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Silva IACE, Favoretto CK, Russo LX. Factors associated with bariatric surgery rates in federative units in Brazil. Rev Saude Publica 2022; 56:117. [PMID: 36629708 PMCID: PMC9749656 DOI: 10.11606/s1518-8787.2022056004133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 02/12/2022] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To analyze the socioeconomic, demographic and health management factors associated with bariatric surgery rates performed by the Brazilian Unified Health System (SUS) in the federative units in Brazil. METHODS Description and analysis of bariatric surgeries rates (per 100,000 inhabitants) performed by SUS in adults from 18 to 65 years old, in the 27 federative units of Brazil, between 2008 and 2018; thus, the econometric methodology of count panel with negative binomial distribution (population-averaged, fixed effects and random effects) was used. Socioeconomic and demographic factors were also investigated, considering the real gross domestic product per capita, the average years of study of adults and life expectancy at birth, and those of health management, given the primary health care coverage, the rate of digestive system surgeons and the rate of hospitals accredited in high complexity care to patients with obesity in the SUS. RESULTS In regional terms, the performance of public bariatric surgeries in Brazil over the period analyzed suffered a great disparity; the procedures happen mostly in the South and Southeast regions, and scarcely in the North region. Moreover, we found a positive relationship between the rate of bariatric surgeries and life expectancy, the rate of digestive system surgeons and the rate of hospitals accredited in high complexity care; however, the average number of years of adult study and coverage of primary health care is a negative association regarding real gross domestic product per capita. CONCLUSION In the period analyzed, the investigated factors explained the rate of bariatric surgeries. Therefore, to train specialized health professionals, the accreditation of hospitals according to the legal framework, preventive actions of primary care, and socioeconomic and demographic factors, conditioning for the offer of surgical treatment by the SUS were crucial. Thus, these are all relevant factors for the formulation of public policies in this area.
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Affiliation(s)
- Ivan Augusto Cecilio e Silva
- Universidade Federal do Rio Grande do SulFaculdade de Ciências EconômicasPrograma de Pós-Graduação em EconomiaPorto AlegreRSBrasilUniversidade Federal do Rio Grande do Sul. Faculdade de Ciências Econômicas. Programa de Pós-Graduação em Economia. Porto Alegre, RS, Brasil
| | - Cassia Kely Favoretto
- Universidade Estadual de MaringáCentro de Ciências Sociais AplicadasDepartamento de EconomiaMaringáPRBrasil Universidade Estadual de Maringá. Centro de Ciências Sociais Aplicadas. Departamento de Economia. Maringá, Paraná, PR, Brasil
| | - Leticia Xander Russo
- Universidade Federal da Grande DouradosFaculdade de Administração, Ciências Contábeis e EconomiaDepartamento de EconomiaDouradosMSBrasil Universidade Federal da Grande Dourados. Faculdade de Administração, Ciências Contábeis e Economia. Departamento de Economia. Dourados, MS, Brasil
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Turri JAO, Anokye NK, Dos Santos LL, Júnior JMS, Baracat EC, Santo MA, Sarti FM. Impacts of bariatric surgery in health outcomes and health care costs in Brazil: Interrupted time series analysis of multi-panel data. BMC Health Serv Res 2022; 22:41. [PMID: 34996426 PMCID: PMC8740498 DOI: 10.1186/s12913-021-07432-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 10/18/2021] [Indexed: 12/12/2022] Open
Abstract
Background The increasing burden of obesity generates significant socioeconomic impacts for individuals, populations, and national health systems worldwide. The literature on impacts and cost-effectiveness of obesity-related interventions for prevention and treatment of moderate to severe obesity indicate that bariatric surgery presents high costs associated with high effectiveness in improving health status referring to certain outcomes; however, there is a lack of robust evidence at an individual-level estimation of its impacts on multiple health outcomes related to obesity comorbidities. Methods The study encompasses a single-centre retrospective longitudinal analysis of patient-level data using micro-costing technique to estimate direct health care costs with cost-effectiveness for multiple health outcomes pre-and post-bariatric surgery. Data from 114 patients who had bariatric surgery at the Hospital of Clinics of the University of Sao Paulo during 2018 were investigated through interrupted time-series analysis with generalised estimating equations and marginal effects, including information on patients' characteristics, lifestyle, anthropometric measures, hemodynamic measures, biochemical exams, and utilisation of health care resources during screening (180 days before) and follow-up (180 days after) of bariatric surgery. Results The preliminary statistical analysis showed that health outcomes presented improvement, except cholesterol and VLDL, and overall direct health care costs increased after the intervention. However, interrupted time series analysis showed that the rise in health care costs is attributable to the high cost of bariatric surgery, followed by a statistically significant decrease in post-intervention health care costs. Changes in health outcomes were also statistically significant in general, except in cholesterol and LDL, leading to significant improvements in patients' health status after the intervention. Conclusions Trends multiple health outcomes showed statistically significant improvements in patients' health status post-intervention compared to trends pre-intervention, resulting in reduced direct health care costs and the burden of obesity.
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Affiliation(s)
- José Antonio Orellana Turri
- Department of Gynecology and Obstetrics, Central Institute of the Hospital of Clinics at the School of Medicine, University of Sao Paulo, R Dr Eneas de Carvalho Aguiar 255, Sao Paulo, SP, Brazil. .,School of Public Health, University of Sao Paulo, Av Dr Arnaldo 715, Sao Paulo, SP, Brazil.
| | - Nana Kwame Anokye
- Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, Kingston Lane, Uxbridge, United Kingdom
| | - Lionai Lima Dos Santos
- Department of Physiotherapy, School of Sciences and Technology, Sao Paulo State University, Rua Roberto Simonsen, Presidente Prudente, SP, 305, Brazil
| | - José Maria Soares Júnior
- Department of Gynecology and Obstetrics, Central Institute of the Hospital of Clinics at the School of Medicine, University of Sao Paulo, R Dr Eneas de Carvalho Aguiar 255, Sao Paulo, SP, Brazil
| | - Edmund Chada Baracat
- Department of Gynecology and Obstetrics, Central Institute of the Hospital of Clinics at the School of Medicine, University of Sao Paulo, R Dr Eneas de Carvalho Aguiar 255, Sao Paulo, SP, Brazil
| | - Marco Aurélio Santo
- Department of Gastroenterology, Digestive Disease Surgery, Central Institute of the Hospital of Clinics at the School of Medicine, University of Sao Paulo, R Dr Eneas de Carvalho Aguiar 255, Sao Paulo, SP, Brazil
| | - Flavia Mori Sarti
- School of Public Health, University of Sao Paulo, Av Dr Arnaldo 715, Sao Paulo, SP, Brazil.,School of Arts, Sciences and Humanities, University of Sao Paulo, Av Arlindo Bettio 1000, Sao Paulo, SP, Brazil
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Assumpção RP, Bahia LR, da Rosa MQM, Correia MG, da Silva EN, Zubiaurre PR, Mottin CC, Vianna DA. Cost-Utility of Gastric Bypass Surgery Compared to Clinical Treatment for Severely Obese With and Without Diabetes in the Perspective of the Brazilian Public Health System. Obes Surg 2020; 29:3202-3211. [PMID: 31214966 DOI: 10.1007/s11695-019-03957-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Obesity is associated with increased morbidity and mortality. Weight loss due to gastric bypass (GBP) surgery improves clinical outcomes and may be a cost-effective intervention. To estimate the cost-effectiveness of GBP compared to clinical treatment in severely obese individuals with and without diabetes in the perspective of the Brazilian public health system. MATERIALS AND METHODS A Markov model was developed to compare costs and outcomes of gastric bypass in an open approach to clinical treatment. Health states were living with diabetes, remission of diabetes, non-fatal and fatal myocardial infarction, and death. We also included the occurrence of complications related to surgery and plastic surgery after the gastric bypass surgery. The direct costs were obtained from primary data collection performed in three public reference centers for obesity treatment. Utility values also derived from this cohort, while transition probabilities came from the international literature. A sensitivity analysis was performed to evaluate uncertainties. The model considered a 10-year time horizon and a 5% discount rate. RESULTS Over 10 years, GBP increased quality-adjusted life years (QALY) and costs compared to clinical treatment, resulting in an incremental cost-effectiveness ratio (ICER) of Int$1820.17/QALY and Int$1937.73/QALY in individuals with and without diabetes, respectively. Sensitivity analysis showed that utility values and direct costs of treatments were the parameters that affected the most the ICERs. CONCLUSION The study demonstrated that GBP is a cost-effective intervention for severely obese individuals in the Brazilian public health system perspective, with a better result in individuals with diabetes.
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Affiliation(s)
- Roberto Pereira Assumpção
- Department of Internal Medicine, State University of Rio de Janeiro, Boulevard 28 de Setembro, 77, 3° andar, Rio de Janeiro, Rio de Janeiro, 20551-030, Brazil.
| | - Luciana Ribeiro Bahia
- Department of Internal Medicine, State University of Rio de Janeiro, Boulevard 28 de Setembro, 77, 3° andar, Rio de Janeiro, Rio de Janeiro, 20551-030, Brazil
| | - Michelle Quarti Machado da Rosa
- Department of Internal Medicine, State University of Rio de Janeiro, Boulevard 28 de Setembro, 77, 3° andar, Rio de Janeiro, Rio de Janeiro, 20551-030, Brazil
| | - Marcelo Goulart Correia
- Biostatistics and Bioinformatics Department, National Institute of Cardiology, Rio de Janeiro, Brazil
| | - Everton Nunes da Silva
- Department of Public Health, University of Brasilia,, Centro Metropolitano, conjunto A, lote 01, Brasília, Distrito Federal, 72.220-275, Brazil
| | - Paula Rosales Zubiaurre
- Center of Morbid Obesity, São Lucas Hospital, Pontifical Catholic University of Rio Grande do Sul, Av. Ipiranga 6690/302, Porto Alegre, Rio Grande do Sul, 90610-000, Brazil
| | - Claudio Corá Mottin
- Center of Morbid Obesity, São Lucas Hospital, Pontifical Catholic University of Rio Grande do Sul, Av. Ipiranga 6690/302, Porto Alegre, Rio Grande do Sul, 90610-000, Brazil
| | - Denizar Araujo Vianna
- Department of Internal Medicine, State University of Rio de Janeiro, Boulevard 28 de Setembro, 77, 3° andar, Rio de Janeiro, Rio de Janeiro, 20551-030, Brazil
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Coleone JD, Bellei EA, De Marchi ACB. Food consumption and glycemic testing of adults and elderly diabetic patients from Public Health: A systematic review of assessment methods. Diabetes Metab Syndr 2019; 13:3005-3010. [PMID: 30057070 DOI: 10.1016/j.dsx.2018.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 07/17/2018] [Indexed: 12/17/2022]
Abstract
AIMS To map and discuss the different methods used to assess food consumption and glycemic testing of adults and elderly diabetic patients from Public Health. MATERIALS AND METHODS A total of 710 records were identified by searching databases integrated by the Virtual Health Library website, between September and October 2017. The Newcastle Ottawa scale was used for study quality assessment. A total of 8 studies met inclusion criteria for analysis. Study characteristics were extracted and synthesized to generate comparisons. RESULTS Food consumption was evaluated by Food Frequency Questionnaire, 24-hour Dietary Recall, Eating Attitudes Test (EAT-26), Questionnaire On Eating and Weight Patterns (QEWP-R), and questioning the salt intake. Glucose testing methods included Postprandial Glucose, Glycated Hemoglobin (HbA1C), fasting glucose, and self-reported diabetes. CONCLUSIONS Most methods that access food consumption use single questionnaires, which are easy to administer and yield easily interpreted results. For glycemic testing, the majority used are conventional methods.
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Affiliation(s)
- Joane Diomara Coleone
- Graduate Program in Human Aging, College of Physical Education and Physiotherapy, University of Passo Fundo, Passo Fundo, Brazil
| | - Ericles Andrei Bellei
- Graduate Program in Applied Computing, Institute of Exact Sciences and Geosciences, University of Passo Fundo, Passo Fundo, Brazil
| | - Ana Carolina Bertoletti De Marchi
- Graduate Program in Human Aging, College of Physical Education and Physiotherapy, University of Passo Fundo, Passo Fundo, Brazil; Graduate Program in Applied Computing, Institute of Exact Sciences and Geosciences, University of Passo Fundo, Passo Fundo, Brazil.
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