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1.
Rev. argent. salud publica ; 37(9): 37-42, 2018.
Artigo em Espanhol | LILACS | ID: biblio-968403

RESUMO

INTRODUCCIÓN: La particularidad del sistema de salud argentino, que se encuentra fragmentado en tres subsistemas y con más de 900 financiadores, lleva a reflexionar sobre cuál es la posibilidad de desarrollar evaluaciones económicas (EE) en forma global y que sirvan de modo eficiente al proceso de toma de decisiones. OBJETIVOS: Identificar y discutir los desafíos metodológicos que implican el diseño de EE en un sistema de salud caracterizado por la fragmentación, la no integración en la prestación de servicios y la presencia de múltiples financiadores. Analizar los aspectos claves de la formulación de las EE y su aplicabilidad en nuestro contexto, así como también la generalización y transferibilidad de sus resultados hacia el sistema de salud en su conjunto. MÉTODOS: Se realizó una búsqueda sistemática de la literatura en las principales fuentes bibliográficas. Se relevaron indicadores a nivel provincial y sectorial. Asimismo, se citan ejemplos de estudios de EE que demuestran las diferencias intersectoriales en los principales elementos metodológicos que componen una EE. CONCLUSIONES: Las características de nuestro sistema de salud fragmentado implican diferencias en términos de estructuras de costos, perspectiva de análisis y umbrales de disponibilidad a pagar según la entidad involucrada. Ello tiene repercusiones metodológicas en la elaboración y en los resultados de las EE y, por tanto, condiciona la aplicabilidad o generalización de los resultados a nivel nacional.


Assuntos
Humanos , Avaliação em Saúde , Sistemas de Saúde , Tomada de Decisões , Argentina , Avaliação da Tecnologia Biomédica
2.
Rev. argent. salud publica ; 8(31): 13-18, jun. 2017. tab, graf
Artigo em Espanhol | LILACS, BRISA/RedTESA | ID: biblio-883100

RESUMO

INTRODUCCIÓN: El cáncer colorrectal (CCR) es una de las principales causas de mortalidad en adultos. En Argentina es la segunda entre las neoplasias, y se observan diferencias en la mortalidad entre las distintas provincias. El rastreo de CCR es subutilizado en Argentina, donde el sistema de salud se encuentra fragmentado. OBJETIVOS: Analizar la costo-efectividad (CE) de diversas estrategias de rastreo basadas en el test de sangre oculta en materia fecal inmunohistoquímico (SOMFihq) anual desde distintos subsectores provinciales. MÉTODOS: Se construyó un modelo de Markov, que permitió comparar tres estrategias: rastreo en población de 50 a 74 años, rastreo en población de 50 a 64 años y no rastreo. RESULTADOS: Se encontraron diferencias de costos y variabilidad clínica. El rastreo a población de 50-74 años presentó una razón de CE incremental levemente mayor que el rastreo en población de 50-64 años, con valores inferiores al producto bruto geográfico per cápita. Este resultado se mostró robusto en el análisis de sensibilidad. CONCLUSIONES: Los resultados comparados en siete subsectores de salud regionales de Argentina ­con diferencias epidemiológicas, organizacionales, de capacidad instalada y de recursos, con su variabilidad de práctica clínica y sus diferentes costos­ indican de manera robusta que el rastreo de CCR se mantiene costo-efectivo en diversos escenarios. Analizar la CE de intervenciones sanitarias en Argentina requiere tener en cuenta el contexto local de los diferentes subsectores de salud.


INTRODUCTION: Colorectal cancer (CRC) is one of the main causes of mortality in adults. In Argentina it is the second among tumors, and there are differences between province mortality rates. CRC screening is underutilized in Argentina, where there is an important fragmentation of the health care system. OBJECTIVES: To assess the cost-effectiveness (CE) of different screening strategies based on annual immunochemical fecal occult blood test (IFOBT) for different health subsectors in the country. METHODS: A Markov model was developed, which allowed to compare three different strategies: screening population aged 50 to 74 years, screening population aged 50 to 64 years, and no screening. RESULTS: Differences in costs and clinical variability were found. Screening the population aged 50 to 74 years showed a slightly higher incremental CE ratio than screening the population aged 50 to 64, with values lower than per capita gross regional product. This result was robust in the sensitivity analysis. CONCLUSIONS: The compared results from seven regional health subsectors in Argentina, with their differences in epidemiology, organization, installed capacity and resources, as well as clinical variability and differences in costs, are robust in showing that CRC screening remains cost-effective under different scenarios. In order to analyze the CE in Argentina, it is necessary to take into account the local context of different health subsectors.


Assuntos
Humanos , Economia da Saúde , Neoplasias Colorretais , Programas de Rastreamento , Análise Custo-Benefício , Sangue Oculto , Avaliação da Tecnologia Biomédica , Análise Custo-Eficiência
3.
Pharmacoeconomics ; 27(7): 561-70, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19663527

RESUMO

A review was performed of the key methodological elements of all the published economic evaluations (EEs), available in the European Network of Health Economics Evaluation Database (EURONHEED), of healthcare technologies conducted in Europe over the past 10 years in order to identify and compare the methodological patterns of EEs conducted in different countries. Selected for analysis were summaries of EEs of interventions for bacterial and viral infections, and diseases of the digestive and respiratory tracts. The summaries were obtained from the EURONHEED. There were 346 studies that fulfilled the selection criteria. The statistical analyses consisted of a descriptive analysis and a bivariate inference analysis to assess associations between the different variables, essentially between the variables of country, year of publication and methodology applied. Of the summaries examined, approximately 50% focused on pharmacological interventions. The most frequent type of analysis was that of cost effectiveness. The technologies most evaluated referred to treatments (versus diagnosis or prevention technologies). The perspective was mostly that of the health service. The sensitivity analysis most applied was univariate and the model type mostly used was the decision-tree. Over the period assessed, there were significant differences between countries in the types of EE, the perspective from which the studies were performed and in the practice of discounting costs and health effects. Although there has been an improvement in methodologies since the year 2000, there are studies that still fail to take into account key elements of EE necessary for a study to be considered of high quality. For better appreciation of the potential capacity for the transfer of results of EEs between jurisdictions, the methodologies used in health EE studies in the different European countries need to be known in greater detail.


Assuntos
Bases de Dados Factuais/estatística & dados numéricos , Assistência à Saúde/economia , Economia Médica , Interpretação Estatística de Dados , Europa (Continente) , Humanos
4.
Health Econ ; 18(6): 629-43, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18677724

RESUMO

In this paper, we have elaborated an index in two phases to measure the degree of transferability of the results of the economic evaluation of health technologies. In the first phase, we have considered the objective factors (critical and non-critical) to derive a general transferability index, which can be used to measure this internal property of the studies of economic evaluation applied to health technologies. In the second phase, with a more specific index, we have measured the degree of applicability of the results of a given study to a different setting. Both indices have been combined (arithmetic and geometric mean) to obtain a global transferability index. We have applied the global index to a sample of 27 Spanish studies on infectious diseases. We have obtained an average value for the index of 0.54, quite far from the maximum theoretical value of 1. We also found that 11 studies lacked some critical factor and were directly deemed as not transferable.


Assuntos
Algoritmos , Tecnologia Biomédica/economia , Assistência à Saúde/economia , Modelos Econométricos , Humanos , Literatura de Revisão como Assunto
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