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Ida FS, Ferreira HP, Vasconcelos AKM, Furtado IAB, Fontenele CJPM, Pereira AC. Post-COVID-19 syndrome: persistent symptoms, functional impact, quality of life, return to work, and indirect costs - a prospective case study 12 months after COVID-19 infection. CAD SAUDE PUBLICA 2024; 40:e00022623. [PMID: 38381867 PMCID: PMC10877695 DOI: 10.1590/0102-311xpt026623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 09/13/2023] [Accepted: 10/05/2023] [Indexed: 02/23/2024] Open
Abstract
The persistent symptoms of post-COVID-19 syndrome negatively impact health, quality of life, and productivity. This study aimed to describe the persistent symptoms of post-COVID-19 syndrome (especially neurological ones) and their 12-month post-infection cognitive, emotional, motor, quality of life, and indirect cost repercussions. Patients showing the first symptoms of COVID-19 from January to June 2021 who developed post-COVID-19 syndrome and sought care at the Fortaleza Unit (Ceará, Brazil) of the SARAH Network of Rehabilitation Hospitals were included in this study. Information was obtained at the baseline follow-up and by telephone interview 12 months post-infection. In total, 58 people participated in this study with an average age of 52.8±10.5 years, of which 60% required an ICU. The most frequent symptoms on admission included fatigue (64%), arthralgia (51%), and dyspnea (47%), whereas, after 12 months, fatigue (46%) and memory impairment (39%). The following scales/functional tests showed alterations: PCFS, MoCA, HAD, FSS, SF-36, TLS5x, timed up and go, 6-minute walk, and handgrip. Indirect costs totaled USD 227,821.00, with 11,653 days of absenteeism. Moreover, 32% of patients were unable to return to work. Better TLS5x and higher SF-36 scores in the functional capacity, physical functioning, vitality, and pain dimensions were associated with return to work (p ≤ 0.05). The most frequent persistent symptoms referred to fatigue, arthralgia, dyspnea, anxiety, and depression, which negatively affected cognitive, emotional, and motor function and quality of life. These symptoms lasted for over a year, especially fatigue and memory alteration, the latter of which being the most reported after COVID-19 infections. Results also show a significant difficulty returning to work and indirect costs of USD 4,847.25 per person/year.
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Affiliation(s)
- Fernando Shizuo Ida
- Centro de Neurorreabilitação SARAH Fortaleza, Rede SARAH de Hospitais de Reabilitação, Fortaleza, Brasil
| | - Hebert Pereira Ferreira
- Centro de Neurorreabilitação SARAH Fortaleza, Rede SARAH de Hospitais de Reabilitação, Fortaleza, Brasil
| | | | - Iris Aline Brito Furtado
- Centro de Neurorreabilitação SARAH Fortaleza, Rede SARAH de Hospitais de Reabilitação, Fortaleza, Brasil
| | | | - Antonio Carlos Pereira
- Faculdade de Odontologia de Piracicaba, Universidade Estadual de Campinas, Piracicaba, Brasil
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Jureidini R, Namur GN, Ribeiro TC, Bacchella T, Stolzemburg L, Jukemura J, Ribeiro Junior U, Cecconello I. ROBOTIC ASSISTED VERSUS LAPAROSCOPIC DISTAL PANCREATECTOMY: A RETROSPECTIVE STUDY. Arq Bras Cir Dig 2023; 36:e1783. [PMID: 38088728 PMCID: PMC10712921 DOI: 10.1590/0102-672020230065e1783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 09/22/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Minimally invasive distal pancreatectomy (MIDP) is associated with less blood loss and faster functional recovery. However, the benefits of robotic assisted distal pancreatectomy (RDP) over laparoscopic distal pancreatectomy (LDP) are unknown. AIMS To compare RDP versus LDP for surgical treatment of benign lesions, pre-malignant and borderline malignant pancreatic neoplasias. METHODS This is a retrospective study comparing LDP with RDP. Main outcomes were overall morbidity and overall costs. Secondary outcomes were pancreatic fistula (PF), infectious complications, readmission, operative time (OT) and length of hospital stay (LOS). RESULTS Thirty patients submitted to LDP and 29 submitted to RDP were included in the study. There was no difference regarding preoperative characteristics. There was no difference regarding overall complications (RDP - 72,4% versus LDP - 80%, p=0,49). Costs were superior for patients submitted to RDP (RDP=US$ 6,688 versus LDP=US$ 6,149, p=0,02), mostly due to higher costs of surgical materials (RDP=US$ 2,364 versus LDP=1,421, p=0,00005). Twenty-one patients submitted to RDP and 24 to LDP developed pancreatic fistula (PF), but only 4 RDP and 7 LDP experienced infectious complications associated with PF. OT (RDP=224 min. versus LDP=213 min., p=0.36) was similar, as well as conversion to open procedure (1 RDP and 2 LDP). CONCLUSIONS The postoperative morbidity of robotic distal pancreatectomy is comparable to laparoscopic distal pancreatectomy. However, the costs of robotic distal pancreatectomy are slightly higher.
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Affiliation(s)
- Ricardo Jureidini
- Universidade de São Paulo, São Paulo State Cancer Institute, Department of Gastroenterology - São Paulo (SP), Brazil
| | - Guilherme Naccache Namur
- Universidade de São Paulo, São Paulo State Cancer Institute, Department of Gastroenterology - São Paulo (SP), Brazil
| | - Thiago Costa Ribeiro
- Universidade de São Paulo, São Paulo State Cancer Institute, Department of Gastroenterology - São Paulo (SP), Brazil
| | - Telesforo Bacchella
- Univesidade de São Paulo, Faculty of Medicine, Department of Gastroenterology - São Paulo (SP), Brazil
| | - Lucas Stolzemburg
- Universidade de São Paulo, São Paulo State Cancer Institute, Department of Gastroenterology - São Paulo (SP), Brazil
| | - José Jukemura
- Univesidade de São Paulo, Faculty of Medicine, Department of Gastroenterology - São Paulo (SP), Brazil
| | - Ulysses Ribeiro Junior
- Universidade de São Paulo, São Paulo State Cancer Institute, Department of Gastroenterology - São Paulo (SP), Brazil
- Univesidade de São Paulo, Faculty of Medicine, Department of Gastroenterology - São Paulo (SP), Brazil
| | - Ivan Cecconello
- Universidade de São Paulo, São Paulo State Cancer Institute, Department of Gastroenterology - São Paulo (SP), Brazil
- Univesidade de São Paulo, Faculty of Medicine, Department of Gastroenterology - São Paulo (SP), Brazil
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da Silva PAL, Lima AFC. Direct costs of treating men with prostate cancer with High Intensity Focused Ultrasound. Rev Esc Enferm USP 2023; 57:e20230132. [PMID: 38009909 PMCID: PMC10680442 DOI: 10.1590/1980-220x-reeusp-2023-0132en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 09/26/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVE To analyze the direct costs of materials, medicines/solutions and healthcare professionals required to treat men with prostate cancer using High Intensity Focused Ultrasound. METHOD Quantitative, exploratory-descriptive research, single case study type. Data were collected from electronic medical records/printed documentation from the Operating Room of a public teaching and research hospital. Health professionals estimated the respective time spent on activities in the following stages: "Before anesthetic induction", "Before performing thermal ablation", "During thermal ablation" and "After performing thermal ablation". Costs were calculated by multiplying the (estimated) time spent by the unit cost of direct labor, adding to the measured cost of materials, medicines/solutions. RESULTS The measured costs with materials corresponded to US$851.58 (SD = 2.17), with medicines/solutions to US$72.13 (SD = 25.84), and estimated personnel costs to US$196.03, totaling US$1119.74/procedure. CONCLUSION The economic results obtained may support hospital managers in the decision-making process regarding the adoption of the High Intensity Focused Ultrasound for the treatment of prostate cancer.
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Affiliation(s)
- Pâmela Adalgisa Lopes da Silva
- Universidade de São Paulo, Escola de Enfermagem, Programa de Pós-Graduação em Gerenciamento em Enfermagem, São Paulo, SP, Brazil
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Loureiro RB, Guidoni LM, Fregona GC, de Oliveira SMDVL, Sacramento D, Pinheiro JDS, Gomes D, Maciel ELN. Follow-up of patients diagnosed with and treated for tuberculosis in Brazil: financial burden on the household. J Bras Pneumol 2023; 49:e20220368. [PMID: 37610956 PMCID: PMC10578937 DOI: 10.36416/1806-3756/e20220368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 05/21/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVE To evaluate the implications of the proportion of annual family income spent in the pre- and post-diagnosis periods in tuberculosis patients followed for after at least one year after completing tuberculosis treatment in Brazil. METHODS This was a cross-sectional study of tuberculosis patients followed for at least one year after completing tuberculosis treatment in five Brazilian capitals (one in each region of the country). RESULTS A total of 62 patients were included in the analysis. The overall average cost of tuberculosis was 283.84 Brazilian reals (R$) in the pre-diagnosis period and R$4,161.86 in the post-diagnosis period. After the costs of tuberculosis disease, 71% of the patients became unemployed, with an overall increase in unemployment; in addition, the number of patients living in nonpoverty decreased by 5%, the number of patients living in poverty increased by 6%, and the number of patients living in extreme poverty increased by 5%. The largest proportion of annual household income to cover the total costs of tuberculosis was for the extremely poor (i.e., 40.37% vs. 11.43% for the less poor). CONCLUSIONS Policies to mitigate catastrophic costs should include interventions planned by the health care system and social protection measures for tuberculosis patients with lower incomes in order to eliminate the global tuberculosis epidemic by 2035-a WHO goal in line with the United Nations Sustainable Development Goals.
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Affiliation(s)
- Rafaela Borge Loureiro
- . Programa de Pós-Graduação em Saúde Coletiva - PPGSC - Universidade Federal do Espírito Santo - UFES - Vitória (ES) Brasil
- . Laboratório de Epidemiologia, Universidade Federal do Espírito Santo - UFES - Vitória (ES) Brasil
| | - Leticia Molino Guidoni
- . Laboratório de Epidemiologia, Universidade Federal do Espírito Santo - UFES - Vitória (ES) Brasil
| | - Geisa Carlesso Fregona
- . Laboratório de Epidemiologia, Universidade Federal do Espírito Santo - UFES - Vitória (ES) Brasil
- . Programa de Tuberculose, Hospital Universitário Cassiano Antônio Moraes - HUCAM - Vitória (ES) Brasil
| | - Sandra Maria do Valle Leone de Oliveira
- . Programa de Pós-Graduação em Doenças Infecciosas e Parasitárias, Universidade Federal de Mato Grosso do Sul - UFMS - Campo Grande (MS) Brasil
- . Fiocruz Mato Grosso do Sul, Campo Grande (MS) Brasil
| | - Daniel Sacramento
- . Núcleo de Controle da Tuberculose, Secretaria Municipal de Saúde de Manaus, Manaus (AM) Brasil
| | - Jair dos Santos Pinheiro
- . Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas/Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (AM) Brasil
- . Programa Estadual de Controle da Tuberculose do Amazonas/Fundação de Vigilância em Saúde - Dra. Rosemary Costa Pinto, Manaus (AM) Brasil
| | - Denise Gomes
- . Centro de Referência à Tuberculose - CRTB - GCC/SCS, Porto Alegre (RS) Brasil
| | - Ethel Leonor Noia Maciel
- . Programa de Pós-Graduação em Saúde Coletiva - PPGSC - Universidade Federal do Espírito Santo - UFES - Vitória (ES) Brasil
- . Laboratório de Epidemiologia, Universidade Federal do Espírito Santo - UFES - Vitória (ES) Brasil
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Reichenbach R, Sgarioni A, Gullo MC, Giovanardi HJ, Moura GS. Clinical and economic comparative analysis of laparotomy versus laparoscopy in the first gastric bypass surgeries in a bariatric and metabolic surgery service in a city in southern Brazil. Rev Col Bras Cir 2023; 50:e20233513. [PMID: 37531502 PMCID: PMC10508681 DOI: 10.1590/0100-6991e-20233513-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 05/07/2023] [Indexed: 08/04/2023] Open
Abstract
INTRODUCTION this paper aims to evaluate the main direct and indirect costs of the first laparotomies and laparoscopies in bariatric surgeries with a clinical-economical retrospective and cross-sectional analysis from 2017 to 2020 at a hospital with specialties besides the basic ones in southern Brazil. METHODS the study sample included 26 participants. The first 13 laparotomies, and the first 13 laparoscopies performed at the bariatric surgery service of the institution were evaluated. The values evaluated in such comparison analyzed the costs of operation and hospitalization. It is important to highlight that, in addition to the cost benefit, other costs take significance in the health area, such as: cost-utility, cost-effectiveness and cost-minimization, in addition to the cost-opportunity that is reassessed in the observation of the broad context associating all the values raised here. The software used for data analysis was Excel version® 365. The economic analysis was performed evidencing the profile of the patients and the direct and indirect costs involved in each segmentation. RESULTS the direct and indirect costs of videolaparoscopy amounted to BRL 10,108.10 and laparoscopy to the amount of BRL 12,568.14. CONCLUSION it was concluded that laparoscopy presents more savings in the aspects of all health valuations to the detriment of laparotomy. It was concluded that the videolaparoscopy presents more savings in the aspects of all health valuations than the laparotomy.
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Affiliation(s)
- Ricardo Reichenbach
- - Hospital Geral de Caxias do Sul, Cirurgia Digestiva - Caxias do Sul - RS - Brasil
- - Pontifícia Universidade Católica, Pós-Graduaçao - Porto Alegre - RS - Brasil
- - Universidade de Caxias do Sul, Medicina - Caxias do Sul - RS - Brasil
| | - Augusto Sgarioni
- - Hospital Geral de Caxias do Sul, Cirurgia Digestiva - Caxias do Sul - RS - Brasil
- - Universidade de Caxias do Sul, Medicina - Caxias do Sul - RS - Brasil
| | | | - Henrique João Giovanardi
- - Hospital Geral de Caxias do Sul, Cirurgia Digestiva - Caxias do Sul - RS - Brasil
- - Universidade de Caxias do Sul, Medicina - Caxias do Sul - RS - Brasil
| | - Gisele Silva Moura
- - Hospital Geral de Caxias do Sul, Cirurgia Digestiva - Caxias do Sul - RS - Brasil
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Simioni CVDMG. Why are CGRP monoclonal antibodies not yet the first line treatment in migraine prevention? Arq Neuropsiquiatr 2022; 80:214-217. [PMID: 35976315 PMCID: PMC9491416 DOI: 10.1590/0004-282x-anp-2022-s125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
Migraine is a prevalent disorder and a cause of high disability, influenced by modifiable and non-modifiable risk factors. Comorbid and psychiatric illnesses are prevalent in migraine patients and should be considered when choosing preventive drugs. There have been unforeseen problems with the use of preventive treatment of migraine with oral drugs, mainly due to side-effects that cannot be tolerated and lack of efficacy, leading to high discontinuation rates. Anti-CGRP monoclonal antibodies (mAbs) have shown better tolerance profiles, based on the low dropout rates in clinical trials due to adverse events. First-line therapy is a term most expressed in some medical specialties that adopt standardized protocol treatments and may not be suitable for treating migraine. Regarding efficacy, mAbs don't seem to perform much better than the current prophylactic oral drugs in reduction of monthly migraine days compared to placebo. Monoclonal antibodies against CGRP pathway have been prescribed recently, which raises some concern about their safety in the long term. Only side effects observation will confirm whether CGRP blockade causes susceptibility to severe side-effects, at least to specific subpopulations. CGRP may play a role in regulating uteroplacental blood flow and myometrial and uterine relaxation, as well as blood pressure control, raising the suspicion that its blockade could cause complications during pregnancy. Recent guidelines retain the recommendation of starting preventive treatment of migraine with oral drugs. Both the fact that it is new and costs are the reason why guidelines recommend the prescription of mAbs only after failure of at least two oral drugs.
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Affiliation(s)
- Caio Vinicius de Meira Grava Simioni
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, São Paulo, SP, Brazil
- Hospital A. C. Camargo Cancer Center, Departamento de Neurologia Adulto, São Paulo, SP, Brazil
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de Moraes CS, Fernandes NMDS, Colugnati FAB. Multidisciplinary treatment for patients with chronic kidney disease in pre-dialysis minimizes costs: a four-year retrospective cohort analysis. J Bras Nefrol 2021; 43:330-339. [PMID: 33843942 PMCID: PMC8428638 DOI: 10.1590/2175-8239-jbn-2020-0226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 01/06/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Chronic kidney disease (CKD) can progress to end-stage renal disease (ESRD), and clinical studies show that this progression can be slowed. The objective of this study was to estimate the costs to Brazil's public health system (SUS) throughout the course of CKD in the pre-dialysis stage compared to the costs to the SUS of dialysis treatment (DT). METHODS A retrospective cohort study was conducted to analyze clinical and laboratory variables; the outcome analyzed was need for DT. To assess cost, a microcosting survey was conducted according to the Methodological Guidelines for Economic Evaluations in Healthcare and the National Program for Cost Management, both recommended by the Brazilian Ministry of Health for economic studies. RESULTS A total of 5,689 patients were followed between 2011 and 2014, and 537 met the inclusion criteria. Average costs increased substantially as the disease progressed. The average cost incurred in stage G1 in Brazilian reals was R$ 7,110.78, (US$1,832.06) and in stage G5, it was R$ 26,814.08 (US$6,908.53), accumulated over the four years. CONCLUSION A pre-dialysis care program may reduce by R$ 33,023.12 ± 1,676.80 (US$ 8,508.26 ± 432.02) the average cost for each year of DT avoided, which is sufficient to cover the program's operation, minimizing cost. These results signal to public health policy makers the real possibility of achieving significant cost reduction in the medium term for CKD care (4 years), to a program that disbursed R$ 24 billion (US$ 6.8 billion) for DT in Brazil between 2009 and 2018.
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Affiliation(s)
- Celso Souza de Moraes
- Universidade Federal de Juiz de Fora, Programa de Pós-Graduação
em Saúde Brasileira, Juiz de Fora, MG, Brasil
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de Souza CL, Salgado TDA, Sardeiro TL, Galdino H, Itria A, Tipple AFV. Post-vaccination anti-HBs testing among healthcare workers: More economical than post-exposure management for Hepatitis B. Rev Lat Am Enfermagem 2020; 28:e3278. [PMID: 32578749 PMCID: PMC7304982 DOI: 10.1590/1518-8345.3534.3278] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 03/03/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to compare the direct cost, from the perspective of the Unified Health System, of assessing the post-vaccination serological status with post-exposure management for hepatitis B among health care workers exposed to biological material. METHOD cross-sectional study and cost-related, based on accident data recorded in the System of Information on Disease Notification between 2006 and 2016, where three post-exposure and one pre-exposure management scenarios were evaluated: A) accidents among vaccinated workers with positive and negative serological status tests for hepatitis B, exposed to known and unknown source-person; B) handling unvaccinated workers exposed to a known and unknown source-person; C) managing vaccinated workers and unknown serological status for hepatitis B and D) cost of the pre-exposure post-vaccination test. Accidents were assessed and the direct cost was calculated using the decision tree model. RESULTS scenarios where workers did not have protective titles after vaccination or were unaware of the serological status and were exposed to a positive or unknown source-person for hepatitis B. CONCLUSION the direct cost of hepatitis B prophylaxis, including confirmation of serological status after vaccination would be more economical for the health system.
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Affiliation(s)
- Camila Lucas de Souza
- Secretaria Municipal de Saúde de Goiânia, Escola Municipal de Saúde
Pública de Goiânia, Goiânia, GO, Brazil
| | | | - Tatiana Luciano Sardeiro
- Secretaria Municipal de Saúde de Goiânia, Centro de Referência em
Saúde do Trabalhador de Goiânia, Goiânia, GO, Brazil
| | - Hélio Galdino
- Universidade Federal de Goiás, Faculdade de Enfermagem, Goiânia, GO,
Brazil
| | - Alexander Itria
- Universidade Federal de Goiás, Instituto de Patologia Tropical em
Saúde Pública, Goiânia, GO, Brazil
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Marcolino MS, Polanczyk CA, Bovendorp ACC, Marques NS, da Silva LA, Turquia CPB, Ribeiro AL. Economic evaluation of the new oral anticoagulants for the prevention of thromboembolic events: a cost-minimization analysis. SAO PAULO MED J 2016; 134:322-9. [PMID: 27581333 PMCID: PMC10876344 DOI: 10.1590/1516-3180.2016.0019260216] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 01/25/2016] [Accepted: 02/26/2016] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Randomized clinical trials have shown that the new oral anticoagulants have at least similar impact regarding reduction of thromboembolic events, compared with warfarin, with similar or improved safety profiles. There is little data on real costs within clinical practice. Our aim here was to perform economic analysis on these strategies from the perspective of Brazilian society and the public healthcare system. DESIGN AND SETTING Cost-minimization analysis; anticoagulation clinic of Hospital Municipal Odilon Behrens, Belo Horizonte, MG, Brazil. METHODS Patients at the anticoagulation clinic were recruited between August and October 2011, with minimum follow-up of four weeks. Operational and non-operational costs were calculated and corrected to 2015. RESULTS This study included 633 patients (59% women) of median age 62 years (interquartile range -49-73). The mean length of follow-up was 64 ± 28 days. The average cost per patient per month was $ 54.26 (US dollars). Direct costs accounted for 32.5% of the total cost. Of these, 69.5% were related to healthcare professionals. With regards to indirect costs, 52.4% were related to absence from work and 47.6% to transportation. Apixaban, dabigatran and rivaroxaban were being sold to Brazilian public institutions, on average, for $ 49.87, $ 51.40 and $ 52.16 per patient per month, respectively, which was lower than the costs relating to warfarin treatment. CONCLUSION In the Brazilian context, from the perspective of society and the public healthcare system, the cumulative costs per patient using warfarin with follow-up in anticoagulation clinics is currently higher than the strategy of prescribing the new oral anticoagulants.
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Affiliation(s)
- Milena Soriano Marcolino
- MD, MSc, PhD. Adjunct Professor, Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG; Institutos Nacionais de Ciência e Tecnologia (INCT) para Avaliação de Tecnologia em Saúde (IATS), Brasília, DF, Brazil.
| | - Carisi Anne Polanczyk
- MD, MSc, PhD. Adjunct Professor, Department of Internal Medicine, Medical School, Universidade Federal Rio Grande do Sul (UFRGS), Porto Alegre, RS; Institutos Nacionais de Ciência e Tecnologia (INCT) para Avaliação de Tecnologia em Saúde (IATS), Brasília, DF, Brazil.
| | | | | | | | | | - Antonio Luiz Ribeiro
- MD, MSc, PhD. Full Professor, Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG; Institutos Nacionais de Ciência e Tecnologia (INCT) para Avaliação de Tecnologia em Saúde (IATS), Brasília, DF, Brazil.
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de Soárez PC, Lara AN, Sartori AMC, Abdala E, Haddad LBDP, D’Albuquerque LAC, Novaes HMD. Healthcare resource utilization and costs of outpatient follow-up after liver transplantation in a university hospital in São Paulo, Brazil: cost description study. SAO PAULO MED J 2015; 133:171-8. [PMID: 26039536 PMCID: PMC10876370 DOI: 10.1590/1516-3180.2013.7000011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 04/09/2013] [Accepted: 03/07/2014] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Data on the costs of outpatient follow-up after liver transplantation are scarce in Brazil. The purpose of the present study was to estimate the direct medical costs of the outpatient follow-up after liver transplantation, from the first outpatient visit after transplantation to five years after transplantation. DESIGN AND SETTING Cost description study conducted in a university hospital in São Paulo, Brazil. METHODS Cost data were available for 20 adults who underwent liver transplantation due to acute liver failure (ALF) from 2005 to 2009. The data were retrospectively retrieved from medical records and the hospital accounting information system from December 2010 to January 2011. RESULTS Mean cost per patient/year was R$ 13,569 (US$ 5,824). The first year of follow-up was the most expensive (R$ 32,546 or US$ 13,968), and medication was the main driver of total costs, accounting for 85% of the total costs over the five-year period and 71.9% of the first-year total costs. In the second year after transplantation, the mean total costs were about half of the amount of the first-year costs (R$ 15,165 or US$ 6,509). Medication was the largest contributor to the costs followed by hospitalization, over the five-year period. In the fourth year, the costs of diagnostic tests exceeded the hospitalization costs. CONCLUSION This analysis provides significant insight into the costs of outpatient follow-up after liver transplantation due to ALF and the participation of each cost component in the Brazilian setting.
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Affiliation(s)
- Patricia Coelho de Soárez
- DDS, MPH, PhD. Adjunct Professor, Department of Preventive Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - Amanda Nazareth Lara
- MD. Attending Physician, Infectious and Parasitic Diseases Clinic, Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - Ana Marli Christovam Sartori
- MD, MSc, PhD. Attending Physician, Infectious and Parasitic Diseases Clinic, Hospital das Clínicas (HC) Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - Edson Abdala
- MD, MSc, PhD. Attending Physician, Digestive Organ Transplantation Service, Department of Gastroenterology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - Luciana Bertocco de Paiva Haddad
- MD, MSc. Attending Physician, Digestive Organ Transplantation Service, Department of Gastroenterology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - Luiz Augusto Carneiro D’Albuquerque
- MD, MSc, PhD. Titular Professor, Digestive Organ Transplantation Service, Department of Gastroenterology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - Hillegonda Maria Dutilh Novaes
- MD, MSc, PhD. Associate Professor, Department of Preventive Medicine, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
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Cavassini ACM, Lima SAM, Calderon IMP, Rudge MVC. Cost-benefit of hospitalization compared with outpatient care for pregnant women with pregestational and gestational diabetes or with mild hyperglycemia, in Brazil. SAO PAULO MED J 2012; 130:17-26. [PMID: 22344355 PMCID: PMC10906692 DOI: 10.1590/s1516-31802012000100004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 02/23/2011] [Accepted: 07/20/2011] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Pregnancies complicated by diabetes are associated with increased numbers of maternal and neonatal complications. Hospital costs increase according to the type of care provided. This study aimed to estimate the cost-benefit relationship and social profitability ratio of hospitalization, compared with outpatient care, for pregnant women with diabetes or mild hyperglycemia. STUDY DESIGN This was a prospective observational quantitative study conducted at a university hospital. It included all pregnant women with pregestational or gestational diabetes, or mild hyperglycemia, who did not develop clinical intercurrences during pregnancy and who delivered at the Botucatu Medical School Hospital (Hospital das Clínicas, Faculdade de Medicina de Botucatu, HC-FMB) of Universidade Estadual de São Paulo (Unesp). METHODS Thirty pregnant women treated with diet were followed as outpatients, and twenty treated with diet plus insulin were managed through frequent short hospitalizations. Direct costs (personnel, materials and tests) and indirect costs (general expenses) were ascertained from data in the patients' records and the hospital's absorption costing system. The cost-benefit was then calculated. RESULTS Successful treatment of pregnant women with diabetes avoided expenditure of US$ 1,517.97 and US$ 1,127.43 for patients treated with inpatient and outpatient care, respectively. The cost-benefit of inpatient care was US$ 143,719.16, and outpatient care, US$ 253,267.22, with social profitability of 1.87 and 5.35, respectively. CONCLUSION Decision-tree analysis confirmed that successful treatment avoided costs at the hospital. Cost-benefit analysis showed that outpatient management was economically more advantageous than hospitalization. The social profitability of both treatments was greater than one, thus demonstrating that both types of care for diabetic pregnant women had positive benefits.
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