ABSTRACT
OBJECTIVES: To perform the cost-effectiveness analysis of three-dimensional transesophageal echocardiography (3DTEE) in comparison to two-dimensional transesophageal echocardiography (2DTEE) for the anatomic-functional evaluation and surgical planning of severe primary mitral regurgitation. METHODS: a complete economic study was based on a systematic review of 3DTEE and 2DTEE accuracy and private health system costs of two different surgical interventions: mitral valve plasty and mitral valve replacement. The prevalence of common postoperative complications was also predicted for elective procedures: atrial fibrillation (8.6%); acute myocardial infarction (1.4%); thrombosis (3.5%); bleeding (1.5%); endocarditis (6.3%). The decision tree method was adopted as a data analysis model. The Bayes" theorem was used based on sensitivity and specificity measurements. The costs, considering literature and professional tables, were: 3DTEE = US$ 349; 2DTEE = US$ 204; diagnostic evaluation = US$ 597; surgical procedure = US$ 3,643; surgical treatment = US$ 374. RESULTS: The deterministic analysis of the diagnostic test shows that 3DTEE (non-dominated) is superior to 2DTEE (absolutely dominated). The 3DTEE presents a cost reduction of US$ 1,147 and incremental effectiveness (true identification) of 22% when compared to 2DTEE. The multivariate probabilistic sensitivity analysis showed that after 100,000 iterations, the diagnosis based on the 3DTEE becomes the first choice regardless of the willingness to pay threshold. CONCLUSIONS: 3DTEE was cost-effective compared to 2DTEE. Thus, 3DTEE is a potential device to promote health compared to 2DTEE for surgical planning of severe primary mitral regurgitation. (AU)
Subject(s)
Cost-Benefit Analysis , Echocardiography, Transesophageal/economics , Mitral Valve InsufficiencyABSTRACT
Aiming to verify the occurrence of alterations in certain skeletal structures in lepromatous face, 70 patients from the "Hospital Lauro de Souza Lima", were clinically and radiographically analysed through a longitudinal study with a 3 years interval: their average age was of 45.41 years and 48.41 years respectively for the first and second examinations.
Subject(s)
Alveolar Process/pathology , Bone Resorption/pathology , Facial Bones/physiopathology , Leprosy/pathology , Nasal Bone/pathology , Facial Bones/diagnostic imaging , Humans , Male , Nose Deformities, Acquired/diagnostic imaging , RadiographyABSTRACT
Facies leprosa was characterized by a combination of nasal change and resorption of nasal bone, anterior nasal spine, supra-incisive alveolar region and anterior alveolar process of the maxilae, associated with the loss of upper incisors teeth, according to the criteria of radiographic interpretation.
