What is the impact of national public expenditure and its allocation on neonatal and child mortality? A machine learning analysis.

BACKGROUND: Understanding the impact of national public expenditure and its allocation on child mortality may help governments move towards target 3.2 proposed in the 2030 Agenda. The objective of this study was to estimate the impacts of governmental expenditures, total, on health, and on other sectors, on neonatal mortality and mortality of children aged between 28 days and five years. METHODS: This study has an ecological design with a population of 147 countries, with data between 2012 and 2019. Two steps were used: first, the Generalized Propensity Score of public spending was calculated; afterward, the Generalized Propensity Score was used to estimate the expenditures' association with mortality rates. The primary outcomes were neonatal mortality rates (NeoRt) and mortality rates in children between 28 days and 5 years (NeoU5Rt). RESULTS: The 1% variation in Int$ Purchasing Power Parity (Int$ PPP) per capita in total public expenditures, expenditure in health, and in other sectors were associated with a variation of -0.635 (95% CI -1.176, -0.095), -2.17 (95% CI -3.051, -1.289) -0.632 (95% CI -1.169, -0.095) in NeoRt, respectively The same variation in public expenditures in sectors other than health, was associates with a variation of -1.772 (95% CI -6.219, -1.459) on NeoU5Rt. The results regarding the impact of total and health public spending on NeoU5Rt were not consistent. CONCLUSION: Public investments impact mortality in children under 5 years of age. Likely, the allocation of expenditures between the health sector and the other social sectors will have different impacts on mortality between the NeoRt and the NeoU5Rt.

Calculation and Allocation of Atmospheric Environment Governance Cost in the Yangtze River Economic Belt of China.

Atmospheric environment governance requires necessary cost input. Only by accurately calculating regional atmospheric environment governance cost and scientifically allocating it within a region can the operability and realization of the coordinated governance of the regional environment be ensured. Firstly, based on the consideration of avoiding the technological regression of decision-making units, this paper constructs a sequential SBM-DEA efficiency measurement model and solves the shadow prices of various atmospheric environmental factors, that is, their unit governance costs. Secondly, combined with the emission reduction potential, the total regional atmospheric environment governance cost can be calculated. Thirdly, the Shapley value method is modified to calculate the contribution rate of each province to the whole region, and the equitable allocation scheme of the atmospheric environment governance cost is obtained. Finally, with the goal that the allocation scheme based on the fixed cost allocation DEA (FCA-DEA) model converges with the fair allocation scheme based on the modified Shapley value, a modified FCA-DEA model is constructed to achieve the efficiency and fairness of the allocation of atmospheric environment governance cost. The calculation and allocation of the atmospheric environmental governance cost in the Yangtze River Economic Belt in 2025 verify the feasibility and advantages of the models proposed in this paper.

A New Exergy Disaggregation Approach for Complexity Reduction and Dissipative Equipment Isolation in Thermoeconomics.

Thermoeconomics connects thermodynamic and economic concepts in order to provide information not available in conventional energy and economic analysis. Most thermoeconomicists agree that exergy is the most appropriate thermodynamic magnitude to associate with cost. In some applications, exergy disaggregation is required. Despite the improvement in result accuracy, the modeling complexity increases. In recent years, different exergy disaggregation approaches have been proposed, mostly to deal with dissipative components and residues, despite all of them also increasing the complexity of thermoeconomics. This study aims to present a new thermoeconomic approach based on exergy disaggregation, which is able to isolate dissipative components with less modeling complexity. This approach, called the A&F Model, splits the physical exergy into two terms, namely, Helmholtz energy and flow work. These terms were evaluated from a thermoeconomic point of view, through a cost allocation in an ideal Carnot cycle, and they were also applied and compared with the UFS Model, through a cost allocation analysis, in a case study with an organic Rankine cycle-powered vapor compression refrigeration system. The complexity and computational effort reduction in the A&F are significantly less than in the UFS Model. This alternative approach yields consistent results.

Analysis of micro-costing through the Time-Driven Activity-Based Costing (TDABC) method in viscosupplementation procedures in different application regimens / Análise do microcusteio por meio de método Time-Driven Activity-Based Costing (TDABC) nos procedimentos de viscossuplementação do joelho em diferentes regimes de aplicação

Objective: To evaluate the micro-costing of viscosupplementation procedures compared to different infiltration regimens. Methods: This study compared, through the Time-Driven ActivityBased Costing method, the micro-costing of these different application regimens using national cost averages as a basis for calculation in a medium-sized outpatient service. Results: The results demonstrated that the difference in costs with the single application is 31.47% less for three and 119.13% for five applications. Conclusions: No study showed a superiority of the five-application regimen over the three-application regimen, which leads one to believe that there is no justification for this procedure from an economic or quality-of-life point of view.

Objective: Avaliar o microcusteio dos procedimentos de viscossuplementação do joelho em diferentes regimes de aplicação. Métodos: Este estudo comparou, por meio do método Time-Driven Activity-Based Costing, o microcusteio desses diferentes regimes de aplicação, usando com base de cálculo médias nacionais de custo em um serviço ambulatorial de porte médio. Resultados: Os resultados encontrados demonstraram que a diferença nos custos com a aplicação única é 31,47% menor para três aplicações e 119,13% para cinco aplicações. Conclusão: Em nenhum estudo houve superioridade do regime de cinco aplicações ao regime de três, fato que leva a acreditar que não há nenhuma justificativa para esse procedimento do ponto de vista econômico ou de qualidade de vida do paciente.

Cooperative game theory approach to develop an incentive mechanism for biopesticide adoption through farmer producer organizations.

Biopesticides have been recognized as viable alternatives to chemical pesticides in controlling agricultural pests for plants and reducing harmful chemical residues. However, small and marginal farmers are facing challenges while adopting biopesticides, namely, high cost and complicated application techniques, resulting in a low level of farmer acceptance. Accordingly, Farmer Producer Organizations (FPOs), voluntarily formed by farmers, develop mutual technical assistance among their members to solve the technical problems of biopesticide adoption. This study assumes that as a new form of farmer cooperative, FPOs have the potential to promote biopesticide adoption through the implementation of collective pesticide adoption (CPA). Along this line, this paper uses a cooperative game-based hybrid method to develop an incentive mechanism of biopesticide adoption for FPOs to implement CPAs. First, we construct a CPA decision model for mixed pesticides (i.e., biopesticides and chemical pesticides) based on multichoice goal programming (MCGP) to compromise the conflicting objectives regarding cost efficiency and chemical residue reduction, thereby obtaining the optimal total cost of pesticide adoption. Second, recognizing the optimal total adoption cost as a baseline, we devise a cooperative game-based cost allocation scheme to maintain farmers' voluntary participation in FPOs. This study demonstrates that the CPA implemented based on our proposed models can at least match if not surpass the economic and environmental performance of farmers' independent pesticide adoption (IPA). We further demonstrate that the proposed cooperative game solution is more suitable for the FPO's cost allocation issue than the eminent solutions, such as the Shapley value.

Cost analysis of drug treatment in hypertensive patients at social security health care family medicine units.

OBJECTIVE: To estimate the increase of drug treatment costs associated with predictive factors of hypertensive patients in family medicine units. MATERIALS AND METHODS: A generalized linear model was employed to estimate costs with data from a microcosting costing study for a 1-year time horizon. Sources of dada were medical electronic files, phar-macy records and unitary prices updated to 2019. RESULTS: From a total of 864 patients older than 65 years were 67% and women 65%. Factors with most influence on mean drug treatment costs were diabetes, age and complications associ-ated with hypertension. Mean annual cost of antihypertensive treatment was 61 dollars (CI95% 55,67) and median were 32 dollars (IQR 30,35) per patient. Incremental costs for diabetes were 23 dollars (CI95% 13,33) and 25 dollars (CI95% 5,45) in the group of ≥ 65 years. CONCLUSION: Diabetes, age and complications were the factors with largest influence on hypertension pharmacological costs.

Cost analysis of drug treatment in hypertensive patients at social security health care family medicine units / Análisis de costo de tratamientos farmacológicos en pacientes hipertensos en unidades de medicina familiar de seguridad social en salud

Abstract: Objective: To estimate the increase of drug treatment costs associated with predictive factors of hypertensive patients in family medicine units. Materials and methods: A generalized linear model was employed to estimate costs with data from a microcosting costing study for a 1-year time horizon. Sources of dada were medical electronic files, pharmacy records and unitary prices updated to 2019. Results: From a total of 864 patients older than 65 years were 67% and women 65%. Factors with most influence on mean drug treatment costs were diabetes, age and complications associated with hypertension. Mean annual cost of antihypertensive treatment was 61 dollars (CI95% 55,67) and median were 32 dollars (IQR 30,35) per patient. Incremental costs for diabetes were 23 dollars (CI95% 13,33) and 25 dollars (CI95% 5, 45) in the group of ≥ 65 years. Conclusion: Diabetes, age and complications were the factors with largest influence on hypertension pharmacological costs.

Resumen: Objetivo: Estimar el aumento de costos de tratamiento farmacológico de hipertensión asociado con factores predictivos en pacientes de unidades de medicina familiar. Material y métodos: El análisis utilizó un modelo lineal generalizado alimentado con información de un estudio de microcosteo en 2016. Las fuentes de información fueron los registros médicos del expediente electrónico y de farmacia y los precios unitarios del cuadro básico de medicamentos transformados a dólares americanos correspondientes a 2019. Resultados: Las variables significativas con mayor influencia fueron diabetes, edad y complicaciones asociadas con hipertensión. El costo promedio anual de tratamiento antihipertensivo por paciente fue de 61 dólares (IC95% 55,67) Los resultados sugieren un costo incremental de 23 dólares (IC95% 13,33) cuando se tiene diabetes y de 25 dólares (IC95% 5, 45) en el grupo ≥ 65 años. Conclusiones: Diabetes, edad y complicaciones son los factores encontrados que más influyen en los costos farmacológicos de tratamiento de la hipertensión.

Advancing universal health coverage in the COVID-19 era: an assessment of public health services technical efficiency and applied cost allocation in Cambodia.

BACKGROUND: Achieving universal health coverage (UHC) is a global priority and a keystone element of the 2030 Sustainable Development Goals. However, COVID-19 is causing serious impacts on tax revenue and many countries are facing constraints to new investment in health. To advance UHC progress, countries can also focus on improving health system technical efficiency to maximize the service outputs given the current health financing levels. METHODS: This study assesses Cambodia's public health services technical efficiency, unit costs, and utilization rates to quantify the extent to which current health financing can accommodate the expansion of social health protection coverage. This study employs Data Envelopment Analysis (DEA), truncated regression, and pioneers the application of DEA Aumann-Shapley applied cost allocation to the health sector, enabling unit cost estimation for the major social health insurance payment categories. RESULTS: Overall, for the public health system to be fully efficient output would need to increase by 34 and 73% for hospitals and health centers, respectively. We find public sector service quality, private sector providers, and non-discretionary financing to be statistically significant factors affecting technical efficiency. We estimate there is potential supply-side 'service space' to expand population coverage to an additional 4.69 million social health insurance beneficiaries with existing financing if the public health system were fully efficient. CONCLUSIONS: Public health service efficiency in Cambodia can be improved by increasing utilization of cost-effective services. This can be achieved by enrolling more beneficiaries into the social health insurance schemes with current supply-side financing levels. Other factors that can lead to increased efficiency are improving health service quality, regulating private sector providers, focusing on discretionary health financing, and incentivizing a referral system.

Inter-provincial responsibility allocation of carbon emission in China to coordinate regional development.

To establish the carbon emission trading scheme and achieve the carbon emission reduction goals in China, it is critical to allocate the carbon emission allowance (CEA). Using the entropy method and the modified fixed cost allocation model (MFCAM), we calculated the CEA and the carbon emission intensity (CEI) reduction targets of 30 Chinese provinces in 2030, from four principles (equity-efficiency-feasibility-sustainability) and three dimensions (economy-society-environment). The results are shown as follows. First, China's total carbon emissions in 2030 calculated in this paper are 17567.9 Mt. Second, on the whole, CEA in China's southeast half of the Hu line is higher than that in the northwest half. Eastern China has a larger final CEA than western China and central China. Third, Henan, Guangdong, Shandong, and Jiangsu are the four provinces with the most CEA, while Gansu, Qinghai, Ningxia, and Hainan are the four regions with the least carbon allowances. Fourth, the regions of Shanxi, Shaanxi, Xinjiang, Ningxia, Inner Mongolia, Guizhou, and Anhui will take on greater responsibility for carbon reduction in the future. On the contrary, the zones of Tianjin, Qinghai, Guangxi, Jilin, Yunnan, and Beijing will be able to sell CEA in the future. Fifth, provinces are divided into three categories from the perspective of CEI reduction. Finally, we put forward relevant policy recommendations based on the conclusions.

Managing the Intervention Costs of Musculoskeletal Disorders in the Hospital Workplace.

OCCUPATIONAL APPLICATIONSThis study demonstrates the applicability of multicriteria tools to solve occupational health and safety (OSH) problems related to cost management in the healthcare sector. To the best of our knowledge, this is the first work in which linear programming and established methods for risk assessment of work-related musculoskeletal disorders (i.e., the Key Item Method) have been combined with the knowledge and experience of the corresponding safety engineer (or OSH auditor or consultant). The ease of implementation of the whole process facilitates its future utilization in working practice without adding an undue burden on existing OSH practices.

TECHNICAL ABSTRACTBackground: Managing the intervention costs of musculoskeletal disorders (MSDs) through the optimal use of the resources and the evaluation of interventions is a cornerstone in Occupational Safety and Health (OSH) management in the healthcare sector.Purpose: We aim to create a practically useful tool for the allocation of work-related MSDs intervention costs and the support of relevant OSH decisions in the hospital workplace.Methods: A legally established risk assessment method was combined with the widely applied Key Item Method and linear programming to develop a functional cost allocation tool for allocating the work-related MSDs intervention costs in the hospital workplace. The proposed tool indicates where investments should be made in an intervention or combination of interventions, to jointly achieve minimization of the risk and maximization of convenience with the minimum possible cost. The primary goal of our study was to evaluate interventions indicated by the tool, in terms of reducing the risk values related to MSDs. The sample studied consisted of 15 female nurses of "Metaxa" Cancer Hospital (Greece). The main selected interventions were related to ergonomic training, improving work conditions, tidiness, and equipment.Results: Implementing these interventions over a two-month period (September to November 2019) led to a significant reduction in employees' risk of strain.Conclusions: The proposed tool can be practically useful in allocating OSH intervention costs for a certain safety investment.

Optimization-driven framework to understand health care network costs and resource allocation.

In the last several decades, the U.S. Health care industry has undergone a massive consolidation process that has resulted in the formation of large delivery networks. However, the integration of these networks into a unified operational system faces several challenges. Strategic problems, such as ensuring access, allocating resources and capacity efficiently, and defining case-mix in a multi-site network, require the correct modeling of network costs, network trade-offs, and operational constraints. Unfortunately, traditional practices related to cost accounting, specifically the allocation of overhead and labor cost to activities as a way to account for the consumption of resources, are not suitable for addressing these challenges; they confound resource allocation and network building capacity decisions. We develop a general methodological optimization-driven framework based on linear programming that allows us to better understand network costs and provide strategic solutions to the aforementioned problems. We work in collaboration with a network of hospitals to demonstrate our framework applicability and important insights derived from it.

Comparative analysis between prevention and treatment costs for gestational diabetes mellitus in primary and tertiary health care in a city in Southern Brazil / Análise comparativa entre os custos de prevenção e tratamento do diabetes mellitus gestacional na assistência à saúde primária e terciária em uma cidade do Sul do Brasil

Objective: The present study's purpose is to evaluate the economic context in which the Brazilian public health system, the only universal public health system with more than 200 million users, stands out. This evaluation will be made through the lens of the execution of gestational health care services in a city of approximately 500 thousand inhabitants in southern Brazil. The care costs of patients with gestational diabetes mellitus (GDM) will be compared to those of patients without GDM, analyzing the different economic valuation methods. And lastly, there was an intent to explore the generated costs in the context of economic valuation applied to health to comprehend better the complexity of the union of the financial and health areas to optimize the services offered. Methods: For the economic context in health, an analysis of health investments was performed through the Transparency Portal. The costs involved in preventing GDM were raised by the Sistema Único de Saúde (SUS) table of procedures performed ordinarily in low-risk pregnancies. The expenses involved in DMG patients were increased at the High-Risk Pregnancy and Fetal Medicine Clinic of DMG patients. Results: Preventing GDM is more cost-effective, cost-minimizing, and cost-useful than treating patients diagnosed with GDM. Conclusion: The result is an extremely interesting costopportunity, given the economic context in which it is presented

Objetivo: O presente estudo tem como objetivo avaliar o contexto econômico em que se encontra o sistema público de saúde brasileiro, único sistema público universal de saúde com mais de 200 milhões de usuários. Essa avaliação será feita sob a ótica da execução de serviços de saúde gestacional em um município de aproximadamente 500 mil habitantes no Sul do Brasil. Os custos assistenciais de pacientes com diabetes mellitus gestacional (DMG) serão comparados aos de pacientes sem DMG, analisando os diferentes métodos de valoração econômica. Também serão analisados os custos gerados no contexto da valoração econômica aplicada à saúde para uma melhor com preensão da complexidade da união das áreas econômica e da saúde com o objetivo de otimizar os serviços oferecidos. Métodos: Para a contextualização econômica em saúde, foi feita a análise dos investimentos em saúde pelo Portal da Transparência. Os custos envolvidos na prevenção da DMG foram levantados pela tabela de procedimentos realizados ordinariamente em gestações de baixo risco do Sistema Único de Saúde (SUS). Os custos envolvidos em pacientes com DMG foram levantados no Ambulatório de Gestação de Alto Risco e Medicina Fetal de pacientes com DMG. Resultados: Prevenir o DMG apresenta maiores custo-benefício, custo-efetividade, custo-minimização e custo-utilidade em comparação com o tratamento das pacientes com o diagnóstico de DMG. Conclusão: O resultado é um custo-oportunidade extremamente interessante, dado o contexto econômico em que se apresenta

Cost-effectiveness of facility-based, stand-alone and mobile-based voluntary counseling and testing for HIV in Addis Ababa, Ethiopia.

BACKGROUND: Globally, there is a consensus to end the HIV/AIDS epidemic by 2030, and one of the strategies to achieve this target is that 90% of people living with HIV should know their HIV status. Even if there is strong evidence of clients' preference for testing in the community, HIV voluntary counseling and testing (VCT) continue to be undertaken predominantly in health facilities. Hence, empirical cost-effectiveness evidence about different HIV counseling and testing models is essential to inform whether such community-based testing are justifiable compared with additional resources required. Therefore, the purpose of this study was to compare the cost-effectiveness of facility-based, stand-alone and mobile-based HIV voluntary counseling and testing methods in Addis Ababa, Ethiopia. METHODS: Annual economic costs of counseling and testing methods were collected from the providers' perspective from July 2016 to June 2017. Ingredients based bottom-up costing approach was applied. The effectiveness of the interventions was measured in terms of the number of HIV seropositive clients identified. Decision tree modeling was built using TreeAge Pro 2018 software, and one-way and probabilistic sensitivity analyses were conducted by varying HIV positivity rate, costs, and probabilities. RESULTS: The cost of test per client for facility-based, stand-alone and mobile-based VCT was $5.06, $6.55 and $3.35, respectively. The unit costs of test per HIV seropositive client for the corresponding models were $158.82, $150.97 and $135.82, respectively. Of the three models, stand-alone-based VCT was extendedly dominated. Mobile-based VCT costs, an additional cost of USD 239 for every HIV positive client identified when compared to facility-based VCT. CONCLUSION: Using a mobile-based VCT approach costs less than both the facility-based and stand-alone approaches, in terms of both unit cost per tested individual and unit cost per HIV seropositive cases identified. The stand-alone VCT approach was not cost-effective compared to facility-based and mobile-based VCT. The incremental cost-effectiveness ratio for mobile-based VCT compared with facility-based VCT was USD 239 per HIV positive case.

Cost objects: How is your ED performing?

BACKGROUND: The aim of this study is to a propose a standardized methodology to identify a list of cost objects that can be used by any ED to compute costs considering that the resulting data must facilitate unit management by improving the information available for decision-making. METHODS: This study considers two stages, first, we analyzed the case-mix of two hospitals collecting their data to define and diagram their processes, activities and to obtain their cost objects, second, we used four additional hospitals to validate our initial findings. RESULTS: We recognized 59 cost objects. Hospitals may have all these cost objects or just a subset of them depending on the services they provide. CONCLUSIONS: Among the main benefits of our cost objects definition are: the possibility of tracing the processes generated by the services delivered by EDs, the economic sense in its grouping, the chance of using any costing methodology, the flexibility with other classification systems such as DRGs and ICDs, and the opportunity of costing for both diseases and treatments. Furthermore, cost comparison among hospitals using our final 59 cost objects list is more accurate and based on comparable units. In different EDs, each cost object will be the result of a similar combination of activities performed. We also present the results of applying this cost objects list to a particular ED. A total of 53 out of 59 cost objects were identified for that particular unit within a calendar year.

The cost of implementing Vietnam's national plan of action for nutrition for 2017-2020.

BACKGROUND: There is an urgent need to carry out a costing exercise of the National Plan of Action for Nutrition (NPAN) 2017-2020 since the costing of nutrition-sensitive interventions was not entirely integrated and proved difficult to track the different sectors' contributions to the nutrition program. OBJECTIVE: To estimate the required budget for the activities of the NPAN in 2017-2020. METHODS: A standard ingredients approach activity-based costing was employed from the provider perspective. RESULTS: The budget amount required for the NPAN activities in 2017, 2018, 2019 and 2020 would be US$ million 269.0; 310.5; 350.2 and 378.1, respectively. State budgets (especially from Ministry of Health) would be the main funding source for the NPAN. The budget required for implementing nutrition-sensitive interventions would be the largest share (more than 90%) while less than 10% are required for nutrition-specific interventions. The four interventions requiring the largest budget proportion (in 2020) included 1) Micronutrient supplementation (28.3%); 2) Breastfeeding & complementary feeding (21.9%); 3) Treatment of severe acute malnutrition (15.6%); and 4) Disease prevention and management (13.4%). CONCLUSIONS: Based on the data from Vietnam National Health account and the data on GDP of Vietnam, the total required budget for the Vietnam NPAN 2017 (USD millions 5,082) as shares of the State budget for health, total State (Government) budget, and GDP would be 5.29%, 0.49% and 0.14%, respectively. From the estimation, Vietnam represents the nutrition strategy which prioritized on nutrition-sensitive actions, similar to most of the SUN Movement member countries.

What is health economics?

OBJECTIVES: This paper describes the principles of economics and their application to the promotion, protection and restoration of oral health in populations and the planning, management and delivery of oral health care. After illustrating the economic determinants of oral health, the demand for oral health care is discussed with particular reference to asymmetric information between patient and provider. The reasons for the market failure in (oral) health care and their implications for efficiency and equity are explained. We go on to describe how economic evaluation contributes to policies aimed at maximising oral health gains where resources are constrained. The behavioural aspects of patients´ demand for and dental professionals´ provision of oral health services are discussed. Finally, we outline methods for planning the dental workforce in ways that reflect system goals.

Data on highway maintenance, rehabilitation, and mobility projects for integrated planning in Texas.

State Highway Agencies (SHAs) have different functional groups that work towards improving the functional and physical performance of highway assets. These functional groups often propose multiple inter-related highway projects on the same network. However, the respective information systems of such functional groups lack interoperability capabilities between them. This data article is related to an earlier study by France-Mensah et al. (France-Mensah et al., 2017) that explored the integrated visualization of highway projects proposed by different functional groups working in the same highway agency. This dataset provides a spatially integrated set of maintenance and capital planning projects which is rarely available due to organizational silos which often exist in highway agencies. The data includes approximately 700 highway projects with over 16 attributes that includes spatial, temporal, cost, and description attributes. The highway projects are located in the Fort Worth District of the Texas Department of Transportation (TxDOT) which is responsible for a large network (approximately 9000 lane miles) of highway assets. The agency currently oversees around $4 billion in construction projects and spends around $120 million annually for asset preservation. An analysis of the fund allocations categorized by different project types for pavement and bridge assets is presented. The data presented can be used to compare competing approaches or policies for cross-asset allocation, spatial-temporal projects coordination, and safety planning in the infrastructure management domain.

Development of clinical value unit method for calculating patient costs.

The objective of the study was to develop the clinical value unit method of allocating indirect costs to patient costs using clinical factors. The method was tested to determine whether it is a more reliable alternative to using the length of stay and marginal mark-up allocation method. The method developed used data from a Polish specialist hospital. The study involved 4,026 patients grouped into nine diagnosis-related groups (DRG). The study methodology involved a three stage approach: (a) identification of correlates of patient costs, (b) a comparison of the costs calculated using the clinical value unit method with the alternative methods: length of stay and marginal mark-up methods, and (c) an estimation of the cost homogeneity of the DRGs. The study showed that length of stay cost allocation method may underestimate the proportion of indirect costs in patient costs for a short in-patient stay and overestimate the cost for the patients with a long stay. The total costs estimated using the marginal mark-up method were higher than those estimated with length of stay method. For most surgical procedures, the mean indirect costs are higher using clinical value unit method than when using length of stay or marginal mark-up method. In all medical procedure cases, the mean indirect costs calculated using the clinical value unit method are in the range between marginal mark-up and length of stay method. We also show that in all DRGs except one, that the coefficient of homogeneity for clinical value unit is higher than for length of stay or marginal mark-up method. We conclude that the clinical value unit method of cost allocation is a more precise and reliable alternative than the other methods.

Análisis de usos y resistencia a antibióticos en una UCI de Montería, Colombia / Analysis of antibiotic uses and resistance in an ICU from Monteria, Colombia

Resumen Introducción: El uso de antibióticos, enfrenta grandes problemas que deben ser resueltos en pro de la calidad de vida de los pacientes buscando un equilibrio en el costo-efectividad. Los análisis farmacoeconómicos son una herramienta útil para determinar qué fármacos deben estar disponibles en guías farmacoterapéuticas. Aunque el método de selección de fármacos varía en cada institución, el principio general es que deben ser elegidos los más efectivos al menor costo. El objetivo fue establecer el costo de los tratamientos, la evaluación de susceptibilidad y resistencia a los antibióticos en una Unidad de Cuidados Intensivos de Montería. Métodos: La muestra se integró por todos los pacientes ingresados a la UCI, que recibieron tratamiento antibiótico, durante doce meses. De las historias clínicas, se identificaron y se clasificaron los tratamientos aplicados, duración del tratamiento, costo del tratamiento por paciente, consumos por paciente de los antibióticos con el fin de estimar los costos de los antibióticos utilizados en pacientes de la UCI. Resultados: Se registraron 670 ingresos, de los cuales el 48,40% recibieron terapia antimicrobiana. Las principales causas de ingreso a la UCI fueron: evento coronario agudo (16,69%), insuficiencia respiratoria aguda (13,83%), sepsis (12,48%). Los microorganismos encontrados fueron: E. coli, K. pneumoniae, S. aureus, P. aeruginosa, S. epidermidis, A. baumanni, A. haemolyticus. Conclusión: Los sistemas estandarizados de vigilancia para el uso de antibióticos es una herramienta esencial en el uso racional y en el control de la resistencia antibacteriana.

Abstract The use of antibiotics, faces major problems that must be solved to ensure high-quality care of patients, which seeking a balance in cost-effectiveness. Pharmacoeconomics analyzes are a useful tool for determining which drugs should be available for pharmacotherapy strategies. Although the method of drug selection varies in each institution, the general principle is that the most effective ones should be chosen amongst the lowest-cost. The objective was to establish the cost of treatments, susceptibility assessment and resistance to antibiotics in an Intensive Care Unit in Montería. The sample was integrated by all the patients admitted to the ICU, who received antibiotic treatment, during twelve months. From the clinical records served, the treatments applied, duration of treatment, cost of treatment per patient, consumption per patient of the antibiotics were identified and classified to estimate the costs in relation to the therapeutic effectiveness of the antibiotics used in patients in the ICU. A total of 670 patients were registered, of whom 48,40% received antimicrobial therapy. The main causes of ICU admission were: acute coronary event (16,69%), acute respiratory failure (13,83%), sepsis (12,48%). The strains were: E. coli, K. pneumoniae, S. aureus, P. aeruginosa, S. epidermidis, A. baumanni, A. haemolyticus. Standardized surveillance systems for the use of antibiotics are an essential strategic intervention for the rational use and control antimicrobial resistance.

Costs of community-based interventions from the Community Transformation Grants.

Limited data are available on the costs of evidence-based community-wide prevention programs. The objective of this study was to estimate the per-person costs of strategies that support policy, systems, and environmental changes implemented under the Community Transformation Grants (CTG) program. We collected cost data from 29 CTG awardees and estimated program costs as spending on labor; consultants; materials, travel, and services; overhead activities; partners; and the value of in-kind contributions. We estimated costs per person reached for 20 strategies. We assessed how per-person costs varied with the number of people reached. Data were collected in 2012-2015, and the analysis was conducted in 2015-2016. Two of the tobacco-free living strategies cost less than $1.20 per person and reached over 6 million people each. Four of the healthy eating strategies cost less than $1.00 per person, and one of them reached over 6.5 million people. One of the active living strategies cost $2.20 per person and reached over 7 million people. Three of the clinical and community preventive services strategies cost less than $2.30 per person, and one of them reached almost 2 million people. Across all 20 strategies combined, an increase of 10,000 people in the number of people reached was associated with a $0.22 reduction in the per-person cost. Results demonstrate that interventions, such as tobacco-free indoor policies, which have been shown to improve health outcomes have relatively low per-person costs and are able to reach a large number of people.