ABSTRACT
BACKGROUND: As Zika virus continues to spread, decisions regarding resource allocations to control the outbreak underscore the need for a tool to weigh policies according to their cost and the health burden they could avert. For example, to combat the current Zika outbreak the US President requested the allocation of $1.8 billion from Congress in February 2016. METHODOLOGY/PRINCIPAL FINDINGS: Illustrated through an interactive tool, we evaluated how the number of Zika cases averted, the period during pregnancy in which Zika infection poses a risk of microcephaly, and probabilities of microcephaly and Guillain-Barré Syndrome (GBS) impact the cost at which an intervention is cost-effective. From Northeast Brazilian microcephaly incidence data, we estimated the probability of microcephaly in infants born to Zika-infected women (0.49% to 2.10%). We also estimated the probability of GBS arising from Zika infections in Brazil (0.02% to 0.06%) and Colombia (0.08%). We calculated that each microcephaly and GBS case incurs the loss of 29.95 DALYs and 1.25 DALYs per case, as well as direct medical costs for Latin America and the Caribbean of $91,102 and $28,818, respectively. We demonstrated the utility of our cost-effectiveness tool with examples evaluating funding commitments by Costa Rica and Brazil, the US presidential proposal, and the novel approach of genetically modified mosquitoes. Our analyses indicate that the commitments and the proposal are likely to be cost-effective, whereas the cost-effectiveness of genetically modified mosquitoes depends on the country of implementation. CONCLUSIONS/SIGNIFICANCE: Current estimates from our tool suggest that the health burden from microcephaly and GBS warrants substantial expenditures focused on Zika virus control. Our results justify the funding committed in Costa Rica and Brazil and many aspects of the budget outlined in the US president's proposal. As data continue to be collected, new parameter estimates can be customized in real-time within our user-friendly tool to provide updated estimates on cost-effectiveness of interventions and inform policy decisions in country-specific settings.
Subject(s)
Health Care Costs , Health Policy , Zika Virus Infection/economics , Zika Virus Infection/prevention & control , Aedes/genetics , Aedes/virology , Animals , Animals, Genetically Modified , Brazil/epidemiology , Caribbean Region/epidemiology , Cost of Illness , Cost-Benefit Analysis/legislation & jurisprudence , Costa Rica/epidemiology , Disease Outbreaks/economics , Disease Outbreaks/legislation & jurisprudence , Disease Outbreaks/prevention & control , Female , Health Care Costs/legislation & jurisprudence , Humans , Incidence , Infant , Microcephaly/etiology , Microcephaly/prevention & control , Microcephaly/virology , Pregnancy , Pregnancy Complications, Infectious/economics , Pregnancy Complications, Infectious/prevention & control , Pregnancy Complications, Infectious/virology , Zika Virus/isolation & purification , Zika Virus Infection/epidemiology , Zika Virus Infection/virologySubject(s)
Biosimilar Pharmaceuticals/therapeutic use , Biosimilar Pharmaceuticals/adverse effects , Biosimilar Pharmaceuticals/economics , Caribbean Region , Cost-Benefit Analysis/legislation & jurisprudence , Drug Approval/economics , Drug Approval/legislation & jurisprudence , Drug Substitution/economics , Drugs, Generic/adverse effects , Drugs, Generic/economics , Drugs, Generic/therapeutic use , Patents as Topic/legislation & jurisprudence , Treatment Outcome , United States , United States Food and Drug Administration/legislation & jurisprudenceSubject(s)
Biosimilar Pharmaceuticals/therapeutic use , Biosimilar Pharmaceuticals/adverse effects , Biosimilar Pharmaceuticals/economics , Caribbean Region , Cost-Benefit Analysis/legislation & jurisprudence , Drug Approval/economics , Drug Approval/legislation & jurisprudence , Drug Substitution/economics , Drugs, Generic/adverse effects , Drugs, Generic/economics , Drugs, Generic/therapeutic use , Patents as Topic/legislation & jurisprudence , Treatment Outcome , United States , United States Food and Drug Administration/legislation & jurisprudenceABSTRACT
A local internist is in the process of ordering an intravenous pyelogram for a patient she suspects of having kidney problems, when a medical student shadowing her in clinic interrupts. The student wants to know why the physician is not ordering a low-osmolality contrast agent for the patient, having read that they are less likely to cause serious side effects than high-osmolality contrast agents. The physician realizes that the medical student is correct, but rejects the suggestion, telling the student that "low-osmolality contrast agents are the standard of care for low-risk patients."
Subject(s)
Conflict, Psychological , Cost Control , Health Care Rationing , Practice Patterns, Physicians' , Resource Allocation , Cost Control/economics , Cost Control/legislation & jurisprudence , Cost-Benefit Analysis/economics , Cost-Benefit Analysis/legislation & jurisprudence , Ethics, Medical , Health Care Rationing/economics , Health Care Rationing/legislation & jurisprudence , Humans , Practice Patterns, Physicians'/economics , Practice Patterns, Physicians'/legislation & jurisprudence , Trust , United States , Vulnerable Populations , Withholding TreatmentABSTRACT
La ideia conceptual es la de presentar una teoría general, de carcterísticas científicas, a los efectos de poder abordar los adecuados caminos conducentesen la administración de riesgos. Tal criterio me llevó a describir la constitución de fatores del tetraedro dela administración de riesgos (factores base: humano, técnico, jurídico y de interrelación) y los elementos-nexo (coadyuvantes) que son el de: semiología, interfaz comunicación -organización y las relaciones laborales). Lo que en difinitiva se propende es al mejoramiento de la: preservación de vidas, recursos naturales y patrimoniales.