Thyroid cancer burden and economic impact on the Brazilian public health system

ABSTRACT Objective: Recent data indicates an increasing incidence of thyroid cancer not accompanied by a proportional increase in mortality, suggesting overdiagnosis, which may represent a big public health problem, particularly where resources are scarce. This article aims to describe and evaluate the procedures related to investigation of thyroid nodules and treatment and follow-up of thyroid cancer and the costs for the Brazilian public health system between 2008 and 2015. Materials and methods: Data on procedures related to investigation of thyroid nodules and treatment/follow-up of thyroid cancer between 2008 and 2015 in Brazil were collected from the Department of Informatics of the Brazilian Unified Health System (Datasus) website. Results: A statistically significant increase in the use of procedures related to thyroid nodules investigation and thyroid cancer treatment and follow-up was observed in Brazil, though a reduction was noted for procedures related to the treatment of more aggressive thyroid cancer, such as total thyroidectomy with neck dissection and higher radioiodine activities such as 200 and 250 milicuries (mCi). The procedures related to thyroid nodules investigation costs increased by 91% for thyroid ultrasound (p = 0.0003) and 128% in thyroid nodule biopsy (p < 0.001). Costs related to treatment and follow-up related-procedures increased by 120%. Conclusion: The increase in the incidence of thyroid cancer in Brazil is directly associated with an increased use of diagnostic tools for thyroid nodules, which leads to an upsurge in thyroid cancer treatment and followup-related procedures. These data suggest that substantial resources are being used for diagnosis, treatment and follow-up of a potentially indolent condition.

[ application of activity based costing system in radiology ward: a case study of Hafez hospital]

Activity Based Costing [ABC] is a method to illustrate cost of products and is capable to provide non-financial information to improve efficiency of organizations. The Aim of this study is to determine cost of radiology and sonography services and to demonstrate difference between fees and cost in public sector. We analyzed more than 100 different radiology and sonography services using work and time study to determine dedicate time and resource for each service in radiology ward of Hafez hospital. Total cost of overhead centers was allotted to services using concurrent equation method after calculation. Monte Carlo simulation method has been used to calculate confidence interval of each cost price. Estimated cost price has been showed in details that included activities description, kind, amount and cost of material, equipment and energy consumed by each service. Also we calculated building depreciation and amount of total cost allotted to each service from overhead centers such as management, accounting and so on. Fees 36678 and 42038 respectively for radiology and sonography services. Our results indicated that main components of cost were human resource [48%], overhead cost [27%], equipment depreciation cost [14%] and material cost [11%]. Due to low productivity, cost of service was higher then received fees. So, for overhead cutting, the best was is increasig service volume. Finally we must mention that for making fees move realistic and imporoving service level use of ABC system is a necessity

Ecocardiografia de contraste nos dias de hoje / Contrast echocardiography today

Atualmente os contrastes para ultrassom estão aprovados para várias situações da prática clínica. Estudos demonstram que são uma alternativa custo-efetiva no universo dos exames cardiológicos, reduzindo o número de testes complementares, especialmente, na investigação da doença arterial coronariana. Alguns softwares, aplicados em ecocardiografia, podem melhorar a visualização do contraste da borda endocárdica, opacificação da cavidade ventricular, ecocardiografia de estresse com contraste para análise de isquemia e viabilidade miocárdicas, perfusão miocárdica e abordagem do fluxo de reserva coronariano. Apesar dos questionamentos sobre a ecocardiografia contrastada, ocorridos nos últimos anos, suas indicações continuam sólidas em diretrizes internacionais e estudos multicêntricos demonstraram que o método é seguro e eficaz, além de enriquecer as informações diagnósticas e prognósticas dentro do campo cardiológico e radiológico. Nesta revisão, são discutidos todos esses pontos com maiores detalhes e com o objetivo de informar sobre as questões relevantes do contraste de microbolhas e como se encontra sua situação nos dias de hoje.

Diagnóstico de sinéquias uterinas por histerossonografia transvaginal / Diagnosis of uterine synechiae in patients with recurrent miscarriages: contribution of transvaginal hysterosonography

OBJETIVO: Avaliar a prevalência de sinéquias uterinas em pacientes com aborto recorrente e a acurácia diagnóstica da ultra-sonografia transvaginal (US-TV) e da histerossonografia (HS). MÉTODOS: Sessenta pacientes não grávidas com passado de três ou mais abortos espontâneos consecutivos foram avaliadas por US-TV, HS e histeroscopia (HTC) para a pesquisa de sinéquias uterinas. A HTC foi considerada o padrão ouro do estudo. A concordância dos achados da US-TV e da HS foram avaliadas pelo coeficiente Kappa e sua significância foi testada. O nível de significância adotado foi de 0,05 (alfa = 5 por cento). Foram calculadas as medidas de sensibilidade, especificidade e valor preditivo positivo e negativo para cada um dos métodos. RESULTADOS: Observou-se a presença de sinéquias uterinas em 16 (26,7 por cento) pacientes. A acurácia da US-TV e da HS foram, respectivamente, de 78,9 por cento e 92,7 por cento. Comparativamente à US-TV, a HS foi muito superior quanto à sensibilidade (78,6 por cento versus 20 por cento) e concordância com a HTC (Kappa = 80 por cento versus Kappa = 27 por cento). CONCLUSÃO: Observou-se boa concordância da HS e concordância ruim da US-TV em relação à HTC para o diagnóstico de sinéquias uterinas. Devido à sua baixa sensibilidade, a US-TV não demonstrou ser um método aplicável à investigação de sinéquias uterinas em pacientes com aborto recorrente. A HS, por sua vez, parece oferecer importante contribuição nesta pesquisa, particularmente por sua simplicidade técnica, baixo custo e elevada acurácia diagnóstica.

BACKGROUND: The aim of this study was to determine the prevalence of uterine synechiae in patients with recurrent miscarriages and to evaluate the diagnostic accuracy of transvaginal ultrasound and of hysterosonography. METHODS: Sixty non-pregnant patients with a history of at least three previous consecutive miscarriages were evaluated by transvaginal ultrasound, hysterosonography and hysteroscopy to detect uterine synechiae. Hysteroscopy was considered the gold standard. Agreement of findings disclosed by transvaginal ultrasound and by the hysterosonography were evaluated according to the Kappa coefficient and their significance was tested. Significance was established at < 0. 05 (Alpha error = 5 percent). Sensitivity, specificity, positive and negative predictive values were determined for each method. RESULTS: Uterine synechiae were identified in 16 patients (26.7 percent). The accuracy of the transvaginal ultrasound and of the hysterosonography was 78.9 percent and 92.7 percent, respectively. When compared to the transvaginal ultrasound, hysterosonography had a much greater sensitivity (78. percent vs. 20.0 percent) and a higher degree of agreement with hysteroscopy (Kappa = 80 percent vs. Kappa = 27 percent). CONCLUSION: For diagnosis of uterine synechiae, hysterosonography had a higher level of agreement with hysteroscopy than the transvaginal ultrasound. In patients with recurrent miscarriages transvaginal ultrasound is not recommended for the investigation of uterine synechiae because of its low sensitivity. Hysterosonography, on the other hand, seems to offer an important contribution especially because it is a simple, low-cost and accurate method for diagnosis of uterine synechiae.

Screening for abdominal aortic aneurysms

OBJECTIVE AND METHODS: Screening for abdominal aortic aneurysms may be useful to decrease mortality related to rupture. We conducted a study to assess the prevalence of abdominal aortic aneurysms in southern Brazil and to define risk factors associated with high prevalence of this disorder. The screening was conducted using abdominal ultrasound. Three groups were studied: Group 1 - cardiology clinic patients; Group 2 - individuals with severe ischemic disease and previous coronary surgery, or important lesions on cardiac catheterism; Group 3 - individuals without cardiac disease selected from the general population. All individuals were male and older than 54 years of age. The ultrasonographic diagnosis of aneurysm was based on an anteroposterior abdominal aorta diameter of 3 cm, or on an abdominal aorta diameter 0.5 cm greater than that of the supra-renal aorta. RESULTS: A total of 2.281 people were screened for abdominal aortic aneurysms in all groups: Group 1 - 768 individuals, Group 2 - 501 individuals, and Group 3 - 1012 individuals. The prevalence of aneurysms was 4.3 percent, 6.8 percent and 1.7 percent, respectively. Age and cigarette smoking were significantly associated with increased prevalence of aneurysms, as was the diagnosis of peripheral artery disease. DISCUSSION: We concluded that screening may be an important tool to prevent the mortality associated with abdominal aortic aneurysms surgery. Additionally, the cost of screening can be decreased if only individuals presenting significant risk factors, such as coronary and peripheral artery disease, smokers and relatives of aneurysm patients, are examined

Comparación de la calidad de la imagen de ecofotogramas impresos en papel térmico vs impresión laser / Quality of the image of echophotograma printers in thermic paper vs printer laser comparation

Se presenta un análisis comparativo experimental de la calidad y el costo de la impresión laser de ecofotogramas en papel Bond vs. la impresión en papel térmico y videoprinter. Se tomaron y se grabaron en VHS 24 estudios ecosonográficos realizados a pacientes de la Consulta de Ginecología y Obstetricia del Hospital Miguel Pérez Carreño para posteriormente tomar una imagen de cada estudio e imprimir una copia en papel termosensible y otra en una impresora laser y papel bond. Estas impresiones fueron analizadas en cuanto a su calidad por 4 gineco-obstetras con más de cinco años de experiencia en ecografía y un fotografo con 25 años de experiencia en su campo. También se realizó un estudio comparativo de costos. No se encontraron diferencias significativas entre la calidad de la imagen impresa en laser y la impresa en videoprinter según los ecografistas, pero hubo diferencia estadísticamente significativa para la evaluación de la calidad por el fotografo a favor de la impresión laser. La evaluación de costos reportó una reducción de más de 50 de los mismos al utilizar la impresión laser tomando como base 5000 impresiones

Costo beneficio de la punción aspiración con aguja fina de masas sólidas abdominales / Cost-benefit analysis of fine needle aspiration biopsy of solid abdominal masses

Se presenta el análisis costo-beneficio de la biopsia por punción aspiración con aguja fina de masas sólidas abdominales. Se compararon los costos de la punción con guía ecográfica, con los de la tomografía computada, los de la laparotomía exploradora y con su uso intraoperatorio. En una serie de 158 punciones con control ecográfico la sensibilidad fue de 85.9%y la exactitud de 88.6%sin falsos positivos ni complicaciones. La tomografía computada como guía representa un costo 349%mayor que la ecografía, con parecida sensibilidad, como fue demostrado en otras series. En pacientes con tumores de cuerpo de páncreas la punción evita los costos de una laparotomía exploradora, y en aquellos que deben operarse posibilita estudios anatomopatológicos diferidos y disminución del tiempo operatorio. Se concluye que la punción de masas abdominales con guía ecográfica es un método sencillo, rápido, eficaz, ambulatorio y con una favorable relación costo-beneficio