No / To assess clinical outcomes and cost-effectiveness of using a two-layer cohesive compression bandage (TLCCB; Coban 2) compared with a two-layer compression system (TLCS; Ktwo) and a four-layer compression system (FLCS; Profore) in treating venous leg ulcers (VLUs) in clinical practice in the UK, from the perspective of the National Health Service (NHS). METHOD: This was a retrospective analysis of the case records of VLU patients, randomly extracted from The Health Improvement Network (THIN) database (a nationally representative database of clinical practice among patients registered with general practitioners in the UK), who were treated with either TLCCB (n=250), TLCS (n=250) or FLCS (n=175). Clinical outcomes and health-care resource use (and costs) over six months after starting treatment with each compression system were estimated. Differences in outcomes and resource use between treatments were adjusted for differences in baseline covariates. RESULTS: Patients' mean age was 75 years old and 57% were female. The mean time with a VLU was 6-7 months and the mean initial wound size was 77-85 cm2. The overall VLU healing rate, irrespective of bandage type, was 44% over the six months' study period. In the TLCCB group, 51% of wounds had healed by six months compared with 40% (p=0.03) and 28% (p=0.001) in the TLCS and FLCS groups, respectively. The mean time to healing was 2.5 months. Patients in the TLCCB group experienced better health-related quality of life (HRQoL) over six months (0.374 quality-adjusted life years (QALYs) per patient), compared with the TLCS (0.368 QALYs per patient) and FLCS (0.353 QALYs per patient). The mean six-monthly NHS management cost was pound2,413, pound2,707 and pound2,648 per patient in the TLCCB, TLCS and FLCS groups, respectively. CONCLUSION: Despite the systems studied reporting similar compression levels when tested in controlled studies, real-world evidence demonstrates that initiating treatment with TLCCB, compared with the other two compression systems, affords a more cost-effective use of NHS-funded resources in clinical practice, since it resulted in an increased healing rate, better HRQoL and a reduction in NHS management cost. The evidence also highlighted the lack of continuity between clinicians managing a wound, the inconsistent nature of the administered treatments and the lack of specialist involvement, all of which may impact on healing. DECLARATION OF INTEREST: This study was supported by an unrestricted research grant from 3M Health Care, UK. 3M Health Care had no influence on the study design, the collection, analysis, and interpretation of data, or on the writing of, and decision to submit for publication, the manuscript.

Les nouvelles technologies médicales contribuent aux dépenses en santé qui ne cessent de croître, alors que les budgets se trouvent limités. L’évaluation économique des technologies devraient permettre d’identifier quelles sont celles qui sont les plus rentables. Malgré cela, plusieurs technologies dont le rapport coût-efficacité reste plutôt limite ou défavorable sont utilisées en médecine moderne et remboursées par notre système public de santé. Ce mémoire se concentre sur deux technologies en santé cardiovasculaire dont le rapport coût-efficacité est plutôt limite mais qui sont fréquemment utilisées au Canada; les tuteurs médicamentés ou pharmaco-actifs et les défibrillateurs cardiaques implantables (DCI). Nous avons fait une évaluation contingente de ces technologies dans le but d’examiner si ce type d’évaluation économique complémentaire pouvait procurer un point de vue nouveau sur la valeur économique et sociétaire des ces technologies. Les résultats de ces deux évaluations indiquent que les patients accordent une grande importance aux bénéfices que procurent ces deux technologies. Nos résultats soutiennent les politiques de santé actuelles de rembourser de façon libérale ces deux technologies. / Technological innovations have greatly contributed to the rising costs in healthcare, while budgets have remained limited. Economic evaluations of technologies should identify which technologies are cost-effective. However, several technologies used in modern medicine are either borderline cost-effective or even not cost-effective according to many studies. This thesis focuses on two technologies in cardiovascular medicine which are considered borderline cost-effective; drug-eluting stents and implantable cardioverter defibrillators. We conducted a contingent valuation of these technologies in hopes of determining if this alternative type of economic evaluation could give a novel point of view on the economic and societal value of these technologies. Results indicated that patients greatly valued benefits provided by these two technologies. Our result support our public healthcare system policies’ of liberal reimbursement of these two technologies.

Réalisé dans le cadre d'un mandat de l'Unité d'évaluation des technologies et des modes d'intervention en santé (UETMIS) du CHU Sainte-Justine / Introduction : La tyrosinémie de type I est une maladie génétique sévère. Elle se caractérise par des manifestations hépatiques, rénales et neurologiques. Depuis 1994, le NTBC représente la thérapie de première ligne. Ce médicament a conduit à une amélioration radicale de la morbidité et du pronostic de la maladie. Objectif : Évaluer les coûts directs des soins de santé reliés au traitement de cette maladie. Cette évaluation économique a été effectuée en trois groupes dont, un groupe historique de patients non traités; un groupe traitement tardif et un groupe traitement précoce par NTBC. Méthode : L’analyse coûts-conséquences inclut les coûts des hospitalisations, des services médicaux et des thérapies associées. Les données proviennent des banques de la RAMQ, de Med-Echo et des dossiers hospitaliers. Résultats : Le NTBC est associé à une réduction significative des hospitalisations, des séjours aux soins intensifs et des greffes hépatiques. Les coûts hospitaliers sont significativement moindres pour les groupes traités (13 979 $, 6 347 $ et 673 $ par année-patient pour les groupes historique, traitement tardif et traitement précoce,respectivement; valeur p < 0,0001). Les coûts des hospitalisations pour greffes par année-patient sont de 4 676$ pour le groupe historique et de 3 567 $ pour le groupe traitement tardif. Les coûts du NTBC par année-patient sont de 66 965 $ et de 51 493 $ pour les groupes traitement tardif et traitement précoce, respectivement. Conclusion : Les résultats démontrent l’impact majeur du NTBC sur la réduction de l’utilisation des ressources de santé, des greffes hépatiques et des coûts associés. / Introduction : Tyrosinemia type I is a severe genetic disorder. Symptoms include hepatic,renal and neurological manifestations. NTBC became the first-line therapy in 1994. This drug has led to a drastic improvement in the prognosis. Objective : To evaluate direct medical costs of healthcare services related to the treatment for this disease. This economic evaluation was conducted among the 3 following groups: an historical group of untreated patients, a late-treatment group and an early-treatment group with NTBC. Methods : The costs-consequences analysis includes costs incurred by hospitalizations, medical services and related treatments. Data are derived from the RAMQ and Med-Echo administrative databases and patients’ hospital charts. Results : NTBC treatment is associated with a significant reduction in hospitalizations, intensive care unit stays and liver transplantations. The cost of hospitalizations is significantly less for both treated groups (13,979 $, 6,347 $ and 673 $ per year-patient for the historical group, the late-treatment and the early-treatment group, respectively; pvalue< 0,0001). The cost of hospitalizations for liver transplantations per year-patient is 4,676 $ for the historical group and 3,567 $ for the late-treatment group. The cost of NTBC per year-patient is 66,965$ and 51,493$ for the late-treatment and the earlytreatment groups, respectively. Conclusion : These results demonstrate that NTBC treatment results in a major reduction in healthcare resources utilization, liver transplantations and associated costs.

O presente trabalho avaliou o uso do lodo residual (biossólido) produzido nas Estações de Tratamento de Esgoto (ETEs) da Região Metropolitana de São Paulo (RMSP) como fertilizante em florestas de eucaliptos. Os aspectos estudados foram demanda potencial, resposta à fertilização em termos de produção madeireira, crescimento das árvores e viabilidade econômica. Foi verificada uma elevada demanda potencial pelo biossólido em povoamentos de eucaliptos localizados a curtas distâncias de transporte rodoviário no entorno da RMSP. Verificou-se também que o biossólido, complementado com P e K minerais no plantio, acelerou a ritmo de crescimento das árvores, aumentou o nível de produção madeireira e reduziu o ciclo de produção de Eucalyptus grandis em proporções semelhantes às observadas para a fertilização mineral convencional. Na avaliação aos 99 meses de idade, foi verificado que a maior dose de biossólido (40 Mg ha-1) não resultou na maior produção de madeira. Se considerada a diferença estatística entre as curvas de crescimento, os modelos testados podem ser divididos em apenas dois grupos: (i) testemunha e dose de 10 Mg ha-1; e (ii) demais tratamentos. A análise econômica (valor presente líquido anualizado e a taxa de juros de 12% ao ano) recomenda a dose de 5 Mg ha-1, com complementação com K mineral no plantio, se utilizado como critério de definição de corte a escolha da idade que maximiza o incremento médio anual em cada tratamento. Para as condições do trabalho concluiu-se que o biossólido não substitui totalmente a fertilização mineral convencional. Economicamente, confirmou-se a expectativa de que elevadas taxas de aplicação do biossólido são inviáveis, devido principalmente à alta umidade natural desse material que encarece significativamente o transporte. / This work evaluates the use of the residual sludge (biosolids) produced by sewage treatment units located in the Metropolitan Region of the City of São Paulo (MRSP) as a fertilizer in Eucalyptus grandis forest plantations. The aspects studied were potential demand, wood production response to the fertilization, trees growth and economic viability. A high level of potential demand was observed for the biosolids on forest eucalyptus plantations located at short ground transportation distances in the MRSP. It was also observed that biosolids, complemented by phosphorous and potassium at the planting stage, increased the growth rate of the trees, resulted in more wood output and reduced the rotation age at levels similar to those observed for conventional mineral fertilization. When evaluated 99 months after planting, it was observed that the highest dosage of biosolids did not result on the highest wood production output. The adjusted models can be separated in only two groups according to the statistical differences among them: (i) control and dosage 10 Mg ha-1; and (ii) all other treatments. The economic analysis (annualized net present value at 12% return rate) recommended dosage 5 Mg ha-1 complemented with K, for rotation lengths defined by the age that maximizes mean annual increment. The use of biosolids does not substitute totally the use of mineral fertilizers. Economically, it was confirmed that the highest biosolid dosages were not viable, due mainly to its high levels of water content and consequently high transportation cost.

O presente trabalho avaliou o uso do lodo residual (biossólido) produzido nas Estações de Tratamento de Esgoto (ETEs) da Região Metropolitana de São Paulo (RMSP) como fertilizante em florestas de eucaliptos. Os aspectos estudados foram demanda potencial, resposta à fertilização em termos de produção madeireira, crescimento das árvores e viabilidade econômica. Foi verificada uma elevada demanda potencial pelo biossólido em povoamentos de eucaliptos localizados a curtas distâncias de transporte rodoviário no entorno da RMSP. Verificou-se também que o biossólido, complementado com P e K minerais no plantio, acelerou a ritmo de crescimento das árvores, aumentou o nível de produção madeireira e reduziu o ciclo de produção de Eucalyptus grandis em proporções semelhantes às observadas para a fertilização mineral convencional. Na avaliação aos 99 meses de idade, foi verificado que a maior dose de biossólido (40 Mg ha-1) não resultou na maior produção de madeira. Se considerada a diferença estatística entre as curvas de crescimento, os modelos testados podem ser divididos em apenas dois grupos: (i) testemunha e dose de 10 Mg ha-1; e (ii) demais tratamentos. A análise econômica (valor presente líquido anualizado e a taxa de juros de 12% ao ano) recomenda a dose de 5 Mg ha-1, com complementação com K mineral no plantio, se utilizado como critério de definição de corte a escolha da idade que maximiza o incremento médio anual em cada tratamento. Para as condições do trabalho concluiu-se que o biossólido não substitui totalmente a fertilização mineral convencional. Economicamente, confirmou-se a expectativa de que elevadas taxas de aplicação do biossólido são inviáveis, devido principalmente à alta umidade natural desse material que encarece significativamente o transporte. / This work evaluates the use of the residual sludge (biosolids) produced by sewage treatment units located in the Metropolitan Region of the City of São Paulo (MRSP) as a fertilizer in Eucalyptus grandis forest plantations. The aspects studied were potential demand, wood production response to the fertilization, trees growth and economic viability. A high level of potential demand was observed for the biosolids on forest eucalyptus plantations located at short ground transportation distances in the MRSP. It was also observed that biosolids, complemented by phosphorous and potassium at the planting stage, increased the growth rate of the trees, resulted in more wood output and reduced the rotation age at levels similar to those observed for conventional mineral fertilization. When evaluated 99 months after planting, it was observed that the highest dosage of biosolids did not result on the highest wood production output. The adjusted models can be separated in only two groups according to the statistical differences among them: (i) control and dosage 10 Mg ha-1; and (ii) all other treatments. The economic analysis (annualized net present value at 12% return rate) recommended dosage 5 Mg ha-1 complemented with K, for rotation lengths defined by the age that maximizes mean annual increment. The use of biosolids does not substitute totally the use of mineral fertilizers. Economically, it was confirmed that the highest biosolid dosages were not viable, due mainly to its high levels of water content and consequently high transportation cost.

Die Dissertation beschreibt am Beispiel einer Längsschnittstudie in der Papierindustrie, wie Effekte von Maßnahmen der betrieblichen Gesundheitsförderung in geschätzten ökonomischen Nutzen übertragen werden können. Ausgangspunkt der Untersuchung ist das Variablen-Modell nach Locke und Latham (1990). Darauf aufbauend wurden geeignete Indikatoren und Messinstrumente ausgewählt und in mehreren Voruntersuchungen überprüft. Hauptinstrument ist ein Fragebogen, der im quasiexperimentellen Design zur Ist-Analyse und nach Umsetzung der Maßnahmen eingesetzt wurde. An der ersten Befragung im Oktober 2000 nahmen 320 Gewerbliche und Angestellte des Unternehmens (Rücklauf 89%), an der zweiten drei Jahre später 402 Mitarbeiter (Rücklauf 91%) teil. Für den Längsschnitt standen die Fragebögen von 118 Mitarbeitern zur Verfügung. Neben den Fragebogendaten wurden personbezogene Daten zum Krankenstand erhoben, die auf freiwilliger Basis mit den Fragebogendaten verknüpft wurden, worauf sich 71% der im Jahr 2000 Befragten und 80% der im Jahr 2003 Befragten einlassen konnten. Zur Absicherung der Validität kamen weitere Untersuchungsmethoden zum Einsatz: für 19 Tätigkeiten wurde eine objektive arbeitspsychologische Tätigkeitsanalyse (Pohlandt, Schulze, Jordan &amp;amp; Richter, 2002) durchgeführt, die beteiligten Bereiche wurden in einem Rankingverfahren durch betriebliche Experten eingeschätzt, die organisationale Einbindung der betrieblichen Gesundheitsförderung wurde zu beiden Untersuchungszeitpunkten mit Hilfe des Fragebogens von Breucker (Prävention online, 2000) erfasst, es fanden 22 strukturierte Interviews mit den Beschäftigten zur Einschätzung der durchgeführten Maßnahmen statt. Die Ergebnisse der ersten Mitarbeiterbefragung wurden zurückgemeldet, diskutiert und zu 12 Maßnahmen verdichtet. Diese 12 Maßnahmen wurden in die Zweitbefragung mit aufgenommen, wobei die aktive Beteiligung an ihnen und die Zufriedenheit mit ihrer Umsetzung eingeschätzt werden sollten. Zur Ermittlung der Effizienz wurden eine erweiterte Kosten-Nutzen-Analyse (nach Schmidt, Hunter &amp;amp; Pearlman, 1982) und eine Kosten-Nutzwert-Analyse (nach Rinza &amp;amp; Schmitz, 1992) durchgeführt. Fast alle im Fragebogen erfassten Variablen hatten sich zwischen der ersten und zweiten Befragung signifikant verbessert (Arbeitsintensität, Tätigkeitsspielraum, Motivationspotenzial der Tätigkeit, soziale Unterstützung, sozialen Stressoren, Commitment, Arbeitszufriedenheit, allgemeines Befinden, psychosomatische Beschwerden). Nicht signifikant waren die Änderungen beim (multimodal beeinflussten) Krankenstand, sowie bei der Einschätzung der Führung. Bezüglich der Effektstärke konnte bei 9 der 12 Maßnahmen mindestens ein positiver Unterscheidungseffekt aufgezeigt werden. Bei der Ermittlung des (subjektiv erlebten) Nutzwertes der Maßnahmen kamen alle 12 Maßnahmen in den positiven Bereich. Mit der Kosten-Nutzen-Analyse wurde ein positives Kosten-Nutzen-Verhältnis für 6 der 9 verbleibenden Maßnahmen (zwischen 1:71 und 1:1,5) ermittelt. Diese Ergebnisse wurden kritisch hinterfragt und durch Einbeziehung von Diskontierung, spezifischen Effizienzkriterien, Sensitivitätsanalysen und Worst-Case-Berechnung relativiert (vgl. Anforderungen nach Drummond, O´Brien, Stoddart &amp;amp; Torrance, 1987/1997). Im Vergleich zur Kosten-Nutzen-Analyse wurden bei der Kosten-Nutzwert-Analyse deutlich andere Rangreihen ermittelt. Die kritische Gesamtschau der Ergebnisse ermöglicht spezifische Empfehlungen für fünf Maßnahmengruppen. Es zeigte sich, dass die gemeinsame Erörterung von Kosten-Nutzen-Analyse und Nutzwert zusätzliche und bisher nicht erfasste Aspekte beim Umgang mit den Maßnahmen eröffnet. / The thesis illustrates a longitudinal study in the paper industry. It shows how effects resulting from measures of occupational health promotion may be translated into an estimated economic advantage. The starting point of the study is the high performance cycle (Locke &amp;amp; Latham: 1990). Proceeding from that, appropriate indicators and measuring instruments were selected and tested in several pre-studies. The main instrument is a questionnaire, used in a comparative design before and after the translation of the measures into practice. 320 white- and blue-collar workers took part in the first survey in October 2000 (response rate 89%), whereas 402 workers participated in the second survey which was conducted three years later (response rate 91%). After all, complete data sets for the longitudinal analysis were available from 118 participants. Apart from that personal data concerning absenteeism were used, which were then connected to the questionnaire data on a voluntary basis. Whereas in 2000, in the first survey, 71% of the participants agreed to the connection of their personal data with the questionnaire, 80% agreed to it in the second survey, in 2003. To guarantee the questionnaire?s validity an array of additional methods was used: an objective occupational job analysis (Pohlandt, Schulze, Jordan &amp;amp; Richter, 2002) of 19 different occupations was carried out and the company?s experts evaluated the branches involved by ranking. Furthermore the organizational embedding of occupational health promotion measures was investigated in both surveys with the help of Breucker?s questionnaire (Prevention online, 2000) and additionally 22 structured interviews with the employees took place in order to evaluate the acceptance of the measures conducted. The results of the first employee survey were reported back, discussed and condensed into 12 measures. These 12 measures were then included in the second survey when the employees? active participation in the measures? implementation and their satisfaction with the measures? effects should be evaluated. To determine the measures? actual efficiency an extended cost-benefit-analysis (with reference to Schmidt, Hunter &amp;amp; Pearlman: 1982) and a cost-utility-analysis (with reference to Rinza &amp;amp; Schmitz: 1992) were conducted. Nearly all variables investigated in the questionnaire had significantly improved between the first and the second survey (indicators of job demands, occupational scope, motivational potential of occupation, social support, social stressors, commitment, job satisfaction, well-being, psychosomatic complaints). Changes in (multi-modally influenced) absenteeism and in the evaluation of the management?s style of leadership were not significant. Referring to the effects? impact 9 out of 12 measures proved to be positively significant in at least one criterion, whereas referring to (subjectively felt) utility all 12 measures turned out to be positively significant. In six of the remaining nine measures the cost-benefit-analysis resulted in a positive cost-benefit-relation (between 1:71 and 1:1,5). These results were critically discussed and taking into account discounting, specific result-criteria, sensitivity analyses and worst case assessment (see quality principles by Drummond, O´Brien, Stoddart &amp;amp; Torrance, 1987/1997) finally adjusted. Comparing the cost-benefit and cost-utility analyses resulted in significantly different rankings. The critical overall view allows for specific recommendations for five measure-groups. Finally, the joint discussion of the cost-benefit analysis and utility turned out to open up additional aspects of how to conduct the measures in future, which have not been described so far.

Les nouvelles technologies médicales contribuent aux dépenses en santé qui ne cessent de croître, alors que les budgets se trouvent limités. L’évaluation économique des technologies devraient permettre d’identifier quelles sont celles qui sont les plus rentables. Malgré cela, plusieurs technologies dont le rapport coût-efficacité reste plutôt limite ou défavorable sont utilisées en médecine moderne et remboursées par notre système public de santé. Ce mémoire se concentre sur deux technologies en santé cardiovasculaire dont le rapport coût-efficacité est plutôt limite mais qui sont fréquemment utilisées au Canada; les tuteurs médicamentés ou pharmaco-actifs et les défibrillateurs cardiaques implantables (DCI). Nous avons fait une évaluation contingente de ces technologies dans le but d’examiner si ce type d’évaluation économique complémentaire pouvait procurer un point de vue nouveau sur la valeur économique et sociétaire des ces technologies. Les résultats de ces deux évaluations indiquent que les patients accordent une grande importance aux bénéfices que procurent ces deux technologies. Nos résultats soutiennent les politiques de santé actuelles de rembourser de façon libérale ces deux technologies. / Technological innovations have greatly contributed to the rising costs in healthcare, while budgets have remained limited. Economic evaluations of technologies should identify which technologies are cost-effective. However, several technologies used in modern medicine are either borderline cost-effective or even not cost-effective according to many studies. This thesis focuses on two technologies in cardiovascular medicine which are considered borderline cost-effective; drug-eluting stents and implantable cardioverter defibrillators. We conducted a contingent valuation of these technologies in hopes of determining if this alternative type of economic evaluation could give a novel point of view on the economic and societal value of these technologies. Results indicated that patients greatly valued benefits provided by these two technologies. Our result support our public healthcare system policies’ of liberal reimbursement of these two technologies.

Introduction : La tyrosinémie de type I est une maladie génétique sévère. Elle se caractérise par des manifestations hépatiques, rénales et neurologiques. Depuis 1994, le NTBC représente la thérapie de première ligne. Ce médicament a conduit à une amélioration radicale de la morbidité et du pronostic de la maladie. Objectif : Évaluer les coûts directs des soins de santé reliés au traitement de cette maladie. Cette évaluation économique a été effectuée en trois groupes dont, un groupe historique de patients non traités; un groupe traitement tardif et un groupe traitement précoce par NTBC. Méthode : L’analyse coûts-conséquences inclut les coûts des hospitalisations, des services médicaux et des thérapies associées. Les données proviennent des banques de la RAMQ, de Med-Echo et des dossiers hospitaliers. Résultats : Le NTBC est associé à une réduction significative des hospitalisations, des séjours aux soins intensifs et des greffes hépatiques. Les coûts hospitaliers sont significativement moindres pour les groupes traités (13 979 $, 6 347 $ et 673 $ par année-patient pour les groupes historique, traitement tardif et traitement précoce,respectivement; valeur p < 0,0001). Les coûts des hospitalisations pour greffes par année-patient sont de 4 676$ pour le groupe historique et de 3 567 $ pour le groupe traitement tardif. Les coûts du NTBC par année-patient sont de 66 965 $ et de 51 493 $ pour les groupes traitement tardif et traitement précoce, respectivement. Conclusion : Les résultats démontrent l’impact majeur du NTBC sur la réduction de l’utilisation des ressources de santé, des greffes hépatiques et des coûts associés. / Introduction : Tyrosinemia type I is a severe genetic disorder. Symptoms include hepatic,renal and neurological manifestations. NTBC became the first-line therapy in 1994. This drug has led to a drastic improvement in the prognosis. Objective : To evaluate direct medical costs of healthcare services related to the treatment for this disease. This economic evaluation was conducted among the 3 following groups: an historical group of untreated patients, a late-treatment group and an early-treatment group with NTBC. Methods : The costs-consequences analysis includes costs incurred by hospitalizations, medical services and related treatments. Data are derived from the RAMQ and Med-Echo administrative databases and patients’ hospital charts. Results : NTBC treatment is associated with a significant reduction in hospitalizations, intensive care unit stays and liver transplantations. The cost of hospitalizations is significantly less for both treated groups (13,979 $, 6,347 $ and 673 $ per year-patient for the historical group, the late-treatment and the early-treatment group, respectively; pvalue< 0,0001). The cost of hospitalizations for liver transplantations per year-patient is 4,676 $ for the historical group and 3,567 $ for the late-treatment group. The cost of NTBC per year-patient is 66,965$ and 51,493$ for the late-treatment and the earlytreatment groups, respectively. Conclusion : These results demonstrate that NTBC treatment results in a major reduction in healthcare resources utilization, liver transplantations and associated costs. / Réalisé dans le cadre d'un mandat de l'Unité d'évaluation des technologies et des modes d'intervention en santé (UETMIS) du CHU Sainte-Justine

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2015-12-09T19:00:22Z No. of bitstreams: 1 Simone Pereira Lermontov.pdf: 27639825 bytes, checksum: 8e739b8c382c9f2fc847de9ba00bbec9 (MD5) / Made available in DSpace on 2015-12-09T19:00:22Z (GMT). No. of bitstreams: 1 Simone Pereira Lermontov.pdf: 27639825 bytes, checksum: 8e739b8c382c9f2fc847de9ba00bbec9 (MD5) Previous issue date: 2010 / Mestrado Acadêmico em Ciências do Cuidado em Saúde / Este estudo objetivou avaliar os custos e consequências do tratamento da pseudartrose com aplicação de células-tronco. A metodologia correspondeu à avaliação econômica parcial do custo e das consequências desse tratamento. O cenário do estudo foi o Hospital Universitário Antonio Pedro e os sujeitos foram oito pacientes operados entre setembro de 2008 e maio de 2009. A perspectiva do estudo foi a do Sistema Único de Saúde, principal fonte de financiamento da assistência médica no Brasil. Para o tratamento estatístico dos dados foram utilizados o software STATISTICA 6.0 e o teste não paramétrico de Spearman. A análise estatística apresentou resultados satisfatórios dentro de uma margem aceitável. O custo total médio do tratamento foi de R$ 1243.199 e o tempo de consolidação foi em média 14.71429 semanas. Observamos através do teste não paramétrico de Spearman que a correlação entre o custo total e o tempo de consolidação é - 0, 5078, uma indicação fraca de que o custo total é inversamente proporcional ao tempo de consolidação. A partir deste estudo, podemos concluir que o custo com o tratamento não foram exorbitantes. O pequeno tamanho da amostra não afetou os resultados de forma significativa, sendo que os achados em relação à idade são parecidos com os de outros estudos, o que nos leva a concluir que a população acometida pela pseudartrose é a economicamente ativa. A criação de um protocolo foi primordial para o levantamento do custo com o tratamento, possibilitando a consolidação dos dados e nos permitindo visualizar de forma mais abrangente o tratamento. O tempo de consolidação foi igual aos melhores resultados vistos em estudo internacionais e o procedimento se mostrou seguro e eficaz. Constatamos que o questionário SF36 é um instrumento de fácil aplicação e foi de confiabilidade no acompanhamento ambulatorial de pacientes submetidos ao tratamento. / The purpose of this study was to evaluate the costs and consequences of the use of stem cells in the treatment of pseudarthrosis. The methodology involved a partial economic assessment of the cost and consequences of this treatment. The study scenario was the Hospital Universitário Antonio Pedro and the subjects were eight patients operated between September 2008 and May 2009. The study perspective was that of the Sistema Único de Saúde, the main financial resource for medical assistance in Brazil. Statistical treatment of the data was performed using the STATISTICA 6.0 application and the Spearman nonparametric test. The results were statistically significant within an acceptable margin of error. The average treatment cost was R$ 1.247,21 and the average time for consolidation was 12.875 weeks. The Spearman nonparametric test showed that the correlation between the total cost and the time for was -0.25, a weak indication that the total cost is inversely proportional to the time for consolidation. From this study, we can conclude that the treatment costs were not prohibitive. The small size of the sample had no significant influence on the results; the agerelated findings are similar to those of other studies and lead to the conclusion that population affected by pseudarthrosis is economically active. The creation of a protocol was essential for cost evaluation, providing a framework for data consolidation and yielding a more general view of the treatment. The time for consolidation was about the same as for the best results reported in the international literature and the procedure was observed to be safe and effective. We concluded that the SF36 questionnaire is an easily applied tool that can be reliably used in the post-treatment follow-up of the patients.

The diploma thesis deals with the proposal to increase labor productivity and economic evaluation in the company EKOSTAVBY Brno. The introductory section describes the theoretical background, the following analysis of the company. The work is based on the current status in the company, focusing mainly on the centre of mechanization and transport. The aim of this paper is to propose certain changes and measures, which would lead to a reduction in the loss rate of the centre.