Análises econômicas em saúde bucal são escassas na literatura e, portanto, muitas das práticas, especialmente aquelas propostas e realizadas nos sistemas públicos de saúde em diferentes países, são realizadas sem o conhecimento de seus aspectos econômicos. Na maioria dos países, os recursos destinados à saúde são limitados e, portanto, carecem de análises econômicas para que se tenha base científica para a proposição e implementação de diretrizes de atenção à saúde. O presente estudo trata de uma análise econômica em saúde bucal que teve por objetivo avaliar o custo, a efetividade e o custo-efetividade do tratamento periodontal sistemático, comparando-o com o tratamento convencional realizado em gestantes no Hospital Materno Infantil Presidente Vargas, na perspectiva do Sistema Único de Saúde, partindo de dados já coletados nos prontuários de 213 pacientes. O custo do tratamento periodontal sistemático e o ofertado pelo HMIPV foram estimados a partir do somatório dos custos de todas as consultas de exames periodontais, instruções de higiene bucal. raspagens alisamentos e polimentos supragengivais e raspagem e alisamento radiculares subgengivais por gestante. O tratamento periodontal sistemático custou R$ 442,80, levando em média 8,23 consultas por gestante, e o tempo médio gasto para a realização do tratamento foi de 6 horas e 35 minutos. O tratamento periodontal ofertado pelo HMIPV teve um custo médio de R$ 144,05 e uma média de 2,96 consulta por paciente; o tempo total médio para a realização desse tratamento foi de 2 horas e 15 minutos. A razão de custo-efetividade para se controlar a doença periodontal por gestante mediante o tratamento periodontal sistemático é de R$ 6,91 e de R$ 9,50 pelo tratamento ofertado pelo HMIPV. Os resultados do presente estudo permitem concluir que o tratamento periodontal sistemático é custo-efetivo em reduzir processo inflamatório periodontal, não sendo influenciado diretamente por tabagismo, renda e escolaridade. / Economic analyses of oral health are scarce in the literature and therefore many of the practices, especially those proposed and implemented in public health systems in different countries, are performed without the knowledge of its economic aspects. In most countries, resources for health are limited and therefore lack economic analyses in order to have a scientific basis for proposing and implementing policies for health care. This study deals with an economic analysis of oral health that aims to assess the cost, effectiveness and cost-effectiveness of systematic periodontal treatment, compared with conventional treatment performed on pregnant women in the Maternal and Child Hospital Presidente Vargas, the prospect of health system, based on data already collected from medical records of 213 patients. The cost of periodontal treatment were estimated from the sum of the costs of all queries including periodontal examinations, oral hygiene instructions, supragingival and subgingival scaling per pregnant women. The systematic periodontal treatment cost was R$ 442.80, taking an average of 8.23 consultations per pregnant woman, and the average time taken for completion of treatment was 6 hours and 35 minutes. Periodontal treatment offered by HMIPV had an average cost of R$ 144.05 and an average of 2.96 consultations per patient, the average total time to perform this treatment was 2 hours and 15 minutes. The cost-effectiveness ratio to control periodontal disease in pregnant women through systematic periodontal treatment is R$ 6.91 and R$ 9.50 for the treatment offered by HMIPV. The results of this study allow us to conclude that the systematic periodontal treatment is cost-effective in reducing periodontal inflammation and is not directly influenced by smoking, income and education.

O diabetes é uma doença crônica, caracterizada pelo aumento dos níveis glicêmicos, podendo levar a complicações, como neuropatia, retinopatia e nefropatia. O profissional farmacêutico possui fundamental papel no controle da doença, sendo responsável pela farmacoterapia, capaz de identificar e resolver problemas relacionados a medicamentos, proporcionar maior adesão ao tratamento e consequente melhoria dos parâmetros clínicos. Com aumento das necessidades em saúde e a disponibilidade finita de recursos, os gestores devem avaliar se tecnologias em saúde são tanto eficazes quanto econômicas. Dessa forma, este trabalho teve como objetivo geral analisar a relação custo efetividade da atenção farmacêutica no tratamento do diabetes mellitus tipo 2. Para tanto, descreveu os principais métodos de avaliação econômica em saúde e baseado nos dados dos estudos de Borges (2008) e Pereira (2012) como, dados clínicos de hemoglobina glicosilada e glicemia de jejum, bem como consumo de medicamentos, número de consultas, além de dados referentes a complicações do diabetes, este trabalho valorizou os custos diretos e indiretos e mensurou as efetividades para controle da glicemia de jejum, controle da hemoglobina glicosilada e anos de vida ganho, segundo tratamento convencional (grupo controle) e tratamento convencional associado a atenção farmacêutica (grupo atenção farmacêutica). Sendo assim, conclui que a atenção farmacêutica exibiu, para o período de 2007 a 2011, maior efetividade para os parâmetros de glicemia de jejum, hemoglobina glicosilada e anos de vida ganhos, associado a menores custos quando comparada ao grupo controle, sendo a alternativa com menor custo efetividade para o tratamento de diabetes mellitus tipo 2, estando posicionada no quadrante dominante \"D\" do diagrama de custo efetividade incremental. / Diabetes is a chronic disease characterized by increased blood glucose levels, which can lead to complications such as neuropathy, retinopathy and nephropathy. Pharmacists has key role in controlling the disease and is responsible for pharmacotherapy, able to identify and resolve drug-related problems, providing greater adherence to treatment and consequent improvement of the clinical parameters. The increase in health needs and the finite availability of resources, managers should assess whether health technologies are both effective as economic. Thus, this study aimed to analyze the cost effectiveness of pharmaceutical care in the treatment of diabetes mellitus type 2. Therefore, described the main economic evaluation methods in health and based on data from Borges studies (2008) and Pereira (2012) as clinical data glycosylated hemoglobin and fasting glucose, and medication consumption, number of visits, as well as data for diabetes complications, this study valued the direct and indirect costs and measured the effectivities for fasting glycemic control, glycosylated hemoglobin control and years of life gained, according to conventional treatment (control group) and conventional treatment associated with pharmaceutical care (pharmaceutical care group). Therefore, concludes that the pharmaceutical care exhibited for the period 2007-2011, more effective for fasting glucose parameters, glycosylated hemoglobin and years of life gained, combined with lower costs when compared to the control group, and the alternative lower cost effectiveness for the treatment of diabetes mellitus type 2, being positioned in the dominant quadrant \"D\" from the incremental cost effectiveness diagram.

M.Comm. / The present study comprises an investigation into and a discussion on the development of expert systems. The theme of the study is of topical interest, since expert systems form an important part of the latest developments in the domain of computer technology. At present, a general deficiency is being experienced in the computer industry in respect of a structured development methodology, and specifically in respect of cost-effective expert systems. The reasons for and causes of the said deficiency, as well as the different ways and means in which possibly to supply this deficiency, represent the issue to be investigated in the present study. Owing to the above-mentioned deficiency in respect of information system methodologies, certain applications and principles have been used throughout the study in a bid to illustrate the differences and similarities between the developmental aspects of certain conventional systems, compared to the same developmental aspects of expert systems. The importance of the various stages of development that the expert system undergo also comes under consideration, together with the development applications and resources, the criteria for cost effectiveness, knowledge engineering and information security. Hereafter, the Sphere Model, based on the introductory chapters, is presented as the solution to the problem posed in the study. This model can, for the entire life cycle of an expert system, be applied in respect of the analysis of the cost effectiveness of such system, and can, at the same time, assist in gathering vital information on the production of subsequent highquality and cost-effective expert systems.

Web-hosting is a well established industry with a wide range of actors with different size and quality of service. One of the challenges for these companies is to setup a system that guarantee uptime around the clock. Web-hosts must be able to assure high reliability to its customer, in order to provide better services than the many competitors that exist on the market. This requires a lot of resources from the companies in form of hardware, software or personnel that monitor the operation 24 hours per day each day of the week. A problem is that small and medium sized companies with up to approximately 10000 customers can’t afford these extra costs for personnel and must therefore rely on other monitoring solutions to be competitive. This thesis will show how automatic monitoring tools can replace some of the responsibilities, performed by human personnel. The tools will also be evaluated and compared with similar tools available on the market. An economic model, that can be used to determine if the solution is worth investing in , is also described.

This thesis addresses the health economic evaluation of community-based interventions against cardiovascular disease (CVD), with special emphasis on the Västerbotten Intervention Project (VIP), run since 1985. The framework is a simple evaluation model consisting of two parts; the selection and measurement of empirical consequences caused by the project under evaluation (e.g. changes in mortality, well-being, use of resources) and a set of values (e.g. efficiency, equity) aimed at assessing the goodness of these consequences. The project’s effects on CVD were predicted by means of risk factors measured in Norsjö between 1985-1990, applied to an epidemiological model based on a logistic risk equation derived from the Framingham population. Cost per life-years saved ranged from £14 900 to net savings, depending on the assumptions. The favourable cost-effectiveness in this kind of intervention has earlier been predicted from theoretical models, but this is the first study based on real experiences from contemporary community-based interventions against CVD. Furthermore, all social classes have benefited from the intervention. Also potential adverse effects in the form of excess mortality due to low cholesterol levels were investigated, and they were negligible in comparison with the health gains. The value of an intervention from a citizen’s perspective was investigated through an interview study (n≈100) in accordance with the contingent valuation method. Great expectations concerning mortality effects on the community level and future savings in health care were good predictors for assigning the intervention a high value. On the contrary, personal benefits in the form of a decreasing risk for CVD had no positive association with the value of the intervention. Hence, the consequences that the cost-effectiveness analysis accounts for - mortality and savings - coincide with the most valuable consequences from the citizen's perspective. In a democracy, the set of values used to determine the success or failure of a programme like a prevention project must agree with values held by the majority of the citizens. Therefore, the attitudes to ethical values among Swedish politicians (n≈450) responsible for health care have been mapped. The support for the health maximization principle was weak, and a trade-off between efficiency and equity was preferred. About 70% of the respondents were prepared to sacrifice health gains to achieve increased equity. / digitalisering@umu

Abstract Though not a life threatening condition, involuntary loss of urine is a miserable situation. It has a multidimensional effect on the afflicted individuals, both men and women – and for the society. The purpose of this study was to evaluate two modern, minimally invasive surgical techniques for the treatment of female stress urinary incontinence (SUI). The techniques evaluated were laparoscopic colposuspension with mesh and staples (LCM) and the tension-free vaginal tape procedure (TVT). The study consisted of four parts. The first part (Study I) was an observational retrospective follow-up study. Data on the first forty patients operated on with LCM at Oulu University Hospital were collected. Patients had SUI or mixed urinary incontinence (MUI) with predominantly stress incontinence. The Studies II–IV were parts of a randomized, multicenter clinical trial, where LCM was compared with TVT. According to the predefined inclusion criteria 128 SUI women were randomly allocated into two treatment groups: 70 patients received TVT treatment as allocated and 51 LCM. There were seven drop-outs after randomization. After one year of follow-up the cure and improvement rate of the patients operated with LCM were ~ 90%. Also a significant improvement was found in Urinary Incontinence Severity Scores (UISS). At base line the score was 12.1 and after one year follow-up 2.7 (p < 0.001). The bladder perforation rate was 15%. In Study II immediate cure rates and complications of LCM and TVT were studied. After six weeks of follow-up there was no difference in cure rates (~ 90%) between the procedures. There was no difference in complication rates. A significant difference was found in the use of anti-inflammatory / opioid drugs in the immediate post-operative period to relief the pain in favour for TVT. Hospital care was also significantly shorter after TVT than LCM. After one year of follow-up (Study III) TVT was found to give better result both objectively and subjectively. Negative stress test result was recorded in 85.7% in the TVT group and 56.9% in the LCM group. A significant difference was also found, when Visual Analoque Scale (VAS), King's College Health Questionnaire (KHQ) and UISS were used as outcome measures, in the favour of TVT. When 48-hour pad test was used as outcome measure there was no statistically significant difference between the groups. The cost-effectiveness (Study IV) of TVT was found to be better than that of LCM after one year of follow-up. In conclusion, the results of this study suggest, that TVT procedure is on the whole a cost-effective alternative for LCM in the treatment of female SUI.

Abstract The number of ambulatory surgical procedures is increasing throughout the world. This is partly due to the development of a number of new anaesthetic, analgesic and adjuvant drugs, each with more rapid onset and shorter duration of action, over the past two decades. An interest in the issues discussed in this thesis arose out a desire to improve the quality of anaesthesia for patients who undergo day-case surgery. A second aim was to compare the different anaesthetic methods in terms of recovery from anaesthesia and costs. A total of 233 patients undergoing day-case knee arthroscopy under either 2% or 5% lidocaine spinal anaesthesia or general anaesthesia with desflurane, isoflurane, propofol or sevoflurane were investigated in two prospective, randomised clinical trials. The overall aims were to find the most suitable, satisfactory and economically feasible method for adult ambulatory knee arthroscopy and to assess the factors that affect the immediate postoperative period and the one-week recovery profile at home. The patients were highly satisfied with all the methods of anaesthesia. There was a slight tendency in favour of general anaesthesia compared to spinal anaesthesia. The general level of pain after ambulatory knee surgery was low after the first few hours postoperatively and continued to be low during the first postoperative week. After short-acting general anaesthesia with desflurane, isoflurane and propofol, home readiness was achieved over two hours earlier than after 5% lidocaine spinal anaesthesia. Home readiness was significantly delayed after 2% lidocaine spinal anaesthesia compared to sevoflurane inhalation anaesthesia. General anaesthesia with isoflurane was cheaper than the other general anaesthetics, i.e. desflurane, sevoflurane, propofol, or 2% and 5% lidocaine spinal anaesthesias. Propofol anaesthesia was the most expensive. The spinal anaesthesia patients had a higher incidence of headache, backache and lower leg pain during the first postoperative week than the patients who had had general anaesthesia. In busy ambulatory surgery units, remarkable savings may be achieved by using short-acting general anaesthetics, i.e. desflurane and isoflurane, instead of propofol or sevoflurane general anaesthesias or lidocaine spinal anaesthesia. This is due to the lower costs of desflurane and isoflurane compared to sevoflurane and propofol and the shorter time needed for postoperative care compared to spinal anaesthesia.

Despite advances in the application of analytics in business functions such as marketing and finance, and a significant degree of interest in the topic of Human Resource analytics, its usage is still nowhere near where it could be. This study’s primary aim was to measure the levels of usage of HR analytics among South African organisations, an exercise that has not been done before. This qualitative, exploratory study was conducted among 16 senior Human Resource practitioners from large organisations in South Africa. Being qualitative, a limitation of this study is that it is not representative and therefore the results cannot be generalised. Further opportunities therefore exist for quantitative, longitudinal research in this field to objectively ascertain the extent of usage of HR analytics. It was found that South African organisations’ usage of HR analytics is still in its infancy and that the concept and its implications are little understood. It also found that there is consensus regarding the importance for HR analytics in organisations and that the HR analytical skills challenge is the main hindrance to implementation. Importantly, the study demonstrated and that the overall outlook for HR analytics is positive. The research makes recommendations and proposes a model that should enable organisations, the HR profession and the academic world to implement HR analytics. / Dissertation (MBA)--University of Pretoria, 2013. / zkgibs2014 / Gordon Institute of Business Science (GIBS) / MBA / Unrestricted

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Class of 2005 Abstract / Objectives: To develop a decision analytic model to compare the clinical and economic outcomes of enteral nutrition (EN) and total parenteral nutritional (TPN) support in acute pancreatitis patients. Methods: All randomized clinical trials comparing EN and TPN in acute pancreatitis patients published in the medical and pharmacy literature were identified. Six trials were identified by searching MEDLINE, Web of Science, Cochrane Controlled Trials Register, International Pharmaceutical Abstracts, HealthStar, Cumulative Index to Nursing & Allied Health Literature, and citation review of applicable literature. The costs used for the decision tree were from the perspective of a hospital. A literature based decision tree was formed based from these costs and the probabilities of events from the six identified clinical trials. The TreeAge Pro computer program (TreeAge Software, Inc.; Williamstown, MA) was used to conduct the cost effectiveness analysis. Therapeutic success was considered, for the purposes of the trial, as having no complications. Results: EN was associated with a lower risk of infections, a reduced length of hospital stay, and fewer surgical interventions. There was no statistical difference in the risk of mortality, adult respiratory distress syndrome or multiple organ failure between groups treated with EN or TPN. The results found that EN dominated TPN by being both less costly and more effective. The average costs for EN and TPN were $46,345 and $73,878, respectively. The success rates were 0.652 and 0.358 for EN and TPN, respectively. Conclusion: Enteral nutrition was the dominant route of administration for nutritional support, when compared to total parenteral nutrition both clinically and economically for acute pancreatitis patients.