Costs of matched-sibling, unrelated, and haploidentical hematopoietic cell transplantation and risk factors for greater financial burden - a Brazilian FACT-accredited single-center analysis.

The complexity and costs of hematopoietic cell transplantation (HCT) have increased over the last decades with the popularization of unrelated donor (URD) transplantation and the introduction of haploidentical transplantation with posttransplant cyclophosphamide. Few studies have addressed this issue. The objective of this study was to analyze HCT costs in a single FACT-accredited private non-profit hospital. We included 79 patients who underwent HCT between 2018 and 2020. We have included all costs from admission day until D + 180. We used a lognormal regression. Median age was 53 y/o and most donors were unrelated (51%). Costs were higher with haploidentical donor (42%, p = 0.017, compared with URD), higher HCT-CI (15% for each point, p = 0.0056), and in patients with liver or gastrointestinal GVHD (45%, p = 0.033), and lower in patients who received CD34 > 2.5 × 10E6/kg (42%, p = 0.0038). We built a score based on the following risk factors: HCT-CI > 3, CD34 ≤ 2.5 × 10E6/kg, haploidentical donor, and donor age > 30 y/o. Patients with 2 + risk factors (N = 53) had a median cost of USD 226,156.00, compared with USD 93,048.00 in patients with zero or 1 point (N = 26, p < 0.0001). In summary, we have shown that HCT costs are higher with lower doses of CD34 cells, haploidentical HCT (provided that the costs of stem cell procurement and ATG are not included), and in patients with higher HCT-CI. Prospective and refined cost analyses comparing haploidentical and URD transplants, as well as effective strategies for patients with higher HCT-CI scores, are warranted. We found no difference in costs between URD and MSD transplantation.

The economic burden of overweight and obesity in Brazil: perspectives for the Brazilian Unified Health System.

OBJECTIVES: Parallel to rising obesity prevalence in Brazil, there is expected to be increased direct health care costs related to non-communicable diseases (NCDs). In this study, we estimated the economic burden of NCDs attributable to overweight and obesity in the Brazilian Unified Health System (SUS). METHODS: We used self-reported body mass index of 85,715 adults from the 2019 Brazilian National Health Survey. Annual costs (1 US$ = 2.281 Reais) with inpatient and outpatient procedures were obtained from the Hospital and Ambulatory Information Systems of the Brazilian SUS. Relative risks for cardiovascular disease, chronic respiratory disease, neoplasm, digestive disease, musculoskeletal disorders, diabetes and kidney diseases, sense organ diseases, and neurological disorders were retrieved from the Global Burden of Disease study. RESULTS: Annually, US$ 654 million (95% uncertainty interval: US$ 418.4 to US$ 893.2) direct health care costs related to NCDs were attributable to overweight and obesity. Attributable costs were higher in women than men. Cardiovascular diseases had the highest attributable costs (US$ 289 million), followed by chronic respiratory diseases (US$ 110 million), neoplasms (US$ 96 million), digestive diseases (US$ 60 million), musculoskeletal disorders (US$ 44 million), diabetes and kidney disease (US$ 31 million), sense organ diseases (US$ 22 million) and neurological disorders (US$ 11 million). CONCLUSIONS: Overweight and obesity account for US$ 654 million direct costs of NCDs annually. Effective policies to promote healthy body weight may have economic benefits.

Treatment burden and perceptions of glucose-lowering therapy among people living with diabetes.

AIMS: Address treatment burden and general perceptions of pharmacological treatment in patients with diabetes. METHODS: We surveyed adult patients with diabetes cared for in a tertiary academic medical center about: i) knowledge about the impact of glucose-lowering medication use on diabetes control and complications, ii) common beliefs about natural medicine and insulin use, iii) attitudes towards glucose-lowering medications, iv) burden of treatment, v) general knowledge of diabetes pharmacological treatment, and vi) perceptions of shared decision-making. RESULTS: Two hundred-four participants completed the survey. While most (90%) agreed that adherence to medication would control diabetes and improve quality of life, 30-40% were not certain that it would translate to fewer disease complications. About one of three thought medications could be harmful (29.4%). Over 50% agreed or was unsure that natural remedies were as good/better than prescribed medications. About 30% acknowledged difficulties taking their diabetes medications and monitoring blood glucose, and over 50% were concerned about treatment costs. Nearly 30% denied receiving a detailed explanation from their clinician regarding their disease and is treatment. CONCLUSIONS: Our results highlight the importance of patient education regarding pharmacological treatment for diabetes, and eliciting sources of distress and treatment burden among patients with diabetes.

Carga financiera familiar asociada al cuidado de la mujer con cáncer de mama / Family financial burden associated with caring for women with breast cancer

El cáncer de mama es una de las enfermedades que causa más muertes de mujeres en el mundo. Hay barreras y situaciones que ponen en riesgo los mejores resultados para su control. Este estudio describirá la carga financiera que asumen estas mujeres y sus familias desde el enfoque de cuidado. Objetivo. Describir la carga financiera familiar asociada al cuidado de la mujer con cáncer de mama. Materiales y métodos. Estudio descriptivo cuantitativo de corte trasversal. Realizado con 71 mujeres de la Fundación SIMMON (Sinergias integradas para el mejoramiento del manejo oncológico). El estudio tiene el aval de la Facultad de Enfermería de la Universidad Nacional de Colombia. Los datos se obtuvieron con la Encuesta "Costo financiero del cuidado de la Enfermedad crónica". "La metodología Caracol" de Mayorga et al. Se usó para analizar los datos, comparándolos a partir de un diagrama. Resultados: La mayor fuente de CF fue transporte con un ángulo de 44,8°, salud con 27,8°, Vivienda con 25°, comunicaciones con 24,4° y por último alimentación con 24°. La mayor fuente de ingresos es su pensión o la de su pareja y el trabajo formal e informal. La mayor fuente de endeudamiento son los préstamos bancarios con 38%. La calificación del nivel de preocupación que genera la CF fue 4 el nivel más alto con 63,3%. Conclusiones: Las mujeres con cáncer de mama tienen una alta CF asociada al cuidado y hacen falta políticas públicas y estrategias sostenibles para mitigarla.

The breast cancer is one of the diseases that cause more deaths of women in the world. There are barriers and situations that put at risk the best results for their control. This study will describe the financial burden that these women and their families assume form the care approach. Objective. Describe the family financial burden associated with caring for women with breast cancer. Materials and methods. Descriptive quantitative study of cross section. Made with 71 women linked to the SIMMON foundation (Integrated synergies for the improvement of oncological management). The study has the endorsement of the Faculty of Nursing of the National University of Colombia. The data was obtained with the Survey "Financial cost of chronic disease care". The Caracol methodology of Mayorga et al. It was used to analyze the data by comparing them from a diagram. Results. The main source of CF was transport with an angle of 44.8°, health with 27.8°, housing with 25°, communications with 24.2° and finally with 24° feeding. The main source of income is your presion or that of your partner and formal and informal work. The biggest source of indebtedness in bank loans with 38%. The level of concern generated by the CF was 4 the highest level with 63.3%. Conclusions. Women with breast cancer have a high CF associated with their care since the diagnosis and public policies and sustainable strategies are needed to mitigate it.