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1.
PLoS One ; 13(10): e0204723, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30332422

RESUMO

Each year, evidence-based clinical guidelines gain more space in the health professionals' practice and in services organization. Due to the scarcity of scientific publications focused on diseases of poverty, the development of well-founded clinical guidelines becomes more and more important. In view of that, this paper aims to evaluate the quality of Brazilian guidelines for those diseases. The AGREE II method was used to evaluate 16 guidelines for poverty-related diseases (PRD) and 16 guidelines for global diseases whose treatment require high-cost technologies (HCD), with the ultimate aim of comparing the results. It was found that, in general, the guideline development quality standard is higher for the HCD guidelines than for the PRD guidelines, with emphasis on the "rigour of development" (48% and 7%) and "editorial independence" (43% and 1%) domains, respectively, which had the greatest discrepancies. The HCD guidelines showed results close to or above international averages, whereas the PRD guidelines showed lower results in the 6 domains evaluated. It can be concluded that clinical protocol development priorities need some redirecting in order to qualify the guidelines that define the healthcare organization and the care of vulnerable populations.


Assuntos
Custos de Cuidados de Saúde , Pobreza/economia , Guias de Prática Clínica como Assunto/normas , Brasil , Efeitos Psicossociais da Doença , Prática Clínica Baseada em Evidências/economia , Prática Clínica Baseada em Evidências/normas , Humanos , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/normas , Doenças Negligenciadas/economia , Doenças Negligenciadas/terapia , Tecnologia de Alto Custo/economia
2.
Health Policy ; 122(12): 1295-1301, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30241797

RESUMO

The Canadian patchwork system of prescription drug coverage and the employer sponsored private health benefits group plans appear vulnerable to cost growth due to insufficient balance of power between fragmented public and private buyers, and pharmaceutical manufacturers. The emergence of "bad" insurance risks caused by new and very expensive treatments featuring high cost specialty medicines - also known as niche buster drugs - exposes this vulnerability. This study fills a gap in knowledge by seeking to better understanding how Canadian private insurers face the arrival of specialty pharmaceuticals. It completes an overview of a body of grey literature composed of publicly available online articles from the employment benefits and group insurance consulting and administration industry; online documents from group benefits sector conferences; and online or on demand materials from Canadian life and health insurers. Claims for high cost specialty drugs generate new bad insurance risks that Canadian health insurers attempt to mitigate through isolated corporate initiatives, industry-wide strategies and calls for universal, public catastrophic coverage. The outcomes of these strategies are limited cost-control measures as well as risk and cost transfers onto plan sponsors, patients and provincial public programs.


Assuntos
Custos de Medicamentos , Planos de Assistência de Saúde para Empregados/economia , Seguradoras/economia , Tecnologia de Alto Custo/economia , Canadá , Controle de Custos , Reforma dos Serviços de Saúde , Humanos , Seguro Saúde/organização & administração , Medição de Risco
4.
Med Intensiva ; 42(7): 425-443, 2018 10.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29789183

RESUMO

The project "Commitment to Quality of Scientific Societies", promoted since 2013 by the Spanish Ministry of Health, seeks to reduce unnecessary health interventions that have not proven effective, have little or doubtful effectiveness, or are not cost-effective. The objective is to establish the "do not do" recommendations for the management of critically ill patients. A panel of experts from the 13 working groups (WGs) of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) was selected and nominated by virtue of clinical expertise and/or scientific experience to carry out the recommendations. Available scientific literature in the management of adult critically ill patients from 2000 to 2017 was extracted. The clinical evidence was discussed and summarized by the experts in the course of consensus finding of each WG, and was finally approved by the WGs after an extensive internal review process carried out during the first semester of 2017. A total of 65 recommendations were developed, of which 5 corresponded to each of the 13 WGs. These recommendations are based on the opinion of experts and scientific knowledge, and aim to reduce those treatments or procedures that do not add value to the care process; avoid the exposure of critical patients to potential risks; and improve the adequacy of health resources.


Assuntos
Cuidados Críticos/normas , Estado Terminal , Contraindicações de Medicamentos , Contraindicações de Procedimentos , Análise Custo-Benefício , Cuidados Críticos/métodos , Gerenciamento Clínico , Humanos , Apoio Nutricional , Cuidados Paliativos/normas , Direitos do Paciente , Tecnologia de Alto Custo , Assistência Terminal/normas , Procedimentos Desnecessários
5.
Stem Cells Transl Med ; 6(8): 1723-1729, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28749065

RESUMO

Cellular therapies and other regenerative medicines are emerging as potentially transformative additions to modern medicine, but likely at a staggering financial cost. Public health care systems' budgets are already strained by growing and aging populations, and many private insurer's budgets are equally stretched. The current systems that most payers employ to manage their cash flow are not structured to absorb a sudden onslaught of very expensive prescriptions for a large portion of their covered population. Despite this, developers of new regenerative medicines tend to focus on the demands of regulators, not payers, in order to be compliant throughout the clinical trials phases, and to develop a product that ultimately will be approvable. It is not advisable to assume that an approved product will automatically become a reimbursed product, as examples from current practice in hematopoietic stem cell transplantation in the U.S. demonstrate; similarly, in Europe numerous Advanced-therapy Medicinal Products achieved market authorization but failed to secure reimbursement (e.g., Glybera, Provenge, ChondroCelect, MACI). There are however strategies and approaches that developers can employ throughout clinical development, in order to generate clinical and health economic data which will be necessary to demonstrate the value proposition of the new product and help ensure market access for patients; furthermore, performance based managed entry agreements coupled with post-launch evidence generation can help overcome challenges around product uncertainty at launch and reduce market access delays. Stem Cells Translational Medicine 2017;6:1723-1729.


Assuntos
Análise Custo-Benefício , Transplante de Células-Tronco Hematopoéticas/economia , Tecnologia de Alto Custo/economia , Europa (Continente) , Transplante de Células-Tronco Hematopoéticas/tendências , Humanos , Tecnologia de Alto Custo/tendências , Estados Unidos
8.
Circulation ; 132(21): 2012-27, 2015 Nov 24.
Artigo em Inglês | MEDLINE | ID: mdl-26596977

RESUMO

We examined evidence on whether mobile health (mHealth) tools, including interactive voice response calls, short message service, or text messaging, and smartphones, can improve lifestyle behaviors and management related to cardiovascular diseases throughout the world. We conducted a state-of-the-art review and literature synthesis of peer-reviewed and gray literature published since 2004. The review prioritized randomized trials and studies focused on cardiovascular diseases and risk factors, but included other reports when they represented the best available evidence. The search emphasized reports on the potential benefits of mHealth interventions implemented in low- and middle-income countries. Interactive voice response and short message service interventions can improve cardiovascular preventive care in developed countries by addressing risk factors including weight, smoking, and physical activity. Interactive voice response and short message service-based interventions for cardiovascular disease management also have shown benefits with respect to hypertension management, hospital readmissions, and diabetic glycemic control. Multimodal interventions including Web-based communication with clinicians and mHealth-enabled clinical monitoring with feedback also have shown benefits. The evidence regarding the potential benefits of interventions using smartphones and social media is still developing. Studies of mHealth interventions have been conducted in >30 low- and middle-income countries, and evidence to date suggests that programs are feasible and may improve medication adherence and disease outcomes. Emerging evidence suggests that mHealth interventions may improve cardiovascular-related lifestyle behaviors and disease management. Next-generation mHealth programs developed worldwide should be based on evidence-based behavioral theories and incorporate advances in artificial intelligence for adapting systems automatically to patients' unique and changing needs.


Assuntos
Doenças Cardiovasculares/terapia , Telefone Celular , Gerenciamento Clínico , Comportamento de Redução do Risco , Telemedicina/instrumentação , Adulto , Tecnologia Biomédica/economia , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/prevenção & controle , Países em Desenvolvimento , Complicações do Diabetes/sangue , Complicações do Diabetes/prevenção & controle , Comportamentos Relacionados com a Saúde , Gastos em Saúde/estatística & dados numéricos , Promoção da Saúde/economia , Promoção da Saúde/métodos , Mão de Obra em Saúde/economia , Mão de Obra em Saúde/estatística & dados numéricos , Humanos , Internet , Pobreza , Autocuidado , Transferência de Tecnologia , Tecnologia de Alto Custo/economia , Telemedicina/economia , Telemedicina/estatística & dados numéricos
9.
J Am Acad Dermatol ; 72(4): 577-86; quiz 587-8, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25773408

RESUMO

Telemedicine is the use of telecommunications technology to support health care at a distance. Dermatology relies on visual cues that are easily captured by imaging technologies, making it ideally suited for this care model. Advances in telecommunications technology have made it possible to deliver high-quality skin care when patient and provider are separated by both time and space. Most recently, mobile devices that connect users through cellular data networks have enabled teledermatologists to instantly communicate with primary care providers throughout the world. The availability of teledermoscopy provides an additional layer of visual information to enhance the quality of teleconsultations. Teledermatopathology has become increasingly feasible because of advances in digitization of entire microscopic slides and robot-assisted microscopy. Barriers to additional expansion of these services include underdeveloped infrastructure in remote regions, fragmented electronic medical records, and varying degrees of reimbursement. Teleconsultants also confront special legal and ethical challenges as they work toward building a global network of practicing physicians.


Assuntos
Tecnologia Biomédica/tendências , Dermatologia/métodos , Telemedicina/tendências , Tecnologia Biomédica/economia , Telefone Celular , Dermatologia/organização & administração , Dermatologia/tendências , Dermoscopia/métodos , Diagnóstico por Imagem , Acesso aos Serviços de Saúde , Humanos , Consentimento Livre e Esclarecido , Mecanismo de Reembolso , Dermatopatias/diagnóstico , Dermatopatias/epidemiologia , Dermatopatias/terapia , Tecnologia de Alto Custo , Telemedicina/instrumentação , Telemedicina/organização & administração
10.
Cancer Radiother ; 18(5-6): 458-60, 2014 Oct.
Artigo em Francês | MEDLINE | ID: mdl-25195115

RESUMO

In 2013, about 6000 patients were treated with brachytherapy, the number diminishing by 2.6% per year since 2008. Prostate, breast and gynecological cancers are the most common types of cancers. Since 2008, the number of brachytherapy facilities has decreased by 18%. In medicoeconomic terms, brachytherapy faces many problems: the coding system is outdated; brachytherapy treatments cost as much as internal radiation; fees do not cover costs; since iridium wire has disappeared from the market, the technique will be transferred to more expensive high-speed or pulse dose rates. The French financing grid based on the national study of costs lags behind changes in such treatments and in the best of cases, hospitals resorting to alternatives such as in-hospital brachytherapy are funded at 46% of their additional costs. Brachytherapy is a reference technique. With intense pressure on hospital pricing, financing brachytherapy facilities will become even more problematic as a consequence of the disappearance of iridium 192 wires. The case of brachytherapy illustrates the limits of the French financing system and raises serious doubts as to its responsiveness.


Assuntos
Braquiterapia/instrumentação , Radioisótopos de Irídio/administração & dosagem , Braquiterapia/economia , Braquiterapia/métodos , Braquiterapia/estatística & dados numéricos , Braquiterapia/tendências , Institutos de Câncer/economia , Comércio , Desenho de Equipamento , Equipamentos e Provisões/provisão & distribução , França , Custos Hospitalares , Humanos , Neoplasias/economia , Neoplasias/radioterapia , Dosagem Radioterapêutica , Tecnologia de Alto Custo/economia , Cobertura Universal do Seguro de Saúde/economia , Vocabulário Controlado
11.
Cancer Radiother ; 18(5-6): 369-78, 2014 Oct.
Artigo em Francês | MEDLINE | ID: mdl-25199865

RESUMO

The identification of the optimal radiation technique in prostate cancer is based on the results of dosimetric and clinical studies, although there are almost no randomized studies comparing different radiation techniques. The feasibility of the techniques depends also on the technical and human resources of the radiation department, on the cost of the treatment from the points of view of the society, the patient and the radiation oncologist, and finally on the choice of the patient. The slow evolution of prostate cancer leads to consider the biochemical failure as the main judgment criteria in the majority of the studies. A proper urinary radio-induced toxicity evaluation implies a long follow-up. Intensity-modulated radiotherapy (IMRT) combined with image-guided radiotherapy (IGRT) is recommended in case of high dose (≥76Gy) to the prostate, pelvic lymph nodes irradiation and hypofractionation schedules. For low-risk tumors, the aim of the treatment is to preserve quality of life, while limiting costs. Stereotactic body radiotherapy shows promising results, although the follow-up is still limited and phase III trials are ongoing. Focal radiation techniques are in the step of feasibility. For intermediate and high-risk tumors, the objective of the treatment is to increase the locoregional control, while limiting the toxicity. IMRT combined with IGRT leads to either a well-validated dose escalation strategy for intermediate risk tumors, or to a strategy of moderate hypofractionated schedules, which cannot be yet considered as a standard treatment. These combined radiation techniques allow finally large lymph node target volume irradiation and dose escalation potentially in the dominant intraprostatic lesion. The feasibility of simultaneous integrated boost approaches is demonstrated.


Assuntos
Adenocarcinoma/radioterapia , Neoplasias da Próstata/radioterapia , Adenocarcinoma/secundário , Adenocarcinoma/terapia , Terapia Combinada , Fracionamento da Dose de Radiação , Acesso aos Serviços de Saúde/economia , Humanos , Irradiação Linfática/ética , Irradiação Linfática/métodos , Metástase Linfática/radioterapia , Masculino , Órgãos em Risco , Seleção de Pacientes , Guias de Prática Clínica como Assunto , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/terapia , Qualidade de Vida , Lesões por Radiação/etiologia , Lesões por Radiação/prevenção & controle , Radiocirurgia/efeitos adversos , Radiocirurgia/economia , Radiocirurgia/ética , Radiocirurgia/métodos , Dosagem Radioterapêutica , Radioterapia Conformacional/efeitos adversos , Radioterapia Conformacional/economia , Radioterapia Conformacional/ética , Radioterapia Conformacional/métodos , Radioterapia Guiada por Imagem/ética , Radioterapia Guiada por Imagem/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Risco , Tecnologia de Alto Custo/ética
12.
Cancer Radiother ; 18(5-6): 365-8, 2014 Oct.
Artigo em Francês | MEDLINE | ID: mdl-25179256

RESUMO

Numerous studies have shown that intensity-modulated radiation therapy is the standard technique for the radiation treatment of head and neck cancers. Intensity-modulated radiation therapy reduces side effects (xerostomia, dysphagia, fibrosis, etc.) and improves the results for cancer localizations with highly complex shapes such as the cavum or nasal cavity. Intensity-modulated radiation therapy is also a costly technique that necessitates a numerous staff, highly trained, with regular practice. If this technique cannot be available (understaffing, overwork, etc.) the choice between entrusting the patient to a colleague and treating the patient with a less sophisticated technique such as 3-dimensional conformal radiation therapy depends on different objective and ethical criteria.


Assuntos
Carcinoma de Células Escamosas/radioterapia , Neoplasias de Cabeça e Pescoço/radioterapia , Radioterapia Conformacional/métodos , Antineoplásicos/uso terapêutico , Carcinoma de Células Escamosas/tratamento farmacológico , Ensaios Clínicos como Assunto , Terapia Combinada , França , Neoplasias de Cabeça e Pescoço/tratamento farmacológico , Acesso aos Serviços de Saúde/economia , Humanos , Curva de Aprendizado , Órgãos em Risco , Transferência de Pacientes/ética , Guias de Prática Clínica como Assunto , Lesões por Radiação/prevenção & controle , Radioterapia (Especialidade)/educação , Radioterapia Conformacional/efeitos adversos , Radioterapia Conformacional/economia , Radioterapia Conformacional/ética , Tecnologia de Alto Custo/ética , Xerostomia/etiologia , Xerostomia/prevenção & controle
13.
Cad Saude Publica ; 30(6): 1293-304, 2014 Jun.
Artigo em Português | MEDLINE | ID: mdl-25099052

RESUMO

This study analyzes the supply and use of computed tomography scanners (CT) in the Brazilian Unified National Health System (SUS) according to State and administrative levels in the year 2009. Secondary data were used to estimate the installed CT capacity in public healthcare facilities and in private services outsourced by the SUS and calculated the rate of utilization. Average national CT utilization was less than 10%. The public sector showed lower CT use than the private sector outsourced by the SUS. The number of CT tests in the SUS was less than half the number produced in developed countries. The results thus suggest the need for further studies on management practices with high-technology equipment in order to improve allocation of current and future public resources in supplying CT tests.


Assuntos
Tecnologia de Alto Custo/estatística & dados numéricos , Tomógrafos Computadorizados/provisão & distribução , Tomógrafos Computadorizados/estatística & dados numéricos , Brasil , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde , Humanos , Programas Nacionais de Saúde , Setor Privado , Setor Público , Características de Residência
14.
G Ital Cardiol (Rome) ; 15(4): 233-9, 2014 Apr.
Artigo em Italiano | MEDLINE | ID: mdl-24873812

RESUMO

BACKGROUND: Percutaneous coronary interventions (PCI) are widespread procedures in the Italian Healthcare System, but concerns are raised about their economic sustainability. In the last decade, public hospitals have outsourced the PCI services (building and maintaining the technological instruments and the personnel) "buying" them from private companies (Buy) rather than building and maintaining them through public expenditure (Make). The aim of this study was to compare the economic and clinical impact of these two management solutions (Buy and Make) in two community hospitals located in the Turin metropolitan area (Italy). METHODS: We conducted: 1) a quantitative assessment in order to compare differences in the economic impact between Buy and Make for providing PCI; 2) a qualitative assessment comparing the clinical characteristics of two inpatient populations undergoing PCI and then analyzing the efficacy of the procedure in-hospital and at 6-month follow-up. RESULTS: Between January and June 2010, a total of 332 patients underwent PCI at the "degli Infermi" Hospital in Rivoli and 340 at the "Maria Vittoria" Hospital in Turin (Italy). There were no significant differences between the two populations neither about the clinical characteristics nor in procedural efficacy (either immediate or at follow-up). For 600 units of diagnostic-therapeutic pathway, the net present value at a discount rate of 3.5% of the Make project is higher than that of the Buy by €278.402,25, and is therefore the less convenient of the two solutions. The Buy solution is still the more convenient of the two at volumes <700 units. CONCLUSIONS: Our findings show that the Buy solution, if tailored to the specific local needs, provides access to sophisticated technology without making worse quality of services and may save capital expenditure below 700 PCI/years.


Assuntos
Cateterismo Cardíaco/economia , Hospitais Comunitários/economia , Serviços Terceirizados/economia , Intervenção Coronária Percutânea/economia , Idoso , Gastos de Capital , Cateterismo Cardíaco/instrumentação , Doença das Coronárias/diagnóstico , Doença das Coronárias/economia , Doença das Coronárias/epidemiologia , Doença das Coronárias/terapia , Redução de Custos , Feminino , Cardiopatias/mortalidade , Mortalidade Hospitalar , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/instrumentação , Recursos Humanos em Hospital/economia , Avaliação de Programas e Projetos de Saúde , Acidente Vascular Cerebral/epidemiologia , Tecnologia de Alto Custo/economia , Fatores de Tempo , Resultado do Tratamento
16.
Ann Pharm Fr ; 72(1): 3-14, 2014 Jan.
Artigo em Francês | MEDLINE | ID: mdl-24438663

RESUMO

Innovative medical devices offer solutions to medical problems and greatly improve patients' outcomes. Like National Health Technology Assessment (HTA) agencies, hospitals face numerous requests for innovative and costly medical devices. To help local decision-makers, different approaches of hospital-based HTA (HB-HTA) have been adopted worldwide. The objective of the present paper is to explore HB-HTA models for adopting innovative medical devices in France and elsewhere. Four different models have been conceptualized: "ambassador" model, "mini-HTA" model, "HTA unit" model and "internal committee". Apparently, "HTA unit" and "internal committee" (or a mixture of both models) are the prevailing HB-HTA models in France. Nevertheless, some weaknesses of these models have been pointed out in previous works. Only few examples involving hospital pharmacists have been found abroad, except in France and in Italy. Finally, the harmonization of the assessment of innovative medical devices in France needs a better understanding of HB-HTA practices.


Assuntos
Tecnologia Biomédica/normas , Aprovação de Equipamentos , Hospitais Universitários , Invenções , Tecnologia Biomédica/métodos , Tomada de Decisões , Aprovação de Equipamentos/normas , França , Órgãos Governamentais/organização & administração , Humanos , Modelos Teóricos , Serviço de Farmácia Hospitalar , Avaliação da Tecnologia Biomédica/organização & administração , Tecnologia de Alto Custo/normas
19.
Cancer Radiother ; 17 Suppl 1: S2-72, 2013 Aug.
Artigo em Francês | MEDLINE | ID: mdl-23916854
20.
Pharmacoeconomics ; 31(9): 731-7, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23877738

RESUMO

Healthcare systems are increasingly under pressure to provide funding for innovative technologies. These technologies tend to be characterized by their potential to make valued contributions to patient health in areas of relative unmet need, and have high acquisition costs and uncertainty within the evidence base on their actual impact on health. Decision makers are increasingly interested in linking reimbursement strategies to the degree of uncertainty in the evidence base and, as a result, reimbursement for innovative technologies is frequently linked to some form of patient access or risk-sharing scheme. As the dominant methods of economic evaluation report final outcomes only at the time horizon of the analysis, they present only aggregated information. This omits much of the information available on how net benefit is distributed within the time horizon. In this article, we introduce the Net Benefit Probability Map (NBPM), which maps net health benefit versus time to identify how certain decision makers can be about the benefit of technologies at multiple time points. Using an illustrative example, we show how the NBPM can inform decision makers about how long it will take for innovative technologies to 'pay off', how methodological choices on discount rates affect results and how alternative payment mechanisms can reduce the risk for decision makers facing innovative technologies.


Assuntos
Análise Custo-Benefício/métodos , Custos de Cuidados de Saúde , Tecnologia de Alto Custo/economia , Incerteza , Tomada de Decisões , Assistência à Saúde/economia , Humanos , Fatores de Tempo
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