<p>With 7 000 new cases in Sweden each year, breast cancer represents 30 percent of all female malignancies and is therefore the most commonly diagnosed cancer among women. There are limitations as to what can be done to prevent the disease but with the use of mammography screening the chances of finding and treating the disease at an early stage are increasing. Unfortunately, mammography screening is associated with radiation, which is an established risk factor for developing breast cancer. However, the newest screening technologies come with a reduced dose which decreases the risk of developing breast cancer due to the radiation.</p><p> </p><p>The effects of this lower dose compared to that of traditional technologies have not yet been studied and the purpose of this paper is therefore to assess the cost-effectiveness of the use of this new technology, with a focus on the number of radiation-induced cancers. A cost-utility analysis was performed where three different mammography technologies (one analogue and two digital) were compared. The total costs and QALYs of breast cancer generated by the use of these three technologies were calculated with the use of a Markov decision-analytic model, where a cohort of hypothetical 40 year-old women was followed throughout life.</p><p> </p><p>The results of the analysis showed that with the new digital technology (the PC-DR), one in 14 100 screened women develops breast cancer due to radiation while with the traditional mammography systems (SFM and the CR) this number is one in 3 500 and 4 300 screened women, respectively. Consequently, the number of induced cancers is decreased with up to 75 percent with the use of the PC-DR. Assuming that only the radiation dose differs between the three units, the analysis resulted in an incremental effect of 0.000269 QALYs over a life-time for the PC-DR when compared to SFM(0.000210 QALYs compared to the CR). The PC-DR was also associated with a 33 SEK (26 SEK) lower cost. Thus, if the only difference can be found in radiation dose, the PC-DR is the dominating technology to use since it is both more effective and costs less. However, it is possible that the PC-DR is more expensive per screening occasion than the other technologies and if so, the PC-DR would no longer be less costly. The study found that the scope for the possibility of excessive pricing is very small and under these circumstances, the willingness to pay for a QALY has to be considered when deciding what technology to invest in.</p>

Hepatitis B virus (HBV) infection is a global leading cause of death as a result of its role in the development of cirrhosis, hepatic decompensation, and hepatocellular carcinoma (HCC). In industrialized nations such as the United States, chronic hepatitis B infection represents a significant and disproportionate disease burden among the foreign-born population. A Markov cohort decision model was developed to determine the cost-effectiveness of HBV screening among new immigrants for the purposes of early detection and treatment, as compared to usual care. The incremental cost-effectiveness ratio for the screening strategy was $45,570 per quality adjusted life year saved. Given the potential for health gains for the immigrant cohort as well as the economic attractiveness of the intervention, some consideration should be given to the addition of a universal HBV screening program to U.S. immigration policy.

Hepatitis B virus (HBV) infection is a global leading cause of death as a result of its role in the development of cirrhosis, hepatic decompensation, and hepatocellular carcinoma (HCC). In industrialized nations such as the United States, chronic hepatitis B infection represents a significant and disproportionate disease burden among the foreign-born population. A Markov cohort decision model was developed to determine the cost-effectiveness of HBV screening among new immigrants for the purposes of early detection and treatment, as compared to usual care. The incremental cost-effectiveness ratio for the screening strategy was $45,570 per quality adjusted life year saved. Given the potential for health gains for the immigrant cohort as well as the economic attractiveness of the intervention, some consideration should be given to the addition of a universal HBV screening program to U.S. immigration policy.

With 7 000 new cases in Sweden each year, breast cancer represents 30 percent of all female malignancies and is therefore the most commonly diagnosed cancer among women. There are limitations as to what can be done to prevent the disease but with the use of mammography screening the chances of finding and treating the disease at an early stage are increasing. Unfortunately, mammography screening is associated with radiation, which is an established risk factor for developing breast cancer. However, the newest screening technologies come with a reduced dose which decreases the risk of developing breast cancer due to the radiation.   The effects of this lower dose compared to that of traditional technologies have not yet been studied and the purpose of this paper is therefore to assess the cost-effectiveness of the use of this new technology, with a focus on the number of radiation-induced cancers. A cost-utility analysis was performed where three different mammography technologies (one analogue and two digital) were compared. The total costs and QALYs of breast cancer generated by the use of these three technologies were calculated with the use of a Markov decision-analytic model, where a cohort of hypothetical 40 year-old women was followed throughout life.   The results of the analysis showed that with the new digital technology (the PC-DR), one in 14 100 screened women develops breast cancer due to radiation while with the traditional mammography systems (SFM and the CR) this number is one in 3 500 and 4 300 screened women, respectively. Consequently, the number of induced cancers is decreased with up to 75 percent with the use of the PC-DR. Assuming that only the radiation dose differs between the three units, the analysis resulted in an incremental effect of 0.000269 QALYs over a life-time for the PC-DR when compared to SFM(0.000210 QALYs compared to the CR). The PC-DR was also associated with a 33 SEK (26 SEK) lower cost. Thus, if the only difference can be found in radiation dose, the PC-DR is the dominating technology to use since it is both more effective and costs less. However, it is possible that the PC-DR is more expensive per screening occasion than the other technologies and if so, the PC-DR would no longer be less costly. The study found that the scope for the possibility of excessive pricing is very small and under these circumstances, the willingness to pay for a QALY has to be considered when deciding what technology to invest in.

Breast cancer is a common disease in Australia and exerts a sizable burden to individuals, families, and health care resources. Studies that assess healthrelated quality-of-life (HRQoL) are particularly relevant as survivors must learn to live with breast cancer, undergo prolonged treatment, use new pharmacological agents, monitor and adjust to a serious condition. Relatively little published evidence exists on the effects of rehabilitation programs for breast cancer survivors but those published demonstrate positive health benefits that alleviate both physical and psychological problems. This study aimed to partly fill this gap and had the objectives of: a) estimating the effectiveness of two rehabilitation interventions for breast cancer survivors over time compared to a non-intervention comparison group; and b) ascertaining which option was cost-effective when taking a societal perspective. Effectiveness was described in terms of HRQoL and functional status and there was a particular focus on upperbody morbidity since the two interventions primarily addressed this aspect of rehabilitation. The study participants comprised three groups: one group received a physiotherapy home-visits service (DAART), the second attended a gentleexercise group program (STRETCH), while the third represented a nonintervention comparison group for later analyses only. Data collection was primarily by way of postal questionnaires while medical and cost data abstraction was also necessary. Reliable and validated instruments were used to collect HRQoL and utility data. The Functional Assessment of Cancer Therapy - Breast Cancer plus the Arm Morbidity module (FACT-B+4), Disabilities of the Arm, Shoulder and Hand (DASH), and the Subjective Health Estimation (SHE) instruments were chosen for their high psychometric performance with various populations, their brevity, quick administration and relevance to a breast cancer sample. Missing data was a small concern overall, however, baseline differences were present and mixed across the three participant groups indicating selection bias was present. DAART showed poorer demographic indicators of socioeconomic status and were older, STRETCH participants had poorer disease and treatment profile, while the non-intervention women had poorer general health characteristics. Based on bivariate analyses, age, presence of comorbidities, chemotherapy, high blood pressure, work status (unpaid/paid), hormone therapy were determined to be factors requiring control for in the multivariate analyses. Benefits were found for multiple dimensions of HRQoL for the DAART intervention. On average, HRQoL levels were fairly high across the three alternative participant groups and no significant group differences were found. However, approximately one-third of the women experienced declining HRQoL between 6- to 12-months and their scores were significantly poorer than other participants. STRETCH incurred higher overall costs per participant (on average) than DAART and the non-intervention groups. This was driven by higher leisure time forgone, travel and higher community costs. DAART experienced the highest program costs (or health system costs). Therefore, by taking a societal perspective, and incorporating the estimated value of more intangible or indirect costs (e.g., volunteers, travel costs etc.) the STRETCH program was more costly. The greatest influence on higher costs incurred by the STRETCH participants was the average out-of-pocket expenses for health care services purchased during the previous 12 months for breast cancer-related problems. Although an exploratory finding, the DAART group emerged as the cost-effective option, that is, the incremental cost per QALY gained was $1,344 compared to STRETCH $14,478. The key drivers in the cost-effectiveness modelling were utility values and health service expenditure. When uncertainty was quantified by way of Monte Carlo modelling, DAART remained the cost-effective choice. This project has highlighted that while many women seem to breeze through their breast cancer diagnosis and treatment, there are a substantial number of women who do not. Therefore, it is quite mistaken to generalise the favourable levels of HRQoL and expect that all women will get back to 'normal'. Given that HRQoL is a very complex concept, it was important to use validated tools that had undergone extensive testing with sound psychometric properties. Health care activities observed in their natural 'real world' setting are preferable to minimise biases that may cause more favourable results than truly occur and allow a better assessment on the impact of the service. The project findings have been interpreted while respecting a number of limitations. These have included potential selection and response bias, missing data, and small numbers of intervention women and defined socio-demographic profiles. Taken together, these are likely to overestimate the true outcomes. Arguably, selection bias and the timing of the interventions are likely to be the strongest factors affecting the generalisability of these findings. Given the caveats of this research, the following recommendations were made: 1. Greater awareness and/or screening of adjustment problems among survivors needs to be considered during recovery from breast cancer surgery. 2. Early physiotherapy should be given to all breast cancer survivors after surgery due to the potential functional, physical and overall HRQoL benefits that may arise. 3. Professionally-led group exercise therapy with psychosocial care appears to have a neutral effect on upper-body recovery and improving HRQoL. However, it provides advantages for attendees in the form of peersupport, education, a holistic focus and the potential for addressing previously unrecognised psychological problems in a caring and acceptable environment. This program, with large community resources (provided voluntarily), represents a very low-cost outlay for health services and should be given support and consideration during follow-up care after breast surgery. 4. From a societal perspective, a home-visiting physiotherapy service represents a cost-effective means to provide rehabilitative care for breast cancer patients and represents an excellent public health investment. Several topics for further research are likely to be important in the future including, among others, other modes and settings of rehabilitation service delivery, barriers to psychosocial care and the indirect financial and work consequences of having breast cancer.

A albumina humana (AH) é um medicamento de ampla utilização e de custo elevado que integra o elenco de procedimentos especiais do Ministério da Saúde no Brasil. Em 2004, a ANVISA publicou uma resolução que estabelece diretrizes para o uso terapêutico deste medicamento. Apesar dos dados da literatura sugerirem conclusões não definitivas sobre os reais benefícios do uso de albumina no tratamento de pacientes com síndrome nefrótica (SN), a diretriz recomenda o uso nos casos de edemas refratários ao uso de diuréticos. O objetivo deste estudo foi avaliar através de análises econômicas a indicação clinica da diretriz para uso de Albumina Humana da ANVISA, em pacientes com Síndrome Nefrótica. A partir de uma coorte concorrente foram realizadas análises econômicas dos tipos custo-efetividade e custoutilidade. A população do estudo foi constituída por pacientes adultos e pediátricos internados com síndrome nefrótica em quatro grandes hospitais do SUS do Estado da Bahia. Os pacientes incluídos foram divididos em dois grupos comparativos conforme o seguimento ou não das orientações de uso de albumina humana da diretriz da ANVISA. A perspectiva da análise econômica foi sobre o provedor de atenção à saúde, o SUS. Os dados de qualidade de vida dos pacientes foram obtidos através de aplicação dos questionários genéricos SF36 e CHQ-PF50. O índice QALY (anos de vida ajustados à qualidade de vida) foi utilizado para a avaliação de custo-utilidade da comparação. Ao final do estudo foram selecionados 109 pacientes, com 60% de adultos, 56% do gênero feminino, mais de 90% de negros e pardos tendo 41,3% seguido as diretrizes da ANVISA. O custo médio global por internação (média de 22 dias) para o SUS foi de R$ 2.360/paciente. Os parâmetros de efetividade analisados, peso, diurese e balanço hídrico foram mais efetivos em termos de custo para os pacientes que seguiram a diretriz. A RCEI para dias de internação evitados evidenciou um custo adicional de R$55,33/dia evitado. A análise de qualidade de vida demonstrou que seguir a diretriz dominou o não seguimento propiciando um acréscimo de 8% de qualidade de vida e gerando uma economia de R$ 3.458,13 por QALY ganho. As análises de sensibilidade das RCEI e RCUI evidenciaram a robustez dos resultados, principalmente na variação do QALY, que mesmo após 60% de variabilidade garantiu economia para o sistema. Os resultados deste estudo forneceram informações sobre o uso de albumina humana em pacientes com síndrome nefrótica que podem juntamente com outros dados nortear as práticas de saúde no SUS do ponto de vista clinico e econômico. As análises econômicas indicaram que apresentam melhores relações de custo-efetividade e custo utilidade os tratamentos dos pacientes que seguiram as orientações da diretriz da ANVISA. / Human albumin (HA) is a drug widely used and of high cost that integrates the cast of special procedures of the Ministry of Health in Brazil. In 2004, ANVISA issued a resolution establishing guidelines for the therapeutic use of this drug. Although data from the literature suggest no definite conclusions about the real benefits of the use of albumin in the treatment of patients with nephrotic syndrome (NS), the guideline recommends the use in cases of edema refractory to diuretics. The aim of this study was to evaluate economic analyzes through the clinical indication of guideline for use of Human Albumin ANVISA, in patients with nephrotic syndrome. Economic analyzes of both cost-effectiveness and cost-utility types were performed from a concurrent cohort. The study population was composed of adult and pediatric patients hospitalized with nephrotic syndrome in four major public hospitals in the State of Bahia. The included patients were divided into two distinct groups according to whether ANVISA’s guidelines for use of human albumin were followed by them or not. The economic perspective of the analysis regarded the health care provider, the NHS. The quality of life data of the patients were obtained through application of generic questionnaires SF36 and CHQ - PF50. The QALY index (quality-adjusted life year) was used to assess cost-utility comparison. At the end of the study 109 patients were selected, consisting of 60% adults, 56 % females, over 80 % blacks and dark-skinned, where 41.3 % followed the guidelines of ANVISA. The overall average cost per hospitalization (22 days average) to the NHS was R$ 2.360/patient. The analyzed parameters, weight, urine volume, and fluid balance were more effective in terms of cost for patients who followed the guidelines. The ICER for days of hospitalization avoided showed an additional cost of R$55.33/avoided day. The quality of life analysis showed that the majority followed the guidelines providing an increase of 8 % for quality of life and generating savings of R$ 3,458.13 per QALY gained. Sensitivity analyzes of the ICER and ICUR showed the robustness of the results, especially the variation of the QALY, which even after 60% of variability guaranteed savings for the system. The results of this study provided information on the use of human albumin in patients with nephrotic syndrome that can, along with other data, guide health care practices in the NHS from both clinical and financial standpoints. The economic analyzes that show better the costeffectiveness and cost utility of treatment patients who followed the recommendations the guideline of ANVISA.

A albumina humana (AH) é um medicamento de ampla utilização e de custo elevado que integra o elenco de procedimentos especiais do Ministério da Saúde no Brasil. Em 2004, a ANVISA publicou uma resolução que estabelece diretrizes para o uso terapêutico deste medicamento. Apesar dos dados da literatura sugerirem conclusões não definitivas sobre os reais benefícios do uso de albumina no tratamento de pacientes com síndrome nefrótica (SN), a diretriz recomenda o uso nos casos de edemas refratários ao uso de diuréticos. O objetivo deste estudo foi avaliar através de análises econômicas a indicação clinica da diretriz para uso de Albumina Humana da ANVISA, em pacientes com Síndrome Nefrótica. A partir de uma coorte concorrente foram realizadas análises econômicas dos tipos custo-efetividade e custoutilidade. A população do estudo foi constituída por pacientes adultos e pediátricos internados com síndrome nefrótica em quatro grandes hospitais do SUS do Estado da Bahia. Os pacientes incluídos foram divididos em dois grupos comparativos conforme o seguimento ou não das orientações de uso de albumina humana da diretriz da ANVISA. A perspectiva da análise econômica foi sobre o provedor de atenção à saúde, o SUS. Os dados de qualidade de vida dos pacientes foram obtidos através de aplicação dos questionários genéricos SF36 e CHQ-PF50. O índice QALY (anos de vida ajustados à qualidade de vida) foi utilizado para a avaliação de custo-utilidade da comparação. Ao final do estudo foram selecionados 109 pacientes, com 60% de adultos, 56% do gênero feminino, mais de 90% de negros e pardos tendo 41,3% seguido as diretrizes da ANVISA. O custo médio global por internação (média de 22 dias) para o SUS foi de R$ 2.360/paciente. Os parâmetros de efetividade analisados, peso, diurese e balanço hídrico foram mais efetivos em termos de custo para os pacientes que seguiram a diretriz. A RCEI para dias de internação evitados evidenciou um custo adicional de R$55,33/dia evitado. A análise de qualidade de vida demonstrou que seguir a diretriz dominou o não seguimento propiciando um acréscimo de 8% de qualidade de vida e gerando uma economia de R$ 3.458,13 por QALY ganho. As análises de sensibilidade das RCEI e RCUI evidenciaram a robustez dos resultados, principalmente na variação do QALY, que mesmo após 60% de variabilidade garantiu economia para o sistema. Os resultados deste estudo forneceram informações sobre o uso de albumina humana em pacientes com síndrome nefrótica que podem juntamente com outros dados nortear as práticas de saúde no SUS do ponto de vista clinico e econômico. As análises econômicas indicaram que apresentam melhores relações de custo-efetividade e custo utilidade os tratamentos dos pacientes que seguiram as orientações da diretriz da ANVISA. / Human albumin (HA) is a drug widely used and of high cost that integrates the cast of special procedures of the Ministry of Health in Brazil. In 2004, ANVISA issued a resolution establishing guidelines for the therapeutic use of this drug. Although data from the literature suggest no definite conclusions about the real benefits of the use of albumin in the treatment of patients with nephrotic syndrome (NS), the guideline recommends the use in cases of edema refractory to diuretics. The aim of this study was to evaluate economic analyzes through the clinical indication of guideline for use of Human Albumin ANVISA, in patients with nephrotic syndrome. Economic analyzes of both cost-effectiveness and cost-utility types were performed from a concurrent cohort. The study population was composed of adult and pediatric patients hospitalized with nephrotic syndrome in four major public hospitals in the State of Bahia. The included patients were divided into two distinct groups according to whether ANVISA’s guidelines for use of human albumin were followed by them or not. The economic perspective of the analysis regarded the health care provider, the NHS. The quality of life data of the patients were obtained through application of generic questionnaires SF36 and CHQ - PF50. The QALY index (quality-adjusted life year) was used to assess cost-utility comparison. At the end of the study 109 patients were selected, consisting of 60% adults, 56 % females, over 80 % blacks and dark-skinned, where 41.3 % followed the guidelines of ANVISA. The overall average cost per hospitalization (22 days average) to the NHS was R$ 2.360/patient. The analyzed parameters, weight, urine volume, and fluid balance were more effective in terms of cost for patients who followed the guidelines. The ICER for days of hospitalization avoided showed an additional cost of R$55.33/avoided day. The quality of life analysis showed that the majority followed the guidelines providing an increase of 8 % for quality of life and generating savings of R$ 3,458.13 per QALY gained. Sensitivity analyzes of the ICER and ICUR showed the robustness of the results, especially the variation of the QALY, which even after 60% of variability guaranteed savings for the system. The results of this study provided information on the use of human albumin in patients with nephrotic syndrome that can, along with other data, guide health care practices in the NHS from both clinical and financial standpoints. The economic analyzes that show better the costeffectiveness and cost utility of treatment patients who followed the recommendations the guideline of ANVISA.

A albumina humana (AH) é um medicamento de ampla utilização e de custo elevado que integra o elenco de procedimentos especiais do Ministério da Saúde no Brasil. Em 2004, a ANVISA publicou uma resolução que estabelece diretrizes para o uso terapêutico deste medicamento. Apesar dos dados da literatura sugerirem conclusões não definitivas sobre os reais benefícios do uso de albumina no tratamento de pacientes com síndrome nefrótica (SN), a diretriz recomenda o uso nos casos de edemas refratários ao uso de diuréticos. O objetivo deste estudo foi avaliar através de análises econômicas a indicação clinica da diretriz para uso de Albumina Humana da ANVISA, em pacientes com Síndrome Nefrótica. A partir de uma coorte concorrente foram realizadas análises econômicas dos tipos custo-efetividade e custoutilidade. A população do estudo foi constituída por pacientes adultos e pediátricos internados com síndrome nefrótica em quatro grandes hospitais do SUS do Estado da Bahia. Os pacientes incluídos foram divididos em dois grupos comparativos conforme o seguimento ou não das orientações de uso de albumina humana da diretriz da ANVISA. A perspectiva da análise econômica foi sobre o provedor de atenção à saúde, o SUS. Os dados de qualidade de vida dos pacientes foram obtidos através de aplicação dos questionários genéricos SF36 e CHQ-PF50. O índice QALY (anos de vida ajustados à qualidade de vida) foi utilizado para a avaliação de custo-utilidade da comparação. Ao final do estudo foram selecionados 109 pacientes, com 60% de adultos, 56% do gênero feminino, mais de 90% de negros e pardos tendo 41,3% seguido as diretrizes da ANVISA. O custo médio global por internação (média de 22 dias) para o SUS foi de R$ 2.360/paciente. Os parâmetros de efetividade analisados, peso, diurese e balanço hídrico foram mais efetivos em termos de custo para os pacientes que seguiram a diretriz. A RCEI para dias de internação evitados evidenciou um custo adicional de R$55,33/dia evitado. A análise de qualidade de vida demonstrou que seguir a diretriz dominou o não seguimento propiciando um acréscimo de 8% de qualidade de vida e gerando uma economia de R$ 3.458,13 por QALY ganho. As análises de sensibilidade das RCEI e RCUI evidenciaram a robustez dos resultados, principalmente na variação do QALY, que mesmo após 60% de variabilidade garantiu economia para o sistema. Os resultados deste estudo forneceram informações sobre o uso de albumina humana em pacientes com síndrome nefrótica que podem juntamente com outros dados nortear as práticas de saúde no SUS do ponto de vista clinico e econômico. As análises econômicas indicaram que apresentam melhores relações de custo-efetividade e custo utilidade os tratamentos dos pacientes que seguiram as orientações da diretriz da ANVISA. / Human albumin (HA) is a drug widely used and of high cost that integrates the cast of special procedures of the Ministry of Health in Brazil. In 2004, ANVISA issued a resolution establishing guidelines for the therapeutic use of this drug. Although data from the literature suggest no definite conclusions about the real benefits of the use of albumin in the treatment of patients with nephrotic syndrome (NS), the guideline recommends the use in cases of edema refractory to diuretics. The aim of this study was to evaluate economic analyzes through the clinical indication of guideline for use of Human Albumin ANVISA, in patients with nephrotic syndrome. Economic analyzes of both cost-effectiveness and cost-utility types were performed from a concurrent cohort. The study population was composed of adult and pediatric patients hospitalized with nephrotic syndrome in four major public hospitals in the State of Bahia. The included patients were divided into two distinct groups according to whether ANVISA’s guidelines for use of human albumin were followed by them or not. The economic perspective of the analysis regarded the health care provider, the NHS. The quality of life data of the patients were obtained through application of generic questionnaires SF36 and CHQ - PF50. The QALY index (quality-adjusted life year) was used to assess cost-utility comparison. At the end of the study 109 patients were selected, consisting of 60% adults, 56 % females, over 80 % blacks and dark-skinned, where 41.3 % followed the guidelines of ANVISA. The overall average cost per hospitalization (22 days average) to the NHS was R$ 2.360/patient. The analyzed parameters, weight, urine volume, and fluid balance were more effective in terms of cost for patients who followed the guidelines. The ICER for days of hospitalization avoided showed an additional cost of R$55.33/avoided day. The quality of life analysis showed that the majority followed the guidelines providing an increase of 8 % for quality of life and generating savings of R$ 3,458.13 per QALY gained. Sensitivity analyzes of the ICER and ICUR showed the robustness of the results, especially the variation of the QALY, which even after 60% of variability guaranteed savings for the system. The results of this study provided information on the use of human albumin in patients with nephrotic syndrome that can, along with other data, guide health care practices in the NHS from both clinical and financial standpoints. The economic analyzes that show better the costeffectiveness and cost utility of treatment patients who followed the recommendations the guideline of ANVISA.

Submitted by Neusa Fagundes (neusa.fagundes@unioeste.br) on 2018-03-09T19:11:49Z No. of bitstreams: 2 Érica_Taguti2014.pdf: 1522601 bytes, checksum: 0c0c5940962174392fdd910bcc90e985 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2018-03-09T19:11:50Z (GMT). No. of bitstreams: 2 Érica_Taguti2014.pdf: 1522601 bytes, checksum: 0c0c5940962174392fdd910bcc90e985 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2014-12-17 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / The aims of this research were update systematic reviews available about partial and complete economic studies of linezolid and estimate differential cost between intravenous and oral administration with hypothetical linezolid switch therapy (intravenous to oral or nasogastric tube). A systematic review was conducted using the terms "clinical outcomes", "analysis cost", "economic outcomes" and "pharmacoeconomic studies" and "linezolid" in the databases Cochrane, IPA, Medline and Scopus, associated with manual search. It was also conducted a cost-minimization analysis among hospitalized patients who used oral and/or intravenous linezolid forms between August, 2009 and August, 2013 in a public hospital in southern Brazil. The research was presented in three different papers. For systematic review were found 1352 articles, of which 24 fulfilled inclusion criteria for the systematic review of partial economic studies and 43 for systematic review of complete economic evaluations. In general, linezolid showed better clinical and economic outcomes compared to antimicrobials such as vancomycin, daptomycin, teicoplanin, particularly in cases of pneumonia patients, infections of skin and soft tissues, infections of methicillin-resistant Staphylococcus aureus, for systematic review of partil and complete economic evaluations, due to the possibility switch therapy. In study of cost-minimization were evaluated records of 152 patients, 103 (67.8%) were treated with linezolid exclusively intravenous route and in 33 (31.7%) opportunities could have been the exchange to oral form administration of antimicrobial. The total cost per patient (mean) after changing from intravenous to oral administration was significantly lower than the real cost paid per patient (mean) (p<0.001). The cost savings associated with switching to oral linezolid administration would be US$14,328.32 over four years. / Os objetivos dessa pesquisa foram atualizar as revisões sistemáticas existentes de estudos econômicos parciais e completos da linezolida e descrever a economia de recursos com a hipotética troca da via de administração do medicamento (endovenosa para oral ou sonda nasoenteral) entre pacientes tratados em um hospital público. Foi conduzida uma revisão sistemática de estudos com os termos “clinical outcomes”, “cost analysis”, “economic outcomes” e “pharmacoeconomic studies” e “linezolid”, nas bases de dados Cochrane, IPA, Medline e Scopus, associado a busca manual. Também foi conduzida uma análise de custo-minimização entre pacientes hospitalizados que utilizaram as formas oral e/ou endovenosa de linezolida entre agosto de 2009 e agosto de 2013 em um hospital público paranaense. As pesquisa foram apresentadas em três diferentes artigos. Para a revisão sistemática foram encontrados 1352 artigos, sendo que 24 preencheram os critérios de inclusão para a revisão sistemática de estudos econômicos parciais e 43 para a revisão sistemática de avaliações econômicas completas. No geral, a linezolida mostrou melhores resultados clínicos e econômicos frente a antimicrobianos como vancomicina, daptomicina, teicoplanina, especialmente nos casos de pacientes com pneumonia, infeções de pele e tecidos moles e infeções por Staphylococcus aureus resistente a meticilina, para estudos econômicos parciais e completos, sendo um dos motivos relacionados à troca da via de administração endovenosa para oral. No estudo de custo-minimização, foram avaliados os prontuários de 152 pacientes, sendo 103 (67,8%) deles foram tratados com linezolida exclusivamente pela via endovenosa e em 33 (31,7%) oportunidades poderia ter ocorrido a troca para a forma oral de administração do antimicrobiano. O custo médio por paciente após a troca hipotética seria significativamente menor do que o valor real gasto (p<0,01) e a economia seria de R$ 32.680,03 em quatro anos.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-05-11T13:06:57Z No. of bitstreams: 1 fabianobolpatoloures.pdf: 543019 bytes, checksum: 65a181a5df2e1bf7806b640db3cdbb35 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-06-20T18:35:51Z (GMT) No. of bitstreams: 1 fabianobolpatoloures.pdf: 543019 bytes, checksum: 65a181a5df2e1bf7806b640db3cdbb35 (MD5) / Made available in DSpace on 2016-06-20T18:35:51Z (GMT). No. of bitstreams: 1 fabianobolpatoloures.pdf: 543019 bytes, checksum: 65a181a5df2e1bf7806b640db3cdbb35 (MD5) Previous issue date: 2013-02-18 / A transição demográfica causa o aumento das doenças crônico-degenerativas, entre elas a osteoporose. Esta doença se caracteriza por diminuição da resistência dos ossos e consequentes fraturas. Entre essas, a fratura do quadril, nome dado às fraturas proximais do fêmur em idosos, sendo a mais devastadora. Alta mortalidade e morbidade associadas, além de custos elevados para os pacientes, a família e a sociedade dão relevância ao assunto. O tempo decorrido entre o trauma e a cirurgia, que é o tratamento ideal, tem influência nos resultados do tratamento. No Brasil, esse tempo é alargado. As evidências são conflitantes na literatura com relação à mortalidade. Os efeitos em qualidade de vida são importantes, uma vez que poucos pacientes retomam as atividades do período anterior à fratura. O objetivo deste trabalho foi analisar os efeitos do tempo decorrido entre o trauma e a cirurgia sobre os custos diretos médico-hospitalares do tratamento e da qualidade de vida em forma de utilidade, medida por meio do instrumento EuroQol-5D, um instrumento genérico de medição de qualidade de vida que se utiliza de cinco dimensões para isso e é transformado em utilidade através de normativas populacionais. A utilidade é um valor cardinal que reúne, em uma só medida, morbidade e mortalidade, variando de 0, morte, a 1, saúde perfeita. Foram criadas duas subamostras, separadas pelo tempo, em precoce, até 4 dias, e tardia, após 4 dias entre o trauma e a cirurgia. Uma árvore de decisão foi utilizada como modelo de análise, para compreender o evento e calcular as probabilidades de óbito intra-hospitalar, óbito durante a recuperação e o resultado em utilidade, além dos custos. O tempo médio entre a fratura e a cirurgia, nesta amostra de 115 pacientes, foi de 9,35 dias, com a permanência média de 13,45 dias. Os resultados, após controle por idade, gênero, tipo de fratura, tipo de tratamento e risco anestésico (ASA) demonstraram influência clinicamente significativa do tempo na mortalidade intra-hospitalar e estatisticamente significativa nos custos (p<0,001), sobretudo devido à diária de enfermaria (p<0,001). A permanência do paciente também foi estatisticamente aumentada no grupo da cirurgia tardia (p<0,001). O custo médio da amostra foi de R$ 5.132,31 (DP= 3.201,92). A razão custo-utilidade do modelo foi de R$ 9.854,34 por QALY para a estratégia da cirurgia precoce. Esta estratégia mostrou-se dominante no modelo e consistentemente dominante após análise de sensibilidade de extremos. O atraso na cirurgia, na nossa região, deveu-se, principalmente, ao atraso na transferência do hospital que recebe o paciente até aquele que tem complexidade para tratá-lo. As linhas-guia brasileiras devem incluir a cirurgia precoce como parte dos objetivos do tratamento por ser mais custo-efetiva. / The demographic transition causes the increase of chronic degenerative diseases, including osteoporosis. This disease is characterized by decreased bone strength and subsequent fractures. Among these, the hip fracture, the name given to the proximal femoral fractures in the elderly, is the most devastating. High mortality and morbidity, as well as high costs for patients, family and society, give relevance to the subject. The time elapsed between trauma and surgery, which is the ideal treatment, has influence on the results of treatment. In Brazil this time is extended. There are conflicting evidence in the literature regarding mortality. The effects on quality of life are important since few patients resume activities from before the fracture. The objective of this study was to analyze the effects of time elapsed between trauma and surgery on the direct costs of medical and hospital treatment and quality of life in the form of utility, measured by the instrument EuroQol-5D, a generic instrument for measuring quality of life that uses five dimensions and is transformed into utility through the population norms. The utility is a cardinal value that brings together measure morbidity and mortality ranges from 0, death, to 1, which is perfect health. Two subsamples were created. They were separated by time. One was Early, until 4 days between trauma and surgery and the other was Late, until four days after. A decision tree was used as a model for analysis, to understand the event and calculate the odds of in-hospital deaths, deaths during the recovery and result in utility, as well as the costs. The average time between fracture and surgery in this sample of 115 patients was 9.35 days, with the average hospital stay of 13.45 days. The results, after being managed by age, gender, type of fracture, type of treatment and anesthetic risk (ASA) demonstrated clinically meaningful influence of time on inhospital mortality and statistically significant on costs (p <0.001) mainly due to nursery daily rate (p<0.001).The patient's stay was also statistically increased in the late surgery group (p <0.001). The average cost of the sample was R$ 5,132.31 (DP= 3,201.92). The cost-utility ratio of the model was R $ 9,854.34 per QALY for the early surgery strategy. This strategy proved to be dominant in the model and consistently dominant after analyzing the sensitivity of extremes. The delay of the surgery in our region, is primarily due to the delay in the transfer from the hospital that receives the patient to the hospital that has the complexity to treat him. The Brazilian-guidelines should include early surgery as part of the treatment goals because they are more cost-effective.