Treatment for human visceral leishmaniasis: a cost-effectiveness analysis for Brazil.

OBJECTIVE: To estimate the cost-effectiveness of strategies for the treatment of VL in Brazil. METHODS: Cost-effectiveness study comparing three therapeutic options: meglumine antimoniate (MA), liposomal amphotericin B (LAMB) and a combination of LAMB plus MA (LAMB plus MA), from public health system and societal perspectives. An analytical decision-making model was used to compare strategies for the following outcomes: early therapeutic failure avoided at 30 days, days of hospitalisation avoided and VL cure at 180 days. The efficacy and safety parameters of the drugs came from a randomised, open-label trial and the cost data came from a cost-of-illness study, both carried out in Brazil. RESULTS: For all outcomes analysed, the LAMB strategy was more effective. The MA strategy was inferior to the LAMB plus MA strategy for the outcomes early therapeutic failure avoided and cure. When only LAMB and MA were compared from a societal perspective, a cost of US$ 278.56 was estimated for each additional early therapeutic failure avoided, a cost of US$ 26.88 for each additional day of hospitalisation avoided and a cost of US$ 89.88 for each additional case of cured VL, for the LAMB strategy vs. MA. CONCLUSION: In Brazil, the LAMB strategy proved to be cost-effective for treating VL, considering a GDP per capita as the willingness-to-pay threshold, for all of the outcomes analysed in comparison to MA.

OBJECTIF: Estimer la rentabilité des stratégies de traitement de la leishmaniose viscérale (LV) au Brésil. MÉTHODES: Etude coût-efficacité comparant trois options thérapeutiques: l'antimoniate de méglumine (AM), amphotéricine B liposomale (LAMB) et une combinaison de LAMB et MA (LAMB plus AM), du point de vue du système de santé publique et sociétal. Un modèle décisionnel analytique a été utilisé pour comparer les stratégies pour les résultats suivants: échec thérapeutique précoce évité à 30 jours, jours d'hospitalisation évités et guérison de la LV à 180 jours. Les paramètres d'efficacité et de sécurité des médicaments provenaient d'un essai randomisé ouvert et les données relatives aux coûts, d'une étude sur le coût de la maladie, toutes deux menées au Brésil. RÉSULTATS: Pour tous les résultats analysés, la stratégie LAMB était plus efficace. La stratégie AM était inférieure à la stratégie LAMB plus AM pour les résultats: échec thérapeutique précoce évité et guérison. Lorsque seules les stratégies LAMB et AM ont été comparées d'un point de vue sociétal, un coût de 278,56 USD a été estimé pour chaque échec thérapeutique précoce additionnel évité, un coût de 26,88 USD pour chaque jour d'hospitalisation additionnel évité et un coût de 89,88 USD pour chaque cas additionnel de LV guéri, pour la stratégie LAMB par rapport à AM. CONCLUSION: Au Brésil, la stratégie LAMB s'est avérée rentable pour traiter la LV, considérant un PIB par habitant comme seuil de volonté de payer, pour tous les résultats analysés par rapport à l'AM.

Patrón de consumo de antineoplásicos utilizados para el tratamiento del cáncer en La Habana del 2011-2015 / Pattern of consumption of antineoplastic used for the treatment of cancer in Havana 2011-2015 / Padrão de consumo de antineoplasicos utilizados no tratamento do cancro em Havana 2011-2015 / Modèle de consommation d'antinéoplasiques utilisés pour le traitement du cancer à La Havane 2011-2015

Resumen Objetivo: Caracterizar el patrón de consumo de los antineoplásicos utilizados para el tratamiento de los pacientes con neoplasias en la provincia La Habana durante el período 2011-2015. Materiales y métodos: Estudio descriptivo, de utilización de medicamentos de consumo con elementos de consecuencias prácticas expresadas en unidades vendidas. Los datos se obtuvieron de la base de datos de la Droguería, según el Formulario Nacional de Medicamentos presente cada año en el Cuadro Básico, durante el período 2011-2015, pertenecientes al Cuadro Básico de Medicamentos de la provincia. Los datos de consumo en unidades físicas de los antineoplásicos se obtuvieron a partir de las ventas por productos de la Unidad Empresarial de Base Mayorista de Medicamentos La Habana. Los precios se obtuvieron del listado oficial de precios: PRECIOS1, del Ministerio de Finanzas y Precios. Se consideró consumo ideal a lo planificado según la demanda de las instituciones de salud y real a la cantidad de unidades vendidas a dichas instituciones. Resultados: El consumo de manera general se mostró ascendente en cada año de estudio de (488578) a (753587). El mayor consumo se concentró en las mostazas nitrogenadas (116709), análogos del ácido fólico (113333), platinos (70336), derivados de la podofilotoxina (61551) y anticuerpos monoclonales (38294). El costo del consumo de medicamentos fue de $51.403.612,75. Conclusiones: El patrón de consumo según unidades vendidas se caracterizó por un incremento del mismo por años de estudio en los diferentes subgrupos con independencia del cumplimiento o no de las solicitudes demandadas por las unidades de salud. El valor económico del consumo de antineoplásicos se incrementó. Los anticuerpos monoclonales fueron el grupo de mayor costo identificado en el estudio.

Abstract Objective: To characterize the consumption pattern of the antineoplastic drugs used for the treatment of patients with neoplastic in the province of La Habana during the period 2011-2015. Materials and methods: Descriptive study of the use of consumer drugs with elements of practical consequences expressed in units sold. The data were obtained from the database of drugstore, according to National Formulary of Medications, present each year in the Basic Chart, during the period 2011-2015, belonging to the Basic Chart of Medicines of the province. The consumption data in physical units of the antineoplastic ones were obtained from the sales by products of the Business Unit of Base Wholesale of Medicine Havana. The prices were obtained from the oficial price list: PRECIOS1, from the Ministry of Finance and Prices. Ideal consumption was considered as planned according to the demand of health institutions and real to the number of units sold to these institutions. Results: Consumption in general was upward in each year of study from (488578) to (753587). The highest consumption was concentrated on nitrogen mustards (116709), folic acid analogues (113333), platines (70336), podophyllotoxin derivatives (61551) and monoclonal antibodies (38294). The cost of drug consumption was $ 51,403,612.75. Conclusions: The pattern of consumption according to units sold was characterized by an increase of the same by years of study in the different subgroups independently of the compliance or not of the requests demanded by the health units. The economic value of antineoplastic consumption increased. Monoclonal antibodies were the highest cost group identified in the study.

Resumo Objetivo: Caracterizar o padrão de consumo de agentes antineoplásicos utilizados no tratamento em utentes com neoplasia na provincia de Havana durante o período de 2011 a 2015. Materiais e métodos: Estudo descritivo, com a utilização de medicamentos, com elementos de consequências prácticas expressas em unidades vendidas. Os dados foram obtidos através do banco de dados de medicação, obtida do Formulário Nacional de Medicamentos em cada ano e representados no Gráfico Básico durante o período 2011-2015. Os dados relativos ao consumo dos antineoplásicos foram obtidos a partir das vendas da Unidade de Negócios da Wholesale Drug Base de Havana. Os preços foram obtidos pela lista de preços oficiais: PREçOS1, do Ministério das Finaças e Preços. Considerou-se que o consumo ideal o planeado de acordo com a procura das Instituiçoes de Saúde e o real as quantidades de unidades vendidas nestas Instituiçoes. Resultado: O consumo geral tem vindo a aumentar em cada ano de estudo, passe de 488578 para 753587. O principal produto consumido foi a mostarda de nitrogenio (116709), análogos de ácido fólico (113333), platinas (70336), derivados de podofilotoxina (61551) e os anticorpos monoclonais (38294). O valor do consumo dos medicamentos foi de US $ 51.403.612,75. Conclusões: O padrão de consumo, de acordo com as unidades vendidas, foi caracterizado por um aumento de acordo com as unidades acrescidas pelos anos de estudos nos diferentes subgrupos, independentemente da conformidade ou não dos pedidos exigidos pelas unidades de saúde. Os gastos com o consumo de antineoplásicos aumentou. Os anticorpos monoclonais foi o grupo identificado no estudo com maior custo.

Résumé Objectif: Caractériser le profil de consommation des antinéoplasiques utilisés pour le traitement des patients atteints de néoplasies dans la province de La Habana pendant la période 2011-2015. Matériaux et méthode: étude descriptive de l'utilisation de médicaments incluant des éléments de conséquences pratiques exprimés en unités vendues. Les données ont été obtenues a partir de la base de données de la Pharmacie pour la période 2011-2015, selon le Formulaire National de Médicaments représenté chaque année dans la Liste des Médicaments Essentiels de cette province. Les données de consommation en unités physiques d'antinéoplastiques ont été obtenues a partir des ventes de chaque produit par l' «Unidad Empresarial de Base Mayorista de Medicamentos La Habana¼ (Unité de base de commerce en gros de médicaments La Havane). Les prix ont été obtenus a partir de la liste des tarifs officiels PRECIOS1, du Ministere des Finances et des Prix. La consommation idéale considérée correspond a la planification réalisée a partir de la demande des institutions de santé et la consommation réelle a la quantité d'unités vendues dans ces institutions. Résultats: Globalement, la consommation a augmenté chaque année étudiée, passant de 488578 a 753587 unités. La consommation la plus importante s'est concentrée sur les moutardes azotées (116709), les analogues d'acide folique (113333), les platines (70336), les dérivés de la podophyllotoxine (61551) et les anticorps monoclonaux (38294). Le cout de la consommation de médicaments a été de 51.403.612,75$. Conclusions: Le modele de consommation selon les unités vendues s'est caractérisé chaque année par une augmentation dans les différents sous- groupes, indépendamment de la satisfaction ou non des demandes réalisées par les unités de santé. La valeur économique de l'utilisation antinéoplasique a augmenté. Le groupe des anticorps monoclonaux a représenté le cout le plus élevé.

Cost of visceral leishmaniasis care in Brazil.

OBJECTIVE: To estimate the Brazilian direct and indirect costs of human visceral leishmaniasis (VL) in 2014. METHODS: Cost-of-illness study on the Brazilian public health system and societal perspective. VL cases registered in the Notifiable Diseases Information System in the year of 2014 were considered. Direct medical costs regarding diagnostic, treatment and care provided to patients with VL were estimated through the top-down approach. The indirect costs related to productivity loss due to premature mortality and morbidity were estimated by means of the human-capital method. RESULTS: In 2014, 9895 suspected cases of VL were reported in the Notifiable Diseases Information System, and 3453 were later confirmed. There were 234 patients with Leishmania-HIV coinfection underwent a secondary prophylaxis. The total cost of VL in Brazil was US$ 14 190 701.50 (US$ 14 189 150.10 to 14 199 940.53) that varied according to the sensitivity analysis. The total of direct medical costs corresponded to US$ 1 873 681.96 (US$1 872 130.55 to 1 882 920.99), and the majority of costs was associated with hospitalisation (40%), followed by treatment (22%), and secondary prophylaxis (18%). Productivity loss corresponded to US$ 11 421 683.37 for premature mortality and US$ 895 336.18 for work absence due to hospitalisation by the illness. CONCLUSIONS: VL represents an expensive health problem for the Brazilian public health system and society, mainly because of its productivity loss due to premature mortality. Interventions to reduce VL lethality could have a great impact on decreasing the cost of illness.

Cost-effectiveness of liposomal amphotericin B in hospitalised patients with mucocutaneous leishmaniasis.

OBJECTIVE: To compare the cost-effectiveness of L-AmB with that of SbV and AmB-D, for the treatment of mucocutaneous leishmaniasis in a hospital in north-east Brazil. METHODS: We developed an economic model based on retrospective data of 73 hospitalised patients in 2006-2012, from hospital and public health system perspectives. RESULTS: In the economic model, 82.2% of patients who started treatment with L-AmB had completed it after 2 months, vs. 22.0% for the SbV and 19.9% for the AmB-D groups. After 12 months of follow-up, these proportions were 100% in the L-AmB, 77.4% in the AmB-D and 72.2% in the SbV group. Markov chain analyses showed that the group that started therapy with SbV had the lowest mean total cost (US$ 3782.38), followed by AmB-D (US$ 5211.27) and L-AmB (US$ 11 337.44). The incremental cost-effectiveness ratio for L-AmB was US$ 18 816.23 against SbV and US$ 24 504.65 against AmB-D. In the sensitivity analysis, the drug acquisition cost of L-AmB significantly influenced the results. CONCLUSIONS: In the treatment of mucocutaneous leishmaniasis, L-AmB is a cost-effective alternative to SbV and AmB-D owing to its higher effectiveness, safety and shorter course.

O custo da mudança - do incômodo ao movimento / The cost of change - from inconvenience to movement / El precio del cambio - del malestar al movimiento / Le coût du changement - de la gêne jusqu'au mouvement

O artigo explicita a complexidade das discussões acerca do preço da formação psicanalítica no Instituto "Durval Marcondes", a partir das reverberações do Simpósio Anual da AMF - "O silêncio sobre o custo e o custo do silêncio na formação psicanalítica", de março de 2017, na SBPSP. A partir do incômodo provocado pelo tema, aponta seus entraves, suas consequências diretas e indiretas e ventila possibilidades de movimentar a questão

This article's purpose is to explain the complexity of the discussions about the cost of psychoanalytic training at "Durval Marcondes" Institute. The author writes about the reverberations of the AMF Annual Symposium "The silence about cost and the cost of silence in the psychoanalytic training", which took place in March, 2017, at The Brazilian Psychoanalytic Society of Sao Paulo (SBPSP). The paper starts from the inconvenience that has arisen from this theme. The author comments on obstacles, direct and indirect effects of this cost. He also thinks about possible ways of heating up the debate on this issue

Este trabajo explicita la complejidad de las discusiones acerca del precio de la formación psicoanalítica en el Instituto "Durval Marcondes", a partir de las reverberaciones del Simposio Anual de la AMF (Asociación de miembros afiliados) "El silencio sobre el costo y el costo del silencio en la formación psicoanalítica", en marzo de 2017, en la SBPSP. A partir del malestar provocado por el tema, señala sus trabas, sus consecuencia directas e indirectas y sugiere posibilidades de movilizar esta cuestión

L'article explicite la complexité des discussions concernant le prix de la formation psychanalytique à l'Institut «Durval Marcondes¼, à partir des réverbérations du Symposium annuel de l'AMF "Silence sur le coût et le coût du silence dans la formation psychanalytique", en mars 2017, à la SBPSP. Prenant comme point de départ la gêne causée par le thème, l'article montre les obstacles, les conséquences directes et indirectes de cette situation et il envisage les possibilités d'imprimer du mouvement à la question

Valores de análise didática pelo mundo / Precios de análisis didáctico en el mundo / Worldwide values of didactic psychoanalysis / Les valeurs de l'analyse didactique par tout dans le monde

Os dados aqui apresentados referem-se a valores pagos pela sessão de análise didática por candidatos em formação. O levantamento foi realizado por meio de canais de comunicação existentes entre colegas participantes da ipso (Associação Internacional de Candidatos) que fazem formação em institutos filiados à IPA em 27 diferentes cidades do mundo. Trata-se de um levantamento informal, e não de uma pesquisa com os rigores metodológicos pertinentes; porém, considera-se que, sendo verdadeiros os valores informados, servem como referência para revelar institutos, cidades e países onde a formação é mais acessível ou mais elitizada. Tal levantamento foi feito para debater questões no Simpósio Anual da AMF (Associação de Membros Filiados) "O silêncio sobre o custo e o custo do silêncio na formação psicanalítica", que aconteceu em março de 2017.

The data presented herein are regarding amounts of money which candidates in psychoanalytic training have spent for sessions of didactic psychoanalysis. The data collection was made through communication channels that exist among colleagues who are part of ipso (International Psychoanalytical Studies Organization). These colleagues are training in institutes that are affiliated to IPA in 27 different cities around the world. This data collection is informal; it has not resulted from a research made with due methodological rigor. However, the author continues, since the values informed herein reflect reality, they can be taken as a reference to reveal institutes, cities, and countries in which psychoanalytic training is more accessible to everyone, and those in which it is more restricted to the elite. The purpose of this data collection was to feed the debate at the AMF's Annual Symposium (AMF - Affiliated Members Association) "The silence about cost and the cost of silence in the psychoanalytic training", which happened in March of 2017.

Los datos presentados aquí se refieren al precio de la sesión de análisis didáctico que pagan los candidatos en formación. El levantamiento fue realizado a través de canales de comunicación existentes entre colegas participantes de la ipso ( International Psychoanalytical Studies Organization) que hacen formación psicoanalítica en institutos afiliados a la IPA en 27 ciudades del mundo. Se trata de un levantamiento informal de datos y no de una investigación con los rigores metodológicos pertinentes. Sin embargo, se considera que, siendo verdaderos los valores informados, sirven como referencia para revelar en qué institutos, ciudades y países la formación psicoanalítica es más accesible o en cuales es más elitizada. Ese levantamiento fue realizado para debatir estas cuestiones en el Simposio Anual de la AMF (Asociación de Candidatos) "O silencio sobre el precio y el precio del silencio en la formación psicoanalítica", que ocurrió en marzo de 2017.

Les données présentées ici concernent les valeurs payées pour la séance d'analyse didactique par des candidats en formation. Ces informations ont été réunies au moyen de canaux de communication existants entre des collègues qui participent à l'ipso (International Psychoanalytical Studies Organization) qui suivent leur formation dans des instituts affiliés à l'ipa dans 27 différentes villes du monde. Il s'agit d'une enquête informelle et non d'une recherche suivant les rigueurs méthodologiques pertinentes, néanmoins, on considère que, si les valeurs présentées sont vraies, elles servent de référence pour divulguer des instituts, des villes et des pays où la formation est plus accessible ou plus élitiste. Ce recueil a été fait pour débattre des questions au Symposium annuel de l'AMF (Association des Membres Affiliés): "Le silence sur le coût et le coût du silence, chez la formation psychanalytique", qui a eu lieu en mars 2017.

Tecnologia, Organização do Trabalho e Custo Cognitivo: Ação Ergonômica em um Núcleo de Segurança da Informação / Technology, Work Organization and Cognitive Cost: Ergonomic Action in a Centre of Information Security / Tecnología, Organización del Trabajo y Coste Cognitivo: Acción Ergonómica en un Núcleo de Seguridad de la Información / Technology, Organisation du Travail et Cout Cognitif: Action Ergonomique dans un Noyau de Securité de L'information

Este estudo pretende ilustrar em que medida os elementos da organização trabalho contribuem ou dificultam a execução das tarefas de monitoramento de fraudes dentro de um Núcleo de Segurança Lógica de uma instituição financeira. Como construto teórico o estudo teve como base a ergonomia cognitiva e a psicologia cognitiva. Como método utilizou-se a Análise Ergonômica da Atividade ­ AET. Participaram do estudo 24 sujeitos, todos comissionados, sendo predominantemente do sexo masculino, faixa etária entre 26 e 50 anos. Os sujeitos do estudo apresentaram reclamações quanto a desconfortos físicos relacionados à rotina de trabalho.

This study intends to illustrate the extent to which the elements of the work organization contribute or hinder the execution of fraud monitoring tasks within a Logical Security Centre of a financial institution. As a theoretical construct the study was based on cognitive ergonomics and cognitive psychology. The Activity Ergonomic Analysis ­ AET was used as a method. Twenty-four subjects, all commissioned, being predominantly male, between 26 and 50 years of age were analyzed. The subjects of the study presented complaints regarding physical discomforts related to the work routine.

Este trabajo pretende demostrar en qué medida los elementos de la organización del trabajo contribuyen o dificultan la ejecución de las tareas de supervisión de estafas dentro de un Núcleo de Seguridad Lógica de una institución financiera. Como constructo teórico el trabajo tuvo como base la ergonomía cognitiva y la psicología cognitiva. Como método se analizó la Análisis Ergonómica de la Actividad ­ AET. Participaron de la investigación 24 sujetos, todos comisionados, predominantemente del sexo masculino, con edades entre 26 y 50 años. Los sujetos de la investigación reportaron reclamaciones sobre malestar físico relacionado con la rutina de trabajo.

Cette étude se propose d'illustrer la mesure dans laquelle les éléments de l'organisation du travail contribuent ou entravent la mise en œuvre des tâches de surveillance de fraude dans un noyau de Sécurité Logique d'une institution financière. Comme base théorique l'étude apporte l'ergonomie cognitive et la psychologie cognitive. Comme méthode, nous avons utilisé l'Analyse Ergonomique de l'Activité - AET. Ving-quatre (24 ) sujets ont participé de l'étude, tous commissionnés, étant surtout des hommes, âgés entre 26 et 50 ans. Les sujets de l'étude présentent des plaintes à propos de malaises physiques liées à la routine de travail.

Incremental cost of implementing residual insecticide treatment with delthametrine on top of intensive routine Aedes aegypti control.

OBJECTIVE: Information on the cost of implementing residual insecticide treatment (RIT) for Aedes control is scarce. We evaluated the incremental cost on top of intensive conventional routine activities of the Aedes control programme (ACP) in the city of Santiago de Cuba, Cuba. METHODS: We conducted the cost analysis study in 2011-2012, from the perspective of the ACP. Data sources were bookkeeping records, activity registers of the Provincial ACP Centre and the accounts of an RIT implementation study in 21 clusters of on average four house blocks comprising 5180 premises. RESULTS: The annual cost of the routine ACP activities was 19.66 US$ per household. RIT applications in rounds at 4-month intervals covering, on average, 97.2% and using 8.5 g of delthametrine annually per household, cost 3.06 US$ per household per year. Delthametrine comprised 66.5% of this cost; the additional cost for deploying RIT comprised 15.6% of the total ACP routine cost and 27% of the cost related to routine adult stage Aedes control. CONCLUSIONS: The incremental cost of implementing RIT is high. It should be weighed against the incremental effect on the burden caused by the array of pathogens transmitted by Aedes. The cost could be reduced if the insecticide became cheaper, by limiting the number of yearly applications or by targeting transmission hot spots.

Cost of neurocysticercosis patients treated in two referral hospitals in Mexico City, Mexico.

OBJECTIVES: To estimate annual costs related to the diagnosis, treatment and productivity losses among patients with neurocysticercosis (NCC) receiving treatment at two referral hospitals, the Instituto Nacional de Neurologia y Neurocirugia (INNN) and the Hospital de Especialidades of the Instituto Mexicano del Seguro Social (HE-IMSS), in Mexico City from July 2007 to August 2008. METHODS: Information on presenting clinical manifestations, diagnostic tests, hospitalisations, surgical procedures and other treatments received by NCC outpatients was collected from medical charts, and supplemented by an individual questionnaire regarding productivity losses and out-of-pocket expenses related to NCC. RESULTS: The annual average per-patient direct costs were US$ 503 (95% CI: 414-592) and US$ 438 (95% CI: 322-571) for patients without a history of hospitalisation and/or surgery seen at the INNN and the HE-IMSS, respectively. These costs increased to US$ 2506 (95% CI: 1797-3215) and US$ 2170 (95% CI: 1303-3037), respectively, for patients with a history of hospitalisation and/or surgery. The average annual per-patient indirect costs were US$ 246 (95% CI: 165-324) and US$ 114 (95% CI: 51-178), respectively, using minimum salary wages for individuals not officially employed. CONCLUSIONS: The total annual cost for patients who had and had not been hospitalised and/or undergone a surgical procedure for the diagnosis or treatment of NCC corresponded to 212% and 41% of an annual minimum wage salary, respectively. The disease tends to affect rural socioeconomically disadvantaged populations and creates health disparities and significant economic losses in Mexico.