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Lopes-Júnior LC, Pessanha RM, Bomfim E, de Lima RAG. Cost-effectiveness of home care services versus hospital care for pediatric patients worldwide: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e30993. [PMID: 36254039 PMCID: PMC9575704 DOI: 10.1097/md.0000000000030993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Despite the expansion of home care services (HCS) in several countries, there is still a need to systematically investigate the available evidence on the cost-effectiveness of this type of service compared to hospital care in the world, particularly for the pediatric population. Hence, we aimed to systematically synthesize and critically evaluate the evidence on the cost-effectiveness of HCS versus in-hospital services worldwide. METHODS A systematic review and meta-analysis protocol guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. Ten databases will be searched: MEDLINE/PubMed, Cochrane Library, Excerpta Medica database, cummulative index to nursing and allied health literature (CINAHL), Web of Science, SCOPUS, Science Direct, PsycINFO, Latin American and Caribbean Health Sciences Literature and Chinese national knowledge infrastructure with no restrictions on publication date or languages. A checklist for assessing the quality of reporting of economic evaluation studies will be applied. To assess the methodological quality of evidence from observational research on comparative effectiveness, the Good Research for Comparative Effectiveness Checklist v5.0 will be used. The heterogeneity among the studies will be assessed using the I2 statistic test. According to the results of this test, we will verify whether a meta-analysis is feasible. If feasibility is confirmed, a random-effect model analysis will be carried out. For data analysis, the calculation of the pooled effect estimates will consider a 95% CI and alpha will be set in 0.05 using the R statistical software, v.4.0.4. In addition, we will rate the certainty of evidence based on Grading of Recommendations Assessment, Development and Evaluation. All methodological steps of this review will be performed independently and paired by 2 reviewers and conducted and managed in the EPPI-Reviewer Software™. RESULTS The results may have relevance for the basis of public health policies, regarding the forms of organization of HCS, especially in terms of complete economic evaluations through cost-effectiveness analysis in relation to hospital care. CONCLUSION To the best of our knowledge this will be the first systematic review and metanalysis to synthesize and critically evaluate the evidence on the cost-effectiveness of HCS versus in-hospital services worldwide. The review will adopt a rigorous approach, adhering to PRISMA Statement 2020, using a comprehensive and systematic search strategy in 10 databases, further the gray literature, pre-prints, with no time period or language restrictions.
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Affiliation(s)
- Luís Carlos Lopes-Júnior
- Graduate Program in Public Health, Health Sciences Center at the Federal University of Espírito Santo (UFES), Vitória, ES, Brazil
- *Correspondence: Luís Carlos Lopes-Júnior, Graduate Program in Public Health at the Federal University of Espírito Santo (UFES), Av. Marechal Campos, 1468 – Maruípe, Zip Code: 29.043-900, Vitória, ES, Brazil (e-mail: )
| | - Raphael Manhães Pessanha
- Graduate Program in Public Health, Health Sciences Center at the Federal University of Espírito Santo (UFES), Vitória, ES, Brazil
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Silva AMD, Ferreira Júnior MA, Cardoso AIDQ, Ivo ML, Almeida JPF, Melo RDS. Costs related to obtaining organs for transplantation: A systematic review. Transplant Rev (Orlando) 2022; 36:100724. [PMID: 36029555 DOI: 10.1016/j.trre.2022.100724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/12/2022] [Accepted: 08/16/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The number of transplants in the world is growing, although there is a demand that exceeds supply. It is worth mentioning that the costs for obtaining organs are considered high. However, few studies have been developed on analyzing the costs of obtaining organs and tissues for transplants in order to support the decision-making of managers and health professionals. OBJECTIVE To summarize the studies related to the cost of obtaining organs for transplants from a deceased donor. METHOD A systematic literature review was conducted in the following databases: PubMed, Cochrane Library CINAHAL, Virtual Health Library (BVS), SCOPUS, Web of Science and EMBASE, using the following descriptors: Costs and cost analysis; Donor Selection; Tissue and Organ Procurement; Tissue and Organ Harvesting; and Tissue Donors, in studies published until April 2021. The risk of bias assessment was performed using the Joanna Briggs Institute's Checklist for Economic Assessments. It was not possible to perform a meta-analysis due to the heterogeneity of the studies. RESULTS A total of 1731 studies were identified, of which 11 were analyzed. The cost of kidneys in US dollars (USD) ranged between USD $1672 and USD $25,058. Obtaining a liver ranged from USD $586 to USD $44,478. Heart procurement ranged from USD $633 to USD $24,264. The combined heart-lung transplant ranged from USD $860 to USD $23,203. Obtaining the pancreas ranged from USD $413 to USD $29,708. CONCLUSIONS Cost of obtaining organs for transplants from a deceased donor is substantial and varies widely across different studies. The overall cost of failures to obtain organs is currently unknown. Understanding organ procurement expenses can help clarify areas in which organ and tissue procurement can improve in cost and efficiency.
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Affiliation(s)
- Aline Moraes da Silva
- Health and Development of the Midwest Region at the Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil.
| | - Marcos Antonio Ferreira Júnior
- Graduate Program in Nursing, Integrated Health Institute, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | | | - Maria Lucia Ivo
- Graduate Program in in Health and Development of the Midwest Region at the Federal University of Mato Grosso do Sul, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
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Miyamoto GC, Ben ÂJ, Bosmans JE, van Tulder MW, Lin CWC, Cabral CMN, van Dongen JM. Interpretation of trial-based economic evaluations of musculoskeletal physical therapy interventions. Braz J Phys Ther 2021; 25:514-529. [PMID: 34340933 DOI: 10.1016/j.bjpt.2021.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 06/21/2021] [Accepted: 06/30/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND As resources for healthcare are scarce, decision-makers increasingly rely on economic evaluations when making reimbursement decisions about new health technologies, such as drugs, procedures, devices, and equipment. Economic evaluations compare the costs and effects of two or more interventions. Musculoskeletal disorders have a high prevalence and result in high levels of disability and high costs worldwide. Because physical therapy interventions are usually the first line of treatment for musculoskeletal disorders, economic evaluations of such interventions are becoming increasingly important for stakeholders in the field of physical therapy, including physical therapists, decision-makers, and reseachers. However, economic evaluations are relatively difficult to interpret for the majority of stakeholders. OBJECTIVE To support physical therapists, decision-makers, and researchers in the field of physical therapy interpreting trial-based economic evaluations and translating the results of such studies to clinical practice. METHODS The design, analysis, and interpretation of economic evaluations performed alongside randomized controlled trials are discussed. To further illustrate and explain these concepts, we use a case study assessing the cost-effectiveness of exercise therapy compared to standard advice in patients with musculoskeletal disorders. CONCLUSIONS Economic evaluations are increasingly being used in healthcare decision-making. Therefore, it is of utmost importance that their design, conduct, and analysis are state-of-the-art and that their interpretation is adequate. This masterclass will help physical therapists, decision-makers, and researchers in the field of physical therapy to critically appraise the quality and results of trial-based economic evaluations and to apply the results of such studies to their own clinical practice and setting.
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Affiliation(s)
- Gisela Cristiane Miyamoto
- Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil; Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, The Netherlands.
| | - Ângela Jornada Ben
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Judith E Bosmans
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Maurits W van Tulder
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Chung-Wei Christine Lin
- Institute for Musculoskeletal Health Sydney, School of Public Healthy, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Johanna Maria van Dongen
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, The Netherlands
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Sobral SS, da Silva Brandão EH, de Barros Gallo C, Molon A, Sobral APT, de Fátima Teixeira da Silva D, Motta LJ, Dos Santos Franco AL, Rodrigues MFSD. Analysis of the psychopathological profile, quality of life, and cost-effectiveness of oral lichen planus patients treated with photobiomodulation. Clin Oral Investig 2021; 26:719-728. [PMID: 34251533 DOI: 10.1007/s00784-021-04050-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/22/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To evaluate the effect of PBM on the psychological profile and quality of life of patients with oral lichen planus (OLP) in comparison to corticoid and to investigate the cost-effectiveness of both treatments. MATERIALS AND METHODS Patients were randomized into two groups: Control (clobetasol propionate 0.05%) and Photobiomodulation (660 nm, 100mW, 177 J/cm2, 5 s, 0.5 J) twice a week for 30 days. The Hospital Anxiety and Depression Scale (HADS) and OHIP-14 were used in different treatment time points and at follow-up. The cost-effectiveness was calculated using the improvement in OHIP-14 after treatment. RESULTS OLP patients showed detected levels of anxiety, depression, and poor quality of life at baseline. No improvement in anxiety and depression was noticed after treatments. However, PBM and corticoid significantly improved the quality of life of OLP patients, considering the OHIP-14-T and the physical pain domain. The treatment with corticoid was more cost-effective than PBM. CONCLUSIONS Psychological distress was not improved after both treatments and PBM is as effective as corticoids in promoting a better quality of life in OLP patients, despite its higher cost. CLINICAL RELEVANCE This study highlights the need for additional therapeutic interventions in OLP patients, to early recognize and to manage the alterations in their psychological profile. Moreover, PBM is an effective therapy in OLP patient's quality of live and although it was a more expensive, the advantage of being a minimally invasive therapy associated with no side effects must be considered in clinical practice, especially in those patients with refractory disease. TRIAL REGISTRATION This study is registered at ClinicalTrials.gov; the registration number is NCT03320460, registered in 17/10/2017.
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Affiliation(s)
- Sérgio Sousa Sobral
- Postgraduate Program in Biophotonics Applied To Health Sciences, Nove de Julho University, UNINOVE, R. Vergueiro, 235/249, São Paulo, CEP 01504-001, Brazil
| | - Eloíza Helena da Silva Brandão
- Postgraduate Program in Biophotonics Applied To Health Sciences, Nove de Julho University, UNINOVE, R. Vergueiro, 235/249, São Paulo, CEP 01504-001, Brazil
| | - Camila de Barros Gallo
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Angela Molon
- Postgraduate Program in Biophotonics Applied To Health Sciences, Nove de Julho University, UNINOVE, R. Vergueiro, 235/249, São Paulo, CEP 01504-001, Brazil
| | - Ana Paula Taboada Sobral
- Postgraduate Program in Biophotonics Applied To Health Sciences, Nove de Julho University, UNINOVE, R. Vergueiro, 235/249, São Paulo, CEP 01504-001, Brazil.,Postgraduate Program in Health and Environment, Universidade Metropolitana de Santos (UNIMES), Santos, Brazil
| | - Daniela de Fátima Teixeira da Silva
- Postgraduate Program in Biophotonics Applied To Health Sciences, Nove de Julho University, UNINOVE, R. Vergueiro, 235/249, São Paulo, CEP 01504-001, Brazil
| | - Lara Jansiski Motta
- Postgraduate Program in Biophotonics Applied To Health Sciences, Nove de Julho University, UNINOVE, R. Vergueiro, 235/249, São Paulo, CEP 01504-001, Brazil
| | - Adriana Lino Dos Santos Franco
- Postgraduate Program in Biophotonics Applied To Health Sciences, Nove de Julho University, UNINOVE, R. Vergueiro, 235/249, São Paulo, CEP 01504-001, Brazil
| | - Maria Fernanda Setúbal Destro Rodrigues
- Postgraduate Program in Biophotonics Applied To Health Sciences, Nove de Julho University, UNINOVE, R. Vergueiro, 235/249, São Paulo, CEP 01504-001, Brazil.
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Sobral APT, Sobral SDS, Campos TM, Horliana ACRT, Fernandes KPS, Bussadori SK, Motta LJ. Photobiomodulation and myofascial temporomandibular disorder: Systematic review and meta-analysis followed by cost-effectiveness analysis. J Clin Exp Dent 2021; 13:e724-e732. [PMID: 34306537 PMCID: PMC8291152 DOI: 10.4317/jced.58084] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 04/16/2021] [Indexed: 11/05/2022] Open
Abstract
Background Photobiomodulation (PBM) is a non-invasive and non-pharmacological treatment, which, has shown beneficial results in the treatment of temporomandibular disorders (TMD) related pain. This systematic review and meta-analysis study aimed to evaluate the efficacy of photobiomodulation in the treatment of myofascial pain associated with (TMD by analyzing randomized clinical trials published from 2007 to February 2019. The secondary objective of the study was to perform a cost-effectiveness analysis of TMD treatment with photobiomodulation in patients with myofascial pain. Material and Methods International databases were used: Pubmed, Medline and Web of Science; the initial search raised 316 papers, and only 17 papers met the inclusion criteria for the systematic review (SR). Of these, only 04 papers met the inclusion criteria for meta-analysis: VAS data represented by numerical scores and placebo control group. Results As for the wavelength, the most used value was 780nm (followed by 830nm. The most used treatment time was 4 offered treatments for 4 weeks; followed by 10 sessions. Regarding periodicity, 9 studies used 2 times a week. The meta-analysis showed that laser-treated groups had painful symptoms improvement that was superior to the control group (mean difference 1.49;95% CI = -1.67; -1.32). Laser therapy showed a cost-effectiveness of $1,464.28 by controlled pain intensity and placebo showed $2,866.20 by controlled pain intensity. Conclusions The studies were considered to have moderate quality of evidence. Laser-treated groups had painful symptoms improvement that was superior to the control group and photobiomodulation was more cost-effective than placebo in patients with TMD and myofascial pain. Key words:Temporomandibular disorder, Myofascial pain, Photobiomodulation, Placebo, Cost-effectiveness.
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Affiliation(s)
| | - Sergio-de Sousa Sobral
- Postgraduate Program in Biophotonics Applied to Health Sciences, UNINOVE - São Paulo, Brazil
| | - Thalita-Molinos Campos
- Postgraduate Program in Biophotonics Applied to Health Sciences, UNINOVE - São Paulo, Brazil
| | | | | | - Sandra-Kalil Bussadori
- Postgraduate Program in Biophotonics Applied to Health Sciences, UNINOVE - São Paulo, Brazil
| | - Lara-Jansiski Motta
- Postgraduate Program in Biophotonics Applied to Health Sciences, UNINOVE - São Paulo, Brazil.,Postgraduate Program
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Sousa DFD, Araújo MFMD, de Mello VD, Damasceno MMC, Freitas RWJFD. Cost-Effectiveness of Passion Fruit Albedo versus Turmeric in the Glycemic and Lipaemic Control of People with Type 2 Diabetes: Randomized Clinical Trial. J Am Coll Nutr 2020; 40:679-688. [PMID: 33141635 DOI: 10.1080/07315724.2020.1823909] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Robust evidence has related yellow passion fruit albedo and long turmeric to the metabolic and glycemic control of diabetes. AIM To analyze the incremental cost-effectiveness of the flour made from yellow passion fruit albedo versus long turmeric merged with piperine in the glycemic and lipid control of individuals with type 2 diabetes. METHOD Eighty-nine patients were enrolled in this randomized, placebo-controlled, clinical trial for 120 days. The first group was prescribed 500 mg capsules, three times a day, of yellow passion fruit albedo flour (FAMA). The second group was prescribed long turmeric capsules (500 mg), merged with piperine (5 mg) (CURPI), at fasting. The third group followed the standard advice recommendations, and ingested a placebo of carboxymethyl cellulose (500 mg) at fasting. RESULTS The group using FAMA showed a higher reduction (-5.9%) of glycemia after fasting, compared to placebo (+9%), and CURPI (-3.2%) (p < 0.05). Regarding HbA1c, the study observed a significant and similar statistical reduction (-0.8%) in the intervention groups, in contrast with the placebo group (p < 0.05). The reduction in HOMA-IR in the CURPI group (-9.4%) was higher than the other groups (p < 0.05). The CURPI group also showed a higher reduction of serum triglyceride levels (-20.8%) compared to the placebo (-0.09%) and FAMA (+1.8%) (p < 0.05) groups. CONCLUSION It was concluded that turmeric is the most cost-effective in comparison with yellow passion fruit albedo, because of its decrease in the levels of triglycerides and HOMA-IR, even when adjusted for confounding variables. On the other hand, HbA1c cost-effectiveness relation was similar.
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Affiliation(s)
- Danilo Ferreira de Sousa
- Health Sciences Institute, University for International Integration of the Afro Brazilian Lusophony University, Redenção, Brazil
| | | | - Vanessa Derenji de Mello
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
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Campos TM, do Prado Tavares Silva CA, Sobral APT, Sobral SS, Rodrigues MFSD, Bussadori SK, Fernandes KPS, Mesquita-Ferrari RA, Horliana ACRT, Motta LJ. Photobiomodulation in oral mucositis in patients with head and neck cancer: a systematic review and meta-analysis followed by a cost-effectiveness analysis. Support Care Cancer 2020; 28:5649-5659. [DOI: 10.1007/s00520-020-05613-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 07/02/2020] [Indexed: 12/29/2022]
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Gama CS, Backman C, Oliveira ACD. Effect of surgical safety checklist on colorectal surgical site infection rates in 2 countries: Brazil and Canada. Am J Infect Control 2019; 47:1112-1117. [PMID: 30979561 DOI: 10.1016/j.ajic.2019.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/28/2019] [Accepted: 03/01/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND The effectiveness of the surgical safety checklist (SSC) in countries with different socioeconomic backgrounds is uncertain. To evaluate the effect of the SSC in 2 different socioeconomic settings, we compared surgical site infection (SSI) rates before and after its implementation in colorectal procedures. METHODS An epidemiological retrospective study was conducted in the university hospitals in Ottawa, Canada, and Belo Horizonte, Brazil. Data were collected through chart review from the period before and after the SSC implementation. RESULTS The SSI rate decreased from 27.7%-25.9% (P = .625) and from 17.0%-14.4% in Canada and Brazil, respectively (P = .448) after the SSC implementation. In Canada, there was no SSI in incomplete SSC, and in Brazil, SSI was 20.0% (P = .026). DISCUSSION Despite high and regular completion of the SSC in the Canadian and Brazilian hospitals, respectively, there was no significant reduction of SSI after the SSC implementation in any setting. However, in Brazil, the association between incomplete SSC and higher SSI rates demonstrated the potential impact of the SSC in developing countries. CONCLUSIONS The effect of the SSC on SSI may be greater in developing countries due to minor investment and consolidation of policies in SSI prevention.
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Oliveira LNDS, Itria A, Lima EC. Cost of illness and program of dengue: A systematic review. PLoS One 2019; 14:e0211401. [PMID: 30785894 PMCID: PMC6382265 DOI: 10.1371/journal.pone.0211401] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 01/14/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Studies on dengue related to the cost of illness and cost of the program are factors to describe the economic burden of dengue, a neglected disease that has global importance in public health. These studies are often used by health managers in optimizing financial resources. A systematic review of studies estimating the cost of dengue was carried out, comparing the costs between the studies and examining the cost drivers regarding the methodological choices. METHODS This study was done according to the guidelines of the Centre for Reviews and Dissemination (CRD). Several databases were searched: Medline, Virtual Health Library and CRD. Two researchers, working independently, selected the studies and extracted the data. The quality of the methodology of the individual studies was achieved by a checklist of 29 items based on protocols proposed by the British Medical Journal and Consolidated Health Economic Evaluation Reporting Standards. A qualitative and quantitative narrative synthesis was performed. RESULTS A literature search yielded 665 publications. Of these, 22 studies are in accordance with previously established inclusion criteria. The cost estimates were compared amongst the studies, highlighting the study design, included population and comparators used (study methodology). The component costs included in the economic evaluation were based on direct and indirect costs, wherein twelve studies included both costs, twelve studies adopted the societal perspective and ten studies used the perspective of the public health service provider, or of a private budget holder. CONCLUSION This study showed that the cost of dengue in 18 countries generated approximately US$ 3.3 billion Purchasing Power Parity (PPP) in 2015. This confirms that the burden of dengue has a great economic impact on countries with common socioeconomic characteristics and similarities in health systems, particularly developing countries, indicating a need for further studies in these countries.
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Affiliation(s)
- Luana Nice da Silva Oliveira
- Faculty of Pharmacy, Center for Economics and Health Assessments, Institute of Health Technology Assessment, Federal University of Goiás, Goiás, Brazil
| | - Alexander Itria
- Institute of Tropical Pathology and Public Health, Department of Collective Health, Federal University of Goiás, Goiás, Brazil
- Center of Economics and Health Assessments, Institute of Health Technology Assessment, Federal University of Goiás, Goiás, Brazil
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Ruschel KB, Rabelo-Silva ER, Rohde LE, de Souza EN, Mussi CM, Polanczyk CA. Cost-Effectiveness of a Home Visit Program for Patients with Heart Failure in Brazil: Evidence from a Randomized Clinical Trial. Value Health Reg Issues 2018; 17:81-87. [PMID: 29754015 DOI: 10.1016/j.vhri.2018.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 01/08/2018] [Accepted: 03/21/2018] [Indexed: 10/16/2022]
Abstract
OBJECTIVE Estimate the cost-effectiveness of a nurse-led home visit (HV) intervention as compared with the standard HF management, within a randomized clinical trial in Brazil. STUDY DESIGN Cost-effectiveness study within a randomized trial. METHODS To assess the cost-effectiveness of four home visits and four telephone calls by nurses in the management of patients with HF within a randomized clinical trial (RCT: NCT01213875) in a perspective Public (PHS-Public Healthcare System) and private healthcare systems of Brazil during time frame of 24 weeks. The outcome was a composite endpoint hospital readmission rate (first visit to the emergency room (ER) and hospital readmission), or all-cause death and incremental cost-effectiveness ratio (ICER) of the study intervention to conventional management. RESULTS Home-based intervention was associated with a reduction in composite endpoint (RR 0.73; 95% confidence interval 0.54 - 0.99; P = 0.049), but at greater cost from the PHS perspective. The ICER at 24 weeks was R$585 per hospital readmission visit prevented. Within the private health insurance framework, home visits were associated with lower costs and lower readmission rates. Results were sensitive to the relative risk of the study intervention, admissions and intervention costs. CONCLUSIONS In Brazil, an intervention based on nurse-led home visits of patients with HF showed a favorable cost-effectiveness profile within the framework of the PHS and was dominant within the private healthcare system. Our analysis suggests that implementation of this program could not only benefit patients, but also provide a financial incentive to health administrators.
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Affiliation(s)
- Karen Brasil Ruschel
- Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil; Institute for Health Technology Assessment (IATS/ CNPq), Porto Alegre, Rio Grande do Sul, Brazil
| | - Eneida R Rabelo-Silva
- Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil; Heart Failure and Transplant Group, Cardiology Division, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil; Nursing School of the Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | - Luis Eduardo Rohde
- Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil; Institute for Health Technology Assessment (IATS/ CNPq), Porto Alegre, Rio Grande do Sul, Brazil; Heart Failure and Transplant Group, Cardiology Division, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Emiliane N de Souza
- Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Cláudia M Mussi
- Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil; Heart Failure and Transplant Group, Cardiology Division, Hospital de Clinicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Carisi A Polanczyk
- Graduate Program in Health Sciences: Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil; Institute for Health Technology Assessment (IATS/ CNPq), Porto Alegre, Rio Grande do Sul, Brazil
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11
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Sobral APT, Godoy CLHD, Fernandes KPS, Bussadori SK, Ferrari RAM, Horliana ACRT, Monken SF, Motta LJ. Photomodulation in the treatment of chronic pain in patients with temporomandibular disorder: protocol for cost-effectiveness analysis. BMJ Open 2018; 8:e018326. [PMID: 29730613 PMCID: PMC5942461 DOI: 10.1136/bmjopen-2017-018326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Epidemiological data show that the signs and symptoms of temporomandibular disorder (TMD) start becoming apparent from 6 years of age, and during adolescence these signs and symptoms are similar to those of adults. The present study aims to estimate the direct costs for treatment of chronic muscle pain with photobiomodulation therapy, occlusal splint and placebo in patients with TMD; to evaluate the effectiveness of photobiomodulation therapy and occlusal splint for treatment of muscle pain in patients with TMD; to analyse the cost-effectiveness of the two proposed treatments for pain; and to describe and compare the results of the analyses of these treatments. METHODS AND ANALYSIS This is a prospective trial of clinical and economic analyses that will include 135 patientswith TMD aged between 15 years and 25 years, randomly assigned to a treatment group: G1 (photobiomodulation), G2 (occlusal splint) and G3 (placebo). The analyses will be based on the cost of each treatment during the 12-month period. The outcome of the analysis of effectiveness will be pain, measured periodically by means of clinical examination of Research Diagnostic Criteria for Temporomandibular Disorders. The cost-effectiveness ratio will be calculated using, as end points, pain and the ratio of the differences in costs between the groups studied. The evaluation of the impact of the treatment on quality of life will be determined by applying the adapted EuroQol-5D. ETHICS AND DISSEMINATION This protocol has been ethically approved by the local medical ethical committee, protocol number 2.014.339. Results will be submitted to international peer-reviewed journals and presented at international conferences. TRIAL REGISTRATION NUMBER NCT03096301.
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Affiliation(s)
- Ana Paula Taboada Sobral
- Postgraduate program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho - UNINOVE, São Paulo, Brazil
| | - Camila Leal H de Godoy
- Dentistry School from Universidade Nove de Julho - UNINOVE, Universidade Nove de Julho - UNINOVE, São Paulo, Brazil
| | - Kristianne P Santos Fernandes
- Postgraduate program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho - UNINOVE, São Paulo, Brazil
| | - Sandra Kalil Bussadori
- Postgraduate program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho - UNINOVE, São Paulo, Brazil
| | | | | | - Sonia F Monken
- Professional Master Health Administration Program, Universidade Nove de Julho - UNINOVE, São Paulo, Brazil
| | - Lara J Motta
- Postgraduate program in Biophotonics Applied to Health Sciences, Universidade Nove de Julho - UNINOVE, São Paulo, Brazil
- Professional Master Health Administration Program, Universidade Nove de Julho - UNINOVE, São Paulo, Brazil
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Abstract
Introdução: Em âmbito odontológico ocorrem ações preventivas na tentativa de se evitar a instalação de cáries, doença que tem prevalência aumentada na população e que constitui um problema de Saúde Pública. Alguns recursos são empregados para tal, como: realização de diagnóstico precoce e a opção por tratamentos conservadores de mínima intervenção. O cimento de ionômero de vidro (CIV), advindo das suas características benéficas que vão de encontro às tendências atuais, mostra-se intimamente relacionado aos preceitos da Odontologia Preventiva e Minimamente Invasiva e as novas técnicas conservadoras preconizadas. Objetivo: O objetivo do presente artigo foi por intermédio da realização de um estudo de revisão de literatura, averiguar as características do CIV que detém papel de destaque no perfil da Odontologia Minimamente Invasiva. Resultados: O cirurgião dentista deve conscientizar-se da classificação, conforme sua composição e natureza físico-química: ionômeros convencionais; ionômeros reforçados por metais; de alta viscosidade e vários tipos de ionômeros de vidro modificados por resina para que escolha corretamente o CIV que será utilizado em suas intervenções clínicas, o que deve ocorrer baseado nas propriedades do material e em sua indicação clínica. Conclusão: Concluiu-se que a efetivação de técnicas preventivas com o CIV na assistência à saúde pública, tendem a minimizar os tratamentos curativos, valorizando concomitantemente os procedimentos odontológicos de baixa complexidade realizados na Atenção Básica, evitando os encaminhamentos para tratamento de casos de maior complexidade a nível da atenção secundária e terciária, economizando recursos.
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