ABSTRACT
To estimate the cost per quality-adjusted life-year (QALY) focusing on the length of time between trauma and surgery. METHODS: A retrospective cohort with systematic sampling was conducted among all the patients who were admitted to the study hospital through the Brazilian National Health System (SUS) over a three-year period. Two treatment strategies were compared: early treatment, if the patient was operated up to the fourth day; and late treatment, if this was done after the fourth day. The cost was the direct medical cost from the point of view of SUS, which was gathered from the management system, from the SUS table of procedures, medications and implant material costs (SIGTAP), to account for the costs associated with the hospital, medical fees and implants used. The outcome of usefulness was measured indirectly by means of EuroQOL-5D, which is an instrument used worldwide, and these measurements were transformed into usefulness by means of the standard rules of the Regional Planning and Development Center of Minas Gerais (CEDEPLAR) of 2013. RESULTS: The sample included 110 patients: 27 in the early group and 83 in the late group. The confounding variables of age, gender, anesthetic risk (ASA), fracture type and surgery type were controlled for. The samples were shown to be homogenous with regard to these variables. The cost per QALY of the early strategy was R$ 5,129.42 and the cost of the late strategy was R$ 8,444.50. CONCLUSION: The early strategy was highly favorable in relation to the late strategy in this study...
Estimar o custo por ano de vida ajustado por qualidade (QALY) com foco no tempo entre o trauma e a cirurgia. MÉTODOS: foi feita uma coorte retrospectiva com amostra sistemática com todos os pacientes internados no hospital do estudo pelo Sistema Único de Saúde (SUS) durante três anos. Compararam-se duas estratégias de tratamento, uma precoce, se o paciente fosse operado até o quarto dia, e outra tardia, se após o quarto dia. O custo foi o direto médico do ponto de vista do SUS, colhido diretamente do Sistema de Gerenciamento da Tabela de Procedimentos, Medicamentos e Custos de Materiais de Implantes (OPM) do SUS (Sigtap), para contagem dos custos associados ao hospital, aos honorários médicos e aos implantes usados, e o desfecho utilidade foi medido indiretamente por meio do EuroQOL-5D, instrumento mundialmente usado e transformado em utilidade pela normativa do Centro de Desenvolvimento e Planejamento Regional de Minas Gerais (Cedeplar) de 2013. RESULTADOS: a amostra contou com 110 pacientes, 27 no grupo precoce e 83 no tardio. Variáveis confundidoras foram controladas, idade, gênero, risco anestésico (ASA) e tipo de fratura e de cirurgia. As amostras se revelaram homogêneas quanto a essas variáveis. O custo por QALY da estratégia precoce foi de R$ 5.129,42 e da estratégia tardia, de R$ 8.444,50. CONCLUSÃO: a estratégia precoce demonstra dominância em relação à tardia neste estudo...
Subject(s)
Humans , Male , Female , Aged , Cost-Effectiveness Analysis , Health Evaluation , Hip FracturesABSTRACT
O presente trabalho foi realizado no período de 16 de novembro a 28 de dezembro de 2009, totalizando 42 dias. Foram utilizados 36 animais distribuídos em três tratamentos de 12 repetições cada, em delineamento inteiramente casualizado. Os tratamentos consistiram de TA =dieta sem inclusão de casca de soja (CS); TACS=dieta com inclusão de 50% de casca de soja e TCS=dieta com inclusão de 100% de casca de soja em substituição ao feno de alfafa. As dietas foram isonutritivas, formuladas para atender às necessidades da categoria correspondente, de acordo com o AEC (1987). Foram avaliados os dados de desempenho animal, as características de carcaça e a viabilidade econômica. Os resultados foram submetidos à analise de variância e as médias comparadas pelo teste de Tukey a 5% de significância, com auxílio do pacote estatístico SAS (2003). Houve diferença para o consumo alimentar e conversão alimentar, já que os animais alimentados com TCS consumiram menos ração que os do TA e apresentaram melhor conversão. Para as características de carcaça, não houve diferença entre os tratamentos, com exceção do peso de pele, que foi superior para os animais alimentados com a dieta TA. O índice de eficiência econômica demonstrou que a casca de soja pode substituir em 100% o feno de alfafa.
The experiment was conducted from November 16 to December 28, 2009, add up 42 days. 36 animals of 35 days old were utilized and assigned to three treatments of 12 repetitions each in experimental design completely randomized. The treatments were: TA=Soybean hulls without; TACS=inclusion soybean hulls 50% and TCS=inclusion soybean hulls 100% substitution of Alfalfa at diet. The diets were isonutritives, formulated by requirement AEC (1987). The avaluated parameters were: performance animal, characteristics carcass and analyze economical. Data were analized by analysis of variance and the average compared by Tukey test (P<0.05). Values differences were detected for average feed intake and feed conversion ratio, where rabbits to feeding diets with TCS had consumption lower that to TA and showed better conversion. For the carcass characteristics effects of inclusion of soybean hulls were no significant, with exception of weight epidermis had higger for animals fed with diet TA. The economical analysis of the results showed that the formulation with soybean hulls will be to substitute the alfafa until 100%.
ABSTRACT
Background: direct costs for treating Guillain-Barré Syndrome (GBS) represent a significant financial burden to public hospitals. Few studies compared the cost of plasma exchange (PE) treatment with human intravenous immunoglobulin (IVIg). Aim: to compare the cost of two therapies for GBS: IVIg and PE. Secondary objective was to evaluate compliance to IVIg prescription guidelines of the Pharmacy and Therapeutics Committee (PTC). Methods: a cross-sectional study included 25 patients with GBS admitted in a university affiliated hospital from June, 2003 through June, 2008. The costs of IVIg (N=20) and PE (N=5) were evaluated through the cost minimization method, considering direct medical costs yield by the management of the institution. Patients receiving treatments other than PE or IVIg were excluded. Data were collected by medical records review. Clinical endpoint was disability on discharge, established by the 7-point scale of Hughes. Compliance to the PTC guidelines was evaluated considering the dose and prescription regime of IVIg. Results: twenty-five participants, ranging from 2 to 70 years of age, were included. No difference occurred in any medical variables related to the treatment or in the main clinical outcome measured by the Hughes scale. The mean direct cost of PE treatment was US$ 6,059± 1,701 per patient, and the same expense for IVIg was US$ 18,344±12,259 (P= 0.035). Total inpatient cost was US$ 25,730± 18,714 in the PE group, and 34,768± 27,766 (P=0.530) in the IVIg group. Conclusion: in a university-based hospital, PE is less expensive than IVIg to treat GBS.
Introdução: os custos diretos do tratamento de Síndrome de Guillain-Barré (SGB) representam parcela significativa dos gastos dos hospitais públicos. Poucos estudos compararam os custos de imunoglobulina intravenosa(IGI) e plasmaferese (PE). Objetivos: comparar os custos de duas terapias para SGB: imunoglobulina intravenosa(IGI) e plasmaferese. Objetivo secundário foi avaliar a adesão à recomendação para uso de imunoglobulina intravenosa da Comissão de Medicamentos da instituição. Métodos: estudo transversal com análise econômica incluindo 25 pacientes com SGB admitidos em um hospital universitário de junho de 2003 a junho de 2008. O custo do uso de IGI (N=20) e plasmaferese (N=5) foi avaliado pelo método de custo-minimização, considerando custos diretos praticados na instituição. Excluíram-se pacientes que receberam outros tratamentos além dos estudados. Os dados foram coletados do prontuário hospitalar. Incapacidade na alta foi avaliada através da escala de sete pontos de Huges. Adesão às recomendações da Comissão de Medicamentos foi avaliada quanto à dose e regime de IGI prescritos. Resultados: incluíram-se 25 participantes, com idade entre 2 e 70 anos. As características clínicas basais foram semelhantes entre os grupos de tratamento, assim como a pontuação na escala de Huges na alta. O custo direto do por paciente foi de US$ 6,059± 1,701 com plasmaferese e de US$ 18,344±12,259 com IGI (P= 0,03). O custo total de internação foi US$ 25,730± 18,714 e US$ 34,768± 27,766 respectivamente ( P=0,53).Conclusão: plasmaferese tem menor custo que IGI no tratamento de pacientes com SGB em um hospital universitário do sul do Brasil.
Subject(s)
Humans , Male , Female , Immunoglobulins, Intravenous/therapeutic use , Plasmapheresis , Guillain-Barre Syndrome/therapy , Cost-Benefit Analysis/economics , Outcome and Process Assessment, Health Care/standards , Cross-Sectional StudiesABSTRACT
No presente trabalho que foi realizado na Fazenda Experimental Lageado, da Universidade Estadual Paulista em Botucatu, SP, objetivou-se avaliar os custos envolvidos na produção de silagem de grãos úmidos de milho, tendo como referência o processamento seco deste cereal, ambos cultivados em sistema de plantio direto. Para a avaliação foram determinados os custos envolvidos nas operações de máquinas agrícolas, insumos e na etapa de pós-colheita. Os resultados observados permitiram concluir que o custo por hectare para produção de silagem de grãos úmidos foi de R$1.398,06, sendo 8,8 por cento menor do que os custos para produção de milho seco (R$ 1.533,78).
This work was carried out at FCA-Botucatu/UNESP - São Paulo State University, with the aim to evaluate the costs involved in high moisture corn silage production, using the corn drying process as witness, both cultivated in no-tillage system. The costs involved in the operations of agricultural machines, inputs and post harvest phase were obtained for evaluation. The results allowed concluding that the cost per hectare for high moisture corn silage (US$ 607.85) was 8.8 percent smaller than the costs for dried corn (US$ 666.86).
ABSTRACT
A análise econômica é fundamental para a tomada de decisão no uso de fontes orgânicas de nutrientes. O objetivo do trabalho foi avaliar aspectos econômicos do uso de fontes orgânicas de nutrientes para auxiliar a tomada de decisão sobre o seu uso em diferentes condições de manejo do solo. Foi utilizado um experimento conduzido durante nove anos na Estação Experimental da Epagri de Campos Novos/SC. Os tratamentos consistiram da combinação de cinco sistemas de preparo (plantio direto, preparo reduzido, preparo convencional, preparo convencional com resíduos queimados e preparo convencional com resíduos retirados), combinados com quatro fontes de nutrientes (TES - testemunha, sem aplicação de nutrientes, AM - adubação mineral de acordo com a recomendação para cada cultura, EA - 5mg ha-1 de matéria úmida de cama de aves, ELB - 60m³ ha-1 de dejeto líquido de bovinos e; ELS - 40m³ ha-1 de dejeto líquido de suínos). Os atributos econômicos utilizados foram os custos variáveis (CV), a receita bruta (RB) e o custo da correção da fertilidade com calcário, P e K (CC), após nove anos de aplicação das fontes de nutrientes. A interpretação para cada combinação de fonte de nutriente e sistema de preparo do solo foi feita por meio de figuras triangulares e a área das mesmas com intervalo de confiança a 90 por cento de probabilidade. Concluiu-se que o desempenho econômico das fontes orgânicas de nutrientes foi dependente do sistema de preparo do solo, sendo que as fontes apresentaram melhor desempenho no sistema plantio direto. O esterco de aves e o esterco líquido de suínos foram as fontes que apresentaram melhor desempenho econômico. O esterco líquido de suínos e o esterco líquido de bovinos, mesmo apresentando áreas diferentes, foram as fontes que apresentaram menor variabilidade nos atributos econômicos avaliados, não havendo um atributo que se destaque dos demais. O custo da correção da fertilidade do solo com calcário, P e K, após nove anos de aplicação...
Economical analysis is important to make decision on the use of organic nutrient sources. The objective of this study was to elaborate an economical analysis of different nutrient sources to help farmers and technicians to make decision about the use of these sources at different soil management. The study was carried out at the Epagri Experimental Station of Campos Novos, using a long-term experiment. The treatments were a combination of five tillage systems (no-till; chisel plow; conventional tillage; conventional tillage with crop residues burned and conventional tillage with crop residues removed from the field), with four nutrient sources (TES=control, no fertilizer; AM=mineral fertilizer according with technical recommendation for each crop; EA=5mg ha-1 of moisture poultry litter; ELB=60m³ ha-1 of liquid cattle manure; and ELS=40m³ ha-1 of slurry pig manure). The economical attributes used were variable costs of production, total income, and the cost of the necessity of lime and fertilizers application to improve soil chemical condition after nine years of applying treatments. A model was used to quantify and analyse the effect of nutrient sources in economical aspects, for each nutrient source within each soil tillage. The outputs were triangular pictures and their areas with 90 percent confidence limits. It was concluded that economical aspect effects of the organic nutrient sources were dependent on tillage systems, and the better performance was in no-till system. EA and ELS showed better economical results. ELS and ELB, even showing different picture areas, were the sources that showed lesser variability in economical attribute evaluated, and did not have one highlight attribute among them. The use of cost of the necessity of lime and fertilizers application to improve soil chemical condition after nine years of applying treatments, showed important participation in nutrient source evaluation in respect to economical aspect.
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Com o objetivo de avaliar a rentabilidade da produção de leite no sistema de produção integração lavoura-pecuária, foi conduzido um experimento, no período de julho de 2004 a abril de 2005, em Castro, Paraná. O delineamento utilizado foi de blocos ao acaso com quatro tratamentos e três repetições, com os tratamentos correspondendo a diferentes níveis de suplementação. Os tratamentos utilizados foram: 1 - pastagem + 20 por cento de suplementação, com Dieta Total Misturada (DTM), suficiente para mantença e produção de 28 litros vaca-1dia-1; 2 - pastagem + 45 por cento de suplementação; 3 - pastagem + 65 por cento de suplementação; e 4 - pastagem + 100 por cento de suplementação. A área experimental utilizada foi de 32,40ha, com 22,4ha no inverno, implantada com o consórcio azevém anual (Lolium multiflorum L.) e aveia preta (Avena strigosa Schreb.), dividida em 12 piquetes. No verão foi utilizada área de 10,0ha, com Quicuio (Pennisetum clandestinum), dividida também em 12 piquetes. Em cada repetição, foram utilizados quatro animais "testers", sendo três vacas da raça HPB e uma da raça Jérsei. O sistema de pastejo adotado foi o de lotação contínua, com carga variável. Foram utilizados animais reguladores para controlar a altura do pasto, mantida em torno de 20cm. Foram avaliadas, duas vezes por semana, a produção individual de leite das vacas, e a cada duas semanas a percentagem de gordura, a percentagem de proteína e a contagem de células somáticas no leite. A análise econômica foi realizada utilizando a metodologia proposta pelo Sistema de Acompanhamento do Custo de Produção de Leite no Paraná - FAEP. O tratamento 1, com 20 por cento de suplementação, apresentou o melhor resultado econômico, com custo operacional total de R$ 0,4635 litro-1, e margem líquida de R$ 0,13 litro-1.
Aiming to evaluate the profitability of milk production under an integrated dairy-crop system, on experiment was carried out at a commercial farm, of Paraná State, from July 2004 up to April 2005. A completely randomized block design, with four treatments, corresponding to different supplementation levels, with three replicates was applied. Treatments were pastures supplemented with 20 percent, 45 percent, 65 percent and 100 percent of supplementation (total diet calculated to give maintenance and milk production of 28kg/cow per day). The experimental area contained 32.4 hectares, being 22.4 hectares used during winter, composed of a mixture of annual ryegrass (Lolium multiflorum L.) and black oat (Avena strigosa Schreb), divided into twelve paddocks. During summer an area of 10 hectares was used, with Kikuyo (Pennisetum clandestinum) also divided in 12 paddocks. Three Holstein and one Jersey cows were used in each experimental unit as testers animals. The grazing system was continuous, with variable stocking. Put-and-take animals were used to control ward height, maintained around 20cm. Individual milk production was evaluated twice a week and percentage of fat, protein and somatic cell count were evaluated weekly. The economic analysis was proceeded using the methodology proposed by the Milk Cost Follow Up System of Paraná State. During the evaluation period, treatment 1 with 20 percent of supplementation showed the best results, with a total operational cost of R$ 0.4635 liter-1 and net income of R$ 0.13 liter-1.
ABSTRACT
OBJECTIVES: The purpose of this study was to assess the complications, duration of admission, cost effectiveness, radiologic stabilization of the anterior cervical bone fusion in the treatment of cervical disc disease with and without plating. MATERIALS AND METHODS: Fifty-two surgically treated patients for cervical disc disease were reviewed. Group I consisted of consecutive treated patients with iliac auto-bone graft without instrumentation after anterior cervical discectomy. Group II consisted of consecutive treated patients with iliac autologous-bone graft with CASPER cervical plate fixations. Radiologic fusion was decided when loss of end plate boundary between graft bone and vertebral body and immobile, maintenance of the disc space were evident on simple dynamic plain films. The patients were discharged after the stabilization of cervical motion by films was of tained. These groups were analysed multiple variably with Mann-Whitney U-test. RESULTS: Group I consisted of 18 patients, group II consisted of 34 patients. Mean age was 49.0+/-8.1 years, mean duration of admission was 17.27+/-10.51 days, mean costs for treatment was 1,970,000+/-475,000 won. In group I, mean age was 47.7(34-60) years, 16 patients had undergo on one-level operation, 2-patients had undergo on two-level operation, mean duration of admission was 28.7+/-10.4 days, mean costs for treatment was 2,194,473+/-561,639 won. The periods of stabilization was 6.6+/-3.36 weeks on radiologic study. Mean periods of out patient follow up was 16.8(6-64) weeks after discharge. Mean period of radiologic follow up was 17.3(4-6) weeks after surgical operation. In group II, mean age was 49.7(37-62) years and 18 patients one-level operation, 14-patients had undergo on two-level operation and 2-patients three-level operation. Mean duration of admission was 11.24+/-3.29 days, mean costs for treatment was 1,850,823+/-389,372 won. The periods of stabilization was 5.88+/-7.07 weeks on radiologic study. Mean period of out patients follow up was 16.7(4-60) weeks after discharge. Mean period of radiologic follow up was 12.4(3-52) weeks after surgical operation. The duration of admission showed statistical significance in Group II but other items showed no significant difference between two groups. CONCLUSIONS: The more economic, early life return and effective method of cervical disc disease in our series were evident in patients who had undergone, iliac bone graft and plate fixations after anterior discectomy.