Research progress, challenges, and recommendations of health economic evaluation in osteoporosis drugs / 中华内分泌代谢杂志

The economic evaluation compares the costs and effectiveness of different strategies for osteoporosis prevention and treatment to facilitate decision-making. In this paper, international and Chinese economic evaluation studies on osteoporosis prevention strategies were reviewed and results were summarized. We have found that the research design and quality of reporting need to be improved. Furthermore, both general and osteoporosis-specific health economic evaluation guidelines were introduced to improve the quality of economic evaluation in osteoporosis in China. Accuracy and integrity of data used in economic evaluation also should be improved.

Fundamental contradiction and coordination mechanism of health economic evaluation between social perspective and hospital perspective / 中国卫生政策研究

This study analyzed the inconsistences between health economic evaluation of social perspective and hospital perspective,and based on the relevant theories of health economic evaluation demonstrated that for health technology,especially innovative ones, there was contradiction between study results of the social perspective and hospitals,leading to pricing decision-making problems. This article believes that involving multiple stakeholders in hospital decision making process and non-bundled pricing method for innovative health technology could be optional mechanisms for resolving this contradiction.

Cost effective evaluation on the intervention topersonality dysfunction in adolescents / 中国心理卫生杂志

Objectives: To implement cost effective evaluation on the interventions to personality dysfunction in adolescents, so as to provide scientific evidences for extending the interventions. Methods: Cost identification, measurement of the cost, and valuing the cost were implemented to calculate the cost of the interventions. Effects of the interventions were measured based on three indicators: (1) differences of the decreasing scores of Personality Diagnostic Questionnaire-4 (PDQ-4) between intervention group and control group from grade one to three, (2) differences of the decrease number of students with personality dysfunction between intervention group and control group from grade one to three, and (3) differences of the incidence of personality dysfunction between intervention group and control group. Cost-effectiveness ratios (CERs) were calculated for the economic evaluation of the interventions. Results: The total cost of the interventions was 67, 860 Yuan. After intervention, among all of the students in intervention group, the cost of reducing one score of PDQ-4 was 9. 25 Yuan. The cost of reducing one person with personality dysfunction was 6169 Yuan. And the cost of avoiding one person developed personality dysfunction was 2714 Yuan. The cost effectiveness were not balanced among Cluster A, Cluster B and Cluster C personality dysfunction. Similar tendency was found among 10 types of personality dysfunction. Conclusion: The "Intervention Measure on Personality Dysfunction" in adolescents is easy to implement and has relative low costs. Further interventions of the specific cluster or type of personality dysfunction can be carried out based on the findings from this study.

A short-time economic evaluation of various modalities of glutamine dipeptide-enriched parenteral nutrition support in patients undergoing elective surgery for gastrointestinal tumors using decision-tree model / 中华临床营养杂志

Objective To assess the short-time economics of various glutamine dipeptide-enriched parenteral nutrition (PN) for patients undergoing elective surgery for gastrointestinal tumors, with an attempt to provide evidence for decision makers on clinical nutrition support.Methods A prospective cohort study was designed.From payer/disburser''s perspective, a cost-effectiveness decision-tree model was developed to assess the clinical outcomes and short-time economic effects of glutamine dipeptide-enriched PN that used in different time points (early postoperative or perioperative).Cost-effectiveness analysis, cost-utility analysis, and incremental cost-effectiveness analysis were adopted in the decision-tree model.One-way sensitivity analysis was performed to determine the robustness of the results.Results Totally 107 patients were included.There was no significant difference between the perioperative alanine(Ala) glutamine(Gln) nutrition support (group A) and early postoperative Ala-Gln nutrition support (group B) in the ratio of 5％ weight declines on the 8th day after surgery and infection-related postoperative complications (72.1％ vs.78.1％, χ2=0.509, P=0.498 and 2.32％ vs.4.69％, χ2=0.060, P=0.806).The levels of prealbumin (PA) and albumin(Alb) and the level of total lymphocyte count(TLC) also the time of recovering gastrointestinal function, length of stay nutritional discharge index(LOSNDI), and direct costs were significantly different [PA:(208.19±56.92)mg/L vs.(187.97±62.05)mg/L, t=2.283,P=0.039;Alb:(33.82±3.91)×109 vs.(31.96±4.57)×109, t=2.184, P=0.036;TLC:(1.19±0.55)×109 vs.(0.89±0.66)×109, t=2.461, P=0.015;the time of recovering gastrointestinal function(3.06±0.28)d vs.(3.39 ± 0.34)d, t=-3.675, P=0.000;LOSNDI:(16.84±2.92)d vs.(18.52 ±3.47)d, t=-2.613, P=0.011;direct costs:￥(17 029.05±317.28) vs.￥(15 610.64±292.56), t=23.764, P=0.000].When LOSNDI and quality-adjusted life years (QALYs) were estimated as indicators of effectiveness, the incremental cost-effectiveness ratios and incremental cost-utility ratios of group A were ￥844.3 and ￥70 920.5, respectively.Net monetary benefit of group B was more than that of group A.One-way sensitivity analysis showed that parameters had no significant effect on the model.Conclusion When using local per capita gross domestic product as threshold, early postoperative Ala-Gln PN was more economical than perioperative Ala-Gln PN strategy evaluation.

Patrones de prescripción del ácido acetilsalicílico / Prescribing patterns of acetylsalicylic acid

Objetivo: Determinar los patrones de prescripción del ácido acetilsalicílico, además de los costos y variables asociados a su utilización en una población de pacientes afiliados al Sistema General de Seguridad Social en Salud (SGSSS) de Colombia en el año 2014. Métodos: Estudio descriptivo de corte transversal. Mediante una base de datos de aproximadamente 3,5 millones de pacientes afiliados al SGSSS de Colombia en 88 ciudades, se seleccionaron pacientes a quienes se les dispensó ácido acetilsalicílico entre el 1.° de enero el30 de marzo de 2014 de manera ininterrumpida. Se analizaron variables sociodemográficas, farmacológicas y de comedicación. Resultados: Un total de 69.807 pacientes recibieron aspirina durante el periodo evaluado, con una edad promedio de 66,7 ± 12,1 años; el 57,1% eran hombres; el 99,8% tomaban alguna comedicación: el 94,8% antihipertensivos; el 22,4% antihipertensivos, antidiabéticos e hipolipemiantes de manera concomitante; el 95,4% estaban en monoterapia con aspirina, y el 4,6% recibían terapia combinada con 2 o más antiagregantes plaquetarios. El análisis multivariado encontró mayor probabilidad de recibir terapia combinada en Bogotá, Barranquilla y Cartagena. La dosis usual fue 100 mg/día y la dosis diaria, definida por 1.000 habitantes/día, fue 19,9. Conclusiones: La prescripción de ácido acetilsalicílico en Colombia se realizó a las dosis recomendadas por la Organización Mundial de la Salud para la prevención del riesgo cardiovascular, y su proporción de uso es inferior cuando se compara con la de otras poblaciones.

Objective: Determine the prescribing patterns of acetylsalicylic acid, costs and variables associated with its use in a population of patients affiliated to the Colombian Health System in 2014. Methods: Cross-sectional descriptive study. Using a database of approximately 3.5 million patients beneficiaries of the Colombian Health System in 88 cities; patients who were dispensed with acetylsalicylic acid continuously since 1st of January to 30th of March 2014 were selected. Sociodemographic, co-medication and pharmacologic variables were analyzed. Results: A total of 69,807 patients were receiving aspirin during the assessment period with a mean age of 66.7 ± 12.1 years; 57.1% were male; 99.8% received some co-medication: 94.8% received antihypertensive agents; 22.4% were receiving antihypertensive, antidiabetic and lipid-lowering drugs concomitantly; 95.4% were receiving monotherapy with aspirin, and 4.6% received combination therapy with 2 or more antiplatelet agents. Multivariate analysis found that it was more likely to receive combination therapy in Bogota, Barranquilla and Cartagena. The usual dose was 100 mg and defined daily dose/1,000 inhabitants/day was 19.9. Conclusions: The prescription of acetylsalicylic acid in Colombia was made at recommended doses by the WHO for the prevention of cardiovascular risk; and their frequency of use was lower when compared with other populations.

Progress on health economic evaluation of colorectal cancer screening / 实用肿瘤学杂志

Colorectal cancer( CRC) has become one of the major cancer threatening residents′health all around the world, and considerable resources are needed for its prevention and control.Economics evaluation could provide the basis of decision-making for improving the allocation efficiency of health resources in the field of CRC prevention and control.This paper comprehensively reviewed the papers that have been published in the field of colorectal cancer screening,from the points of view of published time,regional economic evaluation re-search,evaluation method,the research angle,input and output measurement,model,recommend strategy.

The health economic evaluation of surgical treatment for obscure gastrointestinal bleeding under the guidance of double-balloon enteroscopy / 中华消化内镜杂志

Objective To evaluate the double-balloon enteroscopy(DBE) for obscure gastrointestinal bleeding(OGIB) and evaluate the health economics under the guidance of DBE for surgical treatment of obscure gastrointestinal bleeding.Methods A total of 114 patients,whose hemorrhage etiology could not be determined by conventional gastroscopy,enteroscopy and gastroenterography,underwent DBE.With pathological results as diagnostic criteria,the value of double-balloon enteroscopy for obscure gastrointestinal bleeding diagnosis was studied.Results The sensitivity,specificity and accuracy of DBE for OGIB were 85.86％,63.63％,81.57％,respectively.The positive likelihood ratio was 2.36 and the negative likelihood ratio was 0.22.The total days of hospitalization,hospital costs,cost of hospital drugs were lower in the DBE group than in the control group(27.2 ± 11.8 days VS 16.4 ±5.3 days,35 690.2 ±3 466.5 Yuan VS 19 409.3 ± 9 253.2 Yuan,17 805.8 ± 2 145.5 Yuan VS 9 133.0 ± 4 664.9 Yuan) (all P ＜ 0.05).Conclusion DBE plays an important role in diagnosis of OGIB.It has significance in clinic,health economics,and social benefits.

Evaluación económica del stent medicado vs. convencional para pacientes con infarto agudo de miocardio con elevación del ST en Colombia / Economic evaluation of medicated stent vs. standard stent for patients with acute myocardial infarction with ST elevation in Colombia

Objetivo: Analizar la costo-efectividad y el valor esperado de la información perfecta del stent medicado con sirolimus comparado con el convencional para pacientes con infarto agudo de miocardio con elevación del ST en Colombia. Métodos: Se construyó un modelo de Markov bajo la perspectiva del pagador y un horizonte temporal de diez años. Las probabilidades de transición se extrajeron de estudios clínicos identificados a partir de revisiones de la literatura. Los costos se estimaron mediante el uso de consenso de expertos y manuales tarifarios colombianos. Se realizó un análisis de sensibilidad determinístico alrededor del horizonte temporal, precio del stent medicado y tasa de descuento. Se construyó un análisis de sensibilidad probabilístico (10.000 simulaciones de Monte Carlo) y el valor esperado de la información perfecta para la decisión global y grupos de parámetros. Resultados: En el caso base, el costo por año de vida ajustado por calidad se ubicó en 53.749.654 $. Los resultados no son sensibles al horizonte temporal ni a la tasa de descuento, pero sí al precio del stent medicado. El valor esperado de la información perfecta fue significativamente mayor para la probabilidad de muerte y de sufrir una trombosis muy tardía del stent. Conclusiones: El stent medicado con sirolimus no es costo-efectivo para pacientes con infarto agudo de miocardio con elevación del ST en Colombia. Se recomienda mayor investigación futura sobre la probabilidad de muerte y trombosis muy tardía del stent, así como en subgrupos específicos de pacientes y stents medicados de segunda generación.

Objective: To perform a cost-effectiveness and value of perfect information analysis comparing sirolimus-eluting stent with bare metal stent for patients with ST-segment elevation myocardial infarction in Colombia. Methods: We developed a Markov model from the payer perspective and considering a time horizon of 10 years in the base case. Transition probabilities were extracted from clinical studies identified from literature reviews. Costs were estimated using expert consensus and Colombian tariff handbooks. We performed a deterministic analysis around the time horizon, the discount rate and the price of the drug eluting stent. We developed a probabilistic sensitivity analysis (10,000 Monte Carlo simulations) and a value of perfect information analysis for the global decision and parameter groups. Results: In the base case, the cost per quality adjusted life year gained was $ 53,749,654. The results are sensitive to the drug eluting stent price, but not to the time horizon and the discount rate. The expected value of perfect information was significantly higher for the probability of death and very late stent thrombosis. Conclusions: Sirolimus-eluting stent is not cost-effective for patients with an ST segment elevation myocardial infarction. More future research is recommended around the risk of death and very late stent thrombosis, as well as in specific subgroups of patients and second-generation drug-eluting stents.

Costo efectividad del tratamiento de denervación renal vs. mejor tratamiento médico estándar disponible en el control de la hipertensión resistente en Colombia / Cost-effectiveness renal denervation therapy vs. the best standard medical treatment available in the control of resistant hypertension in Colombia

Objetivo: Mediante la adaptación a Colombia del modelo realizado por BresMed y previo análisis de transferibilidad, se realizó un análisis de costo-efectividad del tratamiento de denervación renal vs. mejor tratamiento estándar en el control de la hipertensión resistente y los eventos cardiovasculares relacionados. Métodos: Se construyó un modelo de Markov con 32 estados de salud y siete resultados finales: accidente cerebrovascular, infarto del miocardio, enfermedad coronaria, falla cardiaca, enfermedad renal crónica terminal, mortalidad cardiovascular y muerte. Se consideró un horizonte de toda la vida, la perspectiva desde el pagador y una tasa de descuento del 3%. Para el cálculo de las probabilidades de sufrir eventos se utilizaron las ecuaciones de riesgo de Framingham y las efectividades se tomaron del estudio clínico SYMPLICITY HTN-2. Los costos se extrajeron del entorno local y las tasas de mortalidad del Observatorio global de salud de la Organización Mundial de la Salud. Los resultados incluyeron los costos de cada alternativa de tratamiento, así como los años de vida ajustados a calidad ganados. Se realizaron análisis determinístico y probabilístico. Resultados: El tratamiento de denervación renal produjo 12,48 años de vida ajustados a calidad ganados a un costo de US $46.509 vs. 11,68 años de vida ajustados a calidad ganados del mejor tratamiento estándar a un costo de US $41.199, con un costo incremental por años de vida ajustados a calidad ganados de US $6.612. Tanto el análisis de sensibilidad univariado como el probabilístico, mostraron la robustez de los resultados. Conclusiones: El tratamiento de denervación renal, con un costo incremental por años de vida ajustados a calidad ganados de $6.612, muy por debajo de 1 PIB per cápita de Colombia, mostró ser altamente costo-efectivo.

Objective: By adapting to Colombia the model conducted by BresMed and preliminary analysis of transferability, an analysis of cost-effectiveness of treatment of renal denervation vs. best standard treatment in the control of resistant hypertension and cardiovascular events, was performed. Methods: A Markov model was constructed with 32 health states and seven outcomes: stroke, myocardial infarction, coronary artery disease, heart failure, terminal chronic kidney disease, cardiovascular mortality and death. A horizon of lifetime, from the payer perspective and a discount rate of 3% was considered. To calculate the odds of experiencing a cardiovascular event, Framingham risk equations and effectiveness were taken from the trial SYMPLICITY HTN-2. Costs were extracted from the local environment and the mortality rates from the global health observatory of the World Health Organization. The results included the costs of each alternative of treatment, as well as the quality adjusted life years (QALY). Deterministic and probabilistic analyzes were performed. Results: Treatment of renal denervation generated 12.48 quality adjusted life years gained at a cost of U.S. $ 46,509 vs .11.68 years of quality adjusted life years gained by the best standard treatment at a cost of U.S. $ 41,199, with an incremental cost per year of quality adjusted life of U.S. $ 6,612 . Both univariate sensitivity analysis and probabilistic analysis showed the strength of the results. Conclusions: Treatment of renal denervation, with an incremental cost per quality -adjusted life years gained of $ 6,612, well below 1 GDP of Colombia per capita, showed to be highly cost-effective.

Análisis de costo efectividad del uso de metoprolol succinato en el tratamiento de la hipertensión arterial y la falla cardiaca en Colombia / Analysis of cost effectiveness of the use of metoprolol succinate in the treatment of hypertension and heart failure in Colombia

Objetivo: realizar una evaluación de costo-efectividad del uso de metoprolol succinato frente a metoprolol tartrato y carvedilol en el tratamiento de pacientes con insuficiencia cardiaca congestiva e hipertensión arterial en Colombia, desde la perspectiva del tercero pagador. Métodos: el estudio se desarrolló mediante un modelo de Markov simulando la historia natural de la enfermedad para un horizonte temporal de cinco años, para lo cual se tomaron 100 pacientes con edad de 45 años. Se evaluaron como desenlaces tanto las hospitalizaciones como las muertes evitadas. Los datos de probabilidades se obtuvieron de estudios clínicos y los costos de bases de datos de instituciones y opinión de expertos, expresados en pesos colombianos de 2009. Se aplicó una tasa de descuento del 3%. Resultados: el costo del brazo tratado con metoprolol succinato fue el menor, con 299 millones de pesos frente a 364 millones y 346 millones de pesos para carvedilol y metoprolol tartrato, respectivamente. El menor número de hospitalizaciones se presentó con metoprolol succinato, y fue de 24 ingresos en el horizonte de tiempo. En el brazo con carvedilol fue donde ocurrieron menos muertes. Los índices mostraron que el metoprolol succinato fue dominante frente a los otros beta-bloqueadores en las hospitalizaciones evitadas y en las muertes en comparación con metoprolol tartrato. Conclusiones: se comprobó la escasa efectividad del metoprolol tartrato, que además generó los mayores costos de atención dentro del modelo. El carvedilol mostró ligeramente mejores resultados en mortalidad frente a metoprolol succinato aunque con costos mayores. El metoprolol succinato es la mejor opción puesto que es la menos costosa y más efectiva medida en relación con las hospitalizaciones. Para la atención de los pacientes con insuficiencia cardiaca congestiva e hipertensión arterial en Colombia, el tratamiento con metoprolol succinato es la opción más recomendable por su menor costo y mayor efectividad en las condiciones del caso base.

Objective: to conduct an assessment of cost-effectiveness of the use of metoprolol succinate versus metoprolol tartrate and carvedilol in the treatment of patients with congestive heart failure and hypertension in Colombia, from the third party payer's perspective. Methods: the study was conducted using a Markov model simulating the natural history of the disease for a time horizon of five years, taking 100 patients aged 45 years. Both hospitalizations and deaths avoided were evaluated as outcomes. The probability data were obtained from clinical studies and the costs of institutions databases and expert opinion, expressed in Colombian pesos of 2009. We applied a discount rate of 3%. Results: the cost of metoprolol succinate treated arm was the lowest, with 299 million pesos compared to 364 million and 346 million pesos for carvedilol and metoprolol tartrate, respectively. The lower number of hospitalizations occurred with metoprolol succinate, and corresponded with 24 admissions at the time horizon. In the carvedilol arm occurred fewer deaths. The indices showed that metoprolol succinate was dominant over the other beta-blockers in avoiding hospitalizations and deaths in comparison with metoprolol tartrate. Conclusions: we found the low effectiveness of metoprolol tartrate, which also generated the highest costs of care within the model. Carvedilol showed slightly better results in mortality compared to metoprolol succinate but with higher costs. Metoprolol succinate is the best choice since it is less costly and more effective in respect to hospitalizations. For the care of patients with congestive heart failure and hypertension in Colombia, treatment with metoprolol succinate is the most recommended option for its lower cost and greater effectiveness in the base case conditions.

Avaliação econômica do custo e das consegüências da aplicação de células-tronco em pseudartrose

Este estudo objetivou avaliar os custos e consequencias do tratamento da pesudartrose com aplicação de células-tronco. A metodologia correspondeu à avaliação econômiva pracial do custo e das consequências desse tratamento. O cenário do estudo foi o Hospital Universitário Antonio Pedro e os sujeitos foram oito pacientes operados Este estudo objetivou avaliar os custos e consequencias do tratamento da pseudartrose com aplicação de células-tronco. A metodologia correspondeu a avaliação economica parcial do custo e das conseqüências desse tratamento. 0 cenário do estudo foi o Hospital Antonio Pedro e os sujeitos foram oito pacientes operados entre setembro de 2008 e maio de 2009. A perspectiva do estudo foi a do Sistema Único de Saúde, principal fonte de financiamento da assistencia medica no Brasil. Para o tratamento estatistico dos dados foram utilizados 0 software STATISTICA 6.0 e 0 teste não parametrico de Spearman. A análise estatistica apresentou resultados satisfatorios dentro de uma margem aceitável. 0 custo total médio do tratamento foi de R$ 1243.199 e 0 tempo de consolidação foi em média 14.71429 semanas. Observamos atraves do teste nao parametrico de Spearman que a correlação entre o custo total e 0 tempo de consolidação é - O,5078, uma indicação fraca de que o custo total é inversamente proporcional ao tempo de consolidação. A partir deste estudo, podemos concluir que 0 custo com o tratamento nao foram exorbitante. 0 pequeno tamanho da amostra não afetou os resultados de forma significativa. sendo que os achados em relação à idade são parecidos com o de outros estudos. 0 que nos leva a concluir que a população acometida pela pseudartrose e a economicamente ativa. A criação de um protocolo foi primordial para o levantamento do custo com o tratamento, possibilitando a consolidação do dados, e nos permitindo visualizar de forma mais abrangente o tratamento, o tempo de consolidação foi igual aos melhores resultados vistos em estudo internacionais e o procedimento se mostrou seguro e eficaz. Constatamos que o questionario SF36 é um instrumento de fácil aplicação e foi de confiabilidade no acompanhamento ambulatorial de pacientes submetidos ao tratamento.

The purpose of this study was to evaluate the costs and consequences of the use od stem cells in the treatment of pseudarthrosis. The methodology involved a partial economic assessmentof the cost and consequences of this treatment. The study scenario was the Hospital Universitario Antonio Pedro and the subjects were eight patients operated between September2008 and May 2009. The study perspective was that of the Sistema Único de Saúde, the mainfinancial resource for medical assistance in Brazil. Statistical treatment of the data was performed using the STATISTIC A 6.0 application and the Spearman nonparametric test. Theresults were statistically significant within an acceptable margin of error. The average treatment costas R$ 1.247.21 and the average time for consolidation was 12.875 weeks.The Spearman nonparametric test showed that the correlation between the total cost and the time for was -0.25. a weak indication that the total cost is inversely proportional to the timefor consolidation. From this study, we can conclude that the treatment costs were not prohibitive. The small size of the sample had no significant influence on the results; the agerelatedfindings are similar to those of other studies and lead to the conclusion that population affected by pseudarthrosis is economically active. The creation of a protocol was essential for cost evaluation, providing a framework for data consolidation and yielding a more generill view of the treatment. The time for consolidation was about the same as tor the best results reported in the international literature and the procedure was observed to be safe andeffective. Weconcluded that the SF36 questionnaire is an easily applied tool that can be reliably used in the post-treatment follow-up of the patients.

Avaliação econômica do custo e das consequências da aplicação de células-tronco em pseudartrose / Economic evaluation of the cost and consequences of the application of stem cells in pseudarthrosis

Este estudo objetivou avaliar os custos e consequências do tratamento da pseudartrose com aplicação de células-tronco. A metodologia correspondeu à avaliação econômica parcial do custo e das consequências desse tratamento. O cenário do estudo foi o Hospital Universitário Antonio Pedro e os sujeitos foram oito pacientes operados entre setembro de 2008 e maio de 2009. A perspectiva do estudo foi a do Sistema Único de Saúde, principal fonte de financiamento da assistência médica no Brasil. Para o tratamento estatístico dos dados foram utilizados o software STATISTICA 6.0 e o teste não paramétrico de Spearman. A análise estatística apresentou resultados satisfatórios dentro de uma margem aceitável. O custo total médio do tratamento foi de R$ 1243.199 e o tempo de consolidação foi em média 14.71429 semanas. Observamos através do teste não paramétrico de Spearman que a correlação entre o custo total e o tempo de consolidação é - 0, 5078, uma indicação fraca de que o custo total é inversamente proporcional ao tempo de consolidação. A partir deste estudo, podemos concluir que o custo com o tratamento não foram exorbitantes. O pequeno tamanho da amostra não afetou os resultados de forma significativa, sendo que os achados em relação à idade são parecidos com os de outros estudos, o que nos leva a concluir que a população acometida pela pseudartrose é a economicamente ativa. A criação de um protocolo foi primordial para o levantamento do custo com o tratamento, possibilitando a consolidação dos dados e nos permitindo visualizar de forma mais abrangente o tratamento. O tempo de consolidação foi igual aos melhores resultados vistos em estudo internacionais e o procedimento se mostrou seguro e eficaz. Constatamos que o questionário SF36 é um instrumento de fácil aplicação e foi de confiabilidade no acompanhamento ambulatorial de pacientes submetidos ao tratamento

The purpose of this study was to evaluate the costs and consequences of the use of stem cells in the treatment of pseudarthrosis. The methodology involved a partial economic assessment of the cost and consequences of this treatment. The study scenario was the Hospital Universitário Antonio Pedro and the subjects were eight patients operated between September 2008 and May 2009. The study perspective was that of the Sistema Único de Saúde, the main financial resource for medical assistance in Brazil. Statistical treatment of the data was performed using the STATISTICA 6.0 application and the Spearman nonparametric test. The results were statistically significant within an acceptable margin of error. The average treatment cost was R$ 1.247,21 and the average time for consolidation was 12.875 weeks. The Spearman nonparametric test showed that the correlation between the total cost and the time for was -0.25, a weak indication that the total cost is inversely proportional to the time for consolidation. From this study, we can conclude that the treatment costs were not prohibitive. The small size of the sample had no significant influence on the results; the agerelated findings are similar to those of other studies and lead to the conclusion that population affected by pseudarthrosis is economically active. The creation of a protocol was essential for cost evaluation, providing a framework for data consolidation and yielding a more general view of the treatment. The time for consolidation was about the same as for the best results reported in the international literature and the procedure was observed to be safe and effective. We concluded that the SF36 questionnaire is an easily applied tool that can be reliably used in the post-treatment follow-up of the patients

Avaliação econômica em Saúde na esfera de atenção local à saúde / Health economic evaluation in a local level government health care system

O estudo tem por finalidade contribuir com a reflexão sobre a possibilidade de se operacionalizar avaliações econômicas em saúde nas esferas de atenção local à saúde e a consequente apreensão dos resultados de estudos para efeito de decisão pelos gestores. Para subsidiar essa reflexão, se utilizou como objeto de análise a avaliação realizada sobre o custo do Programa SAMU/192 no município de Belo Horizonte (MG), dados relativos à efetividade do programa e uma revisão nas bases eletrônicas de dados (SciELO e Medline) sobre o uso de estudos para efeito de decisão. A análise apontou que, mesmo para uma simples avaliação de gastos, ainda existem problemas relativos à disponibilidade de dados, como também no que concerne aos dados para subsidiar a avaliação sobre sua efetividade, e em relação à definição de sistemas e o relacionamento entre sistemas de informação. Assim como mostrou que os estudos são pouco utilizados pelos gestores, levando à conclusão de que a condução e a utilização, para efeito de gestão, de estudos deste porte ainda são pouco factíveis nesta esfera de governo.

This work aims to contribute to the discussion about the possibility of applying health economic evaluations at local level government healthcare system, and consequently use the results of this study into decision making. In order to subside this reflexion, it was analyzed the SAMU/192 Program costs evaluation in the city of Belo Horizonte, as well as data concerning effectiveness of the program and a review on electronic databases (SciELO and Medline) about the application of studies in decision making. The analysis showed that even for a simple evaluation on expenditure, there are still unsolved problems of data availability as well as of data effectiveness on information systems definition and association. It showed that decision makers do not use the result of studies for decision making either. So, we conclude that there is no possibility to apply a health economic evaluation research and have the results used in a local level government health care system.

Análise de custos com pessoal e produtividade de equipes do programa de saúde da família em Fortaleza, Ceará / Costs with personnel and productivity analysis of family health program teams in Fortaleza, Ceará

The research verified the productivity and the operational personnel costs of eight teams of the Family Health Program (PSF) of two Basic Units ofFamily Health (UBASF) in Fortaleza, Ceará, through the methodology of costs by absortion, in 2004. The largest expenses were with personnel (75%), mainly with the PSF teams, and medicines (18%). The federal allocations received in September, 2004, by each PSF team, were R$9,543.33. The total cost by team was R$ 15,719.00. Some professionals of various PSF teams showed productivity above the set objectives, but the average productivity by doctor and nursewas below fifty per cent of objectives, with high idle time making the work onerous. The unity cost of home visits by doctor and prenatal attendance by nurses were checked, and, would be less expensive if the idle time were reduced. Various alternatives of cost reduction were observed, such as scale savings of some resources and services and re-negotiation of contracts with suppliers and cooperatives. The data obtained will contribute to more accurate planning for the installation and maintenance of PSF teams aswell as alternatives of cost reductions, higher productivity, and better quality.

Foram verificados a produtividade e oscustos com pessoal das atividades de oito equipes de duas unidades do PSF de Fortaleza, Ceará, através da metodologia de custeio por absorção, em 2004. Os maiores gastos foram com pessoal (75%), principalmente com os membros das equipes do PSF, e commedicamentos (18%). As verbas federais repassadas, em setembro de 2004, por equipe do PSF, foram de R$9.543,33. O custo global da atuação da equipe foi de R$ 15.719,00. Alguns profissionais de várias equipes do PSF apresentaram produtividade acima das metas planejadas, porém a média geral das atividades por médico e enfermeiro nas equipes ficou abaixo da metade daquelas metas, com alta capacidade ociosa e tornando as atividades muito onerosas. Verificou-se o custo unitário da visita domiciliar por médico e da consulta de pré-natal por enfermeiro, que seriam menos onerosos se a capacidade ociosa fosse menor. Ha várias alternativas de minimização de custos, incluindo economia de escala relativa a alguns recursos e serviços e renegociação de contratos com empresas e cooperativas. As informações possibilitam o planejamento mais preciso, para manutenção e instalação de equipes, além de alternativas de menores custos com maior produtividade e qualidade.