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1.
Eur J Health Econ ; 20(2): 303-316, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30121870

RESUMO

Informal care is a substantial source of support for people with cancer. However, various studies have predicted its disappearance in the near future. The aim of this study is to analyse the catastrophic effect resulting from the substitution of informal care with formal care in patients with blood cancer throughout the different stages of treatment. A total of 139 haematological neoplasm patients who underwent stem cell transplantation in Spain, completed a longitudinal questionnaire according to the three phases of treatment between 2012 and 2013. The economic value of informal care was estimated using proxy good, opportunity cost, and contingent valuation methods. Catastrophic health expenditure measures with thresholds ranging from 5 to 100% were used to value the financial burden derived from substitution. A total of 88.5% of patients reported having received informal care. In 85.37%, 80.49%, and 33.33% of households, more than 40% of their monthly income would have to be devoted to the replacement with formal care, with monthly amounts of €2105.22, €1790.86, and €1221.94 added to the 40% in the short, medium, and long-term, respectively (proxy good method, value = 9 €/h). Informal caregivers are a structural support for patients with blood cancer, assuming significant care time and societal costs. The substitution of informal care with formal care would be financially unaffordable by the families of people with blood cancer.


Assuntos
Cuidadores/economia , Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde , Neoplasias Hematológicas/economia , Assistência ao Paciente/economia , Assistência ao Paciente/métodos , Adolescente , Adulto , Idoso , Cuidadores/estatística & dados numéricos , Análise Custo-Benefício , Feminino , Neoplasias Hematológicas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Econométricos , Assistência ao Paciente/estatística & dados numéricos , Espanha , Transplante de Células-Tronco/economia , Inquéritos e Questionários , Adulto Jovem
2.
Gac. sanit. (Barc., Ed. impr.) ; 32(5): 411-417, sept.-oct. 2018. tab
Artigo em Inglês | IBECS | ID: ibc-174187

RESUMO

Objective: To estimate differences in the economic valuation and sociodemographic and clinical factors associated with informal care between phases of the treatment in the case of blood cancer patients. Methods: 139 haematological cancer patients who underwent a stem cell transplantation completed a longitudinal questionnaire according to 3 phases of the treatment: short-term (pre-transplant), medium-term (1st year post-transplant) and long-term (2nd-6th year post-transplant). Economic value of informal care was estimated using proxy good and opportunity cost methods. Ordered and binary logistic models were performed to identify factors associated with informal care. Results: 123 patients reported having received informal care. A progressive reduction of the number of hours of care was observed between phases. Monetary value per patient ranged from 1,288 to 3,409; 1,045 to 2,786; and 336 to 854 Euros/month in the short, medium and long term, respectively. Patients with acute leukaemia and those who received an unrelated allogeneic transplantation were 22% (short-term) and 33.5% (medium-term) more likely to receive more than 8hours/day of care respect to patients diagnosed with lymphoma and autologous transplantation. In the long term, patients with multiple myeloma were more likely to receive more care. Better health status and higher educational level were associated with fewer daily hours of care. Conclusions: Informal care varies greatly between stages of the treatment depending on the clinical and sociodemographic factors. Significant caring time and societal costs are associated with such care in blood cancer patients


Objetivo: Estimar los factores sociodemográficos y clínicos asociados al cuidado informal a lo largo de las diferentes etapas del tratamiento y su valoración económica en pacientes con neoplasia hematológica. Métodos: 139 pacientes oncohematológicos que recibieron un trasplante de células madre respondieron un cuestionario longitudinal basado en tres fases del tratamiento: corto, medio y largo plazo. Los cuidados informales recibidos se valoraron económicamente mediante los métodos del bien más próximo y coste de oportunidad. Se estimaron modelos de regresión logística ordenada y binaria para identificar factores asociados al cuidado informal. Resultados: 123 pacientes recibieron cuidado informal, con una reducción progresiva del número de horas a lo largo del tiempo. El valor monetario del cuidado informal recibido por paciente fue de 1288-3409 Euros, 1045-2786 Euros y 336-854 Euros/mes en el corto, medio y largo plazo, respectivamente. Los/las pacientes con leucemia aguda y los/las que recibieron un trasplante alogénico no emparentado tuvieron un 22% (corto plazo) y un 33,5% (medio plazo) más probabilidad de recibir >8 horas al día de cuidado respecto a los/las pacientes diagnosticados/as de linfoma y trasplante autólogo. A largo plazo, los/las pacientes con mieloma múltiple fueron más proclives a recibir más atención. Un mejor estado de salud y un mayor nivel de estudios se asociaron a menos horas diarias de cuidado. Conclusiones: Existe gran variación en el tiempo, el valor monetario y los factores asociados al cuidado informal en pacientes con neoplasia hematológica a lo largo de las distintas etapas del tratamiento


Assuntos
Humanos , Neoplasias Hematológicas/epidemiologia , Serviços Hospitalares de Assistência Domiciliar/estatística & dados numéricos , Assistência Domiciliar/estatística & dados numéricos , Transplante de Células-Tronco/enfermagem , Efeitos Psicossociais da Doença , Cuidadores/estatística & dados numéricos , Neoplasias Hematológicas/economia , Visitadores Domiciliares/economia , Fatores Socioeconômicos
3.
Value Health ; 21(8): 911-920, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30098668

RESUMO

OBJECTIVES: To analyze the cost-effectiveness of current technologies (conservative care [CONS], high-ligation surgery [HL/S], ultrasound-guided foam sclerotherapy [UGFS], endovenous laser ablation [EVLA], and radiofrequency ablation [RFA]) and emerging technologies (mechanochemical ablation [MOCA] and cyanoacrylate glue occlusion [CAE]) for treatment of varicose veins over 5 years. METHODS: A Markov decision model was constructed. Effectiveness was measured by re-intervention on the truncal vein, re-treatment of residual varicosities, and quality-adjusted life-years (QALYs) over 5 years. Model inputs were estimated from systematic review, the UK National Health Service unit costs, and manufacturers' list prices. Univariate and probabilistic sensitivity analyses were undertaken. RESULTS: CONS has the lowest overall cost and quality of life per person over 5 years; HL/S, EVLA, RFA, and MOCA have on average similar costs and effectiveness; and CAE has the highest overall cost but is no more effective than other therapies. The incremental cost per QALY of RFA versus CONS was £5,148/QALY. Time to return to work or normal activities was significantly longer after HL/S than after other procedures. CONCLUSIONS: At a threshold of £20,000/QALY, RFA was the treatment with highest median rank for net benefit, with MOCA second, EVLA third, HL/S fourth, CAE fifth, and CONS and UGFS sixth. Further evidence on effectiveness and health-related quality of life for MOCA and CAE is needed. At current prices, CAE is not a cost-effective option because it is costlier but has not been shown to be more effective than other options.


Assuntos
Procedimentos Cirúrgicos Eletivos/economia , Varizes/complicações , Técnicas de Ablação/economia , Tratamento Conservador/economia , Análise Custo-Benefício , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Humanos , Terapia a Laser/economia , Cadeias de Markov , Escleroterapia/economia , Varizes/economia , Varizes/cirurgia
4.
Gac Sanit ; 32(5): 411-417, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28529098

RESUMO

OBJECTIVE: To estimate differences in the economic valuation and sociodemographic and clinical factors associated with informal care between phases of the treatment in the case of blood cancer patients. METHODS: 139 haematological cancer patients who underwent a stem cell transplantation completed a longitudinal questionnaire according to 3 phases of the treatment: short-term (pre-transplant), medium-term (1st year post-transplant) and long-term (2nd-6th year post-transplant). Economic value of informal care was estimated using proxy good and opportunity cost methods. Ordered and binary logistic models were performed to identify factors associated with informal care. RESULTS: 123 patients reported having received informal care. A progressive reduction of the number of hours of care was observed between phases. Monetary value per patient ranged from 1,288 to 3,409; 1,045 to 2,786; and 336 to 854 €/month in the short, medium and long term, respectively. Patients with acute leukaemia and those who received an unrelated allogeneic transplantation were 22% (short-term) and 33.5% (medium-term) more likely to receive more than 8hours/day of care respect to patients diagnosed with lymphoma and autologous transplantation. In the long term, patients with multiple myeloma were more likely to receive more care. Better health status and higher educational level were associated with fewer daily hours of care. CONCLUSIONS: Informal care varies greatly between stages of the treatment depending on the clinical and sociodemographic factors. Significant caring time and societal costs are associated with such care in blood cancer patients.


Assuntos
Neoplasias Hematológicas/economia , Transplante de Células-Tronco Hematopoéticas/economia , Assistência ao Paciente/economia , Adolescente , Adulto , Assistência ao Convalescente/economia , Idoso , Cuidadores/economia , Efeitos Psicossociais da Doença , Escolaridade , Feminino , Nível de Saúde , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Modelos Econômicos , Assistência ao Paciente/estatística & dados numéricos , Estudos Retrospectivos , Espanha , Inquéritos e Questionários , Fatores de Tempo , Adulto Jovem
5.
Int J Technol Assess Health Care ; 31(5): 289-96, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26715372

RESUMO

OBJECTIVES: Although the clinical benefits of endovenous thermal ablation are widely recognized, few studies have evaluated the health economic implications of different treatments. This study compares 6-month clinical outcomes and cost-effectiveness of endovenous laser ablation (EVLA) compared with radiofrequency ablation (RFA) in the setting of a randomized clinical trial. METHODS: Patients with symptomatic primary varicose veins were randomized to EVLA or RFA and followed up for 6 months to evaluate clinical improvements, health related quality of life (HRQOL) and cost-effectiveness. RESULTS: A total of 131 patients were randomized, of which 110 attended 6-month follow-up (EVLA n = 54; RFA n = 56). Improvements in quality of life (AVVQ and SF-12v2) and Venous Clinical Severity Scores (VCSS) achieved at 6 weeks were maintained at 6 months, with no significant difference detected between treatment groups. There were no differences in treatment failure rates. There were small differences in favor of EVLA in terms of costs and 6-month HRQOL but these were not statistically significant. However, RFA is associated with less pain at up to 10 days. CONCLUSIONS: EVLA and RFA result in comparable and significant gains in quality of life and clinical improvements at 6 months, compared with baseline values. EVLA is more likely to be cost-effective than RFA but absolute differences in costs and HRQOL are small.


Assuntos
Terapia a Laser/economia , Terapia a Laser/métodos , Varizes/radioterapia , Varizes/cirurgia , Adulto , Idoso , Análise Custo-Benefício , Feminino , Humanos , Terapia com Luz de Baixa Intensidade/economia , Terapia com Luz de Baixa Intensidade/métodos , Masculino , Pessoa de Meia-Idade , Modelos Econômicos , Satisfação do Paciente , Qualidade de Vida , Resultado do Tratamento
6.
Rev Esp Salud Publica ; 89(2): 201-13, 2015 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-26121629

RESUMO

BACKGROUND: There is little information on factors related to use of to informal care in cancer patients. Our objective is to study sociodemographic and clinical factors associated with use of informal care in patients with hematologic malignancy and analyze how these changes throughout different phases of the treatment. METHODS: 139 patients diagnosed with hematologic malignancy who received an haematopoietic stem cell transplantation between 2006-2011 in two Spanish hospitals completed the developed postal questionnaire. A binary logistic regression model was used to analyse the factors associated with use of informal care each of four phases of the treatment (pretransplant, first year, second and third year, and from the fouth to sixth year postransplant). Dependent variable was receive vs. not receive informal care. RESULTS: Patients diagnosed with acute leukemia had higher probability of receiving informal care during pretransplant period (OR = 6.394) and during the second and third year postransplantation (OR = 42.212). In the long-term (4-6 years), multiple myeloma patients were the ones who required more informal care (OR = 15.977). Health status was statistically significant during all phases. Being male (OR = 0.263), having partner (OR = 0.137) and being employed (OR = 0.110) were associated with lower likelihood of receiving informal care in the long-term. CONCLUSIONS: Over 75% of patients diagnosed with hematologic malignancy received informal care during pretrasplant and first year postransplant. Type of diagnosis and health status are decisive factors in the probability of receiving informal care at all phases, while the type of transplantation is not. Sociodemografic factors are relevant in the long-term.


Assuntos
Cuidadores/estatística & dados numéricos , Neoplasias Hematológicas/terapia , Assistência ao Paciente/estatística & dados numéricos , Adolescente , Adulto , Idoso , Feminino , Nível de Saúde , Transplante de Células-Tronco Hematopoéticas , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Espanha , Inquéritos e Questionários , Adulto Jovem
7.
Gac. sanit. (Barc., Ed. impr.) ; 29(3): 178-183, mayo-jun. 2015. tab
Artigo em Inglês | IBECS | ID: ibc-139024

RESUMO

Introduction: Stem cell transplantation has been used for many years to treat haematological malignancies that could not be cured by other treatments. Despite this medical breakthrough, mortality rates remain high. Our purpose was to evaluate labour productivity losses associated with premature mortality due to blood cancer in recipients of stem cell transplantations. Methods: We collected primary data from the clinical histories of blood cancer patients who had undergone stem cell transplantation between 2006 and 2011 in two Spanish hospitals. We carried out a descriptive analysis and calculated the years of potential life lost and years of potential productive life lost. Labour productivity losses due to premature mortality were estimated using the Human Capital method. An alternative approach, the Friction Cost method, was used as part of the sensitivity analysis. Results: Our findings suggest that, in a population of 179 transplanted and deceased patients, males and people who die between the ages of 30 and 49 years generate higher labour productivity losses. The estimated loss amounts to over €31.4 million using the Human Capital method (€480,152 using the Friction Cost method), which means an average of €185,855 per death. The highest labour productivity losses are produced by leukaemia. However, lymphoma generates the highest loss per death. Conclusions: Further efforts are needed to reduce premature mortality in blood cancer patients undergoing transplantations and reduce economic losses (AU)


Introducción: Durante muchos años el trasplante de células madre se ha usado para tratar neoplasias hematológicas que no podrían haber sido curadas mediante otras terapias. A pesar de este avance médico, la ratio de mortalidad es aún elevada. Nuestro objetivo es evaluar las pérdidas de productividad laboral por mortalidad prematura debido a una neoplasia hematológica en receptores de trasplante de células madre. Métodos: Se recogieron datos primarios de las historias clínicas de pacientes con neoplasia hematológica, trasplantados durante los años 2006 y 2011 en dos hospitales españoles. Se realizó un análisis descriptivo y se calcularon los años potenciales de vida y los años potenciales de vida laboral perdidos. Las pérdidas de productividad laboral se estimaron usando el método del Capital Humano. El método de los Costes de Fricción se empleó como parte del análisis de sensibilidad. Resultados: En una población de 179 pacientes trasplantados y fallecidos, se dan mayores pérdidas de productividad laboral en varones y en personas de edades comprendidas entre los 30 y 49 años. La pérdida estimada está por encima de €31.4 millones usando el método del Capital Humano (€480,152 usando el método Costes Fricción), lo que significa una pérdida media de €185,855 por persona fallecida. Las mayores pérdidas globales son generadas por la leucemia. Sin embargo, el linfoma genera las mayores pérdidas por fallecimiento. Conclusiones: Mayores esfuerzos son necesarios para reducir la mortalidad prematura de pacientes trasplantados por neoplasia hematológica y reducir el impacto económico y social asociado a la misma (AU)


Assuntos
Humanos , Neoplasias Hematológicas/mortalidade , Mortalidade Prematura/tendências , Transplante de Células-Tronco , Anos Potenciais de Vida Perdidos , Valor da Vida
8.
Gac Sanit ; 29(3): 178-83, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25869153

RESUMO

INTRODUCTION: Stem cell transplantation has been used for many years to treat haematological malignancies that could not be cured by other treatments. Despite this medical breakthrough, mortality rates remain high. Our purpose was to evaluate labour productivity losses associated with premature mortality due to blood cancer in recipients of stem cell transplantations. METHODS: We collected primary data from the clinical histories of blood cancer patients who had undergone stem cell transplantation between 2006 and 2011 in two Spanish hospitals. We carried out a descriptive analysis and calculated the years of potential life lost and years of potential productive life lost. Labour productivity losses due to premature mortality were estimated using the Human Capital method. An alternative approach, the Friction Cost method, was used as part of the sensitivity analysis. RESULTS: Our findings suggest that, in a population of 179 transplanted and deceased patients, males and people who die between the ages of 30 and 49 years generate higher labour productivity losses. The estimated loss amounts to over €31.4 million using the Human Capital method (€480,152 using the Friction Cost method), which means an average of €185,855 per death. The highest labour productivity losses are produced by leukaemia. However, lymphoma generates the highest loss per death. CONCLUSIONS: Further efforts are needed to reduce premature mortality in blood cancer patients undergoing transplantations and reduce economic losses.


Assuntos
Eficiência , Neoplasias Hematológicas/mortalidade , Mortalidade Prematura , Transplante de Células-Tronco , Adolescente , Adulto , Idoso , Efeitos Psicossociais da Doença , Feminino , Neoplasias Hematológicas/economia , Neoplasias Hematológicas/terapia , Humanos , Leucemia/economia , Leucemia/mortalidade , Leucemia/terapia , Expectativa de Vida , Linfoma/economia , Linfoma/mortalidade , Linfoma/terapia , Masculino , Pessoa de Meia-Idade , Espanha , Adulto Jovem
9.
Rev. esp. salud pública ; 89(2): 203-215, mar.-abr. 2015. tab
Artigo em Espanhol | IBECS | ID: ibc-135551

RESUMO

Fundamentos: Los factores relacionados con la recepción de cuidado informal (CI) en pacientes oncológicos es una cuestión poco estudiada. El objetivo fue analizar los factores sociodemográficos y clínicos asociados a la recepción de cuidado informal en pacientes con neoplasia hematológica a lo largo de las diferentes etapas del tratamiento. Métodos: 139 pacientes diagnosticados de neoplasia hematológica que recibieron un trasplante de células madre durante el período 2006-2011 en dos centros sanitarios españoles completaron la encuesta elaborada para el estudio. Se estimó un modelo de regresión logística binaria para cada una de las cuatro etapas de tratamiento: pretrasplante, primer año, segundo y tercer año, cuarto al sexto año postrasplante. La variable dependiente fue recibir o no cuidado informal. Resultados: Pacientes diagnosticados de leucemia aguda presentaron mayor probabilidad de recibir CI durante la etapa pretrasplante (OR=6,394) y durante el segundo y tercer año postrasplante (OR=42,212). A largo plazo (4º-6º año) los pacientes con mieloma múltiple fueron los que requirieron mayor cuidado (OR=15,977). El estado de salud fue estadísticamente significativo en la mayoría de las etapas. Ser hombre (OR=0,263), tener pareja (OR=0,137) y estar empleado (OR=0,110) se asociaron a una menor probabilidad de recibir CI a largo plazo. Conclusiones: El CI está presente en más del 75% de los pacientes con neoplasia hematológica durante la etapa pretrasplante y primer año postrasplante. El diagnóstico y estado de salud son decisivos en la probabilidad de recibirlo, pero no el tipo de trasplante. Los factores sociodemográficos cobran protagonismo a largo plazo (AU)


Background: There is little information on factors related to use of to informal care in cancer patients. Our objective is to study sociodemographic and clinical factors associated with use of informal care in patients with hematologic malignancy and analyze how these changes throughout different phases of the treatment. Methods: 139 patients diagnosed with hematologic malignancy who received an haematopoietic stem cell transplantation between 2006-2011 in two Spanish hospitals completed the developed postal questionnaire. A binary logistic regression model was used to analyse the factors associated with use of informal care each of four phases of the treatment (pretransplant, first year, second and third year, and from the fouth to sixth year postransplant). Dependent variable was receive vs. not receive informal care. Results: Patients diagnosed with acute leukemia had higher probability of receiving informal care during pretransplant period (OR=6.394) and during the second and third year postransplantation (OR=42.212). In the long-term (4-6 years), multiple myeloma patients were the ones who required more informal care (OR=15.977). Health status was statistically significant during all phases. Being male (OR=0.263), having partner (OR=0.137) and being employed (OR=0.110) were associated with lower likelihood of receiving informal care in the long-term. Conclusions: Over 75% of patients diagnosed with hematologic malignancy received informal care during pretrasplant and first year postransplant. Type of diagnosis and health status are decisive factors in the probability of receiving informal care at all phases, while the type of transplantation is not. Sociodemografic factors are relevant in the long-term (AU)


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Transplante de Células-Tronco , Neoplasias Hematológicas/cirurgia , Continuidade da Assistência ao Paciente/organização & administração , Seguimentos , Assistência Domiciliar/estatística & dados numéricos , Mieloma Múltiplo/reabilitação , Leucemia/reabilitação , Cuidadores/estatística & dados numéricos , Apoio Social , Nível de Saúde , Inquéritos Epidemiológicos/estatística & dados numéricos , Fatores de Risco
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