Cost analysis in a traditional, complementary and integrative medicine unit in Brazil / Análise de custos em unidade de medicina tradicional, complementar e integrativa no Brasil

ABSTRACT OBJECTIVE To analyze the costs of a specialized service in Traditional Complementary and Integrative Medicines (TCIM) in Northeast Brazil to provide data on the cost linked to the implementation and maintenance of services of this nature and to identify the average cost per user for the Unified Health System. METHODS This is a partial, descriptive, quantitative economic assessment, which used secondary data, later grouped in Microsoft Excel spreadsheets. The method used to analyze such costs was absorption costing, from which the service was divided into three costing centers: productive, administrative and auxiliary. RESULTS After analyzing the data, the total cost of the service in 2014 was estimated at R$ 1,270,015.70, with a proportion of 79.69% of direct costs. The average cost per user in this period was R$ 36.79, considering the total of 34,521 users in individual and collective practices. CONCLUSIONS The service has a cost per user compatible with a specialized service; however, TCIM offers a comprehensive and holistic approach, which can have a positive impact on quality of life.

RESUMO OBJETIVO Analisar os custos de um serviço especializado em Medicinas Tradicionais Complementares e Integrativas (MTCI) no Nordeste brasileiro, com o intuito de fornecer dados sobre o custo atrelado à implantação e manutenção de serviços dessa natureza e identificar o custo médio por usuário para o Sistema Único de Saúde. MÉTODOS Trata-se de uma avaliação econômica do tipo parcial, com caráter descritivo, de natureza quantitativa, que utilizou dados secundários, posteriormente agrupados em planilhas do Microsoft Excel. O método utilizado para analisar tais custos foi o de custeio por absorção, a partir do qual o serviço foi dividido em três centros de custeio: produtivo, administrativo e auxiliar. RESULTADOS Após a análise dos dados, o custo total do serviço em 2014 foi estimado em R$ 1.270.015,70, com proporção de 79,69% de custos diretos. O custo médio por usuário neste período foi R$ 36,79, considerando o total de 34.521 usuários em práticas individuais e coletivas. CONCLUSÕES O serviço apresenta um custo por usuário compatível com um serviço especializado, contudo, as MTCI oferecem abordagem compreensiva e holística, as quais podem impactar de forma positiva a qualidade de vida.

Beneficios económicos del uso de un sistema de dispensación en dosis unitarias en hospitales del Instituto Mexicano del Seguro Social / Economic benefits of using a dose dispensing system at hospital units of the Mexican Institute of Social Security

Objetivo. Estimar los potenciales beneficios económicos en el Instituto Mexicano del Seguro Social (IMSS) respecto al gasto en medicamentos de un sistema de dispensación en dosis unitarias, con base en la bibliografía especializada. Material y métodos. Se realizó una revisión sistemática para identificar el ahorro en medicamentos y errores de medicación. Se cuantificó el gasto total y promedio en medicamentos por nivel de atención médica utilizando las recetas colectivas dispensadas en el IMSS durante 2009. Se aplicaron tres escenarios de ahorro. Resultados. El ahorro total estimado en medicamentos varía de 870.49 a 4 050.05 millones de pesos (mdp). La reducción de los errores de medicación puede contribuir con un ahorro adicional hasta de 3 445.56 mdp. Conclusión. La dispensación por dosis unitaria genera oportunidades de ahorro en el segundo y tercer nivel de atención. El mayor beneficio económico se observó para este último.

Objective. To estimate the potential economic benefits at The Mexican Institute of Social Security (IMSS per its abbreviation in spanish) according to the drug expenditure of using drug dispensing system, based on literature information. Materials and methods. A systematic review was performed to identify savings from drugs and reduction of medication errors. The total and mean health expenditure by level of medical attention was calculated using the dispensed collective prescriptions at IMSS during 2009. Three savings scenarios were applied. Results. The total drug savings were in a range of 870.49 Mexican million pesos to 4050.05 Mexican million pesos. Reductions of medication errors can contribute with additional savings up to 3455.56 Mexican million pesos. Conclusion. The drug dispensing system unit generates savings opportunities at the second and third level of attention. The maximum economic benefit was observed in the last level.

Costo - beneficio de un Servicio de Dosimetría Personal en la Red Asistencial Almenara EsSalud / Cost-benefit of Dosimetry Service own staff in the Health Care Network Almenara EsSalud

OBJETIVO: Determinar el costo-beneficio esperado de un Servicio de Dosimetría personal propio en la Red Asistencial Almenara. METODOLOGÍA: El estudio de costo beneficio de la implementación de un Servicio de Dosimetría personal en la Red Asistencial Almenara, se realizó en tres etapas: 1) Identificación y cuantificación de costos, 2) Identificación y cuantificación de beneficios, y 3) Evaluación económica de los mismos. El análisis consideró la dinámica de los costos y beneficios durante un periodo de 2 años. El Valor Actual Neto (VAN) se obtuvo con una tasa de interés o de descuento de 5 por ciento, y se calculó tanto la razón beneficio/costo como el beneficio neto de la intervención. Se realizó un análisis de sensibilidad con los costos directos con una disminución del 30 por ciento y aumento del 10 por ciento de su valor. RESULTADOS: Los costos del Servicio de Dosimetría personal propio fueron de US $ 25120.38 y del tercerizado de US $ 77853.46, y los beneficios fueron $ 24927853.72 y $ 24650349.65 para el propio y tercerizado respectivamente. El valor actual neto (VAN) de la alternativa propuesta fue de US $ 23715692.69, el índice de rentabilidad (IR) de 992.34 y la tasa interna de retorno (TIR) de 99134 por ciento. El análisis costo-beneficio demostró que por cada dólar destinado en la implementación de este servicio se generaría un ahorro de US $ 675.72. CONCLUSIÓN: Un Servicio de Dosimetría Personal propio en la Red Asistencial Almenara es una decisión costo-beneficio

OBJECTlVE: To determine the cost-benefit expected of a dosimetry service own staff in the Health Care Network Almenara. METHODOLOGY: The study of cost-benefit analysis of the implementation of a dosimetry service personnel in the Health Care Network Almenara, was conducted in three stages: 1) Identification and quantification of costs, 2) Identification and quantification of benefits, and 3) economic evaluation of the same. The analysis considered the dynamics of the costs and benefits for a period of 2 years. The Net Present Value (NPV) was obtained with an interest rate or discount of 5 per cent, and calculation both the cost/benefit ratio as the net profit from the intervention. It was conducted a sensitivity analysis with the direct costs with a 30 per cent decrease and increase of 10 per cent of its value. RESULTS: The costs of the dosimetry service own personnel were US $ 25120.38 and outsourced US $ 77853.46, and the benefits were $ 24927853.72 and $ 24650349.65 for own and outsourced respectively. The net present value (NPV) of the alternative proposal was US $ $ 23715692.69, the rate of return (IR) 992.34 and the internal rate of return (IRR) of 99134 per cent. The cost-benefit analysis showed that for every dollar spent in the implementation of this service will generate a savings of $ 675.72. CONCLUSION: A dosimetry service own personnel in the Health Care Network Almenara is a decision cost-benefit

Evaluación de una unidad de tratamiento del ataque cerebral en un hospital universitario / Evaluation of a stroke unit at a university hospital in Chile

Background: Stroke is the second specific cause of death in Chile, with a mortality rate of 48.6 per 100.000 inhabitans. It accounts for 6 percent of all hospitalizations among adults. Aim: To study the type of patients hospitalized at a Stroke Unit in a general hospital and the costs and benefits of such unit. Material and methods: A descriptive and retrospective study using a patient registry, developed in Access® that included separate sections for ischemic and hemorrhagic stroke. Established diagnostic criteria were used. The mean costs per patient and complications were also calculated. Results: During 2003, 425 stroke patients were admitted to our hospital and 105 (age range 30-89 years, 58 percent female) were hospitalized at the Stroke Unit. Eighty three percent had ischemic and 16 percent had hemorrhagic stroke. The most common etiologies were thrombosis in 41 percent, embolism in 36 percent, lacunar in 13 percent, arterial dissection in 5 percent and transient ischemic attack in 3 percent. Fifty eight percent of patients had partial anterior ischemic stroke (PACI), 73 percent had hypertension and 29.5 percent diabetes. Only 18 percent arrived to the Stroke Unit with less of 6 hours of evolution, 7 percent of patients were admitted within the 3 hours after the onset of symptoms and 18 percent, from 3 to 6 hours. The mean lenght of stay in the Stroke Unit was 6.6 days and at the hospital 9.9 days (p <0.01). The mean costs per patient at the Stroke Unit and at the hospital were US$ 5.550 and US$ 4.815, respectively (p =ns). Conclusions: The Stroke Unit decreases hospital stay days without raising costs importantly. The inclusion criteria for stroke patients admitted to the Unit were adequate and the stroke registry allowed a good assessment of the Unit operation.

Cost effective strategy for promotion of appropriate case management of diarrheal diseases--establishment of DTUs.

Oral rehydration therapy (ORT) is one of the essential components of child survival technologies which are currently being utilised to reduce morbidity and mortality on account of common illnesses. ORT has made it possible to undertake a global effort to reduce deaths from dehydration and diarrhea associated malnutrition. Appropriate case management can also combat deaths from dysentery and persistent diarrhea. During the last decade considerable success has been achieved by incorporating this simple, effective and economic therapeutic intervention in the primary health care package. However, the ultimate objective of improved case management of diarrhea including the use of ORT at all levels of health care system is yet to be achieved. Patients with dysentery need antimicrobial therapy apart from ORT. Clinical experience has shown that with ORT and appropriate dietary therapy, most patients with persistent diarrhea can be managed effectively. Unfortunately, injudicious use of intravenous fluids and irrational prescription of antibiotics and anti-diarrheal agents is quite common even in the hands of pediatricians. The training of mothers visiting health facilities is poor for ORT and feeding. Establishment of diarrhea training and treatment units (DTUs) is aimed to improve current practices in the teaching hospitals and to promote appropriate case management of diarrhea by all health personnel.