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ABSTRACT Objective. The rational use of medicines offers a cost-saving strategy to maximize therapeutic outcomes for developing and developed countries. The aim of this study was to evaluate the rational use of medicines for selected noncommunicable diseases (NCDs) at three pharmacies at public hospitals in Jamaica using the World Health Organization's (WHO's) prescribing indicators. Methods. In this retrospective cross-sectional study, prescriptions for adult outpatients containing at least one medicine for cardiovascular disease, diabetes, cancer, chronic obstructive pulmonary disease or asthma that were filled between January and July 2019 were reviewed using WHO's prescribing indicators for the rational use of medicines. Data were analyzed and expressed as descriptive and inferential statistics. For all analyses conducted, significance was determined at P < 0.05. Results. A total of 1 500 prescriptions covering 5 979 medicines were reviewed; prescriptions were mostly written for female patients aged 42-60 years. Polypharmacy was observed in 35.6% (534) of prescriptions, and there was an average of 4 medicines per prescription, with a maximum of 17. Most of the prescriptions at each site were filled, with the main reason for not dispensing a medicine being that it was out of stock. Generic prescribing was high for all sites, accounting for more than 95% (5 722) of prescribed medicines. There was full compliance with prescribing according to the WHO Model List of Essential Medicines at two of the sites, but it was just off the target at Site 1, by 1.4%. Conclusions. The WHO guidelines for the rational use of medicines were followed with respect to the proportion of medicines prescribed from the WHO Model List and the proportion of antibiotics prescribed. The number of medicines per prescription and the proportion of medicines prescribed by generic name did not meet the WHO criteria. However, prescribing was aligned with treatment guidelines for the selected NCDs.
RESUMEN Objetivo. El uso racional de los medicamentos proporciona una estrategia de ahorro de costos para maximizar los resultados terapéuticos tanto en los países en desarrollo como en los países desarrollados. El objetivo de este estudio fue evaluar el uso racional de medicamentos para algunas enfermedades no transmisibles (ENT) seleccionadas en tres farmacias de hospitales públicos de Jamaica, usando los indicadores de prescripción de la Organización Mundial de la Salud (OMS). Métodos. En este estudio transversal retrospectivo se examinaron las prescripciones realizadas a pacientes ambulatorios adultos que incluían al menos un medicamento para enfermedades cardiovasculares, diabetes, cáncer, enfermedad pulmonar obstructiva crónica o asma, dispensadas entre enero y julio del 2019, utilizando los indicadores de prescripción para el uso racional de medicamentos de la OMS. Los datos se analizaron y expresaron mediante estadística descriptiva e inferencial. Para todos los análisis realizados se estableció un nivel de significación de p <0,05. Resultados. Se examinó un total de 1 500 prescripciones que incluían 5 979 medicamentos; la mayor parte de ellas correspondían a pacientes de sexo femenino de 42 a 60 años. Se observó que había polimedicación en el 35,6% (534) de las prescripciones, con un promedio de 4 y un máximo de 17 medicamentos por receta. En todos los centros se dispensó la mayor parte de los medicamentos prescritos, y el motivo principal para no hacerlo fue la falta de existencias del medicamento en cuestión. La prescripción de genéricos fue elevada en todos los centros y supuso más del 95% (5 722) de los medicamentos prescritos. En dos centros la prescripción se realizó en su totalidad de acuerdo con la Lista Modelo de Medicamentos Esenciales de la OMS, pero en el centro 1 no se alcanzó el objetivo por un 1,4%. Conclusiones. Se siguieron las directrices de la OMS para el uso racional de medicamentos en cuanto a la proporción de medicamentos prescritos de la Lista Modelo de la OMS y la proporción de antibióticos prescritos. El número de medicamentos por receta y la proporción de medicamentos prescritos mediante su nombre genérico no cumplieron con los criterios de la OMS. Sin embargo, las prescripciones estaban en consonancia con las directrices de tratamiento de las enfermedades no transmisibles seleccionadas.
RESUMO Objetivo. O uso racional de medicamentos é uma estratégia de contenção de custos para maximizar os resultados terapêuticos em países desenvolvidos e em desenvolvimento. O objetivo deste estudo foi avaliar o uso racional de medicamentos para algumas doenças não transmissíveis selecionadas em três farmácias de hospitais públicos na Jamaica a partir dos indicadores de prescrição preconizados pela Organização Mundial da Saúde (OMS). Métodos. Estudo transversal retrospectivo que avaliou receitas médicas de pacientes ambulatoriais adultos contendo pelo menos um medicamento prescrito para doença cardiovascular, diabetes, câncer, doença pulmonar obstrutiva crônica ou asma e dispensadas entre janeiro e julho de 2019. A avaliação foi realizada a partir dos indicadores de prescrição preconizados pela OMS para o uso racional de medicamentos. Os dados obtidos foram analisados por meio de estatísticas descritivas e inferenciais. O nível de significância de p <0,05 foi adotado em todas as análises. Resultados. Ao todo, foram analisadas 1 500 receitas médicas compreendendo 5 979 medicamentos. Em sua maioria, as receitas foram prescritas para pacientes do sexo feminino com idades entre 42 e 60 anos. A polifarmácia foi observada em 35,6% (534) das receitas; em média, foram prescritos 4 medicamentos, até um máximo de 17. As farmácias estudadas dispensaram a maior parte dos medicamentos receitados. O principal motivo para não fornecer algum medicamento foi o desabastecimento. O percentual de medicamentos genéricos foi alto em todos os locais, representando mais de 95% (5 722) do volume receitado. Houve plena observância da Lista Modelo de Medicamentos Essenciais da OMS nas receitas analisadas em dois dos locais estudos, e observância quase completa (diferença de 1,4%) no local 1. Conclusões. As diretrizes da OMS de uso racional de medicamentos foram cumpridas no que se refere ao percentual de medicamentos receitados de acordo com a Lista Modelo da OMS e o percentual de antibióticos receitados. Os critérios da OMS não foram cumpridos quanto ao número de medicamentos por receita e ao percentual receitado usando o nome genérico. Porém, os medicamentos foram receitados de acordo com as diretrizes terapêuticas para as doenças não transmissíveis selecionadas.
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Background: The comparison of triclosan-coated sutures (TCS) was made with conventional nonantimicrobial-coated sutures (NCS) to reduce surgical site infection (SSI). This study demonstrates the efficacy and economic outcome of TCS versus NCS for SSIs in mastectomy in India. Methods: In this retrospective analysis, 100 patients were included for both conditions桾CS and NCS梖rom a private and public hospital in India. A systematic literature search of available evidence for both SSI incidences and TCS efficacy data in India were gathered. We collected cost data from a private and public hospital, respectively, for mastectomy in India. The cost-effectiveness of TCS in comparison with the conventional NCS was calculated using a decision-tree deterministic model. We performed a one-way sensitivity analysis to compare TCS with NCS. Results: Cost savings with the use of TCS increased with an increase in SSI incidence and an increase in efficacy for mastectomies in both public and private hospitals. We found a base cost saving of Indian rupees (INR) 27,299 at a private hospital and INR 2,958 at a public hospital for mastectomies. The incremental cost of TCS suture was 0.01% in a private hospital whereas 0.17% in a public hospital. Conclusion: The use of TCS resulted in reduced SSI incidence and cost savings for mastectomy in India.
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@#Introduction: Untreated iron deficiency (ID) can lead to severe anaemia, requiring blood transfusion, or increased mortality risk. Globally intravenous (IV) iron is increasingly recognised as a recommended option for patients. This study aims to evaluate the budget impact associated with introducing a new intravenous (IV) iron, ferric derisomaltose (Monofer® [IIM]) as one of the treatment options for the management of ID in the Ministry of Health Malaysia (MOHM) setting. Methods: A 5-year budget impact model was developed from 2020 to 2024 for patients with ID that require a high iron dose (≥500 mg), using the perspective of MOHM. The model was built with four external medical specialists, each with experience and deep knowledge of ID management, to support estimations on the future development of iron use in Malaysia. Results: Compared to the current market mix with the existing IV iron products (i.e., iron sucrose and iron dextran), a cost-saving of MYR 53,910 could be achieved with the introduction of IIM in 2020. The uptake of IIM into MOHM over five years is estimated to lead to an overall budget saving of MYR 11,837,524 over a 5-year time horizon. Conclusion: The use of IIM in place of the current IV iron products in MOHM resulted in a significant cost saving by reducing the number of visits required to achieve the targeted iron dose and the shorter IV infusion time with IIM.
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Resumen: Objetivo: Identificar y describir los beneficios en ahorro logrado y tiempo diferido de duración por teleconsulta de dermatología, en pacientes atendidos en Guerrero Negro, Baja California Sur. Materiales y métodos: Estudio observacional de costos unitarios. Se revisaron 58 expedientes de pacientes atendidos en la teleconsulta de dermatología en Guerrero Negro. Se analizaron variables demográficas, motivo de atención, unidad de referencia y los indicadores de ahorro logrado y tiempo de espera. Este estudio fue clasificado sin riesgo y se autorizó por el comité de ética e investigación. Resultados: El 81.6% fueron mujeres, predominó el grupo de edad de 31 a 50 años en el 29.3% de los casos, de acuerdo a la ocupación, predominaron las amas de casa en un 24.1%, el principal diagnóstico fue la dermatosis, el 50% de los casos pertenecían a la Unidad de Medicina familiar número 35. El tiempo real para obtener una teleconsulta versus consulta presencial fue de 638.50 + 879.05 versus 1,165.71+ 671.69 horas (p=0.000; IC 95% 0.000 - 0.050). Se comparó el costo en pesos mexicanos del traslado de la teleconsulta versus consulta presencial $302.08 ± 695.62 versus $5,014±$5,377.28 (p=0.003 IC 95% 0.000 - 0.050). Conclusiones: En este trabajo se muestra que el uso de la tecnología de la información y comunicación son útiles al servicio de la salud. Existe beneficio en los indicadores que se midieron: tiempo diferido de la consulta al obtener una consulta en máximo 10 días, al comparar de 45 a 60 días para una atención presencial, además del ahorro logrado en los costos unitarios al tener un gasto máximo de $302.00 pesos por concepto de traslado de las unidades periféricas a Guerrero Negro, comparado con $5,014.00 necesarios para acudir a la consulta presencial.
Abstract: Objective: Identify and describe the benefits in savings achieved and deferred duration of dermatology teleconsultation in patients treated in Guerrero Negro, Baja California Sur. Materials and methods: Observational study of unit costs. Fifty-eight files of patients treated at the dermatology teleconsultation in Guerrero Negro were reviewed. Demographic variables, reason for care, unit of reference, and indicators of savings achieved and waiting time were analyzed. This study was classified without risk and was authorized by the ethics and research committee. Results: 81.6% were women, the age group of 31 to 50 years prevailed in 29.3% of cases, according to occupation, housewives predominated in 24.1%, the main diagnosis was dermatosis, 50% of the cases belonged to Family Medicine Unit number 35. The real time to obtain a tele consultation versus face-to-face consultation was 638.50 + 879.05 versus 1.165.71 + 671.69 hours (p = 0.000; 95% CI 0.000 - 0.050). The costin Mexican pesos of the transfer of teleconsultation versus face-to-face consultation was $ 302.08 ± 695.62 versus $ 5,014 ± $ 5,377.28 (p = 0.003 95% CI 0.000 - 0.050). Conclusions: This work shows that the use of information and communication technology is useful in the service of health. There is benefit in the indicators that were measured: deferred time of the consultation when obtaining a consultation in a maximum of 10 days, when comparing 45 to 60 days for face-to-face care, in addition to the savings achieved in unit costs by having a maximum expenditure of $302.00 pesos for the transfer of peripheral units to Guerrero Negro, compared to the $ 5,014.00 needed to attend the face-to-face consultation.
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ABSTRACT: In micropropagation, potassium nitrate (KNO3), an ACS reagent grade chemical, used in the preparation of growing mediums is expensive and its procurement depends on bureaucratic procedures, as it is controlled by the Brazilian Army. This research to assessed the effect of replacing the ACS KNO3 for a commercially available fertilizer (KNO3- based) on the micropropagation of the prickly pear cactus (Opuntia stricta (Haw.) Haw. cv. Elephant Ear. Treatments used six different fertilizer concentrations (0, 0.5, 1, 1.5, 2 and 2.5 g L-1) and a control consisting of 1.9 g L-1 KNO3, as shown in the MS salts. The survival, size and number of sprouts and the value of fresh biomass were evaluated. After seedling acclimation, we assessed the survival, number of sprouts, length, and number of roots, racket formation, average fresh biomass mass, macronutrient absorption and morphological changes of the seedlings. Explants inoculated with fertilizers at concentrations of 0.0; 2.0 and 2.5 g L-¹ did not grow. The response of explants at concentrations of 0.5 and 1.5 g L-1 of the fertilizer were the same as those developed in a KNO3 medium, and at a concentration of 1.0 g L-1, in all variables, the means were higher than those of the control medium. Therefore, it showed the feasibility of using fertilizers in the in vitro cultivation of the prickly pear cactus, which may remove bureaucratic barriers and reduce product costs by 99.12%.
RESUMO: Na micropropagação, o nitrato de potássio (KNO3), reagente puro para análise (P.A.), utilizado no preparo dos meios de cultura, possui custo elevado e a sua aquisição depende de trâmites burocráticos, por se tratar de substância controlada pelo Exército Brasileiro. O objetivo deste trabalho foi avaliar o efeito da substituição do KNO3 P.A. por fertilizante comercial (com fonte de KNO3), encontrado livremente no comércio, na micropropagação de palma (Opuntia stricta (Haw.) Haw. cv Orelha de Elefante. Os tratamentos foram de seis concentrações do fertilizante (0; 0,5; 1; 1,5; 2 e 2,5 g L-1) e um controle constituído de 1,9 g L-1 de reagente KNO3, conforme mostrado nos sais MS. Avaliou-se a sobrevivência, tamanho e número de brotações do explante, e o valor da biomassa fresca. Após a aclimatização das mudas avaliou-se a sobrevivência, número de brotações, comprimento da parte aérea, número de raízes, formação da raquete, massa média da biomassa fresca, absorção de macronutrientes e alterações morfológicas das mudas. Os explantes inoculados em meio com fertilizantes nas concentrações de 0,0; 2,0 e 2,5 g L-¹ não se desenvolveram. A resposta dos explantes nas concentrações de 0,5 e 1,5 g L-1 do fertilizante foram iguais aos desenvolvidos em meio contendo KNO3, e na concentração de 1,0 g L-1, em todas as variáveis, as médias foram superiores em relação as do controle. Dessa forma, constatou-se a viabilidade do uso do fertilizante no cultivo in vitro da palma, o que propiciou a eliminação dos entraves burocráticos e redução no custo de 99,12% na compra do produto.
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Abstract Introduction: Invasive procedures performed by trained nephrologists can reduce delays in making a definitive vascular access, complications, number of procedures on the same patient, and costs for the Public Health System. Objective: to demonstrate that a long-term tunneled central venous catheter (LTCVC) implanted by a nephrologist is safe, effective, and associated with excellent results. Methods: A retrospective study analyzed 149 consecutively performed temporary-to-long-term tunneled central venous catheter conversions in the operating room (OR) from a dialysis facility from March 2014 to September 2017. The data collected consisted of the total procedures performed, demographic characteristics of the study population, rates of success, aborted procedure, failure, complications, and catheter survival, and costs. Results: the main causes of end stage renal disease (ESRD) were systemic arterial hypertension and diabetes mellitus, 37.9% each. Patients had a high number of previous arteriovenous fistula (1.72 ± 0.84) and temporary catheter (2.87 ± 1.9) attempts until a definitive vascular access was achieved, while the preferred vascular site was right internal jugular vein (80%). Success, abortion, and failure rates were 93.3%, 2.7% and 4%, respectively, with only 5.36% of complications (minors). Overall LTCVC survival rates over 1, 3, 6, and 12 months were 93.38, 71.81, 54.36, and 30.2%, respectively, with a mean of 298 ± 280 days (median 198 days). The procedure cost was around 496 dollars. Catheter dysfunction was the main reason for catheter removal (34%). Conclusion: Our analysis shows that placement of LTCVC by a nephrologist in an OR of a dialysis center is effective, safe, and results in substantial cost savings.
Resumo Introdução: Procedimentos invasivos realizados por nefrologistas podem reduzir o número de procedimentos no mesmo paciente, complicações e atrasos na obtenção de acesso vascular definitivo, bem como proporcionar menor custo para o Sistema de Saúde. Objetivo: Demonstrar a segurança, a eficácia e os resultados dos implantes de cateteres venosos centrais de longa permanência (CLP) realizados por nefrologista sem fluoroscopia. Métodos: Estudo retrospectivo que analisou 149 implantes de CLP por nefrologista no centro cirúrgico de clínica de diálise, sem auxílio de fluoroscopia, no período de março/2014 a setembro/2017. Os dados coletados consistiram em: características demográficas da população estudada, taxas de sucesso, procedimento abortado, falha no procedimento, complicações observadas, patência do cateter e custos. Resultados: Houve um elevado número de tentativas fístulas arteriovenosas (1,72 ± 0,84) e de cateter de curta permanência (2,87 ± 1,9) até a realização de um acesso vascular definitivo. O sítio vascular preferido foi a veia jugular interna direita (80%). Taxas de sucesso, procedimentos abortados e falhas foram de 93,3%, 2,7% e 4,0%, respectivamente, com apenas 5,36% de pequenas complicações. A patência dos CLP com 1, 3, 6 e 12 meses foram de 93,38%, 71,81, 54,36% e 30,2%, respectivamente, com média de 298 ± 280 dias (mediana 198 dias). Os custos dos procedimentos foram em torno de US$ 496. Disfunção foi o principal motivo da remoção do cateter (34%). Conclusão: Nossa análise mostra que o implante de CLP por nefrologista no centro cirúrgico de clínica de diálise é eficaz e seguro e está associado à redução significativa de custos.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Catheterization, Central Venous/methods , Catheters, Indwelling/economics , Catheters, Indwelling/adverse effects , Central Venous Catheters/economics , Central Venous Catheters/adverse effects , Ambulatory Care/methods , Operating Rooms , Retrospective Studies , Follow-Up Studies , Renal Dialysis/methods , Treatment Outcome , Nephrologists , Kidney Failure, Chronic/therapyABSTRACT
Abstract Background: Coronary angiography with two catheters is the traditional strategy for diagnostic coronary procedures. TIG I catheter permits to cannulate both coronary arteries, avoiding exchanging catheters during coronary angiography by transradial access. Objective: The aim of this study is to evaluate the impact of one-catheter strategy, by avoiding catheter exchange, on coronary catheterization performance and economic costs. Methods: Transradial coronary diagnostic procedures conducted from January 2013 to June 2017 were collected. One-catheter strategy (TIG I catheter) and two-catheter strategy (left and right Judkins catheters) were compared. The volume of iodinated contrast administered was the primary endpoint. Secondary endpoints included radial spasm, procedural duration (fluoroscopy time) and exposure to ionizing radiation (dose-area product and air kerma). Direct economic costs were also evaluated. For statistical analyses, two-tailed p-values < 0.05 were considered statistically significant. Results: From a total of 1,953 procedures in 1,829 patients, 252 procedures were assigned to one-catheter strategy and 1,701 procedures to two-catheter strategy. There were no differences in baseline characteristics between the groups. One-catheter strategy required less iodinated contrast [primary endpoint; (60-105)-mL vs. 92 (64-120)-mL; p < 0.001] than the two-catheter strategy. Also, the one-catheter group presented less radial spasm (5.2% vs. 9.3%, p = 0.022) and shorter fluoroscopy time [3.9 (2.2-8.0)-min vs. 4.8 (2.9-8.3)-min, p = 0.001] and saved costs [149 (140-160)-€/procedure vs. 171 (160-183)-€/procedure; p < 0.001]. No differences in dose-area product and air kerma were detected between the groups. Conclusions: One-catheter strategy, with TIG I catheter, improves coronary catheterization performance and reduces economic costs compared to traditional two-catheter strategy in patients referred for coronary angiography.
Resumo Fundamento: A cineangiocoronariografia com dois cateteres é a estratégia tradicional para procedimentos coronarianos de diagnóstico. O cateter TIG I permite canular ambas as artérias coronárias, evitando a troca de cateteres durante a cineangiocoronariografia por acesso transradial. Objetivo: O objetivo deste estudo é avaliar o impacto da estratégia de um cateter, evitando a troca de cateter, no desempenho da coronariografia por cateterismo e nos seus custos econômicos. Métodos: Foram coletados os procedimentos diagnósticos coronarianos transradiais realizados entre janeiro de 2013 e junho de 2017. A estratégia de um cateter (cateter TIG I) e a estratégia de dois cateteres (cateteres coronários direito e esquerdo de Judkins) foram comparadas. O volume de contraste iodado administrado foi o endpoint primário. Os endpoints secundários eram espasmo radial, duração do procedimento (tempo de fluoroscopia) e exposição a radiações ionizantes (produto dose-área e kerma no ar). Os custos econômicos diretos também foram avaliados. Para as análises estatísticas, valores de p < 0,05 bicaudais foram considerados estatisticamente significativos. Resultados: De um total de 1.953 procedimentos em 1.829 pacientes, 252 procedimentos foram atribuídos à estratégia de um cateter e 1.701 procedimentos à estratégia de dois cateteres. Não houve diferenças nas características basais entre os grupos. A estratégia de um cateter exigiu menos contraste iodado [endpoint primário; (60-105) -mL vs. 92 (64-120) -mL; p < 0,001] em comparação com a estratégia de dois cateteres. Além disso, o grupo da estratégia de um cateter apresentou menos espasmo radial (5,2% vs. 9,3%, p = 0,022) e menor tempo de fluoroscopia [3,9 (2,2-8,0) -min vs. 4,8 (2,9-8,3) -min, p = 0,001] e economia de custos [149 (140-160)-€/procedimento vs. 171 (160-183) -€/procedimento; p < 0,001]. Não foram detectadas diferenças no produto dose-área e kerma no ar entre os grupos. Conclusões: A estratégia de um cateter, com cateter TIG I, melhora o desempenho da coronariografia por cateterismo e reduz os custos econômicos em comparação com a estratégia tradicional de dois cateteres em pacientes encaminhados para cineangiocoronariografia.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Coronary Angiography/methods , Cardiac Catheters/economics , Radiation Dosage , Radiation, Ionizing , Spasm , Time Factors , Fluoroscopy , Cardiac Catheterization/economics , Cardiac Catheterization/instrumentation , Cardiac Catheterization/methods , Retrospective Studies , Cost Savings/economics , Coronary Angiography/economics , Coronary Angiography/instrumentation , Radial Artery/diagnostic imaging , Myocardial Ischemia/diagnostic imaging , Contrast MediaABSTRACT
Abstract Objective: To describe the reasons for the disposal of blood in the coordinating blood center of the State of Paraná and to estimate the financial costs resulting from potentially avoidable discards. Method: A descriptive, retrospective and documentary analysis, with data related to the period from 2010 to 2015 of a Brazilian coordinating blood center collected from a governmental database and analyzed by descriptive statistics. This study was approved by the Ethics Research Committee (CAEE 63074916.0.0000.5225). Results: 101,813 units were discarded, representing 22.3% of the total of 455,684 produced; plasma was the most discharged blood component. The main reason for discarding was lipemia (35.8%); the analysis showed that 56.9% of the disposals were considered potentially avoidable with an estimated paid value of approximately US$2 million. Conclusion: The expressive potential of avoidance of disposal of blood units and blood components highlights the importance of planning actions aiming at their best use, contributing to the reduction of amounts paid for these processes.
Resumen Objetivo: Describir las causas de desechos de sangre en un hemocentro coordinador del estado de Paraná y estimar los costos financieros recurrentes de desechos potencialmente evitables. Método: Descriptivo, retrospectivo y análisis documental, con datos relativos al período de 2010 a 2015 de un hemocentro coordinador brasileño recolectados a partir de la base del Sistema Hemovida y analizados por estadística descriptiva. El proyecto fue aprobado por el Comité de Ética en Investigación con el número CAEE 63074916.0.0000.5225. Resultados: Se desecharon 101.813 unidades, lo que representa el 22,3% del total de 455.684 producidas; el plasma fue el hemocomponente más desechado. Hubo predominio de desecho por lipemia (35,8%); y el análisis demostró que el 56,9% de los desechos se consideraron potencialmente evitables, un valor pago estimado de US$2 millones. Conclusión: El significativo potencial de evitar el desecho de unidades de sangre y hemocomponentes destaca la importancia de planificar acciones con vistas a mejorar el uso, contribuyendo así a reducir los costos de las tarifas que se pagan por estos procesos.
Resumo Objetivo: Descrever os motivos de descarte de sangue no hemocentro coordenador do Estado do Paraná e estimar os custos financeiros decorrente de descartes potencialmente evitáveis. Método: Descritivo, retrospectivo e análise documental, cujos dados relativos ao período de 2010 a 2015 foram coletados a partir de base do Sistema Hemovida, e analisados por estatística descritiva. O projeto foi aprovado pelo Comitê de Ética em Pesquisa sob CAEE 63074916.0.0000.5225. Resultados: Foram descartadas 101.813 unidades, que representaram 22,3% do total de 455.684 produzidas; o plasma foi o hemocomponente mais descartado. Houve prevalência de descarte por lipemia (35,8%); a análise demonstrou que 56,9% dos descartes foram considerados potencialmente evitáveis, um valor pago estimado de US$ 2 milhões. Conclusão: O expressivo potencial de evitabilidade de descarte de unidades de sangue e hemocomponentes destaca a importância no planejamento de ações com vistas ao seu melhor uso, contribuindo para a redução de valores pagos para esses processos.
Subject(s)
Humans , Blood , Medical Waste Disposal/economics , Costs and Cost Analysis , Brazil , Retrospective StudiesABSTRACT
BACKGROUND: The aim of our study was to review the findings of health insurance fraud investigations and to evaluate their impacts on medical costs for target and non-target organizations. An interrupted time series study design using generalized estimation equations was used to evaluate changes in cost following fraud investigations. METHODS: We used National Health Insurance claims data from 2009 to 2015, which included 20,625 medical institutions (1,614 target organizations and 19,011 non-target organizations). Outcome variable included cost change after fraud investigation. RESULTS: Following the initiation of fraud investigations, we found statistically significant reductions in cost level for target organizations (−1.40%, p < 0.001). In addition, a reduction in cost trend change per month was found for both target organizations and non-target organizations after fraud investigation (target organizations, −0.33%; non-target organizations of same region, −0.19%; non-target organizations of other regions, −0.17%). CONCLUSION: This study suggested that fraud investigations are associated with cost reduction in target organization. We also found similar effects of fraud investigations on health expenditure for non-target organizations located in the same region and in different regions. Our finding suggests that fraud investigations are important in controlling the growth of health expenditure. To maximize the effects of fraud investigation on the growth of health expenditure, more organizations needed to be considered as target organizations.
Subject(s)
Cost Savings , Delivery of Health Care , Fraud , Health Expenditures , Health Policy , Insurance, Health , Interrupted Time Series Analysis , Korea , National Health ProgramsABSTRACT
Objective To systematic review the influence of case-based payment on inpatient costs since China′s new medical reform. Methods Studies about inpatient costs before and after the implementation of case-based payment were collected. The literature collected underwent a meta-analysis by RevMan 5. 0. Results A total of 11 articles in compliance were included in the study. The meta-analysis of random effect model showed the overall effect size (SMD) was -1. 54 with 95% CI being -1. 79, -1. 29, showing a significant difference (P<0. 05). The subgroup analysis showed that the overall effect size (MD) in the low-cost disease group was -585. 57 yuan with 95% CI being -750. 34, -420. 80, showing a significant difference (P < 0. 05). The overall effect size (MD) in the high-cost disease group was-4 172.65 yuan with 95% CI being -5 368. 21, -2 977. 10, showing a significant difference ( P <0.05). The funnel plot was approximately symmetrical, suggesting a publication bias as less likely in the study. Conclusions The implementation of case-based payment has reduced the inpatient costs to some extent thanks to China′s new healthcare reform. And the effect in the high-cost disease group was more obvious than that in the low-cost disease group.
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OBJECTIVES: Negative-pressure wound therapy has been widely adopted to reduce the complexity of treating a broad range of acute and chronic wounds. However, its cost is high. The objective of this study was to evaluate the following two different methods of negative-pressure wound therapy in terms of healing time: a low-cost method of negative-pressure wound therapy (a pressure stabilizer device connected to a hospital wall-vacuum system with a gauze-sealed dressing, USP) and the standard of care (vacuum-assisted closure, VAC). METHODS: This is a randomized, controlled, non-inferiority, unblinded trial. Patients admitted with complex injuries to a trauma center in a public referral hospital who were indicated for orthopedic surgery were randomized to a USP or VAC group. The primary outcome was the time required to achieve a "ready for surgery condition", which was defined as a wound bed with healthy granulation tissue and without necrosis or purulent secretion. Wound bed area contraction, granulation tissue growth and the direct costs of the dressings were secondary outcomes. RESULTS: Variation in area and granulation tissue growth were essentially the same between the systems, and healing time was equal between the groups (p=0.379). In both systems, serial debridement increased wound area (p=0.934), and granulation tissue was also increased (p=0.408). The mean treatment cost was US$ 15.15 in the USP group and US$ 872.59 in the VAC group. CONCLUSIONS: For treating complex traumatic injuries, USP was non-inferior to and less expensive than VAC.
Subject(s)
Humans , Male , Female , Adult , Wound Healing , Negative-Pressure Wound Therapy/methods , Wounds and Injuries/economics , Wounds and Injuries/therapy , Brazil , Prospective Studies , Treatment Outcome , Debridement , Negative-Pressure Wound Therapy/economics , Negative-Pressure Wound Therapy/instrumentationABSTRACT
Resumen Introducción. Las metas globales para controlar la epidemia de HIV contemplan que la carga viral sea indetectable en 90 % de las personas en tratamiento. El costo de la medición de la carga viral en lotes de muestras puede reducirse y, así, aumentar la cobertura cuando los recursos son limitados; sin embargo, su eficacia disminuye al aumentar la prevalencia del fracaso del tratamiento antirretroviral. Objetivo. Evaluar estrategias para disminuir la proporción de pacientes con fracaso del tratamiento antirretroviral en los lotes de muestras y, de esta manera, aumentar el ahorro en las pruebas de carga viral. Materiales y métodos. Las estrategias evaluadas fueron: a) la organización de los lotes de muestras según el esquema de tratamiento antirretroviral, y b) la exclusión de aquellos pacientes con antecedente reciente de fracaso del tratamiento antirretroviral, aquellos con menos de 12 meses de tratamiento antirretroviral y aquellos sin tratamiento antirretroviral previo. Los resultados de los lotes se compararon con los resultados individuales. Resultados. El valor diagnóstico negativo fue similar para los pacientes con esquema de primera línea (100,0 %; IC95% 99,5-100,0) o de segunda línea de tratamiento (99,4 %; IC95% 96,9-99,9). La incidencia del fracaso del tratamiento antirretroviral fue menor en los pacientes con tratamiento de primera línea (p<0,01), lo cual permitió un mayor ahorro en las pruebas de laboratorio en este grupo (74,0 %; IC95% 71,0-76,7) que en los pacientes con tratamiento de segunda línea (50,9 %; IC95% 44,4-57,3) (p<0,01). Conclusión. La selección de las muestras que se incluyeron en los lotes para determinar la carga viral del HIV según el tipo de esquema de tratamiento, permitió maximizar el porcentaje de ahorro en pruebas de laboratorio.
Abstract Introduction: HIV viral load testing is a key factor to evaluate the accomplishment of the UNAIDS target of 90% of viral suppression among people receiving antiretroviral therapy. Pooled samples are a potentially accurate and economic approach in resource-constrained settings, but efficiency can be negatively affected by high prevalence rates of virological failure. Objective: Strategies were assessed to increase the relative efficiency of pooled HIV viral load testing in resource-constrained settings. Materials and methods: We evaluated two strategies: a) plasma samples were not included in pools if patients had <12 months on antiretroviral therapy, patients had previous viral load >1,000 copies/ml, or were antiretroviral therapy naïve patients, and b) plasma pools were organized separately for first and second-line antiretroviral therapy regimens. Individual viral load tests were used to compare pooled results. Results: Negative predictive values were similar for patients on first (100.0%; 95% CI 99.5 to 100.0) and second-line antiretroviral therapy regimens (99.4%; 95% CI 96.9 to 99.9). However, the incidence of virological failure among individuals on first-line antiretroviral therapy was lower than second-line antiretroviral therapypatients (p <0.01), resulting in greater savings in laboratory tests in patients on first-line antiretroviral therapy (74.0%; 95% CI 71.0 to 76.7) compared with the group of patients on second-line antiretroviral therapy (50.9%; 95% CI 44.4 to 57.3) (p<0.01). Conclusion: Selecting the samples to be included in the pools and selecting the pools according to ART regimens are criteria that could lead to decreased spending on laboratory tests for HIV viral load determination in resource-constrained settings.
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Female , Humans , Male , Specimen Handling/methods , Viremia/blood , HIV Infections/blood , HIV-1/isolation & purification , Viral Load/economics , Cost Control/methods , Health Resources/economics , Specimen Handling/economics , Viremia/economics , Viremia/drug therapy , RNA, Viral/blood , HIV Infections/economics , HIV Infections/drug therapy , Predictive Value of Tests , Treatment Failure , Patient Selection , Viral Load/methods , Antiretroviral Therapy, Highly Active , Drug Resistance, Viral , Anti-Retroviral Agents/classification , Anti-Retroviral Agents/therapeutic use , Developing Countries , GuatemalaABSTRACT
ABSTRACT Objective: To determine the knowledge of Brazilian Orthopedic Surgeons on the costs of orthopedic surgical devices used in surgical implants . Methods: A questionnaire was applied to Brazilian Orthopedic Surgeons during the 46th Brazilian Congress on Orthopedics and Traumatology . Results: Two hundred and one Orthopedic Surgeons completely filled out the questionnaire. The difference between the average prices estimated by the surgeons and the average prices provided by the supplier companies was 47.1%. No differences were found between the orthopedic specialists and other subspecialties on the prices indicated for specific orthopedic implants. However, differences were found among orthopedic surgeons who received visits from representatives of implant companies and those who did not receive those visits on prices indicated for shaver and radiofrequency device. Correlation was found between length of orthopedic experience and prices indicated for shaver and interference screw, and higher the experience time the lower the price indicated by Surgeons for these materials . Conclusion: The knowledge of Brazilian Orthopedic Surgeons on the costs of orthopedic implants is precarious. Reduction of cost of orthopedics materials depends on a more effective communication and interaction between doctors, hospitals and supplier companies with solid orientation programs and awareness for physicians about their importance in this scenario. Level of Evidence III, Cross-Sectional Study.
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Introducción. Los protocolos de la cirugía con recuperación acelerada (fast-track surgery) han demostrado disminución de la estancia hospitalaria y los costos médicos en cirugía colorrectal. La evidencia sobre su aplicación en cirugía general es escasa si se compara con otras especialidades quirúrgicas. En este estudio se revisa la evidencia científica sobre la estrategia fast-track en cirugía gastrointestinal alta. Métodos. Se revisaron PubMed y Medline con el término "fast track surgery" y "ERAS surgery". Se incluyeron estudios clínicos controlados de asignación aleatoria que contaran con un grupo de control de pacientes con cuidado convencional. Se excluyeron trabajos no relacionados con cirugía gastrointestinal alta. Se analizaron las diferencias de medias sopesadas, tomando como puntos finales la estancia hospitalaria, la morbilidad, la mortalidad y la rehospitalización. Resultados. Cinco estudios clínicos de asignación aleatoria cumplieron con los criterios de inclusión. Cuatro estudios de gastrectomías y uno de perforación de úlcera duodenal. De un total de 385 pacientes, se compararon 197 (51 %) en el grupo con cuidado convencional y 188 (49 %) en grupo con fast-track. Al comparar el cuidado convencional con el fast-track, la estancia hospitalaria fue de 7,5 Vs. 5,7 días, (p=0,019), y la morbilidad, de 22 % Vs. 14 % (p=0,017), respectivamente. No se obtuvieron diferencias significativas en la mortalidad (p=0.347) ni en las rehospitalizaciones (p=0.954) entre los dos grupos. Conclusión. La estrategia fast-track disminuye la estancia hospitalaria, y puede implementarse en forma segura en pacientes que requieren cirugía gastrointestinal alta, sin incrementar la morbilidad, la mortalidad ni las rehospitalizaciones.
Introduction: Fast-track surgery protocols (FT) have demonstrated reduction in hospital length of stay (LOS) and medical costs in colorectal surgery. The evidence on FT applied to general surgery is sparse. This study reviews the scientific evidence of FT strategy in upper gastrointestinal surgery (UGIS). Methods: PubMed and Medline databases were reviewed with the term "Fast Track surgery" and "ERAS surgery". Randomized clinical trials (RCT) regarding FT strategies in UGIS were included only if a control group with conventional care (CC) was compared. Studies not related to UGIS were excluded. The differences in weighted means were analyzed using as end points the LOS, morbility, mortality, and hospital readmission. Results: Five RCT met the inclusion criteria: four randomized clinical studies on gastrectomies, and one on perforated duodenal ulcer From a total of 385 patients, 197 (51%) included the CC group and 188 (49%) in FT group were compared. The LOS of CC vs. FT groups was 7.5 and 5.7 days, respectively (p=0.019), and morbidity of 22% vs. 14%. Respectively (p=0.019). No significance differences were obtained on mortality (p=0.347) or hospital readmission (p=0.954) between the two groups. Conclusion: Fast-Track strategy decreases length of hospital stay, and could be safely implemented in patients undergoing upper gastrointestinal surgery, without increasing morbidity, mortality or readmission rates.
Subject(s)
Humans , General Surgery , Cost Savings , Digestive System Surgical Procedures , Patient Discharge , Recovery of Function , Upper Gastrointestinal TractABSTRACT
Background:Polypharmacy is a significant economic burden.Objective:We tested whether using reverse auction (RA) as compared with commercial pharmacy (CP) to purchase medicine results in lower pharmaceutical costs for heart failure (HF) and heart transplantation (HT) outpatients.Methods:We compared the costs via RA versus CP in 808 HF and 147 HT patients followed from 2009 through 2011, and evaluated the influence of clinical and demographic variables on cost.Results:The monthly cost per patient for HF drugs acquired via RA was $10.15 (IQ 3.51-40.22) versus $161.76 (IQ 86.05‑340.15) via CP; for HT, those costs were $393.08 (IQ 124.74-774.76) and $1,207.70 (IQ 604.48-2,499.97), respectively.Conclusion:RA may reduce the cost of prescription drugs for HF and HT, potentially making HF treatment more accessible. Clinical characteristics can influence the cost and benefits of RA. RA may be a new health policy strategy to reduce costs of prescribed medications for HF and HT patients, reducing the economic burden of treatment.
Fundamento:A polifarmácia tem um significativo peso econômico.Objetivo:Testar se o uso de pregão em comparação ao de farmácias comerciais (FC) para a compra de medicamentos reduz o custo do tratamento de pacientes ambulatoriais de insuficiência cardíaca (IC) e transplante cardíaco (TC).Métodos:Comparação dos custos do tratamento através de pregão versus FC em pacientes de IC (808) e TC (147) acompanhados de 2009 a 2011, avaliando-se a influência de variáveis clínicas e demográficas no custo.Resultados:Os custos mensais por paciente para medicamentos de IC adquiridos através de pregão e através de FC foram $10,15 (IQ 3,51-40,22) e $161,76 (IQ 86,05-340,15), respectivamente. Para TC, aqueles custos foram $393,08 (IQ 124,74-774,76) e $1.207,70 (IQ 604,48-2.499,97), respectivamente.Conclusão:O pregão pode reduzir o custo dos medicamentos prescritos para IC e TC, podendo tornar o tratamento de IC mais acessível. As características clínicas podem influenciar o custo e os benefícios do pregão, que pode ser uma nova estratégia de política de saúde para baixar os custos dos medicamentos prescritos para IC e TC, diminuindo o peso econômico do tratamento. (Arq Bras Cardiol. 2015; [online].ahead print, PP.0-0).
Subject(s)
Adult , Aged , Humans , Middle Aged , Young Adult , Competitive Bidding/economics , Drug Costs/statistics & numerical data , Drug Therapy/economics , Heart Failure/economics , Heart Transplantation/economics , Brazil , Cost Control , Cost-Benefit Analysis , Drug Prescriptions/economics , Heart Failure/drug therapy , Outpatients/statistics & numerical data , Retrospective Studies , Statistics, Nonparametric , Stroke Volume , Ventricular Function, LeftABSTRACT
OBJETIVO: Analisar modalidades de serviço de atenção domiciliar discutindo a inserção da enfermagem. MÉTODOS: Estudo de caso qualitativo realizado em quatro operadoras de planos de saúde no município de Belo Horizonte/Minas Gerais. Os dados foram obtidos de entrevistas e acompanhamento de casos. RESULTADOS: Os serviços de atenção domiciliar são agrupados em três Modalidades: Cuidados prolongados no domicilio; Atenção provisória no domicilio e Uso intenso de tecnologias e de cuidados. Nas modalidades, a enfermagem assume ações assistenciais e de gestão do cuidado e qualifica a atenção por meio do uso apropriado das tecnologias leves. Há uma tendência à terceirização do serviço de enfermagem na atenção domiciliar. CONCLUSÃO: A inclusão do trabalho do enfermeiro nas modalidades de atenção domiciliar representa ao mesmo tempo um componente de redução de custos e contribui para a transição tecnológica pelo estabelecimento de novas formas de cuidado no domicilio.
OBJECTIVE: To evaluate modalities of home care services, discussing the inclusion of nursing. METHODS: A qualitative case study conducted with four health plan providers in the city of Belo Horizonte / Minas Gerais (Brazil). Data were obtained from interviews and case management. RESULTS: The home care services are grouped into three modalities: long-term care at home; temporary care at home; and, use of intensive technologies and care. In these modalities, nurses assume care actions, management of the care, and qualifying the care through the appropriate use of soft technologies. There is a trend towards outsourcing of nursing services to home care. CONCLUSION: The inclusion of the work of nurses in home care modalities represents both a component of cost reduction and contributes to the technological transition by establishing new forms of care at home.
OBJETIVO: Analizar modalidades de servicio de atención domiciliaria discutiendo la inserción de la enfermería. MÉTODOS: Estudio de caso cualitativo realizado en cuatro operadoras de planes de salud en el municipio de Belo Horizonte/Minas Gerais. Los datos fueron obtenidos de entrevistas y acompañamiento de casos. Resultados: Los servicios de atención domiciliaria son agrupados en tres MODALIDADES: Cuidados prolongados en el domicilio; Atención provisional en el domicilio y Uso intenso de tecnologías y de cuidados. En las modalidades, la enfermería asume acciones asistenciales y de gestión del cuidado y cualifica la atención por medio del uso apropiado de las tecnologías leves. Hay una tendencia a la tercerización del servicio de enfermería en la atención domiciliaria. CONCLUSIÓN: La inclusión del trabajo del enfermero en las modalidades de atención domiciliaria representa al mismo tiempo un componente de reducción de costos y contribuye a la transición tecnológica por el establecimiento de nuevas formas de cuidado en el domicilio.
Subject(s)
Cost Savings , Delivery of Health Care , Home Care Services , Nursing Care , Prepaid Health Plans , Supplemental Health , Brazil , Qualitative ResearchABSTRACT
OBJECTIVE: This study attempts to quantify the impact of the introduction of local second-level health services on nonmedical costs (NMCs) for residents of the rural Ecuadorian county of La Maná. METHODS: NMCs for patients accessing second-level health care were assessed by using a quasi-experimental pre- and postintervention study design. In 2007, before local second-level health care services existed, and then in 2008, after the introduction of second-level health care services in the form of a county hospital, 508 patients from the county who sought second-level health care were interviewed. RESULTS: Mean NMCs per patient per illness episode were US$ 93.58 before the county hospital opened and US$ 12.62 after it opened. This difference was largely due to reductions in transport costs (US$ 50.01 vs. US$ 4.28) and food costs (US$ 25.38 vs. US$ 7.28) (P < 0.001 for each category). CONCLUSIONS: NMCs can be decreased sevenfold with the introduction of a county hospital in a rural province previously lacking second-level health care. Introduction of rural second-level health care reduces financial barriers and thus may increase access to these health services for poorer patients in rural communities.
OBJETIVO: Este estudio tiene por objeto cuantificar la repercusión de la introducción de servicios de salud locales de segundo nivel sobre los costos no médicos para los residentes del cantón rural ecuatoriano de La Maná. MÉTODOS: Se evaluaron los costos no médicos de los pacientes que tuvieron acceso a atención médica de segundo nivel mediante un estudio cuasiexperimental de análisis previo y posterior a la intervención. En el 2007 (antes de que existieran servicios locales de este tipo) y en el 2008 (después de la introducción de atención médica de segundo nivel representada por el hospital del cantón) se entrevistaron a 508 pacientes del cantón que requirieron atención médica de segundo nivel. RESULTADOS: Los costos no médicos medios por paciente y por episodio de enfermedad fueron de US$ 93,58 antes de la apertura del hospital local y de US$ 12,62 después de la inauguración del establecimiento. Esta diferencia se debió en gran parte a la reducción de los costos de transporte (US$ 50,01 frente a US$ 4,28) y de los costos de alimentación (US$ 25,38 frente a US$ 7,28) (P < 0,001 para cada categoría). CONCLUSIONES: Es posible reducir los costos no médicos a una séptima parte mediante la apertura de un hospital local en una zona rural que anteriormente carecía de atención médica de segundo nivel. La introducción de atención médica de segundo nivel en una zona rural reduce los obstáculos financieros y, por lo tanto, podría aumentar el acceso a estos servicios de salud para los pacientes más pobres en las comunidades rurales.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Young Adult , Cost of Illness , Health Services Accessibility/economics , Hospitals, Rural/economics , Rural Health/economics , Cost Savings/statistics & numerical data , Costs and Cost Analysis , Economics/statistics & numerical data , Ecuador , Food/economics , Housing/economics , Income/statistics & numerical data , Surveys and Questionnaires , Transportation of Patients/economicsABSTRACT
PURPOSE: The purpose of this study was to examine the effect of maximal sterile barrier precaution on the central venous catheter-related infection and subsequent cost savings. METHODS: Study subjects were 462 hospitalized patients with central venous, catheter of more than 48 hours duration. Data collection period was from April 2008 to February 2009 at a tertiary university hospital in Seoul. Subjects were randomly assigned to either the treatment or the usual care group. Patients in the treatment group (n=209) were treated by staff using maximal sterile barrier precautions and the comparison group(n=253) received traditional care. RESULTS: Central venous catheter-days was2,821 in treatment group and 3,515 in comparison group. The incidence density of central venous catheter-related infection was 2.1 times higher in the comparison group (8.2 per 1,000 catheter-days) compared with the treatment group (3.9 per 1,000 catheter-days). The incidence density of central venous catheter-related bloodstream infection was 4.54 times higher than in the comparison group (3.2 per 1,000 catheter-days) compared with the treatment group (0.7 per 1,000 catheter-days). The attributable cost of central venous catheter-related infection in the treatment group was 10,174,197 won and that of the comparison group was 22,224,554 won. Attributable cost by area was also significantly lower compared with that of the comparisons. CONCLUSION: The maximal sterile barrier precaution during central venous catheter insertion was an effective intervention to reduce central venous catheter-related infection rate and provides a significant cost savings.
Subject(s)
Humans , Catheter-Related Infections , Catheters , Central Venous Catheters , Cost Savings , Data Collection , IncidenceABSTRACT
Objective To explore whether health examination save medical insurance fund or not. Methods To observe the sparing medical cost which 371 health examination people avoid repeated checking and shorten the length of stay during hospitalization from March 2006 to March 2007. To observe the effect of sparing medical cost because of regular health examination, early discovery diseases, pretreatment promptly and avoidance transforming to advanced diseases. Results Because of avoiding repeated checking and shortening the length of stay,everybody save the medical cost about 570 yuan,371 people can save about 21 ten thousands yuan. To statistics the average hospital cost of different courses of eight common diseases and malignant tumors from January to November at 2007, we discovered that the medical cost is large distinction between the earlier period and advanced stage of disease. For example: the medical cost of one stage of hypertension is 6608 yuan ,the two stage is 8838 yuan ,the three stage is 13 869 yuan, and the stage of hypertensive heart disease is 13 033 yuan. Parts of health examination crowd who stay at my hospital from 1996 were visited for five years ,we conformed many chronic diseases by prompt intervention can relieve and even reverse, avoiding the transformation to incurable disease which will consume a large number of strength and money. Conclusion Health examination resource is a medical treatment resource which isn't restricted by social security fund, the utilization can not only save medical cost but also discover and treat diseases earlier, thus we can save the strength and money before the advanced diseases.