Canasta alimentaria normativa: perspectivas actuales e implicaciones para la salud pública en Venezuela / Normative Food Basket current perspectives and implications for public health in Venezuela

La Canasta Alimentaria Normativa (CAN) es un instrumento estratégico de planificación y seguimiento, que impacta el ámbito económico (fijación del salario mínimo SM y del umbral de la pobreza relativa), la seguridad alimentaria y la salud pública. El objetivo fue describir la evolución histórica de la CAN en Venezuela, contrastando su valoración económica respecto al SM durante el período 1990 ­ 2023. Tipo de estudio: Descriptivo. Se empleó la CAN del Instituto Nacional de Estadísticas/Instituto Nacional de Nutrición (INE/INN) y su comparación con la canasta del Centro de Documentación y Análisis Social de la Federación Venezolana de Maestros(CENDAS ­ FVM). Los valores mensuales de la CAN y del SM se recalcularon a dólares USA, de acuerdo a la tasa de cambio oficial. No se incluyó evaluación de la estructura interna, ni sus expresiones en términos de aporte de energía y nutrientes. Resultados: Desde 1990 hasta el año 2015, se requirieron entre1,0 y 1,8 SM y entre 0,6 y 1,7 Ingresos Mínimos Legales (IML)para acceder a la CAN. Para el año 2023 se requirieron hasta 78,3SM y 51,6 IML. El valor promedio de la canasta del CENDAS-FVM fue superior al valor de la CAN INE/INN, en una proporción de 1,7: 1. Conclusiones: la CAN resultó sensible en identificar los cambios y tendencias de su estimación económica, en el ambiente inflacionario venezolano. El uso de sus resultados está sujeta a cierto grado de discrecionalidad política. El costo de la CAN, expresa una contracción del poder de compra de los hogares venezolanos con potenciales impactos sobre la nutrición y la salud física y mental a corto y largo plazo.

The Normative Food Basket (NFB) represents astrategic planning and monitoring instrument, which impactsthe economic sphere (setting of the minimum wage (MW) andthe relative poverty threshold), food security and public health.The objective was to describe the historical evolution of the NFB in Venezuela, contrasting its economic valuation with respect to the MW during the period 1990 ­ 2023. Type of study: Descriptive. The NFB of the National Institute of Statistics/National Institute of Nutrition (NIS/NIN) was used and itscomparison with the basket of the Center for Documentationand Social Analysis of the Venezuelan Federation of Teachers (CENDAS ­ FVM). The monthly values of the NFB and theMW were recalculated into dollars (US$), according to theofficial exchange rate. No evaluation of the internal structurewas included, nor its expressions in terms of energy and nutrientcontribution. Results: From 1990 to 2015, between 1.0 and1.8 MW and between 0.6 and 1.7 Minimum Legal Income(MLI) were required to access the NFB. By 2023, up to 78.3MW and 51.6 MLI were required. The average value of the CENDAS-FVM basket was higher than the value of the NFBNIS/NIN, in a proportion of 1.7: 1. Conclusions: As a statistical operation, the NFB was sensitive in identifying changes andtrends in its estimate economic, in the Venezuelan inflationaryenvironment. The use of its results is subject to a certain degree ofpolitical discretion. The cost of CAN expresses a contraction inthe purchasing power of Venezuelan households with potentialimpacts on nutrition and physical/mental health in the shortand long term.

Análise das solicitações de medicamentos não padronizados de um hospital universitário terciário / Analysis of requests for non-standard medicines from a tertiary university hospital

Introdução: O uso extensivo de medicamentos não padronizados causa aumento de custos em saúde, além de potencial redução de segurança e uso racional de medicamentos. A Comissão de Farmácia e Terapêutica orienta a prescrição de medicamentos, por meio da avaliação e seleção de medicamentos a serem incluídos no formulário de medicamentos padronizados, com base nas melhores evidências científicas disponíveis e no perfil dos pacientes locais, promovendo o uso racional de medicamentos. O objetivo deste trabalho foi analisar as solicitações de fornecimento de medicamentos não padronizados na instituição. Métodos: Trata-se de um estudo observacional e descritivo onde foram analisadas as solicitações de medicamentos não padronizados realizadas entre fevereiro de 2016 e dezembro de 2021, identificando os medicamentos envolvidos e seus respectivos custos. Resultados: Foram realizadas 203 solicitações no período, sendo 174 incluídas no estudo. Os medicamentos que tiveram mais solicitações foram o rituximabe (41), a imunoglobulina humana (31), o sucralfato (23), a nitazoxanida (12) e o eltrombopague (7). As solicitações com maior custo foram as de imunoglobulina humana (US$ 799,702.38), rituximabe (US$ 717,320.26), eltrombopague (US$ 281,062.50), ruxolitinibe (US$ 167,867.46) e bortezomibe (US$ 149,033.52). As principais clínicas que solicitaram medicamentos não padronizado foram a neurologia (47), a hematologia (30), as moléstias infecciosas e parasitárias (17), e a anestesiologia (12). As solicitações de maior custo foram realizadas pela neurologia (US$ 145,519.08), hematologia (US$ 120,980.25), transplante de medula óssea (US$ 51,635.11) e dermatologia (US$ 44,813.40). Conclusão: O estudo demonstrou que há um fluxo estruturado de solicitação de medicamentos não padronizados na instituição, sendo uma importante ferramenta de gerenciamento dessas solicitações, evitando a aquisição desnecessária de itens que não compõem o elenco terapêutico do hospital.

Introduction: Widespread use of non-formulary drugs (NFD) increases cost and may reduce safety and rational use of medicines. The Pharmacy and Therapeutics Committee provides guidance on drug prescription by evaluating and selecting medications to be included in a hospital's formulary based on best scientific evidence available and local patients' profile, promoting rational use of medicines. The objective of this study was to assess non-formulary drugs prescriptions at a tertiary hospital. Methods: This was a retrospective study. NFD prescribed and its associated costs were assessed through NFD request forms received from February 2016 to December 2021. Results: A total of 203 NFD request forms were received, from which 174 were included in this study. The most frequently prescribed NFD included rituximab (n = 41), immunoglobulin (31), sucralfate (23), nitazoxanide (12), and eltrombopag (7), with the highest costs being with immunoglobulin (US$ 799,702.38), rituximab (US$ 717,320.26), eltrombopag (US$ 281,062.50), ruxolitinib (US$ 167,867.46), and bortezomib (US$ 149,033.52). The most frequent requesting specialties were neurology (n = 47), hematology (30), infectious disease (17) and anesthesiology (12), and highest costs requests were from neurology (US$ 145,519.08), hematology (US$ 120,980.25), bone marrow transplant unit (US$ 51,635.11), and dermatology (US$ 44,813.40). Conclusion: This study showed that a structured request flow for NFD prescription is a critical procedure in order to better manage drug prescription within the hospital, promoting rational use of medicines and preventing unnecessary spending with drugs for which the clinical indication may be covered by a drug already in the hospital's formulary.

Health education can save the environment from medicine residues

Abstract The incorrect disposal of medicines and their environmental impact has been related to the health medicalization and the improper use of medication by society. In this sense, it is very important to know the profile of drug disposal for foster health policies. The aim was to identify the profile of disposal of medicines by the population, including the cost perspective. This is an inquiry descriptive study that began in September 2019. Medicine disposal health education program was carried out over six months in two University pharmacies. A questionnaire for sociodemographic and discarded medicines data collection was applied. Logistic regression analysis for variables association of correct disposal and the chi-square and t-student analysis for comparison between disposal programs were performed for a level of 5% and test power of 80%. Medicines weighed 23.3 kg and 28.5 kg, with the cost variation from US$ 13.5 to US$ 16.1 until the final treatment. The correct disposal was strongly associated with the disposal reason (p=0.013), source of information (p=0.006), prescription (p=0.03), form of use (p=0.01), acquisition source (p=0.001), cost with medication (p=0.0001), education (p=0.028) and age (p=0.05). The correct medicine disposal was associated with important features of the community related to education health.

Compounded drugs as an alternative to the therapeutical gaps of inborn errors of metabolism

Abstract Inborn errors of metabolism are rare disorders with few therapeutic options for their treatments, which can make patients suffer with complications. Therefore, compounded drugs might be a promising option given that they have the ability of meeting the patient's specific needs, (i) identification of the main drugs described in the literature; (ii) proposal of compounding systems and (iii) calculation of the budgetary addition for the inclusion of these drugs into the Brazilian Unified Health System. The research conducted a literature review and used management data as well as data obtained from official Federal District government websites. The study identified 31 drugs for the treatment of inborn errors of metabolism. Fifty eight percent (58%) (18) of the medicines had their current demand identified, which are currently unmet by the local Health System. The estimated budget for the production of compounded drugs was of R$363,16.98 per year for approximately 300 patients. This estimated cost represents a budgetary addition of only 0.17% from the total of expenditures planned for drug acquirement. There is a therapeutic gap for inborn errors of metabolism and compounding pharmacies show potential in ensuring access to medicine therapy with a low-cost investment.

Análisis de costos de la detección de microglobulina alfa 1 placentaria en el abordaje de la sospecha de amenaza de parto pretérmino / Cost analysis of the alpha 1 placental microglobulin measurement as screening on suspected preterm labor

Objetivo: identificar el potencial beneficio económico de implementar la medición de microglobulina alfa 1 placentaria en las usuarias con sospecha de amenaza de parto pretérmino que acceden al Servicio de Emergencias del Hospital de las Mujeres Dr. Adolfo Carit Eva, como mecanismo para la reducción del impacto en la mortalidad maternoinfantil y optimizar recursos económicos en la Caja Costarricense de Seguro Social. Métodos: estudio económico, de enfoque cuantitativo-retrospectivo, con diseño transversal. Se consultaron fuentes secundarias del Departamento de Registros Médicos y Estadística del Hospital de las Mujeres Dr. Adolfo Carit Eva y se calculó el costo de atención de las pacientes hospitalizadas por diagnóstico de "trabajo de parto falso antes de las 37 semanas completas de gestación", según la Clasificación Estadística Internacional de Enfermedades y Problemas Relacionados con la Salud, décima revisión (CIE-10), en comparación con el hipotético escenario de que, en el mismo evento de salud, se implemente la medición cualitativa de microglobulina alfa 1 placentaria. Para el análisis de los datos se determinaron los costos tanto individuales como colectivos en pruebas diagnósticas de control, así como el costo hospitalario y de tratamiento médico, lo cual permitió estimar los costos individuales, totales y promedio del ingreso innecesario de estas usuarias. Para el cálculo de costos de sospecha de amenaza de parto pretérmino descartada, se plantearon los siguientes escenarios: internamiento de la totalidad de pacientes con sospecha de una posible amenaza de parto pretérmino (n=60) y la utilización de la prueba cualitativa de microglobulina alfa1 placentaria, tomando en consideración su valor predictivo negativo (97%). Posteriormente, se estimó el valor del cociente costo/ahorro (el cual se interpreta como beneficioso en caso de ser menor a 1 y no beneficioso en caso de ser mayor a 1). Resultados: se reportó una incidencia de parto pretérmino de 10,1%; los costos derivados de la atención a pacientes con sospecha de parto pretérmino provienen principalmente de la hospitalización. Se obtiene un costo mínimo por paciente de ¢3 317 071,21 colones que se traducen a $5 593,79 USD según tipo de cambio vigente el 30 de noviembre del 2019, de acuerdo con el Banco Central de Costa Rica. Por su parte, se estima un costo máximo de 6 356 780, 1 colones, lo que equivale a 11 219,96 USD al tipo de cambio vigente el 30 de noviembre del 2019. Por lo cual, una vez determinado el supuesto escenario de la implementación de la prueba de microglobulina alfa 1 placentaria en las pacientes que consultan a Emergencias por sospecha de amenaza de parto pretérmino, se demuestra que existe un potencial ahorro efectivo de recursos. Conclusión: Se recomienda tomar como referente el valor predictivo negativo de microglobulina alfa 1 placentaria en su medición cualitativa, como prueba diagnóstica auxiliar en el manejo de la sospecha de amenaza de parto pretérmino. Empero, es necesario efectuar estudios complementarios para estimar el valor predictivo positivo y otros estudios económicos para valorar la incorporación de esta prueba en el algoritmo de atención de las amenazas de parto pretérmino.

Aim: identify the possible economic benefit of implementing the measurement of placental alpha 1 microglobulin in users with suspected Preterm Labor Threat, who access the emergency service of the Hospital de The Women Dr. Adolfo Carit Eva, as a mechanism to impact on maternal and infant mortality and economic resources in the Costa Rican Social Security Fund. Methods: economic study, quantitative-retrospective approach, with cross-sectional design. This study included the consult of secondary sources of the Department of Medical Records and Statistics of the Hospital; where the cost of care for hospitalized patients diagnosed with ICD-10 "False Labor before 37 weeks" is calculated; compared to a hypothetical scenario where the qualitative measurement of placental alpha 1 microglobulin is implemented for this same health event. For the data analysis, both individual and collective costs were determined in diagnostic control tests, as well as hospital and medical treatment costs, which allowed estimating the individual, total and average costs of admission of these users. To calculate the costs of suspected Preterm Labor Treat ruled out, the following scenarios were proposed: hospitalization of all patients in whom a possible Preterm Labor Treat is suspected (n= 60) and use of the qualitative placental alpha1 microglobulin test, taking into account their negative predictive value (97%). Subsequently, the value of the cost/savings ratio is estimated (interpreted as beneficial if it is less than 1 and not beneficial otherwise). Results: An incidence of preterm delivery of 10.1% was reported; the costs derived from the care of patients with suspected preterm delivery come mainly from hospitalization. Therefore, when developing the respective cost analysis, it is evident that the economic benefit of to incorporate qualitative measurement of placental alpha 1 microglobulin is derived mainly from the decrease in hospitalization. A minimum cost per patient of 3,317,071.21 colones is obtained, which translates to 5,593.79 dollars at the exchange rate in force on November 30, 2019 according to the Central Bank of Costa Rica. For its part, a maximum cost of 6,356,780.1 colones is estimated, which translates to 11,219.96 dollars at the exchange rate in effect on November 30, 2019. Therefore, once the assumed scenario of the implementation of the placental alpha1 microglobulin test in patients who consult the Emergencies for suspected Preterm Labor Threat has been determined, there is a potential effective saving of resources. Conclusion: the use of the qualitative measurement of placental alpha 1 microglobulin, as an auxiliary diagnostic test in the management of the suspected threat of preterm delivery, it is recommended, from take the negative predictive value as a reference. However, it is necessary to carry out complementary studies to estimate the positive predictive value and other economic studies to include this test in the care algorithm of the Preterm Labor Threat.

Diagnostic costs: a research in a family medicine outpatient clinic

The aim of this study is to evaluate the direct diagnostic costs for disease groups and other variables (such as gender, age, seasons) that are related to the direct diagnostic costs based on a 3-year data. The population of the study consisted of 31,401 patients who applied to family medicine outpatient clinic in Turkey between January 1st, 2016 and December 31st, 2018. With this study, we determined in which disease groups of the family medicine outpatient clinic weremost frequently admitted. Then, total and average diagnostic costs for these disease groups were calculated. Three-year data gave us the opportunity to examine the trend in diagnostic costs. Based on this, we demonstratedwhich diseases' total and average diagnostic costs increased or decreased during 3 years. Moreover, we examined how diagnostic costs showed a trend in both Turkish liras and USA dollars' rate for 3 years. Finally, we analysedwhether the diagnostic costs differed according to variables such as age, gender and season. There has been relatively little analysis on the diagnostic costs in the previous literature. Therefore, we expect to contribute to both theoristsand healthcare managers for diagnostic costs with this study.

Spending Estimates for Gastric Cancer in Central Brazil

Abstract Stomach cancer is the second leading cause of death by cancer worldwide and is even more pronounced in South America. In Brazil, it is estimated that an increase in the number of cases due to this cancer occurred in the biennium 2018-2019. In this study, we investigated the expenditures of the State Health Department of Goiás on hospitalizations and treatment of gastric cancer for the Unified Health System (SUS) from 2008-2016. This is a cross-sectional, descriptive, and analytical study based on secondary data from the Unified Health System computing department (DATASUS) and the System of Management of the Table of Procedures, Medications, Orthosis, Prosthesis, and Special Materials of SUS through CONECTA-SUS related to International Classification of Diseases-10/C16 (ICD-10/C16) procedures for gastric neoplasms. A total of I$ 5,697,958.20 was spent on gastric tumor in the last nine years in Goiás, I$ 4,492,916.67 (0.3%) on hospitalizations, and I$ 1,997,120.91 on treatment. This study presents a current and relevant estimate of the costs of gastric cancer patients in Goiás. Moreover, we provide information on the extent of the cancer issue to public health. Our analysis offers components for service management and studies that reduce resource allocation in more rational ways

The clinical pharmacist's role in a high-cost medicine pharmacy: Patient-centered care

Abstract In Brazil, medicine dispensing is a pharmacy service provided within the national health system that allows the pharmacist to interact directly with the patient in order to prevent, detect and solve problems related to pharmacotherapy and health needs. However, it is known that most dispensing services provided in the country are still limited to supplying medications and, at their finest, offering advice on medication utilization. Attempts to change this scenario present new challenges the area of pharmacy, which involve the need for a patient-centered pharmaceutical service model. This paper describes the patient-centered pharmaceutical service of high-cost medicine dispensing performed at a pharmacy linked to the Brazilian Unified Health System. In the model described here, the medicine-dispensing activity is the pharmacist's main field of practice, which consists of identifying patient needs related to health care itself and medication utilization. It also aims to introduce the instrument developed (a Pharmaceutical Care Protocol) that contributed to implementing this clinical service provided by the pharmacist. The protocols guide and qualify the service by providing information that helps in evaluating the effectiveness and safety of treatments and in the preparation of the care plan and can be used as a basis for other services that intend to adopt clinical pharmacy practices.

Custos catastróficos em pacientes com tuberculose no Brasil: estudo em cinco capitais / Costos catastróficos en pacientes con tuberculosis en Brasil: un estudio en cinco capitales / Catastrophic costs in tuberculosis patients in Brazil: a study in five capitals

Resumo Objetivo avaliar o impacto econômico domiciliar do adoecimento pela tuberculose no Brasil. Método pesquisa transversal multicêntrica de 2016 a 2018, em cinco capitais do Brasil, em pacientes diagnosticados com tuberculose. Os custos totais foram a soma dos custos diretos e indiretos incorridos antes e durante o diagnóstico e tratamento. A regressão logística foi utilizada para estudar determinantes de custos catastróficos. A pobreza foi medida como renda familiar per capita diária < U$ 5,5. Resultados trezentos e sessenta e um pacientes foram inscritos no estudo. O custo extrapolação foi de R$3.664,47 (DP: R$ 2.667,67) e o custo total de extrapolação foi de R$22.291,82 (DP: R$ 16.259,50). No geral, 29% dos participantes do estudo foram caracterizados como pobres antes da tuberculose, e 39% depois. Em média, a renda diminuiu em 11% dos participantes e 41% tiveram custos catastróficos. Os determinantes estatisticamente significativos de experimentar custos catastróficos foram: participante ser o chefe da família, vivendo na pobreza antes da tuberculose, desemprego e interrupção do trabalho durante o tratamento (p < 0,05). Conclusão e implicações para a prática embora o tratamento seja financiado pelo governo, a tuberculose continua resultando em custos catastróficos e diminuição da renda para muitas famílias no Brasil.

Resumen Objetivo evaluar el impacto económico domiciliario de enfermarse por tuberculosis en Brasil. Método Investigación multicéntrica transversal de 2016 a 2018, en cinco capitales de Brasil, en pacientes diagnosticados con tuberculosis. Los costos totales fueron la suma de los costos directos e indirectos incurridos antes y durante el diagnóstico y el tratamiento. Se utilizó la regresión logística para estudiar los determinantes de los costos catastróficos. La pobreza se midió como un ingreso familiar diario per cápita < U$ 5,5. Resultados se inscribieron 361 pacientes en el estudio. El costo de extrapolación fue de R$ 3.664,47 (DE: R$ 2.667,67) y el costo total de extrapolación fue R$ 22.291,82 (DE: R$ 16.259,50). En general, el 29% de los participantes se caracterizaron como pobres antes de la tuberculosis y el 39%, después. En promedio, los ingresos disminuyeron en 11% de los participantes y el 41% tuvo costos catastróficos. Determinantes estadísticos de costos catastróficos: participante ser cabeza de familia; vivir en pobreza antes de la tuberculosis; desempleo; interrupción del trabajo durante el tratamiento (p<0.05). Conclusión e implicaciones para la práctica aunque el tratamiento es financiado por el gobierno, la tuberculosis sigue teniendo costos catastróficos y una disminución de los ingresos para muchas familias en Brasil.

Abstract Objective to assess the home economics impact of illness from Tuberculosis in Brazil. Method multicenter cross-sectional research from 2016 to 2018, in five capitals of Brazil, in patients diagnosed with tuberculosis. The total costs were the sum of the direct and indirect costs incurred before and during diagnosis and treatment. Logistic regression was used to study determinants of catastrophic costs. Poverty was measured as daily household income per capita < U$ 5.5. Results 361 patients were enrolled in the study. The extrapolation cost was R$ 3,664.47 (SD: R$ 2,667.67) and the total extrapolation cost was R$ 22,291.82 (SD: R$ 16,259.50). Overall, 29% of study participants were characterized as poor before tuberculosis, and 39% afterwards. On average, income declined by 11% among participants and 41% had catastrophic costs. The statistically significant determinants of experiencing catastrophic costs were: participant being the head of the family; living in poverty before tuberculosis; unemployment and interruption of work during treatment (p <0.05). Conclusion and implications for practice although treatment is financed by the government, tuberculosis continues to cause catastrophic costs and decreased of income for many families in Brazil.

Cirurgias bariátricas realizadas no Estado do Espírito Santo: perfil e evolução dos custos entre 2008 e 2017 / Bariatric surgeries in Espirito Santos: characteristic and evolution of costs from 2008 to 2017

Introdução: A obesidade é considerada um importante problema de saúde pública e a cirurgia bariátrica (CB) é um dos componentes da linha de cuidado para seu tratamento e viabilização da redução do peso corporal. Objetivo: Analisar as características, evolução e custos diretos dos procedimentos relacionados à cirurgia bariátrica no estado do Espírito Santo de 2008 a 2017. Métodos: Estudo observacional, descritivo e retrospectivo, baseado em dados secundários disponíveis nos arquivos de domínio público presentes no Sistema de Informações Hospitalares do Sistema Único de Saúde e no Sistema de Comunicação de Informação Hospitalar e Ambulatorial, do Ministério da Saúde. Os indicadores calculados foram CB por sexo e por faixa etária, bem como os gastos com serviços hospitalares e profissionais. Resultados: Houve crescimento no número de cirurgias bariátricas e nos custos da mesma ao longo dos dez anos analisados, na ordem de 184% e 483%, respectivamente. Também se constatou que 87% (n=2.923) dos procedimentos foram realizados no público feminino, que houve um quantitativo expressivo de CB na faixa etária entre 24 e 34 anos e que os custos representaram 0,85% dos gastos hospitalares no Espírito Santo. Conclusões: Há a necessidade de se discutir a articulação, junto aos demais serviços da rede de atenção à saúde, para implementação de uma linha de cuidado efetiva que englobe, além da cirurgia bariátrica, o acompanhamento da saúde por outros serviços de saúde, em especial pela Atenção Primária. (AU)

Introduction: Obesity is considered an important public health problem and bariatric surgery (BS) is one of the components of the line of care for its treatment and enabling the reduction of body weight. Objective: To analyze how resources, evolution and costs of procedures related to bariatric surgery in the state of Espírito Santo from 2008 to 2017. Methods: Observational, descriptive and retrospective study, using secondary data available in the public domain files from the Hospital Information System and the Hospital and Ambulatory Information Communication System, of the Ministry of Health. The calculated indicators were BS by sex and by age group, as well as expenses with hospital and professional services. Results: There was an increase in the number of bariatric surgeries and their costs over the ten years analyzed, of 184% and 483%, respectively. We also found that 87% (n = 2.923) of the procedures performed in the female public, which had a significant quantitative number of BS in the age group from 24 to 34 years old and that the costs represented 0.85% of hospital expenses in Espírito Santo. Conclusions: There is a need to discuss an articulation with the other services in the health care network to implement a line of effective care that includes, in addition to bariatric surgery, or health monitoring by other health services, especially by Primary Care. (AU)

Cost analysis of a medication dispensing service in community pharmacy in Brazil

This study was aimed to calculate in detail the costs of a medication dispensing service in community pharmacy in Brazil. Descriptive and retrospective analysis with a cost analysis based on mixed costing; absorption costing and time-driven activity based-costing, considering year 2018 and both public and private health system perspectives within a one-year time horizon to estimates costs related to implement and to deploy the service, costs per patient and costs per activity of process (US$ 1 = R$ 3.8310 in October, 2018). Total costs of dispensing service ranged from US$ 24,451.61 to US$ 37,914.48. Costs per patient ranged from US$ 2.43 to US$ 3.77. Costs per activity of the process ranged from US$ 0.39 in pharmacotherapy assessment to US$ 2.46 in pharmaceutical interview. This provides evidence to deploy and implement a structured medication dispensing service in community pharmacy in Brazil with a view to optimize the usage of medicines.

Genotype®MTBDRplus and Xpert®MTB/RIF in the diagnosis of tuberculosis and resistant tuberculosis: cost analysis in a tertiary referral hospital

Abstract INTRODUCTION: The present study sought to assess the mean and activity based cost (ABC) of the laboratory diagnosis for tuberculosis through the application of conventional and molecular techniques-Xpert®MTB/RIF and Genotype®MTBDRplus-in a tertiary referral hospital in Brazil. METHODS: The mean cost and ABC formed the basis for the cost analysis of the TB laboratory diagnosis. RESULTS: The mean cost and ABC were US$ 4.00 and US$ 3.24, respectively, for a bacilloscopy; US$ 6.73 and US$ 5.27 for a Lowenstein-Jensen (LJ) culture; US$ 105.42 and US$ 76.56 for a drug sensitivity test (DST)-proportions method (PM) in LJ; US$ 148.45 and US$ 136.80 for a DST-BACTECTM MGITTM 960 system; US$ 11.53 and US$ 9.89 for an Xpert®MTB/RIF; and US$ 84.21 and US$ 48.38 for a Genotype®MTBDRplus. CONCLUSIONS: The mean cost and ABC proved to be good decision-making parameters in the diagnosis of TB and MDR-TB. The effective implementation of algorithms will depend on the conditions at each location.

Proposal of accuracy analysis of indoor tracking systems in basketball / Proposta de análise de precisão de sistemas de rastreamento interno em basquetebol

ABSTRACT The development of tracking technology caused a exponentially grow-up of research into this topic. The use of standardized methodologies is useful to contrast data of different studies. On the other hand, a low-cost reference system is needed. For this reason, the main aim of the present research is the description of a specific protocol to accuracy assessment of tracking location in indoor conditions in basketball. It can resume in three steps with detailed and easily procedures in the method section. The accuracy analysis method presented can report the centimeter of accuracy in each coordinate that the tracking system measure. A standardized protocol to evaluate the location on indoor conditions in basketball will provide to the sport science professionals a useful tool to analyze the accuracy and reliability of all tracking system, being the results can compare both within and between-court.

RESUMO O desenvolvimento da tecnologia de rastreamento causou um crescimento exponencial das pesquisas sobre esse tópico. O uso de metodologias padronizadas é útil para contrastar dados de diferentes estudos. Por outro lado, é necessário um sistema de referência de baixo custo. Por este motivo, o principal objetivo da presente pesquisa é a descrição de um protocolo específico para avaliação da acurácia do rastreamento de localização em condições internas no basquete. Pode retomar em três etapas com procedimentos detalhados e fáceis na seção do método. O método de análise de precisão apresentado pode relatar o centímetro de precisão em cada coordenada medida pelo sistema de rastreamento. Um protocolo padronizado para avaliar a localização em condições internas no basquetebol fornecerá aos profissionais de ciências do esporte uma ferramenta útil para analisar a precisão e a confiabilidade de todo o sistema de rastreamento, sendo que os resultados podem ser comparados dentro e entre as quadras.

O custo do cateterismo vesical de demora nos pacientes internados na unidade de terapia intensiva / El costo de la sonda vesical en pacientes hospitalizados en la unidad de cuidados intensivos / The cost of the urinary catheterization in patients admitted to the intensive care unit

Valorar os itens do custo direto do cateter vesical de demora (CVD) e realizar sua avaliação econômica parcial nos pacientes internados na Unidades de Terapia Intensiva (UTIs) com e sem infecções do trato urinário (ITU). Método: Trata-se de estudo descritivo do tipo série de casos, que utilizou a avaliação econômica parcial para estudar os custos diretos do cateterismo vesical de demora, analisando prontuários dos pacientes. Resultados: 48,45% do custo do CVD deve-se ao sistema coletor de urina, seguido do cloridrato de lidocaína (20,38%) e cateter Foley (12,70%). O aumento dos custos do CVD, associado ao tratamento da ITU, representa um aumento do custo em 18 vezes em ambas as UTIs, extrapolando o valor dos tratamentos em R$ 3.537.692,79, abrindo possibilidades para trabalhos de avaliação do custo-efetividade. Conclusão: A ITU associada ao CVD traz grande impacto no orçamento hospitalar, cabendo à análise econômica a alocação racional de recursos.

Urinary catheters (UC) are one of the most widely used invasive devices in intensive care units (ICUs), and its insertion is a major contributor to the development of complications, increasing hospitalization time and costs. Objectives: To evaluate the direct cost of UC and to carry out their partial economic evaluation in patients hospitalized in the ICU with and without UTI. Methods: Descriptive study, using partial economic evaluation by analyzing patients’ charts from a specific form. Results: 48.45% of the UC’s cost are due to the urine collection system, followed by lidocaine hydrochloride (20.38%) and Foley catheter (12.70%). The increase in UC’s costs, associated with UTI treatment, represent >18 times. By extrapolating the value of UTI’s treatments to the Brazilian healthcare system, the difference would be R$ 3,537,692.79. Conclusion: Catheter- associated UTI has a large impact on the hospital budget.

Los catéteres urinarios (CAU) son uno de los dispositivos invasivos más ampliamente utilizados en las unidades de cuidados intensivos (UCI), y su inserción es un importante contribuyente al desarrollo de complicaciones, hospitalización y costos. Objetivos: Evaluar el coste directo de la CAU y desarrollar una evaluación económica parcial em pacientes hospitalizados en la UCI con y sin infección del tracto urinario. Métodos: Estudio descriptivo mediante el análisis de los archivos de los pacientes. Resultados: 48,45% del costo de la UC se deben al sistema de recolección de orina, seguido de clorhidrato de lidocaína (20,38%) y el catéter de Foley (12,70%). El aumento de los costos de la CAU, associados con el tratamiento en la UCI representan >18 veces. Extrapolando el valor de los tratamientos UCI para el sistema de salud brasileño, la diferencia sería R$ 3,537,692.79. Conclusión: ITU asociada al catéter tiene un gran impacto en el presupuesto de hospital.

Custos do câncer do colo uterino: revisão das técnicas de apuração de custos em estudos publicados entre 2010-2013 / Costs of cervical cancer: review of costing techniques in studies published between 2010-2013

O carcinoma do colo uterino é o quarto tipo de câncer mais frequente na população feminina e responsável por 12% de todos os cânceres em mulheres. A Organização Mundial de Saúde (OMS) estimou 528.000 novos casos e 265.000 óbitos esperados por esta causa em 2012, cerca de 85% de sua incidência em países menos desenvolvidos. Diante de um problema de saúde pública dessa magnitude, a alocação dos recursos de forma racional visa garantir uma melhoria nos padrões de saúde para que o acesso seja com equidade e integralidade. Revisar as técnicas de apuração dos custos do câncer de colo uterino em estudos publicados no período de janeiro de 2010 a abril de 2013.Foi realizada busca na base do Medline (via PubMed) utilizando as palavras-chave: "costs and cost analysis" and "cervical cancer", de janeiro de 2010 à 22 de abril de 2013, sendo recuperados 261 estudos não duplicados. No entanto, 116 foram excluídos pelo título, por não se tratar de avaliações dos custos, 145 artigos foram excluídos pela leitura do resumo e destes, catorze foram lidos integralmente e incluídos no estudo, os quais foram avaliados quanto aos critérios do roteiro do Consolidated Health Economic Evaluation Reporting Standarts (CHEERS). Observou-se que nenhum estava de acordo com todos os critérios preconizados no CHEERS. Quanto ao desenho, quatro (28,5%) eram estudos de custo em coortes retrospectivas, um (7,1%) apresentou um corte transversal, quatro (28,5%) realizaram análise de custo do tipo parcial, três (21,4%) usaram análise de custo-efetividade e duas (14,2) análises de custo da carga da doença. A grande maioria, dez (71,4%), dos catorze estudos selecionados adotou a perspectiva do Sistema Nacional de Saúde, três (21,4%), a perspectiva da sociedade e um (7,1%), a hospitalar. Encontrou-se grande heterogeneidade na forma de obtenção dos custos, à exceção de um, o que tornou impossível a comparação. Espera-se que este trabalho possa auxiliar futuros estudos de avaliação econômica com a utilização dos roteiros e assim possa direcionar melhor as pesquisas e contribuir com os tomadores de decisão na melhor alocação dos recursos em saúde.(AU)

The uterine cervix carcinoma is the fourth most common cancer in the female population, accounting for 12% of all cancers in women. According to estimates of the World Health Organization (WHO) 528,000 new cases and 265,000 deaths were expected in 2012, about 85% of its incidence in developing countries. Faced with a great magnitude public health problem, the allocation of resources rationally aims to ensure an improvement in health standards so that access is fair and complete. This study aims to review the calculation techniques of treatment of cervical cancer costs in published studies from January 2010 to April 2013. A search was performed on electronic library Medline (by PubMed) using the keywords: "costs and cost analysis" and "cervical cancer", from January 2010 to April 22, 2013. We retrieved 261 not duplicate studies, 116 were excluded because the title not contain assessments of the costs, 145 articles were excluded after the summary reading, and only fourteen were read thoroughly and included in the study. All of selected studies were evaluated according to the script created by the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) and none followed all these criteria. In relation to type of economic analysis three (21.4%) were identified as costeffectiveness analysis, two (14.2%) as cost analysis of burden the disease, one (7.1%) identified as cross-section, four (28.57%) were cost analysis as partial type and four (28.57%) cost studies in retrospective cohorts. Ten (71.4%) of fourteen selected studies adopted the perspective of the National Health System. Three (21.4%) adopted the perspective of society and only one (7.1%) adopted the hospital perspective. The studies demonstrated a heterogeneity in ways to obtaining the costs making impossible compare them. It is hoped that this work will assist in future studies of economic evaluation with the use of scripts and thus can better direct research and contribute to decision makers in better allocation of health resources.(AU)

Índice de Paridad Poder de Compra Nutricional: comparación de los precios calóricos entre dietas habituales y saludables / Index of Nutritional Purchasing Power Parity: comparison of caloric costs of a healthy versus an unhealthy diet

OBJETIVO: Validar el Índice de Paridad Poder de Compra Nutricional (Nut3-CiO) como un instrumento que permite comparar los precios calóricos de una dieta saludable versus una dieta no saludable entre regiones o ciudades de un país a través del tiempo. MÉTODOS: Se construyeron índices de precios calóricos y se empleó la "ley de un solo precio" para derivar el índice Nut3-CiO. Se obtuvieron tasas de inflación calóricas sobre las que se realizó estadística descriptiva básica. El Nut3-CiO se aplicó a las principales ciudades de México durante el período enero de 1996 a diciembre 2010. RESULTADOS: El comportamiento estadístico del Nut3-CiO reveló que en las ciudades de México los productos de la dieta habitual son más baratos que los productos de la dieta saludable. Se observó un comportamiento cíclico del índice, una correlación alta entre la inflación de la dieta habitual y la inflación de la canasta básica, y una alta persistencia de los precios. CONCLUSIONES: El índice Nut3-CiO permite comparar periódicamente el diferencial de precios de dos tipos de dietas -habituales y saludables- entre las ciudades de un mismo país. Este instrumento podría ayudar a las autoridades de salud a identificar las ciudades en donde resulta más -o menos- fácil para los consumidores acceder a una dieta habitual o saludable en términos de costo. Asimismo, hace posible estimar el porcentaje de ajuste que deberían tener los precios relativos en cada ciudad para alcanzar los niveles de paridad poder de compra nutricional.

OBJECTIVE: Develop the Index of Nutritional Purchasing Power Parity (Nut3-CiO) as an instrument to compare the caloric costs of a healthy versus an unhealthy diet between regions or cities in a country over time. METHODS: Indices of caloric prices were constructed and the "law of one price" was used to derive the Nut3-CiO index. Caloric inflation rates were obtained using basic descriptive statistics. The Nut3-CiO was applied in the major cities of Mexico during the period from January 1996 to December 2010. RESULTS: The statistical behavior of the Nut3-CiO revealed that, in Mexican cities, products for a typical diet are less expensive than products for a healthy diet. The findings showed a cyclical behavior to the index, a high correlation between inflation for the typical diet and inflation for the market basket, and a high persistence of prices. CONCLUSIONS: The Nut3-CiO index makes it possible to periodically compare the price differential of two types of diets-typical and healthy-between cities in a single country. This instrument could help health authorities identify the cities where it is easier or more difficult for consumers to access a typical or healthy diet in terms of cost. Furthermore, it makes it possible to estimate the percentage adjustment necessary in each city to attain levels of nutritional purchasing power parity.

Coeficientes técnicos de produção da priprioca (Cyperus articulatus L. ) em sistema orgânico, na região de Belém (PA) / Technical coefficients of priprioca production (Cyperus articulatus L. ) in organic system at the region of Belém (PA)

Foram elaborados os coeficientes técnicos de produção de priprioca (Cyperus articulatus) em três áreas fornecedoras parceiras da Natura, situadas na região do entorno de Belém, Amazônia Oriental. Para elaboração dos coeficientes técnicos de produção de priprioca, os itens de custo e as atividades que compreendem o cultivo, a colheita e o beneficiamento foram levantados e classificados em: Insumos; Serviços; Equipamentos; e Outros. O detalhamento destas atividades e o valor dos itens foram obtidos e construídos in loco, juntamente com os agricultores. As informações utilizadas neste trabalho consideraram a produção de 1 tonelada de raiz de priprioca, cultivadas anualmente em sete canteiros de 60 m² (1,2 m largura x 50 m comprimento), espaçamento de 0,20 x 0,20 m, em sistema orgânico com rendimento médio de 2,5 kg m2 -1. Os resultados descrevem os materiais consumidos, o tempo de mão-de-obra para realização das operações e os custos, baseados na realidade local. Conclui-se com este trabalho que a elaboração do coeficiente técnico de produção auxilia o agricultor a estimar o custo de produção de uma determinada matéria prima e evidencia as atividades que podem contribuir no lucro como, por exemplo, as boas práticas de produção.

Were prepared the technical coefficients of priprioca (Cyperus articulatus) production in three areas suppliers partner of Natura, situated around Belem, Eastern Amazon. For preparation of technical coefficients of priprioca production, the cost items and activities that comprise the growing, harvesting and processing were collected and classified as: Inputs, Services, Equipment, and Others. The details of these activities and the value of the items were obtained and constructed in situ, together with the farmers. Information used in this study considered the production of one tonne of priprioca root cultivated annually in seven plots of 60 m² (1,2 m wide x 50 m length) 0,20 x 0,20 m, in an organic system average yield of 2,5 kg m2 -1. The results describe the materials consumed, the time of manpower to carry out the operations and costs, based on local realities. Were conclude with this work that the preparation of the technical coefficient production helps farmers to estimate the cost of production and highlights the activities that can contribute to profit, for example, good manufacturing practices.

Participation Determinants in the DRG Payment System of Obstetrics and Gynecology Clinics in South Korea / 예방의학회지

OBJECTIVES: The Diagnosis Related Group (DRG) payment system, which has been implemented in Korea since 1997, is based on voluntary participation. Hence, the positive impact of this system depends on the participation of physicians. This study examined the factors determining participation of Korean obstetrics & gynecology (OBGYN) clinics in the DRG-based payment system. METHODS: The demographic information, practice-related variables of OBGYN clinics and participation information in the DRG-based payment system were acquired from the nationwide data from 2002 to 2007 produced by the National Health Insurance Corporation and the Health Insurance Review & Assessment Service. The subjects were 336 OBGYN clinics consisting of 43 DRG clinics that had maintained their participation in 2003-2007 and 293 no-DRG (fee-for-service) clinics that had never been a DRG clinic during the same period. Logistic regression analysis was carried out to determine the factors associated with the participation of OBGYN clinics in the DRG-based payment system. RESULTS: The factors affecting participation of OBGYN clinics in the DRG-based payment system were as follows (p<0.05): (1) a larger number of caesarian section (c/sec) claims, (2) higher cost of a c/sec, (3) less variation in the price of a c/sec, (4) fewer days of admission for a c/sec, and (5) younger pregnant women undergoing a c/sec. CONCLUSIONS: These results suggest that OBGYN clinics with an economic practice pattern under a fee-for-service system are more likely to participate in the DRG-based payment system. Therefore, to ensure adequate participation of physicians, a payment system with a stronger financial incentive might be more suitable in Korea.

Atención de las enfermedades cardiovasculares en la Caja Costarricense de Seguro Social: 1998-2005 / Care of cardiovascular diseases in the Caja Costarricense de Seguro Social: 1998-2005

En este artículo se presentan las principales características de la morbilidad por enfermedades cardiovasculares y el costo en que incurre la Caja Costarricense de Seguro Social en la atención de las mismas.

Hospitalización y costos de los inmigrantes en el Hospital Enrique Baltodano Briceño, Liberia, Guanacaste, durante 2003 / Hospitalization and cost of the inmigrants in the Hospital Enrique Baltodano Briceño, Liberia, Guanacaste, during 2003

Objetivo: Evaluar dentro del área de intervención, la Política vigente en materia de Atención a la Población Migrante, en base a la estrategia: Mejoramiento de la cobertura, estimación costo aporte y registro del aseguramiento de la población migrante trabajadora que acudió al servicio de Urgencias del Hospital Enrique Baltodano Briceño durante el año 2003. Métodos: Se trata de un estudio descriptivo de corte transversal. Se recogieron las siguientes variables: nacionalidad, sexo, código de asegurado, servicio de hospitalización y costos de atención. Resultados: Se registraron 87524 hojas de puerta en el servicio de Urgencias del Hospital Enrique baltodano Briceño durante el año 2003, correspondientes a 5758 personas extranjeras, de las cuales 1890 requierieron hospitalización. Del total de pacientes Hospitalizados, 1406 (74,4 por ciento) correspondieron a mujeres, 355 (18,7 por ciento) hombres y 13 (0,7 por ciento) eran solteros. Los que requirieron ser hospitalizados en los servicios de Obstetricia, 1053 (55,7 por ciento), Medicina, 218 (11,5 por ciento), Cirugía, 180 (9,5 por ciento) Ginecología, 80 (4,3 por ciento), y otros servicios 359 (19,0 por ciento). Respecto a la nacionalidad de los pacientes hospitalizados, 1668 (88,3 por ciento) correspondieron a pacientes nicaragüenses, y 222 (11,7 por ciento) fueron de otras nacionalidades. En cuanto al Código de Asegurado de los pacientes hospitalizados, 1029 (54,5 por ciento) era de Código 20 (Asegurado por el Estado, Nomenclatura válida hasta Dic.2003), 444 (23,5 por ciento) correspondieron a otros asegurados, 236 (12,5 por ciento) pacientes internados con Código de Asegurado 2 y por último 181 (9,5 por ciento) pacientes con Código de Asegurado 1. Los costos estimados de la atención de los 5758 extranjeros que fueron atendidos en el servicio de Urgencias considerando el uso del servicio de Laboratorio y Rayos X, estuvo alrededor de ¢278.030.788,00. Finalmente los costos estimados de hospitalización de los 1890 pacientes internados, considerando un promedio de 3 días por pacientes, fue alrededor de ¢488.731.705,00. Conclusiones: Los pacientes inmigrantes que asisten al servicio de Urgencias del Hospital Enrique Baltodano Briceño de Liberia, pertenecen en su mayoría a la población nicaragüense del sexo femenino que requieren ser internados en el servicio de Obste...