Costo del proceso diagnóstico del cáncer de mama en las Unidades de Medicina Familiar del Instituto Mexicano del Seguro Social, Querétaro, México / Cost of the diagnostic process for breast cancer in the Family Medicine Units of the Mexican Social Security Institute

Objetivo: determinar el costo del proceso diagnóstico del cáncer de mama. Métodos: estudio de costos, en mujeres de 40 años y más, de enero a diciembre del 2010 de las unidades de medicina familiar del Instituto Mexicano del Seguro Social. La muestra se calculó con la fórmula de promedios para población infinita para un total de 245 mujeres. El costo se estimó mediante la técnica de tiempos y movimientos y consulta de expertos; el costo por uso de intervención se calculó con el uso promedio por intervención multiplicado por el costo unitario del mismo. El costo total del proceso diagnóstico se obtuvo de la suma de los costos de cada uno de las intervenciones. El plan de análisis incluyó promedios, porcentajes e intervalos de confianza. Resultados: el costo promedio del proceso diagnóstico fue de $852,45. Conclusión: el proceso diagnóstico de cáncer de mama incluye tamizaje y casos confirmados. El costo del proceso diagnóstico es relativamente bajo ofreciendo mejores perspectivas para el paciente y el sistema de salud.

Objective: to determine the cost of the diagnostic process for breast cancer. Methods: costs were calculated, in women 40 years and older, from January to December 2010 of the Family Medicine Units of the Mexican Social Security Institute. The sample was calculated with the formula for infinite population averages for a total of 245 women. The cost was estimated by time and motion technique and expert consultation, the intervention cost was calculated using the average usage per intervention multiplied by the unit cost thereof. The total cost of the diagnostic process was obtained from the sum of the costs of each of the interventions. The analysis plan included means, percentages and confidence interval. Results: the average cost of the diagnostic process was $852.45. Conclusions: the diagnostic process for breast cancer include screening and confirmatory cases. The cost of the diagnostic process is low, offers better prospects for the patient and the health system.

Prevention of cervical cancer in women with ASCUS in the Brazilian Unified National Health System: cost-effectiveness of the molecular biology method for HPV detection / Prevenção de câncer de colo uterino em pacientes com ASCUS no Sistema Único de Saúde: custo-efetividade de método de biologia molecular para HPV

This study aimed to assess the performance of PCR as a means of detecting HPV 16/18 compared to the single probe-based PCR for detecting high-risk HPV, and evaluate these methods for detecting cervical intraepithelial neoplasia (CIN) in follow-ups for ASCUS testing. It also compares the costs of cytology, PCR methods, colposcopy and biopsy in the Brazilian Unified National Health System. Of the 81 patients with ASCUS, 41 (50.6%) tested positive for HPV 16/18 in PCR testing and 47 (58.02%) tested positive for high-risk HPV with single probe-based PCR testing. The negative predictive value was 93.75% for HPV 16/18 PCR and 100% for single probe-based PCR in cases that progressed to high-grade CIN. The annual costs of patient referral were the following: R$2,144.52 for referral of patients with ASCUS cytology for colposcopy; R$6,307.44 for referral of patients with ASCUS cytology and PCR positive for HPV 16/18 or colposcopy; R$3,691.80 for referral of patients with ASCUS cytology with single probe-based PCR positive for high-risk HPV. Therefore, cost per user can be reduced by performing single probe-based PCR for high-risk HPV on patients with ASCUS.

Os objetivos deste estudo foram avaliar o desempenho do PCR para detecção de HPV 16/18 versus PCR sonda única para a detecção de HPV de alto risco, avaliar estes métodos na detecção de neoplasia intraepitelial cervical (NIC) no seguimento de ASCUS, e comparar os custos de citologia, métodos de PCR, colposcopia e biópsia no Sistema Único de Saúde. Das 81 pacientes com ASCUS, 41 (50,6%) foram positivas para o HPV 16/18 PCR, e 47 (58,02%) foram positivas para PCR sonda única para HPV de alto risco. O valor preditivo negativo foi de 93,75% para HPV 16/18 PCR e 100% para PCR sonda única em casos que evoluíram para NIC de alto grau. Os custos anuais encaminhando todas as pacientes com ASCUS para a colposcopia, encaminhando à colposcopia as pacientes com ASCUS e PCR positivo para HPV 16/18 e encaminhando à colposcopia aquelas pacientes com ASCUS e PCR sonda única para HPV de alto risco positivo foram de R$2.144,52, R$6.307,44 e R$3.691,80, respectivamente. Considerando eventual redução dos custos para utilização em grandes quantidades, este método poderia ser realizado em ASCUS.

Liver biopsy for histological assessment - the case against

Percutaneous liver biopsy [LB] remains an important tool in the diagnosis and management of parenchymal liver diseases. In current practice, it is most frequently performed to assess the inflammatory grade and fibrotic stage of commonly encountered liver diseases, with the diagnostic role relegated to secondary importance. The role of LB remains a vastly controversial and debated subject, with an ever- increasing burden of evidence that questions its routine application in all patients with liver dysfunction. It remains, essentially, an invasive procedure with certain unavoidable risks and complications. It also suffers shortcomings in diagnostic accuracy since a large liver sample is required for an ideal assessment, which in clinical practice is not feasible. LB is also open to observer interpretation and prone to sampling errors. In recent years, a number of noninvasive biomarkers have evolved, each with an impressive range of diagnostic certainty approaching that achieved with LB. These noninvasive tests represent a lower-cost option, are easily reproducible, and serve as suitable alternatives to assess hepatic inflammation and fibrosis. This article aims to debate the shortcomings of LB while simultaneously demonstrating the diagnostic accuracy, reliability and usefulness of noninvasive markers of liver disease thereby making the case for their utilization as suitable alternatives to LB in many, although not all, circumstances

Contribution of the liver biopsy in intensive care unit

Our aim was to evaluate the indications and contribution of liver biopsy [LB] in intensive care [ICU] and to compare them to those of LB in gastroenterology. We included retrospectively 37 successive LB achieved in ICU and 38 successive LB achieved in gastroenterology. All data were reviewed by three intensivists and three gastroenterologists to determine the contribution of the LB. The indications of LB were different in the two units. The most frequent indications were cirrhosis [36.8%], isolated biological hepatic disruptions [26.3%] and histological classification of viral hepatitis [18.4%] in gastroenterology and isolated biological hepatic disruptions [48.6%], hepatopathy during pregnancy [27%] and fever of unknown origin [10.8%] in intensive care unit. According to the six reviewers, LB was enough contributive in the two units, [78.4% in ICU and 71.1% in gastroenterology -p=0.46-]. It allowed to eliminate, to confirm, or to change a diagnosis in more than 70% of cases and allowed to modify the course of therapy in 21.6% of cases in ICU and in 26.3% of cases in gastroenterology [p=0.6]. The LB is a feasible technique in ICU and can be as contributive as it is in gastroenterology

Avaliação da utilidade do exame histopatológico como rotina em tonsilectomias / Evaluation of the utility of histopathologic exam as a routine in tonsillectomies

A tonsilectomia é uma das cirurgias mais realizadas em todo o mundo. Apresenta uma grande variedade de indicações, seja em adultos ou crianças. É comum o envio do material retirado para exame histopatológico, seja para análise de material suspeito ou como documentação médico-legal de prova de remoção. OBJETIVO: Avaliar a necessidade e o custo do exame histopatológico de rotina para tonsilectomias. METODOLOGIA: Revisado o resultado histopatológico de todas as tonsilectomias no período de 1978 a 2004 num hospital universitário e analisado o prontuário dos casos encontrados de malignidade. RESULTADOS: Um total de 2.103 resultados de análise histopatológica foi analisado. Desta amostra, apenas quatro casos apresentaram algum tipo de malignidade, sendo todas elas linfomas do tipo não-Hodgkin e já suspeitados antes da cirurgia.DISCUSÃO: A literatura mundial encontra resultados semelhantes e cada vez mais se avalia o envio para análise de todos os casos de tonsilectomia. O custo do exame é alto e seu resultado, nos casos de malignidade, pôde ser previsto em todos os casos antes da cirurgia. CONCLUSÃO: Análise histopatológica de todas as tonsilectomias de rotina não está indicada. Os fatores de risco estabelecidos por Beaty deveriam guiar a solicitação de análise histopatológica, para assim conseguirmos diminuir os custos com exames desnecessários.