Long-term impact of competitive biddings and an antimicrobial stewardship program in a general hospital in Chile / Impacto de un programa de control de antimicrobianos (PCA) y licitaciones públicas sobre el consumo de estos medicamentos

ABSTRACT Background: The long-term effect of an antimicrobial stewardship program (ASP) and its integrated impact with competitive biddings have been seldom reported. Aim: To evaluate the long-term effect of an ASP on antimicrobial consumption, expenditure, antimicrobial resistance and hospital mortality. To estimate the contribution of competitive biddings on cost-savings. Material and Methods: A comparison of periods prior (2005-2008) and posterior to ASP initiation (2009 and 2015) was done. An estimation of cost savings attributable to ASP and to competitive biddings was also performed. Results: Basal median antimicrobial consumption decreased from 221.3 to 170 daily defined doses/100 beds after the start of the ASP. At the last year, global antimicrobial consumption declined by 28%. Median antimicrobial expenditure per bed (initially US$ 13) declined to US$ 10 at the first year (-28%) and to US$ 6 the last year (-57%). As the reduction in consumption was lower than the reduction in expenditure during the last year, we assumed that only 48.4% of savings were attributable to the ASP. According to antimicrobial charges per bed from prior and after ASP implementation, we estimated global savings of US$ 393072 and US$ 190000 directly attributable to the ASP, difference explained by parallel competitive biddings. Drug resistance among nosocomial bacterial isolates did not show significant changes. Global and infectious disease-associated mortality per 1000 discharges significantly decreased during the study period (p < 0.05). Conclusions: The ASP had a favorable impact on antimicrobial consumption, savings and mortality rates but did not have effect on antimicrobial resistance in selected bacterial strains.

Antecedentes: Existe poca información sobre el impacto a largo plazo de un programa de control de antimicrobianos (PCA) y su efecto combinado con licitaciones públicas de fármacos. Objetivo: Evaluar el impacto de un PCA sobre el consumo, gasto, mortalidad y estimar la contribución de las licitaciones. Material y Métodos: Comparación antes (2005-2008) - después (2009-2015) del PCA y estimación porcentual del ahorro atribuible al PCA y licitaciones. Resultados: El consumo bajó de 221,3 a 170 dosis diarias definidas por 100 días camas (medianas) al primer año. En el último año el consumo declinó un 27,6%. La mediana del gasto por cama ocupada se redujo de 13 a 10 US$ el primer año y a 6 US$ el último año (-57%). Debido a que el gasto bajó más que el consumo, estimamos que solo el 48,4% del ahorro fue debido al PCA (cuociente de ambas reducciones: −27,6%/-57%). De acuerdo con el gasto en antimicrobianos por cama entre ambos períodos, se calculó un ahorro global de 393.000 US$ y de 190.000 US$ directamente atribuible al PCA, siendo la diferencia explicada por licitaciones. Los porcentajes de resistencia en cepas de infecciones nosocomiales no mostraron incrementos o reducciones significativas en el tiempo y la mortalidad por egresos asociada a enfermedades infecciosas (Códigos CIE 10) se redujo significativamente (p < 0,05). Conclusiones: El PCA se asoció a largo plazo a un impacto favorable sobre el consumo de antimicrobianos, gasto por antimicrobianos y egresos por enfermedades infecciosas sin un impacto en la resistencia antimicrobiana. Las licitaciones tuvieron un efecto aditivo en el ahorro.

Economic analysis of costs with enteral and parenteral nutritional therapy according to disease and outcome / Análise econômica dos custos com terapia nutricional enteral e parenteral conforme doença e desfecho

ABSTRACT Objective To conduct an economic analysis of enteral and parenteral diet costs according to the type of disease and outcome (survivors versus deaths). Methods It is a cross-sectional, observational, retrospective study with a qualitative and quantitative design, based on analysis of hospital accounts from a healthcare insurance provider in the Southern region of Brazil. Results We analyzed 301 hospital accounts of individuals who used enteral and parenteral diets. The total cost of the diet was 35.4% of hospital account total costs. The enteral modality accounted for 59.8% of total dietary costs. The major costs with diets were observed in hospitalizations related to infections, cancers and cerebro-cardiovascular diseases. The major costs with parenteral diet were with admissions related by cancers (64.52%) and dementia syndromes (46.17%). The highest ratio between total diet costs with the total of hospital account costs was in dementia syndromes (46.32%) and in cancers (41.2%). The individuals who died spent 51.26% of total of hospital account costs, being 32.81% in diet (47.45% of total diet value and 58.81% in parenteral modality). Conclusion Enteral and parenteral nutritional therapies account for a significant part of the costs with hospitalized individuals, especially in cases of cancers and dementia syndromes. The costs of parenteral diets were higher in the group of patients who died.

RESUMO Objetivo Realizar uma análise econômica de custos da terapia nutricional enteral e parenteral, conforme o tipo de doença e o desfecho (sobreviventes versus óbitos). Métodos Estudo transversal, observacional, retrospectivo, com estratégia qualitativa e quantitativa, a partir da análise de contas hospitalares de uma operadora de saúde da Região Sul do Brasil. Resultados Foram analisadas 301 contas hospitalares de usuários que utilizaram dieta enteral e parenteral. O custo total com dieta foi de 35,4% do custo total das contas hospitalares. A modalidade enteral representou 59,8% do custo total em dieta. Os maiores custos com dieta foram observados em internações relacionadas a infecções, cânceres e doenças cérebro-cardiovasculares. Os maiores custos com dieta parenteral foram observados nas internações relacionadas aos cânceres (64,52%) e às síndromes demenciais (46,17%). A maior relação entre o custo total com dieta e o custo total da conta foi na síndrome demencial (46,32%) e no câncer (41,2%). Os usuários que foram a óbito consumiram 51,26% dos custos totais das contas, sendo 32,81% com dieta (47,45% do valor total com dieta e 58,81% do custo na modalidade parenteral). Conclusão As terapias nutricionais enteral e parenteral representaram uma parte importante dos custos no tratamento de indivíduos hospitalizados, principalmente nos casos dos cânceres e nas síndromes demenciais. O custo com dieta parenteral foi maior no grupo de usuários que foram a óbito.

Compensation for Work-Related Hematologic, Liver, and Infectious Diseases

Occupational diseases may be defined only medically or scientifically, and even then, their definition is not simple. However, compensable occupational diseases involve the additional layer of legal systems and social welfare policies as well. Their multifaceted nature makes determining the work-relatedness of these diseases more complex. Korea has established standards for the recognition of occupational diseases in Schedule 5 of the Enforcement Decree of the Labor Standards Act, and specific criteria for the recognition of occupational diseases are listed in Schedule 3 of the Enforcement Decree of the Industrial Accident Compensation Insurance Act. The new list of compensable occupational diseases comprises 13 articles as an open-ended system. The newly added articles pertain to lymphohematopoietic (Article 5) and infectious diseases (Article 9), as well as diseases of other target organs. Furthermore, the article on liver diseases (Article 8) has been partially revised. The new act has been changed to clarify the meaning as it has been presented in recent research. It is necessary to achieve agreement among concerned parties, including experts from the legal, medical, and social domains to resolve the issues of work-relatedness, causation, notion of aggravation, and so on for preparing a list and a process that are more reasonable.

Avaliação econômica em saúde: aplicações em doenças infecciosas / Economic evaluation in health: applications in infectious diseases

O crescimento dos gastos em saúde, impulsionado pela incorporação de novas tecnologias diagnósticas e terapêuticas e pelo aumento da expectativa de vida da população, tem causado grande preocupação especialmente em países em desenvolvimento. A avaliação econômica em saúde visa a otimizar benefícios utilizando os recursos de maneira eficiente. O objetivo deste artigo é capacitar os leitores a identificar as características básicas, diferenciar os principais tipos e compreender as metodologias utilizadas nas avaliações econômicas em saúde, com enfoque nas doenças infecciosas. Assim sendo, revisamos os conceitos de perspectiva de estudo, horizonte analítico, custos e taxa de desconto. Além disso, identificamos as características dos estudos de custo-minimização, custo-efetividade, custo-utilidade e custo-benefício acompanhados de exemplos, descrevemos os principais desenhos de estudos econômicos, discutimos o uso de modelos matemáticos e examinamos a importância da análise de sensibilidade. Nas considerações finais, abordamos a incorporação da avaliação econômica em saúde no Brasil.

The rise in healthcare expenditures due to the incorporation of new diagnostic and therapeutic technologies and increasing life expectancy is a major concern, particularly in developing countries. The role of economic evaluation in health is to optimize the benefits of available resources. This article aims to allow readers to identify the basic characteristics and types of economic evaluation in health and understand its methods, with an emphasis on infectious diseases. We thus review the following concepts: study perspective, analytic scope, costs, and discount rate. We also focus on characteristics of cost-minimization, cost-effectiveness, cost-utility, and cost-benefit analyses, with examples. The article describes the most popular study designs for economic evaluation, discusses different models, and examines the importance of sensitivity analysis. Our final comments address the importance of adopting economic evaluations in health in Brazil.

Desafíos del plan ampliado de inmunizaciones: Chile 2006 / Challenges of the immunizations extended program (PAI): Chile 2006

The support given to infant immunization programs wishes to improve life quality and strengthen the public image of the government and its health ministry. At an international level, Chile has always been an example on public immunization, so it is necessary to examine our PAI, in terms of valency number administered in the public system versus private resources. In this document, a proposal by stages is made, according to costs, availability and most relevant epidemiologic data for new schemes. First Stage: Hepatitis B in newborns, Haemophilus influenzae b 4° doses and Hepatitis A in toddlers. Second Stage: combined vaccines with acellular Pertussis and injectable Polio vaccine. Third Stage: Chickenpox 1 dose and Rotavirus vaccines. Fourth Stage: conjugated anti pneumococcal vaccines and Human Papiloma Virus vaccine. In conclusion, the important progress on immunizations and the huge amount of resources invested worldwide show us the tendency that should be followed by our Health Ministry.

El impulso a los programas de vacunación infantil apunta a mejorar la calidad de vida de la población y a fortalecer la imagen pública del Estado y sus ministerios de salud. A nivel internacional, Chile siempre ha sido referente en vacunación pública por lo cual parece necesario revisar nuestro PAI, específicamente en la vacunación del niño, en términos del número de valencias administradas en el sistema público, versus aquellas que puede recibir un menor cuya familia cuenta con más recursos económicos. En este documento se hace una propuesta por etapas, según costos, factibilidad y datos epidemiológicos más relevantes, para nuevas valencias o nuevos esquemas. Primera Etapa: Hepatitis B en el Recién Nacido, Haemophillus influenzae b cuarta dosis y Hepatitis A en el lactante. Segunda Etapa: Incorporación de Vacunas combinadas con Pertussis acelular e incorporación de vacuna con Polio Inyectable. El costo necesario para estas modificaciones sería comparable al gasto público per capita en vacunas en el niño en países vecinos. Tercera Etapa: Varicela en una dosis y vacunas anti Rotavirus. Cuarta Etapa: Vacunas anti neumocócicas conjugadas y vacunas anti Virus Papiloma Humano. En conclusión, el avance en vacunas experimentado a nivel mundial y el enérgico traspaso de recursos que los países desarrollados y otros en vías de desarrollo hacen a su población mediante la incorporación de nuevas vacunas en sus programas preventivos, nos indica la tendencia que debería seguir nuestro Ministerio de Salud.

Epidemiological profile of India: historical and contemporary perspectives.

Knowledge and understanding of the epidemiological profile is an essential pre-requisite to assess and address public health needs in the country and to enable efficient programme planning and management. The need for adequate and accurate health information and data to undertake such an exercise cannot be over-emphasized. The present effort is a modest attempt to critically analyse the epidemiological profile of India from the historical and contemporary perspective. In order to assess the successes achieved as well caution against the daunting challenges awaiting the country, parameters such as disease burden and health status indicators, are increasingly being used. Changes in the population age structure, improvements in the nation's economic status, altered life-styles of people and duality of disease burden testify to the demographic, development and health transition occurring in the country. Population stabilization, poverty alleviation, life-style modification, surveillance and control of communicable and non-communicable diseases constitute the major challenges demanding urgent attention in the future.

Costos económicos en la producción de servicios de salud: del costo de los insumos al costo de manejo de caso / Economic costs for the production of health services: From cost of inputs to cost of case management

Objetivo. Generar información sobre los costos de producción de servicios de salud. Material y métodos. Siguiendo los criterios de Kessner se seleccionaron como trazadores: hipertensión, diabetes, diarreas y neumonías. Posteriormente, se definió el manejo de casos y, por medio de la metología de costeo por manejo de caso, se definieron las funciones de producción, así como los insumos y costos unitarios requeridos para satisfacer la demanada de servicios médicos de cada enfermedad. Se procesaron los datos en una hoja de cálculo para identificar los costos de manejo de casos hospitalarios y ambulatorios para cada enfermedad de estudio es posible identificar el peso relativo, tanto de las distintias funciones de producción, como de los diferentes tipos de insumos. Dependiendo de las frecuencias relativas, tanto insumos como funciones de producción se clasificaron en alto, medio y bajo impacto sobre el costo total de manejo de caso Conclusiones. A partir de la información generada se sugiere replantear los procesos de planeación, organización y asignación de recursos, en función de demandas de servicios hospitalarios y ambulatorios para cada trazador. Asimismo, se sugieren acciones para propiciar ganancias económicas en la utilización de recursos y en el uso más eficiente de los mismos