Effectiveness and Cost-effectiveness of Minimal Ovarian Stimulation in-vitro Fertilization versus Conventional Ovarian Stimulation in Poor Responders: Economic Evaluation Alongside a Propensity Score Adjusted Prospective Observational Study.

OBJECTIVE: Information on the pregnancy rate after successive in-vitro fertilization (IVF) cycles and their associated costs is relevant for couples undergoing assisted reproduction treatments (ARTs). This study, therefore, sought to investigate the effectiveness and the cost-effectiveness of two ARTs, the minimal ovarian stimulation IVF (MS-IVF) compared to the conventional ovarian stimulation IVF (C-IVF) from the payer's perspective. METHODS: A 10-months follow-up prospective observational study was conducted in a sample of couples who sought ARTs in a private clinic in Southern Brazil. Women had to satisfy the Bologna Criteria and be older than 35 years. The effect outcome was pregnancy rate per initiated cycle. Medication costs were based on medical records. Costs and effect differences were estimated using seemingly unrelated regressions adjusted for the propensity score estimated based on women's characteristics. RESULTS: All 84 eligible women who agreed to participate received a total of 92 IVF cycles (MS-IVF, n=27[35 cycles]; C-IVF n=57[57 cycles]. The effect difference between MS-IVF and C-IVF was -5.1% (95%CI, -13.2 to 5.2). Medication costs of MS-IVF were significantly lower than C-IVF by €-1260 (95%CI, -1401 to -1118). The probabilities of MS-IVF being cost-effective compared to C-IVF ranged from 1 to 0.76 for willingness-to-pay of €0 to €15,000 per established pregnancy, respectively. CONCLUSIONS: Even though there were no positive effect differences between groups, MS-IVF might be cost-effective compared to C-IVF from the payer's perspective due to its relatively large cost savings compared to C-IVF. However, further investigation is needed to confirm these findings in a larger sample.

[Social control: a challenge for the health counselor]. / Controle social: um desafio para o conselheiro de saúde.

The study aimed to analyze the profile of Health Counselors in the Municipality of Jequié-BA, and identify their knowledge about the function. A descriptive, exploratory and qualitative research was carried out with ten active Health Counselors, in 2008. Data analysis was performed according to the technique of Collective Subject Discourse, and the following categories emerged: the importance of acting as Health Counselor; counselor's function; and lack of training for the role. The results showed that they understand the relevance of social control. However, recognized that some Counselors still have a misconception about their role; showed a lack of training; and indicated the lack of parity as a serious problem that must be reviewed in order to make this board authentic. It was concluded that there is a need to review the actions and reset the representatives of the segments, government and health worker.

Controle social: um desafio para o conselheiro de saúde / Social control: a challenge for the health counselor / Control social: un desafio para el consejero de salud

Objetivou-se analisar o perfil dos Conselheiros de Saúde do Município de Jequié-BA e identificar seu conhecimento acerca da função. Pesquisa descritiva, exploratória e qualitativa, realizada com dez Conselheiros de Saúde, atuantes em 2008. A análise dos dados foi feita segundo a técnica do Discurso do Sujeito Coletivo, emergindo as seguintes categorias: importância de atuar como Conselheiro de Saúde; função do Conselheiro e falta de capacitação para a função. Os resultados mostram que eles compreendem a relevância do controle social. Entretanto, reconhecem que alguns Conselheiros possuem ainda um conceito equivocado quanto ao seu papel; revelam a carência de capacitação e apontam a falta de paridade como um grave problema que deve ser revisto, a fim de que haja a legitimação deste Conselho. Concluiu-se que há necessidade de rever as ações e redefinir os representantes dos segmentos, governo e trabalhadores em saúde.

The study aimed to analyze the profile of Health Counselors in the Municipality of Jequié-BA, and identify their knowledge about the function. A descriptive, exploratory and qualitative research was carried out with ten active Health Counselors, in 2008. Data analysis was performed according to the technique of Collective Subject Discourse, and the following categories emerged: the importance of acting as Health Counselor; counselor's function; and lack of training for the role. The results showed that they understand the relevance of social control. However, recognized that some Counselors still have a misconception about their role; showed a lack of training; and indicated the lack of parity as a serious problem that must be reviewed in order to make this board authentic. It was concluded that there is a need to review the actions and reset the representatives of the segments, government and health worker.

Objetivó-se analizar el perfil de los Consejeros de Salud del municipio de Jequié-BA e identificar el conocimiento de ellos acerca de su función. Realizó-se un estudio descriptivo, exploratorio y cualitativo, con dieces Consejeros de Salud, activos en 2008. El análisis de datos se realizó de acuerdo a la técnica del Discurso del Sujeto Colectivo, y surgieron las siguientes categorías: la importancia de actuar como Consejero de Salud; la función de Consejero; y falta de capacitación para la función. Los resultados muestran que ellos entienden la importancia del control social. Sin embargo, reconocen que algunos Consejeros todavía tienen una idea errónea acerca de su papel y muestran una falta de formación; e indican la falta de paridad como un problema grave que debe ser revisado, a fin de que haga legitimación de este Consejo. Se concluyó que existe una necesidad de revisar las acciones y restablecer los representantes de los segmentos, gobierno y trabajadores de salud.