Analysis of catastrophic costs incurred by patients with multidrug-resistant tuberculosis in an outpatient clinic in the state of Rio de Janeiro

ABSTRACT Background: Multidrug-resistant tuberculosis (MDR-TB) is a serious global public health concern associated with social vulnerability. In Brazil, the Unified Health System (SUS, Portuguese) provides free diagnosis and treatment for MDR-TB; however, other expenses may still be incurred for patients and their families which, according to the World Health Organization (WHO), can be catastrophic when these costs surpass 20.0% of the annual household income. This study aimed to assess the extent of catastrophic costs related to the diagnostic and therapeutic aspects of MDR-TB among patients receiving care at an outpatient clinic in Rio de Janeiro. Methods: This prospective study used convenience sampling from July 2019 to June 2021. Data regarding direct and indirect costs were collected using a standardized questionnaire endorsed by the WHO. To analyze any impoverishment occurred from MDR-TB, a threshold established by the Brazilian Institute of Geography and Statistics for 2019 and 2020 of US$ 79,562 and US$ 94,5273, respectively, was applied. Descriptive statistics were used for data analysis, including mean; standard deviation; variation coefficient; median; and maximum, minimum, and interquartile ranges. Results: A total of 65 patients were interviewed. Among the participants, 73.8% experienced catastrophic costs, with indirect costs exerting the most significant impact (median: US$ 3,825.9), in contrast to direct costs (median: US$ 542.7). When comparing the periods before and after diagnosis, the prevalence of poverty increased from 12.0% to 28.0%. Conclusions: Despite the support from the SUS in Brazil, diagnostic and therapeutic cascades incur additional costs, exacerbating social vulnerability among patients with MDR-TB.

Gastrointestinal food allergy: Prevalence, characterization, and direct costs in a referral center in Bogotá / Alergia alimentaria gastrointestinal: prevalencia, caracterización y costos directos en un centro de remisión en Bogotá

Abstract Introduction: The prevalence and incidence of gastrointestinal food allergy has increased in recent years with high associated costs, but usually with a good prognosis; nonetheless, in Colombia, information is scarce. This study intends to describe demographic variables, symptomatology, clinical picture, nutritional status, management, and natural history of the disease, determine its prevalence in the Colombian pediatric population by age group, and describe its direct costs. Materials and methods: The study was conducted in three phases. In the first, we estimated the prevalence of the disease from the review of the RIPS and MIPRES databases between 2015 and 2019. Secondly, we checked the medical records selected per the inclusion and exclusion criteria for characterization and costs. Lastly, through a telephone survey, we asked about the current state of the disease and its resolution. Results: The estimated prevalence adjusted for underreporting was 0.04 % for the pediatric population and 0.148 % for those under five. The most frequent diagnoses were allergic proctocolitis (59.3 %) and secondary functional gastrointestinal disorders (13.9 %). The most frequent allergen was cow's milk protein. Early management is related to an excellent nutritional prognosis. Direct costs are mainly related to using formulas (92 %) and medical appointments (3.4 %); 89 % of parents consider that the food allergy will resolve over time. Conclusions: This retrospective study is the most extensive in Colombia, drawing local conclusions that may be compared with other countries.

Resumen Introducción: la prevalencia e incidencia de la alergia alimentaria gastrointestinal ha aumentado en los últimos años, con importantes costos asociados, pero usualmente de buen pronóstico; sin embargo, en Colombia la información es escasa. Los objetivos del presente estudio son describir variables demográficas, sintomatología, clínica, estado nutricional, manejo e historia natural de la enfermedad; conocer su prevalencia en la población pediátrica colombiana por grupo etario, y describir sus costos directos. Materiales y métodos: el estudio se desarrolló en 3 fases: en la primera, se estimó la prevalencia de la enfermedad a partir de la revisión de las bases RIPS y MIPRES de 2015 a 2019; en la segunda, se revisaron las historias clínicas seleccionadas por los criterios de inclusión y exclusión para caracterización y costos; y en la tercera, por medio de una encuesta telefónica se interrogó el estado actual de la enfermedad y su resolución. Resultados: la prevalencia estimada ajustada por subregistro fue de 0,04 % para la población pediátrica y de 0,148 % para los menores de 5 años. Los diagnósticos más frecuentes fueron proctocolitis alérgica (59,3 %) y trastornos gastrointestinales funcionales secundarios (13,9 %). El alérgeno más frecuente fue la proteína de leche de vaca. El manejo temprano está relacionado con buen pronóstico nutricional. Los costos directos se relacionan principalmente con el uso de fórmulas (92 %) y consultas médicas (3,4 %). El 89 % de los padres considera la resolución de la alergia a través del tiempo. Conclusiones: este es el estudio retrospectivo más grande en Colombia, lo que permite conclusiones locales que pueden ser comparadas con otros países.

Costos generados por la atención al paciente grave en unidades de cuidados intensivos / Costs generated by the care of the critically ill patient in intensive care units

Introducción: Las Unidades de Cuidados Intensivos brindan atención a pacientes con condiciones clínicas que ponen su vida en peligro o con potencialidad a ello. Por ende, se requiere de personal altamente especializado, equipamiento y medicamentos; lo cual genera altos gastos. Objetivo: Describir los costos de la atención al paciente crítico atendido en la Unidad de Cuidados Intensivos. Métodos: Se realizó un estudio de evaluación económica parcial de descripción de costos. El universo estuvo conformado por 455 pacientes, se seleccionó una muestra de 155 mediante un muestreo aleatorio simple. La recolección de los datos se realizó a través de los registros de costos del Departamento de Contabilidad y Estadística, historia clínica, tarjeta y ficha de costo. Resultados: Los costos diarios por paciente fueron de 656,76 CUP. El departamento de radiología fue el de mayores cargos (23069,88 CUP), el complementario más indicado fue el hemograma (883). Los catéteres de abordaje venoso profundo constituyeron el instrumental más empleado y generó un gasto total de 144,26 CUP. Los electrólitos y los antimicrobianos constituyeron los grupos medicamentosos que mayores gastos generaron (49133,95 y 24896,08 CUP, respectivamente). Las hemodiálisis generaron un gasto de 142441 CUP. Conclusiones: Los estudios imagenológicos y de laboratorio necesarios para el diagnóstico y seguimiento, así como el empleo de antimicrobianos, electrólitos y equipamiento y procederes para la atención al paciente grave presentan elevados costos(AU)

Introduction: Intensive Care Units provide care to patients with clinical conditions that put their lives in danger or with potential to it. Therefore, highly specialized personnel, equipment and medicines are required; which generates high expenses. Objective: Describe the costs of care for critical patients treated in the Intensive Care Unit. Methods: A partial economic evaluation study of cost description was conducted. The overall sample was made up of 455 patients; a sample of 155 was selected by a simple random sampling. Data collection was carried out through the cost records of the Department of Accounting and Statistics, medical histories, card and cost sheet. Results: Daily costs per patient were 656.76 CUP. The radiology department was the one with the highest charges (23069.88 CUP), the most indicated complementary test was the blood count (883). Deep vein catheters were the most used instruments and generated a total expenditure of 144.26 CUP. Electrolytes and antimicrobials were the drug groups that generated the highest costs (49133.95 and 24896.08 CUP, respectively). Hemodialysis generated an expense of 142 441 CUP. Conclusions: Imaging and laboratory studies necessary for diagnosis and follow-up, as well as the use of antimicrobials, electrolytes and equipment and procedures for the care of the critically ill patient present high costs(AU)

Impacto socioeconómico de pacientes asistidos en la policlínica de EPOC del Hospital Pasteur en 2018

Resumen: Introducción: La EPOC es una enfermedad respiratoria prevalente con un importante impacto socioeconómico a nivel mundial. Existe escasa bibliografía que cuantifique la repercusión económica de la EPOC en países latinoamericanos. Objetivos: Estimar el impacto socioeconómico de pacientes con diagnóstico espirométrico de EPOC asistidos en la Policlínica de EPOC del Hospital Pasteur de Montevideo entre el 1º de enero de 2018 y el 31 de diciembre de 2018, determinando los costos directos de su atención. Metodología: Estudio observacional, descriptivo y transversal. Se obtuvieron datos de características demográficas, severidad y costos directos derivados de la atención sanitaria revisando historias clínicas. Resultados: De los 84 pacientes vistos en 2018, 57 tuvieron confirmación espirométrica. Predominó el sexo masculino (64.9%). La edad promedio fue 67.3 ± 11.09 años. 78.8% tenía primaria completa como nivel educativo más avanzado. El tabaquismo estuvo presente en 98.2%. La comorbilidad más prevalente fue el alcoholismo (36.8%), seguido por la hipertensión arterial (35.1%) 45.6% se encontraba en la categoría GOLD B de severidad, seguida por GOLD D 43,8%. Se analizaron costos directos derivados de la atención sanitaria en 49 pacientes. El total fue USD 190.552,46, correspondiendo 15% a medicamentos (55% oxígenoterapia domiciliaria), 76% exacerbaciones (98% internaciones), 2% estudios paraclínicos y 7% salario médico. Se observó un incremento de costos a medida que aumentaba la categoría de severidad no estadísticamente significativa, probablemente debido al n pequeño. Conclusiones: La EPOC tiene una importante repercusión socioeconómica, principalmente determinada por los costos de las exacerbaciones.

Abstract: Introduction: COPD is a prevalent respiratory disease with an important socioeconomic impact worldwide. There is scarce bibliography regarding COPD´s economic impact in Latin American countries. Objectives. To estimate the socioeconomic impact of patients with a COPD spirometric diagnosis assisted at Hospital Pasteur´s COPD clinic in Montevideo between January 1st 2018 and December 31st 2018, determining the direct costs related to their attention. Methodology: Observational, descriptive and transversal study. Data concerning demographic characteristics, severity and direct costs derived from health care was obtained revising clinical records. Results: 57 out of the 84 patients seen in 2018 had spirometric confirmation. Male sex prevailed (64.9%). The average age was 67.3 ± 11.09 years. In 78.8% de most advanced education level achieved was primary school. Smoking was present in 98.2%. The most prevalent comorbidity was alcohol abuse (36.8%), followed by arterial hypertension (35.1%). 45.6% belonged to the severity category GOLD B, followed by GOLD D (43.8%). Direct costs were analyzed in 49 patients. The total cost was USD 190.552,46; 15% corresponded to medication (55% home oxygen therapy), 76% exacerbations (98% hospital admissions), 2% diagnostic and follow up studies and 7% doctors´ salary. We observed a tendency to an increase in costs when increasing the severity category which was not statistically significant, probably due to the low n. Conclusions: COPD has an important socioeconomic impact, determined mostly by the cost of exacerbations.

Resumo: Introdução: A DPOC é uma doença respiratória prevalente com significativo impacto socioeconômico em todo o mundo. Há pouca literatura que quantifique o impacto econômico da DPOC em países da América Latina. Metas. Estimar o impacto socioeconômico de pacientes com diagnóstico espirométrico de DPOC atendidos na Policlínica de DPOC do Hospital Pasteur em Montevidéu entre 1º de janeiro de 2018 e 31 de dezembro de 2018, determinando os custos diretos de seus cuidados. Metodologia: Estudo observacional, extenso e transversal. Dados sobre características demográficas, gravidade e custos diretos decorrentes da assistência à saúde foram obtidos por meio de revisão de prontuários. Resultados: Dos 84 pacientes atendidos em 2018, 57 tiveram confirmação espirométrica. O sexo masculino predominou (64,9%). A média de idade foi de 67,3 ± 11,09 anos. 78,8% tinham o ensino fundamental completo como nível educacional mais avançado. O tabagismo esteve presente em 98,2%. A comorbidade mais prevalente foi o alcoolismo (36,8%), seguido de hipertensão arterial (35,1%) 45,6% estava na categoria GOLD B de gravidade, seguida de GOLD D 43,8%. Custos diretos derivados de cuidados de saúde em 49 pacientes foram analisados. O total foi de US$ 190.552,46, 15% correspondendo a medicamentos (55% oxigenoterapia domiciliar), 76% exacerbações (98% internações), 2% estudos paraclínicos e 7% salário médico. Observou-se aumento nos custos à medida que a categoria de gravidade aumentou, não estatisticamente significativo, provavelmente devido ao pequeno n. Conclusões: A DPOC tem um impacto socioeconômico significativo, determinado principalmente pelos custos das exacerbações.

Custos diretos dos curativos de úlceras vasculogênicas realizados por uma unidade de tratamento integral de ferida / Direct costs corresponding to vasculogenic ulcer dressings performed in a comprehensive wound care unit / Costos directos de las curaciones de úlceras vasculogênicas realizadas en una unidad de tratamiento integral de heridas

RESUMO Objetivo: aferir os custos diretos médios de curativos de úlceras vasculogênicas realizados por profissionais de enfermagem em pacientes atendidos por uma Unidade de Tratamento Integral de Ferida. Método: Pesquisa quantitativa, exploratório-descritiva, conduzida numa Unidade de Tratamento Integral de Ferida, localizada em Vitória da Conquista, Bahia - Brasil, em março, agosto e setembro de 2020. Calcularam-se os custos multiplicando-se o tempo despendido (cronometrado) pelos profissionais pelo custo da mão de obra direta, somando-se aos custos dos insumos. Análise de dados com estatística descritiva. Resultados: O custo direto médio total foi de US$11.90 (DP±10.79) para os curativos ambulatoriais (n=42), US$7.22 (DP±8.69) para os domiciliares (n=22) e US$3.10 (DP±2.57) para os hospitalares (n=11), com expressiva contribuição dos custos com terapia tópica: US$9.82 (DP±10.55), US$5.60 (DP±8.43) e US$1.30 (DP±0.22) respectivamente. Conclusão: os resultados poderão subsidiar a revisão dos insumos requeridos para os curativos de úlceras vasculogênicas, notadamente, das terapias tópicas e materiais/soluções.

ABSTRACT Objective: to assess the mean direct costs corresponding to vasculogenic ulcer dressings performed by Nursing professionals on patients treated at a Comprehensive Wound Care Unit. Method: A quantitative and exploratory-descriptive research study, conducted in March, August and September 2020 at a Comprehensive Wound Care Unit located in Vitória da Conquista, Bahia, Brazil. The costs were calculated multiplying the time spent (timed) by the professionals by the cost of direct labor, adding the costs of the inputs. Data analysis was performed by means of descriptive statistics. Results: The total mean direct costs were as follows: US$ 11.90 (SD±10.79) for outpatient dressings (n=42), US$ 7.22 (SD±8.69) for home dressings (n=22) and US$ 3.10 (SD±2.57) for hospital dressings (n=11), with a significant contribution from the costs of topical therapies: US$ 9.82 (SD±10.55), US$ 5.60 (SD±8.43) and US$ 1.30 (SD±0.22), respectively. Conclusion: the results may support a review of the inputs required for vasculogenic ulcer dressings, notably, regarding topical therapies and materials/solutions.

Objetivo: medir los costos directos medios correspondientes a curaciones de úlceras vasculogénicas realizadas por profesionales de Enfermería en pacientes atendidos por una Unidad de Tratamiento Integral de Heridas. Método: investigación cuantitativa y exploratoria-descriptiva realizada en marzo, agosto y septiembre de 2020 en una Unidad de Tratamiento Integral de Heridas situada en Vitória da Conquista, Bahía, Brasil. Los costos se calcularon multiplicando el tiempo empleado (cronometrado) por los profesionales por el costo de la mano de obra directa, sumando los costos de los insumos. Los datos se analizaron por medio de estadística descriptiva. Resultados: El costo directo medio total fue de US$ 11,90 (DE±10,79) para las curaciones ambulatorias (n=42), US$ 7,22 (DE±8,69) para las domiciliarias (n=22) y US$ 3,10 (DE±2,57) para las hospitalarias (n=11), con una significativa contribución de los costos de las terapias tópicas: US$ 9,82 (DE±10,55), US$ 5,60 (DE±8,43) y US$ 1,30 (DE±0,22), respectivamente. Conclusión: los resultados pueden sustentar una revisión de los insumos necesarios para las curaciones de úlceras vasculogénicas, en particular, las terapias tópicas y los materiales/soluciones.

Economic impact of pharmaceutical interventions in a medium complexity Brazilian university hospital

Abstract Clinical pharmacists have been increasing their participation mainly through actions aimed at patient care, with international studies demonstrating favorable cost-benefit ratio from pharmacists interventions. However, there are few studies carried out in Brazil about the subject. This study aims to assess the economic impact of pharmaceutical interventions (PIs) in a hospital setting performed in October 2018. Each performed PI was registered and associated with the direct cost of drugs for economic impact analysis. A total of 185 PIs were evaluated, comprising 106 patients. The most intervened drugs were antibiotics, presenting the greatest economic impact, R$2,370. The total economic impact was R$2,578, mainly in the Pediatric Intensive Care Unit that represented R$1,701. Regarding the economic impact by PI as the "Suspension of drug without indication" saved R$1,360 while the "Inclusion of required drugs" cost R$807. It was estimated that the savings would be R$30,936 and, if PIs were performed at day zero, the savings would be R$79,728 per year. An average of 1.75 PI per patient was performed with an economic impact of R$14 per PI. Our results showed that clinical pharmacist's role in the evaluation of pharmacotherapy is important for patients' health and represents a positive economic impact.

Awareness about the concept of Activity Based Costing (ABC) among medical laboratory Professionals

Background: Medical laboratories are an integral and essential component of the healthcare system. Information about costing and resource management is of paramount importance for providing services at a reasonable price and without quality compromise. Awareness of a scientific method of cost accountingActivity Based Costing (ABC), may contribute significantly to enhance the laboratories capacity to manage its resources efficiently. Objective: This study was done to know the awareness of Activity based costing. Materials & Methods: A preformed validated questionnaire was sent to various laboratory professionals affiliated to private and teaching hospital laboratories. 121 responses were recorded, percentages of which were entered in EXCEL sheets, graphically represented and analysed. Results: Majority of our participants were from medium sized laboratories (40%), working in private sectors, using a combination of automated & semi-automated technologies & not being accredited by regulating bodies. Activity based costing was being implemented in only 14 labs, with more than 70% of respondents not having an adequate knowledge about the same. Inadequate training (44.6%), not being involved in costing (46.3%) and assumed practical difficulties in implementing (9.1%) were some of the reasons cited. Conclusion: Healthcare providers from the laboratory had limited awareness on costing methods like ABC. Efforts to implement and create awareness about the same if made can upscale quality, and sustainable service delivery in lab services at reasonable costs especially in developing country like ours.

Direct healthcare costs and their relationships with age at start of drug use and current pattern of use: a cross-sectional study

ABSTRACT BACKGROUND: It is well known that early start of drug use can lead users to psychosocial problems in adulthood, but its relationship with users' direct healthcare costs has not been well established OBJECTIVES: To estimate the direct healthcare costs of drug dependency treated at a community mental health service, and to ascertain whether early start of drug use and current drug use pattern may exert influences on these costs. DESIGN AND SETTING: Retrospective cross-sectional study conducted at a community mental health service in a municipality in the state of São Paulo, Brazil. METHODS: The relationships between direct healthcare costs from the perspective of the public healthcare system, age at start of drug use and drug use pattern were investigated in a sample of 105 individuals. A gamma-distribution generalized linear model was used to identify the cost drivers of direct costs. RESULTS: The mean monthly direct healthcare costs per capita for early-start drug users in 2020 were 1,181.31 Brazilian reais (BRL) (274.72 United State dollars (USD) according to purchasing power parity (PPP)) and 1,355.78 BRL (315.29 USD PPP) for late-start users. Early start of drug use predicted greater severity of cannabis use and use of multiple drugs. The highest direct costs were due to drug dependence combined with alcohol abuse, and due to late start of drug use. CONCLUSIONS: Preventive measures should be prioritized in public policies, in terms of strengthening protective factors before an early start of drug use.

Custos diretos da dor lombar em hospitais financiados pelo Sistema Único de Saúde / Direct costs of low back pain in hospitals financed by the Unified Health System

INTRODUÇÃO: A dor lombar é um sintoma altamente incapacitante, que leva a um impacto social negativo para as pessoas que experimentam o sintoma, e econômico para os cofres públicos de diversos países, com gastos excessivos e por vezes desnecessários com procedimentos não resolutivos. OBJETIVOS: Relatar o número de procedimentos clínicos e cirúrgicos e os custos diretos da dor lombar em hospitais financiados pelo Sistema Único de Saúde. MÉTODOS: Os dados sobre os procedimentos clínicos e cirúrgicos foram coletados no Sistema de Informações Hospitalares no website do DATASUS, no período entre 2013 e 2018. Realizou-se análise descritiva dos dados. RESULTADOS: nos seis anos analisados os procedimentos para tratamento da dor lombar custaram financeiramente R$ 24.427.238. Estes custos aumentaram de forma expressiva ao longo dos anos observados. Realizou-se 1.689 procedimentos cirúrgicos e cada um custou em média R$ 3.290. A região sudeste do país foi a que teve maior gasto financeiro para o tratamento do sintoma (R$ 12.442.930). CONCLUSÃO: O custo da dor lombar ao longo dos anos para o sistema público está aumentando rapidamente e provavelmente é impulsionado pelo aumento no número de cirurgias.

INTRODUCTION: Low back pain is a highly disabling symptom, which leads to a negative social impact for people who experience the symptom, and economic, for public coffers in several countries, with excessive and sometimes unnecessary expenses with non-resolving procedures. OBJECTIVES: To report the number of clinical and surgical procedures and the direct costs of low back pain in hospitals financed by the Unified Health System. METHODS: The data on clinical and surgical procedures were collected in the Hospital Information System on the DATASUS website between 2013 and 2018. A descriptive analysis of the data was carried. RESULTS: In the six years analyzed, the procedures for the treatment of low back pain cost R$ 24,427,238. These costs have increased significantly over the years observed. 1,689 surgical procedures were performed, and each cost an average of R$ 3,290. The southeastern region of the country was the one that had the greatest financial expenditure for the treatment of the symptom (R$ 12,442,930). CONCLUSION: The cost of low back pain over the years to the public system is increasing rapidly and is probably driven by the increase in the number of surgeries.

Costs of nursing procedures/interventions: an integrative literature review / Gastos de procedimientos/intervenciones de enfermería: revisión integrativa de la literatura / Custos de procedimentos/intervenções de enfermagem: revisão integrativa da literatura

ABSTRACT Objectives: to analyze the scientific production of nurses regarding the costs of procedures/interventions performed by nursing professionals. Methods: integrative literature review with a sample of 17 primary articles selected from the CINAHL, Scopus, EMBASE databases and the PubMed portal. Results: all studies were conducted in hospitals, with quantitative, exploratory-descriptive studies, considering the case study method, with the description of costs method adopted, and the number of Brazilian publications stood out (12; 70.58%). The calculation of direct costs was most common due to the absence/difficulty of accessing information in the studied hospitals. This made it impossible to obtain the indirect costs that would be necessary for the composition of the total cost. Conclusions: it was shown that studies about the cost of procedures/interventions are still scarce, often covering only the calculation of direct costs. Nurses need to develop studies on such costs using the same methodology in different contexts of health care.

RESUMEN Objetivos: analizar la producción científica de enfermeros sobre los gastos de procedimientos/intervenciones realizados por profesionales de enfermería. Métodos: revisión integrativa de la literatura con muestra de 17 artículos primarios seleccionados en las bases CINAHL, Scopus, EMBASE y en el portal PubMed. Resultados: todos los estudios han sido conducidos en instituciones hospitalarias, con estudios cuantitativos, exploratorio-descriptivos, en la modalidad estudio de caso, con la descripción del método de costeo adoptado, destacándose el número de publicaciones brasileñas (12; 70,58%). Prevaleció la apuración de los gastos directos debido a la ausencia/dificultad de acceso a informaciones, en los hospitales estudiados, que posibilitaran también la obtención de los gastos indirectos que serían necesarios para la composición del costo total. Conclusiones: se evidenció que la producción de estudios sobre costeo de procedimientos/intervenciones aún es escasa, abarcando, frecuentemente, apenas la apuración de los gastos directos. Se indica la necesidad de los enfermeros desarrollaran estudios sobre tales gastos adoptando la misma metodología en diferentes contextos de atención a la salud.

RESUMO Objetivos: analisar a produção científica de enfermeiros sobre os custos de procedimentos/intervenções realizados por profissionais de enfermagem. Métodos: revisão integrativa da literatura com amostra de 17 artigos primários selecionados nas bases CINAHL, Scopus, EMBASE e no portal PubMed. Resultados: todos os estudos foram conduzidos em instituições hospitalares, com estudos quantitativos, exploratório-descritivos, na modalidade estudo de caso, com a descrição do método de custeio adotado, destacando-se o número de publicações brasileiras (12; 70,58%). Prevaleceu a apuração dos custos diretos devido à ausência/dificuldade de acesso a informações, nos hospitais estudados, que possibilitassem também a obtenção dos custos indiretos que seriam necessários para a composição do custo total. Conclusões: evidenciouse que a produção de estudos sobre custeio de procedimentos/intervenções ainda é escassa, abrangendo, frequentemente, apenas a apuração dos custos diretos. Indica-se a necessidade de os enfermeiros desenvolverem estudos sobre tais custos adotando a mesma metodologia em diferentes contextos de atenção à saúde.

Cost effectiveness analysis in the management of stroke in a tertiary care hospital

Background: Stroke has a high economic impact on the society especially in a developing country like India. In India health insurance doesn抰 cover all people leading to out of pocket expenditure. The objective of the present study was to study the cost of illness and outcome of stroke in a tertiary care hospital.Methods: Direct medical and nonmedical costs were obtained after 28 days of follow-up. The outcome of the stroke was measured by modified Rankin scale (mRS).Results: The mean age of the patients was 65.38�.98 years. Majority of the patients suffered from ischemic stroke and belonged to lower middle socioeconomic group. The mean cost of stroke was INR 39819. There was improvement in the mRS score after 28 days following treatment of acute stroke.Conclusions:Direct medical costs forms major component of cost of stroke. Early management and hospital discharge can reduce the economic burden of stroke.

Costos económicos de la infección respiratoria aguda en un Municipio de Colombia / Economic costs of acute respiratory infection in a municipality of Colombia

RESUMEN Objetivo: Estimar los costos económicos de las infecciones respiratorias agudas (IRA) en el municipio de AquitaniaBoyacá, 2014. Métodos: Evaluación económica parcial, tipo descripción de costos desde la perspectiva del sistema de salud. Se utilizó la técnica de micro-costeo para estimar los costos asociados a las IRA en Aquitania-Boyacá. Los costos se discriminaron por los siguientes rubros: consultas, exámenes de laboratorio e imágenes, medicamentos, materiales e insumos y estancia hospitalaria. Se utilizaron medidas de tendencia central para resumir la información con sus respectivas medidas de dispersión. Los análisis estadísticos se realizaron en Microsoft Excel 2013®. Resultados: Los 1.576 pacientes, representaron 2.471 atenciones por IRA en la Empresa Social del Estado (ESE) Salud Aquitania, de las cuales el 15,6% fueron en el servicio de urgencias, 81,4% en consulta externa y 3% en el servicio de hospitalización de la ESE Salud Aquitania. El promedio de estancia hospitalaria fue de 2,5 días, (máximo de cinco días). El costo promedio de un paciente con IRA hospitalizado fue $759.437 (RIC$639.132-$879.742); para mujeres fue de $753.879 (RIC$548.862-$877.895) y en hombres de $764.397 (RIC$618.523-$910.271). El rubro que representó un mayor peso en el total del costo por caso hospitalizado fue la estancia hospitalaria, con el 64%. Conclusión: las IRA representan una elevada carga económica al municipio de Aquitania Boyacá. La carga económica para el sistema de salud de la atención de pacientes ambulatorios en Aquitania-Boyacá en 2014 fue de $78.9 millones de pesos y la relacionada con la hospitalización fue de $56.198.338 (IC95% $ 47.295.768 - $65.100.908).

ABSTRACT Objective: To estimate the economic costs related to Acute Respiratory Infections (ARI) in a Colombian municipality. Methods: A retrospective cost-of-illness study was conducted to estimate economic costs due to ARI in Aquitania-Boyacá. The micro-costing (bottom-up) technique was used to estimate the costs associated with ARI in the municipality of Aquitania-Boyacá. Costs were divided by the following items: consultations, laboratory and images, drugs, materials and supplies and the hospital stay. Measures of central tendency were used to summarize the information with their respective dispersion measures. Statistical analyzes were performed in Microsoft Excel 2013®. Results: The 1,576 patients accounted for 2,471 ARI in the Empresa Social del Estado (ESE) Salud Aquitania, of which 15.6% were in the emergency department, 81.4% in the outpatient department and 3% in the hospitalization service. The average length of stay was 2.5 days (maximum of 5 days). The mean cost of a patient with hospitalized ARI was $ 759,437 (ICR $639,132- $ 879,742); for women was $ 753,879 (ICR $548,862- $ 877,895) and for men $ 764,397 (ICR $618,523- $ 910,271). Length of stay was the largest share of total cost per case, with 64%. Conclusion: ARI represented a high economic burden to the municipality of Aquitania-Boyacá. The economic burden for the health care system of outpatient in the municipality in 2014 was $78,9 million pesos and that related to hospitalization was $ 56,198,338 (IC95% $ 47,295,768- $ 65,100,908).

Costes directos de atención médica del pie diabético en el segundo nivel de atención médica / Direct costs in the management of diabetic foot

Introducción: Una de las complicaciones frecuentes de la diabetes mellitus es el pie diabético; su manejo oportuno define el futuro funcional del paciente y disminuye el gasto en la atención de estos pacientes. Objetivo: Analizar los costos directos en la atención de pacientes con pie diabético con base en la escala de Wagner. Material y métodos: Estudio transversal en pacientes con pie diabético en el que se analizaron los costes directos de la atención médica; se evaluaron días de hospitalización, estudios de laboratorio e imagen, debridaciones quirúrgicas, amputaciones menores y amputaciones mayores. En todo momento se conservó el anonimato de los participantes. Resultados: Se incluyeron 68 pacientes con pie diabético. De estos, 22 se eliminaron por tener expedientes clínicos incompletos, quedando finalmente 46 pacientes. Treinta y tres (72%) eran hombres, con una edad promedio de 59 años. Se observó incremento de los costos promedio/totales en forma ascendente desde el Wagner 1 al Wagner 5. Los costos directos más altos de hospitalización se atribuyeron a los costes día/cama y a las debridaciones quirúrgicas. Conclusiones: El incremento del coste de atención es directamente proporcional a la escala de Wagner. Este estudio constituye un punto de partida hacia la cuantificación de la carga económica del pie diabético en instituciones de seguridad social. La atención médica en estos pacientes es menor en el I nivel comparada con el II nivel de atención. El diagnóstico precoz disminuiría los costes de la atención de estos pacientes.

Introduction: Diabetic foot is one of the common complications of diabetes mellitus, early management defines the functional future of the patient and reduces the cost in attention. Objective: To analyze the direct costs of patients diagnosed with diabetic foot based on Wagner Scale. Material and methods: Cross-sectional study, in patients with diabetic foot; direct costs of medical care were evaluated: days of hospitalization, laboratory and imaging tests, surgical debridations, minor and major amputations were evaluated. At all times the anonymity of the participants was preserved. Results: There were 68 patients with diabetic foot, of these 22 were removed for having incomplete medical records, being included 46 patients: 33(72%) men, mean age 59 years-old. Ascending increase in average and total costs was observed, from 1 to 5 Wagner Classification. Direct costs were higher in day hospitalization and debridations compared to others. Conclusions: This study is a starting point for the quantification of the economic burden of diabetic foot in Social Security Institutions. A guide based treatment for diabetic foot whould lower direct costs for these patients. Medical attention costs in these patients are less in I Level Medical Facility compared with II Level.

Direct Medical Costs in Children with Rotavirus and Non-rotavirus Diarrhea Admitted to a Pediatric Intensive Care Unit and High Dependency Unit in Delhi.

Objective: To estimate direct medical costs of diarrheal hospitalization of children <5 years admitted in pediatric intensive care unit (PICU) or high dependency unit (HDU). Methods: Analysis of medical records and hospital bills of 84 children during two time frames, 2005-08 and 2012-14. Results: Direct medical costs in PICU increased from INR 17,941 to INR 50,663 per child for rotavirus diarrhea and INR 11,614 to INR 27,106 for non-rotavirus diarrhea, and in HDU from approximately INR 5,800 to INR 10,500 per child for all-cause diarrhea between the two time frames. Conclusions: Costs of PICU and HDU care are high and should be included in cost-effectiveness analysis of vaccination.

Indirect and direct costs of treating patients with ankylosing spondylitis in the Brazilian public health system / Custos diretos e indiretos do tratamento de pacientes com espondilite anquilosante pelo sistema público de saúde brasileiro

ABSTRACT Introduction: Patients with Ankylosing Spondylitis (AS) require a team approach from multiple professionals, various treatment modalities for continuous periods of time, and can lead to the loss of labour capacity in a young population. So, it is necessary to measure its socio-economic impact. Objectives: To describe the use of public resources to treat AS in a tertiary hospital after the use of biological medications was approved for treating spondyloarthritis in the Health Public System, establishing approximate values for the direct and indirect costs of treating this illness in Brazil. Material and methods: 93 patients selected from the ambulatory spondyloarthritis clinic at the Hospital de Clínicas of the Federal University of Paraná between September 2011 and September 2012 had their direct costs indirect treatment costs estimation. Results: 70 patients (75.28%) were male and 23 (24.72%) female. The mean age was 43.95 years. The disease duration was calculated based on the age of diagnosis and the mean was 8.92 years (standard deviation: 7.32); 63.44% were using anti-TNF drugs. Comparing male and female patients the mean BASDAI was 4.64 and 5.49 while the mean BASFI was 5.03 and 6.35 respectively. Conclusions: The Brazilian public health system's spending related to ankylosing spondylitis has increased in recent years. An important part of these costs is due to the introduction of new, more expensive health technologies, as in the case of nuclear magnetic resonance and, mainly, the incorporation of anti-TNF therapy into the therapeutic arsenal. The mean annual direct and indirect cost to the Brazilian public health system to treat a patient with ankylosing spondylitis, according to our findings, is US$ 23,183.56.

RESUMO Introdução: Os pacientes com espondilite anquilosante (EA) exigem uma abordagem de equipe com vários profissionais e várias modalidades de tratamento, continuamente; além disso, a doença pode levar à perda da capacidade de trabalho em uma população jovem, de modo que é necessário medir o seu impacto socioeconômico. Objetivos: Descrever o uso de recursos públicos para o tratamento da EA em um hospital terciário após o uso dos fármacos biológicos ter sido aprovado para o tratamento das espondiloartrites pelo Sistema Público de Saúde e estabelecer valores aproximados para os custos diretos e indiretos do tratamento dessa doença no Brasil. Material e métodos: Foram estimados os custos de tratamento diretos e indiretos de 93 pacientes com EA do ambulatório de espondiloartrite do Hospital de Clínicas da Universidade Federal do Paraná, entre setembro de 2011 e setembro 2012. Resultados: Dos pacientes, 70 (75,28%) eram do sexo masculino e 23 (24,72%) do feminino. A idade média foi de 43,95 anos. A duração da doença foi calculada com base na idade do diagnóstico e a média foi de 8,92 anos (desvio padrão: 7,32); 63,44% dos indivíduos usavam fármacos anti-TNF. Na comparação dos pacientes dos sexos masculino e feminino, a média no Bath Ankylosing Spondylitis Disease Activity Index (Basdai) foi de 4,64 e 5,49, enquanto a média no Bath Ankylosing Spondylitis Functional Index (Basfi) foi de 5,03 e 6,35, respectivamente. Conclusões: Os gastos do sistema público de saúde brasileiro relacionados com a espondilite anquilosante aumentaram nos últimos anos. Uma parte importante desses custos deve-se à introdução das novas tecnologias de saúde, mais dispendiosas, como no caso da ressonância nuclear magnética e, principalmente, da incorporação da terapia anti-TNF ao arsenal terapêutico. O custo médio anual direto e indireto do sistema público de saúde brasileiro para tratar de um paciente com espondilite anquilosante, de acordo com os resultados deste estudo, é de US$ 23.183,56.

Costos directos e indirectos del diagnóstico y tratamiento de reclusos con sífilis / Direct and indirect costs of the diagnosis and treatment of prisoners with syphilis

Se realizó un estudio de descripción de costos en el Centro Penitenciario "Mar Verde" de la provincia de Santiago de Cuba, desde enero del 2008 hasta diciembre del 2009, con vistas a calcular los costos directos e indirectos pertinentes para el diagnóstico y tratamiento de pacientes infectados por sífilis, para lo cual se compararon los resultados antes y después de efectuar una intervención educativa en la población de penados, por un grupo de promotores seleccionados y preparados en la prevención de infecciones de transmisión sexual. El impacto de la intervención se midió por medio de la disminución del número de afectados con sífilis. Finalmente, después de la actividad educativa, la incidencia de la enfermedad decreció en una tasa de 1,1 por cada 100 habitantes y los costos del tratamiento antiinfeccioso de los reclusos disminuyeron en $ 1 344,48, para obtener un beneficio económico de 1 513,04 pesos cubanos.

A study of costs description was carried out in "Mar Verde" Prison in Santiago de Cuba, from January, 2008 to December, 2009, with the objective of calculating the direct and indirect pertinent costs for the diagnosis and treatment of patients infected by syphilis, for which the results were compared before and after developing an educational intervention in the prisoners population, by a group of selected and prepared promoters in the prevention of sexual transmission infections. The impact of the intervention was measured by means of a decrease in the number the affected prisoners with syphilis. Finally, after the educational activity, the incidence of the disease fell at a rate of 1,1 per 100 inhabitants and the costs of the treatment against infection of the prisoners decreased in $1 344,48, to obtain an economic benefit of 1 513,04 Cuban pesos.

Multicenter Survey on the Economic Burden of Pediatric Allergic Rhinitis / 소아알레르기및호흡기학회지

PURPOSE: The prevalence of allergic rhinitis is rapidly increasing and results in relatively high socio-economic burden on their family and community. However, studies on the economic burden of pediatric allergic rhinitis in Korea are limited. Therefore, we conducted this study to investigate the impact of pediatric allergic rhinitis on economic burden. METHODS: Two hundred sixty two children with allergic rhinitis were enrolled in 6 secondary or tertiary medical centers in Seoul from July to September, 2008. We collected data of the economic burden of allergic rhinitis (direct medical costs, direct nonmedical costs, and indirect costs) by face to face questionnaire survey. We compared the economic burden according to the severity and the duration of allergic rhinitis. RESULTS: The mean age of subjects was 6.54 years, and male were 174 (66.4%). Direct medical costs (10,000 Korean Won/yr) were 177.75, and direct nonmedical costs were 57.92. Although, there was no statistical significance, direct medical costs showed increasing trends in severe allergic rhinitis.(P=0.053) In addition, direct medical costs were positively correlated with duration of allergic rhinitis.(R=0.195, P=0.002). About 17% of the parents who care the allergic rhinitis children experienced the work absence due to their child's illness. CONCLUSION: The economic burdens of allergic rhinitis were positively correlated with the severity and duration of illness. Particularly costs for alternative medicine including oriental medicine were related with severity and duration allergic rhinitis. Therefore, special efforts for education with evidence based treatment strategy are necessary to decrease the economic burden of allergic rhinitis.

Análisis comparativo de costos directos y funcionamiento global en personas afectadas por trastorno bipolar I y II, en tratamiento ambulatorio / Comparative Analysis for Direct Costs and Global Functions in Persons Affected By Bipolar Disorders I and II in Outpatient Treatment

Objetivo: Evaluar los costos directos, el nivel de funcionamiento y la tasa de empleo reportada en una muestra aleatoria de personas con trastorno bipolar (TB) I y II que se atienden en forma ambulatoria. Métodos: Se analizaron y compararon los costos directos de los tratamientos ambulatorios de 165 pacientes con diagnóstico de trastorno bipolar tipo I y II (el costo mensual del tratamiento farmacológico, el número de consultas mensuales, el número de internaciones y días de internación). Se estimó el funcionamiento global y se consignó la condición laboral. Resultados: El 51,5% (n=85) de los pacientes presentaba diagnóstico de TB tipo I y 48,5% (n=80) de TB tipo II. El 40,6% de los pacientes se encontraba desocupado; el puntaje de GAF fue 73 ± 12,59. Los costos mensuales del tratamiento farmacológico fueron de $480 ± $350,4 por paciente sin diferencia entre los TB. Un mayor porcentaje de pacientes con TB I había tenido internaciones y recibía antipsicóticos, mientras que un mayor porcentaje de pacientes con TB II recibía antidepresivos y asistía al psicólogo. Discusión: Los pacientes con diagnóstico de TB I y TB II deben afrontar tratamientos farmacológicos que implican un costo promedio equivalente a un cuarto del ingreso mínimo en nuestro país, independientemente del tipo de trastorno bipolar que padezcan. Ambos grupos de pacientes presentaban una elevada tasa de desempleo y puntajes de funcionamiento global relativamente bajos.

Objective: To evaluate the direct costs, the functional level and the employment rate reported for a random sample of people with Bipolar Disorders (BD) I and II that are cared for as outpatients. Methods: The direct costs of outpatient treatment for 165 patients diagnosed with types I and II bipolar disorders were compared and analyzed (the monthly cost of pharmacological treatments, the number of consultations per month, the number of hospitalizations and the days spent in hospital). Global functioning was estimated and their employment was recorded. Results: 51,5% (N=85) of the patients had been diagnosed with type I BD and 48.5% (N=80) with BD type II. 40,6% of the patients were unemployed; the GAF score was 73 ± 12,59. Monthly costs of pharmacological treatment were $480 ± $350,4 per patient, with no difference between the type of BD. A larger percentage of type I BD patients had been hospitalized and received anti-psychotic drugs, whereas a greater percentage of BD II patients received anti-depressants and went to a psychologist. Discussion: Patients diagnosed with BDI and BD II must face pharmacological treatments that imply an average cost equal to one quarter of the minimum income in our country, independent of the type of bipolar disorder they suffer. Both groups of patients presented a high level of unemployment and relatively low global functioning scores.

The Financial Burden of Asthma: A Nationwide Comprehensive Survey Conducted in the Republic of Korea

PURPOSE: Asthma-related morbidity and mortality are increasing, and the financial burden imposed by this condition will substantially increase. Nevertheless, little information is available regarding the nature and magnitude of the burden due to asthma at the national level. This study was conducted to characterize the financial burden imposed by asthma in the Republic of Korea at the national level. METHODS: The overall prevalence of asthma and the costs of related medical services were determined using data from the National Health Insurance Corporation, which is responsible for the National Health Insurance scheme. Indirect costs, including expenditures on complementary and alternative medicines, and the economic impact of an impaired quality of life (intangible costs) were estimated by surveying 660 asthmatics, and these estimates were transformed to the national level using the prevalence of asthma. RESULTS: The prevalence of asthma and total costs related to the disease in 2004 were 4.19% and $2.04 billion, respectively. Direct costs and indirect costs contributed equally to total costs (46.9% and 53.1%, respectively). However, when intangible costs were included, total costs rose to $4.11 billion, which was equivalent to 0.44% of the national gross domestic product in 2004. CONCLUSIONS: The results provide evidence that asthma is a major health cost factor in the Republic of Korea and that intangible costs associated with asthma are significant cost drivers.

Socioeconomic Costs of Overweight and Obesity in Korean Adults

This study was conducted to estimate the socioeconomic costs of overweight and obesity in a sample of Korean adults aged 20 yr and older in 2005. The socioeconomic costs of overweight and obesity include direct costs (inpatient care, outpatient care and medication) and indirect costs (loss of productivity due to premature deaths and inpatient care, time costs, traffic costs and nursing fees). Hypertension, diabetes mellitus, dyslipidemia, ischemic heart disease, stroke, colon cancer and osteoarthritis were selected as obesity-related diseases. The population attributable fraction (PAF) of obesity was calculated from national representative data of Korea such as the National Health Insurance Corporation (NHIC) cohort data and the 2005 Korea National Health and Nutrition Examination Survey (KNHANES) data. Direct costs of overweight and obesity were estimated at approximately U$1,081 million equivalent (men: U$497 million, women: U$584 million) and indirect costs were estimated at approximately U$706 million (men: U$527 million, women: U$178 million). The estimated total socioeconomic costs of overweight and obesity were approximately U$1,787 million (men: U$1,081 million, women: U$706 million). These total costs represented about 0.22% of the gross domestic product (GDP) and 3.7% of the national health care expenditures in 2005. We found the socioeconomic costs of overweight and obesity in Korean adults aged 20 yr and older are substantial. In order to control the socioeconomic burden attributable to overweight and obesity, effective national strategies for prevention and management of obesity should be established and implemented.