Physiological responses of tambaqui (Colossoma macropomum) fed diets supplemented with silage from fish and vegetables residues / Respostas fisiológicas de tambaqui (Colossoma macropomum) alimentado com dietas suplementadas com silagem de resíduos de pescado e vegetais

The demand for products to replace high-cost raw materials, such oil and fish meal, in the manufacture of feed for use in aquaculture, while also guaranteeing the nutritional quality of the diets, is increasing. Silage produced with fish and vegetables residues is a low-cost and efficient protein source. The objective of the present study was to evaluate the physiological and biochemical responses of tambaqui fingerlings fed four different levels of silage included in commercial feed with 28% crude protein, over two periods: 45 and 90 days. Each treatment was carried out over three replications, with 10 tambaqui in each 100 L experimental tank. At the end of each established period, blood samples were collected from five animals from each repetition to determine the hematological and biochemical variables. Body weight and total length, hepatosomatic and liposomal indices and hematocrit of specimens fed with diets supplemented with silage did not exhibit significant changes in both assessment period. After 45 days of feeding, the hemoglobin concentration increased when tambaqui were fed a diet including 20% silage. The red blood cell count, mean corpuscular volume and mean corpuscular hemoglobin did not change between treatments in either period. The total protein concentrations increased significantly in the plasma of tambaqui fed with diets with the inclusion of 5 and 10% of silage, evaluated after feeding for 45 days. It was found that the groups which had silage included in their diet did not exhibit significant alterations in the evaluated parameters, and the diet was therefore not consider harmful to the health of tambaqui. Therefore, the use of silage as a feed supplement during tambaqui farming is a sustainable alternative for producers, as it leads to a reduction of impacts of fish and vegetables waste disposal.

A procura por insumos que substituam produtos de alto custo, como óleo e farinha de peixe, na fabricação de rações para uso na aquicultura é crescente, sendo necessário garantir a qualidade nutricional das dietas. A silagem produzida a partir de resíduos de pescado e de vegetais apresenta-se como uma alternativa de baixo custo e eficiente fonte proteica. O objetivo do presente estudo foi avaliar as respostas fisiológicas e bioquímicas de alevinos de tambaqui alimentados com quatro níveis de inclusão de silagem em ração comercial com 28% de proteína bruta, em dois períodos: 45 e 90 dias. Cada tratamento foi realizado em três repetições, com 10 tambaquis em cada caixa experimental de 100 L. Ao término de cada período estabelecido, amostras sanguíneas foram coletadas de cinco animais de cada repetição para determinação das variáveis hematológicas e bioquímicas. Peso, comprimento total e índices hepatossomático e lipossomático de espécimes alimentados com silagem não mostraram alterações significativas em ambos os períodos de avaliação, bem como os valores de hematócrito. A concentração de hemoglobina de tambaqui após 45 dias de alimentação aumentou quando foi fornecida dieta com inclusão de 20% de silagem. A contagem de eritrócitos, volume corpuscular médio e hemoglobina corpuscular média não apresentaram alterações entre os tratamentos, em ambos os períodos. As proteínas totais aumentaram significativamente no plasma de tambaquis que receberam dietas com inclusão de 5 e 10% de silagem, avaliados após 45 dias de alimentação. Evidenciou-se que os grupos com inclusão de silagem na dieta não apresentaram alterações significativas nos parâmetros avaliados, assim não sendo prejudiciais à higidez do tambaqui. Portanto, o uso da silagem como suplemento alimentar durante o cultivo do tambaqui é uma alternativa sustentável para produtores, por promover a redução do descarte de resíduos de pescado e da agricultura.

The impact of COPD on the private healthcare system in Brazil: an economic analysis / Impacto da DPOC no sistema de saúde privado no Brasil: uma análise econômica

Objective: To assess healthcare resource utilization and hospitalization costs of patients with chronic obstructive pulmonary disease (COPD) exacerbations in the Brazilian private healthcare system. Methods: A retrospective cohort study, considering data from an administrative database of a private company (Orizon). Patients aged ≥40 years old and with at least one COPD-related claim identified by the ICD-10 code (J40 to J44) at any time during the eligibility period (January/2010 to December/2013) were included in the analysis. Follow-up was performed until December/2014, death or inactivation of a health plan. Sociodemographic characteristics, number of emergency visits, hospital admissions (number and length of stay), length of hospital stay in an intensive care unit (ICU), number of severe COPD exacerbations, therapeutic approach, and hospitalization costs were assessed. Results: The analysis included 8,254 COPD patients. Emergency visits, hospital admission, and exacerbation rates were 0.4, 0.2, and 0.1 per person-year, respectively. The mean length of hospital stays and the length of stay of patients requiring or not ICU stay were 16.6 (SD = 77.0), 8.7 (SD = 36.9), and 27.6 (SD = 109.7), respectively. Mean costs associated to emergency department visits and hospitalizations were 258.2 BRL (SD = 383.1) and 38,165.4 BRL (SD = 124,683.5), respectively. Hospitalizations costs without ICU stay were 11,810.1 BRL (SD = 31,144.1) and 74,585.3 BRL (SD = 182,808.1) for those with ICU utilization. Conclusion: Costs for COPD management during disease exacerbation are very high and may reach almost 75 thousand BRL per hospitalization. The prevention of COPD exacerbations and better disease control may reduce the economic burden on the private healthcare system in Brazil.

Objetivo: Avaliar a utilização de recursos e custos de pacientes com exacerbação da doença pulmonar obstrutiva crônica (DPOC) no sistema de saúde suplementar (SSS) do Brasil. Métodos: Estudo de coorte retrospectiva, considerando banco de dados administrativo de uma empresa privada (Orizon). Pacientes com ≥40 anos e pelo menos um registro de admissão relacionado à DPOC identificado com CID-10 J40-J44, entre janeiro/2010 e dezembro/2013, foram incluídos e acompanhados até dezembro/2014, morte ou inativação no plano. Características sociodemográficas, número de visitas de emergência, admissões hospitalares (número e tempo de hospitalização), tempo de hospitalização em unidade de terapia intensiva (UTI), número de exacerbações graves, estratégias terapêuticas e custos hospitalares foram as variáveis analisadas. Resultados: A análise incluiu 8.254 pacientes com DPOC. As taxas de visita à emergência, internação hospitalar e exacerbação da doença foram de 0,4, 0,2 e 0,1 por pessoa-ano, respectivamente. Os tempos médios de hospitalização, hospitalização sem utilização de UTI e hospitalização com necessidade de UTI foram de 16,6 (DP = 77,0), 8,7 (DP = 36,9) e 27,6 (DP = 109,7) dias, respectivamente. Os custos médios relacionados à visita de emergência e por hospitalização foram de 258,2 BRL (DP = 383,1) e 38.165,4 BRL (DP = 124.683,5), respectivamente. Os custos para pacientes que não utilizaram UTI foram de 11.810,1 BRL (DP = 31.144,1) e de 74.585,3 BRL (DP = 182.808,1) para aqueles com necessidade desse serviço. Conclusão: Os custos para o manejo dos pacientes com exacerbação da DPOC são muito elevados, podendo chegar a 75.000 BRL por hospitalização. A prevenção de exacerbações e o melhor controle da doença podem reduzir esse impacto econômico no SSS.

Flebite associada ao cateter venoso periférico em cardiologia: incidência, fatores de risco e custos associados / Phlebitis associated with peripheral venous catheter in cardiology: incidence, risk factors and associated costs

Objetivo: Determinar a incidência de flebite, fatores de risco associados e custos diretos de tratamento. Métodos: Estudo descritivo, correlacional, com análise de custo direto. Utilizaram-se dados da documentação dos enfermeiros entre janeiro 2019 e agosto 2021. Resultados: Incluíram-se 2.374 pessoas com cateter venoso periférico, com internamento na cardiologia. A incidência de flebite foi de 12,38%, das quais 78,23% eram de grau 1 de severidade. Verificou-se associação estatística entre o desenvolvimento de flebite e a administração de amiodarona endovenosa, dias de hospitalização e serviço de internamento. Estimaram-se 1662€ de custos adicionais ao tratamento da flebite, em material clínico e horas de cuidados de enfermagem. Conclusão: Os cuidados de enfermagem são eficazes na identificação precoce e tratamento da flebite, promovendo redução de custos adicionais e garantindo melhores cuidados e ganhos em saúde.

Objective: This study aimed to identify the incidence rate of phlebitis, associated risk factors and treatment direct costs. Methods: Descriptive, correlational study with direct cost analisys. Data from the nurses' clinical records between January 2019 and August 2021 were used. Results: Included 2,374 files of people with peripheral venous catheter who were admitted to Cardiology. The phlebitis incidence rate was 12.38% and regarding severity 78.23% were grade 1. The phlebitits was significantly related with intravenous amiodarone administration, length of stay and physical department. This represents €1662 of additional treatment costs, in clinical supplies and nursing time. Conclusion: Nursing care is effective in the early identification and treatment of phlebitis, reducing costs and improve clinical and economic outcomes.

The impact of depression in the Brazilian private healthcare system: patient journey and economic burden study associating claim database and expert's opinion approach / O impacto da depressão no sistema de saúde privado brasileiro: estudo da jornada do paciente e da carga econômica associando banco de dados de sinistros e abordagem de opinião de especialistas

Objective: The study aimed to describe the profile and economic burden of patients with depression from the perspective of the Brazilian Private Healthcare System (PHS). Methods: A two-step methodological quantitative-qualitative research design was performed: retrospective descriptive analysis of the Orizon database of patients with at least one claim of depression (F33, F38, or F39) in PHS (2013-2019) and experienced physicians perspective from an expert meeting. Results: 1,802 patients fulfilling the eligibility criteria counted BRL 74,978 million across the 4-year period. Over this period, nearly 60% of patients had a medical appointment (6.6 appointments per patient, on average), 61% had a psychologist, 9.8% had a psychiatrist appointment, and an average of 115.2 exams and 8.7 emergency visits per patient were performed. According to the experts, the economic impact of depression is more significant when considering the indirect costs related to productivity loss and impairment in occupational and interpersonal functioning. Conclusion: Identifying and diagnosing patients with depression and their real burden is challenging; even with significant costs identified in the claim database analyses in the Brazilian PHS, the real impact must be higher if indirect costs are considered. The depressive disorder should be prioritized in the Brazilian PHS to establish more adequate health policies.

Objetivo: O estudo teve como objetivo descrever o perfil e a carga econômica de pacientes com depressão na perspectiva do Sistema Único de Saúde (SUS). Métodos: Foi realizado um projeto de pesquisa quantitativo-qualitativo metodológico em duas etapas: análise descritiva retrospectiva do banco de dados Orizon de pacientes com pelo menos uma alegação de depressão (F33, F38 ou F39) no PHS (2013- 2019) e perspectiva de médicos experientes de uma reunião de especialistas. Resultados: 1.802 pacientes que preencheram os critérios de elegibilidade totalizaram R$ 74,978 milhões no período de 4 anos. Nesse período, cerca de 60% dos pacientes tiveram consulta médica (6,6 consultas por paciente, em média), 61% tiveram psicólogo, 9,8% consulta com psiquiatra e foram realizados em média 115,2 exames e 8,7 atendimentos de emergência por paciente . Segundo os especialistas, o impacto econômico da depressão é mais significativo quando considerados os custos indiretos relacionados à perda de produtividade e prejuízo no funcionamento ocupacional e interpessoal. Conclusão: Identificar e diagnosticar pacientes com depressão e sua real carga é desafiador; mesmo com custos significativos identificados nas análises da base de sinistros do SUS brasileiro, o impacto real deve ser maior se considerados os custos indiretos. O transtorno depressivo deve ser priorizado na APS brasileira para o estabelecimento de políticas de saúde mais adequadas.

Extracorporeal photopheresis in chronic graft-versus-host disease: clinical description and economic study

Abstract Introduction Although extracorporeal photopheresis (ECP) is a promising second-line therapy in the treatment of chronic graft-versus-host disease (cGVHD), its use is limited by its high cost. This study aims to describe the clinical evolution of patients who underwent ECP therapy for cGVHD and to perform an economic analysis of the therapy Methods This was a case series between 2016 and 2020 describing the clinical response to ECP and a micro-cost analysis of the therapy using time-driven activity-based costing. Results Six patients underwent ECP for corticosteroid-dependent cGVHD The cost per ECP session is 14,960.90 Brazilian reais (BRL), which primarily consists of the ECP kit with an activator (82.78%), followed by the hospital's physical structure (14.66%), human resources (2.48%) and exams/inputs (0.08%). The number of sessions performed ranged from 2 to 42. The total cost of the therapy per patient ranged from BRL 30,000 to 500,000. Conclusion The response of the patient with cGVHD to treatment with ECP was variable. These micro-costing results can be used to develop remuneration and cost control strategies in hematopoietic stem cell transplantation programs, as well as in further economic studies.

Ameliorating effects of ethanol extract of root bark of Salacia nitida on blood electrolyte and renal perturbations in Plasmodium berghei-infected mice

Abstract Malaria, a disease of public health concern is a known cause of kidney failure, and dependence on herbal medicines for its treatment is increasing due to the high cost of drugs. So this study is designed to evaluate the ameliorating effect of ethanol extract from Salacia nitida root bark on electrolyte and renal perturbations in Plasmodium berghei-infected mice. Thirty malariainfected mice divided into five groups of six mice each and another group of six uninfected mice were used for the study. 280, 430, and 580 mg/kg of extract were given to infected mice in groups B, C, and D, 4 mg/kg of artesunate given to group E mice, and 4 ml/kg of physiological saline given to group A and uninfected group F mice for five days. Serum Na+, K+, HCO3, Cl-, TB, urea, creatinine, BUN concentrations, and BUN/creatinine ratio were determined using standard methods. Results showed significant increases (p < 0.05) in Na+, K+, and HCO3 and decreases in Cl-, TB, urea, creatinine, BUN, and BUN/creatinine ratio in the infected treated mice in groups B - E. This study showed that ethanol extract of S. nitida root bark is efficient in the treatment of renal disorders and blood electrolyte perturbations

Percentual de utilização de instrumentais em procedimentos cirúrgicos / Percentage of use of instruments in surgical procedures / Porcentaje de uso de instrumentos en procedimientos quirúrgicos

Objetivo: analisar o percentual de instrumentais cirúrgicos que compõem a caixa de laparotomia exploradora e não são utilizados durante as cirurgias. Método: estudo descritivo, transversal com abordagem quantitativa, que contabilizou instrumentais constituintes da caixa de laparotomia exploradora utilizados e não utilizados durante 13 cirurgias realizadas em um período de 17 dias, em um hospital do interior paulista. Resultados: nas 13 cirurgias analisadas, obteve-se um total de 1300 (100%) pinças presentes nas caixas, onde 832 (64%) não foram utilizadas e 468 (36%) foram utilizadas. Nos tempos cirúrgicos, o maior número de uso foi de 166 (35,5%) artigos, para preensão e afastadores. Conclusão: houve 64% de instrumentais não utilizados nas cirurgias analisadas. Há necessidade de implementar estratégias gerenciais que reduzam os números encontrados e, consequentemente, reduzam gastos, para gerar menor desperdício e reduzir falhas no gerenciamento de recursos materiais.

Objective: to analyze the percentage of surgical instruments that make up the operating laparotomy box and are not used during surgeries. Method: descriptive, cross-sectional study with quantitative approach, which counted instrumental constituents of the exploratory laparotomy box used and not used during 13 surgeries performed in a period of 17 days, in a hospital in the interior of São Paulo. Results: in the 13 surgeries analyzed, a total of 1300 (100%) tweezers were obtained in the boxes, where 832 (64%) were not used and 468 (36%) were used. In surgical times, the highest number of use was 166 (35.5%) articles, for seizures and reparators. Conclusion: there were 64% of instruments not used in the analyzed surgeries. There is a need to implement management strategies that reduce the numbers found and, consequently, reduce expenses, to generate less waste and reduce failures in the management of material resources.

Objetivo: analizar el porcentaje de instrumentos quirúrgicos que componen la caja de laparotomía quirúrgica y no se utilizan durante las cirugías. Método: estudio descriptivo, transversal con enfoque cuantitativo, que contó constituyentes instrumentales de la caja de laparotomía exploratoria utilizada y no utilizada durante 13 cirugías realizadas en un período de 17 días, en un hospital del interior de São Paulo. Resultados: en las 13 cirugías analizadas, se obtuvieron un total de 1300 (100%) pinzas en las cajas, donde no se utilizaron 832 (64%) y 468 (36%). En tiempos quirúrgicos, el mayor número de uso fue de 166 (35,5%) artículos, para convulsiones y reparadores. Conclusión: hubieran 64% de instrumentos no utilizados en las quirurgias analizadas. Es necesario implementar estrategias de gestión que reduzcan los números encontrados y, en consecuencia, reduzcan los gastos, para generar menos residuos y reducir las fallas en la gestión de los recursos materiales.

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.

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.

3D-QSARpy: Combining variable selection strategies and machine learning techniques to build QSAR models

Abstract Quantitative Structure-Activity Relationship (QSAR) is a computer-aided technology in the field of medicinal chemistry that seeks to clarify the relationships between molecular structures and their biological activities. Such technologies allow for the acceleration of the development of new compounds by reducing the costs of drug design. This work presents 3D-QSARpy, a flexible, user-friendly and robust tool, freely available without registration, to support the generation of QSAR 3D models in an automated way. The user only needs to provide aligned molecular structures and the respective dependent variable. The current version was developed using Python with packages such as scikit-learn and includes various techniques of machine learning for regression. The diverse techniques employed by the tool is a differential compared to known methodologies, such as CoMFA and CoMSIA, because it expands the search space of possible solutions, and in this way increases the chances of obtaining relevant models. Additionally, approaches for select variables (dimension reduction) were implemented in the tool. To evaluate its potentials, experiments were carried out to compare results obtained from the proposed 3D-QSARpy tool with the results from already published works. The results demonstrated that 3D-QSARpy is extremely useful in the field due to its expressive results.

Cout réel de la prise en charge des cancers du col de l'utérus en radiothérapie au Cameroun / The real cost of the management of cervical cancers by radiotherapy in Cameroon

Introduction. Le cancer du col utérin est le deuxième cancer de la femme au Cameroun. La radiothérapie reste une des modalités thérapeutiques phares dans la prise en charge de cette pathologie et l'État participe en y apportant une subvention. Toutefois, plusieurs patientes n'accèdent pas au traitement en raison des difficultés financières. Notre objectif était d'évaluer le coût réel de la prise en charge afin de servir de support aux politiques d'aide aux patientes. Méthodologie. Uneétude descriptive, transversale portant sur les patientes traitées en radiothérapie à l'Hôpital Général de Douala pour cancer du col de l'utérus a été réalisée d'octobre 2020 à janvier 2021.Résultats. Au total 35 dossiers de patientes ont été inclus. Lespatientes avaient de faibles revenus (<108.810 XAF /mois, 51,3%), étaient sans assurance maladie (88,6%), provenant en majorité des villes hors de Douala (54,3%), avec des cancers localement évolués. Le coût global moyen du traitement était de 511 264 XAF+/-103479 XAF (779,42 +/-157,75 euros) pour chaque patiente. La durée moyenne de traitement était de 57,34 jours, avec un nombre médian de 27 séances. Les frais supplémentaires pendant le traitement provenaient de la chimiothérapie, de la gestion des effets secondaires, notamment des transfusions sanguines, et du bilan de suivi. Plus de la moitié des patientes ont eu besoin d'une prise en charge supplémentaire par chimiothérapie ou chirurgie. Conclusion. La prise en charge du cancer du col utérin par radiothérapie est coûteuse et peu accessible à la majorité des patientes Camerounaises.

Introduction.Cervix cancer is the second cancer among women in Cameroon. Radiotherapy is often warranted in its management. Many patients do not access treatment due to financial difficulties. Our objective was to assess the real cost of care in order to support patient assistance policies. Methodology. A descriptive cross over study of women treated by radiotherapy at the Douala General Hospital from October 2020 to January 2021 was conducted. Results. A total number of 35 patient files were included in the study. Patients generally had low income (<108.810 XAF /month), without medical insurance, lived out of Douala, and were diagnosed at locally advanced stages of their disease. Average cost of treatment for radiotherapy alone was 511,264 XAF +/-103,479 XAF. Average duration of treatment was 57.34 days, with a median number of 27 sessions. Extra cost came from chemotherapy, management of side effects especially from blood transfusions, and imaging. More than half of the patients required additional expense for adjunct chemotherapy or surgery. Conclusion. The total cost of treatment for cervix cancer by radiotherapy is quite expensive, and not accessible to the average Cameroonian

On addressing the burden of uncorrected refractive errors

@#Uncorrected or unaddressed refractive error (URE) is the leading cause of treatable visual impairment (VI) globally. A significant factor is the prohibitive costs of corrective options. The World Health Organization recently recommended the use of effective refractive error coverage (eREC) to determine the burden and management of URE. To increase eREC, spectacles should be made available and affordable. Most developing countries use ready-made glasses produced in bulk to address presbyopia. Timor-Leste employed a tiered- pricing for these ready-made spectacles which were found to be effective. The Philippines can adopt similar initiatives considering that prescription spectacles are not covered by its national health insurance. Prescription spectacles should also receive coverage from the national insurance. Policies should also be created that will set-up optical units inside government hospitals and primary health care units that can dispense low cost or free prescription spectacles. Dedicated government posts for optometrists should be created to man the said units. Existing colleges of optometry can partner with nearby public health facilities to man their optical units similar to partnerships made for other health professions. State universities can also consider opening colleges of optometry where they can tie up return services conditions or follow ladderized programs based on community demands similar to existing ones for other health professions

Gestión de proyectos en investigación clínica / Project management in clinical research

El éxito de una investigación depende de los aspectos científicos y de gestión. Los proyectos de investigación tienen similitud con otros proyectos de negocio. En este artículo se revisa la aplicación de metodología de gestión de proyectos del Project Management Institute (PMI) a un proyecto de investigación en sus fases de inicio, planificación, implementación, monitorización y cierre. Se plantean 3 desafíos en la implementación relacionados con el reclutamiento, seguimiento y gestión del dato. (AU)

The success of an investigation depends on the scientific and managerial aspects. Research projects are similar to other business projects. This manuscript reviews the application of the project management methodology of the project management institute applied to a research project in its initial, planning, implementation, monitoring and closure phases. There are 3 implementation challenges related to data recruitment, monitoring and management. (AU)

Avaliação econômica de uma estratégia individual de empoderamento farmacoterapêutico: um modelo em longo prazo aplicado do diabetes mellitus tipo II / Economic evaluation of an individual pharmacotherapeutic empowerment strategy: an applied long-term model for type II diabetes mellitus

Objetivos: contribuir para a geração de dados de avaliação econômica de estratégias de empoderamento farmacoterapêutico para pacientes com Diabetes Mellitus tipo 2 (DM tipo 2). Métodos: este estudo farmacoeconômico é aninhado a um ensaio clínico com controle não randomizado que incluiu pacientes ≥18 anos de idade, cadastrados no HIPERDIA. Os pacientes foram alocados em um modelo de Markov conforme valores de hemoglobina glicada do acompanhamento. As probabilidades do surgimento de complicações relativas ao DM, incluindo-se óbito, foram estimadas por dez anos. Cada complicação do DM tipo 2 teve seu custo estabelecido para determinação do custo anual. Resultados: entre os participantes da intervenção, não ocorrem óbitos ocasionados por DM tipo 2, e a progressão de complicações mantém-se estável durante os anos simulados, enquanto, no grupo controle, 60% dos pacientes podem evoluir para óbito nos dez anos, e a probabilidade de serem acometidos por complicações relacionadas ao DM tipo 2 é crescente. Com relação aos custos, ao final de dez anos, os pacientes que participaram da Estratégia Individual de Empoderamento Farmacoterapêutico (EIEF) tiveram um custo médio de UU$134,45 poupando a vida de 100% dos pacientes, e os pacientes do atendimento convencional um custo médio de UU$237,12 e 40% dos pacientes acompanhados chegariam ao final do ciclo com vida. Conclusão: a EIEF parece ser uma alternativa economicamente viável em longo prazo, bem como para a promoção do controle glicêmico.

Objectives: contribute to the data generation for the economic evaluation of pharmacotherapeutic empowerment strategies for type 2 diabetes mellitus patients (type 2 DM). Method: This pharmacoeconomic study is nested in a clinical trial with non-randomized control that included patients ≥18 years old, registered in HIPERDIA. The patients were allocated to a Markov model according to the follow-up glycated hemoglobin values. The probabilities of the appearance of complications related to DM, including death, have been estimated for ten years. Each complication of type 2 DM had its cost established to determine the annual cost. Results: Among the participants in the intervention, there are no deaths caused by type 2 DM, and the progression of complications remains stable during the simulated years, whereas in the control group, 60% of the patients can progress to death in ten years and the probability of being affected by complications related to type 2 DM is increasing. Regarding costs, at the end of ten years, patients who participated in Individual Pharmacotherapeutic Empowerment Strategy (IPES) had an average cost of US$ 134.45, saving 100% of patient's lives, and conventional care patients cost an average of US$ 237.12 and 40% of the patients followed would reach the end of the life cycle. Conclusion: The IPES seems like an economically viable and long-term economic alternative and promotes glycemic control.

Custeio Baseado em Atividade e Tempo (TDABC) do modelo CEDMAC de terapia assistida para dispensação de medicamentos imunobiológicos para doenças reumatológicas no SUS / Time-Driven Activity Based Costing (TDABC) of the CEDMAC model of assisted therapy for dispensing immunobiological rheumatologic medications at SUS

Objetivos: Mensurar o custo dos procedimentos de infusão de imunobiológicos no modelo CEDMAC (Centro de Dispensação de Medicações de Alto Custo) e estimar o custo minimização integral gerada pela existência desse modelo. Métodos: A metodologia de Custeio Baseado em Atividade e Tempo (TDABC) foi usada para calcular os custos dos procedimentos. Tempos de atividades, capacidades máximas de atendimento e fluxos dos processos internos foram obtidos em entrevistas e validados por meio de acompanhamento de pacientes. Os procedimentos foram categorizados em três tipos: a) aplicação subcutânea, b) infusão endovenosa rápida e c) infusão endovenosa longa. O custo-minimização foi estimado a partir de análise de 2017 para pacientes com artrite reumatoide (AR). Resultados: Ao longo de 2019, foram realizados 12.074 atendimentos no CEDMAC. Desses atendimentos, 60% foram de aplicação subcutânea (custo de R$ 117,90), 30%, de infusão endovenosa rápida (custo de R$ 169,90) e 10%, de endovenosa longa (custo de R$ 217,50). Usando a análise realizada em 2017, foi possível calcular o custo-minimização integral do modelo (uma economia líquida estimada de R$ 1.258.024,26 ao ano) e também extrapolar esses valores para todo o SUS caso o modelo fosse difundido no país (uma economia líquida estimada de R$ 189.401.652,88). Conclusão: Utilizando o método de TDABC, foi possível realizar de maneira rápida e eficiente o custeio dos principais procedimentos realizados no modelo CEDMAC. Essa análise embasará a solicitação da incorporação desses procedimentos na tabela unificada do SUS. Caso os procedimentos sejam incorporados e o modelo CEDMAC, difundido pelo Brasil, estima-se que a economia gerada seja da ordem de 189 milhões de reais ao ano.

Objectives: To measure the costs of immunobiological infusion procedures in the CEDMAC model (Centro de Dispensação de Medicações de Alto Custo) and to estimate the full cost-minimization generated by the existence of this model. Methods: Time-Driven Activity Based Costing (TDABC) methodology was used to calculate the procedures costs. Activity times, service capacities and internal flows were obtained from employee interviews and validated by follow-up with patients. Procedures were categorized into three types: a) subcutaneous, b) intravenous fast infusion, and c) intravenous slow infusion. The full cost-minimization was estimated based on a 2017 analysis of the cost-minimization for rheumatoid arthritis (RA) patients. Results: In 2019, 12,074 patients were attended at CEDMAC. Of these, 60% of infusions were subcutaneous (costing R$ 117.90 each), 30% were fast intravenous infusion (costing R$ 169.90), and 10% were slow intravenous infusion (costing R$ 217.50). Using a 2017 RA analysis, it was possible to calculate the full cost-minimization of the model, with an estimated net savings of R$ 1,258,024.26 per year. The estimated net savings if the model were disseminated throughout the country for the entire SUS would be R$ 189,401,652.88. Conclusion: Using the TDABC method it was possible to quickly and efficiently estimate the cost allocation of the main procedures performed in the CEDMAC model. This analysis will support the request for incorporating these procedures into SUS. If the procedures were incorporated, and the CEDMAC model was disseminated throughout Brazil, the savings generated by this initiative could be up to 189 million reais per year.

Direct costs associated with lupus nephritis management in the Private Healthcare System in Brazil: an expert panel perspective / Custos diretos associados ao manejo da nefrite lúpica no Sistema de Saúde Privado no Brasil: uma perspectiva segundo painel de especialistas

Objective: To estimate direct medical costs of lupus nephritis (LN) in the Brazilian private healthcare system. Methods: An expert panel of five specialists were convened to discuss health resource usage in LN patient management. The discussion included diagnosis, treatment, and disease monitoring, including dialysis and kidney transplantation. Unit costs (in BRL) were obtained from public sources, and an estimation of 1-year costs was conducted. Results: Approximately 76.0% of patients with LN undergo kidney biopsy, of which 48.1% present with LN classes III­IV and 21.4% have class V. Around 67.5% of patients with LN classes III­IV experience an average of four renal flares annually. Overall, 20.3% of patients present refractory LN, and 10.3% have end-stage kidney disease (ESKD), requiring dialysis and kidney transplantation. Estimated total weighted annual costs per patient were BRL 115,824.81 for LN classes III­IV, BRL 85,684.79 for LN class V, BRL 115,594.98 for refractory LN; and BRL 325,712.88 for ESKD. The main annual cost driver for LN classes III­IV was renal flares (BRL 60,240.41; 52.0%) and dialysis for LN class V (BRL 31,128.38; 36.3%). Conclusions: Total direct costs increase when LN progresses to ESKD. Although it is challenging to improve the diagnosis, identification of the disease at an early stage, together with rapid initiation of treatment, are fundamental elements to optimize results, potentially reducing costs to the system and the impact of disease burden and quality of life on patients.

Objetivo: Estimar os custos médicos diretos da nefrite lúpica (NL) no sistema suplementar de saúde brasileiro. Métodos: Um painel de cinco especialistas foi estruturado para discutir o uso de recursos em saúde no manejo de pacientes com NL. Nesta discussão, incluíram-se o diagnóstico, o tratamento e o monitoramento da doença, contemplando também diálise e transplante renal. Os custos unitários foram obtidos de fontes públicas e os resultados expressos em custo anual. Resultados: Aproximadamente 76,0% dos pacientes com NL são submetidos à biópsia renal, sendo 48,1% com NL de classes III-IV e 21,4% de classe V. Cerca de 67,5% dos pacientes com classes III-IV apresentam, aproximadamente, quatro flares renais anuais. No geral, 20,3% dos pacientes apresentam NL refratária e 10,3% desenvolvem doença renal terminal (DRT), necessitando de diálise e transplante renal. O custo ponderado anual estimado por paciente foi de R$ 115.824,81 para NL de classes III-IV, R$ 85.684,79 para classe V, R$ 115.594,98 para NL refratária e R$ 325.712,88 para DRT. O principal fator para incremento dos custos anuais para NL de classes III-IV foram os flares renais (R$ 60.240,41; 52,0%) e, na classe V, a diálise (R$ 31.128,38; 36,3%). Conclusões: Há um incremento dos custos diretos da NL na progressão para DRT. Embora seja desafiador melhorar o diagnóstico, a identificação da doença em uma fase precoce, aliada ao tratamento iniciado de forma célere, são elementos fundamentais para otimizar os resultados, potencialmente reduzindo os custos ao sistema e o impacto da carga da doença e qualidade de vida dos pacientes.

Cost comparison of dupilumab and omalizumab for the treatment of severe allergic asthma patients from the Brazilian private healthcare system perspective / Comparação dos custos de dupilumabe e omalizumabe para o tratamento de pacientes com asma alérgica grave na perspectiva do sistema de saúde privado brasileiro

Objective: To compare the costs of dupilumab and omalizumab for treating severe allergic asthma patients from the perspective of the Brazilian private healthcare system. Methods: Using clinical and demographic inputs from the literature, we simulated a cohort of 5,000 severe allergic asthma patients and estimated the treatment cost with omalizumab. Results: In the simulated cohort, 81.3% were female, the mean body weight was 75.1 kg (SD 13.1), and the mean serum IgE was 532 IU/mL (SD 688). All patients were eligible for treatment with dupilumab, but 830 (16.6%) were ineligible for treatment with omalizumab due to serum IgE level and/or body weight combinations, according to the product label. Over four weeks, the mean dose of omalizumab was 537 mg (SD 285). The annual mean per-patient cost for treatment with omalizumab was BRL 110,783.89 (SD 58,385.81), ranging from BRL 31,797.49 to BRL 246,643.15. The treatment cost with dupilumab is BRL 111,724.21 for the first year and BRL 107,599.91 for subsequent years. Conclusions: We observed slightly lower mean treatment costs with dupilumab than with omalizumab. However, while the treatment cost with dupilumab is fixed and predictable, the treatment cost with omalizumab is highly variable, depending on patients' characteristics. Health managers should consider these findings for reimbursement and clinical protocol development decisions.

Objetivo: Comparar os custos de dupilumabe e omalizumabe para o tratamento de pacientes com asma alérgica grave na perspectiva do sistema de saúde privado brasileiro. Métodos: Utilizando parâmetros clínicos e demográficos a partir de dados da literatura, simulamos uma coorte com 5.000 pacientes com asma alérgica grave e estimamos o custo de tratamento com o omalizumabe. Resultados: Na coorte simulada, 81,3% eram do sexo feminino, com peso médio de 75,1 kg (DP 13,1) e IgE sérica de 532 IU/mL (DP 688). Todos os pacientes eram elegíveis para o tratamento com dupilumabe, porém 830 (16,6%) não eram elegíveis para o tratamento com omalizumabe devido a combinações específicas de IgE sérica e/ou peso corporal, de acordo com a bula do produto. Para o período de 4 semanas, a dose média de omalizumabe foi de 537 mg (DP 285). O custo médio anual por paciente do tratamento com omalizumabe foi de R$ 110.783,89 (DP 58.385,81), variando de R$ 31.797,49 a R$ 246.643,15. O custo do tratamento com dupilumabe é de R$ 111.724,21 no primeiro ano e R$ 107.599,91 nos anos seguintes. Conclusões: Foi observado que o custo médio do tratamento com dupilumabe é ligeiramente menor que o custo com omalizumabe. Todavia, enquanto o custo do tratamento com dupilumabe é fixo e previsível, o custo do tratamento com omalizumabe é altamente variável, dependendo de características dos pacientes. Esses achados devem ser considerados pelos gestores de saúde para decisões sobre reembolso e desenvolvimento de protocolos clínicos.

Cost-related variables in the public purchase of dental materials for endodontic application: 10-year analysis

Aim: This study analyzed public procurements for different endodontic materials used in the Brazilian public health system and evaluated the variables related to their cost. Methods: A time-series study was performed by screening materials for endodontic application in the public Brazilian Databank of Healthcare Prices from 2010 to 2019. Data were categorized according to material composition and clinical application. The collated variables were used in a multiple linear regression model to predict the impact of unit price in procurement processes. Results: A total of 5,973 procurement processes (1,524,693 items) were evaluated. Calcium hydroxides were found in 79% of the observations (4,669 processes). Prices drop each year by US$1.87 while MTAs and epoxy resins are increasingly purchased at higher prices (US$50.87; US$67.69, respectively). The microregion, the procurement modality, and the type of institution had no influence on unit prices in the adjusted model (p > 0.05). Conclusions: Calcium hydroxide-based materials were the cheapest and most frequently purchased endodontic materials in the public health care system. Novel formulations are being implemented into clinical practice over time and their cost may be a barrier to the broad application of materials such as MTAs, despite their effectiveness