Custo-utilidade do tratamento primário não farmacológico do glaucoma de ângulo aberto / Cost-utility of primary non-pharmacological treatment of open-angle glaucoma

RESUMO Objetivo: Avaliar o impacto econômico de iniciar o tratamento do glaucoma primário de ângulo aberto com estratégias não farmacológicas nos centros de referência para o tratamento do glaucoma no Sistema Único de Saúde. Métodos: A população foi oriunda de uma coorte hipotética de pacientes aos 60 anos de idade, portadores de glaucoma primário de ângulo aberto inicial. A estratégia 1 se baseou apenas em uso de colírios. As estratégias 2 e 3 tiveram como tratamento inicial a trabeculoplastia seletiva a laser. Na estratégia 2, após a falência do laser, foi realizado o implante de dispositivo trabecular (iStent inject®), seguido de uso de colírios. A estratégia 3 iniciou-se com o tratamento medicamentoso logo após a falência do laser. O modelo desenvolvido foi o de Markov. Foi usada a razão de custo-utilidade incremental como medida de desfecho. Resultados: As estratégias 2 e 3 geraram ganho de qualidade de vida e foram dominantes em relação à estratégia 1, sendo mais efetivas e baratas. Porém a relação custo-efetividade da estratégia 2 sofreu um impacto significativo, de acordo com a idade de entrada no modelo. Conclusão: As estratégias não farmacológicas do glaucoma primário de ângulo aberto inicial foram custo-efetivas sob a perspectiva do Sistema Único de Saúde em um horizonte da expectativa de vida da população.

ABSTRACT Objective: To evaluate the economic impact of starting the treatment of primary open angle glaucoma with non-pharmacological strategies within the scope of reference centers for the treatment of glaucoma in the Unified Health System. Methods: The population of this study comes from a hypothetical cohort of patients aged 60 years with initial primary open angle glaucoma. The reference strategy (strategy 1) is based only on the use of eye drops, following the guidelines of the clinical protocol of the Brazilian Ministry of Health. Strategies 2 and 3 have the same initial treatment, with selective laser trabeculoplasty. In strategy 2, after laser failure, a trabecular device (iStent inject®) is implanted, followed by the use of eye drops as needed, and in strategy 3, it starts with the drug treatment right after the failure of the laser. The model developed for the cost-utility analysis was the Markov model. The incremental cost-utility ratio was used as an outcome measure. Results: Strategies 2 and 3 generated a gain in quality of life and were dominant over strategy 1, being at the same time more effective and less costly in relation to clinical treatment. The two non-pharmacological strategies (2 and 3) proved to be cost-effective; however, the cost-effectiveness of strategy 2 suffers a significant impact according to the age of entry into the model. Conclusion: It is concluded that the initial non-pharmacological treatment strategies of the initial primary open angle glaucoma are cost-effective from the perspective of the Unified Health System in a horizon of the life expectancy of the population.

The economic impact of providing dengue vaccination in the workplace in Brazil / O impacto econômico da vacinação contra dengue no local de trabalho no Brasil

Objective: To estimate the economic value of implementing a workplace dengue vaccination program from an employer perspective. Methods: The cost of a vaccination program was compared with the economic benefits in terms of reduced absenteeism and presenteeism in companies in Brazil. Input data were obtained from published literature and national databases. The time horizon was five years, including a 2-year vaccination program. Sensitivity analyses were performed to evaluate the impact of key parameters' uncertainty. Results: 846 cases were simulated among the employees over five years, accountable for 2,112 sick leave days and 7,120 sick days at work. Assuming a coverage rate of 30%, vaccination reduced the number of sick leave days and sick days at work by 17.5% over five years compared to no vaccination. Considering an employee vaccine copayment of 50%, the levels of remaining investment per dose administered for the employer in the retail sector ranged from US$ 17.99 to US$ 27.99, according to different vaccine price scenarios, and from US$ 6.10 to US$ 16.10 in the service sector. In the energy sector, vaccination was cost-saving in all price scenarios, ranging from a profit for the employer of US$ 21.14 to US$ 31.14. Results were most sensitive to the level of co-payment, overall time horizon of the analysis, dengue incidence, and employee contribution to operating income. Conclusions: Dengue contributes a significant proportion of absenteeism and presenteeism in private companies. Our analysis suggests that dengue vaccination in the workplace may be considered as a valuable investment and, in some cases, a cost-saving option for employers.

Objetivo: Estimar o valor econômico da implementação de um programa de vacinação contra a dengue no local de trabalho sob a perspectiva do empregador. Métodos: O custo de um programa de vacinação foi comparado com os benefícios econômicos em termos de redução do absenteísmo e do presenteísmo em empresas no Brasil. Os dados foram baseados na literatura publicada e em bases de dados nacionais. O horizonte temporal foi de cinco anos, incluindo um programa de vacinação de dois anos. Foram realizadas análises de sensibilidade para avaliar o impacto das incertezas de parâmetros-chave. Resultados: Oitocentos e quarenta e seis casos foram simulados entre os empregados em cinco anos, os quais foram responsáveis por 2.112 dias de licença médica e 7.120 dias com a doença no ambiente de trabalho. Assumindo uma taxa de cobertura de 30%, a vacinação reduziu o número de dias de licença médica devido à doença e os dias com a doença no ambiente de trabalho em 17,5% ao longo de cinco anos em comparação com a não realização da vacinação. Considerando um copagamento da vacinação pelos funcionários de 50%, os níveis de investimento remanescente por dose administrada para o empregador no setor varejista variaram de US$ 17,99 a US$ 27,99 de acordo com diferentes cenários de preços da vacina e de US$ 6,10 a US$ 16,10 no setor de serviços. No setor de energia, a vacinação resultou em economia de custos em todos os cenários de preços, que vão desde uma economia para o empregador de US$ 21,14 até US$ 31,14. Os resultados foram mais sensíveis ao nível de copagamento, horizonte de tempo global da análise, incidência de dengue e contribuição dos funcionários para a receita operacional. Conclusões: A dengue contribui com uma parcela significativa do absenteísmo e do presenteísmo em empresas privadas. Nossa análise sugere que a vacinação contra dengue no local de trabalhopode ser considerada um investimento valioso e, em alguns casos, uma opção que traz economia para os empregadores.

Custo-efetividade do afatinibe versus pemetrexede associado a cisplatina, erlotinibe e gefitinibe no tratamento de primeira linha de pacientes com câncer de pulmão não pequenas células localmente avançado ou metastático, com mutação do receptor do fator de crescimento epidermoide (EGFR+), na perspectiva do Sistema de Saúde Suplementar do Brasil / Cost-effectiveness of afatinib versus pemetrexed plus cisplatin, erlotinib and gefitinib as first line treatment in patients with locally advanced or metastatic epidermal growth factor receptor mutation (EFGR+) non-small cell lung cancer in the Brazilian private healthcare system

Objetivo: Comparar os custos e efetividade do afatinibe versus pemetrexede associado a cisplatina (PEM/CIS), erlotinibe e gefitinibe no tratamento de primeira linha de pacientes com câncer de pulmão não pequenas células (CPNPC) com mutação no receptor de fator de crescimento epidermoide (EGFR+) localmente avançado ou metastático, no Sistema de Saúde Suplementar brasileiro. Métodos: O modelo de Markov foi utilizado para estimar anos de vida livres de progressão (PFLY), anos de vida (LY), anos de vida ajustados pela qualidade (QALY) e desfechos clínicos por sete anos. Utilizaram-se dados de sobrevida, segurança e utilidade dos estudos LUX-Lung 1, 3 e 6 e LUCEOR. A eficácia comparativa versus gefitinibe e erlotinibe foi estimada utilizando modelos bayesianos de comparação indireta. A utilização dos recursos foi estimada por painel de especialistas, e custos diretos foram estimados utilizando-se bases de dados oficiais. Resultados: Afatinibe mostrou aumento da sobrevida livre de progressão (0,41 PFLY), sobrevida global (0,16 LY) e qualidade de vida (0,21 QALY) com custo incremental (R$ 8.549), resultando em razão de custo-efetividade incremental (RCEI) de R$ 20.639/PFLY. Comparado ao erlotinibe, o afatinibe mostrou aumento de 0,46 PFLY, 0,13 LY e 0,20 QALY, com menor custo (-R$ 21.327). Comparado ao gefitinibe, o afatinibe mostrou incrementos de 0,53 PFLY, 0,37 LY, 0,34 QALY, com custo incremental de R$ 24.890, resultando em RCEI de R$ 46.709/PFLY. Considerando-se três vezes o PIB per capita como limiar de custo-efetividade (R$ 86.628), o afatinibe é custo-efetivo versus PEM/CIS e gefitinibe e dominante quando comparado ao erlotinibe. Conclusão: Sugere-se que o afatinibe é uma opção custo-efetiva quando comparado ao PEM/CIS, erlotinibe e gefitinibe no tratamento de primeira linha de pacientes com CPNPC EGFR+.

Objective: To compare costs and effectiveness of afatinib versus pemetrexed plus cisplatin (PEM/ CIS), erlotinib and gefitinib, as first line treatment in patients with locally advanced or metastatic epidermal growth factor receptor mutation (EGFR+) non-small cell lung cancer (NSCLC) in the Brazilian Private Healthcare System. Methods: A Markov model was used to estimate 7year progression-free life years (PFLY), life years (LY), quality-adjusted life years (QALY) and clinical outcomes of afatinib. Partitioned survival, safety and utility data from the LUX-Lung 1, 3 and 6 and LUCEOR trials were used. Comparative effectiveness versus gefitinib and erlotinib was estimated using Bayesian indirect treatment comparison. Resource use was estimated by an expert panel and direct costs were estimated from official databases. Results: Compared with PEM/CIS, afatinib was associated with increased progression free survival (0.41 PFLY), increased overall survival (0.16 LY) and increased quality of life (0.21 QALY) with incremental cost (BRL 8,549), resulting in an incremental cost-effectiveness ratio (ICER) of BRL 20.639/PFLY. Compared to erlotinib, afatinib was associated with additional 0.46 PFLY, 0.13 LY and 0.20 QALYs with lower cost (- BRL 21,327). When compared to gefitinib, afatinib was associated with incremental 0.53 PFLY, 0.37 LY and 0.34 QALY and increased cost (BRL 24,890), resulting in an ICER of BRL 46,709/PFLY. Considering 3 PIB per capita as a threshold (BRL 86,628), afatinib is a cost-effective technology versus PEM/CIS and gefitinib and dominant when compared to erlotinib. Conclusion: Findings suggest that afatinib is a cost-effective option, when compared to PEM/CIS, erlotinib and gefitinib, as first line treatment in EGFR+ NSCLC patients.

Medical economics research on surgical management of hypertensive cerebral hemorrhage / 中华老年医学杂志

Objective To evaluate the effectiveness among computed tomography-guided aspiration.minimally invasive microsurgery and conventional craniotomy on patients with intracerebral hemorrhage and their quality of life separately.Then to study the cost-effectiveness of the 3 surgical procedures. Methods One hundred and five patients with intracerebral hemorrhages were randomized into 3 groups:conventional group,stereotactic group and key-hole group.Karnofsky Performance Status Scale was examined 3 months after operation,and the cost of hospitahzation was calculated separately,then the cost-effectiveness was compared using cost-utility analysis. Results Costs of 3 procedures were 9741 yuan,7957 yuan and 13256 yuan separately,and Karnofsky Performance Status Scale were 59.7,63.7 and 50.3 separately.When self-care case was achieved in all conventional group,the stereotactic group and key-hole group need to remedy 51 eases and 10 cases separately.and the total cost was 496819 yuan for stereotactic group and 79575 yuan for key-hole group. Conclusions Minimally invasive microsurgery is optimal treatment for intracerebral hemorrhage.

Comparación de costo-efectividad entre dos técnicas anestésicas: anestesia con sevofluorane-remifentanil frente a isofluorane-remifentanil / Cost-Effective Comparison Between Two Anesthesia Techniques: Sevofluorane-Remifentanyl vs Isofluorane-Remifentanyl

Nos encontramos en la era de la optimización de costos, por lo que es necesario realizar estudios farmacoeconómicos para identificar la costo- efectividad de los anestésicos actuales. Metodología: este estudio prospectivo, cegado al paciente, comparó los costos directos, los tiempos de recuperación y satisfacción de 45 pacientes que se asignaron aleatoriamente a dos grupos de anestesia balanceada (grupo sevofluoraneremifentanil n = 24 o grupo isofluoraneremifentanil n = 21) que iban a ser sometidos a cirugías de otorrinolaringología. Resultados: los tiempos de recuperación temprana (apertura ocular, respuesta a comandos, extubación, orientación y salida de sala) fueron menores en el grupo ISO y tuvieron diferencia estadísticamente significativa. Se encontraron datos variables en los costos de adquisición de los halogenados gastados, que fueron menores para el isofluorane, lo cual hacía también menos costosos los insumos anestésicos durante las cirugías; sin embargo, los costos en la sala de cirugía, en recuperación y sala de ambulatorios y los costos totales no mostraron diferencias significativas. La satisfacción fue similar entre los dos grupos. Conclusiones: una técnica basada en sevofluorane-remifentanil no es más costo-efectiva que utilizar isofluorane-remifentanil para pacientes ambulatorios sometidos a cirugías de otorrinolaringología.

We are in the of costs optimization era, reason why it is necessary to make pharmaceutical economics studies to identify the costeffectiveness of today's anesthetics. Methods: this prospective study, blinded to the patient, compared the direct costs, recovery times and satisfaction of 45 patients randomly assigned to two balanced anesthesia groups (sevofluoraneremifentanil group n = 24 or isofluoraneremifentanil group n = 21) submitted to otorhinolaringology surgical procedures. Results: the times of early recovery (ocular opening, answer to commandos, extubación, orientation and room leave) were smaller in ISO group and had statistically significant difference. Variable data was found in acquisition costs of halogenados gastados, lesser for isofluorane, which also made the anesthetic supplies less expensive during surgical procedures; nevertheless, costs in the delivery room, in recovery and ambulatory room, and the total costs did not show significant differences. Satisfaction was similar between both groups. Conclusions: a sevofluorane-remifentanil based technique is not more cost-effective than to use isofluoraneremifentanil for ambulartory patients submitted to otorhinolaringology surgical procedures.

Costbenefit analysis of large medical equipments in HIS / 医疗卫生装备

This paper introduces the costbenefit analysis of large medical equipments in HIS. Modern economic management of large medical equipments has been accomplished partly.

Design of the costbenefit analys is of large medical equipm ent in HIS / 医疗卫生装备

This paper introduces the design,function implementation of the costbenefit analysis of large medical equipment in HIS.The modern economic management of large medical equipment has been accomplished partly through this system.