Costos y resultados del tratamiento con Heberprot-P® en pacientes con pie diabético del Policlínico Ramón López Peña / Costs and Outcomes of Heberprot-P® Treatment in Patients with Diabetic Foot Ulcer from Ramón López Peña Polyclinic

Introducción: Las úlceras del pie diabético constituyen una de las principales causas de morbilidad y discapacidad, con una importante repercusión por la carga económica de la enfermedad y desde el punto de vista social, por la disminución de la calidad de vida de los pacientes. Objetivo: Evaluar costos y resultado del tratamiento ambulatorio con el Heberprot P® para la atención al paciente con úlcera del pie diabético. Métodos: Se realizó un estudio descriptivo, longitudinal y retrospectivo de 22 pacientes con pie diabético tratados con Heberprot-P®, en la consulta para tales fines del Policlínico Ramón López Peña en el año 2019. Resultados: El 63,6 por ciento de los pacientes que acudieron a consulta presentaron Pie de Riesgo grado cero; la úlcera neuroinfecciosa fue la de mayor incidencia de presentación (94,5 por ciento). Se obtuvo una efectividad del 95,4 por ciento del total de los casos tratados. La mayoría de los tratados necesitaron entre 3-8 bulbos del medicamento, con un promedio de 5 sesiones de tratamiento por paciente, a un costo promedio de $ 3 549,8 /caso tratado. Conclusiones: El tratamiento con el Heberprot P® es altamente efectivo para la cicatrización de las UPD, evitando en gran medida las amputaciones de los miembros inferiores de los pacientes con diabetes mellitus, con una consiguiente disminución del costo económico que tienen estas intervenciones sanitarias para el país(AU)

Introduction: Diabetic foot ulcer is one of the main causes of morbidity and disability, with an important repercussion due to the economic burden of the disease and from the social point of view, due to the decrease in patients' quality of life. Objective: To assess costs and outcomes of outpatient treatment with Heberpro-P® for the care of patients with diabetic foot ulcers. Methods: A descriptive, longitudinal and retrospective study was carried out of 22 patients with diabetic foot treated with Heberprot-P®, in the consultation for such purposes of Ramón López Peña Polyclinic in 2019. Results: 63.6 percent of the patients who came for consultation presented zero risk foot; neuroinfectious ulcer was the one with the highest incidence of presentation (94.5 percent). An effectiveness rate of 95.4 percent of the total of treated cases was obtained. Most of those treated needed three to eight bulbs of the medication, with an average of five treatment sessions per patient, at an average cost of 3549.8 Cuban pesos per treated case. Conclusions: Treatment with Heberprot-P® is highly effective for the healing of diabetic foot ulcers, largely avoiding amputations of lower limbs of patients with diabetes mellitus, with a consequent decrease in the economic cost of these health interventions for the country(AU)

Application of health economics assessment techniques in the prevention and control of important infectious diseases: a review / 中国血吸虫病防治杂志

Due to the relative shortage of health resources, rational allocation and utilization of health resources is critical to achieving the maximum economic benefits in developing countries, which requires a health economic assessment to meet the needs to balance the competitive requirements of cost reduction and effectiveness enhancement. This review describes the advances in applications of health economic assessment techniques in four major infectious diseases, including AIDS, tuberculosis, hepatitis B and schistosomiasis. Currently, there is no standard economic assessment in the prevention and control of infectious diseases, and notably, the transparency of cost research is limited, which may affect the popularization of the study conclusions. Further health economic assessments of infectious diseases are required to improve the quality, standard and transparency of the economic evaluation through formulating strategies, to improve the standardization of studies, to improve the popularization of the study conclusions and to improve the applicability of the economic evaluation for policies.

Diferentes metodologias para a avaliação de políticas em saúde mental no Brasil e no mundo: uma revisão teórica / Distinct methodologies for mental health policy evaluation in Brazil and the world: a theoretical review

Transtornos mentais como a depressão, a ansiedade e a distimia são enfermidades que afetam gravemente a população mundial e são uma das principais causas de incapacidade no trabalho tanto no Brasil quanto em diversos outros países. Estima-se que até 36 milhões de pessoas sofram de depressão no país e até 350 milhões ao redor do mundo. Trata-se de um problema econômico, social e humano, pois provoca diminuição do bem-estar dos indivíduos e de toda a sociedade, ao reduzir a renda e a riqueza, a felicidade e as oportunidades reais das pessoas de fazer e ser o que valorizaram. É nesse contexto que a Economia possibilita ferramentas para análise de políticas públicas, neste caso, aquelas relacionadas à saúde mental. Para tanto, o procedimento metodológico utilizado foi uma revisão de natureza teórica sobre os diferentes métodos que podem ser empregados para a avaliação da saúde mental no Brasil e no mundo. Foram descritos três referenciais teóricos: a Economia Tradicional, a Economia da Felicidade e a Abordagem das Capacitações. Os resultados apontam que cada uma dessas três abordagens econômicas permite entender, de um ângulo diferente, os problemas relacionados às doenças mentais, enriquecendo, assim, as possibilidades de promoção de políticas públicas. Entretanto, ainda são poucos os estudos sobre o tema em Economia da Felicidade e na Abordagem das Capacitações. No Brasil, tais estudos concernentes à saúde mental são exíguos, independentemente da metodologia utilizada.

Mental disorders such as depression, anxiety and dysthymia are diseases that severely affect the world's population and are a major cause of disability at work both in Brazil and in many other countries. It is estimated that up to 36 million people suffer from depression in Brazil and up to 350 million around the world. It is an economic, social and human issue because it causes a decrease in the well-being of individuals and the whole of society by reducing income and wealth, happiness and real opportunities for people do and be what they value. In this regard, Economics provides tools for analysis of public policy, in this case those related to mental health. Therefore, the methodological procedure employed is a theoretical review on the different methods that may be employed for mental health assessment in Brazil and worldwide. Three theoretical references were reported: the Traditional Economics, the Happiness Economics and the Capability Approach. The results show that each of these three economic approaches allows to understand the concerns related to mental illnesses from a different angle, thus enriching the possibilities of promoting public policies. However, there are still few studies on the subject of Happiness Economics and, specially, the Capability Approach. In Brazil, such studies concerning mental health are lacking regardless of the methodology used.

Strengthen the studies on vaccine safety surveillance and economic assessment in China: not a moment too soon / 中华预防医学杂志

Vaccination is among the most economic and effective intervention measures to combat infectious diseases. National immunization program is the best approach to achieve the major public health value of vaccines, and is an important sign of equity of medical service. The evidences accumulated by the studies on vaccine safety and economic assessment are the important basis for the decision making for immunization.

Profilaxis antibiótica preoperatoria en pacientes con cirugías ginecológicas en el Hospital Homero Castanier Crespo / Preoperative antibiotic prophylaxis performed on patients with gynecological surgeries at ¨Homero Castanier Crespo¨

Introducción: el uso inadecuado de los antimicrobianos constituye una preocupación mundial. En Ecuador, este problema se agrava porque no se han tomado las medidas pertinentes para controlar la situación. No se realizan programas de vigilancia de infecciones producidas por bacterias resistentes ni control en el uso indiscriminado. Existe poco conocimiento por parte de los servidores de salud y ausencia de comités de infecciones en los hospitales. Objetivo: evaluar la calidad de la prescripción y el costo del tratamiento de la profilaxis antibiótica preopereatoria mediante el seguimiento farmacoterapéutico en pacientes operadas de afecciones ginecológicas. Método: se realiza un estudio retrospectivo, y una evaluación económica, del tipo minimización de costos del tratamiento utilizado. En el hospital Homero Castanier Crespo de la Ciudad de Azogues, Ecuador desde septiembre 2015 hasta marzo 2016. Resultados: la mayoría de las pacientes tenían entre 21 y 40 años de edad. Los principales motivos de cirugía fueron quiste de ovario roto y mioma uterino. Predominaron las cirugías limpias-contaminadas. El antimicrobiano más utilizado fue la cefazolina en dosis única, cada 24, 12 y 8 horas. Aproximadamente en un 20 por ciento de los casos, se realizó cambio de tratamiento injustificadamente. Predominaron los PRM6. La mayoría de las prescripciones resultaron inadecuadas. El costo global por antimicrobianos fue de 503,09 USD. Si la profilaxis se hubiera aplicado adecuadamente, se hubiera ahorrado 435,45 USD. Conclusiones: se sugiere el rediseño del Protocolo de Profilaxis Antibiótica Preoperatoria del Hospital Homero Castanier Crespo(AU)

Introduction: The inappropriate use of antimicrobials is a world concern and in Ecuador, this problem worsens because there are not relevant measures in place to control the situation. Neither surveillance programs of infections caused by resistant bacteria nor control of the indiscriminate use of antimicrobials are implemented. The health professionals´ knowledge is poor about it and the infection commissions are nonexistent in hospitals. Objective: To evaluate the quality of prescription and the cost of treatment of preoperative antibiotic prophylaxis through drug therapy follow-up in patients operated on for gynecological problems. Method: A retrospective study and an economic assessment of treatment cost minimization type was carried out in Homero Castanier Crespo¨hospital in Ciudad de Azogues, Ecuador, from September 2015 to March 2016. Results: Most of the patients were 21 to 40 years-old. The main reasons for surgery were ruptured ovarian cyst and uterine myoma. Clean-contaminated surgeries predominated. The most used antimicrobial was cefazoline at a single dose every 8, 12 and 24 hours. Around 20 percent of cases changed their treatment with no justification. PRM6 prevailed. Most of prescriptions were inadequate. The global cost of antimicrobials was 503.09 US dollars. If prophylaxis would have been correctly applied, then 435.45 US dollars had been saved. Conclusions: It is suggested that the preoperative protocol of antibiotic prophylaxis be redesigned in Homero Castanier Crespo(AU)

Reassessment of the potential economic impact of cattle parasites in Brazil / Reavaliação do potencial impacto econômico de parasitos de bovinos no Brasil

The profitability of livestock activities can be diminished significantly by the effects of parasites. Economic losses caused by cattle parasites in Brazil were estimated on an annual basis, considering the total number of animals at risk and the potential detrimental effects of parasitism on cattle productivity. Estimates in U.S. dollars (USD) were based on reported yield losses among untreated animals and reflected some of the effects of parasitic diseases. Relevant parasites that affect cattle productivity in Brazil, and their economic impact in USD billions include: gastrointestinal nematodes - $7.11; cattle tick (Rhipicephalus (Boophilus) microplus) - $3.24; horn fly (Haematobia irritans) - $2.56; cattle grub (Dermatobia hominis) - $0.38; New World screwworm fly (Cochliomyia hominivorax) - $0.34; and stable fly (Stomoxys calcitrans) - $0.34. The combined annual economic loss due to internal and external parasites of cattle in Brazil considered here was estimated to be at least USD 13.96 billion. These findings are discussed in the context of methodologies and research that are required in order to improve the accuracy of these economic impact assessments. This information needs to be taken into consideration when developing sustainable policies for mitigating the impact of parasitism on the profitability of Brazilian cattle producers.

A rentabilidade da atividade pecuária pode ser diminuída significativamente pelos efeitos dos parasitos que afetam o gado. As perdas econômicas causadas pelos parasitos dos bovinos, no Brasil, foram estimadas em uma base anual, considerando-se o número total de animais em risco e os efeitos negativos do parasitismo sobre a produtividade do gado. Estimativas em dólares baseiam-se em perdas de rendimento conhecidas em animais não tratados, e refletem alguns dos efeitos de doenças parasitárias. Aqui, tais perdas são referidas como perdas potenciais. Parasitos relevantes que afetam o bem-estar do gado e a produtividade no Brasil e seu impacto econômico em dólares incluem: nematódeos gastrintestinais - $7,11 bilhões; carrapato bovino (Rhipicephalus (Boophilus) microplus) - $3,24 bilhões; mosca-dos-chifres (Haematobia irritans) - $2,56 bilhões; berne (Dermatobia hominis) - $0,38 bilhões; mosca-da-bicheira (Cochliomyia hominivorax) - $0,34 bilhões; e a mosca-dos-estábulos (Stomoxys calcitrans) - $0,34 bilhões. A perda econômica anual combinada, devido aos parasitos internos e externos dos bovinos aqui listados, foi estimada em pelo menos $13,96 bilhões. Tais resultados são discutidos no contexto de metodologias e pesquisas necessárias, como a que envolve os efeitos da resistência aos parasiticidas de uso veterinário, para melhorar a precisão de tais avaliações de impacto econômico. Essa informação deve ser considerada pelos tomadores de decisão para influenciar programas de investigação e regulação, a fim de desenvolver políticas sustentáveis que reduzam o impacto do parasitismo sobre a rentabilidade dos pecuaristas brasileiros.

Contribution to economic evaluation of systems that value animal welfare at farm / Contribución para la evaluación económica de sistemas que procuran el bienestar / Contribuição para a avaliação econômica de sistemas que prezam pelo Bem-Estar dos animais de produção

The demand for “welfare friendly” products increases as public conscience and perception on livestock production systems grow. The public and policy-makers demand scientific information for education and to guide decision processes. This paper describes some of the last decade contributions made by scientists on the technical, economical and market areas of farm animal welfare. Articles on animal welfare were compiled on the following themes: 1) consumer behavior, 2) technical and economical viability, 3) public regulation, and 4) private certification policies. Most studies on the economic evaluation of systems that promote animal welfare involved species destined to produce export items, such as eggs, beef and pork. Few studies were found on broilers, dairy cows and fish, and data regarding other species, such as horses, sheep and goats were not found. Scientists understand that farm animal welfare is not only a matter of ethics, but also an essential tool to gain and maintain markets. However, it is unfortunate that little attention is paid to species that are not economically important for exports. Studies that emphasize on more humane ways to raise animals and that provide economic incentives to the producer are needed. An integrated multidisciplinary approach is necessary to highlight the benefits of introducing animal welfare techniques to existing production systems.

La demanda por productos diferenciados en términos de bienestar animal, crece a medida que aumenta la información, conciencia y percepción del público con relación a la producción animal. La sociedad, los encargados de la legislación y los científicos del área, buscan información para la construcción de opinión y la toma de decisiones. Por esto, los investigadores deben usar su capacidad técnica, de investigación y analítica para evaluar los efectos de la producción pecuaria en el bienestar animal y humano. El objetivo de esta revisión, fue analizar las contribuciones de los científicos sobre las implicaciones técnicas, económicas y mercadotécnicas de las mejoras del bienestar animal, para dejar disponible un análisis más preciso de lo que se ha realizado académicamente sobre el tema en la última década. Se compilaron artículos sobre bienestar animal aplicados a la producción animal, en los siguientes temas: 1) comportamiento del consumidor, 2) viabilidad técnica y económica, 3) regulación pública y 4) políticas privadas de certificación. Se encontró que los estudios de evaluación económica en sistemas que procuran el bienestar animal, se concentraron en criaderos destinados a productos de exportación, como huevos, carne bovina y suina. Pocos trabajos se han desarrollado sobre aves de carne, bovinos lecheros y peces. No se encontraron datos sobre otras especies diferentes a las antes mencionadas. Los científicos perciben que el bienestar animal, además de ser una cuestión ética, es esencial para conquistar y mantener mercados. Sin embargo, es preocupante que este tipo de investigaciones se realicen en menor medida en especies poco representativas en las exportaciones. Trabajos sobre bienestar animal, son esenciales para viabilizar técnicas de producción menos agresivas con los animales y para agregar valor a sus productos, incluso a aquellos destinados al consumo interno. Son necesarias más investigaciones en todos los abordajes propuestos, adicionando conocimientos multidisciplinarios para diferentes áreas de estudio.

A procura por produtos diferenciados em relação ao bem-estar animal cresce à medida que aumentam as informações, a consciência e a percepção do público em relação à produção animal. A sociedade e os envolvidos na legislação buscam informação para a construção de opinião e toma de decisões junto aos cientistas da área. Por isso os pesquisadores devem, da maneira mais objetiva possível, usar sua capacidade técnica, investigativa e analítica para avaliar os diversos efeitos da pecuária no bem-estar animal e humano. O Objetivo desta pesquisa foi analisar as contribuições de cientistas sobre as implicações técnicas, econômicas e mercadológicas das melhorias do bem-estar animal, de forma a disponibilizar um análise do que vem sendo feito no setor acadêmico sobre o tema. Foram estudadas publicações da última década (2001-2011), onde se compilaram artigos com enfoque no bem-estar aplicado à produção animal, sob as abordagens: 1) comportamento do consumidor; 2) viabilidade técnica e econômica; 3) regulamentação pública; e 4) políticas privadas de certificação. Constatou-se que estudos de avaliação econômica em sistemas que prezam pelo bem-estar animal se concentraram em criações destinadas a produzir bens de exportação, como ovos e carnes bovina e suína. Aves de corte, bois leiteiros e peixes foram objeto de poucos trabalhos. Não foram encontrados dados sobre outras espécies. Os cientistas percebem que o bem-estar animal, além de uma questão ética, é essencial na conquista e manutenção dos mercados. No entanto, é muito preocupante que estas pesquisas sejam nitidamente menos intensas para espécies pouco representativas para as exportações. Trabalhos na área do bem-estar animal são essenciais para viabilizar técnicas de criação menos agressivas aos animais e para agregar valor aos produtos, mesmo destinados ao mercado interno, e se devem ampliar a outras espécies. Mais pesquisas são necessárias em todas as abordagens propostas, acrescentando conhecimentos de forma multidisciplinar para várias áreas de estudos.

Avaliação em saúde e avaliação econômica em saúde: introdução ao debate sobre seus pontos de interseção / Health assessment and economic assessment in health: introduction to the debate on the points of intersection

O estudo pretende inferir a existência, ou não, de um continuum entre a Avaliação em Saúde e a Avaliação Econômica em Saúde ao evidenciar os pontos de interseção entre essas formas de avaliação. Para tanto se realizou uma revisão bibliográfica no que concerne à fundamentação teórica, métodos e enfoques de ambas as formas de avaliação. Tomando por base a fundamentação teórica dos modelos de avaliação em saúde, normativa e pesquisa avaliativa, como referida por Hartz et al., e as abordagens teóricas da avaliação econômica, welfarista e extrawelfarista, referidas por Brouwer et al., concluiu-se que há um continuum, entre o modelo da pesquisa avaliativa, adotada na avaliação em saúde, e a abordagem teórica extrawelfarista da avaliação econômica em saúde e entre a abordagem normativa da avaliação em saúde e o enfoque welfarista da avaliação econômica em saúde. No que tange, entretanto, à prática avaliativa no dia a dia das instituições, os estudos realizados, em geral, ainda são concebidos sob um enfoque normativo e sob uma abordagem welfarista.

The study aims to infer the existence of a continuum between Health Assessment and Economic Assessment in Health, by highlighting points of intersection of these forms of appraisal. To achieve this, a review of the theoretical foundations, methods and approaches of both forms of assessment was conducted. It was based on the theoretical model of health evaluation as reported by Hartz et al and economic assessment in health approaches reported by Brouwer et al. It was seen that there is a continuum between the theoretical model of evaluative research and the extrawelfarist approach for economic assessment in health, and between the normative theoretical model for health assessment and the welfarist approaches for economic assessment in health. However, in practice the assessment is still conducted using the normative theoretical model and with a welfarist approach.

Evaluación económica en salud y toma de decisiones en el contexto sanitario cubano / Economic assessment in health care and the decision-making in the health care context

Objetivo: identificar cuáles son los factores que fortalecen y los que limitan el adecuado uso de las evaluaciones económicas en función de la toma de decisiones en el contexto sanitario cubano. Métodos: se seleccionó un conjunto de profesionales vinculados a la toma de decisiones en diferentes ámbitos del Sistema Nacional de Salud. Se realizaron grupos focales para cada nivel identificado y entrevistas de profundidad a directivos, médicos, profesores e investigadores escogidos para conocer sus criterios al respecto. Resultados: se encontraron factores de carácter práctico, metodológico y administrativo que fortalecen y otros que limitan el desarrollo de la evaluación económica en el país. Conclusiones: se propone un conjunto de acciones para fortalecer el uso de la evaluación económica en salud en el proceso de toma de decisiones en Cuba

Objective: to identify the factors that strengthen and those factors that limit the adequate use of economic assessment as a function of the decision-making process in the Cuban health care system. Methods: there was selected a group of professionals linked to the decision-making process at various contexts of the national health care system. Focal groups for each identified level were organized in addition to making in-depth interviews to chosen managers, physicians, professors and researchers to find their criteria on this issue. Results: practical, methodological and administrative factors that either strengthen or limit the development of economic assessment nationwide were identified. Conclusions: a number of actions were put forward to strengthen the use of economic assessment in health in the decision-making process in Cuba

Propuesta de reglas de decisión en las evaluaciones económicas de tecnologías sanitarias para el contexto cubano / Proposals of decision rules in economic assessment of health technologies for the Cuban context

INTRODUCCIÓN: Aunque las evaluaciones económicas en el sector sanitario cubano han crecido en número y en calidad, con poca periodicidad son utilizadas en la toma de decisiones, ni se solicitan con frecuencia. Una de las posibles causas para no emplearlas es que casi ninguna muestra las reglas de decisión aplicadas por los investigadores para la alternativa que proponen, lo que incrementa la incertidumbre de los encargados de tomar decisiones. OBJETIVO: Presentar un grupo de reglas de decisión en evaluaciones económicas que forman parte de la literatura. RESULTADOS: Se presentan criterios de decisión para evaluaciones económicas de tipo costo efectividad (plano costo efectividad); costo utilidad (considerada una variante de la técnica costo efectividad) emplea como criterio de decisión el plano costo efectividad también; costo beneficio utiliza el valor actual neto, la razón costo beneficio bruta y la tasa interna de rendimiento. CONCLUSIÓN: La aplicación de reglas de decisión en las evaluaciones económicas contribuye a la reducción de la incertidumbre en el momento de decidir entre alternativas

INTRODUCTION: Although the economic assessments in the Cuban health sector have increased in number and in quality, they are neither used frequently used in the decision-making nor are frequently requested. One of the potential causes of this non-use is that almost any shows of decision rules applied by researchers for the own alternative increasing the uncertainty of those charged of decisions-making. OBJECTIVE: To present a series of decision rules in economic assessments to be part of the literature. RESULTS: Some decision criteria are presented for economic assessment of cost-effectiveness ( cost-effectiveness plan); cost-usefulness (a variant of cost-effectiveness technique) which uses as decision criterion also the cost-effectiveness plan; cost-benefit uses the net current value, the gross cost-benefit ratio and the performance internal rate. CONCLUSION: The researches related to economic evaluations must to be enclosed by the decision rules on the proposed alternatives, thus it allow to decision-maker to make the choice

Aspectos metodológicos críticos en las evaluaciones económicas de salud en el contexto cubano / Critical methodological aspects of the health economic assessments in the Cuban setting

Diversos factores participan como determinantes en el aumento sostenido de los costos de atención de la salud, lo que ha obligado a los gobiernos de todos los países del mundo a priorizar la asignación de los recursos disponibles entre diversas opciones de gasto en salud. Ante esta situación es de suma importancia lograr una mayor eficiencia en la aplicación de los recursos existentes. En este artículo se presentan los pasos básicos para la realización de evaluaciones económicas en salud, escasas aún en Cuba, con el objetivo de contribuir a su mejor comprensión. Se profundiza en dos de las acciones específicas de este tipo de estudio: la identificación de opciones de comparación y el análisis de resultados. A pesar del paso de avance dado en el campo metodológico con la Guía de Evaluación Económica en Salud cubana todavía se debe insistir en el rigor metodológico de este tipo de estudios

A number of factors are involved as determinants in the sustained increase of health care costs, all of which has forced the governments worldwide to prioritize the allocation of the available resources among several health expenditure choices. In the face of this situation, it is extremely important to achieve higher efficiency in the use of existing resources. This paper presented the basic steps to make health economic assessments, still very limited in Cuba, in order to contribute to a better understanding. It delved into two specific actions of this type of study, that is, identification of comparison options and analysis of results. Despite the step forward represented by the Cuban Health Economic Assessment Guideline in the methodological field, it is necessary to insist on the methodological rigor that this type of studies must have

Fundamentos de los estudios de costo de la enfermedad: valoración actual del costo del glaucoma / Basic principles of study of disease costs: current assessment of glaucoma cost

INTRODUCCION: los estudios del costo de la enfermedad consisten en una estimación cuantificada y valorada en unidades monetarias de un conjunto de efectos de una enfermedad, un grupo de enfermedades o de un factor de riesgo, sobre los recursos, y sobre otras variables que tienen un efecto presumible sobre el bienestar de los individuos y la sociedad. OBJETIVOS: explicar los fundamentos generales de los estudios de costo de la enfermedad, y describir el estado actual de un caso particular, del glaucoma. MÉTODOS: se aplicó el modelo Big 6 desarrollado por Mike Eisenberg y Bob Berkoeitz, como método sistemático de solución de problemas de información, apoyada en el pensamiento crítico, para realizar la búsqueda de bibliografía. RESULTADOS: los estudios del costo de la enfermedad se consideran un estudio parcial, o bien un tipo de ejercicio de preevaluación que puede servir de punto de partida de estudios de evaluación propiamente dichos. Los estudios sobre las implicaciones socioeconómicas del glaucoma, refieren que los costos de la atención al paciente aumentan a medida que empeora esta enfermedad, y que la efectividad en el tratamiento al paciente y el retraso en la progresión de la enfermedad, pueden reducir significativamente la carga económica del glaucoma. CONCLUSIONES: los estudios de costo de la enfermedad pueden demostrar que las enfermedades requieren una mayor asignación de recursos para la prevención y para el tratamiento, y ayudarán a influir en las decisiones sobre las prioridades de investigación y monitorear el impacto de iniciativas de políticas en la salud visual

INTRODUCTION: studies of disease costs are an quantified valuation and assessed in monetary units of a series of disease effects, a group of diseases or of a risk factor on the resources and on other variables with a likely effect on the subject and society wellbeing. OBJECTIVES: to explain the general the basic principles of studies of disease cost and to describe the current state of a particular case of the glaucoma. METHODS: Big 6 form was applied developed by Mike Eisenberg and Bob Berkoeitz, as a systemic method of information problems solution supported in the critical thought to carry out the search of reference. RESULTS: the disease cost studies are a partial study or a type of pre-evaluation exercise that may to be the starting point of evaluation studies as such. The studies on the socioeconomic implications of glaucoma showed that the costs of patient care increase according to the worsening of disease and that the activity in patient treatment and a retard in the disease progression may to reduce significantly the economic burden of glaucoma. CONCLUSIONS: the disease cost studies may to demonstrate that diseases require a major resources allocation to prevention and to treatment and will help to influence in the decisions on the research priorities and to monitoring the impact of initiative of politics in visual health

Elementos de calidad para la evaluación hospitalaria del paciente con enfermedad cerebrovascular / Quality elements to the hospital assessment of the patient presenting with cerebrovascular disease

La enfermedad cerebrovascular constituye un problema de salud para Cuba, al ser la tercera causa de muerte y la primera de discapacidad en el adulto, con serias repercusiones para el paciente, su familia y la sociedad. La presente revisión pretende actualizar acerca de los indicadores de calidad y los estudios de evaluación económica de la enfermedad. Se revisan diferentes definiciones de calidad en el sector de la salud, se discute acerca de la evaluación continua de la calidad mediante indicadores apropiados y la eficiencia de la atención hospitalaria con sus implicaciones sociales y económicas como un imperativo para este sector en Cuba. Partiendo del principio de que la salud no tiene precio, aunque para recuperarla y mantenerla sea preciso incurrir en elevados costos, se trata el tema de la evaluación económica con la premisa de que la economía y la salud deben constituir un binomio inseparable.

The cerebrovascular disease is a health problem for Cuba being the third cause of death and the first one of adult's inability with serious repercussions for the patients, its family and society. The aim of present review is to update on the quality indicators and the economic assessment studies of disease. In health field some different quality definitions are reviewed, approaching on the continuous assessment of quality by appropriate indictors and the hospital care efficiency with its social and economic implications as an essential feature for this field in Cuba. From the principle that the health has not price, although to recover and to maintain it be necessary to incur in high costs, the subject of economic assessment is approached with the premise that the economy and health are essential for this field in Cuba. From the principle that health has not price, although to recover and to maintain it is necessary incur in high costs, the subject of economic assessment is approached with the premise that the economy and the health must to be an inseparable binomial feature.

Evaluación económica de la incapacidad laboral temporal en una institución de salud / Economic assessment of temporary work disability in a health care institution

La seguridad social cubana garantiza una cobertura total a toda la población desde el triunfo de la Revolución. La incapacidad laboral temporal es un aspecto que el sistema actual de seguridad social contempla. El Anexo II de la Resolución Ministerial 176/89 regula la prescripción, por los médicos, de los días de reposo. Este trabajo tiene el objetivo de valorar la repercusión económica, para el Instituto de Cardiología y Cirugía Cardiovascular, del pago por los certificados médicos presentados por sus trabajadores en el año 2005. Se realizó una evaluación económica parcial del tipo descripción de costos. Fueron revisados los 224 certificados médicos recibidos en el centro en ese año. Se confrontó la incapacidad laboral temporal prescrita con lo establecido y se cuantificaron las diferencias. Los certificados médicos recibidos prescribieron 523 días màs que lo reglamentado, en términos económicos significó el pago de 4 286,03 pesos por encima de lo estipulado. Se indican màs días de reposo por certificados médicos que lo autorizado por la Resolución Ministerial 176/89. Se considera que el Anexo ll tiene 17 años de emitido y debe ser revisado y ampliado el espectro diagnóstico

Since the triumph of the revolution, Cuban social welfare assures overall coverage to the whole population. Temporary work disability is an issue that the present social welfare system takes into account. Annex 2 to the ministerial resolution no 176 of 1989 stipulates the prescription by physicians of the number of days that an individual under treatment should rest. Objectives To assess the economic impact of the payment of medical leaves submitted by sick workers at the Institute of Cardiovascular Surgery and Cardiology in 2005. Partial cost description-type economic assessment was made in which all the 224 medical leaves submitted that year were checked. The prescribed temporary work disability was compared with that of the resolution, and then differences were estimated. Medical leaves prescribed 523 days more than the number set by the law, which economically accounted for the payment of 4 286,03 pesos in excess. The number of rest days prescribed in medical leaves was higher than the number stipulated by the ministerial resolution no 176 of 1989. It was considered that Annex 2 was issued 17 years ago; therefore, the diagnostic range should be reviewed and expanded

Economic Assessment of Insulin Glargine and Insulin Determir for Type 2 Diabetes / 中国药房

OBJECTIVE: To conduct cost-effective analysis according to clinical trial results of foreign type 2 diabetic patients treated with insulin glargine and insulin determir in order to provide reference for application of basal insulin in China. METHODS: Cost-minimization analysis was used due to the clinical trial results that two kinds of basal insulin had no significant differences in glycemic control. The cost of treatment was detected and evaluated from the perspective of medical insurance. RESULTS: When insulin glargine and insulin determir had same effect on glycemic control and hypoglycemia risk, insulin glargine was 40.77% cheaper than insulin determir in terms of the yearly treatment cost. The cost of treatment of insulin glargine was cheaper than that of insulin glargine although some key factors were adjusted. CONCLUSION: As compared with insulin determir, the cost of treatment is decreased by using insulin glargine for type 2 diabetic patients. Moreover, effect of insulin glargine on glycemic control is the same to insulin determir, which is advantage for controlling the increase of health expenditure.