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2.
Artículo en Portugués | PAHO-IRIS | ID: phr-51945

RESUMEN

[RESUMO]. Objetivo. Estimar os custos atribuíveis a hipertensão arterial, diabetes mellitus e obesidade no Sistema Único de Saúde (SUS) no Brasil em 2018. Métodos. Realizou-se uma estimativa dos custos atribuíveis a doenças crônicas não transmissíveis a partir dos riscos relativos e das prevalências populacionais de hipertensão, diabetes e obesidade, considerando custos de hospitalizações, procedimentos ambulatoriais e medicamentos distribuídos pelo SUS para tratamento dessas doenças. As informações de custo foram obtidas nos sistemas de informação em saúde disponíveis no SUS. A análise explorou os custos das doenças segundo sexo e idade na população adulta. Resultados. Os custos totais de hipertensão, diabetes e obesidade no SUS alcançaram 3,45 bilhões de reais (R$) (IC95%: 3,15 a 3,75) em 2018, ou seja, mais de 890 milhões de dólares (US$). Desses custos, 59% foram referentes ao tratamento da hipertensão, 30% ao do diabetes e 11% ao da obesidade. No total, 72% dos custos foram com indivíduos de 30 a 69 anos de idade e 56%, com mulheres. Considerando separadamente a obesidade como fator de risco para hipertensão e diabetes, os custos atribuíveis a essa doença chegaram a R$ 1,42 bilhão (IC95%: 0,98 a 1,87), ou seja, 41% dos custos totais. Conclusões. As estimativas dos custos atribuíveis às principais doenças crônicas associadas à alimentação inadequada evidenciam a grande carga econômica dessas doenças para o SUS. Os dados mostram a necessidade de priorizar políticas integradas e intersetoriais para a prevenção e o controle da hipertensão, do diabetes e da obesidade e para alcançar os objetivos da Década de Ação das Nações Unidas sobre Nutrição.


[ABSTRACT]. Objective. To estimate the cost attributable to arterial hypertension, diabetes mellitus, and obesity in the Unified Health System of Brazil in 2018. Method. The study estimated the cost attributable to non-communicable chronic diseases based on relative risk and population prevalence of hypertension, diabetes, and obesity, considering the cost of hospitalizations, outpatient procedures, and medications distributed by the SUS to treat these diseases. Cost data were obtained from SUS information systems. The analysis explored the cost of disease according to sex and age in the adult population. Results. The total cost of hypertension, diabetes, and obesity in the SUS reached R$ 3.45 billion (95%CI: 3.15-3.75) in 2018, that is, more than US$ 890 million. Of this amount, 59% referred to the treatment of hypertension, 30% to diabetes, and 11% to obesity. The age group from 30 to 69 years accounted for 72% of the total costs, and women accounted for 56%. When obesity was considered separately as a risk factor for hypertension and diabetes, the cost attributable to this diseases reached R$ 1.42 billion (95%CI: 0.98-1.87), i.e., 41% of the total cost. Conclusions. The estimates of costs attributable to the main chronic diseases associated with inadequate diet revealed a heavy economic burden of these disorders for the SUS. The data show the need to prioritize integrated and intersectoral policies for the prevention and control of hypertension, diabetes, and obesity, and may support the advocacy for interventions such as fiscal and regulatory measures to ensure that the objectives of the United Nations Decade of Action on Nutrition are met.


[RESUMEN]. Objetivo. Estimar los costos atribuibles a la hipertensión arterial, la diabetes mellitus y la obesidad en el Sistema Único de Salud (SUS) de Brasil en el 2018. Métodos. Se estimaron los costos atribuibles a las enfermedades crónicas no transmisibles a partir de los riesgos relativos y de las tasas de prevalencia poblacional de hipertensión, diabetes y obesidad, teniendo en cuenta los costos de hospitalización, los procedimientos ambulatorios y los medicamentos distribuidos por el SUS para el tratamiento de esas enfermedades. Los datos de costos se obtuvieron en los sistemas de información de salud disponibles en el SUS. En el análisis se exploraron los costos de las enfermedades según el sexo y la edad de la población adulta. Resultados. Los costos totales atribuibles a la hipertensión, la diabetes y la obesidad en el SUS alcanzaron R$ 3,450 milliones (IC 95%: de 3,15 a 3,75) en el 2018, o sea, más de US$ 890 millones. De esos costos, 59% correspondió al tratamiento de la hipertensión, 30% al de la diabetes y 11% al de la obesidad. En total, 72% de los costos correspondieron a personas de 30 a 69 años y 56%, a mujeres. Al considerarse por separado la obesidad como factor de riesgo de hipertensión y diabetes, los costos atribuibles a esa enfermedad alcanzaron R$ 1.420 millones (IC 95%: de 0,98 a 1,87), o sea, 41% del total. Conclusiones. Las estimaciones de los costos atribuibles a las principales enfermedades crónicas relacionadas con la alimentación inadecuada ponen de manifiesto la pesada carga económica de esas enfermedades para el SUS. Los datos muestran la necesidad de priorizar políticas integradas e intersectoriales para la prevención y el control de la hipertensión, la diabetes y la obesidad, y permiten apoyar la defensa de intervenciones como medidas fiscales y regulatorias para alcanzar los objetivos del Decenio de las Naciones Unidas de Acción sobre la Nutrición.


Asunto(s)
Enfermedades no Transmisibles , Costos y Análisis de Costo , Política Pública , Obesidad , Brasil , Hipertensión , Diabetes Mellitus , Enfermedades no Transmisibles , Costos y Análisis de Costo , Política Pública , Obesidad , Hipertensión , Brasil , Enfermedades no Transmisibles
5.
Science ; 367(6484): 1300-1301, 2020 03 20.
Artículo en Inglés | MEDLINE | ID: mdl-32193307
7.
JAMA ; 323(9): 854-862, 2020 03 03.
Artículo en Inglés | MEDLINE | ID: mdl-32125403

RESUMEN

Importance: Most studies that have examined drug prices have focused on list prices, without accounting for manufacturer rebates and other discounts, which have substantially increased in the last decade. Objective: To describe changes in list prices, net prices, and discounts for branded pharmaceutical products for which US sales are reported by publicly traded companies, and to determine the extent to which list price increases were offset by increases in discounts. Design, Setting, and Participants: Retrospective descriptive study using 2007-2018 pricing data from the investment firm SSR Health for branded products available before January 2007 with US sales reported by publicly traded companies (n = 602 drugs). Net prices were estimated by compiling company-reported sales for each product and number of units sold in the US. Exposures: Calendar year. Main Outcomes and Measures: Outcomes included list and net prices and discounts in Medicaid and other payers. List prices represent manufacturers' price to wholesalers or direct purchasers but do not account for discounts. Net prices represent revenue per unit of the product after all manufacturer concessions are accounted for (including rebates, coupon cards, and any other discount). Means of outcomes were calculated each year for the overall sample and 6 therapeutic classes, weighting each product by utilization and adjusting for inflation. Results: From 2007 to 2018, list prices increased by 159% (95% CI, 137%-181%), or 9.1% per year, while net prices increased by 60% (95% CI, 36%-84%), or 4.5% per year, with stable net prices between 2015 and 2018. Discounts increased from 40% to 76% in Medicaid and from 23% to 51% for other payers. Increases in discounts offset 62% of list price increases. There was large variability across classes. Multiple sclerosis treatments (n = 4) had the greatest increases in list (439%) and net (157%) prices. List prices of lipid-lowering agents (n = 11) increased by 278% and net prices by 95%. List prices of tumor necrosis factor inhibitors (n = 3) increased by 166% and net prices by 73%. List prices of insulins (n = 7) increased by 262%, and net prices by 51%. List prices of noninsulin antidiabetic agents (n = 10) increased by 165%, and net prices decreased by 1%. List price increases were lowest (59%) for antineoplastic agents (n = 44), but discounts only offset 41% of list price increases, leading to 35% increase in net prices. Conclusions and Relevance: In this analysis of branded drugs in the US from 2007 to 2018, mean increases in list and net prices were substantial, although discounts offset an estimated 62% of list price increases with substantial variation across classes.


Asunto(s)
Costos de los Medicamentos/tendencias , Honorarios Farmacéuticos/tendencias , Costos y Análisis de Costo , Honorarios Farmacéuticos/legislación & jurisprudencia , Medicaid/economía , Estudios Retrospectivos , Estados Unidos
8.
JAMA ; 323(9): 844-853, 2020 Mar 03.
Artículo en Inglés | MEDLINE | ID: mdl-32125404

RESUMEN

Importance: The mean cost of developing a new drug has been the subject of debate, with recent estimates ranging from $314 million to $2.8 billion. Objective: To estimate the research and development investment required to bring a new therapeutic agent to market, using publicly available data. Design and Setting: Data were analyzed on new therapeutic agents approved by the US Food and Drug Administration (FDA) between 2009 and 2018 to estimate the research and development expenditure required to bring a new medicine to market. Data were accessed from the US Securities and Exchange Commission, Drugs@FDA database, and ClinicalTrials.gov, alongside published data on clinical trial success rates. Exposures: Conduct of preclinical and clinical studies of new therapeutic agents. Main Outcomes and Measures: Median and mean research and development spending on new therapeutic agents approved by the FDA, capitalized at a real cost of capital rate (the required rate of return for an investor) of 10.5% per year, with bootstrapped CIs. All amounts were reported in 2018 US dollars. Results: The FDA approved 355 new drugs and biologics over the study period. Research and development expenditures were available for 63 (18%) products, developed by 47 different companies. After accounting for the costs of failed trials, the median capitalized research and development investment to bring a new drug to market was estimated at $985.3 million (95% CI, $683.6 million-$1228.9 million), and the mean investment was estimated at $1335.9 million (95% CI, $1042.5 million-$1637.5 million) in the base case analysis. Median estimates by therapeutic area (for areas with ≥5 drugs) ranged from $765.9 million (95% CI, $323.0 million-$1473.5 million) for nervous system agents to $2771.6 million (95% CI, $2051.8 million-$5366.2 million) for antineoplastic and immunomodulating agents. Data were mainly accessible for smaller firms, orphan drugs, products in certain therapeutic areas, first-in-class drugs, therapeutic agents that received accelerated approval, and products approved between 2014 and 2018. Results varied in sensitivity analyses using different estimates of clinical trial success rates, preclinical expenditures, and cost of capital. Conclusions and Relevance: This study provides an estimate of research and development costs for new therapeutic agents based on publicly available data. Differences from previous studies may reflect the spectrum of products analyzed, the restricted availability of data in the public domain, and differences in underlying assumptions in the cost calculations.


Asunto(s)
Desarrollo de Medicamentos/economía , Industria Farmacéutica/economía , Investigación Farmacéutica/economía , Costos y Análisis de Costo/estadística & datos numéricos , Costos de los Medicamentos , Industria Farmacéutica/estadística & datos numéricos , Estados Unidos , United States Food and Drug Administration
11.
Med Care ; 58(4): 314-319, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32197027

RESUMEN

BACKGROUND: Community health worker (CHW) programs take many forms and have been shown to be effective in improving health in several contexts. The extent to which they reduce unnecessary care is not firmly established. OBJECTIVES: This study estimates the number of hospitalizations and emergency department (ED) visits that would need to be avoided to recoup program costs for a CHW program that addressed both medical and social needs. RESEARCH DESIGN: A programmatic cost analysis is conducted using 6 different categories: personnel, training, transportation, equipment, facilities, and administrative costs. First, baseline costs are established for the current program and then estimate the number of avoided ED visits or hospitalizations needed to recoup program costs using national average health care estimates for different patient populations. MEASURES: Data on program costs are taken from administrative program records. Estimates of ED visit and hospitalization costs (or charges in some cases) are taken from the literature. RESULTS: To fully offset program costs, each CHW would need to work with their annual caseload of 150 participants to avoid almost 50 ED visits collectively. If CHW participants also avoided 2 hospitalizations, the number of avoided ED visits needed to offset costs reduces to about 34. CONCLUSIONS: Estimates of avoided visits needed to reach the break-even point are consistent with the literature. The analysis does not take other outcomes of the program from the clients' or workers' perspectives into account, so it is likely an upper bound on the number of avoided visits needed to be cost-effective.


Asunto(s)
Servicios de Salud Comunitaria/economía , Agentes Comunitarios de Salud/economía , Servicio de Urgencia en Hospital/economía , Hospitalización/economía , Procedimientos Innecesarios/economía , Costos y Análisis de Costo , Humanos , Kansas
12.
PLoS Negl Trop Dis ; 14(3): e0008096, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32203517

RESUMEN

BACKGROUND: Vector-borne diseases are important causes of mortality and morbidity in humans and livestock, particularly for poorer communities and countries in the tropics. Large-scale programs against these diseases, for example malaria, dengue and African trypanosomiasis, include vector control, and assessing the impact of this intervention requires frequent and extensive monitoring of disease vector abundance. Such monitoring can be expensive, especially in the later stages of a successful program where numbers of vectors and cases are low. METHODOLOGY/PRINCIPAL FINDINGS: We developed a system that allows the identification of monitoring sites where pre-intervention densities of vectors are predicted to be high, and travel cost to sites is low, highlighting the most efficient locations for longitudinal monitoring. Using remotely sensed imagery and an image classification algorithm, we mapped landscape resistance associated with on- and off-road travel for every gridded location (3m and 0.5m grid cells) within Koboko district, Uganda. We combine the accessibility surface with pre-existing estimates of tsetse abundance and propose a stratified sampling approach to determine the most efficient locations for longitudinal data collection. Our modelled predictions were validated against empirical measurements of travel-time and existing maps of road networks. We applied this approach in northern Uganda where a large-scale vector control program is being implemented to control human African trypanosomiasis, a neglected tropical disease (NTD) caused by trypanosomes transmitted by tsetse flies. Our accessibility surfaces indicate a high performance when compared to empirical data, with remote sensing identifying a further ~70% of roads than existing networks. CONCLUSIONS/SIGNIFICANCE: By integrating such estimates with predictions of tsetse abundance, we propose a methodology to determine the optimal placement of sentinel monitoring sites for evaluating control programme efficacy, moving from a nuanced, ad-hoc approach incorporating intuition, knowledge of vector ecology and local knowledge of geographic accessibility, to a reproducible, quantifiable one.


Asunto(s)
Entomología , Monitoreo del Ambiente/métodos , Sistemas de Información Geográfica , Modelos Biológicos , Modelos Estadísticos , Tecnología de Sensores Remotos , Animales , Costos y Análisis de Costo , Humanos , Insectos Vectores , Ganado , Control de Plagas , Trypanosoma , Tripanosomiasis Africana , Moscas Tse-Tse , Uganda , Enfermedades Transmitidas por Vectores
13.
J Med Syst ; 44(5): 92, 2020 Mar 18.
Artículo en Inglés | MEDLINE | ID: mdl-32189085

RESUMEN

An electronic health (e-health) system, such as a medical cyber-physical system, offers a number of benefits (e.g. inform medical diagnosis). There are, however, a number of considerations in the implementation of the medical cyber-physical system, such as the integrity of medical / healthcare data (e.g. manipulated data can result in misdiagnosis). A number of digital signature schemes have been proposed in recent years to mitigate some of these challenges. However, the security of existing signatures is mostly based on conventional difficult mathematical problems, which are known to be insecure against quantum attacks. In this paper, we propose a certificateless signature scheme, based on NTRU lattice. The latter is based on the difficulty of small integer solutions on the NTRU lattice, and is known to be quantum attack resilience. Security analysis and performance evaluations demonstrate that our proposed scheme achieves significantly reduced communication and computation costs in comparison to two other competing quantum resilience schemes, while being quantum attack resilience.


Asunto(s)
Seguridad Computacional , Confidencialidad , Registros Electrónicos de Salud/normas , Algoritmos , Comunicación , Costos y Análisis de Costo , Errores Diagnósticos , Humanos , Examen Físico
14.
Bioresour Technol ; 302: 122822, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32007307

RESUMEN

Microalgae are source of third generation biofuel having the key advantage of high lipid productivity. In recent times, biorefinery is seen as promising option to further reduce the production cost of microalgae biofuel. However, exact energy balance analysis has not been performed on important biorefinery routes. In this aspect, three biorefinery routes, all based on lipid based biorefinery route are evaluated for economical production of microalgal biofuel and valorised products. Biorefinery route 1 involves production of biodiesel, pigments, and animal feed. Biorefinery route 2 involves biogas and pigments production and two stage fermentation, and third biorefinery route involves bio-hydrogen and pigments production. Finally, the technoeconomic assessment of three biorefinery routes were reviewed, net energy savings, and life-cycle costing approaches to economize microalgal biorefinery are suggested.


Asunto(s)
Microalgas , Animales , Biocombustibles , Biomasa , Costos y Análisis de Costo , Lípidos
16.
PLoS One ; 15(2): e0227961, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32023267

RESUMEN

PURPOSE: Trastuzumab (TZM) improves survival and the risk of recurrence among patients with early-stage HER2+ breast cancer (BC). TZM treatment can be given intravenously (IV-TZM) or subcutaneously (SC-TZM). Although both methods have similar efficacy and safety, they differ in dosage and administration. Previous studies of cost minimization determined that SC-TZM is associated with lower costs than IV-TZM; however, those studies did not include the costs associated with body weight-based dosage and the treatment of adverse drug reactions (ADRs). METHODS/PATIENTS: We performed a model-based cost-minimization analysis. The analysis included direct and indirect medical costs associated with TZM preparation (adjusted by body weight) and administration and also costs due to severe ADRs and non-medical costs that occurred during the total treatment course (18 cycles). We performed a sensitivity analysis to test the robustness of the results across various TZM costs and patient body weights. RESULTS: The overall cost (in USD) of IV-TZM treatment was $83,309.1 per patient compared with $77,067.7 per patient for SC-TZM. Thus, one year of SC-TZM treatment cost $6,241.4 less per patient than one year of IV-TZM treatment. The sensitivity analysis revealed that the results were mainly driven by the price of each TZM vial and body weight. CONCLUSION: SC-TZM is a cost-saving therapy for Chilean patients with early-stage HER2+ BC. Given their similar efficacy and safety, we suggest the use of SC formulations rather than IV formulations. The use of SC-TZM instead of IV-TZM may have a significant economic impact on public/private healthcare systems.


Asunto(s)
Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/economía , Costos y Análisis de Costo , Costos de la Atención en Salud , Receptor ErbB-2/metabolismo , Trastuzumab/economía , Trastuzumab/uso terapéutico , Administración Intravenosa , Relación Dosis-Respuesta a Droga , Femenino , Recursos en Salud , Humanos , Incidencia , Inyecciones Subcutáneas , Trastuzumab/administración & dosificación , Trastuzumab/efectos adversos
17.
PLoS Negl Trop Dis ; 14(2): e0008088, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-32109246

RESUMEN

BACKGROUND: Rabies lyssavirus (RABV) is the aetiologic agent of rabies, a disease that is severely underreported in Nigeria as well as elsewhere in Africa and Asia. Despite the role that rabies diagnosis plays towards elucidating the true burden of the disease, Nigeria-a country of 180 million inhabitants-has a limited number of diagnostic facilities. In this study, we sought to investigate two of the World Organization for Animal Health (OIE)-recommended diagnostic assays for rabies-viz; the direct fluorescent antibody test (DFA) and the direct rapid immunohistochemical test (dRIT) in terms of their relative suitability in resource-limited settings. Our primary considerations were (1) the financial feasibility for implementation and (2) the diagnostic efficacy. As a case study, we used suspect rabies samples from dog meat markets in Nigeria. METHODS/PRINCIPAL FINDINGS: By developing a simple simulation framework, we suggested that the assay with the lowest cost to implement and routinely use was the dRIT assay. The costs associated with the dRIT were lower in all simulated scenarios, irrespective of the number of samples tested per year. In addition to the cost analysis, the diagnostic efficacies of the two assays were evaluated. To do this, a cohort of DFA-positive and -negative samples collected from dog meat markets in Nigeria were initially diagnosed using the DFA in Nigeria and subsequently sent to South Africa for diagnostic confirmation. In South Africa, all the specimens were re-tested with the DFA, the dRIT and a quantitative real-time polymerase chain reaction (qRT-PCR). In our investigation, discrepancies were observed between the three diagnostic assays; with the incongruent results being resolved by means of confirmatory testing using the heminested reverse transcription polymerase reaction and sequencing to confirm that they were not contamination. CONCLUSIONS/SIGNIFICANCE: The data obtained from this study suggested that the dRIT was not only an effective diagnostic assay that could be used to routinely diagnose rabies, but that the assay was also the most cost-effective option among all of the OIE recommended methods. In addition, the results of our investigation confirmed that some of the dogs slaughtered in dog markets were rabies-positive and that the markets posed a potential public health threat. Lastly, our data showed that the DFA, although regarded as the gold standard test for rabies, has some limitations-particularly at low antigen levels. Based on the results reported here and the current challenges faced in Nigeria, we believe that the dRIT assay would be the most suitable laboratory test for decentralized or confirmatory rabies diagnosis in Nigeria, given its relative speed, accuracy, cost and ease of use.


Asunto(s)
Técnica del Anticuerpo Fluorescente Directa/veterinaria , Inmunohistoquímica/veterinaria , Carne/virología , Virus de la Rabia/aislamiento & purificación , Rabia/veterinaria , Animales , Anticuerpos Antivirales/inmunología , Costos y Análisis de Costo , Pruebas Diagnósticas de Rutina/métodos , Enfermedades de los Perros/virología , Perros , Técnica del Anticuerpo Fluorescente Directa/economía , Técnica del Anticuerpo Fluorescente Directa/métodos , Humanos , Inmunohistoquímica/economía , Inmunohistoquímica/métodos , Nigeria/epidemiología , Rabia/epidemiología , Sensibilidad y Especificidad
18.
Rev Soc Bras Med Trop ; 53: e20190175, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32049199

RESUMEN

INTRODUCTION: The present study sought to assess the mean and activity based cost (ABC) of the laboratory diagnosis for tuberculosis through the application of conventional and molecular techniques-Xpert®MTB/RIF and Genotype®MTBDRplus-in a tertiary referral hospital in Brazil. METHODS: The mean cost and ABC formed the basis for the cost analysis of the TB laboratory diagnosis. RESULTS: The mean cost and ABC were US$ 4.00 and US$ 3.24, respectively, for a bacilloscopy; US$ 6.73 and US$ 5.27 for a Lowenstein-Jensen (LJ) culture; US$ 105.42 and US$ 76.56 for a drug sensitivity test (DST)-proportions method (PM) in LJ; US$ 148.45 and US$ 136.80 for a DST-BACTECTM MGITTM 960 system; US$ 11.53 and US$ 9.89 for an Xpert®MTB/RIF; and US$ 84.21 and US$ 48.38 for a Genotype®MTBDRplus. CONCLUSIONS: The mean cost and ABC proved to be good decision-making parameters in the diagnosis of TB and MDR-TB. The effective implementation of algorithms will depend on the conditions at each location.


Asunto(s)
Costos y Análisis de Costo/estadística & datos numéricos , Mycobacterium tuberculosis/genética , Tuberculosis Resistente a Múltiples Medicamentos/diagnóstico , Tuberculosis Resistente a Múltiples Medicamentos/economía , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/economía , Brasil , Genotipo , Humanos , Mycobacterium tuberculosis/aislamiento & purificación , Sensibilidad y Especificidad , Centros de Atención Terciaria
19.
BMC Health Serv Res ; 20(1): 76, 2020 Feb 03.
Artículo en Inglés | MEDLINE | ID: mdl-32013946

RESUMEN

BACKGROUND: Interventions targeting community health workers (CHWs) aim to optimise the delivery of health services to underserved rural areas. Whilst interventions are evaluated against their objectives, there remains limited evidence on the economic costs of these interventions, and the practicality and value of scale up. The aim of this paper is to undertake a cost analysis on a CHW training and supervision intervention using exclusive breastfeeding rates amongst mothers as an outcome measure. METHODS: This is a retrospective cost analysis, from an implementer's perspective, of a cluster randomised controlled trial investigating the effectiveness of a continuous quality improvement (CQI) intervention aimed at CHWs providing care and support to pregnant women and women with babies aged < 1 year in South Africa. RESULTS: One of the outcomes of the RCT revealed that the prevalence of exclusive breastfeeding (EBF) significantly improved, with the cost per mother EBF in the control and intervention arm calculated at US$760,13 and US$1705,28 respectively. The cost per additional mother practicing EBF was calculated to be US$7647, 88, with the supervision component of the intervention constituting 64% of the trial costs. In addition, women served by the intervention CHWs were more likely to have received a CHW visit and had significantly better knowledge of childcare practices. CONCLUSION: Whilst the cost of this intervention is high, adapted interventions could potentially offer an economical alternative for achieving selected maternal and child health (MCH) outcomes. The results of this study should inform future programmes aimed at providing adapted training and supervision to CHWs with the objective of improving community-level health outcomes.


Asunto(s)
Lactancia Materna/estadística & datos numéricos , Agentes Comunitarios de Salud/economía , Agentes Comunitarios de Salud/organización & administración , Capacitación en Servicio/economía , Madres/psicología , Costos y Análisis de Costo , Femenino , Humanos , Lactante , Embarazo , Mejoramiento de la Calidad , Estudios Retrospectivos , Sudáfrica
20.
BMC Health Serv Res ; 20(1): 80, 2020 Feb 03.
Artículo en Inglés | MEDLINE | ID: mdl-32013963

RESUMEN

BACKGROUND: Recently, the Executive Branch and Judiciary in Brazil increased spending due to larger numbers of lawsuits that forced the State to provide health goods and services. This phenomenon, known as health judicialization, has created challenges and required the Executive Branch and Judiciary to create institutional strategies such as technical chambers and departments to reduce the social, economic and political distortions caused by this phenomenon. This study aims to evaluate the effects of two institutional strategies deployed by a Brazilian municipality in order to cope with the economic, social and political distortions caused by the phenomenon of health judicialization regarding access to medicines. METHODS: A longitudinal study was carried out in a capital in the Central-West Region of Brazil. A sample of 511 lawsuits was analyzed. The variables were placed into three groups: the sociodemographic characteristics and the plaintiffs' disease, the characteristics of the claimed medical products and the institutional strategies. To analyze the effect of the interventions on the total cost of the medicines in the lawsuits, bivariate and multivariate linear regressions with variance were performed. For the categorical outcomes, Poisson regressions were performed with robust variance, using a significance level of 5%. RESULTS: A reduction in the costs of medicines in the lawsuits and of the requests for medicines within the SUS formulary was verified after the deployment of the Department of Assessment of Nonstandardized Medicines (DAMNP) and the Technical Chamber of Health Assessment (CATS); an increase in processed prescriptions from the Brazilian Universal Health System was observed after the deployment of the CATS; and an increase in medicines outside the SUS formulary without a therapeutic alternative was verified after the CATS. CONCLUSION: The institutional strategies deployed were important tools to reduce the high costs of the medicines in the lawsuits. In addition, they represented a step forward for the State, provided a benefit to society and indicated a potential path for the health and justice systems of other countries that also face problems caused by the judicialization of health.


Asunto(s)
Política de Salud/legislación & jurisprudencia , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Preparaciones Farmacéuticas/economía , Servicios Farmacéuticos/legislación & jurisprudencia , Brasil , Ciudades , Costos y Análisis de Costo , Humanos , Estudios Longitudinales
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