Socioeconomic and fiscal returns of expanded investment in immunization: a case for life-course vaccination in Colombia.

Despite the health, societal, and economic benefits of immunization, many countries focus primarily on childhood immunizations and lack robust policies and sufficient resources for immunizations that can benefit populations across the life course. While the benefits of childhood vaccination are well documented, there is limited evidence on the financial and social return on investment that policymakers can use to inform decisions around administering a life-course immunization program. We developed a cost-benefit model from a societal perspective to evaluate the inclusion of 5 vaccines across the life course in Colombia's national immunization program. This model estimated a return of US$1.3 per US$1.0 invested in the first 2 decades, increasing to US$3.9 after 60 years. Primary benefits were productivity gains, followed by fiscal savings and household averted expenditure on health care. Furthermore, vulnerable households are predicted to receive 3.2 times greater income protection than formally employed households under a life-course immunization program. Consequently, there is a potential to reduce Colombia's income inequality and poverty rate by increasing access to immunization for all ages.

Improving alcohol management in primary health care in Mexico: A return-on-investment analysis.

INTRODUCTION: Alcohol screening, brief advice and referral to treatment (SBIRT) in primary health care is an effective strategy to decrease alcohol consumption at population level. However, there is relatively scarce evidence regarding its economic returns in non-high-income countries. The current paper aims to estimate the return-on-investment of implementing a SBIRT program in Mexican primary health-care settings. METHODS: Empirical data was collected in a quasi-experimental study, from 17 primary health-care centres in Mexico City regarding alcohol screening delivered by 145 health-care providers. This data was combined with data from a simulation study for a period of 10 years (2008 to 2017). Economic investments were calculated from a public sector health-care perspective as clinical consultation costs (salary and material costs) and program costs (set-up, adaptation, implementation strategies). Economic return was calculated as monetary gains in the public sector health-care, estimated via simulated reductions in alcohol consumption, dependent on population coverage of alcohol interventions delivered to primary health-care patients. RESULTS: Results showed that scaling up a SBIRT program in Mexico over a 10-year period would lead to positive return-on-investment values ranging between 21% in scenario 4 (confidence interval -8.6%, 79.5%) and 110% in scenario 5 (confidence interval 51.5%, 239.8%). Moreover, over the 10-year period, up to 16,000 alcohol-related deaths could be avoided as a result of implementing the program. DISCUSSION AND CONCLUSIONS: SBIRT implemented at national level in Mexico may lead to substantial financial gains from a public sector health-care perspective.

Strategic control of cattle co-parasitized by tick, fly and gastrointestinal nematodes: Is it better to use ecto + endoparasiticide or just endectocide formulations?

Ticks, flies, and gastrointestinal helminths (GINs) significantly affect cattle productivity; thus, ectoparasiticide, endoparasiticide, and endectocide drugs have commonly been used for their control. The study aimed to compare the technical (parasites counts), productive, and financial effects of a treatment protocol comprising ecto- + endoparasiticides formulations (T01: fluazuron 2.5 mg/kg + fipronil 1.25 mg/kg and fenbendazole 5 mg/kg; n = 15) to a treatment with one formulation of endectocide (T02: ivermectin 450 µg/kg + abamectin 250 µg/kg; n = 15) over 308 days under field conditions in crossbred cattle co-parasitized by Rhipicephalus microplus, Haematobia irritans, and GINs. Bovine weight gain and return on investment (ROI) were also evaluated. Bovines from T01 received four treatments against the cattle tick and two against two GINs. For T02, four treatments were performed. Animals from T01 gained 15.4 kg more than T02 and provided a comparative ROI of 15.8. In cattle co-parasitized with R. microplus, H. irritans, and GINs, the treatment protocol used in this study with ecto- + endoparasiticidal action formulations showed better technical results regarding parasite counts and productive and financial data than the strategic treatment protocol using only an endectocide formulation.

Workers' Healthcare Assistance Model (WHAM): Development, Validation, and Assessment of Sustainable Return on Investment (S-ROI).

The present study aimed to present and validate the Worker´s Healthcare Assistance Model (WHAM), which includes an interdisciplinary approach to health risk management in search of integral and integrated health, considering economic sustainability. Through the integration of distinct methodological strategies, WHAM was developed in the period from 2011 to 2018, in a workers' occupational health centre in the oil industry in Bahia, Brazil. The study included a sample of 965 workers, 91.7% of which were men, with a mean age of 44.9 years (age ranged from 23 to 73 years). The Kendall rank correlation coefficient and hierarchical multiple regression analysis were used for the validation of WHAM. The assessment of sustainable return on investment (S-ROI) was made using the WELLCAST ROI™ decision support tool, covering workers with heart disease and diabetes. WHAM can be considered an innovative healthcare model, as there is no available comparative model. WHAM is considered robust, with 86% health risk explanatory capacity and with an 85.5% S-ROI. It can be concluded that WHAM is a model capable of enhancing the level of workers' health in companies, reducing costs for employers and improving the quality of life within the organization.

Avaliação da atratividade econômica e estratégias de crescimento no mercado de leite orgânico / Evaluation of economic attractiveness and strategies for organic milk market development

Muito têm se discutido sobre os padrões modernos de produção agropecuária, e em especial sobre produtos cuja origem e produção estão lastreados em práticas que buscam equilibrar a produção com a exploração dos recursos naturais do meio em que está inserida, tornandose uma fonte de produtos confiáveis cujo consumo sabidamente não irá estimular a degradação do meio ambiente, nem tampouco submeter a saúde humana a possíveis riscos relacionados com o consumo de produtos agropecuários que eventualmente apresentem resíduos ou traços de produtos químicos normalmente utilizados na agropecuária convencional. Baseado nestes padrões, os produtos orgânicos, dentre eles o leite, objeto do presente estudo, vêm conquistando cada vez mais uma posição sólida em nichos de mercado que buscam o binômio valorização da saúde e preservação do meio ambiente. Fato é que a produtividade alcançada por uma propriedade baseada em conceitos orgânicos é menor que a convencional, no entanto a rentabilidade final líquida ultrapassa a destas já que os ganhos extras auferidos estão baseados na maior qualidade de produto final oferecido a um nicho de mercado disposto a pagar pelos benefícios do leite orgânico. No presente estudo comparou-se economicamente uma propriedade leiteira que opera dentro do conceito orgânico com outra propriedade que utiliza a tecnologia convencional, além da atuação do Brasil no mercado orgânico do leite. Para efeito comparativo dados de literatura de propriedades semelhantes em países do primeiro mundo, onde este mercado é bem consolidado, foram analisados. Concluiu-se que as taxas de retorno do leite orgânico foram atraentes em comparação ao convencional e que a produção nacional ainda é baixa ao se comparar com os países que se destacam no cenário mundial.

Much has been discussed about modern patterns of agricultural production, and especially about products whose origin and production are based on practices that seek to balance production with the exploitation of the natural resources of the environment in which it is inserted. The consumption of these products is known to be not conducive to environmental degradation nor hazard to human health mainly by incurring in possible risks related to the consumption of agricultural products that may present residues or traces of chemicals normally used in conventional farming. Based on these standards, the organic products, among them the milk, object of the present study have been gaining an increasingly solid position in market niches that seek the binomial valorization of health and preservation of the environment. It is a fact that the productivity achieved by a property based on organic concepts is lower than the conventional one, nevertheless the final net profitability surpasses the conventional one since the extra gains obtained are based on the greater quality of final product offered to a niche market willing to pay for the benefits of organic milk. In the present study we compared a dairy property that operates within the organic concept with another property that uses conventional technology. For comparison purposes data extracted from literature of similar properties in first world countries, where this market is well consolidated, were used. Figures collected in both properties express better investment return rates for the organic milk producer and that still there is a very low market share for this product when compared to countries in the first world.

Avaliação da atratividade econômica e estratégias de crescimento no mercado de leite orgânico / Evaluation of economic attractiveness and strategies for organic milk market development

Muito têm se discutido sobre os padrões modernos de produção agropecuária, e em especial sobre produtos cuja origem e produção estão lastreados em práticas que buscam equilibrar a produção com a exploração dos recursos naturais do meio em que está inserida, tornandose uma fonte de produtos confiáveis cujo consumo sabidamente não irá estimular a degradação do meio ambiente, nem tampouco submeter a saúde humana a possíveis riscos relacionados com o consumo de produtos agropecuários que eventualmente apresentem resíduos ou traços de produtos químicos normalmente utilizados na agropecuária convencional. Baseado nestes padrões, os produtos orgânicos, dentre eles o leite, objeto do presente estudo, vêm conquistando cada vez mais uma posição sólida em nichos de mercado que buscam o binômio valorização da saúde e preservação do meio ambiente. Fato é que a produtividade alcançada por uma propriedade baseada em conceitos orgânicos é menor que a convencional, no entanto a rentabilidade final líquida ultrapassa a destas já que os ganhos extras auferidos estão baseados na maior qualidade de produto final oferecido a um nicho de mercado disposto a pagar pelos benefícios do leite orgânico. No presente estudo comparou-se economicamente uma propriedade leiteira que opera dentro do conceito orgânico com outra propriedade que utiliza a tecnologia convencional, além da atuação do Brasil no mercado orgânico do leite. Para efeito comparativo dados de literatura de propriedades semelhantes em países do primeiro mundo, onde este mercado é bem consolidado, foram analisados. Concluiu-se que as taxas de retorno do leite orgânico foram atraentes em comparação ao convencional e que a produção nacional ainda é baixa ao se comparar com os países que se destacam no cenário mundial.(AU)

Much has been discussed about modern patterns of agricultural production, and especially about products whose origin and production are based on practices that seek to balance production with the exploitation of the natural resources of the environment in which it is inserted. The consumption of these products is known to be not conducive to environmental degradation nor hazard to human health mainly by incurring in possible risks related to the consumption of agricultural products that may present residues or traces of chemicals normally used in conventional farming. Based on these standards, the organic products, among them the milk, object of the present study have been gaining an increasingly solid position in market niches that seek the binomial valorization of health and preservation of the environment. It is a fact that the productivity achieved by a property based on organic concepts is lower than the conventional one, nevertheless the final net profitability surpasses the conventional one since the extra gains obtained are based on the greater quality of final product offered to a niche market willing to pay for the benefits of organic milk. In the present study we compared a dairy property that operates within the organic concept with another property that uses conventional technology. For comparison purposes data extracted from literature of similar properties in first world countries, where this market is well consolidated, were used. Figures collected in both properties express better investment return rates for the organic milk producer and that still there is a very low market share for this product when compared to countries in the first world.(AU)

Viabilidade econômica da produção do sucedâneo de caviar de ovas da truta arco-íris / Economic viability to produce caviar substitute using roes of rainbow trout

Roes of rainbow trout (Oncorhynchus mykiss) can be used to produce caviar substitutes, resulting ina high-value added product. This study evaluated the market potential of rainbow trout roe inCampos do Jordão City (São Paulo State, Brazil) (22°44′20″S, 45°35′27″W) and the economic aspectsof its production, considering two scenarios: production in existing processing plants (scenario A)and building a plant for its production (scenario B). To estimate the net present value rates (NPV),we used different asking prices (US$ 8.50, US$ 10.00 and US$ 12.50) and interest rates (11%). Themarket research indicated a great potential for the caviar substitute, perceived as a differential ingastronomy. The results showed economic viability in scenario A, with satisfactory profitabilityand return on venture capital for the short-term at different prices. In scenario B, economic viabilityis attained at the highest price, US$ 12.50; all other simulations require careful consideration fromthe investor.

Ovas de truta arco-íris podem ser utilizadas para a confecção de sucedâneo de caviar, resultandoem produto de alto valor agregado. Este estudo objetivou avaliar o potencial de mercado doproduto no município de Campos do Jordão – SP (22°44′20″S, 45°35′27″W), e os aspectoseconômicos da sua produção nas seguintes simulações: produção em estrutura de processamentopreviamente existente (simulação A), construção de estrutura específica para sua produção(simulação B), diferentes preços de venda (R$ 19,00; R$ 22,50 e R$ 28,00), e taxa de juros de 11%para estimativa do valor presente líquido (VPL). O estudo de mercado indicou grande potencialpara o sucedâneo, visto como diferencial na gastronomia. Os resultados demonstraram aviabilidade do investimento para todas as simulações da condição A, com alta rentabilidade erecuperação do investimento em curto prazo. A condição B apresentou viabilidade apenas para opreço de US$ 12.50; todas as outras simulações para esta condição requerem análise cuidadosa porparte do investidor.

Viabilidade econômica da produção do sucedâneo de caviar de ovas da truta arco-íris / Economic viability to produce caviar substitute using roes of rainbow trout

Roes of rainbow trout (Oncorhynchus mykiss) can be used to produce caviar substitutes, resulting ina high-value added product. This study evaluated the market potential of rainbow trout roe inCampos do Jordão City (São Paulo State, Brazil) (22°44′20″S, 45°35′27″W) and the economic aspectsof its production, considering two scenarios: production in existing processing plants (scenario A)and building a plant for its production (scenario B). To estimate the net present value rates (NPV),we used different asking prices (US$ 8.50, US$ 10.00 and US$ 12.50) and interest rates (11%). Themarket research indicated a great potential for the caviar substitute, perceived as a differential ingastronomy. The results showed economic viability in scenario A, with satisfactory profitabilityand return on venture capital for the short-term at different prices. In scenario B, economic viabilityis attained at the highest price, US$ 12.50; all other simulations require careful consideration fromthe investor.(AU)

Ovas de truta arco-íris podem ser utilizadas para a confecção de sucedâneo de caviar, resultandoem produto de alto valor agregado. Este estudo objetivou avaliar o potencial de mercado doproduto no município de Campos do Jordão SP (22°44′20″S, 45°35′27″W), e os aspectoseconômicos da sua produção nas seguintes simulações: produção em estrutura de processamentopreviamente existente (simulação A), construção de estrutura específica para sua produção(simulação B), diferentes preços de venda (R$ 19,00; R$ 22,50 e R$ 28,00), e taxa de juros de 11%para estimativa do valor presente líquido (VPL). O estudo de mercado indicou grande potencialpara o sucedâneo, visto como diferencial na gastronomia. Os resultados demonstraram aviabilidade do investimento para todas as simulações da condição A, com alta rentabilidade erecuperação do investimento em curto prazo. A condição B apresentou viabilidade apenas para opreço de US$ 12.50; todas as outras simulações para esta condição requerem análise cuidadosa porparte do investidor.(AU)

Economic Evaluation of Bariatric Surgery in Mexico Using Discrete Event Simulation.

OBJECTIVES: Morbid obesity represents high costs to health institutions in controlling associated comorbidities. It has been shown that bariatric surgery resolves or improves comorbidities, thus reducing resource utilization. This analysis estimated the total costs of treating morbid obesity and related comorbidities through conventional treatment compared to bariatric surgery under the Mexican public health system perspective. METHODS: An economic evaluation model was developed by using discrete event simulation. One hundred fifty patients were created in each arm, with considered comorbidities allocated randomly. Preoperative comorbidity prevalences and bariatric surgery's efficacy for resolving them were obtained from published literature. Comorbidity treatment costs were obtained from the 2007 Mexican Institute of Social Security diagnosis-related group list and publications from the National Institute of Public Health. Only 12 patients were operated each month on the surgical arm. Complications associated with comorbidities were not considered. The considered time frame for simulation was 10 years, with a 4.5% annual discount rate. RESULTS: Return on investment, or cost breakeven point, for bariatric surgery was obtained after 6.8 years. Total costs for the surgical group were 52% less than conventional treatment group costs after 10 years. Bariatric surgery reduced the cost of treating type 2 diabetes, hypertension, and hypercholesterolemia by 59%, 53%, and 65%, respectively. Return on investment for bariatric surgery in patients with type 2 diabetes as the only comorbidity was 4.4 years. CONCLUSIONS: Despite conservative assumptions, investment in bariatric surgery is recouped in 6.8 years, generating relevant potential savings in the treatment of morbidly obese patients. In high-risk subpopulations, return on investment time is shorter.