Predictors Of Catastrophic Costs Of Tuberculosis (TB) Among Patients Co-Affected With TB-HIV And TB-Diabetes In Bhavnagar Region, Western India

Background: By the year 2030, no family with a patient of tuberculosis (TB) is supposed to incur cata-strophic costs. In India, a significant number of people suffer from TB, and many faces catastrophic costs. Our objective was to determine the predictors of catastrophic costs due to TB among co-prevalent TB-HIV and TB-diabetes patients. Methods: We conducted a cross-sectional study among 234 patients co-affected with TB-HIV and 304 patients with TB-diabetes co-prevalence in the Bhavnagar region (western part of India). TB costs was estimated using a validated questionnaire. Multivariable logistic regression was used to determine the significant predictors of catastrophic costs of TB. Results: Four percent of patients in each group incurred catastrophic costs due to TB. Female gender [aOR 6 (1.2-33)], being single [aOR 9 (1.5-52)], low socioeconomic status [aOR 7 (1.2-30)], private con-sultation for TB [aOR 9 (1.5-53)], and hospitalization in first HIV visit [aOR 19 (3-137)] were significant-ly predicted catastrophic costs of TB among patients co-affected with TB-HIV. Among patients with TB-diabetes co-prevalence, hospitalization in first TB visit [aOR 7 (2-29)], and private consultation for TB [aOR 7 (1.6-30)] were the significant predictors. Conclusions: Despite a lower percentage of TB-HIV/ TB-diabetes patients facing catastrophic costs, hospitalization and private care-seeking are the “modifiable” determinants of TB catastrophic costs in our study setting.

Impactos da insuficiência cardíaca no sistema de saúde e previdenciário brasileiro: qual é o custo da doença? / Impacts of heart failure on the Brazilian health and pension system: what is the cost of the disease?

Objetivo: Estimar os principais custos indiretos da insuficiência cardíaca (IC) na população brasileira, sobre o sistema de saúde, o custo previdenciário e o quanto se perde em produtividade pelas complicações da doença. Métodos: Estudo ecológico desenvolvido com dados secundários, para a série histórica de 2018 a 2021, minerados do Departamento de Informática do Sistema Único de Saúde (Datasus), do Instituto Brasileiro de Geografia e Estatística (IBGE), e indicadores previdenciários coletados da Previdência Social e Instituto Nacional do Seguro Social (INSS). Resultados: Foram registrados 77.290 óbitos por IC no Brasil para o período, distribuídos uniformemente em relação ao sexo. A taxa de mortalidade foi diversificada entre as regiões brasileiras, com ênfase para Sudeste e Nordeste. As projeções indicam um gasto total de mais de R$ 1 bilhão com hospitalizações, com custo médio hospitalar de R$ 1.725,27 por pessoa. O custo médio por internação ultrapassou os R$ 2 bilhões de reais. Aproximadamente 3% das despesas federais são destinadas a pagamentos de benefícios relacionados a IC. Do total de afastamentos, 65% correspondem a homens e 35%, a mulheres, com custos que podem chegar a R$ 6 bilhões perdidos por ano. Conclusão: Os resultados sugerem um aumento do afastamento de portadores de IC da força de trabalho, o que acarreta maiores dispêndios para o sistema de saúde e pagamentos de benefícios previdenciários, como auxílio-doença e aposentadoria por incapacidade de longa duração. Este é o primeiro estudo que estima e correlaciona os dados socioepidemiológicos e os custos de saúde e previdenciários da IC no Brasil.

Objective: To estimate the main indirect costs of heart failure (HF) in the Brazilian population, on the health system, social security cost, and how much is lost in productivity due to the complications of the disease. Methods: Ecological study developed with secondary data, for the historical series from 2018 to 2021, mined from the Department of Informatics of the Unified Health System (Datasus), from the Brazilian Institute of Geography and Statistics (IBGE), and social security indicators collected from Social Security and the National Social Security Institute (INSS). Results: There were 77,290 deaths from HF in Brazil for the period, evenly distributed according to sex. The mortality rate was diversified among Brazilian regions, with emphasis on the Southeast and Northeast. Projections indicate a total expenditure of more than BRL 1 billion with hospitalizations, with an average hospital cost of BRL 1,725.27 per person. The average cost per hospitalization exceeded BRL 2 billion. Approximately 3% of federal expenditures are earmarked for IC benefit payments. Of the total number of absences, 65% correspond to men and 35% to women, with costs that can reach R$ 6 billion lost per year. Conclusion: The results suggest an increase in the removal of HF patients from the workforce, which leads to higher expenditures for the health system and payments of social security benefits, such as sick pay and retirement due to long-term disability. This is the first study that estimates and correlates socio-epidemiological data, health and social security costs of HF in Brazil.

Cost-utility analysis of traditional drug therapy with and without exercise program for hypertensive patients in real-life data primary health care

Abstract Aim: The study aimed to conduct a cost-utility analysis of traditional drug therapy (TDT) provided for hypertensive patients at primary care in comparison to the protocol based on combination with an exercise program (TDT+E) in real-life conditions, adopting a health system perspective. Methods: Longitudinal study based on enrollment of 49 hypertensive adults distributed into two groups, for 12 months. Quality-adjusted life years were estimated using health-related quality of life. Direct health care costs were calculated including inputs and human resources in primary care from medical records. Sensitivity analysis was performed based on multivariate and probabilistic scenarios. Results: Incremental cost-effectiveness ratios of TDT+E in comparison to TDT were +79.69. Sensitivity analysis showed that TDT+E presented advantages considering uncertainties. Conclusion: Our findings show that exercise programs may improve quality of life and life expectancy among hypertensive patients.

Costos de atención del cáncer de mama en el Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, México / Health-care costs of breast cancer at the Institute of Social Security and Services for Government Workers in Mexico

Resumen: Objetivo: Calcular los costos del tratamiento habitual y normativo del cáncer de mama (CaMa) en el Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE). Material y métodos: Se utilizó la metodología de procesos, desde la perspectiva del prestador. Se identificaron los recursos utilizados durante un año de tratamiento a través de cuestionarios en línea aplicados a oncólogos (tratamiento habitual) de diferentes hospitales y a partir de la revisión de guías clínicas (tratamiento normativo). Resultados: El costo anual habitual fue de $113.6 millones de dólares. Los costos en hospitales regionales y generales para el estadio I son 1.23 y 1.12 mayores al de alta especialidad. Los costos en los estadios 0-II son mayores al normativo por mayor uso de consultas y quimioterapia. Conclusiones: El costo anual del CaMa representó 3.8% del presupuesto del ISSSTE en 2017. Incrementar la eficiencia de los recursos destinados a su tratamiento requeriría mejorar la adherencia a las guías clínicas y la detección temprana.

Abstract: Objective: To estimate the cost of common versus normative practice in the treatment of breast cancer (BrCa) at the Mexican Institute of Social Security and Services for Government Workers (ISSSTE). Materials and methods: A process approach from the perspective of providers. We identified the resources utilized during one year of treatment through online questionnaires administered to oncologists in various hospitals (common treatment) as well as by conducting a clinical guidelines review (normative treatment). Results: The cost of common treatment was USD113.6 million annually. For stage I cases, it proved 1.23 and 1.12 times higher in regional and general as opposed to highly specialized hospitals. For stages 0-II cases, it was higher than normative treatment owing to greater use of consultations and chemotherapy. Conclusions: BrCa accounts for 3.8% of the ISSSTE budget in 2017. Achieving greater efficiency in the use of resources allocated for BrCa treatment requires stricter adherence to clinical guidelines as well as early detection.

Associação entre custos por equipe de saúde da família e porte de unidade básica de saúde em uma capital do sul do Brasil / Association between costs per family health team and size of basic health unit in a capital of southern Brazil

Resumo O objetivo deste artigo é verificar a existência de associação entre o número de equipes de saúde da família em unidades de atenção primária (porte) e os custos por equipe individualmente. 46 unidades básicas de saúde foram incluídas na amostra para verificar associação por meio de regressão linear múltipla entre custos por equipe (variável dependente) e quantidade de equipes por unidade, controlado pelos atendimentos produzidos (variáveis independentes). Os dados utilizados foram derivados de um estudo de apuração de custeio por absorção. Houve importante associação inversa entre o porte da unidade e os custos por equipe, controlado pelos atendimentos (R² ajustado =0,69; p<0,001 para IC=95%), ainda que os custos por equipe em unidades de mesmo porte tenham variado consideravelmente. Os resultados encontrados versam em favor da alocação de um maior número de equipes de saúde da família na mesma unidade, reduzindo os custos por equipe.

Abstract The scope of this article is to verify the existence of the association between the number of family health teams in primary care units and the individual costs per team. A total of 46 basic health units were included in the sample to verify association through multiple linear regression between the costs per team (dependent variable) and the number of teams per unit, controlled by the number of health care procedures (independent variables). The data used were derived from a study of assessment of costing by absorption. There was an important inverse association between the size of the unit and the costs per team, controlled by the number of health care procedures (adjusted R² =0.69; p<0.001 for CI=95%), although costs per team in similar sized units varied considerably. The results encountered tend to suggest the benefits of the allocation of a larger number of family health teams in the same unit, thereby reducing the costs per team.

Carga económica de la fibrilación auricular en Colombia / Financial burden of atrial defibrillation in Colombia

Resumen Objetivo: Determinar la carga económica de la fibrilación auricular en Colombia. Materiales y métodos: Se realizó un estudio retrospectivo sobre bases de datos de atención de pacientes con diagnóstico de fibrilación auricular. Los pacientes fueron identificados a partir de los diagnósticos registrados en las atenciones ambulatorias y hospitalarias, utilizando como referencia el código diagnóstico CIE-10 de fibrilación auricular (I48x). Luego de la identificación de los pacientes se construyó un algoritmo que simulaba la historia natural y de atención de la enfermedad, el cual fue elaborado a partir de guías de manejo de la enfermedad. Se utilizó una técnica de microcosteo en función de una base de datos oficial de una aseguradora colombiana, teniendo en cuenta la historia natural de la enfermedad construida. Resultados: El costo anual de un paciente con fibrilación auricular diagnosticada correctamente es de $6.218.179, el de un paciente con evento tromboembólico agudo o signos inespecíficos como primera manifestación de la enfermedad es de $23.665.300, y el de un paciente con un infarto previo al diagnóstico de fibrilación auricular es de $37.493.968. Conclusiones: En términos de costos, el paciente que se mantiene controlado pese a que se incurra en costos de tecnologías para su control, es menos costoso que aquel que genera episodios agudos.

Abstract Objective: To determine the financial cost of atrial defibrillation in Colombia. Materials and methods: A retrospective study was carried out using health care data bases on patients with a diagnosis of atrial fibrillation. The patients were identified from the diagnoses recorded in ambulatory and hospital care registers, using the atrial fibrillation ICD-10 diagnostic (I48x). After the patients were identified, an algorithm was constructed by using the management guidelines for the disease and that simulated the natural history and care of the disease. A micro-costing technique was used in accordance with an official data base of a Colombian insurance Company, taking into account the natural history of the disease constructed. Results: The mean annual cost of a patient correctly diagnosed with atrial fibrillation is $6,218.179, that of the patient with an acute thrombo-embolic event or non-specific signs as a first manifestation of the disease is $23,665.300, and that of the patient with an infarction prior to the diagnosis of atrial fibrillation is $37,493.968. Conclusions: In terms of costs, the patient that is maintained under control, despite the technological costs of their control, is less costly than one that has acute episodes.

Análisis de parámetros de calidad y de costos, de uso del catéter venoso central de inserción periférica frente al catéter de inserción central, en población pediátrica del Hospital Universitario del Valle, Cali, Colombia. 2011-2014 / Analysis of quality parameters and costs of using the central venous catheter of peripheral insertion versus the central insertion catheter in pediatric patients at Hospital Univeristario Del Valle, Cali Colombia 2011-2014

Objetivo: estimar parámetros de calidad y de costos en el procedimiento de inserción de Catéter Venoso Central y el Catéter Venoso Central de inserción periférica. Metodología: Se evaluaron las historias de niños (edad 31 días -15 años ), que ingresaron al Hospital Universitario del Valle, entre enero de 2011 y diciembre de 2014, que requirieron canalización de una vena central. Se evaluaron variables demográficas, de calidad y se estimaron costos de ambos procedimientos. Resultados: Se evaluaron 100 procedimientos de inserción Central y 100 de inserción periférica, los últimos tuvieron menor tiempo de espera, se realizaron en la habitación, no requirieron ayuno, ni traslado al quirófano, a un menor costo, lo cual impactó la oportunidad de administración de tratamiento farmacológico, la evolución y la estancia hospitalaria. Conclusiones: Se recomienda que el procedimiento de inserción periférica sea la primera elección en niños que requieran tratamientos endovenosos mayores a cinco días, para esto es necesario conformar un grupo que supervise el funcionamiento de los catéteres y brinde educación continua al personal de salud de los servicios de hospitalización y a familiares, contar con una sala de procedimiento para la inserción del PICC que brinde seguridad y adecuado manejo del dolor.

Aim: to estimate quality and cost parameters of central venous catheter insertion peripheral and central venous catheter procedures. Methods: we reviewed records of 200 children (31 days - years old), hospitalised at a University Hospital between January 2011 and December 2014 who required central vein access. We assessed demographic, quality variables and cost of both procedures. Results: we reviewed records of 100 central insertion and 100 peripheral insertion procedures. Peripheral insertions had less waiting time, were conducted next to the child's bed, without need for fasting or transfering to the operating room, at a lower cost, all of these ensured timely administration of medicaments and nutrition, which resulted in lower stance time. The peripheral insertion also freed surgeon and operating room time to perform other interventions. Conclusions: We recommend that peripheral insertion procedure should be the first choice in children requiring intravenous treatments longer than five days. In order to establish a periferal insertion procedure in a hospital, a team is required to follow-up the patients and provide continuing education to health personnel in services and to family members, there is also a need for an appropiate space for insertion procedures and pain management.

Aplicação do método de custeio baseado em atividade e tempo (TDABC) em uma Instituição de Longa Permanência de Idosos (ILPI) / The application of time-driven activity-based costing in an Elderly People Institution

Objetivos: O envelhecimento da população brasileira é caracterizado por ser um processo progressivo e crescente. A necessidade de gerenciamento econômico robusto dos serviços disponibilizados à saúde do idoso torna-se imprescindível. O objetivo deste estudo foi avaliar a estrutura de gestão de custos de uma Instituição de Longa Permanência de Idosos (ILPI). Métodos: As orientações para a aplicação do método de custeio baseado em atividade e tempo (TDABC) foram utilizadas como método de análise de custos. Os dados dos anos de 2018 e 2019 foram considerados para formar as análises e viabilizar a compreensão dos diferentes graus de consumo de recursos, durante o ciclo de cuidados da ILPI. Resultados: A aplicação da metodologia estimou o custo unitário de cada residente considerando o seu grau de dependência devido a sua condição clínica. Pôde-se identificar pontos de melhorias gerenciais, com ênfase na revisão da alocação das capacidades de hospedagem. Conclusões: O TDABC, como uma metodologia de fácil aplicação para estruturação dos custos relacionados a cada paciente, traz resultados oportunos para a melhor gestão e otimização de recursos em organizações de saúde. Sugere-se para trabalhos futuros a aplicação de um estudo de precificação dos serviços da ILPI, de modo que essa possa pautar os valores de mensalidades cobradas em bases mais sólidas.

Objectives: The need for a robust management of services focus on the elderly health becomes essential. The objective of this study was to evaluate the costs structure of an Elderly Long Term Care Institution (ILPI). Methods: The literature orientations for the application of the time-driven activity-based costing (TDABC) were used as a cost analysis method. Data from 2018 and 2019 were considered to form the analyzes and enable the understanding of the different degrees of resource consumption during the LTCI care cycle. Results: The application of the methodology estimated the unit cost of each resident considering their degree of dependence due to their clinical condition. Management improvement points could be identified, with emphasis on the review of hosting capacity allocation. Conclusions: TDABC as an easily applied methodology that brings timely results for better resource management and optimization in healthcare organizations. It is suggested for future researches the application of a pricing study of the services of ILPI, so that it can guide the monthly fees charged on a better substantiated basis.

Real-world evidence of health outcomes and medication use 24 months after bariatric surgery in the public healthcare system in Brazil: a retrospective, single-center study

OBJECTIVES: The number of bariatric procedures has significantly increased in Brazil, especially in the public Unified Health System. The present study describes health outcomes and medication use in obese patients treated in a major hospital that performs publicly funded surgery in Brazil. METHODS: A retrospective, single center study was conducted to collect real-world evidence of health outcomes and medication use in 247 obese patients (female, 82.2%) who underwent open Roux-en-Y gastric bypass. Changes in weight and body mass index (BMI), presence of apnea, hypertension, and type 2 diabetes (T2D), and medication use (hypertension, diabetes, and dyslipidemia) were assessed preoperatively and up to 24 months postoperatively. The mean cost of medications was calculated for the 12-month preoperative and 24-month postoperative periods. RESULTS: During the surgery, the mean age of patients was 43.42 years (standard deviation [SD], 10.9 years), and mean BMI was 46.7 kg/m2 (SD, 6.7 kg/m2). At 24 months, significant declines were noted in weight (mean, -37.6 kg), BMI (mean, -14.3 kg/m2); presence of T2D, hypertension, and apnea (-29.6%, -50.6%, and -20.9%, respectively); and number of patients using medications (-66.67% for diabetes, -41.86% for hypertension, and -55.26% for dyslipidemia). The mean cost of medications (total costs for all medications) decreased by >50% in 12-24 postoperative months compared to that in 12 preoperative months. CONCLUSION: Roux-en-Y gastric bypass successfully reduced weight, BMI, and comorbidities and medication use and cost at 24 months in Brazilian patients treated in the public Unified Health System.

Sleep pattern, obesity and healthcare expenditures in Brazilian adults / Padrões do sono, obesidade e despesas em saúde com brasileiros adultos

Abstract The aim of this study was to analyze the relationship between sleep pattern and healthcare expenditures in adults, as well as to identify whether physical activity, biochemical markers and obesity affect this relationship. The sample was composed of 168 adults aged ≥ 50 years attended by two Basic Healthcare Units in Presidente Prudente, SP, Brazil. Health expenditure, sleep pattern, anthropometry, adiposity index, physical activity, metabolic and cardiovascular variables were assessed. Statistical analyses were performed using Kruskal-Wallis, Mann-Whitney and Spearman tests. Sleep disorders were positively correlated to higher costs with medicines and negatively correlated to costs with laboratory tests, even after adjusts by confounders. In addition, healthcare costs were also correlated to physical activity score, blood pressure, obesity and metabolic variables. Severe sleep disorders and high percentage of body fat were associated with increased use of medications. Sleep pattern is correlated to primary care healthcare costs, obesity and physical activity level.

Resumo O objetivo deste estudo foi analisar a relação entre padrão de sono e despesas de saúde em adultos, bem como identificar se atividade física, marcadores bioquímicos e obesidade afetam esse relacionamento. A amostra foi composta por 168 adultos com idade ≥ 50 anos atendidos por duas unidades básicas de saúde em Presidente Prudente, SP, Brasil. Foram avaliadas as despesas de saúde, padrões do sono, antropometria, atividade física, variáveis metabólicas e cardiovasculares. Foram utilizados Kruskal-Wallis, Mann-Whitney e Spearman. Os distúrbios do sono foram correlacionados positivamente com os custos mais elevados com medicamentos e negativamente com os custos com testes laboratoriais, mesmo após ajuste por fatores de confusão. Além disso, os custos de saúde também foram correlacionados ao escore de atividade física, pressão arterial, obesidade e variáveis metabólicas. Distúrbios graves do sono e alta porcentagem de gordura corporal foram associados ao aumento do uso de medicamentos. O padrão de sono está correlacionado com os custos de cuidados de saúde primários, obesidade e atividade física.

The tale of lenalidomide clinical superiority over thalidomide and regulatory and cost-effectiveness issues / A narrativa de que a lenalidomida é clinicamente superior à talidomida, e questões regulatórias e de custo-efetividade

Abstract In April 2017, the National Sanitary Surveillance Agency (ANVISA-Brazil) approved lenalidomide (LEN) for multiple myeloma (MM) and myelodysplastic syndrome. ANVISA had rejected the first application in 2010, and denied a request for reconsideration in 2012. The reason for rejection was the lack of comparative effectiveness studies proving that LEN was more effective than thalidomide (THAL), a strictly controlled drug regulated by Federal law 10.651/2003 and dispensed to patients (at no costs) through public health system units and hospitals. ANVISA unexplained retreat on the LEN approval for marketing was an unquestionable triumph of the lobbying that ensued the denial, at the forefront of which were politicians, Congress members, patient organizations and medical societies. Two randomized (phase III) trials and three observational (case-control and population-based cohort) compared the effectiveness of THAL- versus LEN-based therapies in MM. Overall, these studies showed no difference in efficacy between LEN- and THAL-based therapies. LEN caused less neuropathy, and more severe hematologic adverse effects. It is much costlier than THAL, and substitution of THAL by LEN shall raise considerably public healthcare costs in Brazil.

Resumo A Agência Nacional de Vigilância Sanitária (ANVISA) aprovou em abril de 2017 a lenalidomida (LEN) para o mieloma múltiplo (MM) e síndrome mielodisplásica. A ANVISA havia negado o registro em 2010, e indeferido um recurso apresentado em 2012. O motivo do indeferimento foi a falta de estudos comparativos de efetividade demonstrando que LEN era mais eficaz do que a talidomida (TAL), um medicamento rigorosamente controlado pela lei federal 10.651/2003 e dispensado gratuitamente a pacientes através de unidades de saúde e hospitais públicos. O recuo não explicado da ANVISA em relação ao registro da LEN foi um inquestionável triunfo do lobby que sucedeu a recusa inicial do registro, a frente do qual estavam políticos, membros do Congresso, associações de pacientes e sociedades médicas. Dois ensaios randomizados (fase III) e três estudos observacionais (caso-controle e coorte de base populacional) compararam a efetividade de terapias para o MM com TAL- e com LEN. Em conjunto, esses estudos mostraram que não havia diferenças quanto a eficácia de tratamentos com LEN- e aqueles com TAL. A LEN causou menos neuropatias, e efeitos adversos hematológicos mais graves. Ela é muito mais cara do que a TAL, e a substituição da TAL pela LEN aumentará muito os custos da assistência pública à saúde no Brasil.

MODERN MEDICAL DEVICES AND HOSPITAL DECISION-MAKING: A REVIEW OF ETHICAL AND SOCIAL CONSIDERATIONS DURING THE MANUFACTURE AND THE USE OF ADVANCED MEDICAL DEVICES

@#The adoption of technologically advanced medical devices assisted healthcare providers to examine and treat diseases. However, technological advancements could increase the threats to safety, security, and reliability of the devices from complications associated with manufacturing, functionality, and the clinical application of the devices.

Atenção domiciliar: perfil assistencial de serviço vinculado a um hospital de ensino / Home care: care profile of a service linked to a teaching hospital

Resumo Objetivos: Descrever o perfil dos usuários e cuidadores atendidos pelo Serviço de Atenção Domiciliar; verificar associações e correlações entre as variáveis. Método: Estudo do tipo documental, quantitativo, realizado entre maio e novembro de 2017. A análise dos dados foi feita por meio de estatística básica, teste qui-quadrado e coeficiente de correlação de Pearson. Resultados: Dos 46 usuários, a maioria era idosa, do sexo feminino (71,74%), com renda de até dois salários mínimos (65,22%), dependentes para o autocuidado (89,13%). A variável "grau de dependência" teve associação estatisticamente significante com o sexo (p=0,025), o motivo de inclusão (p=0,003), especialidade médica (p=0,013), classificação no SAD (p<0,001) e a presença de cuidador familiar (p=0,017). Demandavam 7,46 equipamentos de saúde, sendo que 70% eram arcados pela família; e 6,78 procedimentos de enfermagem, dos quais 52% eram realizados pelo cuidador. Houve diferença estatisticamente significante entre os custos e gastos assumidos pelas famílias (p<0,001), o número de equipamentos de saúde (p<0,001) e o número de procedimentos de enfermagem demandados (p<0,001). Sobre os cuidadores, a maioria era do sexo feminino (85,71%), com idade média de 62,3 anos, 50% eram filhos(as) e 23,81% esposos(as). Conclusão: Funções, responsabilidades, custos e gastos são transferidos às famílias, onerando o cuidado domiciliar.

Abstract Objectives: To describe the profile of the users and caregivers attended by the Home Care Service; to verify associations and correlations among variables. Method: Documentary, quantitative study conducted between May and November 2017. Data analysis was performed using basic statistics, chi-square test and Pearson's correlation coefficient. Results: Of the 46 users, most were elderly, female (71.74%), with income of up to two minimum wages (65.22%), dependent for self-care (89.13%). The variable "degree of dependence" had a statistically significant association with sex (p = 0.025), inclusion motive (p = 0.003), medical specialty (p = 0.013), SAD classification (p <0.001) and presence of caregiver (p = 0.017). They demanded 7.46 health equipment, 70% of which were housed by the family; and 6.78 nursing procedures, of which 52% were performed by the caregiver. There was a statistically significant difference between the costs and expenses assumed by the families (p <0.001), the number of health facilities (p <0.001) and the number of nursing procedures required (p <0.001). Among caregivers, most of them were female (85.71%), with a mean age of 62.3 years, 50% were children and 23.81% were spouses. Conclusion: Functions, responsibilities, costs and expenses are transferred to families, burdening home care.

Early Detection is Important to Reduce the Economic Burden of Gastric Cancer

PURPOSE: Early detection of gastric cancer is important to improve prognosis. Early detection enables local treatment, such as endoscopic submucosal dissection (ESD). Therefore, we investigated whether early detection of gastric cancer could reduce healthcare costs by comparison according to stage and treatment modalities. MATERIALS AND METHODS: Medical care costs were investigated according to tumor stage and initial treatment modality in 1,188 patients newly diagnosed with gastric cancer at 7 medical institutions from December 2011 to June 2012. Total medical care costs during the first-year after diagnosis (total first-year costs) were examined, including the costs of initial treatment, post-initial treatment, and inpatient and outpatient visits. RESULTS: Stage I (75.3%) was the most common cancer stage. ESD was the second most common treatment following surgery. Total first-year costs increased significantly from stages I to IV. The costs of initial treatment and post-initial treatment were lowest in patients with stage I cancer. Among patients with stage I cancer, total first-year costs were significantly lower when treated by ESD; in particular, initial ESD treatment costs were much lower than others. CONCLUSIONS: The cost of healthcare has increased significantly with increasing cancer stages. ESD can greatly reduce medical care costs of gastric cancer. Thus, early detection of gastric cancer is important to reduce healthcare costs.

Predictors of micro-costing components in liver transplantation

OBJECTIVES: Although liver transplantation procedures are common and highly expensive, their cost structure is still poorly understood. This study aimed to develop models of micro-costs among patients undergoing liver transplantation procedures while comparing the role of individual clinical predictors using tree regression models. METHODS: We prospectively collected micro-cost data from patients undergoing liver transplantation in a tertiary academic center. Data collection was conducted using an Intranet registry integrated into the institution’s database for the storing of financial and clinical data for transplantation cases. RESULTS: A total of 278 patients were included and accounted for 300 procedures. When evaluating specific costs for the operating room, intensive care unit and ward, we found that in all of the sectors but the ward, human resources were responsible for the highest costs. High cost supplies were important drivers for the operating room, whereas drugs were among the top four drivers for all sectors. When evaluating the predictors of total cost, a MELD score greater than 30 was the most important predictor of high cost, followed by a Donor Risk Index greater than 1.8. CONCLUSION: By focusing on the highest cost drivers and predictors, hospitals can initiate programs to reduce cost while maintaining high quality care standards.

Healthcare Costs for Acute Hospitalized and Chronic Heart Failure in South Korea: A Multi-Center Retrospective Cohort Study

PURPOSE: Although heart failure (HF) is recognized as a leading contributor to healthcare costs and a significant economic burden worldwide, studies of HF-related costs in South Korea are limited. This study aimed to estimate HF-related costs per Korean patient per year and per visit. MATERIALS AND METHODS: This retrospective cohort study analyzed data obtained from six hospitals in South Korea. Patients with HF who experienced ≥one hospitalization or ≥two outpatient visits between January 1, 2013 and December 31, 2013 were included. Patients were followed up for 1 year [in Korean won (KRW)]. RESULTS: Among a total of 500 patients (mean age, 66.1 years; male sex, 54.4%), the mean 1-year HF-related cost per patient was KRW 2,607,173, which included both, outpatient care (KRW 952,863) and inpatient care (KRW 1,654,309). During the post-index period, 22.2% of patients had at least one hospitalization, and their 1-year costs per patient (KRW 8,530,290) were higher than those of patients who had only visited a hospital over a 12-month period (77.8%; KRW 917,029). Among 111 hospitalized patients, the 1-year costs were 1.7-fold greater in patients (n=52) who were admitted to the hospital via the emergency department (ED) than in those (n=59) who were not (KRW 11,040,453 vs. KRW 6,317,942; p<0.001). CONCLUSION: The majority of healthcare costs for HF patients in South Korea was related to hospitalization, especially admissions via the ED. Appropriate treatment strategies including modification of risk factors to prevent or decrease hospitalization are needed to reduce the economic burden on HF patients.

Diagnóstico de problemáticas asistenciales en clínicas y hospitales de Barranquilla / Diagnosis of healthcare issues in clinics and hospital of Barranquilla

Objetivo Identificar y evaluar las principales problemáticas asistenciales en clínicas y hospitales de la ciudad de Barranquilla, Colombia. Método Estudio descriptivo aplicado a población de clínicas [23] y hospitales [5]. Se utilizó un nivel de confianza del 95 %, nivel de error del 5 % y p=0.5. El tamaño de muestra resultante para la población de clínicas y hospitales fue de 18 y 4 respectivamente. Los hospitales y clínicas fueron seleccionados aleatoriamente. Se diseñó una encuesta compuesta por 21 preguntas acerca del estado de los diferentes procesos asistenciales del sector. Los resultados se procesaron con la ayuda del software Microsoft Excel 2010. Resultados El 50 % de los hospitales manifestaron tener problemáticas en las áreas de Consulta Externa, Hospitalización y Estadística. Por su parte, el 61,1 % de las clínicas presentan dificultades en el área de Urgencias, 50 % en Intervención Quirúrgica, 50 % en Hospitalización y 38,9 % en Consulta Externa. Conclusiones El diagnóstico de problemáticas asistenciales en clínicas y hospitales de la ciudad de Barranquilla determina que si bien el proceso de hospitalización es un punto común de mejora potencial en clínicas y hospitales de la ciudad; las mayores prioridades de intervención las presentan en su orden Intervención Quirúrgica, Urgencias y Estadística.(AU)

Objective To identify and assess the main healthcare issues found in clinics and hospitals in Barranquilla. Methods Descriptive study applied on two populations: clinics [23] and hospitals [5]. A confidence level of 95 % and the alpha level of 5 % and p=0.5 were used in the study. The resulting sample size for clinics and hospitals was 18 and 4, respectively. Clinics and hospitals were randomly and a 21-question survey was designed to find out the status of the different healthcare processes in the Health Care Sector. The results were processed by using Microsoft Excel 2010 software. Results On one hand, 50 % of the hospitals expressed having problems in outpatient, hospitalization and statistical departments. On the other hand, 61.1 % of the clinics have difficulties in Emergency rooms, 50 % in Surgical Services, 50% in Hospitalization and 38.9 % in Outpatient Department. Conclusions The diagnosis regarding healthcare issues in clinics and hospitals of Barranquilla determines that although the Hospitalization process is a common point for potential improvement in both hospitals and clinics of the city, the greatest priority should be given to Surgical Services, Emergency Department and Statistical Department, due to their average intervention priority.(AU)

Custo e caracterização de infecção hospitalar em idosos / Cost and characterization of hospital infection among the elderly

O crescimento de idosos representa impacto direto no setor saúde. A hospitalização predispõe os idosos a complicações como a infecção hospitalar (IH). Objetivo: caracterizar perfil e custos de IH em idosos em um hospital terciário público. Método: estudo analítico, transversal. Idosos com IH em 2010 compuseram a população de estudo. Os dados derivaram de setores intra-hospitalares e as análises dos programas Excel 2010 e SPSS. Resultados: Participaram do estudo 341 idosos com índice de IH 3% superior à média mensal. Os sítios infecciosos mais frequentes foram: trato respiratório (58,1%), urinário (28,6%) e sítio cirúrgico (4,6%). Cada internação custou em média R$ 28.714,10 e a antibioticoterapia representou 5% desse valor. O aumento de 15 dias à média de permanência acrescentou R$ 17.946,30 aos custos com a internação. Conclusão: o idoso apresenta maior vulnerabilidade à IH. Os quadros infecciosos prolongam internações e elevam custos variando conforme o sítio.

The increase in the number of elderly individuals has a direct impact on the health system with hospitalization complications such as hospital infection (HI). The objective of this study is to characterize and evaluate the cost of HI among the elderly in a public hospital for the elderly. Descriptive, cross-sectional research was conducted. Elderly individuals with HI in 2010 comprised the population of the study. The data were drawn from hospital records and analysis was performed using Excel 2003 and SPSS software. The results indicated that 341 seniors participated in the study with a HI index 3% higher than the monthly average. The most frequent infectious sites were: respiratory tract infection (58.1%), urinary tract infection (28.6%) and surgical infection (4.6%). Each hospitalization cost R$ 28,714.10 on average and 5% of this amount was for antibiotics. The increase of 15 days average added R$ 17,946.3 to costs of hospitalization. The conclusion drawn is that the elderly have increased vulnerability to HI. The infections extend the hospitalization period and increase costs varying according to the nature of the infection.

Treatment of breast cancer patients from a public healthcare system in a private center: costs of care for a pilot public-private partnership in oncology / Pacientes com câncer de mama oriundas do Sistema Único de Saúde tratadas no setor privado: custos de um piloto de parceria público-privada em oncologia

OBJECTIVE: To describe the flow and costs associated with the diagnosis and treatment of patients with breast cancer who come from the public healthcare system and were treated at Hospital Israelita Albert Einstein. METHODS: Between August 2009, and December 2011, 51 patients referred by the Unified Public Healthcare System (SUS) had access to Hospital Israelita Albert Einstein for diagnostic radiology, medical oncology, radiotherapy, and oncologic/breast reconstruction surgery. The data were collected retrospectively from the hospital records, patient charts, pharmacy records, and from the hospital billing system. RESULTS: The total sum spent for diagnosis and treatment of these 51 patients was US$ 1,457,500.00. This value encompassed expenses with a total of 85 hospitalizations, 2,875 outpatient visits, 16 emergency room visits, and all expenses associated with these stays at the hospital. The expenditure for treatment of each patient submitted to biopsy, breast conserving surgery, adjuvant chemotherapy without trastuzumab (a regime with taxane followed by anthracycline), radiotherapy, and 5 years of tamoxifen was approximately US$ 25,500.00. CONCLUSION: Strategies for cost-reduction of treatment in the private setting are necessary to enable future large-scale public-private partnerships in oncology.

OBJETIVO: Descrever os fluxos e os custos associados ao diagnóstico e tratamento de pacientes com câncer de mama provenientes do Sistema Único de Saúde e tratadas no Hospital Israelita Albert Einstein. MÉTODOS: Entre agosto de 2009 e dezembro de 2011, 51 pacientes do Sistema Único de Saúde tiveram acesso à estrutura do Hospital Israelita Albert Einstein para os serviços de radiologia, oncologia, radioterapia e cirurgia oncológica/reconstrutora de mama. Os dados foram coletados retrospectivamente, a partir do registro hospitalar de câncer, prontuários, registros de farmácia e do sistema de cobrança do hospital. RESULTADOS: O valor total gasto para o diagnóstico e tratamento dessas 51 pacientes foi de R$ 2.915.000,00. Esse valor compreendeu os gastos com um total de 85 internações, 2.875 atendimentos ambulatoriais, 16 atendimentos no pronto atendimento e todos os custos associados a essas passagens pelo hospital. O valor gasto para o tratamento de cada paciente submetida à biópsia, setorectomia, quimioterapia adjuvante sem trastuzumabe (esquema com taxano seguido de antraciclina), radioterapia e 5 anos de tamoxifeno, foi de, aproximadamente, R$ 51.000,00 CONCLUSÃO: Estratégias de redução do custo do tratamento na rede privada seriam necessárias para permitir futuras parcerias público-privadas em grande escala, em oncologia.

Costs of Maternal Health-related Complications in Bangladesh.

This paper assesses both out-of-pocket payments for healthcare and losses of productivity over six months postpartum among women who gave birth in Matlab, Bangladesh. The hypothesis of the study objective is that obstetric morbidity leads women to seek care at which time out-of-pocket expenditure is incurred. Second, a woman may also take time out from employment or from doing her household chores. This loss of resources places a financial burden on the household that may lead to reduced consumption of usual but less important goods and use of other services depending on the extent to which a household copes up by using savings, taking loans, and selling assets. Women were divided into three groups based on their morbidity patterns: (a) women with a severe obstetric complication (n=92); (b) women with a less-severe obstetric complication (n=127); and (c) women with a normal delivery (n=483). Data were collected from households of these women at two time-points—at six weeks and six months after delivery. The results showed that maternal morbidity led to a considerable loss of resources up to six weeks postpartum, with the greatest financial burden of cost of healthcare among the poorest households. However, families coped up with loss of resources by taking loans and selling assets, and by the end of six months postpartum, the households had paid back more than 40% of the loans.