OBJECTIVE: To conduct a cost-effectiveness analysis of riociguat and bosentan in the management of chronic thromboembolic pulmonary hypertension (CTEPH) from a United States payer perspective. METHODS: A Markov model was developed following the recommendations of the International Society of Pharmacoeconomics and Outcomes Research - Society for Medical Decision Making Modeling Good Research Practices. A cohort of patients with inoperable CTEPH or post-pulmonary endarterectomy CTEPH were simulated over their lifetime. Health outcomes were measured as quality-adjusted life years (QALY). Efficacy and safety data were obtained from BENEFiT and CHEST-1 trials. Drugs costs, associated costs for the management of CTEPH, were obtained from Redbook and published information such as the Healthcare Cost and Utilization Project (HCUPnet) and Centers for Medicare & Medicaid Services Physician Fee Schedule. Deterministic and probabilistic sensitivity analyses were performed to assess the robustness of the model projections. RESULTS: Riociguat was more effective than bosentan with an incremental cost of $132,065 and an incremental quality-adjusted life year (QALY) of 0.20, corresponding to an incremental cost-effectiveness ratio (ICER) of -$649,380 per QALY (in favor of riociguat). Riociguat had a lower total discounted lifetime cost compared to bosentan ($2,307,488 versus $2,439,555). Probabilistic sensitivity analyses confirmed dominance of riociguat in 74% of the Monte Carlo simulations. CONCLUSIONS: Results of this model indicates that riociguat is more effective and less costly than bosentan in the management of patients with inoperable CTEPH or post-pulmonary endarterectomy CTEPH.

Le changement climatique menacera probablement la durabilité de la plupart des systèmes agricoles en région méditerranéenne et notamment au sud de la méditerranée. Le comportement des systèmes agricoles sera différent selon les régions sur la base de contextes biophysique, socio-économique, institutionnel et politique. L'objectif de cette thèse est d'analyser la résilience et la capacité d'adaptation au changement climatique des exploitations agricoles en prenant comme référence celles de la Basse Vallée de Medjerda (Nord de la Tunisie). Pour répondre à cet objectif, trois questions principales sont successivement abordées. Le premier chapitre décrit, en se basant sur une large revue de littérature, les effets agri environnementaux du changement climatique en région méditerranéenne et particulièrement en Tunisie. Le deuxième chapitre analyse les effets potentiels du changement climatique sur la résilience des exploitations agricoles de la Basse Vallée de Medjerda (BVM). Pour faire bref, la résilience d'une exploitation est sa capacité à assurer par elle-même sa viabilité économique et par conséquent sa pérennité. Pour ce faire, un cadre conceptuel a été construit. Ce cadre est basé sur trois étapes impliquant la définition de l'échelle spatiale, les forces exogènes, les indicateurs et les seuils de persistance. A cet effet, une chaîne de modèles biophysique-socioéconomique au niveau régional a été utilisée pour simuler l'effet du changement climatique d'une part sur les rendements des cultures et sur la salinité du sol à l'échelle de la parcelle, et d'autre part sur la résilience et la capacité d'adaptation des exploitations agricoles. Cette approche quantitative permet la simulation de stratégie d'adaptation agricole système en calculant trois indicateurs : le stock de terres, le stock de main-d'œuvre et le flux des revenus, en réponse au changement climatique. Le troisième chapitre évalue les stratégies d'adaptation possibles permettant de faire face aux effets du changement climatique. Ces stratégies ont été identifiées dans le cadre d'une approche participative, en concertation avec les agriculteurs et les experts locaux au niveau de la BVM et simulées en utilisant la chaîne de modèles. Les résultats de cette étude montrent une hétérogénéité des comportements des exploitations agricoles en fonction de la diversité et du degré d‘intensification des activités de production agricoles (végétale et animale). Les exploitations agricoles les plus diversifiées et les moins intensifiées avec une activité animale importante semblent être plus résilientes au changement climatique que les exploitations spécialisées ayant un système de production intensif. Nous constatons que les stratégies d'adaptation basées sur l'augmentation des doses d'irrigation pour satisfaire les besoins croissants en eau des cultures, l'irrigation de complément des céréales, et l'amélioration de l'efficience des systèmes d'irrigation améliorent la résilience des exploitations agricoles de la Basse Vallée de Medjerda. Ces stratégies ont un effet plus important sur la profitabilité des exploitations agricoles si elles sont accompagnées par une tarification d'eau binôme. Les résultats de cette étude montrent que les systèmes agricoles peuvent s'adapter au changement climatique de différentes façons. La méthodologie utilisée peut être adaptée à d'autres régions de la Méditerranée et permettra d'aider les experts et les décideurs politiques à proposer et tester des stratégies d'adaptation au changement climatique dans ces régions. / Climate change would impact sustainability of most agricultural systems in the Mediterranean region and particularly in the south of the Mediterranean. It is expected that agricultural systems react differently depending on biophysical, socioeconomic and political contexts of each agriculture. The objective of this thesis is to analyze the resilience and adaptive capacity to climate change of the farming systems of the Low Valley of Medjerda (Northern Tunisia). To meet this objective, three main steps are developed. The first chapter describes, based on a literature review, the agri-environmental effects of climate change in the Mediterranean region and particularly in Tunisia. The second chapter analyzes the potential impact of climate change on the resilience of the farming systems in the Low Valley of Medjerda (LVM). To do this, an operational Framework was built. The third chapter assesses the possible adaptive strategies to cope with the effects of climate change. These strategies have been identified through a participatory approach, in consultation with farmers and local experts in the LVM watershed. For this purpose, a chain of regional biophysical-socio-economic models was used to simulate the effect of climate change, on crop yields and soil salinity at field scale, and on the resilience and adaptability of farming systems. The results of this study show heterogeneous behaviors of farming systems depending on the diversity and the degree of intensification of agricultural production (crop and livestock). More diversified and less intensified farming systems with a large animal activity seem to be more resilient than specialized farms with intensive production system. In addition, as expected, we find that adaptation strategies based on the increasing of irrigation doses to meet the increased crop water requirements (SIrr.am), supplemental irrigation of cereal (SIrr.c) and the improvement of the efficiency of irrigation systems (SIrr.sys)improve the resilience of farming systems in the LVM watershed. These strategies have a greater effect on the profitability of farming systems if they are accompanied by a binominal water tariff. The methodology used in this research can be adapted for other Mediterranean regions and assist experts and policy makers to propose and test strategies for adapting to climate change in these regions.

<div>In the last half century, much research effort has gone into identifying the causes and effects of societal burdens. Industrial activity may arguably be the most widely responsible cause, but the effects, or social impacts (SIs), resulting from industrial activity are typically considered externalities and not evaluated alongside economic performance of industries. It is clear however that people are fundamental to the progress and development of economies. Understanding how people are affected by economies, and in particular industrial economic activity, starts with recognizing that impacts on people can no longer be considered externalities. The coordinating lack of understanding of social performance, i.e., how stakeholder needs are impacted by industrial production, limits the capacity of decision makers to make fully informed choices. A </div><div>multidisciplinary perspective is needed to address this gap in understanding. The new approach, economic input-output social impact assessment, integrates economic production with social impacts and is further demonstrated to provide a measurable path forward to evaluate the social performance of industries. It is shown that changes in industrial activity, e.g., growth, in the U.S. will have a directly related and predictable change in social impact.</div>

Este trabalho analisa quais os efeitos que o cumprimento do antigo e do novo Código Florestal trariam à economia do país e de seus estados. A partir da base de dados do projeto AgLue (Agricultural Land Use and Expansion Model) são obtidos os déficits de APP (Área de Preservação Permanente) e RL (Reserva Legal) na agricultura e na pecuária para cada microrregião do país. Essas informações são agregadas e compatibilizadas com os dados do Censo Agropecuário de 2006, resultando numa matriz que contém o percentual que cada cultura agropecuária teria que reduzir de sua área colhida (ou de pastagem) para se adequar a legislação. Para calcular os impactos econômicos utilizou-se o modelo de equilíbrio geral computável TERM-BR, a partir do qual se podem obter os resultados regionais e nacionais e os efeitos econômicos das restrições impostas pelo cumprimento da APP e da RL isoladamente. Os resultados obtidos mostram que as recentes mudanças alteram, mesmo que em pequena escala, os impactos econômicos do Código Florestal. Em sua versão anterior, o efetivo cumprimento da lei implicaria redução de 0,37% do Produto Interno Bruto (PIB) do país, enquanto que no novo Código esta retração seria de 0,19%. Para ambos os casos, o instrumento da APP é o maior responsável pelas variações. Ademais, verificaram-se impactos distintos entre os setores econômicos e as unidades da federação, sendo os segmentos agropecuários os mais afetados pelas restrições legais e os estados da região Norte os mais beneficiados economicamente pelas mudanças na legislação. / This research analyses the effects of the implementation of the Forest Law, both in its new and its previous version, on economy of Brazil and its states. The deficits of APP (Permanent Preservation Area) and RL (Legal Reserve) on agriculture and livestock, by region, are obtained from AgLue (Agricultural Land Use and Expansion Model) database. This information is aggregated and matched with Agricultural Census of 2006 database, resulting in a matrix that indicates for each agricultural sector what percent of harvested or pasture area has to be reduced due to legislation. An applied general equilibrium model TERM-BR was used to measure the economic impacts. This model allows the analysis of regional and national results and economic effects of APP and RL restrictions individually. The results indicated that recent changes on legislation modify, although in a small scale, the economic impacts of the Forest Law. In its previous version, the compliance of the law would imply a reduction of 0,37% of Brazilian GDP while in its new version this impact is a reduction of 0,19%. In both cases, the APP is the major responsible for GDP variations. Furthermore, different impacts between the economic sectors and the states were observed. The agricultural sectors were the most negatively affected by legal restrictions while states in the North region benefited the most, in economic terms, from changes in the legislation.

Introdução: A malária humana apresenta sintomas inespecíficos e exige diagnóstico laboratorial e identificação da espécie para o seu manejo. O diagnóstico baseia-se na microscopia, exame barato, que exige profissionais experientes. Nos últimos anos surgiram testes imunocromatográficos de execução rápida e custo mais elevado em comparação à microscopia. Estudos de validação demonstraram sensibilidade e especificidade comparáveis à microscopia, podendo ser alternativa confiável em áreas sem laboratório. Objetivo: Realizar análise de custo-efetividade do uso do OptiMAL® - teste rápido (TR) registrado no Brasil e validado em áreas endêmicas - comparado à microscopia. Métodos: A perspectiva da análise foi a do sistema público de saúde brasileiro SUS, o horizonte analítico de seis meses e o ano de 2006, a referência temporal. Doze municípios do Estado do Pará constituíram a área de estudo. Foi construído modelo de decisão considerando dois desfechos: casos diagnosticados adequadamente e casos conduzidos adequadamente em três cenários: o cenário 1 corresponde a 100% dos exames realizados, o cenário 2 considera somente os exames feitos nas áreas com laboratório e o cenário 3 corresponde a 30% dos exames, realizados em áreas isoladas. Os parâmetros epidemiológicos principais foram prevalência da malária entre indivíduos sintomáticos e acurácia - sensibilidade e especificidade - dos métodos diagnósticos, cujas estimativas foram obtidas a partir do Sistema de Informação de Vigilância Epidemiológica da Malária e literatura científica. Foram estimados custos diretos médicos e não-médicos, considerando diretrizes nacionais e dados municipais. Fontes de dados de custos incluíram o Sistema de Informação de Insumos Estratégicos, a Tabela de Procedimentos do SUS e o Sistema de Informação Hospitalar do SUS. Foram estimadas as razões média e adicional de custo-efetividade (RCEA) e realizada análise de sensibilidade. O software utilizado foi o TreeAge Pro 2005. Resultados: O TR foi dominado pela microscopia nos cenários 1 e 2. Em áreas isoladas a estratégia microscopia apresentou RCEA de R$1.193,00 por caso diagnosticado adequadamente e de R$1.016,67 por caso conduzido adequadamente quando comparada com o OptiMAL®. O TR tornou-se mais custo-efetivo nos dois desfechos dos três cenários com a redução da acurácia da gota espessa, na análise de sensibilidade. Conclusões: o TR foi menos custo-efetivo em todos os cenários, quando a acurácia da microscopia manteve-se elevada. / Introduction: Diagnosis of malaria is based on blood microscopy, a lowcost procedure that requires experienced technicians. Rapid immunochromatography tests (RDT) were developed with the advantage of being easy-to-use tools but with higher costs. RDT validation showed similar accuracy compared to microscopy suggesting that the RDT could be a reliable alternative in areas without lab facilities. Objective: To perform costeffectiveness analysis for the use of OptiMAL® in comparison with the thick blood smear microscopy. Methods: The study was conducted from the perspective of the Brazilian Public Health System, the analytic horizon was of six months, and the time frame was 2006. The analysis was performed through a decision tree with two outcomes: properly diagnosed cases and properly conducted cases. There were defined three scenarios in 12 municipalities of the State of Pará: the scenario 1 considered the whole malaria tests performed in 2006; the scenario 2 considered the malaria tests performed in the endemic areas with access to lab facilities; and the scenario 3 considered the 30% malaria tests performed in areas without lab facilities. The main epidemiological measures were the prevalence of malaria and the accuracy of the diagnostic methods. Epidemiological estimates were obtained from the Brazilian Malaria Surveillance Information System and the scientific literature. Direct medical and non-medical costs were estimated taking into consideration the national guidelines and the data obtained from the municipalities. Cost data sources were the Information System for Strategic Resources from the Health Surveillance Secretariat, the Reimbursement Values Table and the Hospital Information System of the Brazilian Public Health System. The average and the incremental costeffectiveness ratio (ICER) were estimated and it was conducted a sensitivity analysis. Data were analyzed with the TreeAge Pro 2005 software. Results: RDT strategy was dominated by the microscopy strategy in the scenarios 1 and 2. The ICER for the microscopy strategy in the scenario 3 was R$1,193.00 per properly diagnosed case and it was R$1,016.67 per properly conducted case compared with the OptiMAL® strategy. The sensitivity analysis showed that the RDT was cost-effective for both outcomes in all the scenarios when the thick blood smear accuracy was reduced. Conclusions: The RDT is the least cost effective strategy, providing that microscopy accuracy is high.

Exploiting high altitude wind energy using power kites is an emerging topic in the field of renewable energy. The claimed advantages of power kites over traditional wind power technologies are the lower construction costs, less land occupation and more importantly, the possibility of efficiently harvesting wind energy at high altitudes, where more dense and steady wind power exists. One of the most challenging issues to bring the power kite concept to real industrialization is the controller design. While traditional wind turbines can be inherently stabilized, the airborne nature of kites causes a strong instability of the systems. This thesis aims to develop a novel economic model predictive path-following control (EMPFC) framework to tackle the path-following control of power kites, as well as provide insightful stability analysis of the proposed control scheme. Chapter 3 is focused on the stability analysis of EMPFC. We proceed with a sampled-data EMPC scheme for set-point stabilization problems. An extended definition of dissipativity is introduced for continuous-time systems, followed by giving sufficient stability conditions. Then, the EMPFC scheme for output path-following problems is proposed. Sufficient conditions that guarantee the convergence of the system to the optimal operation on the reference path are derived. Finally, an example of a 2-DoF robot is given. The simulation results show that under the proposed EMPFC scheme, the robot can follow along the reference path in forward direction with enhanced economic performance, and finally converges to its optimal steady state. In Chapter 4, the proposed EMPFC scheme is applied to a challenging nonlinear kite model. By introducing additional degrees of freedom in the zero-error manifold (i.e., the space where the output error is zero), a relaxation of the optimal operation is achieved. The effectiveness of the proposed control scheme is shown in two aspects. For a static reference path, the generated power is increased while the kite is stabilized in the neighborhood of the reference path. For a dynamic reference path, the economic performance can be further enhanced since parameters for the reference path are treated as additional optimization variables. The proposed EMPFC achieves the integration of path optimization and path-following, resulting in a better economic performance for the closed-loop system. Simulation results are given to show the effectiveness of the proposed control scheme. Finally, Chapter 5 concludes the thesis and future research topics are discussed. / Graduate / 2020-05-14

Disertacijoje nagrinėjamos šalies pagrindinių ekonominių indikatorių modeliavimo galimybės, analizuojamos teorinės bei praktinės vertinimo prielaidos, šalies ūkio ypatumų sąlygojami apribojimai, tiriama Lietuvos bei užsienio šalių ekonominių modelių struktūra, šiuose modeliuose naudojamų ekonominių indikatorių rinkiniai bei pasirinkti metodai. Norint gauti patikimus rezultatus, darbe atlikta ekonominio modeliavimo metodų lyginamoji analizė. Disertacijos tyrimų objektas – makroekonominių, verslo bei socialinių indikatorių laiko eilutės. Pagrindinis disertacijoje keliamas darbo tikslas – sukurti pagrindinių šalies ekonomikos pokyčius matuojančių indikatorių dinamikos modelį, kurį naudojant galima kompleksiškai vertinti susiformavusių ekonominių indikatorių adekvatumą, jų suderinamumą bei tarpusavio sąveiką, tirti esamą šalies ekonominę būklę bei jos tvarumą, analizuoti atskirų ekonominių indikatorių pokyčių pasekmes ekonominei būsenai, kurti skirtingus ekonominius scenarijus bei įvertinti šalies ūkio ekonominę perspektyvą. Darbe sprendžiami pagrindinai uždaviniai: kuriamo šalies ekonomikos indikatorių dinamikos modelio struktūros bei teorinio pagrindimo nustatymas, tinkamų kompleksinio modeliavimo metodų parinkimas, modelio bei prognozių tikslumo ir stabilumo tyrimas, programinių priemonių sukūrimas. Atlikus esamų ekonominio modeliavimo metodų analizę, disertacijos užsibrėžtiems tikslams pasiekti ir uždaviniams įgyvendinti, buvo nuspręsta kurti naują šalies ekonominės būsenos... [toliau žr. visą tekstą] / The doctoral thesis investigates the opportunities for the modelling of leading county‘s economic indicators, analyses the theoretical and practical assumptions, the limitations conditioned by the country’s economic features, studies the structure of economic models existing in Lithuania and foreign countries, the set of economic indicators used and selected methods of modelling. A comparative analysis of economic modelling methods was also carried out. The object of this research is the time series of macroeconomic, business and social indicators. The goal of the work – to create the model of indicators that measure the country‘s economic dynamics, which enables the comprehensive assessment of the adequacy, coherence and interoperability of available economic indicators, the investigation and analysis of the current economic situation and its sustainability, the evaluation of the consequences of changes in certain economic indicators for the economic situation, the development of different economic scenarios, and the assessment of the country’s economic prospects. The main tasks solved in the work: determination of the structure and theoretical validity of the model of county‘s economic indicators dynamics, selection of appropriate comprehensive modelling methods, investigation of the accuracy and stability of the model and forecasts, development of software. After an analysis of existing economic modelling methods, in order to achieve the objectives and goals of the thesis... [to full text]

A formação de redes flexíveis tem sido alternativa, principalmente para as pequenas e médias empresas, como forma de obter vantagens competitivas. Contudo, além do objetivo principal dessas redes, aspectos culturais e organizacionais trazidos pelos integrantes das mesmas devem ser ponderados. Esta dissertação apresenta um estudo dos aspectos considerados relevantes para o relacionamento entre a governança e seus integrantes, dentro de uma rede flexível de supermercados. Três dimensões foram estudadas: foco de negócio, formato de exploração econômica e processos operacionais, avaliadas sobre a perspectiva de quatro construtos, motivação, gestão, comunicação e decisão. A pesquisa foi realizada dentro da abordagem múltipla de casos, levando em conta três tipos de formatos de exploração econômica: o associativismo, a franquia e o licenciamento de marca. O levantamento das informações foi realizado por meio de entrevistas semi estruturadas, sendo para cada rede, entrevistados a governança e seis integrantes. Observou-se que os elementos motivacionais para a formação das redes são semelhantes, mas que a gestão estratégica em sua maioria atende fatores e situações divergentes relativamente ao foco do negócio e os processos operacionais. Para o formato associativista, foi possível identificar a baixa preocupação em relação à integração, treinamentos e processos operacionais, aliada a forte independência dos integrantes, funcionando com características de centrais de compras. Para os formatos de franquia e licenciamento de marca o valor principal reside na padronização de procedimentos e na relevância para treinamentos dos novos integrantes. Os três formatos de redes trazem em comum a preocupação com os procedimentos orientativos em relação aos fornecedores nas negociações de compra e nas promoções em ponto de venda. Evidenciou-se a ampliação do foco do negócio das redes flexíveis de supermercado e a consequente transição de centrais de compras para formatos mais abrangentes do negócio. / Submitted by Marcelo Teixeira (mvteixeira@ucs.br) on 2014-05-06T13:22:48Z No. of bitstreams: 1 Dissertacao Claralucia Prates Machado.pdf: 1436285 bytes, checksum: d6c0037423ce5a43f1fee5d6221e224d (MD5) / Made available in DSpace on 2014-05-06T13:22:48Z (GMT). No. of bitstreams: 1 Dissertacao Claralucia Prates Machado.pdf: 1436285 bytes, checksum: d6c0037423ce5a43f1fee5d6221e224d (MD5) / Flexible networks formation has been an alternative, mainly for small and medium enterprises, as a way to gain competitive advantages. However, beyond the primary objective of these networks, organizational and cultural aspects brought by the participant members should be considered. This work presents a study of the aspects relevant to the relationship between governance and its members, within a flexible network of supermarkets. Three dimensions were studied: business focus, form of economic exploitation and operational processes, evaluated on the prospect of four constructs, motivation, management, communication and decision. The research was conducted into the multiple case approach, taking into account three types of formats economic exploitation: associativism, franchising and brand licensing. The lifting information was conducted through semi-structured interviews, and for each network, governance and interviewed six members. It was observed that the motivational elements for the formation of networks are similar, but that strategic management in their majority caters factors and situations diverging to the focus of the business and operational processes. For the format associativist, it was possible identify the low concern regarding integration, trainings and operational processes, coupled with the strong independence of members, functioning with characteristics of central purchasing. For formats franchise and brand licensing the primary value resides in the standardization of procedures and relevance to trainings of new members. The three formats networks bring in common the concern with the procedures orientative towards suppliers in the purchases and promotions at point of sale. The analysis reveals the expansion of the business focus of flexible networks supermarket and the consequent transition from central purchasing formats for broader business.

Introdução: A malária humana apresenta sintomas inespecíficos e exige diagnóstico laboratorial e identificação da espécie para o seu manejo. O diagnóstico baseia-se na microscopia, exame barato, que exige profissionais experientes. Nos últimos anos surgiram testes imunocromatográficos de execução rápida e custo mais elevado em comparação à microscopia. Estudos de validação demonstraram sensibilidade e especificidade comparáveis à microscopia, podendo ser alternativa confiável em áreas sem laboratório. Objetivo: Realizar análise de custo-efetividade do uso do OptiMAL® - teste rápido (TR) registrado no Brasil e validado em áreas endêmicas - comparado à microscopia. Métodos: A perspectiva da análise foi a do sistema público de saúde brasileiro SUS, o horizonte analítico de seis meses e o ano de 2006, a referência temporal. Doze municípios do Estado do Pará constituíram a área de estudo. Foi construído modelo de decisão considerando dois desfechos: casos diagnosticados adequadamente e casos conduzidos adequadamente em três cenários: o cenário 1 corresponde a 100% dos exames realizados, o cenário 2 considera somente os exames feitos nas áreas com laboratório e o cenário 3 corresponde a 30% dos exames, realizados em áreas isoladas. Os parâmetros epidemiológicos principais foram prevalência da malária entre indivíduos sintomáticos e acurácia - sensibilidade e especificidade - dos métodos diagnósticos, cujas estimativas foram obtidas a partir do Sistema de Informação de Vigilância Epidemiológica da Malária e literatura científica. Foram estimados custos diretos médicos e não-médicos, considerando diretrizes nacionais e dados municipais. Fontes de dados de custos incluíram o Sistema de Informação de Insumos Estratégicos, a Tabela de Procedimentos do SUS e o Sistema de Informação Hospitalar do SUS. Foram estimadas as razões média e adicional de custo-efetividade (RCEA) e realizada análise de sensibilidade. O software utilizado foi o TreeAge Pro 2005. Resultados: O TR foi dominado pela microscopia nos cenários 1 e 2. Em áreas isoladas a estratégia microscopia apresentou RCEA de R$1.193,00 por caso diagnosticado adequadamente e de R$1.016,67 por caso conduzido adequadamente quando comparada com o OptiMAL®. O TR tornou-se mais custo-efetivo nos dois desfechos dos três cenários com a redução da acurácia da gota espessa, na análise de sensibilidade. Conclusões: o TR foi menos custo-efetivo em todos os cenários, quando a acurácia da microscopia manteve-se elevada. / Introduction: Diagnosis of malaria is based on blood microscopy, a lowcost procedure that requires experienced technicians. Rapid immunochromatography tests (RDT) were developed with the advantage of being easy-to-use tools but with higher costs. RDT validation showed similar accuracy compared to microscopy suggesting that the RDT could be a reliable alternative in areas without lab facilities. Objective: To perform costeffectiveness analysis for the use of OptiMAL® in comparison with the thick blood smear microscopy. Methods: The study was conducted from the perspective of the Brazilian Public Health System, the analytic horizon was of six months, and the time frame was 2006. The analysis was performed through a decision tree with two outcomes: properly diagnosed cases and properly conducted cases. There were defined three scenarios in 12 municipalities of the State of Pará: the scenario 1 considered the whole malaria tests performed in 2006; the scenario 2 considered the malaria tests performed in the endemic areas with access to lab facilities; and the scenario 3 considered the 30% malaria tests performed in areas without lab facilities. The main epidemiological measures were the prevalence of malaria and the accuracy of the diagnostic methods. Epidemiological estimates were obtained from the Brazilian Malaria Surveillance Information System and the scientific literature. Direct medical and non-medical costs were estimated taking into consideration the national guidelines and the data obtained from the municipalities. Cost data sources were the Information System for Strategic Resources from the Health Surveillance Secretariat, the Reimbursement Values Table and the Hospital Information System of the Brazilian Public Health System. The average and the incremental costeffectiveness ratio (ICER) were estimated and it was conducted a sensitivity analysis. Data were analyzed with the TreeAge Pro 2005 software. Results: RDT strategy was dominated by the microscopy strategy in the scenarios 1 and 2. The ICER for the microscopy strategy in the scenario 3 was R$1,193.00 per properly diagnosed case and it was R$1,016.67 per properly conducted case compared with the OptiMAL® strategy. The sensitivity analysis showed that the RDT was cost-effective for both outcomes in all the scenarios when the thick blood smear accuracy was reduced. Conclusions: The RDT is the least cost effective strategy, providing that microscopy accuracy is high.

Este trabalho analisa quais os efeitos que o cumprimento do antigo e do novo Código Florestal trariam à economia do país e de seus estados. A partir da base de dados do projeto AgLue (Agricultural Land Use and Expansion Model) são obtidos os déficits de APP (Área de Preservação Permanente) e RL (Reserva Legal) na agricultura e na pecuária para cada microrregião do país. Essas informações são agregadas e compatibilizadas com os dados do Censo Agropecuário de 2006, resultando numa matriz que contém o percentual que cada cultura agropecuária teria que reduzir de sua área colhida (ou de pastagem) para se adequar a legislação. Para calcular os impactos econômicos utilizou-se o modelo de equilíbrio geral computável TERM-BR, a partir do qual se podem obter os resultados regionais e nacionais e os efeitos econômicos das restrições impostas pelo cumprimento da APP e da RL isoladamente. Os resultados obtidos mostram que as recentes mudanças alteram, mesmo que em pequena escala, os impactos econômicos do Código Florestal. Em sua versão anterior, o efetivo cumprimento da lei implicaria redução de 0,37% do Produto Interno Bruto (PIB) do país, enquanto que no novo Código esta retração seria de 0,19%. Para ambos os casos, o instrumento da APP é o maior responsável pelas variações. Ademais, verificaram-se impactos distintos entre os setores econômicos e as unidades da federação, sendo os segmentos agropecuários os mais afetados pelas restrições legais e os estados da região Norte os mais beneficiados economicamente pelas mudanças na legislação. / This research analyses the effects of the implementation of the Forest Law, both in its new and its previous version, on economy of Brazil and its states. The deficits of APP (Permanent Preservation Area) and RL (Legal Reserve) on agriculture and livestock, by region, are obtained from AgLue (Agricultural Land Use and Expansion Model) database. This information is aggregated and matched with Agricultural Census of 2006 database, resulting in a matrix that indicates for each agricultural sector what percent of harvested or pasture area has to be reduced due to legislation. An applied general equilibrium model TERM-BR was used to measure the economic impacts. This model allows the analysis of regional and national results and economic effects of APP and RL restrictions individually. The results indicated that recent changes on legislation modify, although in a small scale, the economic impacts of the Forest Law. In its previous version, the compliance of the law would imply a reduction of 0,37% of Brazilian GDP while in its new version this impact is a reduction of 0,19%. In both cases, the APP is the major responsible for GDP variations. Furthermore, different impacts between the economic sectors and the states were observed. The agricultural sectors were the most negatively affected by legal restrictions while states in the North region benefited the most, in economic terms, from changes in the legislation.