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1.
Value Health Reg Issues ; 20: 154-158, 2019 Sep 24.
Artigo em Inglês | MEDLINE | ID: mdl-31561148

RESUMO

BACKGROUND: Only a small share of new drugs is truly innovative; 85% to 90% of all new health technologies have little or no advantage over existing therapeutic alternatives. Health economic evaluations can be used to induce acceptable prices for new technologies through threshold pricing. OBJECTIVE: This work discusses a cost-effectiveness threshold (λ) to be applied to the price regulation of substitute technologies. METHODS: Considering that substitute technologies add only small marginal benefits in terms of innovation or ethical considerations to the system, it does not make sense to allow a loss of efficiency to list them. It has been postulated that the threshold calculated from opportunity costs (κ) represents its maximum possible value and that there must be a threshold (ß) that maximizes consumer surplus. For a substitute technology to be listed, the cost of treatment associated with it must be lower than the cost of treatment of the incumbent technology added to the difference in effectiveness priced at the threshold. RESULTS: There is no reason for us to believe that the oligopolistic pharmaceutical market is currently charging prices at the cost of production. That way, the cost-effectiveness ratio of the incumbent technology, when lower than κ, is shown through a deductive process to be a plausible estimate for λ that fulfills the objective of maximizing consumer benefit, granting producers a part of the combined surplus to stimulate research and development; that is, it would be between ß and κ. CONCLUSION: In conclusion, the price of substitute technologies should be limited by the cost-effectiveness ratio of the incumbent technology.

2.
Cien Saude Colet ; 23(11): 3799-3810, 2018 Nov.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30427450

RESUMO

Patient satisfaction is an important criterion for assessing the quality of Brazilian mental health services at Psychosocial Care Centers (CAPS - from the Portuguese 'Centro de Atenção Psicossocial'). The aim of this study was to evaluate the satisfaction of users at the main CAPS in a region of Minas Gerais state, Brazil, as well as associated factors. This was a cross-sectional study with 11 CAPS. Patients were interviewed using the Patient Satisfaction with Mental Health Services Scale (SATIS-BR) and a semi-structured questionnaire containing sociodemographic and clinical variables. The users were satisfied with the CAPS, particularly in terms of staff competence and the welcome received and care provided. The physical facilities and comfort at the centers obtained the lowest satisfaction scores on the scale. Almost half of the users were unfamiliar with basic aspects of their drug therapy, such as the name of medicines, and one-third reported inappropriate use of medications. Users of midsize CAPS and those providing treatment for alcohol and drug addiction were more satisfied than patients at mental health or 24-hour CAPS. Although this study identified a need for improvement in physical facilities, mechanisms of participation and patient empowerment, the users were satisfied with the CAPS care model.

3.
Artigo em Inglês | MEDLINE | ID: mdl-30468095

RESUMO

BACKGROUND: Zika virus is a newly emerging infection, associated with increasingly large outbreaks especially in tropical countries such as Brazil. A future Zika vaccine can contribute to decreasing the number of cases and associated complications. Information about consumers' willingness to pay (WTP) for a hypothetical Zika vaccine can help price setting discussions in the future in Brazil, starting with the private market. METHODS: A cross-sectional study conducted among residents of Minas Gerais, Brazil, regarding their WTP for a hypothetical Zika Vaccine. The mean effective protection was 80%, with the possibility of some local and systemic side-effects. RESULTS: 517 people were interviewed. However, 30 would not be vaccinated even if the vaccine was free. Most of the resultant interviewees (489) were female (58.2%), had completed high school (49.7%), were employed (71.2%), had private health insurance (52.7%) and did not have Zika (96.9%). The median individual maximum willingness to pay for this hypothetical Zika vaccine (one dose) was US$31.34 (BRL100.00). CONCLUSION: Such discussions can contribute to decision-making about prices once a Zika vaccine becomes available in Brazil alongside other ongoing programmes to control the virus.

4.
Appl Health Econ Health Policy ; 16(5): 697-709, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30051254

RESUMO

BACKGROUND: Schizophrenia is associated with significant economic burden. In Brazil, antipsychotic drugs and outpatient and hospital services are provided by the Brazilian National Health System (SUS) for patients with schizophrenia. However, few studies capture the cost of managing these patients within the Brazilian NHS. This is important to appraise different management approaches within universal healthcare systems. OBJECTIVE: Our objective was to use real-world data to describe the costs associated with the treatment of schizophrenia in adults receiving atypical antipsychotics in Brazil from 2000 to 2010. METHODS: We integrated three national databases for adult patients with schizophrenia receiving one or more atypical antipsychotics. We assessed only direct medical costs and the study was conducted from a public-payer perspective. A multivariate log-linear regression model was performed to evaluate associations between costs and clinical and demographic variables. RESULTS: We identified 174,310 patients with schizophrenia, with mean ± standard deviation (SD) annual costs of $US1811.92 ± 284.39 per patient. Atypical antipsychotics accounted for 79.7% of total costs, with a mean annual cost per patient of $US1578.74 ± 240.40. Mean annual costs per patient were $US2482.90 ± 302.92 for psychiatric hospitalization and $US862.96 ± 160.18 for outpatient psychiatric care. Olanzapine was used by 47.7% of patients and represented 62.8% of the total costs of atypical antipsychotics. Patients who used clozapine had the highest mean annual cost per patient for outpatient psychiatric care and psychiatric hospitalization. CONCLUSIONS: Atypical antipsychotics were responsible for the majority of the schizophrenia treatment costs, and psychiatric hospitalization costs were the highest mean annual cost per patient. Authorities should ensure efficient use of atypical antipsychotics and encourage outpatient psychiatric care over psychiatric hospitalization where possible.

5.
Expert Rev Pharmacoecon Outcomes Res ; 18(3): 277-288, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29468951

RESUMO

INTRODUCTION: Cost-effectiveness thresholds (CETs) are used to judge if an intervention represents sufficient value for money to merit adoption in healthcare systems. The study was motivated by the Brazilian context of HTA, where meetings are being conducted to decide on the definition of a threshold. Areas covered: An electronic search was conducted on Medline (via PubMed), Lilacs (via BVS) and ScienceDirect followed by a complementary search of references of included studies, Google Scholar and conference abstracts. Cost-effectiveness thresholds are usually calculated through three different approaches: the willingness-to-pay, representative of welfare economics; the precedent method, based on the value of an already funded technology; and the opportunity cost method, which links the threshold to the volume of health displaced. An explicit threshold has never been formally adopted in most places. Some countries have defined thresholds, with some flexibility to consider other factors. An implicit threshold could be determined by research of funded cases. Expert commentary: CETs have had an important role as a 'bridging concept' between the world of academic research and the 'real world' of healthcare prioritization. The definition of a cost-effectiveness threshold is paramount for the construction of a transparent and efficient Health Technology Assessment system.


Assuntos
Assistência à Saúde/economia , Modelos Econômicos , Avaliação da Tecnologia Biomédica/métodos , Brasil , Análise Custo-Benefício , Humanos , Aceitação pelo Paciente de Cuidados de Saúde
6.
Res Social Adm Pharm ; 14(10): 891-900, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29195731

RESUMO

BACKGROUND: Pharmaceutical interventions may have an impact on different treatment aspects, such as therapy adherence, reducing the number of different medications in use and lowering treatment costs. OBJECTIVE: Identify pharmaceutical interventions in the mental health field and their possible application in Brazilian public mental health services, considering the evidence-based model to establish implementation options. METHODS: A structured search of the literature was performed in the Pubmed (Medline), Cochrane, PsycINFO and Lilacs databases to identify the main pharmaceutical intervention studies conducted in the mental health area. The articles selected were evaluated according to the quality of the evidence. The current laws and public database were researched to collect information on services and procedures provided by the Brazilian units, known as CAPS, and the number the pharmacists allocated to them. The proposal to synthesize the results of pharmaceutical interventions in Brazil was based on SUPPORT methodology items to prepare evidence-based policies. RESULTS: A total of 1442 studies were identified, 18 of which were included. Several interventions are reported in the literature, educational interventions being frequently cited. However, there is a need for further studies with more methodological rigor. The number of pharmacists working in the CAPS is insufficient to cover all the services, since only 26.5% of CAPS employ pharmacists, who work an average of 29 (±11.1) hours a week. Three options were formulated to implement interventions in the Brazilian context that consider including pharmacists on the basic team of CAPS professionals and educational interventions through pharmacist training. CONCLUSIONS: The present study could support the establishment of health policies, based on a synthesis of the evidence, contextualization of the current situation, given the absence of local evidence, and a discussion of the options available to implement pharmaceutical interventions in the Brazilian health system. Organizational changes in CAPS are needed to broaden pharmacist participation on the multidisciplinary team.


Assuntos
Saúde Mental , Assistência Farmacêutica , Política de Saúde , Humanos , Formulação de Políticas
7.
Ciênc. Saúde Colet ; 23(11): 3799-3810, Oct. 2018. tab
Artigo em Português | LILACS-Express | ID: biblio-974712

RESUMO

Resumo A satisfação dos usuários é um importante critério para avaliar a qualidade dos Centros de Atenção Psicossocial (CAPS). O objetivo foi avaliar a satisfação de usuários dos principais CAPS de uma região de Minas Gerais e seus fatores associados. Foi realizado um estudo transversal em 11 CAPS, os usuários foram entrevistados para aplicação da Escala de Avaliação da Satisfação dos Usuários com os Serviços de Saúde Mental e um formulário semi-estruturado com variáveis sociodemográficas e clínicas. Os usuários estavam satisfeitos com os CAPS, sobretudo quanto à competência dos profissionais, acolhida e ajuda recebida no serviço. Condições físicas e conforto do serviço obtiveram os menores escores na escala de avaliação de satisfação. Verificou-se que quase metade dos usuários não conhecia aspectos básicos de sua terapia medicamentosa, como o nome dos medicamentos em uso, e um terço relatou que já fez uso inadequado destes. Os usuários dos CAPS álcool e drogas ou de serviços de médio porte estavam mais satisfeitos que os dos CAPS saúde mental ou serviços com funcionamento 24h. Os usuários estão satisfeitos com o modelo de atenção praticado nos CAPS, embora detectada a necessidade de melhorias na estrutura física, mecanismos de participação e empoderamento dos usuários.


Abstract Patient satisfaction is an important criterion for assessing the quality of Brazilian mental health services at Psychosocial Care Centers (CAPS - from the Portuguese 'Centro de Atenção Psicossocial'). The aim of this study was to evaluate the satisfaction of users at the main CAPS in a region of Minas Gerais state, Brazil, as well as associated factors. This was a cross-sectional study with 11 CAPS. Patients were interviewed using the Patient Satisfaction with Mental Health Services Scale (SATIS-BR) and a semi-structured questionnaire containing sociodemographic and clinical variables. The users were satisfied with the CAPS, particularly in terms of staff competence and the welcome received and care provided. The physical facilities and comfort at the centers obtained the lowest satisfaction scores on the scale. Almost half of the users were unfamiliar with basic aspects of their drug therapy, such as the name of medicines, and one-third reported inappropriate use of medications. Users of midsize CAPS and those providing treatment for alcohol and drug addiction were more satisfied than patients at mental health or 24-hour CAPS. Although this study identified a need for improvement in physical facilities, mechanisms of participation and patient empowerment, the users were satisfied with the CAPS care model.

8.
J. bras. econ. saúde (Impr.) ; 9(2): http://www.jbes.com.br/images/v9n2/207.pdf, ago. 2017.
Artigo em Inglês | LILACS, ECOS | ID: biblio-868028

RESUMO

Objective: The aim of this study is to conduct a systematic review on cost-effectiveness analysis of oral antipsychotic agents to identify the trend of cost-effectiveness of drugs available for the treatment of schizophrenia. Methods: A search was conducted in three databases (MEDLINE, LILACS and PsycINFO) for head-to-head economic comparisons of antipsychotic agents. A manual search in journals, dissertations and theses databases, congresses abstracts and the Cochrane Library was also conducted to ensure comprehensiveness. After evaluation by independent reviewers, complete economic evaluations of oral antipsychotic medications were included in the final analysis. Results: Twenty four studies were included in the final analysis. The trend observed in the pooled studies showed that risperidone, olanzapine and clozapine were the most cost-effective drugs included to treat schizophrenia. Aripiprazole and haloperidol were considered comparable to quetiapine or ziprasidone and less cost-effective than olanzapine and risperidone in the pooled analysis. After removal of comparisons that had sponsored drugs included, risperidone, olanzapine and clozapine were still considered the most cost-effective strategies to treat schizophrenia. The analysis of only cost-utility studies shows approximately the same results of the other analysis. Conclusions: An analysis that consider first- vs. second-generation antipsychotics polled together might be biased by the different profiles of the specific drugs, not considering the heterogeneity of the group of second-generation antipsychotics. There seems to be a difference in the cost-effectiveness profiles between specific antipsychotic drugs. Risperidone, olanzapine and clozapine seem to be the drugs most considered cost-effective to treat schizophrenia. This result was robust to changes in funding.


Objetivo: O objetivo deste estudo é conduzir uma revisão sistemática de custo-efetividade de antipsicóticos orais para identificar uma tendência de custo-efetividade dos medicamentos disponí- veis para o tratamento da esquizofrenia. Métodos: Uma busca eletrônica foi realizada nas bases de dados Medline (via PubMed), Lilacs (via VS) e PsycINFO para avaliações econômicas comparando head-to-head medicamentos antipsicóticos para esquizofrenia. Uma busca manual complementar foi realizada para garantir abrangência. Resultados: Depois da avaliação por revisores independentes, 24 avaliações econômicas completas de antipsicóticos orais para esquizofrenia foram incluídas na análise final. A tendência observada no conjunto dos estudos mostrou que a risperidona, a olanzapina e a clozapina foram mais comumente consideradas os medicamentos mais custo-efetivos para esquizofrenia. Aripiprazol e olanzapina foram considerados comparáveis a quetiapina ou ziprasidona e menos custo-efetivos, no geral, que olanzapina e risperidona. Após a remoção das comparações que incluíam medicamentos dos patrocinadores dos estudos, a mesma tendência foi observada. A análise apenas de estudos de custo-utilidade mostra o mesmo padrão. Conclusões: Análises que consideram medicamentos de primeira e segunda geração agrupados podem trazer vieses por conta da heterogeneidade entre medicamentos específicos. Parece haver uma diferença de custo-efetividade entre os medicamentos. Risperidona, olanzapina e clozapina são mais comumente consideradas custo-efetivas. Esse resultado foi robusto a mudanças no financiamento.


Assuntos
Humanos , Antipsicóticos , Análise Custo-Benefício , Revisão , Esquizofrenia
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