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1.
Artículo en Inglés | MEDLINE | ID: mdl-39475681

RESUMEN

BACKGROUND: In low- and middle-income countries, pregnancy in adolescence represents an important public health issue. Rates of early pregnancy have significant social and economic consequences that extend beyond the individual sphere, impacting public/governmental budgets. AIM: To estimate the cost implications of early pregnancies from the perspective of the Brazilian Unified Public Health System. METHODS: This retrospective secondary data analysis focuses on assessing direct hospital costs. The study cohort comprises adolescents and young adults who underwent prenatal care at a reference maternity hospital between January and December 2021. Individual procedure costs were extracted from hospital records and converted into monetary values using the Brazilian Federal Fee. The sample size for each group was determined based on preliminary data collected during a pilot study. Descriptive analyses presented costs stratified by age groups. To estimate budgetary impacts and sensitivity we used national live birth incidence rates. RESULTS: The mean cost per case of adolescent pregnancy was US$ 704.92 (SD: 1,707.74) and for adult pregnancy was US$ 592.40 (SD: 941.43). The cost of hospital admission accounted for 61% of the total cost of adolescent pregnancies. The annual budget impact of pregnancies among women under 30 years was estimated at US$ 1 billion, with 239 million coming from women under 20 years old. CONCLUSION: Pregnancy in adolescence may lead to a significant annual budget impact, representing 24% of costs attributed to pregnancies among women under 30 years. Costs related to hospital admissions and complications represent a substantial share of the total costs of adolescent pregnancy.


Rates of early pregnancy have significant social and economic consequences that extend beyond the individual sphere, impacting public/governmental budgets. This article provides the annual impact of adolescent pregnancy on public health in Brazil, which amounts to US$ 239 million.

2.
Am J Hosp Palliat Care ; : 10499091241285890, 2024 Sep 23.
Artículo en Inglés | MEDLINE | ID: mdl-39313454

RESUMEN

OBJECTIVES: Identify the costs of an oncology patient at the end of life. METHODS: A systematic literature review was conducted by screening Embase, PubMed and Lilacs databases, including all studies evaluating end-of-life care costs for cancer patients up to March 2024. The review writing followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The quality of the included studies was assessed using the Drummond checklist. The protocol is available at PROSPERO CRD42023403186. RESULTS: A total of 733 studies were retrieved, and 43 were considered eligible. Among the studies analyzed, 41,86% included all types of neoplasms, 18.60% of lung neoplasm, All articles performed direct cost analysis, and 9.30% also performed indirect cost analysis. No study evaluated intangible costs, and most presented the macrocosting methodology from the payer's perspective. The articles included in this review presented significant heterogeneity related to populations, diagnoses, periods considered for evaluation of end-of-life care, and cost analyses. Most of the studies were from a payer perspective (74,41%) and based on macrocosting methodologies (81,39%), which limit the use of the information to evaluate variabilities in the consumption of resources. CONCLUSIONS: Considering the complexity of end-of-life care and the need for consistent data on costs in this period, new studies, mainly in low- and middle-income countries with approaches to indirect and intangible costs, with a societal perspective, are important for public policies of health in accordance with the trend of transforming value-based care, allowing the health care system to create more value for patients and their families.

3.
PLoS One ; 19(8): e0307691, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-39133678

RESUMEN

OBJECTIVES: This study aimed to ascertain utility and vision-related quality of life in patients awaiting access to specialist eye care. A secondary aim was to evaluate the association of utility indices with demographic profile and waiting time. METHODS: Consecutive patients that had been waiting for ophthalmology care answered the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25). The questionnaire was administered when patients arrived at the clinics for their first visit. We derived a utility index (VFQ-UI) from the patients' responses, then calculated the correlation between this index and waiting time and compared utility across demographic subgroups stratified by age, sex, and care setting. RESULTS: 536 individuals participated in the study (mean age 52.9±16.6 years; 370 women, 69% women). The median utility index was 0.85 (interquartile range [IQR] 0.70-0.92; minimum 0.40, maximum 0.97). The mean VFQ-25 score was 70.88±14.59. Utility correlated weakly and nonsignificantly with waiting time (-0.05, P = 0.24). It did not vary across age groups (P = 0.85) or care settings (P = 0.77). Utility was significantly lower for women (0.84, IQR 0.70-0.92) than men (0.87, IQR 0.73-0.93, P = 0.03), but the magnitude of this difference was small (Cohen's d = 0.13). CONCLUSION: Patients awaiting access to ophthalmology care had a utility index of 0.85 on a scale of 0 to 1. This measurement was not previously reported in the literature. Utility measures can provide insight into patients' perspectives and support economic health analyses and inform health policies.


Asunto(s)
Calidad de Vida , Humanos , Masculino , Femenino , Persona de Mediana Edad , Adulto , Encuestas y Cuestionarios , Anciano , Visión Ocular/fisiología , Listas de Espera , Oftalmología
5.
Front Pharmacol ; 15: 1345842, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38841371

RESUMEN

Objective: This study evaluated the influence of technology on accurately measuring costs using time-driven activity-based costing (TDABC) in healthcare provider organizations by identifying the most recent scientific evidence of how it contributed to increasing the value of surgical care. Methods: This is a literature-based analysis that mainly used two data sources: first, the most recent systematic reviews that specifically evaluated TDABC studies in the surgical field and, second, all articles that mentioned the use of CareMeasurement (CM) software to implement TDABC, which started to be published after the publication of the systematic review. The articles from the systematic review were grouped as manually performed TDABC, while those using CM were grouped as technology-based studies of TDABC implementations. The analyses focused on evaluating the impact of using technology to apply TDABC. A general description was followed by three levels of information extraction: the number of cases included, the number of articles published per year, and the contributions of TDABC to achieve cost savings and other improvements. Results: Fourteen studies using real-world patient-level data to evaluate costs comprised the manual group of studies. Thirteen studies that reported the use of CM comprised the technology-based group of articles. In the manual studies, the average number of cases included per study was 160, while in the technology-based studies, the average number of cases included was 4,767. Technology-based studies, on average, have a more comprehensive impact than manual ones in providing accurate cost information from larger samples. Conclusion: TDABC studies supported by technologies such as CM register more cases, identify cost-saving opportunities, and are frequently used to support reimbursement strategies based on value. The findings suggest that using TDABC with the support of technology can increase healthcare value.

6.
Cerebrovasc Dis ; : 1-9, 2023 Sep 15.
Artículo en Inglés | MEDLINE | ID: mdl-37717574

RESUMEN

INTRODUCTION: The growing cost of stroke care has created the need for outcome-oriented and cost-saving payment models. Identifying imbalances in the current reimbursement model is an essential step toward designing impactful value-based reimbursement strategies. This study describes the variation in reimbursement fees for ischemic stroke management across the USA. METHODS: This Medicare Fee-For-Service claims study examines USA beneficiaries who suffered an ischemic stroke from 2021Q1 to 2022Q2 identified using the Medicare-Severity Diagnosis-Related Groups (MS-DRGs). Demographic national and regional US data were extracted from the Census Bureau. The MS-DRG codes were grouped into four categories according to treatment modality and clinical complexity. Our primary outcome of interest was payments made across individual USA and US geographic regions, assessed by computing the mean incremental payment in cases of comparable complexity. Differences between states for each MS-DRG were statistically evaluated using a linear regression model of the logarithmic transformed payments. RESULTS: 227,273 ischemic stroke cases were included in our analysis. Significant variations were observed among all DRGs defined by medical complexity, treatment modality, and states (p < 0.001). Differences in mean payment per case with the same MS-DRG vary by as high as 500% among individual states. Although higher payment rates were observed in MS-DRG codes with major comorbidities or complexity (MCC), the variation was more expressive for codes without MCC. It was not possible to identify a standard mean incremental fee at a state level. At a regional level, the Northeast registered the highest fees, followed by the West, Midwest, and South, which correlate with poverty rates and median household income in the regions. CONCLUSIONS: The payment variability observed across USA suggests that the current reimbursement system needs to be aligned with stroke treatment costs. Future studies may go one step further to evaluate accurate stroke management costs to guide policymakers in introducing health policies that promote better care for stroke patients.

7.
Orphanet J Rare Dis ; 18(1): 159, 2023 Jun 22.
Artículo en Inglés | MEDLINE | ID: mdl-37349725

RESUMEN

BACKGROUND: The economic burden of rare diseases on health systems is still not widely measured, with the generation of accurate information about the costs with medical care for subjects with rare diseases being crucial when defining health policies. Duchenne Muscular Dystrophy (DMD) is the most common form of muscular dystrophy, with new technologies recently being studied for its management. Information about the costs related to the disease in Latin America is scarce, and the objective of this study is to evaluate the annual hospital, home care and transportation costs per patient with DMD treatment in Brazil. RESULTS: Data from 27 patients were included, the median annual cost per patient was R$ 17,121 (IQR R$ 6,786; 25,621). Home care expenditures accounted for 92% of the total costs, followed by hospital costs (6%) and transportation costs (2%). Medications and loss of family, and patient's productivity are among the most representative consumption items. When disease worsening due to loss of the ability to walk was incorporated to the analysis, it was shown that wheelchair users account for an incremental cost of 23% compared with non-wheelchair users. CONCLUSIONS: This is an original study in Latin America to measure DMD costs using the micro-costing technique. Generating accurate information about costs is crucial to provide health managers with information that could help establish more sustainable policies when deciding upon rare diseases in emerging countries.


Asunto(s)
Costo de Enfermedad , Distrofia Muscular de Duchenne , Humanos , Enfermedades Raras , Distrofia Muscular de Duchenne/terapia , Brasil , Costos de la Atención en Salud
9.
BMC Health Serv Res ; 23(1): 198, 2023 Feb 24.
Artículo en Inglés | MEDLINE | ID: mdl-36829122

RESUMEN

BACKGROUND: The COVID-19 pandemic raised awareness of the need to better understand where and how patient-level costs are incurred in health care organizations, as health managers and other decision-makers need to plan and quickly adapt to the increasing demand for health care services to meet patients' care needs. Time-driven activity-based costing offers a better understanding of the drivers of cost throughout the care pathway, providing information that can guide decisions on process improvement and resource optimization. This study aims to estimate COVID-19 patient-level hospital costs and to evaluate cost variability considering the in-hospital care pathways of COVID-19 management and the patient clinical classification. METHODS: This is a prospective cohort study that applied time-driven activity-based costing (TDABC) in a Brazilian reference center for COVID-19. Patients hospitalized during the first wave of the disease were selected for their data to be analyzed to estimate in-hospital costs. The cost information was calculated at the patient level and stratified by hospital care pathway and Ordinal Scale for Clinical Improvement (OSCI) category. Multivariable analyses were applied to identify predictors of cost variability in the care pathways that were evaluated. RESULTS: A total of 208 patients were included in the study. Patients followed five different care pathways, of which Emergency + Ward was the most followed (n = 118, 57%). Pathways which included the intensive care unit presented a statistically significant influence on costs per patient (p <  0.001) when compared to Emergency + Ward. The median cost per patient was I$2879 (IQR 1215; 8140) and mean cost per patient was I$6818 (SD 9043). The most expensive care pathway was the ICU only, registering a median cost per patient of I$13,519 (IQR 5637; 23,373) and mean cost per patient of I$17,709 (SD 16,020). All care pathways that included the ICU unit registered a higher cost per patient. CONCLUSIONS: This is one of the first microcosting study for COVID-19 that applied the TDABC methodology and demonstrated how patient-level costs vary as a function of the care pathways followed by patients. These findings can be used to develop value reimbursement strategies that will inform sustainable health policies in middle-income countries such as Brazil.


Asunto(s)
COVID-19 , Vías Clínicas , Humanos , Brasil , Estudios Prospectivos , Pandemias , Factores de Tiempo , Costos de Hospital , Hospitales , Hospitalización , Costos de la Atención en Salud
10.
Clinics (Sao Paulo) ; 78: 100294, 2023 Oct 28.
Artículo en Inglés | MEDLINE | ID: mdl-39491280

RESUMEN

OBJECTIVES: To measure Quality of Life (QoL) and costs of Heart Failure (HF) outpatients in Brazil as an introduction to the Value-Based Health Care (VBHC) concept. MATERIALS AND METHODS: Cross-sectional study, patients with HF, with ejection fraction <50%, were recruited from three hospitals in Brazil. Two QoL (36-Item Short Form Survey [SF-36] and Minnesota Living with Heart Failure Questionnaire [MLHFQ]) and two anxiety/depression questionnaires were applied. SF-36 scores were stratified by domains. Treatment costs were calculated using the Time-Driven Activity-Based Costing (TDABC) method. Results were stratified by NYHA functional class and sex. RESULTS: From October 2018 to January 2021, 198 patients were recruited, and the median MLHFQ (49.5 [IQR 21.0, 69.0]) and SF-36 scores demonstrated poor QoL, worse at higher NYHA classes. A third of patients had moderate/severe depression and anxiety symptoms, and women had higher anxiety scores. Mean costs of outpatient follow-up were US$ 215 ± 238 for NYHA I patients, US$ 296 ± 399 for NYHA II and US$ 667 ± 1012 for NYHA III/IV. Lab/exam costs represented 30% of the costs in NYHA I, and 74% in NYHA III/IV (US$ 63.26 vs. US$ 491.05). CONCLUSION: Patients with HF in Brazil have poor QoL and high treatment costs; both worsen as the NYHA classification increases. It seems that HF has a greater impact on the mental health of women. Costs increase mostly related to lab/exams. Accurate and crossed information about QoL and costs is essential to drive care and reimbursement strategies based on value.

11.
Clinics ; Clinics;78: 100294, 2023. tab, graf
Artículo en Inglés | LILACS-Express | LILACS | ID: biblio-1528412

RESUMEN

Abstract Objectives: To measure Quality of Life (QoL) and costs of Heart Failure (HF) outpatients in Brazil as an introduction to the Value-Based Health Care (VBHC) concept. Materials and methods: Cross-sectional study, patients with HF, with ejection fraction <50%, were recruited from three hospitals in Brazil. Two QoL (36-Item Short Form Survey [SF-36] and Minnesota Living with Heart Failure Questionnaire [MLHFQ]) and two anxiety/depression questionnaires were applied. SF-36 scores were stratified by domains. Treatment costs were calculated using the Time-Driven Activity-Based Costing (TDABC) method. Results were stratified by NYHA functional class and sex. Results: From October 2018 to January 2021, 198 patients were recruited, and the median MLHFQ (49.5 [IQR 21.0, 69.0]) and SF-36 scores demonstrated poor QoL, worse at higher NYHA classes. A third of patients had moderate/severe depression and anxiety symptoms, and women had higher anxiety scores. Mean costs of outpatient follow-up were US$ 215 ± 238 for NYHA I patients, US$ 296 ± 399 for NYHA II and US$ 667 ± 1012 for NYHA III/IV. Lab/exam costs represented 30% of the costs in NYHA I, and 74% in NYHA III/IV (US $ 63.26 vs. US$ 491.05). Conclusion: Patients with HF in Brazil have poor QoL and high treatment costs; both worsen as the NYHA classification increases. It seems that HF has a greater impact on the mental health of women. Costs increase mostly related to lab/exams. Accurate and crossed information about QoL and costs is essential to drive care and reimbursement strategies based on value.

13.
Intern Emerg Med ; 17(8): 2299-2313, 2022 11.
Artículo en Inglés | MEDLINE | ID: mdl-36153772

RESUMEN

The COVID-19 pandemic caused unprecedented pressure over health care systems worldwide. Hospital-level data that may influence the prognosis in COVID-19 patients still needs to be better investigated. Therefore, this study analyzed regional socioeconomic, hospital, and intensive care units (ICU) characteristics associated with in-hospital mortality in COVID-19 patients admitted to Brazilian institutions. This multicenter retrospective cohort study is part of the Brazilian COVID-19 Registry. We enrolled patients ≥ 18 years old with laboratory-confirmed COVID-19 admitted to the participating hospitals from March to September 2020. Patients' data were obtained through hospital records. Hospitals' data were collected through forms filled in loco and through open national databases. Generalized linear mixed models with logit link function were used for pooling mortality and to assess the association between hospital characteristics and mortality estimates. We built two models, one tested general hospital characteristics while the other tested ICU characteristics. All analyses were adjusted for the proportion of high-risk patients at admission. Thirty-one hospitals were included. The mean number of beds was 320.4 ± 186.6. These hospitals had eligible 6556 COVID-19 admissions during the study period. Estimated in-hospital mortality ranged from 9.0 to 48.0%. The first model included all 31 hospitals and showed that a private source of funding (ß = - 0.37; 95% CI - 0.71 to - 0.04; p = 0.029) and location in areas with a high gross domestic product (GDP) per capita (ß = - 0.40; 95% CI - 0.72 to - 0.08; p = 0.014) were independently associated with a lower mortality. The second model included 23 hospitals and showed that hospitals with an ICU work shift composed of more than 50% of intensivists (ß = - 0.59; 95% CI - 0.98 to - 0.20; p = 0.003) had lower mortality while hospitals with a higher proportion of less experienced medical professionals had higher mortality (ß = 0.40; 95% CI 0.11-0.68; p = 0.006). The impact of those association increased according to the proportion of high-risk patients at admission. In-hospital mortality varied significantly among Brazilian hospitals. Private-funded hospitals and those located in municipalities with a high GDP had a lower mortality. When analyzing ICU-specific characteristics, hospitals with more experienced ICU teams had a reduced mortality.


Asunto(s)
COVID-19 , Humanos , Adolescente , Pandemias , Brasil/epidemiología , Estudios Retrospectivos , Unidades de Cuidados Intensivos , Mortalidad Hospitalaria , Estudios de Cohortes , Hospitales Generales , Sistema de Registros
14.
Artículo en Portugués | LILACS, ECOS | ID: biblio-1412815

RESUMEN

Objetivo: O objetivo do estudo é medir o custo assistencial por paciente e revisar o ressarcimento do Sistema Único de Saúde (SUS) na linha de cuidado de acidente vascular cerebral isquêmico (AVCi). Métodos: Estudo prospectivo, com 24 pacientes na amostra, na unidade de referência na instituição para tratamento de AVC, no período de novembro/2019 a dezembro/2019. O método utilizado para apuração de custos foi o custeio baseado em atividade e tempo (TDABC), no qual os custos são coletados focando o paciente e os cuidados dispensados durante a assistência. A perspectiva do estudo é a do prestador de serviços do SUS, que se concentrou na avaliação de custos. Foram realizadas as análises de custo total por paciente, componente de custo, custo e tempo por fase na linha de cuidado, custo médio diário e custo médio diário do SUS. Resultados: O custo médio do paciente com AVCi auferido pelo método TDABC é de R$ 14.079,70, sendo a sua maioria justificada em custos de estrutura da unidade de AVC. A atividade com mais custos foi a unidade de AVC e realização de exames. Conclusões: Foi identificado no estudo que os principais contribuintes para a geração de custos na linha de cuidado são as atividades que demandam mais tempo, os medicamentos dispensados e os exames denominados de "alto custo" realizados. Os custos reais aferidos em relação ao ressarcimento previsto pelo SUS e estabelecimentos de saúde credenciados neste estudo demonstram que apenas 39% do custo real está coberto pelo SUS no AVCi.


Objective: The objective of the study is to measure the cost of care per patient and review the SUS reimbursement in the ischemic stroke (CVA) line of care. Methods: A prospective study, 24 patients in the sample at the reference unit at the institution for the treatment of stroke from November/2019 to December/2019. The method used to calculate costs was activity and timebased costing (TDABC), in which costs are collected focusing on the patient and the care provided during care. The perspective of the study is that of the SUS service provider who focused on cost assessment. Analyzes of total cost per patient, per cost component, cost and time per phase in the care line, average daily cost and average daily SUS cost were performed. Results: The average cost of a patient with ischemic stroke earned by the TDABC method is R$ 14,079.70, most of which are justified in the cost of the structure of the stroke unit. The activity with the most costs was the stroke unit and examinations. Conclusions: The main contributors to the generation of cost in the care line were identified in the study: the activities that demand more time, the medicines dispensed, and the so-called "high cost" tests performed. The real costs measured in relation to the reimbursement provided by the SUS and accredited health establishments in this study demonstrate that only 39% of the real cost is covered by the SUS in Ischemic Stroke.


Asunto(s)
Costos y Análisis de Costo , Accidente Cerebrovascular Isquémico
15.
Health Policy Plan ; 37(9): 1098-1106, 2022 Oct 12.
Artículo en Inglés | MEDLINE | ID: mdl-35866723

RESUMEN

The unsustainable increases in healthcare expenses and waste have motivated the migration of reimbursement strategies from volume to value. Value-based healthcare requires detailed comprehension of cost information at the patient level. This study introduces a clinical risk- and outcome-adjusted cost estimate model for stroke care sustained on time-driven activity-based costing (TDABC). In a cohort and multicentre study, a TDABC tool was developed to evaluate the costs per stroke patient, allowing us to identify and describe differences in cost by clinical risk at hospital arrival, treatment strategies and modified Rankin Score (mRS) at discharge. The clinical risk was confirmed by multivariate analysis and considered patients' National Institute for Health Stroke Scale and age. Descriptive cost analyses were conducted, followed by univariate and multivariate models to evaluate the risk levels, therapies and mRS stratification effect in costs. Then, the risk-adjusted cost estimate model for ischaemic stroke treatment was introduced. All the hospitals collected routine prospective data from consecutive patients admitted with ischaemic stroke diagnosis confirmed. A total of 822 patients were included. The median cost was I$2210 (interquartile range: I$1163-4504). Fifty percent of the patients registered a favourable outcome mRS (0-2), costing less at all risk levels, while patients with the worst mRS (5-6) registered higher costs. Those undergoing mechanical thrombectomy had an incremental cost for all three risk levels, but this difference was lower for high-risk patients. Estimated costs were compared to observed costs per risk group, and there were no significant differences in most groups, validating the risk and outcome-adjusted cost estimate model. By introducing a risk-adjusted cost estimate model, this study elucidates how healthcare delivery systems can generate local cost information to support value-based reimbursement strategies employing the data collection instruments and analysis developed in this study.


Asunto(s)
Isquemia Encefálica , Accidente Cerebrovascular Isquémico , Accidente Cerebrovascular , Brasil , Análisis Costo-Beneficio , Humanos , Estudios Prospectivos , Accidente Cerebrovascular/terapia
16.
Cien Saude Colet ; 27(5): 2035-2043, 2022 May.
Artículo en Inglés | MEDLINE | ID: mdl-35544829

RESUMEN

Referral of cases from primary to secondary care in the Brazilian public healthcare system is one of the most important issues to be tackled. Telehealth strategies have been shown effective in avoiding unnecessary referrals. The objective of this study was to estimate cost per referred case by a remotely operated referral management system to further inform the decision making on the topic. Analysis of cost by applying time-driven activity-based costing. Cost analyses included comparisons between medical specialties, localities for which referrals were being conducted, and periods of time. Cost per referred case across localities ranged from R$ 5.70 to R$ 8.29. Cost per referred case across medical specialties ranged from R$ 1.85 to R$ 8.56. Strategies to optimize the management of referral cases to specialized care in public healthcare systems are still needed. Telehealth strategies may be advantageous, with cost estimates across localities ranging from R$ 5.70 to R$ 8.29, with additional observed variability related to the type of medical specialty.


Asunto(s)
Atención Secundaria de Salud , Telemedicina , Brasil , Atención a la Salud , Humanos , Derivación y Consulta
17.
Ciênc. Saúde Colet. (Impr.) ; Ciênc. Saúde Colet. (Impr.);27(5): 2035-2043, maio 2022. tab, graf
Artículo en Inglés | LILACS-Express | LILACS | ID: biblio-1374971

RESUMEN

Abstract Referral of cases from primary to secondary care in the Brazilian public healthcare system is one of the most important issues to be tackled. Telehealth strategies have been shown effective in avoiding unnecessary referrals. The objective of this study was to estimate cost per referred case by a remotely operated referral management system to further inform the decision making on the topic. Analysis of cost by applying time-driven activity-based costing. Cost analyses included comparisons between medical specialties, localities for which referrals were being conducted, and periods of time. Cost per referred case across localities ranged from R$ 5.70 to R$ 8.29. Cost per referred case across medical specialties ranged from R$ 1.85 to R$ 8.56. Strategies to optimize the management of referral cases to specialized care in public healthcare systems are still needed. Telehealth strategies may be advantageous, with cost estimates across localities ranging from R$ 5.70 to R$ 8.29, with additional observed variability related to the type of medical specialty.


Resumo O encaminhamento de casos da atenção primária para a secundária no Sistema Único Brasileiro é uma das questões mais importantes a ser enfrentada. As estratégias de telessaúde têm se mostrado eficazes para evitar encaminhamentos desnecessários. O objetivo deste estudo foi estimar o custo por caso encaminhado por meio de um sistema de gerenciamento de referenciamentos operado remotamente para subsidiar a tomada de decisão sobre o tema. Análise de custo por meio da aplicação de custeio baseado em atividades orientado pelo tempo (time-driven activity-based costing ou TDABC). As análises de custo incluíram comparações entre especialidades médicas, localidades para as quais os encaminhamentos estavam sendo conduzidos e períodos de tempo. O custo por referenciamento em todas as localidades variou entre R$ 5,70 a R$ 8,29. O custo por referenciamento nas especialidades médicas variou entre R$ 1,85 a R$ 8,56. Estratégias para otimizar a gestão dos referenciamentos para a atenção especializada nos sistemas públicos de saúde ainda são necessárias. As estratégias de telessaúde podem ser vantajosas, com estimativas de custo entre as localidades variando entre R$ 5,70 a R$ 8,29, com variabilidade adicional observada relacionada ao tipo de especialidade médica.

18.
Value Health Reg Issues ; 28: 46-53, 2022 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-34800831

RESUMEN

OBJECTIVES: Advances in telemedicine offer a unique opportunity to expand access to the health system. Nevertheless, few studies have described the impact of telediagnosis implementation on health and economic outcomes. METHODS: An ophthalmology telediagnosis service (TeleOftalmo) was compared with traditional face-to-face care provided by the Brazilian public health system. For both groups, utility data were collected at 2 time points using the Visual Function Questionnaire-Utility Index instrument from interviews with 536 patients. The cost per patient encounter was analyzed according to the time-driven activity-based costing. Value analyses were conducted to ascertain whether and how telemedicine service has the potential to generate cost savings for the health system. RESULTS: Visual function-related quality of life did not differ significantly between TeleOftalmo and face-to-face care groups. Using the current model, the telemedicine service assisted an average of 1159 patients per month at a median cost per telediagnosis of Int$97 (interquartile range, Int$82-Int$119) versus Int$77 (interquartile range, Int$75-Int$80) for face-to-face care. If the telemedicine service was redesigned, considering the opportunities for improvement identified, it could operate at a cost of Int$53 per telediagnosis (a 31% cost savings) and could serve 3882 patients per month. CONCLUSIONS: This study demonstrates the potential value of a telemedicine service. There was no difference in patient-perceived utility between a telediagnostic ophthalmology service and face-to-face care by an eye specialist. TeleOftalmo has the potential to be a cost-saving strategy for the Brazilian health system and could be a template for implementation of telediagnostic services in other regions.


Asunto(s)
Oftalmología , Telemedicina , Brasil , Ahorro de Costo , Humanos , Calidad de Vida
19.
Artif Organs ; 46(5): 964-971, 2022 May.
Artículo en Inglés | MEDLINE | ID: mdl-34913492

RESUMEN

Around 5% of coronavirus disease 2019 (COVID-19) patients develop critical disease, with severe pneumonia and acute respiratory distress syndrome (ARDS). In these cases, extracorporeal membrane oxygenation (ECMO) may be considered when conventional therapy fails. This study aimed to describe the clinical characteristics and in-hospital outcomes of COVID-19 patients with ARDS refractory to lung-protective ventilation and prone positioning on ECMO support, as well as to review the available literature on ECMO use and COVID-19 patients' outcome. Patients from this case series were selected from the Brazilian COVID-19 Registry. From the 7646 patients included in the registry, only eight received ECMO support (0.1%), in four hospitals. The median age of the entire sample was 59 (interquartile range 54.2-64.4) years old and 87.5% were male. Hypertension (50.0%), diabetes mellitus (50.0%) and obesity (37.5%) were the most frequent comorbidities. The indications for ECMO were PaO2 /FiO2 ratio <80 mm Hg for more than 6 h or PaO2 /FiO2 ratio <60 mm Hg for more than 3 h. The mortality rate was 87.5%. In conclusion, in this case series of COVID-19 patients with ARDS refractory to conventional therapy who received ECMO support, a very high mortality was observed. Our findings are not different from previous studies including a small number of patients; however, there is a huge difference from Extracorporeal Life Support Organization results, which encourages us to keep looking for improvement.


Asunto(s)
COVID-19 , Oxigenación por Membrana Extracorpórea , Síndrome de Dificultad Respiratoria , Brasil/epidemiología , COVID-19/complicaciones , COVID-19/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sistema de Registros , Síndrome de Dificultad Respiratoria/terapia
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