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1.
Brasília; CONITEC; nov. 2020.
No convencional en Portugués | BRISA/RedTESA | ID: biblio-1120427

RESUMEN

INTRODUÇÃO: A artrite psoríaca (AP) é uma doença articular inflamatória crônica, sendo associada comumente à pacientes com psoríase. A AP pode causar danos e incapacidade articular permanente. A AP pertence ao grupo das espondiloartrites. As espondiloartrites são caracterizadas por apresentar sorologia negativa do fator reumatoide e acometimento da pele (psoríase), unhas (ungueal), articulações periféricas, do esqueleto axial (espondilite ou sacroileíte), entesites (local de inserção de tendões, ligamentos e cápsula articular às superfícies ósseas) e dactilites ("dedo em salsicha"). O Protocolo Clínico e Diretrizes Terapêuticas (PCDT) de AP divide o tratamento em não medicamentoso e medicamentoso. O tratamento não medicamentoso consiste no controle de fatores relacionados ao risco aumentado de outras doenças crônicas e o no incentivo aos hábitos saudáveis. Já o medicamentoso pode incluir as seguintes classes farmacológicas: anti-inflamatórios não esteroides (AINEs), medicamentos modificadores do curso da doença sintéticos (MMCD-s) e os MMCD biológicos (MMCD-b), que incluem os medicamentos anti-TNF adalimumabe, etanercepte, infliximabe e golimumabe; e o inibidor de citocinas anti-IL-17, secuquinumabe 300 mg, para os casos de resposta inadequada aos MMCD-b anti-TNF. PERGUNTA DEMANDANTE: Certolizumabe pegol é mais eficaz e seguro em pacientes com AP, moderada a grave, resistente ao tratamento com AINEs e MMCD-s, com falha prévia ao uso de MMCD-b, anti-TNF atualmente disponíveis no SUS, em comparação ao secuquinumabe 300 mg? TECNOLOGIA: Certolizumabe Pegol (Cimzia®). EVIDÊNCIAS CIENTÍFICAS: Foram incluídas cinco publicações (um ensaio clínico randomizado - ECR, RAPID-PsA, com quatro relatos, e um estudo observacional). Além disso, o demandante apresentou três ECR (FUTURE 2, 3 e 5) com três relatos cada. Os estudos FUTURE e o estudo RAPID-PSA fizeram parte da revisão sistemática (RS) com meta-análise em rede (network meta-analysis, NMA). A RS com NMA, principal estudo apresentado pelo demandante, avaliou os desfechos periféricos de AP (ACR20, ACR50, ACR70, PsARC) e os desfechos de segurança do certolizumabe pegol em comparação ao secuquinumabe 300 mg. O ECR RAPID-PsA comparou certolizumabe pegol com placebo, avaliando os desfechos de eficácia, em 96 semanas e 216 semanas. A segurança, comparada com placebo, foi avaliada em 216 semanas de tratamento. Já o estudo observacional avaliou os seguintes desfechos: taxa de descontinuação, persistência e adesão ao longo de 12 meses. Apenas um estudo avaliou o desfecho MDA, que é considerado pelo PCDT de AP como o desfecho mais adequado para a doença, porém foi contra placebo (RAPID-PsA 216 semanas). AVALIAÇÃO ECONÔMICA: Foi conduzido um estudo de custo-minimização para utilização do certolizumabe pegol na última etapa de terapia com MMCD-b, comparando-se com secuquinumabe 300 mg, sob a perspectiva do SUS, em um horizonte temporal de um ano. O tratamento com certolizumabe pegol, para a indicação proposta, resultaria em uma redução de custos de R$ 6.211,20 por paciente em comparação ao secuquinumabe 300 mg. AVALIAÇÃO DE IMPACTO ORÇAMENTÁRIO: O impacto orçamentário mostrou uma economia de recursos de aproximadamente 72 milhões com a incorporação do certolizumabe pegol em 5 anos. CONSIDERAÇÕES FINAIS: As evidências demonstram que certolizumabe pegol é eficaz e seguro contra placebo. Os resultados da RS com NMA sugerem uma possível similaridade entre as tecnologias, porém associada a importantes limitações principalmente para os desfechos de ACR (20/50/70) e de segurança. Os ECR incluídos e avaliados pelo Rob 2.0 apresentaram alto risco de viés, pois muitos desfechos não foram planejados. Os achados do estudo observacional, taxa de descontinuação, persistência e adesão ao longo de 12 meses, demonstram inferioridade do certolizumabe pegol em relação aos MMCD-b disponíveis no PCDT vigente para AP. RECOMENDAÇÃO PRELIMINAR DA CONITEC: A Conitec em sua 80ª reunião ordinária, no dia 08 de agosto de 2019, recomendou a não incorporação no SUS do certolizumabe pegol para pacientes com artrite psoríaca, moderada a grave, resistente ao tratamento com anti-inflamatórios não esteroides, medicamentos modificadores do curso da doença sintéticos e medicamentos modificadores do curso da doença biológico, anti-TNF. Considerou-se que as evidências científicas são frágeis, principalmente do ponto de vista metodológico. Além disso, existem muitas limitações e incertezas na possível economia informada pelo fabricante, devido as evidências apresentadas para subsidiar o estudo de custo-minimização e análise de impacto orçamentário. CONSULTA PÚBLICA: A Consulta Pública nº 54/2019 foi realizada entre os dias 30/08/2019 a 18/09/2019. Foram recebidas 81 contribuições no total, das quais 38 (47%) foram pelo formulário para contribuições técnico-científicas e 43 (53%) pelo formulário para contribuições sobre experiência ou opinião de pacientes, familiares, amigos ou cuidadores de pacientes, profissionais de saúde ou pessoas interessadas no tema. Das 38 contribuições de cunho técnico-científico, 76% discordaram totalmente, 8% discordaram parcialmente, 3% concordaram parcialmente e 13% concordaram totalmente com a recomendação preliminar da Conitec. Das 43 contribuições recebidas sobre experiência ou opinião, apenas 29 foram avaliadas, pois quatorze vieram em branco. Cerca de 83% discordaram totalmente, 10% discordaram parcialmente e 7% concordaram totalmente com a recomendação preliminar da Conitec. Após a apreciação das contribuições encaminhadas na consulta pública nº 54/2019, o plenário da Conitec considerou que: I) os dados da comparação indireta demonstraram que a eficácia e segurança do certolizumabe pegol são semelhantes ao secuquinumabe 300 mg; II) Foram apresentados pelo demandante estudos de segurança do certolizumabe durante a gestação e lactação; III) A avaliação de custo-minimização e a AIO demonstram economia em comparação ao secuquinumabe 300 mg. RECOMENDAÇÃO FINAL DA CONITEC: Os membros da Conitec presentes na 82ª reunião ordinária, no dia 09 de outubro de 2019, deliberaram por unanimidade recomendar a incorporação do certolizumabe pegol para o tratamento de pacientes adultos com artrite psoríaca ativa, moderada a grave, que tiveram resposta inadequada prévia aos anti-inflamatórios não esteroides, medicamentos modificadores do curso da doença sintéticos, e aos medicamentos modificadores do curso da doença biológicos, anti-TNF, disponíveis no SUS. Foi assinado o Registro de Deliberação nº 476/2019. DECISÃO: Incorporar o certolizumabe pegol para o tratamento da artrite psoríaca, conforme Protocolo Clínico e Diretrizes Terapêuticas do Ministério da Saúde, no âmbito do Sistema Único de Saúde - SUS. Dada pela Portaria nº 59, publicada no Diário Oficial da União nº 224, seção 1, página 79, em 20 de novembro de 2019.


Asunto(s)
Humanos , Artritis Psoriásica/tratamiento farmacológico , Antiinflamatorios no Esteroideos/efectos adversos , Antirreumáticos/efectos adversos , Certolizumab Pegol/uso terapéutico , Evaluación de la Tecnología Biomédica , Sistema Único de Salud , Brasil , Análisis Costo-Beneficio/economía
2.
J Environ Qual ; 49(3): 534-544, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-33016405

RESUMEN

Many states are adopting more stringent nutrient load restrictions, requiring utilities to invest in costly improvements. To date, substantial research has been done to independently assess the nutrient removal efficacy of wastewater treatment technologies and stormwater control measures. The analysis presented here provides a unique assessment by evaluating combinations of nutrient load reduction strategies across water supply, wastewater, and stormwater sectors. A demonstration study was conducted evaluating 7812 cross-sector removal strategies in the urban water system using empirical models to quantify efficacy of common wastewater treatment, water management, and stormwater control measures (SCMs). Pareto optimal solutions were evaluated to identify the most cost-effective strategies. To meet stringent nutrient requirements, wastewater treatment facilities (WWTFs) will likely require advanced biological nutrient removal with carbon and ferric addition. Even with these technologies, WWTFs may still be unable to obtain target nutrient requirements. In addition, municipalities can consider water management practices and SCMs to further reduce nutrient loading or provide a more cost-effective nutrient removal strategy. For water management practices, source separation and effluent reuse were frequently identified as part of the most effective nutrient strategies but face engineering, political, and social adoption barriers. Similarly, SCMs were frequently part of effective nutrient removal strategies compared to only adopting nutrient removal practices at WWTFs. This research provides the framework and demonstrates the value in using an urban water system approach to identify optimal nutrient removal strategies that can be easily applied to other urban areas.


Asunto(s)
Nutrientes , Agua , Ciudades , Análisis Costo-Beneficio , Aguas Residuales
3.
Plant Genome ; 13(1): e20009, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-33016627

RESUMEN

Successful management and utilization of increasingly large genomic datasets is essential for breeding programs to accelerate cultivar development. To help with this, we developed a Sorghum bicolor Practical Haplotype Graph (PHG) pangenome database that stores haplotypes and variant information. We developed two PHGs in sorghum that were used to identify genome-wide variants for 24 founders of the Chibas sorghum breeding program from 0.01x sequence coverage. The PHG called single nucleotide polymorphisms (SNPs) with 5.9% error at 0.01x coverage-only 3% higher than PHG error when calling SNPs from 8x coverage sequence. Additionally, 207 progenies from the Chibas genomic selection (GS) training population were sequenced and processed through the PHG. Missing genotypes were imputed from PHG parental haplotypes and used for genomic prediction. Mean prediction accuracies with PHG SNP calls range from .57-.73 and are similar to prediction accuracies obtained with genotyping-by-sequencing or targeted amplicon sequencing (rhAmpSeq) markers. This study demonstrates the use of a sorghum PHG to impute SNPs from low-coverage sequence data and shows that the PHG can unify genotype calls across multiple sequencing platforms. By reducing input sequence requirements, the PHG can decrease the cost of genotyping, make GS more feasible, and facilitate larger breeding populations. Our results demonstrate that the PHG is a useful research and breeding tool that maintains variant information from a diverse group of taxa, stores sequence data in a condensed but readily accessible format, unifies genotypes across genotyping platforms, and provides a cost-effective option for genomic selection.


Asunto(s)
Sorghum , Análisis Costo-Beneficio , Genoma , Genómica , Haplotipos , Sorghum/genética
4.
Rev Sci Tech ; 39(2): 625-635, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-33046914

RESUMEN

Livestock production systems and the societies in which they are embedded face a set of risks presented by infectious diseases and natural and human-made disasters which compromise animal health. Within this set, threats are posed by natural, deliberate and accidental actions that can cause sudden changes in animal health status, requiring the allocation of additional resources to manage animal health. Determining the benefit of preparing for such emergencies is a challenge when the total set of risks includes the unknown. Any method for analysing the economic costs and benefits of animal health emergencies must not only accommodate this uncertainty, but make it a central feature of the analysis. Cost-benefit analysis is a key approach to economically evaluating animal health interventions. However, the value of this approach in dealing with uncertainty is often called into question. This paper makes the case that, by restricting the outcomes of an emergency event to specified states of nature, boundaries can be placed on the uncertainty space, allowing cost-benefit analysis to be performed. This method, which merges state-contingent analysis with cost-benefit analysis, is presented here. Further discussion on the economic characteristics of emergency events, and the nature of the threats posed to animal health systems, is also provided.


Asunto(s)
Enfermedades Transmisibles , Desastres , Animales , Enfermedades Transmisibles/veterinaria , Análisis Costo-Beneficio , Urgencias Médicas/veterinaria , Humanos , Ganado
5.
Rev Saude Publica ; 54: 94, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33027344

RESUMEN

OBJECTIVE: To perform a cost-benefits analysis of a clinical pharmacy (CP) service implemented in a Neurology ward of a tertiary teaching hospital. METHODS: This is a cost-benefit analysis of a single arm, prospective cohort study performed at the adult Neurology Unit over 36 months, which has evaluated the results of a CP service from a hospital and Public Health System (PHS) perspective. The interventions were classified into 14 categories and the costs identified as direct medical costs. The results were analyzed by the total and marginal cost, the benefit-cost ratio (BCR) and the net benefit (NB). RESULTS: The total 334 patients were followed-up and the highest occurrence in 506 interventions was drug introduction (29.0%). The marginal cost for the hospital and avoided cost for PHS was US$182±32 and US$25,536±4,923 per year; and US$0.55 and US$76.4 per patient/year. The BCR and NB were 0.0, -US$26,105 (95%CI -31,850 - -10,610), -US$27,112 (95%CI -33,160-11,720) for the hospital and; 3.0 (95%CI 1.97-4.94), US$51,048 (95%CI 27,645-75,716) and, 4.6 (95%CI 2.24-10.05), US$91,496 (95%CI 34,700-168,050; p < 0.001) for the PHS, both considering adhered and total interventions, respectively. CONCLUSIONS: The CP service was not directly cost-benefit at the hospital perspective, but it presented savings for forecast cost related to the occurrence of preventable morbidities, measuring a good cost-benefit for the PHS.


Asunto(s)
Servicio de Farmacia en Hospital/economía , Adulto , Brasil , Análisis Costo-Beneficio , Hospitales Universitarios , Humanos , Estudios Prospectivos
6.
Rev Lat Am Enfermagem ; 28: e3365, 2020.
Artículo en Inglés, Portugués, Español | MEDLINE | ID: mdl-33027403

RESUMEN

OBJECTIVE: to evaluate the cost-effectiveness ratio and the budget impact of sending text messages associated with medical consultations in order to reduce the viral load of patients infected with the Human Immunodeficiency Virus. METHOD: a randomized clinical trial, basis for the development of a dynamic cohort model with Markov states in order to compare medical appointments for adults infected with the Human Immunodeficiency Virus versus the alternative strategy that associated medical consultations to sending text messages through telephone. RESULTS: 156 adults participated in the study. As for the viral load, it was verified that in the control group there was an increase, in the intervention group A (weekly messages) there was a reduction (p = 0.002) and in group B (biweekly messages) there was no statistically significant difference. Sending text messages would prevent 286,538 new infections by the Human Immunodeficiency Virus and 282 deaths in the 20-year period, compared to the standard treatment. The alternative strategy would result in saving R$ 14 billion in treatment costs. CONCLUSION: weekly sending messages in association with the standard treatment can reduce the circulating viral load due to its effect in decreasing new infections, in addition to reducing health costs.


Asunto(s)
Infecciones por VIH , Envío de Mensajes de Texto , Adulto , Análisis Costo-Beneficio , VIH , Infecciones por VIH/epidemiología , Infecciones por VIH/terapia , Humanos , Aceptación de la Atención de Salud
7.
BMJ Open ; 10(10): e038390, 2020 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-33004397

RESUMEN

INTRODUCTION: In order to avoid unnecessary hospital admission and associated complications, there is an urgent need to improve the early detection of infection in nursing home residents. Monitoring signs and symptoms with checklists or aids called decision support tools may help nursing home staff to detect infection in residents, particularly during the current COVID-19 pandemic.We plan to conduct a survey exploring views and experiences of how infections are detected and managed in practice by nurses, care workers and managers in nursing homes in England and Sweden. METHODS AND ANALYSIS: An international cross-sectional descriptive survey, using a pretested questionnaire, will be used to explore nurses, care workers and managers views and experiences of how infections are detected and managed in practice in nursing homes. Data will be analysed descriptively and univariate associations between personal and organisational factors explored. This will help identify important factors related to awareness, knowledge, attitudes, belief and skills likely to affect future implementation of a decision support tool for the early detection of infection in nursing home residents. ETHICS AND DISSEMINATION: This study was approved using the self-certification process at the University of Surrey and Linköping University ethics committee (Approval 2018/514-32) in 2018. Study findings will be disseminated through community/stakeholder/service user engagement events in each country, publication in academic peer-reviewed journals and conference presentations. A LAY summary will be provided to participants who indicate they would like to receive this information.This is the first stage of a plan of work to revise and evaluate the Early Detection of Infection Scale (EDIS) tool and its effect on managing infections and reducing unplanned hospital admissions in nursing home residents. Implementation of the EDIS tool may have important implications for the healthcare economy; this will be explored in cost-benefit analyses as the work progresses.


Asunto(s)
Control de Enfermedades Transmisibles , Infecciones por Coronavirus , Uso Excesivo de los Servicios de Salud/prevención & control , Casas de Salud/estadística & datos numéricos , Pandemias , Manejo de Atención al Paciente , Neumonía Viral , Instituciones de Cuidados Especializados de Enfermería/estadística & datos numéricos , Betacoronavirus/aislamiento & purificación , Control de Enfermedades Transmisibles/métodos , Control de Enfermedades Transmisibles/organización & administración , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Análisis Costo-Beneficio , Estudios Transversales , Inglaterra/epidemiología , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud/normas , Hospitalización , Humanos , Manejo de Atención al Paciente/economía , Manejo de Atención al Paciente/métodos , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Gestión de la Práctica Profesional/economía , Proyectos de Investigación , Suecia/epidemiología
8.
Neuquén; s.n; sept. 2020.
No convencional en Español | BRISA/RedTESA | ID: biblio-1120652

RESUMEN

CONTEXTO: Ante el avance de la pandemia COVID-19 muchas provincias argentinas se encuentran en el límite de saturación de su capacidad sanitaria, especialmente para los pacientes más críticos que requieren hospitalización, oxigenoterapia y asistencia respiratoria mecánica (ARM). Se han analizado distintas alternativas en los pacientes con hipoxemias moderadas a severas que no corrigen con máscara reservorio. METODOLOGÍA: Un equipo multidisciplinario e independiente de conflictos de interés con el proveedor de esta tecnología, y de tecnologías alternativas realizó una evaluación de tecnología sanitaria enfocada en responder las preguntas clínicas: 1. ¿Cuál es la eficacia de los cascos para ventilación no invasiva en los pacientes internados con COVID-19? 2. ¿Cuál es la seguridad de los cascos para ventilación no invasiva en los pacientes internados con COVID-19? 3. ¿Cuál es el costo y la factibilidad de incorporar cascos para ventilación no invasiva en los pacientes internados con COVID-19? 4. ¿Cuál es el potencial impacto en la red prestacional pública de los cascos para ventilación no invasiva en los pacientes internados con COVID-19? Se realizó una búsqueda bibliográfica en las principales bases de datos, en buscadores genéricos de internet, y financiadores de salud. Se dio prioridad a las Revisiones Sistemáticas (RS), evaluaciones de tecnologías sanitarias (ETS), evaluaciones económicas (EE), guías de práctica clínica (GPC), políticas de cobertura (PC) de diferentes sistemas de salud, ensayos clínicos aleatorizados (ECA), y estudios observacionales, desde 2000 hasta agosto 2020 sin ninguna restricción de idioma. RESULTADOS: Descripción de la Tecnología: Este informe se centra en el casco marca ECLERIS, por tratarse de un dispositivo médico "de pared" que no requiere equipamiento mecánico complejo, por ser fabricado en Argentina, cuenta con autorización de la Administración Nacional de Medicamentos, Alimentos y Tecnología Médica (ANMAT), y su adquisición es más factible en el contexto de pandemia. Tecnologías Alternativas: En el presente informe la tecnología no se compara con equipos de ARM, sino con la mejor alternativa disponible cuando estos ya no se encuentran disponibles, qué es escenario asumido. Estas alternativas pueden ser aquellos dispositivos que ofrecen oxígeno suplementario a presión atmosférica (máscaras y máscaras reservorio). No se compara en este caso la VNI con el respirador, ya que en este escenario se asume agotada la capacidad de respiradores. Pese a lo cual se incluirán en las búsquedas y análisis de estudios o guías que analicen la comparación entre VNI y ARM para buscar información sobre seguridad. Acerca del contexto, se analiza su utilización en salas de internación, guardia de emergencias y derivaciones en ambulancia. CONCLUSIÓN: La mayoría de las autoridades sanitarias recomiendan, cuando está disponible, la intubación precoz y ARM en los pacientes con neumonía grave y SDRA por COVID. Al analizar la eficacia en los pocos estudios identificados (de baja calidad), estos preferencian la VNI en contraposición a la intubación temprana, basada en evidencia indirecta (proveniente de pacientes con SARS y MERS) y en un estudio descriptivo de SARS-Cov2. En esos contextos mostrarían disminución de la mortalidad, aunque es necesario realizar más estudios. En el presente informe los cascos de VNI tipo ECLERIS no se comparan con equipos de ARM, sino con la mejor alternativa cuando estos ya no se encuentran disponibles, que es el escenario asumido y esperado. Estas alternativas pueden ser aquellos dispositivos que ofrecen oxígeno suplementario a presión atmosférica (máscaras y máscaras reservorio). La capacidad de limitar el tratamiento a pacientes seleccionados puede amplificar los beneficios potenciales reduciendo la tasa de fracaso. Si la combinación de hCPAP y la posición prona redujera la tasa de intubación, el sistema de salud podría mejorar la asignación de camas de UCI, otorgando un mejor tratamiento a todos los pacientes que necesitan asistencia ventilatoria.


Asunto(s)
Humanos , Infecciones por Coronavirus/terapia , Ventilación no Invasiva/métodos , Hipoxia/complicaciones , Argentina , Evaluación de la Tecnología Biomédica , Análisis Costo-Beneficio
9.
Lima; Instituto Nacional de Salud; sept. 2020.
No convencional en Español | BRISA/RedTESA | ID: biblio-1122251

RESUMEN

INTRODUCCIÓN: Este documento técnico se realiza a solicitud de la Dirección de Prevención y Control de Enfermedades No Transmisibles, Raras y Huérfanas del Ministerio de Salud; la cual motivó la realización de la pregunta PICO por parte de médicos y especialistas de la siguiente manera, P: pacientes con diagnóstico de diabetes mellitus tipo 1 (DM1); I: análogos de insulina humana; C: insulina humana; O: control glucémico, calidad de vida y eventos adversos. A. Cuadro clínico La DM1 es una forma de enfermedad autoinmune que ocasiona la destrucción de las células que producen insulina. En el Perú, para el 2018, los casos de DM1 representaron el 2,7% del total de casos de diabetes. El uso de insulina representa el pilar de tratamiento farmacológico de las personas con DM1, permitiendo alcanzar un adecuado control glicémico y disminuir las complicaciones macro y microvasculares. En la actualidad, además de la insulina humana recombinante, existen en el mercado nuevas formulaciones denominados análogos de insulina humana, desarrollados con el propósito de imitar de forma más precisa el comportamiento de la insulina fisiológica. B. Tecnología sanitaria Los análogos de insulina son un tipo de insulinas cuyas moléculas han sido modificadas en la secuencia de aminoácidos. Existen tres tipos principales: de acción rápida (aspart, lispro, glulisina), de acción prolongada (glargina, detemir, degludec) y las formulaciones de análogos de insulina premezclados. Los análogos de insulina permiten emular más estrechamente la fisiología normal de la insulina y seleccionar diferentes regímenes según las preferencias y estilo de vida del paciente. Sin embargo, su precio es significativamente más alto que la insulina humana. En Perú, los análogos de insulina humana cuentan con un total de doce registros sanitarios vigentes. OBJETIVO: Describir la evidencia científica disponible sobre la eficacia y seguridad del uso de análogos de insulina humana para el control glicémico de pacientes con diabetes tipo 1. METODOLOGÍA: Se realizó una búsqueda en Medline, Cochrane Database of Systematic Reviews, CENTRAL, EMBASE y LILACS hasta el 01 de setiembre de 2020, complementada con la búsqueda de evidencia en páginas institucionales de agencias gubernamentales y buscadores genéricos. La calidad de la evidencia se valoró usando: AMSTAR 2 para RS y AGREE II para valorar el rigor metodológico de las GPC. RESULTADOS: Se identificó cinco revisiones sistemáticas, siete guías de práctica clínica y cinco evaluaciones de tecnología sanitaria. CONCLUSIONES: En adultos con DM1, los análogos de insulina de acción rápida redujeron en promedio la glucosa postprandial en 19 mg/dL, la hemoglobina glicosilada en 0,13% y el riesgo de hipoglicemia general, nocturna y severa (en 7%, 45% y 32%, respectivamente) comparado con insulina humana. En población pediátrica, no se observó una reducción en los niveles de hemoglobina glicosilada, ni en el riesgo de episodios de hipoglicemia. En ambas poblaciones, el impacto sobre la calidad de vida fue inconsistente. En adultos con DM1, los análogos de insulina de acción lenta redujeron en promedio la hemoglobina glicosilada en 0,17% y el riesgo de hipoglicemia general y nocturna (en 7% y 32%, respectivamente), sin diferencias en el riesgo de hipoglicemia severa. El impacto sobre la calidad de vida fue inconsistente. Las seis GPC incluyen en sus recomendaciones el uso de análogos de insulina e insulina humana para pacientes pediátricos o adultos con DM1. En tres de ellas, se recomienda preferentemente usar análogos de insulina, mientras en otras tres no se establece algún tipo de preferencia entre el uso de ambas formulaciones. Cinco informes de ETS, procedentes de agencias de Canadá, España y Perú, coinciden en no recomendar el uso de análogos de insulina debido a insuficiente evidencia sobre su beneficio clínico y aspectos relacionados con su costo-efectividad. Dos RS fueron consideradas como nivel de confianza críticamente bajo, mientras que tres RS fueron consideradas como nivel de confianza alto. Las GPC incluidas obtuvieron un puntaje global promedio en la evaluación de calidad que varió entre 69,4% y 80,4%.


Asunto(s)
Humanos , Diabetes Mellitus Tipo 1/prevención & control , Insulina Regular Humana/análogos & derivados , Perú , Evaluación de la Tecnología Biomédica , Análisis Costo-Beneficio
10.
J Environ Manage ; 263: 110333, 2020 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-32883470

RESUMEN

The Total Maximum Daily Load (TMDL) program established by the United States Environmental Protection Agency (US EPA) to improve America's water quality is being applied to the Chesapeake Bay watershed to mitigate the "dead zone" problem. Agricultural activities are the major nonpoint source of nitrogen (N), contributing 44% of total N to the Bay. Best Management Practices (BMPs) are recognized as an effective way to mitigate N loss of agricultural activities. However, because of physical and economic heterogeneity in agricultural regions, targeting BMPs to areas that produce disproportionate nutrient losses has the potential to reduce the costs of achieving water quality goals. The purpose of this study is to examine the potential to reduce costs of meeting a regional water quality goal by targeting N load reductions within- and across-counties. Based on TMDL developed by the US EPA in 2010 for the Chesapeake Bay watershed, the N reduction goal is 35% for Pennsylvania by 2025. We examine the effects of targeting the required reductions within counties, across counties, and both within and across counties for the Susquehanna watershed. Using the uniform strategy to meet 35% N reduction as the baseline, results show that costs of achieving a regional 35% N reduction goal can be reduced by 13%, 31% and 36% with cross-county targeting, within-county targeting and within and across county targeting, respectively. Cost effectiveness of government subsidy programs for water quality improvement in agriculture can be increased by targeting them to areas with lower N abatement costs.


Asunto(s)
Nitrógeno , Calidad del Agua , Agricultura , Análisis Costo-Beneficio , Pennsylvania
12.
J Environ Radioact ; 222: 106351, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32892905

RESUMEN

Radon, a gaseous radioactive decay product of naturally-occurring uranium is widely distributed in the environment in rocks and soils and, in certain circumstances, can accumulate in the built environment. Initial studies confirmed a direct link between exposure to both radon gas and its short-lived radioactive progeny, and increased lung-cancer incidence, and demonstrated that radon levels in domestic housing can be sufficiently high to expose occupants to increased risk of lung-cancer. Subsequent studies worldwide have shown that it is cost-effective to detect and reduce domestic radon levels in order to reduce this risk. Recent advances in the early detection of lung-cancer, coupled with the development of improved treatment procedures, have progressively improved survival from the disease, with the numbers surviving at 5 years doubling over recent years, during which period the real costs of lung cancer treatment have risen by around 30%. In the meantime, however, in addition to radon and tobacco-smoke, other airborne pollutants have been identified as risk-factors for lung-cancer. This paper reviews both these actual developments and anticipated future trends, and concludes that since these advances in diagnosis and treatment of lung-cancer have had only a modest effect on cost-effectiveness, it is still important to conduct radon monitoring and remediation programmes. While the general increase in life-expectancy improves the cost-effectiveness of radon remediation programmes significantly, reducing tobacco-smoking incidence reduces that cost-effectiveness but with the overall benefit of reducing radon-related lung-cancers. The challenge remains of encouraging affected householders to remediate their homes to reduce radon levels.


Asunto(s)
Contaminación del Aire Interior , Neoplasias Pulmonares , Monitoreo de Radiación , Radón , Contaminación del Aire Interior/economía , Contaminación del Aire Interior/prevención & control , Análisis Costo-Beneficio , Vivienda , Humanos , Neoplasias Pulmonares/epidemiología , Reino Unido
13.
Crit Care Resusc ; 22(3): 191-199, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32900325

RESUMEN

OBJECTIVE: To determine whether hydrocortisone is a cost-effective treatment for patients with septic shock. DESIGN: Data linkage-based cost-effectiveness analysis. SETTING: New South Wales and Queensland intensive care units. PARTICIPANTS AND INTERVENTION: Patients with septic shock randomly assigned to treatment with hydrocortisone or placebo in the Adjunctive Glucocorticoid Therapy in Patients with Septic Shock (ADRENAL) trial. MAIN OUTCOME MEASURES: Health-related quality of life at 6 months using the EuroQoL 5-dimension 5-level questionnaire. Data on hospital resource use and costs were obtained by linking the ADRENAL dataset to government administrative health databases. Clinical outcomes included mortality, health-related quality of life, and quality-adjusted life-years gained; economic outcomes included hospital resource use, costs and cost-effectiveness from the health care payer perspective. We also assessed cost-effectiveness by sex. To increase the precision of cost-effectiveness estimates, we conducted unrestricted bootstrapping. RESULTS: Of 3800 patients in the ADRENAL trial, 1772 (46.6%) were eligible and 1513 (85.4% of those eligible) were included. There was no difference between hydrocortisone or placebo groups in regards to mortality (218/742 [29.4%] v 227/759 [29.9%]; HR, 0.93; 95% CI, 0.78-1.12; P = 0.47), mean number of QALYs gained (0.10 ± 0.09 v 0.10 ± 0.09; P = 0.52), or total hospital costs (A$73 515 ± 61 376 v A$69 748 ± 61 793; mean difference, A$3767; 95% CI, -A$2891 to A$10 425; P = 0.27). The incremental cost of hydrocortisone was A$1 254 078 per quality-adjusted life-year gained. In females, hydrocortisone was cost-effective in 46.2% of bootstrapped replications and in males it was cost-effective in 2.7% of bootstrapped replications. CONCLUSIONS: Adjunctive hydrocortisone did not significantly affect longer term mortality, health-related quality of life, health care resource use or costs, and is unlikely to be cost-effective.


Asunto(s)
Antiinflamatorios/economía , Antiinflamatorios/uso terapéutico , Hidrocortisona/economía , Hidrocortisona/uso terapéutico , Choque Séptico/tratamiento farmacológico , Análisis Costo-Beneficio , Femenino , Humanos , Masculino , Nueva Gales del Sur , Calidad de Vida , Años de Vida Ajustados por Calidad de Vida , Choque Séptico/mortalidad
14.
Bone Joint J ; 102-B(9): 1128-1135, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32862681

RESUMEN

AIMS: The rate of dislocation when traditional single bearing implants are used in revision total hip arthroplasty (THA) has been reported to be between 8% and 10%. The use of dual mobility bearings can reduce this risk to between 0.5% and 2%. Dual mobility bearings are more expensive, and it is not clear if the additional clinical benefits constitute value for money for the payers. We aimed to estimate the cost-effectiveness of dual mobility compared with single bearings for patients undergoing revision THA. METHODS: We developed a Markov model to estimate the expected cost and benefits of dual mobility compared with single bearing implants in patients undergoing revision THA. The rates of revision and further revision were calculated from the National Joint Registry of England and Wales, while rates of transition from one health state to another were estimated from the literature, and the data were stratified by sex and age. Implant and healthcare costs were estimated from local procurement prices and national tariffs. Quality-adjusted life-years (QALYs) were calculated using published utility estimates for patients undergoing THA. RESULTS: At a minimum five-year follow-up, the use of dual mobility was cost-effective with an estimated incremental cost-effectiveness ratio (ICER) of between £3,006 and £18,745/QALY for patients aged < 55 years and between 64 and 75 years, respectively. For those aged > 75 years dual mobility was only cost-effective if the timeline was beyond seven years. The use of dual mobility bearings was cost-saving for patients aged < 75 years and cost-effective for those aged > 75 years if the time horizon was beyond ten years. CONCLUSION: The use of dual mobility bearings is cost-effective compared with single bearings in patients undergoing revision THA. The younger the patient is, the more likely it is that a dual mobility bearing can be more cost-effective and even cost-saving. The results are affected by the time horizon and cost of bearings for those aged > 75 years. For patients aged > 75 years, the surgeon must decide whether the use of a dual mobility bearing is a viable economic and clinical option. Cite this article: Bone Joint J 2020;102-B(9):1128-1135.


Asunto(s)
Artroplastia de Reemplazo de Cadera/economía , Análisis Costo-Beneficio , Prótesis de Cadera/economía , Reoperación/economía , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis
15.
Khirurgiia (Mosk) ; (8): 75-81, 2020.
Artículo en Ruso | MEDLINE | ID: mdl-32869619

RESUMEN

Treatment of patients with ventral hernias remains one of the most pressing problems of abdominal surgery. Surgeons are trying to find a «gold standard¼ for the treatment of this pathology. Great hopes are placed on minimally invasive techniques, however, due to their high cost, they do not yet find mass distribution in everyday practice. In our opinion, this is short-sighted. We tried to analyze the feasibility of using minimally invasive techniques in the treatment of patients with ventral hernias of various locations, from the position of clinical and economic efficiency.


Asunto(s)
Hernia Ventral/cirugía , Herniorrafia/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos , Análisis Costo-Beneficio , Hernia Ventral/economía , Herniorrafia/economía , Humanos , Procedimientos Quirúrgicos Mínimamente Invasivos/economía
16.
Zhongguo Zhong Yao Za Zhi ; 45(15): 3497-3504, 2020 Aug.
Artículo en Chino | MEDLINE | ID: mdl-32893536

RESUMEN

To evaluate the economy and applicability of Jinye Baidu Granules in the treatment of acute upper respiratory tract infection, a randomized, double-blind, positive drug parallel control clinical trial was conducted in this study. Stratified block random, double-blind and double simulation test was used. The experimental group took Jinye Baidu Granules, 10 g/time, three times a day, and Compound Shuanghua Granules placebo, 6 g/time, four times a day. The control group took Compound Shuanghua Granules, 6 g/time, 4 times a day, and Jinye Baidu Granules placebo, 10 g/time, 3 times a day. The course of treatment was 5 days. The total cost of this study included direct medical cost and indirect medical cost. The incremental cost-effect analysis method was used for evaluation. Treeage Pro software was used to build a pharmaco-economics model and make statistical analysis. Patients from 10 hospitals were divided into experimental group(304 cases) and control group(302 cases). The baseline values of age, sex ratio, clinical symptoms and signs scores, and important physical examination indexes of the two groups were compared. After 5 days of treatment, the cost per capita of the experimental group was(388.06±94.17) Yuan, and that of the control group was(378.47±95.46) Yuan. The cost of direct medical treatment per capita was(271.24±54.11) Yuan for the experimental group and(264.88±112.71) Yuan for the control group. The average cost of indirect medical treatment was(116.82±82.75) Yuan in the experimental group and(113.59±87.77) Yuan in the control group, with no significant difference in the cost of medical treatment per capita, the cost of direct medical treatment per capita and the cost of indirect medical treatment per capita between both groups. The results of incremental cost-effect analysis based on the total score difference in symptoms and signs after 5 days of treatment showed that ICER=23.39 Yuan/score, which was less than the willingness to pay 100 Yuan/score determined through expert interviews. The experimental group had economic advantages over the experimental group, with the economic probability of 53%. Sensitivity analysis supported the robustness of the results. The results of incremental cost-effect analysis based on the total recovery rate of symptoms and signs showed that compared with the experimental group, the control group had lower cost, better effect and absolute economic advantage, with a corresponding probability of 55%. Based on the above results, it is concluded that there is no significant difference in economic outcome between Jinye Baidu Gra-nules and Compound Shuanghua Granules in the treatment of acute upper respiratory tract infection.


Asunto(s)
Infecciones del Sistema Respiratorio , Análisis Costo-Beneficio , Método Doble Ciego , Humanos , Mercadotecnía
17.
BMC Public Health ; 20(1): 1374, 2020 Sep 09.
Artículo en Inglés | MEDLINE | ID: mdl-32907562

RESUMEN

BACKGROUND: Influenza epidemics significantly weight on the Brazilian healthcare system and its society. Public health authorities have progressively expanded recommendations for vaccination against influenza, particularly to the pediatric population. However, the potential mismatch between the trivalent influenza vaccine (TIV) strains and those circulating during the season remains an issue. Quadrivalent vaccines improves vaccines effectiveness by preventing any potential mismatch on influenza B lineages. METHODS: We evaluate the public health and economic benefits of the switch from TIV to QIV for the pediatric influenza recommendation (6mo-5yo) by using a dynamic epidemiological model able to consider the indirect impact of vaccination. Results of the epidemiological model are then imputed in a health-economic model adapted to the Brazilian context. We perform deterministic and probabilistic sensitivity analysis to account for both epidemiological and economical sources of uncertainty. RESULTS: Our results show that switching from TIV to QIV in the Brazilian pediatric population would prevent 406,600 symptomatic cases, 11,300 hospitalizations and almost 400 deaths by influenza season. This strategy would save 3400 life-years yearly for an incremental direct cost of R$169 million per year, down to R$86 million from a societal perspective. Incremental cost-effectiveness ratios for the switch would be R$49,700 per life-year saved and R$26,800 per quality-adjusted life-year gained from a public payer perspective, and even more cost-effective from a societal perspective. Our results are qualitatively similar in our sensitivity analysis. CONCLUSIONS: Our analysis shows that switching from TIV to QIV to protect children aged 6mo to 5yo in the Brazilian influenza epidemiological context could have a strong public health impact and represent a cost-effective strategy from a public payer perspective, and a highly cost-effective one from a societal perspective.


Asunto(s)
Análisis Costo-Beneficio , Vacunas contra la Influenza , Gripe Humana/prevención & control , Salud Pública , Vacunación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Niño , Preescolar , Economía Médica , Femenino , Hospitalización/economía , Humanos , Lactante , Virus de la Influenza B/clasificación , Virus de la Influenza B/inmunología , Vacunas contra la Influenza/economía , Vacunas contra la Influenza/inmunología , Gripe Humana/economía , Gripe Humana/epidemiología , Gripe Humana/virología , Persona de Mediana Edad , Modelos Económicos , Años de Vida Ajustados por Calidad de Vida , Estaciones del Año , Incertidumbre , Vacunación/economía , Adulto Joven
18.
Lancet Psychiatry ; 7(10): 893-910, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32949521

RESUMEN

Mental illness and substance use disorders in the workplace have been increasingly recognised as a problem in most countries; however, evidence is scarce on which solutions provide the highest return on investment. We searched academic and grey literature databases and additional sources for studies that included a workplace intervention for mental health or substance abuse, or both, and that did an economic analysis. We analysed the papers we found to identify the highest yielding and most cost-effective interventions by disorder. On the basis of 56 studies, we found moderate strength of evidence that cognitive behavioural therapy is cost-saving (and in some cases cost-effective) to address depression. We observed strong evidence that regular and active involvement of occupational health professionals is cost-saving and cost-effective in reducing sick leave related to mental health and in encouraging return to work. We identified moderate evidence that coverage for pharmacotherapy and brief counselling for smoking cessation are both cost-saving and cost-effective. Addressing mental health and substance misuse in the workplace improves workers' wellbeing and productivity, and benefits employers' bottom line (ie, profit). Future economic analyses would benefit from the consideration of subgroup analyses, examination of longer follow-ups, inclusion of statistical and sensitivity analyses and discussion around uncertainty, and consideration of potential for bias.


Asunto(s)
Servicios de Salud del Trabajador/economía , Servicios de Salud del Trabajador/métodos , Terapia Ocupacional/economía , Terapia Ocupacional/métodos , Trastornos Relacionados con Sustancias/rehabilitación , Terapia Cognitivo-Conductual/economía , Terapia Cognitivo-Conductual/métodos , Análisis Costo-Beneficio , Economía Médica , Humanos , Salud Mental , Ensayos Clínicos Controlados Aleatorios como Asunto , Ausencia por Enfermedad/estadística & datos numéricos , Lugar de Trabajo
19.
Int J Radiat Oncol Biol Phys ; 108(2): 430-434, 2020 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-32890526

RESUMEN

PURPOSE: Health systems have increased telemedicine use during the SARS-CoV-2 outbreak to limit in-person contact. We used time-driven activity-based costing to evaluate the change in resource use associated with transitioning to telemedicine in a radiation oncology department. METHODS AND MATERIALS: Using a patient undergoing 28-fraction treatment as an example, process maps for traditional in-person and telemedicine-based workflows consisting of discrete steps were created. Physicians/physicists/dosimetrists and nurses were assumed to work remotely 3 days and 1 day per week, respectively. Mapping was informed by interviews and surveys of personnel, with cost estimates obtained from the department's financial officer. RESULTS: Transitioning to telemedicine reduced provider costs by $586 compared with traditional workflow: $47 at consultation, $280 during treatment planning, $237 during on-treatment visits, and $22 during the follow-up visit. Overall, cost savings were $347 for space/equipment and $239 for personnel. From an employee perspective, the total amount saved each year by not commuting was $36,718 for physicians (7243 minutes), $19,380 for physicists (7243 minutes), $17,286 for dosimetrists (7210 minutes), and $5599 for nurses (2249 minutes). Patients saved $170 per treatment course. CONCLUSIONS: A modified workflow incorporating telemedicine visits and work-from-home capability conferred savings to a department as well as significant time and costs to health care workers and patients alike.


Asunto(s)
Análisis Costo-Beneficio , Oncología por Radiación/métodos , Telemedicina/economía , Infecciones por Coronavirus/epidemiología , Humanos , Pandemias , Neumonía Viral/epidemiología , Oncología por Radiación/economía , Factores de Tiempo
20.
Water Sci Technol ; 82(2): 227-241, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32941165

RESUMEN

The wastewater industry is undergoing a paradigm shift from focusing solely on treatment to incorporating concepts aimed at mitigating environmental impacts such as energy and nutrient recovery and water reuse. This study uses life cycle assessment and life cycle cost analysis to investigate the effect of expanding anaerobic digestion (AD) capacity and adding combined heat and power on environmental and cost indicators at a mid-sized wastewater treatment facility (WWTF) in Massachusetts, USA. Since 2014, Massachusetts has banned the disposal of organic waste from commercial organizations producing more than one ton of material per week. The WWTF's additional digester capacity allows the co-digestion of municipal solids with a food-based engineered bioslurry due to this ban. Study data were compiled for several AD feedstock quantity and performance scenarios, and compared to a baseline scenario representative of historic plant operations prior to co-digestion. Reductions in environmental impact are demonstrated for six of eight environmental impacts, including global climate change potential and cumulative energy demand. Eutrophication potential increases by 10 percent and 24 percent across assessed scenarios. Water use remains relatively constant across scenarios. Facility energy production increases dramatically with co-digestion, satisfying 100 percent of the WWTF's thermal energy requirement and producing surplus electricity assuming full AD capacity utilization.


Asunto(s)
Eliminación de Residuos , Aguas Residuales , Anaerobiosis , Análisis Costo-Beneficio , Alimentos
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