancer, between 2000 and 2007. Preoperative NLR was calculated. Follow-up was obtained from a prospectively maintained colorectal cancer database, clinical records and questionnaires. Uni and multivariable analysis were performed to identify associations, and survival analysis was performed using Kaplan-Meier curves. Results: One hundred twenty two patients with a mean age of69years (52% males), were evaluated. Median follow-up was 73 months, and overall survival for 1 and 5years was 95% and 68%, respectively. On a multivariable analysis after adjusting for age, sex, tumor depth invasion, use of adjuvant therapies and American Society of Anesthesiology preoperative risk score, an NLR > 5 was associated with an increased perioperative complication rate (odds ratio: 3,06, p = 0,033). Kaplan-Meier survival analysis showed a worse overall and disease-free survival for patients with NLR greater than five. Conclusions: A preoperative NLR of five or more is associated with greater perioperative morbidity and worse oncological outcomes in patients undergoing resection for elective stage II colon cancer.
Subject(s)
Aged , Female , Humans , Male , Colonic Neoplasms/blood , Lymphocytes , Neutrophils , Colonic Neoplasms/mortality , Colonic Neoplasms/surgery , Disease-Free Survival , Follow-Up Studies , Kaplan-Meier Estimate , Leukocyte Count , Multivariate Analysis , Neoplasm Staging , PrognosisABSTRACT
En los últimos años, la investigación traslacional (IT) se ha establecido como una prioridad en salud a nivel mundial. Esta revisión tiene por objetivo: (1) definir la IT y describir su naturaleza compleja; (2) identificar componentes de IT; (3) vincular IT a la toma de decisiones en políticas de salud; (4) reconocer algunos obstáculos y desafíos de IT asociados a la toma de decisiones en políticas de salud. Para ello se realizó una búsqueda sistemática en bases de datos y literatura gris seleccionada, que incluyan como palabras clave IT y políticas de salud, encontrándose 60 documentos. Los resultados indican una evolución del concepto de IT en el tiempo, incorporando recientemente la inherente complejidad que existe en la transferencia del conocimiento científico en salud. La literatura internacional muestra aplicaciones de la IT en diversos escenarios de investigación y práctica clínica. La aplicación de IT a salud pública y toma de decisiones en salud es aún incipiente pero necesaria y podría convertirse en una prioridad para políticas de salud en un país.
Recently, the translational research model (TR) has been established as a key feature in health worldwide. The objectives of this review are: (1) to define the TR and describe its complex nature; (2) to identify the components of the TR; (3) to link the TR to the decision-making process in health policies; (4) to recognize frequent obstacles and challenges of the association between the TR and the decision-making process in health policies. A systematic literature review was conducted in scientific databases and selected grey literature was done including TR and health policy as key words. We found 60 papers. Results show that the concept of TR and its theoretical formulation has evolved over time and has only recently incorporated the complexity that exists in the transference of scientific knowledge to health. International literature shows different applications of the TR in both research and clinical practice. The application of the TR to public health and health policy decision making is relatively new but necessary and could become a priority for health policies in the countries.