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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
71

Měření efektivity vzdělávání zaměstnanců společnosti FOXCONN, s.r.o. / Evaluation of Training Effectiveness of FOXCONN, s.r.o. company

Řezáčová, Petra January 2017 (has links)
This thesis deals with the practical aspects of corporate training with the main focus on assessment and measurement of its outputs and effectiveness. The theoretical part introduces to the reader the concepts of corporate education and professional development as well as with their current trends. Next chapters describe the methods of analyzing educational needs and defining development goals. Moreover, various models of assessing the training effectiveness are presented. The application part of this thesis consists of empirical research conducted in the FOXCONN corporation. The purpose of this research was to evaluate training effectiveness of two types of trainings, using Kirkpatrick and Brinkerhoff models, and to address current issues of corporate education and propose solutions to them.
72

Hodnocení efektivnosti investičního projektu ve veřejném sektoru / The evaluation of the effectiveness of the investment project in the public sector

Čelůstka, Tomáš January 2009 (has links)
The aim of this thesis is the evaluation of the effectiveness of the investment project in the public sector. Evaluation is based on C&B analysis, which is primarily intended for evaluating investments and interventions in the public sphere. Its aim is to give all the financial impacts of the project, whether positive or negative in order to evaluate the benefits arising from the implementation in relation to financial investments made in the project. The criterion for the success of these projects is not profit, but social benefits arising from them. The higher these benefits are, the greater is the efficiency of investment. The thesis is divided into three parts (excluding introduction and conclusion). The first section explains the important concepts that readers bring to the evaluation of investment efficiency in the public sector. In the second part contains the theoretical basis from which comes out the practical part. In her is then applied method of CBA and determined the final results.
73

Evaluation du dispositif de surveillance de la tuberculose bovine dans la faune sauvage en France à l'aide de méthodes épidémiologique, économique et sociologique / Evaluation of bovine tuberculosis surveillance system in wildlife in France using epidemiological, economical and sociological methods

Rivière, Julie 27 May 2016 (has links)
Les maladies animales émergentes, les maladies zoonotiques et le développement du commerce international ont conduit à une augmentation des besoins en systèmes de surveillance en santé animale performants. Toutefois, le contexte économique actuel conduit à des restrictions budgétaires importantes, induisant une diminution des ressources allouées à la surveillance. Dans ce contexte, l’évaluation régulière des dispositifs de surveillance, sur lesquels sont fondées les décisions sanitaires, est indispensable afin de vérifier leur bon fonctionnement, la qualité des données collectées, et permettre leur amélioration.Notre travail a porté sur l’évaluation d’un dispositif de surveillance complexe, Sylvatub, le dispositif de surveillance de l’infection à Mycobacterium bovis dans la faune sauvage, constitué de plusieurs composantes de surveillance et ciblant plusieurs espèces sauvages. Nous avons appliqué quatre méthodes d’évaluation : (i) une méthode quantitative d’estimation de la sensibilité de la surveillance par arbres de scénarios, (ii) une méthode quantitative d’estimation des coûts de la surveillance, permettant le calcul d’un ratio coût-efficacité, (iii) une méthode semi-quantitative permettant l’étude du fonctionnement général du dispositif et (iv) une méthode qualitative permettant d’investiguer l’acceptabilité de la surveillance. Ces travaux ont permis d’évaluer le dispositif Sylvatub dans son contexte environnemental et économique, en intégrant des facteurs comportementaux et sociaux, et ont permis la formulation de recommandations pour l’évolution du dispositif et son amélioration.Ces travaux ont également permis de souligner les avantages méthodologiques et opérationnels de l’utilisation complémentaire de plusieurs méthodes pour l’évaluation de dispositifs de surveillance complexes et proposent des perspectives méthodologiques pour favoriser l’intégration des méthodes d’évaluation. L’évaluation du dispositif Sylvatub devra être poursuivie et complétée par celle du dispositif de surveillance en élevage bovin afin d’étudier les interconnexions entre les populations domestiques et sauvages dans ce système multi-hôtes particulier. / Emerging animal diseases, zoonotic diseases and the development of international trade have led to an increase in the need for efficient animal health surveillance systems. However, the current economic environment led to significant budget cuts, resulting in a reallocation of resources dedicated to surveillance. In this context, regular evaluation of surveillance systems, on which are based the health decisions, is essential to ensure their operation, the quality of the collected data and to allow their improvement.This study focused on the evaluation of a complex surveillance system, the Sylvatub network for the surveillance of Mycobacterium bovis infection in wildlife, which consists of several surveillance components focusing on several wild species. We have used four evaluation methods: (i) a quantitative method to estimate the surveillance sensitivity by scenario trees modelling, (ii) a quantitative method to estimate the surveillance costs, enabling the estimation of a cost-effectiveness ratio, (iii) a semi-quantitative method to estimate the global operation of the system, and (iv) a qualitative method to investigate the acceptability of the surveillance. This study allowed to assess the Sylvatub network in its environmental and economical context, with the integration of behavioral and social factors; and allowed the development of recommendations for the evolution of the surveillance system and its improvement.This study has highlighted the methodological and operational advantages of the complementary use of several methods for the evaluation of complex surveillance systems. It provides methodological perspectives to support the integration of evaluation methods. The assessment of the Sylvatub system should be deepened and complemented by the evaluation of the surveillance system in cattle to explore interconnections between domestic and wild populations in this particular multi-host system.
74

Оценка эффективности стратегии развития машиностроительного предприятия : магистерская диссертация / Effectiveness evaluation of the development strategy of a machine-building enterprise

Силин, В. А., Silin, V. A. January 2021 (has links)
Оценка эффективности стратегии развития на машиностроительном предприятии является важным аспектом в экономике предприятия и необходима для обратной связи с целью корректировки стратегии. Целью магистерской диссертации является развитие методических основ оценки эффективности стратегии развития. В работе рассматривается теоретические и методические вопросы исследования оценки эффективности стратегии развития. В качестве источников использовалась научно-исследовательская и методическая литература, нормативно-правовые акты и финансовые отчетности организаций в открытом доступе. В магистерской диссертации была предложена методика оценки эффективности стратегии развития машиностроительного предприятия, дополненная коэффициентами, позволяющими проводить сравнительный анализ стратегий, и коэффициентами результативности деятельности, которые связывают направления стратегии развития с экономическими показателями, что позволяет предприятиям проводить комплексный анализ своей стратегии развития, а также корректировать ее в соответствии с результатами оценки. / Effectiveness evaluation of the development strategy at a machine-building enterprise is an important aspect in the economy of enterprise and necessary for feedback to adjust the strategy. The purpose of the master's thesis is to develop methodological foundations for effectiveness evaluation of the development strategy. The paper deals with the theoretical and methodological issues of the study of effectiveness evaluation of development strategy. Research and methodological literature, regulatory legal acts and financial statements of organizations in the public domain were used as sources. The master's thesis proposed a methodology for evaluating the effectiveness of the development strategy of a machine-building enterprise, supplemented by coefficients that allow to make comparative analysis of strategies and performance coefficients that link the directions of the development strategy with economic indicators, which allows enterprises to conduct a comprehensive analysis of their development strategy, as well as adjust it in accordance with the results of the assessment.
75

The development and validation of an assessment framework for measuring the organisational effectiveness of a metropolitan municipality in South Africa

Olivier, Benjamin Hugh 12 1900 (has links)
The aim of this quantitative study was to develop and validate a model to measure the organisational effectiveness of a metropolitan municipality in South Africa. The literature review phase explored the concept of organisational effectiveness and the assessment thereof in both the Public and Private Sectors. The literature review indicated that there is a clear distinction between business performance (operational and financial performance) and the larger concept of organisational effectiveness, and also that the measurement of organisational effectiveness in the Public Sector differed from the measurement thereof in the Private Sector. The literature review also indicated that measures of Public Sector effectiveness could not be directly applied to measure the effectiveness of Private Sector organisations. From the literature review a proposed theoretical model for measuring the organisational effectiveness of a metropolitan municipality in South Africa was proposed. This proposed model included organisational and behavioural variables contained in traditional approaches to organisational effectiveness, variables that were identified in previous organisational effectiveness studies, as well as variables contained in existing assessment models of organisational effectiveness. This model was then validated during the empirical phase by conducting a survey of an existing metropolitan municipality in South Africa (n = 6514) and exposing the results of the survey to Structural Equation Modelling (SEM). The confirmatory factor analysis conducted as part of SEM subsequently identified three main and 10 secondary statistically significant organisational and behavioural variables that could be used to measure the effectiveness of a metropolitan municipality in South Africa. The three main variables identified were (1) Healthy Systems, (2) Goal Achievement and (3) Service Delivery, while the 10 secondary variables identified were (1) Diversity, (2) Training & Development, (3) Rewards & Recognition, (4) Management Practices, (5) Internal Functioning, (6) Work Environment, (7) Interpersonal Relations, (8) Workforce Equity, (9) Customer Satisfaction and (10) Vision & Mission. It was thus recommended that metropolitan municipalities in South Africa could use this validated model as an assessment framework to measure their current organisational effectiveness, to identify aspects which need to be rectified to improve effectiveness, and to compare and benchmark their municipality in order to learn from other metropolitan municipalities to improve their effectiveness. / Industrial & Organisational Psychology / D. Admin. (Industrial and Organisational Psychology)
76

Evaluating value based financial performance measures

Erasmus, Petrus Daniel 03 1900 (has links)
Thesis (PhD (Economics))--University of Stellenbosch, 2008. / The primary financial objective of a firm is the maximisation of its shareholders’ value. A problem faced by the shareholders of a firm is that it is difficult to determine the effect of management decisions on the future share returns of the firm. Furthermore, it may be necessary to implement certain monitoring costs to ensure that management is focused on achieving this objective. A firm would, therefore, benefit from being able to identify those financial performance measures that are able to link the financial performance of the firm to its share returns. Implementing such a financial performance measure in the valuation and reward systems of a firm should ensure that management is aligned with the objective of shareholder value maximisation, and rewarded for achieving it. A large number of traditional financial performance measures have been developed. These measures are often criticised for excluding a firm’s cost of capital, and are considered inappropriate to be used when evaluating value creation. Furthermore, it is argued that these measures are based on accounting information, which could be distorted by Generally Accepted Accounting Practice (GAAP). Studies investigating the relationship between these measures and share returns also provide conflicting results. As a result of the perceived limitations of traditional measures, value based financial performance measures were developed. The major difference between the traditional and value based measures is that the value based measures include a firm’s cost of capital in their calculation. They also attempt to remove some of the accounting distortions resulting from GAAP. Proponents of the value based measures present these measures as a major improvement over the traditional financial performance measures and report high levels of correlation between the measures and share returns. A number of studies containing contradictory results have been published. On the basis of these conflicting results it is not clear whether the value based measures are able to outperform the traditional financial performance measures in explaining share returns. The primary objectives of this study are thus to: • Determine the relationship between the traditional measures earnings before extraordinary items (EBEI) and cash from operations (CFO), and shareholder value creation; • Investigate the value based measures residual income (RI), economic value added (EVA), cash value added (CVA) and cash flow return on investments (CFROI), and to determine their relationship with the creation of shareholder value; • Evaluate the incremental information content of the value based measures above the traditional measures. The information content of the traditional measures and the value based measures are evaluated by employing an approach developed by Biddle, Bowen and Wallace (1997). The first phase of this approach entails the evaluation of the relative information content of the various measures in order to determine which measure explains the largest portion of a firm’s market-adjusted share returns. The second phase consists of an evaluation of the incremental information content of the components of a measure in order to determine whether the inclusion of an additional component contributes statistically significant additional information beyond that contained in the other components. The study is conducted for South African industrial firms listed on the Johannesburg Securities Exchange for the period 1991 to 2005. The data required to calculate the measures investigated in the study are obtained from the McGregor BFA database. This database contains annual standardised financial statements for listed and delisted South African firms. It also contains EVA, cost of capital and invested capital amounts for those firms listed at the end of the research period. Including only these listed firms in the research sample would expose the study to a survivorship bias. Hence these values are estimated for those firms that delisted during the period under review by employing a similar approach to the one used in the database. The resulting sample consists of 364 firms providing 3181 complete observations. Since different information is required to calculate the various measures included in the study, different samples are compiled from this initial sample and included in the tests conducted to evaluate the information content of the measures. The results of this study indicate that the value based measures are not able to outperform EBEI in the majority of the relative information content tests. Furthermore, the measures EVA, CVA and CFROI are also not able to outperform the relatively simple value based measure RI. The results from the incremental information content tests indicate that although some of the components of the value based measures provide statistically significant incremental information content, the level of significance for these relatively complex adjustments is generally low. Based on these results, the claims made by the proponents of the value based measures cannot be supported. Furthermore, if a firm intends to incorporate its cost of capital in its financial performance measures, the measure RI provides most of the benefits contained in the other more complex value based measures.
77

The relationship between student perceptions of teachers and classrooms, teacher goal orientation toward teaching, and student ratings of teacher effectiveness

Riekenberg, Janet Jester 30 September 2010 (has links)
The concept of teaching effectiveness is challenging for researchers to define. Hypothesized as a multidimensional construct, it encompasses content knowledge, pedagogical knowledge, personality characteristics of the teacher, and classroom dynamics. No single dimension, trait, or behavior, however, fully captures what it means to be an effective teacher. Measures, such as peer observation, self-report surveys, and student evaluations, assess teacher effectiveness in higher education. Student evaluations of teachers (SETs) assess multiple areas, including: course content, objectives, organization, and the nature, difficulty, and value of a course; teacher preparation, enthusiasm, and subject knowledge; teacher goals for structuring classroom activities and engaging students in academic pursuits (Cashin, 1995; Feldman, 1996; Marsh, 1984; Midgley, 1998). SETs can be seen as expressions of students’ perceptions about an instructor, a course, and a class, but what influences those perceptions? One concept, classroom community, hypothesizes that students’ sense of community is influenced by the quality of interaction with their instructors, fellow students, and course content. Investigations of classroom community associate higher sense of community with more positive academic outcomes. Teachers’ goals for structuring class activities and engaging students is another concept hypothesized to influence students’ perceptions. Teachers’ goal orientation towards their own teaching is also a factor that appears to influence academic outcomes. Using goal orientation theory, Kucsera, Roberts, Walls, Walker & Svinicki (2009) identified three orientations that influence how teachers approach teaching. To date little research has explored how teacher goal orientation might influence students’ perceptions. This study examined whether there is a relationship between teachers’ goal orientation towards their teaching, students’ perceptions of teacher goals for classroom structure and student engagement, sense of community, and student ratings of teacher effectiveness. Undergraduate business communications faculty completed a survey about their goals for their own teaching while their students took a survey about their sense of community in the classroom, their perceptions of their teachers’ goals for engaging them in academic work and an end-of-semester course instructor survey. Hierarchical linear modeling was used to analyze the data. Results generally indicated that students’ perceptions are associated with SETs outcomes while teachers’ goal orientations are not. / text
78

Impacto dos medicamentos imunobiológicos e da doença coronária na evolução de pacientes com artrite reumatoide: uma análise de custo-efetividade / Impact of immunobiological drugs and coronary disease evolution of patients with rheumatoid arthritis: a cost-effectiveness analysis

Gomes, Rafael Kmiliauskis Santos 02 June 2017 (has links)
Introdução: Estudos epidemiológicos têm estabelecido que a artrite reumatoide está associada com um aumento de doença cardiovascular. A avaliação de anti-TNF sobre a redução do risco de infarto agudo do miocárdio e óbito por causa cardiovascular tem demonstrado resultados promissores. A avaliação econômica para esses desfechos ainda não está estabelecida. Objetivo: Realizar uma análise de custo efetividade de anti-TNF versus Dmards para evitar um caso novo de morbidade e óbito cardiovascular na artrite reumatoide. Método: Foi realizada uma análise de custo efetividade por meio do modelo de Markov, ciclo de transição de 6 meses e horizonte temporal de 30 anos sob perspectiva do sistema público de saúde do Brasil mensurado pela razão de custo efetividade incremental. Custo em Reais no ano de 2015 e efetividade em evitar um caso novo de doença coronariana isquêmica aguda e óbito cardiovascular. Resultados: O custo médio em 30 anos de Dmards e anti-TNF foi de R$ 14.291.105,28 e R$ 96.151.873,86, respectivamente. A efetividade incremental para doença arterial coronariana foi de 2,69 e consequente razão incremental de custo efetividade de R$ 30.527.502,27, enquanto para óbito cardiovascular a efetividade incremental foi de 1,33 casos evitados e uma razão incremental de custo efetividade de R$ 61.634.231,69. A análise univariada identificou que o parâmetro de maior impacto na razão incremental de custo efetividade de ambos os desfechos foi o medicamento anti-TNF. A análise de sensibilidade estabeleceu que, para atingir o valor de disposição a pagar por semestre para evitar um infarto agudo do miocárdio, o custo médio do anti-TNF deveria ser de R$ 1.337,47 ou diferença de incidência entre as estratégias de 0,032. Ainda, para evitar um óbito cardiovascular, o custo médio deveria ser de R$ 954,22 ou diferença de incidência de 0,071. Todas as análises realizadas estabeleceram uma relação desfavorável da estratégia do tratamento medicamentoso com anti-TNF. Conclusão: Os achados da análise de custo efetividade entre pacientes com artrite reumatoide para desfecho cardiovascular quando comparada a estratégia de tratamento medicamentoso de anti-TNF em relação à estratégia dominante com Dmards após os 6 primeiros meses de exposição aos medicamentos apontaram para uma relação desfavorável, ultrapassando o valor de disposição a pagar recomendado pelo Ministério da Saúde do Brasil no ano de 2015. Descritores: artrite reumatoide; doenças cardiovasculares; infarto do miocárdio; óbito; avaliação de custo-efetividade; anti fator de necrose tumoral; drogas anti-reumáticas modificadoras de doença. / Introduction: Epidemiological studies have established that rheumatoid arthritis is associated with an increase in cardiovascular disease. The evaluation of anti-TNF on the reduction of the risk of acute myocardial infarction and death due to cardiovascular causes has shown promising results. The economic evaluation for these outcomes is not yet established. Objective: To perform a cost-effectiveness analysis of anti-TNF versus Dmards to avoid a new case of cardiovascular morbidity and death in rheumatoid arthritis. Method: A cost effectiveness analysis was performed using the Markov model, a 6-month transition cycle and a 30-year time horizon under the perspective of the Brazilian public health system measured by the incremental cost-effectiveness ratio. Cost in Reais in the year 2015 and effectiveness in avoiding a new case of acute ischemic coronary disease and cardiovascular death. Results: The average cost in 30 years of Dmards and anti-TNF was R$ 14,291,105.28 and R$ 96,151,873.86, respectively. The incremental effectiveness for coronary artery disease was 2.69 and a consequent incremental cost-effectiveness ratio of R$ 30,527,502.27, while for cardiovascular death, incremental effectiveness was 1.33 cases avoided and an incremental cost-effectiveness ratio of R$ 61,634,231.69. The univariate analysis identified that the parameter of greatest impact in the incremental cost-effectiveness ratio of both outcomes was the anti-TNF drug. The sensitivity analysis established that the average cost of anti-TNF should be R$ 1,337.47 or incidence difference between strategies of 0.032 in order to reach the amount of willingness to pay per semester to avoid an acute myocardial infarction. Also, to avoid a cardiovascular death, the average cost should be R$ 954.22 or incidence difference of 0.071. All the analyzes carried out established an unfavorable relationship of the drug treatment strategy with anti-TNF. Conclusions: The findings of the cost-effectiveness economic analysis among individuals with rheumatoid arthritis for cardiovascular outcome when compared to the strategy of anti-TNF drug treatment compared to the dominant strategy with Dmards after the first 6 months of drug exposure pointed to an unfavorable relationship, surpassing the amount of willingness to pay recommended by the Ministry of Health of Brazil in the year 2015.
79

Estudo comparativo entre os custos dos tratamentos clínico, cirúrgico e percutãneo em portadores de doença multiarterial coronária estável: 10 anos de seguimento / Comparative study between the costs of clinical, surgical and percutaneous treatments in patients with stable coronary multiple arterial disease: 10 years\' follow-up

Magalhães, Cibelle Dias 21 September 2017 (has links)
Introdução: Análise da custo-efetividade no tratamento da doença multiarterial coronária têm ganhado importância nos ensaios clínicos, uma vez que as principais opções terapêuticas: cirurgia de revascularização miocárdica (CRM), intervenção coronária percutânea (ICP) e tratamento medicamentoso (TM) apresentam eficácia similar em determinados subgrupos de pacientes. Atualmente os interesses direcionados à análise econômica têm crescido, uma vez que os gastos na saúde aumentaram com o desenvolvimento de novas tecnologias, porém os recursos disponíveis são finitos e merecem ser administrados. Objetivo: Analisar, prospectivamente, o custo comparativo das três formas terapêuticas da doença multiarterial coronária estável, durante dez anos de seguimento. Métodos: Foi computado o custo terapêutico global de 611 pacientes do ensaio clínico The Second Medicine, Angioplasty, or Surgery Study (MASS II), baseado na remuneração fornecida pelo sistema de saúde suplementar do Instituto do Coração do HC/FMUSP, utilizando valores em dólares. Posteriormente, a análise de custoefetividade foi realizada corrigindo o custo cumulativo obtido em cada grupo para o \"tempo livre de eventos clínicos\" e também para a combinação de \"tempo livre de eventos\" acrescido de \"tempo livre de angina\". Resultados: O TM apresentou um custo cumulativo ao final de dez anos de US$6.183; o ICP apresentou um custo de US$14.292; e o grupo CRM apresentou um custo de US$12.316. Os custos corrigidos para sobrevida livre de eventos foram, US$11.136 para TM; US$26.912 para ICP e US$17.883 para CRM. Houve diferença estatisticamente significativa entre os 3 grupos (p < 0,0001) e a análise pareada, mostrou um menor custo para o grupo tratamento clínico tanto comparado com CRM (p < 0,0001) quanto comparado com ICP (p < 0,0001). O tratamento CRM contra ICP, também mostrou menor custo (p < 0,0001). Os custos corrigidos para sobrevida livre de eventos e angina foram, US$25.690 para TM; US$45.989 para ICP e US$27.920 para CRM; com expressiva diferença entre os 3 grupos (p < 0,0001). Na comparação dos grupos, observou-se um menor custo no grupo tratamento clínico comparado com ICP (p < 0,0001), o grupo angioplastia também teve um maior custo quando comparado com o grupo cirúrgico (p < 0,001). Contudo entre o grupo tratamento medicamentoso e tratamento cirúrgico não houve diferença significativa (p=0,5613). Conclusão: A análise econômica comparativa de longa data, revelou que ICP foi o tratamento menos custo-efetivo. O tratamento medicamentoso foi o mais custo-efetivo na prevenção de eventos, porém na prevenção de eventos e angina, teve custo-efetividade semelhante ao tratamento cirúrgico / Introduction: The cost-effectiveness analysis in multivessel coronary artery disease treatment have gained importance in clinical trials, since the main treatment options: coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI) and medical treatment (MT) have similar efficacy in certain subgroups of patient. Currently, the concernment in economic analysis have grown, since Medical Treatment costs have increased with the constant development of new technologies, but the available budget are finite and should be administered. Objective: prospectively analyze the comparative cost of the three medical treatments for stable multivessel coronary artery disease, during ten years follow-up. Methods: It was calculated the overall therapeutic cost of 611 patients in the clinical trial \"The Second Medicine, Angioplasty, or Surgery Study (MASS II) \", considering the remuneration provided by the health insurance system of the Heart Institute of HC/FMUSP converted to dollar currency. Afterward, the costeffectiveness analysis was conducted by adjusting the cumulative cost obtained at each group for the \"time free of clinical events\" and also for the combination of \"time free of events\" and \"time free of angina\". Results: The MT had a cumulative cost, at the end of ten years, of US$ 6,183.00; PCI had a cost of US$ 14,292.00; and the CABG group had a cumulative cost of US$ 12,316.00. The costs adjusted for \"events-free survival\" were US$ 11,136.00 for MT; US$ 26,912.00 for PCI and US$ 17,883.00 for CABG. There was a statistically significant difference between the 3 groups (p < 0.0001) and paired analysis showed lower cost for the medical treatment group compared with CABG (p < 0.0001) and PCI (p < 0.0001). The CABG compared with PCI also showed lower cost (p < 0.0001). The adjusted costs for \"survival free of clinical events and angina\" were US$25,690.00 for MT; US$45,989.00 for PCI and US$27,920.00 for CABG; with a significant difference between the 3 groups (p < 0.0001). Comparing the groups, it can be seen a lower cost in the medical treatment group, compared with CABG (p < 0.0001), and also in comparison with PCI (p < 0.0001). However, the comparison between the medical treatment group and surgical treatment group showed no significant difference (p=0.5613). Conclusion: The long-term comparative economic analysis revealed that PCI showed up to be the least cost-effective treatment. The medical treatment was the most cost-effective in \"events prevention\", but considering \"events and angina prevention\", it had a cost-effectiveness similar to surgical treatment
80

Análise de custo-efetividade de estratégias de rastreamento do câncer do colo do útero no Brasil / Cost-effectiveness analysis of cervical cancer screening strategy in Brazil

Viscondi, Juliana Yukari Kodaira 22 November 2017 (has links)
O câncer do colo do útero é o quarto tipo de câncer mais frequente em mulheres em todo mundo. No Brasil, estima-se que cerca de 16 mil novos casos ocorrem por ano. A redução deste tipo de câncer ao longo dos anos deve-se ao rastreamento das lesões intraepiteliais cervicais por meio do exame citológico de Papanicolaou. Em 2014, o Programa Nacional de Imunização (PNI) introduziu a vacina contra o papilomavírus humano (HPV) como prevenção primária deste câncer, uma vez que este vírus é uma causa necessária para o surgimento desta malignidade. A vacinação não substitui o rastreamento, visto que não há proteção contra todos os tipos de HPV de alto risco e nem imunização de toda a população. A incorporação do programa de vacinação interfere nos resultados do programa de rastreamento, pois leva a diminuição dos casos de câncer e lesões precursoras. Desta forma, existe a necessidade de explorar novas estratégias de rastreamento, considerando também outras tecnologias existentes. Objetivo: desenvolver um modelo do tipo Markov para realizar uma análise de custo-efetividade de estratégias de rastreamento do câncer do colo do útero para hipotéticas coortes imunizadas e não imunizadas contra o vírus do HPV no Brasil na perspectiva do Sistema Único de Saúde (SUS). Métodos: A primeira parte é a exploração e avaliação qualitativa de estudos de avaliação econômica sobre estratégias de rastreamento para prevenção do câncer do colo do útero que utilizaram um modelo do tipo Markov feita por meio de uma revisão sistemática. A reunião das várias abordagens utilizadas e das principais características destes modelos poderá auxiliar a construção de um modelo em cenários onde há poucos profissionais capacitados com esta técnica. Baseando-se nesta revisão e nas consultas a especialistas das áreas de ginecologia, virologia e epidemiologia, foi desenvolvido um modelo matemático de análise de decisão estático do tipo Markov que simula a história natural do câncer do colo do útero considerando a imunização contra o HPV. Este modelo simula o seguimento de uma coorte de mulheres, dos 10 anos até o óbito, cujos parâmetros foram estimados a partir de dados secundários (revisão da literatura, sistemas de informação em saúde e inquéritos populacionais) nacionais específicos do rastreamento e calibrados de forma a refletir as condições reais de rastreamento encontradas no Brasil. Resultados: A revisão dos modelos de Markov para avaliação econômica de estratégias de rastreamento do câncer do colo do útero mostrou que a declaração do problema e a descrição das estratégias a serem comparadas foram muito bem relatados. Em contrapartida, os itens de avaliação da incerteza e consistência do modelo e a consistência precisam melhorar o relato. Os resultados obtidos por meio da calibração do modelo se mostraram satisfatórios, pois alcançaram uma boa concordância com os dados empíricos. A análise do caso base sugeriu que a melhor estratégia foi o Teste HPV-DNA como triagem para o encaminhamento da citologia ou da colposcopia, com repetição a cada 5 anos, para mulheres entre 30 e 70 anos. Esta estratégia promove um ganho de 9,5 dias ao longo dos anos e detecta, a cada 100 mil mulheres, 6 casos a mais de câncer e 16 de NIC II/III. A razão de custo-efetividade incremental (RCEI) foi de R$16.056,94 por ano de vida ganho, na perspectiva do sistema de saúde. Conclusão: Estudos futuros devem considerar metodologias que levem em conta a incerteza, a heterogeneidade e a consistência no modelo de decisão e utilizar diretrizes validadas para o relato do estudo / Cervical cancer is the fourth most common cancer in women worldwide. In Brazil, it is estimated that around 16,000 new cases occur per year. The reduction of this type of cancer over the years owes to cervical intraepithelial lesions screening through pap smears. In 2014, the National Immunization Program (NIP) introduced a vaccine against human papillomavirus (HPV) as the primary prevention of this cancer, since this virus is a necessary cause for the onset of this malignancy. Vaccination does not replace screening because there is no protection against all types of high risk HPV nor immunization of the entire population. Incorporation of the vaccination program interferes with the results of the screening program, leading to a decreased number of cancer cases and precursor lesions. In this way, there is a need to explore new screening strategies, also considering other existing technologies. Objective: Determining a Markov based model to perform a cost-effectiveness analysis of cervical cancer screening strategies for hypothetical immunized and non-immunized cohorts against the HPV in Brazil from the perspective of the Unified Health System (UHS). Methods: The first part is a qualitative appraisal and assessment of economic evaluation studies on screening strategies for cervical cancer prevention using a Markov based model done through a systematic review. The combination of different approaches and of the main features of these models can be auxiliary in the construction of a model in scenarios where there are few professionals trained with this technique. Based on this review and consultations with specialists in the areas of gynecology, virology and epidemiology, a Markov model for decision analysis was developed, which simulates the natural history of cervical cancer considering immunization against HPV. This model simulates the follow-up of a cohort of women, from 10 years-old to death, whose parameters were estimated from secondary data, particular to screening and calibrated in order to reflect real screening conditions found in Brazil. Results: A review of Markov models for economic evaluation of cervical cancer screening strategies showed that the report of the problem statement and the description of the compared strategies were well conducted. In contrast, the uncertainties of the model and the consistency were the worst items. The results obtained by calibration of the model were satisfactory, since a good agreement with empirical data was achieved. The baseline case analysis suggested that the best strategy was the HPV-DNA Test as triage for cytology or colposcopy referral, repeated every 5 years, for women between 30 and 70 years-old. This strategy promotes a gain of 9.5 days over the years and detects, every 100,000 women, 6 cases of cancer and 16 of CIN 2/3. The incremental cost-effectiveness ratio (ICER) was R$16,056.94 per life years gained from the health system perspective. Conclusion: Future studies should consider methodologies that take into account uncertainty, heterogeneity and consistency in the decision model and use validated guidelines for the study report

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