ABSTRACT
OBJECTIVES: Vascular and biliary complications associated with liver transplants involve high morbidity and mortality as well as cost overrun for health systems. Efforts to prioritize their prevention require not only clinical information but also information on costs that reflect the economic burden on health systems. The objective of this study was to describe cost overrun incurred from early vascular and biliary complications after liver transplant. METHODS: This cases series included liver transplant patients treated at the San Vicente Foundation University Hospital, Rionegro, Antioquia, from January 1, 2013, to December 31, 2018. All liver transplant patients treated during the above period were included; the absence of clinical records on the variables of interest was considered the exclusion criterion. A probabilistic analysis of patient cost was performed. Monte Carlo simulations as well as a 1-way sensitivity analysis per transplant cost component were performed. RESULTS: Records from 154 patients were assessed. The average patient age was 56.9 (SD 10.9) years; 42.9% of patients were women. Of all, 36.4% patients were classified as Child C, and the average Model for End-Stage Liver Disease score was 19.6. The average cost for patients without complications was $27 834.82, whereas that for patients with early vascular complications was $36 747.83 and for those with early biliary complications was $38 523.74. CONCLUSION: Early vascular and biliary complications after liver transplant increase healthcare costs, with the increase being significant in patients with biliary complications.
Subject(s)
Biliary Tract Diseases/etiology , Health Care Costs/standards , Liver Transplantation/adverse effects , Vascular Diseases/etiology , Aged , Biliary Tract Diseases/economics , Biliary Tract Diseases/epidemiology , Colombia/epidemiology , Female , Health Care Costs/statistics & numerical data , Hospitals/statistics & numerical data , Humans , Liver/physiopathology , Liver Transplantation/economics , Liver Transplantation/methods , Male , Middle Aged , Retrospective Studies , Vascular Diseases/economics , Vascular Diseases/epidemiologyABSTRACT
BACKGROUND: Chronic venous disease (CVD) and disability are worldwide problems and have significant socioeconomic implications. This study aims to analyze the time trends and social security burden of temporary work disability due to CVD in Brazil. METHODS: An ecological time series study using the Brazilian Social Security System database was performed from 2005 to 2014. Data from all benefits granted to workers with temporary disability due to CVD were analyzed. The cases were identified using diagnosis codes I83-I83.9 of the International Classification of Diseases 10th Revision (ICD-10). The time trend analyses were performed by the Joinpoint Regression Model, with sex, age, regions, income, and category of affiliation as variables. Crude and age-standardized rates were calculated. RESULTS: A total of 429,438 benefits were granted for temporary work disability due to CVD from 2005 to 2014, with a growing trend and an age-standardized annual percent change (APC) of 3.4 (95% CI: 2.6-4.2) (p < 0.05). Social security expense increased 3.5-fold, and the number of days in benefit doubled from 2005 to 2014. In total, 27,017,818 working days were lost. The average duration of benefits was 55.3 days. The majority of workers were women (68.2%) (p < 0.001), between 30 and 59 years old, employed, had a monthly income ≤2 minimum wages (MW) (83.2%), and lived in the regions southeast (53.6%) and south (29.3%). Significantly higher APCs were observed for women than for men (APC: 4.9, 95% CI: 4.0-5.7 versus APC: 1.2, 95% CI: 0.1-2.4). All regions in Brazil had a significant growing trend, except in the north. No significant growth was observed in the age group of 60-69 years. A decreasing trend was observed in workers with monthly incomes above 2 MW (p < 0.05). CONCLUSIONS: Temporary work disability due to CVD and social security burden showed increasing trends with millions of working days lost, particularly among women and low-income workers. Preventing disability is challenging, and public policies are needed to reduce the social and economic impact of disability. Therefore, measures for promoting health at the workplace should be encouraged.
Subject(s)
Disabled Persons/statistics & numerical data , Social Security/economics , Vascular Diseases/economics , Vascular Diseases/epidemiology , Adolescent , Adult , Aged , Brazil/epidemiology , Chronic Disease , Databases, Factual , Female , Humans , Male , Middle Aged , Time Factors , Young AdultSubject(s)
Ambulatory Care/economics , Centers for Medicare and Medicaid Services, U.S./economics , Health Care Costs , Health Expenditures , Medicare/economics , Reimbursement Mechanisms/economics , Vascular Diseases/economics , Vascular Diseases/therapy , Veins , Advisory Committees , Ambulatory Care/legislation & jurisprudence , Ambulatory Care/organization & administration , Centers for Medicare and Medicaid Services, U.S./legislation & jurisprudence , Centers for Medicare and Medicaid Services, U.S./organization & administration , Chronic Disease , Evidence-Based Medicine/economics , Government Regulation , Health Care Costs/legislation & jurisprudence , Health Expenditures/legislation & jurisprudence , Humans , Medicare/legislation & jurisprudence , Medicare/organization & administration , Policy Making , Registries , Reimbursement Mechanisms/legislation & jurisprudence , United States , Vascular Diseases/diagnosisABSTRACT
Existem diversas opções para o tratamento da doença oclusiva dos troncos supra-aórticos, de acordo com a apresentação clínica e a localização das lesões arteriais. As abordagens cervicais são aceitas como alternativas de baixa morbimortalidade, com elevada perviedade em longo prazo. Os autores relatam um caso tratado com sucesso através de derivação carótido-carotídea cruzada por via retrofaríngea associada à endarterectomia da bifurcação carotídea. São discutidos também os aspectos clínicos e as opções cirúrgicas ou endovasculares para o melhor tratamento desses pacientes.