Gestión de casos: Análisis de costo eficiencia en continuidad de cuidados de Pacientes crónicos complejos / Case management: cost-effectiveness analysis in continuity of patient care of the Complex Chronic Patients Unit

Objetivo: Evaluar la relación entre los costes asociados al número y días de ingresos previos y posteriores a la inclusión a la Unidad de pacientes crónicos complejos (PCC). Métodos: Se realizó un análisis de coste-efectividad, descriptivo, con cálculo de medias y desviaciones típicas; además de utilizar la t-Student para muestras pareadas, con el software SPSS v20.0, para un nivel de significación alfa <0,05. Los resultados del cómputo se obtuvieron de la Unidad de Codificación de los pacientes captados por la enfermera gestora de casos, y que sobrevivieron un año en seguimiento por la Unidad PCC. Resultados: Se captaron un total de 132 PCC, con un total de 563 ingresos previos, a 204 post inclusión. La media de número de ingresos al año antes fue de 4,27 (DT: 3,35), y se redujo a 1,55 (DT: 1,74). Por otro lado, el número de días de estancia hospitalaria total se redujo de 3.835 a 1.897 días, que equivale una diferencia de coste estimado en 11165.164,36 de euros. La media de días de ingreso antes fue de 29,05, y se redujo a 14,37 días, encontrando una significación estadística (p<0,001) entre días de ingresos previos y posteriores. Conclusiones: La inclusión en la Unidad PCC garantiza, mediante el liderazgo por la enfermera gestora de casos, una mejora coste-efectiva sin gastos añadidos, por optimizar recursos ya existentes interniveles asistenciales, mediante la identificación de PCC y sus necesidades prioritarias, planificación al alta con informes individualizados y garantizando el contacto. (AU)

Objective: Evaluate the relationship between the costs associated with the number and days of admission before and after inclusion in the Complex Chronic Patients Unit (CCP). Methods: A descriptive cost-effectiveness analysis was performed, with calculation of arithmetic averages and standard deviations; in addition to using the t-Student for paired samples, with the SPSS Enfermería GlobalNº 72 Octubre 2023Página 78v20.0 software, for a significance level alpha <0.05. The results of the computation were obtained from the Coding Unit of the patients recruited by the case manager nurse, who survived one year of follow-up by the CCP Unit. Results: A total of 132 CCP were recruited, with a total of 563 previous admissions, which were reduced to 204 post inclusion. The average number of admissions of the previous year was 4.27 (SD: 3.35), and it was reduced to 1.55 (SD: 1.74). On the other hand, the number of days of total hospital stay was reduced from 3,835 to 1,897 days, which is equivalent to a difference in estimated cost of 11,165,164.36 euros. The average number of days of admission before was 29.05, and it was reduced to 14.37 days, finding a statistical significance (p<0.001) between days of admission before and after. Conclusions: Inclusion in the CCP Unit guarantees, through the leadership of the case manager nurse, a cost-effective improvement without added expenses, by optimizing already existing interlevel care resources, through the identification of CCP and their priority needs, discharge planning with reports individualized and guaranteeing contact. (AU)

Análisis de costo-efectividad de los cuidados paliativos a pacientes oncológicos de fin de vida / Cost-effectiveness analysis of palliative care of cancer patients in the end of life / Análise de custo-efetividade dos cuidados paliativos de pacientes oncológicos na terminalidade da vida

En pacientes con enfermedad terminal, los servicios de cuidados paliativos domiciliarios pueden alinear sus preferencias de cuidado en domicilio con resultados sanitarios deseables. El objetivo fue estudiar la costo-efectividad de los cuidados paliativos domiciliarios en pacientes oncológicos en el último año de vida en el subsector público de salud de una provincia argentina. Se desarrolló un modelo de Markov de costo-efectividad desde una perspectiva social y del financiador de salud, de modo que el mismo pudiera reflejar la realidad de los cuidados paliativos domiciliarios en el ámbito local, en comparación con los cuidados habituales. Se calcularon los costos directos para el sistema de salud, con base en información local, así como también los costos indirectos de los cuidados informales no remunerados. La provisión de cuidados paliativos incrementó en un 10,32% la probabilidad que los pacientes fallezcan en el hogar, en relación con los cuidados habituales, con un ahorro anual de USD 750 y USD 1.012 por paciente desde la perspectiva social y del financiador, respectivamente, en el subsector público de salud de Río Negro. Tanto desde la perspectiva social como del financiador, la estrategia de implementación de un servicio organizado de cuidados tiene una mayor efectividad, medida en porcentaje de pacientes que fallecen en su domicilio, a un menor costo. El principal inductor de costos corresponde, desde la perspectiva social, a los cuidados informales provistos por las familias, mientras que desde la perspectiva del financiador corresponde a los salarios del personal de salud.

Home palliative care services of terminal patients may associate home care preferences with desirable health outcomes. This study aimed to evaluate the cost-effectiveness of home palliative care of cancer patients in the last year of life in the public health subsector in a province of Argentina. A cost-effectiveness Markov model was developed from a social and the health funder's perspective in order to reflect the reality of home palliative care at the local level compared with usual care. Direct costs to the health system and indirect costs of unpaid informal care were estimated based on local information. Palliative care increased the likelihood of patients dying at home by 10.32% compared with usual care, with annual savings of USD 750 and USD 1,012 per patient, respectively, from both the social and the funder's perspective in the public health subsector in Río Negro. From both the social and financial perspective, the strategy to implement organized care services was more effective and lower-cost, measured by the percentage of patients who died at home. From a social perspective, the main cost inducer was the formal care provided by families, but from the funder's perspective, it refers to the salaries of the health team.

Os serviços de cuidados paliativos domiciliares de pacientes terminais podem associar as preferências de cuidado domiciliar com resultados desejáveis de saúde. O objetivo deste texto foi avaliar a relação custo-efetividade dos cuidados paliativos domiciliares em pacientes oncológicos no último ano de vida, no subsetor de saúde pública de uma província na Argentina. Um modelo Markov de custo-efetividade foi desenvolvido a partir de uma perspectiva social e do financiador de saúde para que pudesse refletir a realidade dos cuidados paliativos domiciliares em âmbito local comparado aos cuidados habituais. Os custos diretos para o sistema de saúde e os custos indiretos de cuidados informais não remunerados foram calculados com base em informações locais. A prestação de cuidados paliativos aumentou 10,32% a probabilidade de os doentes morrerem em casa em relação com os cuidados habituais, com uma economia anual de USD 750 e USD 1.012 por paciente, respetivamente, na perspectiva social e do financiador, no subsetor da saúde pública de Rio Negro. Tanto do ponto de vista social como no financeiro, a estratégia de implantação de serviços de cuidados organizados foi mais eficaz e com menor custo, medida pelo percentual de pacientes que faleceram em casa. O principal indutor de custos corresponde, do ponto de vista social, aos cuidados informais prestados pelas famílias, enquanto do ponto de vista do financiador se refere aos salários da equipe de saúde.

A multi-country, prospective cohort study to evaluate the economic implications of relapse among children recovered from severe acute malnutrition: a study protocol.

BACKGROUND: Community-based management of acute malnutrition (CMAM) is an effective intervention at recovering children from severe acute malnutrition (SAM) and preventing mortality. However, there is growing evidence that for many children recovery is not sustained post-discharge. This study will assess the economic implications of relapse by calculating the average cost of treating a case of SAM that relapses after initial CMAM treatment compared to the cost of a case that remains recovered for 6 months post-discharge. METHODS: This protocol outlines the methods for a cost-efficiency analysis to assess cost per episode of treatment for acute malnutrition for children enrolled in CMAM programs for initial SAM treatment in Mali, Somalia and South Sudan. Cost data will be collected and analyzed on a monthly basis for each CMAM service component (outpatient treatment program for SAM, supplementary feeding program for moderate acute malnutrition, and inpatient stabilization care for SAM with medical complications). Financial data will be extracted from expenditure records from institutional accounting systems where possible. Where these are not present, cost data will be collected via interview and review of financial documents. Staff time allocation interviews will be conducted. This data will be applied to quantify personnel costs, to apportion costs that are shared between programs and to exclude staff time spent on research activities. DISCUSSION: This study will provide the first estimates to address the limited evidence on the economic implications of SAM relapse in CMAM programs. Data from this economic analysis will help raise awareness and provide actionable data for the global nutrition community to address the financial burden of relapse. Estimating the cost of relapse in three countries representing different geographic and operational contexts will help in generalizing these results. TRIAL REGISTRATION: Registration # IORG0007116, Date of registration: 06/09/2020. This study is not registered as a clinical trial as it is observational research and does not include an intervention. The study has received the required ethical approvals as outlined in the declarations.

Evidências científicas sobre custos em saúde: estudo bibliométrico / Evidencias científicas sobre costos en salud: estudio bibliométrico / Scientific evidence about health costs: bibliometic study

RESUMO Objetivo: Analisar as evidências científicas disponíveis sobre custos em saúde publicados em bases de dados nacionais e uma biblioteca virtual por enfermeiros brasileiros. Método: Trata-se de análise bibliométrica das publicações de enfermeiros brasileiros acerca dos custos em saúde, sem limite temporal de busca, em diferentes idiomas, indexadas em bases de dados nacionais e em uma biblioteca virtual, são elas: Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Base de Dados de Enfermagem (BDENF), e Scientific Eletronic Library online (SciELO), respectivamente. Resultados: Segundo a análise, identificaram-se 212 artigos publicados em periódicos brasileiros, no período de 1983 a 2022. Destes, a maioria foi desenvolvida na Região Sudeste, com destaque para maior número de publicações em 2015. Houve maior frequência de publicação em seis periódicos, com predomínio na Revista da Escola de Enfermagem da Universidade de São Paulo com 33 artigos sobre custos em saúde. Destaca-se que 64,2% das publicações direcionaram-se às ações em serviços de alta complexidade. Conclusão: A interpretação dos dados permitiu expor que, apesar do baixo número de publicações no decorrer dos anos de 1980 a 1990, a partir de 2006 é expressivo o crescimento da produção científica brasileira quanto aos custos em saúde, demonstrando a possibilidade de acesso e interesse dos enfermeiros para entender as ferramentas da gestão de custos imbricados no processo de trabalho da enfermagem, o que pode otimizar a gestão financeira dos serviços de saúde.

RESUMEN Objetivo: analizar las evidencias científicas disponibles sobre costos en salud publicados en bases de datos nacionales y una biblioteca virtual por enfermeros brasileños. Método: se trata de análisis bibliométrico de las publicaciones de enfermeros brasileños acerca de los costos en salud, sin límite temporal de búsqueda, en diferentes idiomas, indexadas en bases de datos nacionales y en una biblioteca virtual, son ellas: Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS), Base de Dados de Enfermagem (BDENF), y Scientific Eletronic Library Online (SciELO), respectivamente. Resultados: según el análisis, se identificaron 212 artículos publicados en revistas brasileñas, en el período de 1983 a 2022. De estos, la mayoría fue desarrollada en la Región Sudeste de Brasil, con destaque para mayor número de publicaciones en 2015. Hubo mayor frecuencia de publicación en seis revistas, con predominio en la Revista da Escola de Enfermagem de la Universidad de São Paulo con 33 artículos sobre costos en salud. Se destaca que el 64,2% de las publicaciones se dirigieron a las acciones en servicios de alta complejidad. Conclusión: la interpretación de los datos permitió exponer que, a pesar del bajo número de publicaciones a lo largo de los años 1980 a 1990, a partir de 2006 es expresivo el crecimiento de la producción científica brasileña en cuanto a los costos en salud, demostrando la posibilidad de acceso e interés de los enfermeros para entender las herramientas de la gestión de costos presentes en el proceso de trabajo de la enfermería, lo que puede optimizar la gestión financiera de los servicios de salud.

ABSTRACT Objective: To analyze available scientific evidence on healthcare costs published in national databases and in a virtual library by Brazilian nurses. Method: This is a bibliometric analysis of publications by Brazilian nurses about health costs, with no search time limit, in different languages, indexed in national databases and in a virtual library, namely: Latin American and Caribbean Literature in Health Sciences (LILACS), Base de Dados de Enfermagem (BDENF), and Scientific Electronic Library online (SciELO), respectively. Results: According to the analysis, 212 articles published in Brazilian journals were identified, from 1983 to 2022. Of these, most were developed in the Southeast Region, with emphasis on the greater number of publications in 2015. There was a higher frequency of publication in six journals, with predominance in Revista da Escola de Enfermagem of the University of São Paulo with 33 articles on health costs. It is noteworthy that 64.2% of publications were directed to actions in highly complex services. Conclusion: The interpretation of the data allowed exposing that, despite the low number of publications over the years 1980 to 1990, from 2006 onwards, the growth of Brazilian scientific production regarding health costs is significant, demonstrating the possibility of access and interest of nurses to understand the cost management tools embedded in the nursing work process, which can optimize the financial management of health services.

Cost-efficiency assessments of marine monitoring methods lack rigor-a systematic mapping of literature and an end-user view on optimal cost-efficiency analysis.

Global deterioration of marine ecosystems, together with increasing pressure to use them, has created a demand for new, more efficient and cost-efficient monitoring tools that enable assessing changes in the status of marine ecosystems. However, demonstrating the cost-efficiency of a monitoring method is not straightforward as there are no generally applicable guidelines. Our study provides a systematic literature mapping of methods and criteria that have been proposed or used since the year 2000 to evaluate the cost-efficiency of marine monitoring methods. We aimed to investigate these methods but discovered that examples of actual cost-efficiency assessments in literature were rare, contradicting the prevalent use of the term "cost-efficiency." We identified five different ways to compare the cost-efficiency of a marine monitoring method: (1) the cost-benefit ratio, (2) comparative studies based on an experiment, (3) comparative studies based on a literature review, (4) comparisons with other methods based on literature, and (5) subjective comparisons with other methods based on experience or intuition. Because of the observed high frequency of insufficient cost-benefit assessments, we strongly advise that more attention is paid to the coverage of both cost and efficiency parameters when evaluating the actual cost-efficiency of novel methods. Our results emphasize the need to improve the reliability and comparability of cost-efficiency assessments. We provide guidelines for future initiatives to develop a cost-efficiency assessment framework and suggestions for more unified cost-efficiency criteria.

Planned oocyte cryopreservation (Planned OC): systematic review and meta-analysis of cost-efficiency and patients' perspective.

BACKGROUND: Advances in vitrification techniques have enabled planned oocyte cryopreservation ('Planned OC'). OBJECTIVES: To explore the cost-efficiency and utilisation of planned OC, as well as patients' perspectives on the process. SEARCH STRATEGY: A systematic search in PubMed/MEDLINE, Embase, Cochrane Database and PsychINFO, for all relevant studies published between January 2007 and December 2019. SELECTION CRITERIA: The protocol followed PRISMA guidelines in PECO format, and was registered with PROSPERO. DATA COLLECTION AND ANALYSIS: Two independent reviewers evaluated all manuscripts for inclusion eligibility. Authors were contacted for missing data. Included studies were assessed for risk of bias and for heterogeneity. Weighted effects were measured and plotted. MAIN RESULTS: The search yielded 12 545 records, of which 43 were included. Planned OC is cost-efficient at 35, assuming 60% utilisation; and at 37 assuming utilising donor sperm when necessary. At 38 it is cost-efficient to defer planned OC in favour of undergoing 2 IVF cycles. Currently, utilisation of banked-oocytes within 22-58 months, is up to 15%. Nine percent of warmed banked oocytes result in life births. Online resources and treating physicians are equally important sources of information regarding planned OC. Most patients think planned OC is ideal before age 35 and are not fully aware of what the process entails and tend to overestimate the success rates. The main barrier to wider endorsement of planned OC is being wary of potential health implications or of limited success. CONCLUSION: Planned OC is an adequate method for preserving fertility. However, knowledge gaps result in under-utilisation leading to reduced cost-efficiency. TWEETABLE ABSTRACT: Identifying facilitators and barriers for wider adoption of banking oocytes can enhance the cost-efficiency of this modality.

Complementary music therapy for cancer patients in at-home palliative care and their caregivers: protocol for a multicentre randomised controlled trial.

BACKGROUND: Patients with advanced cancer, receiving at-home palliative care, are subject to numerous symptoms that are changeable and often require attention, a stressful situation that also impacts on the family caregiver. It has been suggested that music therapy may benefit both the patient and the caregiver. We propose a study to analyse the efficacy and cost utility of a music intervention programme, applied as complementary therapy, for cancer patients in palliative care and for their at-home caregivers, compared to usual treatment. METHOD: A randomised, double-blind, multicentre clinical trial will be performed in cancer patients in at-home palliative care and their family caregivers. The study population will include two samples of 40 patients and two samples of 41 caregivers. Participants will be randomly assigned either to the intervention group or to the control group. The intervention group will receive a seven-day programme including music sessions, while the control group will receive seven sessions of (spoken word) therapeutic education. In this study, the primary outcome measure is the assessment of patients' symptoms, according to the Edmonton Symptom Assessment System, and of the overload experienced by family caregivers, measured by the Caregiver Strain Index. The secondary outcomes considered will be the participants' health-related quality of life, their satisfaction with the intervention, and an economic valuation. DISCUSSION: This study is expected to enhance our understanding of the efficacy and cost-utility of music therapy for cancer patients in palliative care and for their family caregivers. The results of this project are expected to be applicable and transferrable to usual clinical practice for patients in home palliative care and for their caregivers. The approach described can be incorporated as an additional therapeutic resource within comprehensive palliative care. To our knowledge, no previous high quality studies, based on a double-blind clinical trial, have been undertaken to evaluate the cost-effectiveness of music therapy. The cost-effectiveness of the project will provide information to support decision making, thereby improving the management of health resources and their use within the health system. TRIAL REGISTRATION: The COMTHECARE study is registered at Clinical Trials.gov, NCT04052074. Registered 9 August, 2019.

Cost-effectiveness analysis of glycaemic control of a glucose monitoring system (FreeStyle Libre®) for patients with type 1 diabetes in primary health care of Burgos. / Análisis de coste-efectividad de control glucémico con FreeStyle Libre® en pacientes diabéticos tipo 1 en atención primaria de salud de Burgos.

OBJECTIVE: This study seeks to evaluate the clinical effectiveness and cost-effectiveness of FreeStyle Libre® versus traditional monitoring in patients with type 1 diabetes mellitus in the Health Area of Burgos (Spain). METHOD: A transversal ambispective descriptive study was carried out to compare costs and effectiveness between two forms of glycaemic control. The information was obtained from the computerized clinical history (Medora) and by referring to patients. An analysis of the monitoring material and clinical glycaemic control variables (HbA1c and symptomatic hypoglycaemia events, <70mg/dL) were carried out one year before and one year after the start of FreeStyle Libre®. RESULTS: We included 23 patients with type 1 diabetes mellitus of 35.4 (± 15.1) years old (60.9% males). Monitoring by FreeStyle Libre® system has an average annual cost per patient four times higher than the traditional method. The HbA1c level was reduced by 5% (P=.024) and the rate of symptomatic hypoglycaemia decreased by 58.9% (P=.013). This determines an effectiveness in the absolute risk reduction of .232 (23.2%) of hypoglycaemia and an incremental cost-effectiveness of €6,194.71. CONCLUSIONS: The FreeStyle Libre® system has a high clinical effectiveness associated with a high but potentially acceptable cost for glycaemia monitoring in type 1 diabetes mellitus.

Retinal exams requested at Primary Care Unit: indications, results and alternative strategies of evaluation / Exames de retina solicitados em Unidades Básicas de Saúde: indicações, resultados e estratégias alternativas de avaliação

ABSTRACT Objective To evaluate indications, results and strategy of retinal exams requested at Primary Care Units. Methods A retrospective study that analyzed the indications and results of retinal exams, in the modalities clinical dilated fundus exams and color fundus photographs. In the following situations, patients were considered eligible for color fundus photographs if visual acuity was normal and ocular symptoms were absent: diabetes mellitus and/or hypertension, in use of drugs with potential retinal toxicity, diagnosis or suspicion of glaucoma, stable and asymptomatic retinopathies, except myopia greater than -3.00 diopters. Results A total of 1,729 patients were evaluated (66% female, age 63.5±15.5 years), and 1,190 underwent clinical dilated fundus exam and 539 underwent color fundus photographs. Diabetes was present in 32.2%. The main indications were diabetes (23.7%) and glaucoma evaluation (23.5%). In 3.4% of patients there was no apparent indication. The main results were a large cup/disc ratio (30.7%) and diabetic retinopathy (13.2%). Exam was normal in 9.6%, detected peripheral changes in 7% and could not be performed in 1%. Considering patients eligible for fundus photographs (22.4%), more than half underwent clinical dilated fundus exams. Conclusion Regarding exam modality, there were no important differences in the distribution of indications or diagnosis. Color fundus photograph is compatible with telemedicine and more cost-effective, and could be considered the strategy of choice in some scenarios. Since there are no clear guidelines for retinal exams indications or the modality of choice, this study may contribute to such standardization, in order to optimize public health resources.

RESUMO Objetivo Avaliar as indicações, os resultados e a estratégia de exames de retina solicitados em Unidades Básicas de Saúde. Métodos Estudo retrospectivo no qual foram analisados as indicações e os resultados de exames de retina, nas modalidades mapeamento de retina e retinografia. Em casos de boa acuidade visual e sintomas oculares ausentes, foram considerados elegíveis para avaliação por retinografia: pacientes com diabetes mellitus e/ou hipertensão arterial sistêmica, em uso de medicação com potencial toxicidade retiniana, diagnóstico ou suspeita de glaucoma, e retinopatias estáveis e assintomáticas, exceto miopia maior que -3,00 dioptrias. Resultados Foram avaliados 1.729 pacientes (66% do sexo feminino, idade 63,5±15,5 anos). Destes, 1.190 realizaram mapeamento de retina e 539 realizaram retinografia. Diabetes estava presente em 32,2%. As principais indicações para solicitação do exame foram diabetes (23,7%) e investigação de glaucoma (23,5%). Em 3,4%, não havia indicação aparente. Os principais resultados foram aumento da escavação papilar (30,7%) e retinopatia diabética (13,2%). O exame foi normal em 9,6%; detectou alterações periféricas em 7%; e sua realização foi impossível em 1%. Dos pacientes elegíveis para retinografia (22,4%), mais da metade foi submetida ao mapeamento de retina. Conclusão Não houve diferenças importantes nas distribuições de indicações ou diagnósticos em relação à modalidade de exame. A retinografia, compatível com telemedicina e mais custo-efetiva, pode ser considerada a modalidade de escolha em determinadas situações. Na ausência de consenso quanto às indicações para a solicitação de exames da retina ou sua modalidade, este estudo pode contribuir para tal padronização, de modo a otimizar recursos do sistema público de saúde.

Value-based medicine and palliative care: how do they converge?

Introduction: Sick persons need doctors who understand their pathology, know how to treat their problem, and accompany them through their illness. This study aimed to synthesize the state of knowledge regarding the concept of value-based medicine (VBM) through an integrative literature review, and establish how VBM can be applied in palliative care. Areas covered: An integrative review was conducted with the keywords 'value-based medicine,' 'patient-centered care,' and 'medicina baseada em valor' (Portuguese for VBM) in PubMed and Virtual Health Library, identifying 17,189 articles in total. Of these, 10 articles met the eligibility criteria. VBM combines the highest level of technical-scientific data with patients' values. It is defined as the combination of evidence-based medicine, patient-centered care, and cost-effectiveness. Patients' values are a set of preferences, concerns, and expectations that contribute toward accommodating their needs in the treatment clinic. Expert opinion: Like VBM, palliative care focuses on patients' values and quality of life, respecting natural limits. The early development of a care plan with active participation of the patient in the face of life-threatening diseases should be encouraged and can bring peace and comfort in a person's final moments.

Multicenter randomized controlled trial on the comparison of multi-family therapy (MFT) and systemic single-family therapy (SFT) in young patients with anorexia nervosa: study protocol of the THERAFAMBEST study.

BACKGROUND: Anorexia nervosa (AN) is a serious psychiatric illness that begins most of the time during adolescence. An early and efficacious intervention is crucial to minimize the risk of the illness becoming chronic and to limit the occurrence of comorbidities. There is a global consensus on optimal treatment for adolescents suffering from AN: international guidelines recommend single-family therapy that involves the patient and his/her family. Several family therapy approaches have been developed to date. However, these approaches, which imply a direct questioning of intrafamilial dynamics, are not suitable for all patients and families, and the rates of dropout or poor response to treatment remain quite high. A modality of family therapy has been adapted to AN, known as multi-family therapy (MFT), which consists in bringing together several families whose children suffers from the same illness. Objectives of the present randomized clinical trial are to evaluate whether the implementation of MFT in a multi-disciplinary treatment program for adolescents with AN is at least as efficacious as the use of systemic single-family therapy (SFT), with respect to the evolution of body mass index and other clinical outcomes 12 and 18 months after the start of treatment. A cost-efficiency analysis will also be conducted. METHODS: One hundred fifty patients meeting the inclusion criteria will be randomly assigned to one of the two treatment groups. Patients and their families will receive 10 sessions of therapy spread over 12 months. Body weight, eating disorder and other psychopathology-related symptoms, quality of family relationships, and family satisfaction with treatment will be evaluated during the treatment and at an 18 months follow-up. A cost-efficiency analysis will also be carried out. DISCUSSION: We hypothesize that MFT is at least as efficacious as SFT, but at a lesser cost. The identification of possible preferential indications for each technique could help the improvement of therapeutic indications for adolescents suffering from AN and contribute to the earliness of intervention, which is associated with a better outcome. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03350594 . Registered on 22 November 2017. IDRCB number 2016-A00818-43.

Jejum pré-operatório abreviado favorece realimentação pós-operatória com menor custo de internação hospitalar em pacientes oncológicos / Abbreviated preoperative fasting favours postoperative oral intake at lower hospital admission costs for cancer patients

RESUMO Objetivo: avaliar a viabilidade de abreviação do jejum em cirurgias colorretais oncológicas, bem como, o impacto no desfecho cirúrgico dos pacientes. Métodos: estudo prospectivo comparativo randomizado com pacientes submetidos à cirurgias eletivas colorretais, por câncer, no período de maio a setembro de 2017. Os pacientes foram randomizados eletronicamente em dois grupos de acordo com o jejum pré-operatório a ser adotado: convencional ou abreviado. Resultados: dos 33 pacientes incluídos, 15 seguiram o protocolo de jejum abreviado e 18 de jejum convencional. Ambos os grupos apresentaram perfis comparáveis. Nenhum paciente foi submetido a preparo mecânico do cólon. Em 69,7% dos casos, a cirurgia envolveu dissecção baixa do reto. Os procedimentos foram equivalentes em relação às variáveis intraoperatórias e complicações graves. O tempo para atingir realimentação plena foi menor para o jejum abreviado (10 versus 16 dias, p=0,001), assim como, o tempo de internação hospitalar (2 versus 4 dias, p=0,009). Os custos hospitalares foram menores no jejum abreviado (331 versus 682 reais, p<0,001). A análise univariável revelou correlação entre a realimentação plena e o jejum abreviado [HR 0,29 (IC95%: 0,12-0,68] e com a distensão abdominal [HR 0,12(IC95%: 0,01-0,94)]. Após análise multivariável, o jejum abreviado apresentou menor tempo para realimentação plena [HR 0,39(IC95%: 0,16-0,92]. Conclusão: o jejum pré-operatório abreviado favorece a recuperação metabólico-nutricional, diminuindo o tempo para realimentação plena. A implantação do protocolo de abreviação do jejum reduz custos de internação hospitalar.

ABSTRACT Objective: to evaluate the feasibility of abbreviated fasting in oncologic colorectal surgeries, as well as the impact on the surgical outcome of the patients. Methods: prospective randomized comparative study with patients undergoing elective colorectal cancer surgeries from May to September 2017. Patients were randomized electronically into two groups according to the preoperative fast to be adopted: conventional or abbreviated. Results: of the 33 patients included, 15 followed the abbreviated fasting protocol and 18 the conventional fasting. Both groups had comparable profiles. No patient underwent mechanical preparation of the colon. In 69.7% of the cases, surgery involved low rectal dissection. The procedures were equivalent in relation to intraoperative variables and severe complications. The time to achieve complete oral intake was shorter for abbreviated fasting (10 versus 16 days, p=0.001), as well as the length of inhospital stay (2 versus 4 days, p=0.009). Hospital costs were lower in the abbreviated fasting (331 versus 682 reais, p<0.001). The univariable analysis revealed a correlation between complete oral intake and abbreviated fasting [HR 0.29 (IC95%: 0.12-0.68] and abdominal distension [HR 0.12 (IC95% 0.01-0.94)]. After multivariable analysis, abbreviated fasting presented a lower time for complete oral intake [HR 0.39 (IC95%: 0.16-0.92]. Conclusion: the abbreviated preoperative fasting favors the metabolic-nutritional recovery, reducing the time for complete oral intake. The implementation of the abbreviation protocol reduces hospital admission costs.

Análise custo-efetividade de antimicrobianos usados em pacientes infectados por Klebsiella Pneumoniae Carbapenemase / Cost-effectiveness analysis of antimicrobials used in patients infected with Klebsiella Pneumoniae Carbapenemase

Introdução: A infecção por Klebsiella pneumoniae produtora de carbapenemase vem aumentando ao longo dos últimos anos a nível mundial, necessitando do uso de antimicrobianos de última geração. No entanto, o uso destes antimicrobianos e da terapia associada durante a infecção eleva o custo do tratamento sem impactar no aumento da efetividade do mesmo. Objetivo: Realizar análise custo-efetividade de antimicrobianos usados no tratamento de pacientes infectados por Klebsiella pneumoniae produtora de carbapenemase internados em hospital terciário. Método: trata-se de um estudo de custo-efetividade realizado com dados de vida real, originados em uma coorte prospectiva. A efetividade foi avaliada por meio do sucesso terapêutico do tratamento antimicrobiano, negativação do antibiograma, reinfecção e taxa de óbito hospitalar. O custo direto foi mensurado por meio do tratamento antimicrobiano, exames laboratoriais, diária hospitalar e tratamento medicamentoso associado. Resultado: a monoterapia de amicacina apresentou a melhor razão de custo-efetividade (R$ 9.345) por morte evitada ao considerar todos os tratamentos antimicrobianos. Ao ser considerado somente as terapias combinadas, o tratamento baseado em amicacina e meropenem apresentou a melhor razão de custo-efetividade por morte evitada (R$ 13.389). A alteração dos custos e efetividades por meio da análise de sensibilidade reforçaram os dados da análise de custo-efetividade. Conclusão: o tratamento basesado na combinação de amicacina e meropenem pode ser utilizado como alternativa para o tratamento de pacientes infectados por Klebsiella pneumoniae produtora de carbapenemase, pois possui boa relação custo-efetividade e reduz a possibilidade do aumento da resistência bacteriana.

Introduction: Klebsiella pneumoniae carbapenemase infection has increased over the last few years worldwide, requiring the use of state-of-the-art antimicrobial agents. However, the use of these antimicrobials and associated therapy during infection may increase the cost of treatment without impacting the effectiveness of the treatment. Objective: To evaluate the cost-effectiveness analysis of antimicrobials used in the treatment of patients infected with Klebsiella pneumoniae carbapenemase admitted to a tertiary hospital. Method: This is a cost-effectiveness study carried out with real-life data, originated in a prospective cohort. The effectiveness was evaluated through the therapeutic success of antimicrobial treatment, antibiogram negativity, reinfection and hospital death rate. The direct cost was measured through antimicrobial treatment, laboratory tests, hospital daily and associated drug treatment. Results: amikacin monotherapy had the best cost-effectiveness ratio (R$ 9,345.65) when considering all antimicrobial treatments. When considering only the combination therapies, the treatment based on amikacin and meropenem presented the best cost-effectiveness ratio (R$ 13,389.09). The change in costs and effectiveness through the sensitivity analysis reinforced the data of the cost-effectiveness analysis. Conclusion: the treatment based on the combination of amikacin and meropenem can be used as a first alternative for the treatment of patients infected by Klebsiella pneumoniae carbapenemase, since it is cost-effective and reduces the possibility of increased bacterial resistance.

Optimización de recursos para determinar la carga viral de HIV-1 en un país con pocos recursos / Optimizing resources to reduce costs to determine HIV viral load in limited resources settings

Resumen Introducción. Las metas globales para controlar la epidemia de HIV contemplan que la carga viral sea indetectable en 90 % de las personas en tratamiento. El costo de la medición de la carga viral en lotes de muestras puede reducirse y, así, aumentar la cobertura cuando los recursos son limitados; sin embargo, su eficacia disminuye al aumentar la prevalencia del fracaso del tratamiento antirretroviral. Objetivo. Evaluar estrategias para disminuir la proporción de pacientes con fracaso del tratamiento antirretroviral en los lotes de muestras y, de esta manera, aumentar el ahorro en las pruebas de carga viral. Materiales y métodos. Las estrategias evaluadas fueron: a) la organización de los lotes de muestras según el esquema de tratamiento antirretroviral, y b) la exclusión de aquellos pacientes con antecedente reciente de fracaso del tratamiento antirretroviral, aquellos con menos de 12 meses de tratamiento antirretroviral y aquellos sin tratamiento antirretroviral previo. Los resultados de los lotes se compararon con los resultados individuales. Resultados. El valor diagnóstico negativo fue similar para los pacientes con esquema de primera línea (100,0 %; IC95% 99,5-100,0) o de segunda línea de tratamiento (99,4 %; IC95% 96,9-99,9). La incidencia del fracaso del tratamiento antirretroviral fue menor en los pacientes con tratamiento de primera línea (p<0,01), lo cual permitió un mayor ahorro en las pruebas de laboratorio en este grupo (74,0 %; IC95% 71,0-76,7) que en los pacientes con tratamiento de segunda línea (50,9 %; IC95% 44,4-57,3) (p<0,01). Conclusión. La selección de las muestras que se incluyeron en los lotes para determinar la carga viral del HIV según el tipo de esquema de tratamiento, permitió maximizar el porcentaje de ahorro en pruebas de laboratorio.

Abstract Introduction: HIV viral load testing is a key factor to evaluate the accomplishment of the UNAIDS target of 90% of viral suppression among people receiving antiretroviral therapy. Pooled samples are a potentially accurate and economic approach in resource-constrained settings, but efficiency can be negatively affected by high prevalence rates of virological failure. Objective: Strategies were assessed to increase the relative efficiency of pooled HIV viral load testing in resource-constrained settings. Materials and methods: We evaluated two strategies: a) plasma samples were not included in pools if patients had <12 months on antiretroviral therapy, patients had previous viral load >1,000 copies/ml, or were antiretroviral therapy naïve patients, and b) plasma pools were organized separately for first and second-line antiretroviral therapy regimens. Individual viral load tests were used to compare pooled results. Results: Negative predictive values were similar for patients on first (100.0%; 95% CI 99.5 to 100.0) and second-line antiretroviral therapy regimens (99.4%; 95% CI 96.9 to 99.9). However, the incidence of virological failure among individuals on first-line antiretroviral therapy was lower than second-line antiretroviral therapypatients (p <0.01), resulting in greater savings in laboratory tests in patients on first-line antiretroviral therapy (74.0%; 95% CI 71.0 to 76.7) compared with the group of patients on second-line antiretroviral therapy (50.9%; 95% CI 44.4 to 57.3) (p<0.01). Conclusion: Selecting the samples to be included in the pools and selecting the pools according to ART regimens are criteria that could lead to decreased spending on laboratory tests for HIV viral load determination in resource-constrained settings.

Nursing role on rapid recovery programmes fast-track. / Rol de enfermería en los programas de recuperación intensificada (fast-track).

Rapid recovery (RR) or fast-track programmes are aimed at reducing surgical stress, leading to a reduction in nurse workload, costs and hospital stay, greater patient empowerment, early post-surgical recovery and reduced morbidity and mortality. These new protocols require the coordinated participation of a multidisciplinary team. Based on an integrative review of the literature, this paper aims to define the concept of a RR or fast track programme and show the existing evidence on the implementation of these programmes in nursing. The benefits and low incidence of damage of RR programmes in nursing justify their implementation. The programmes require greater support and diffusion in order to develop, as well as more research to increase the evidence on the effectiveness and efficiency of the protocols.

Custo-efetividade do uso do curativo de colágeno e alginato no tratamento de áreas doadoras de enxerto de pele de espessura parcial / Cost-effectiveness of collagen wound dressing with alginate for the treatment of split-thickness skin graft donor sites / El costo-efectividad de la utilización del apósito de colágeno con alginato en el tratamiento de las áreas donadoras de injerto de espesor parcial de la piel

OBJETIVO: Avaliar a utilização do curativo de colágeno e alginato de cálcio em áreas doadoras de enxerto de pele parcial em relação ao curativo com gaze tipo rayon. MÉTODO: Foi realizado estudo clínico prospectivo na Divisão de Cirurgia Plástica e Queimaduras do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, no período de 2010 a 2015. Os pacientes foram selecionados de forma consecutiva e distribuídos de forma randomizada em três grupos de acordo com o tratamento usado na área doadora: rayon exposto, embebido em soro fisiológico 0,9%; rayon coberto por gaze de algodão estéril e atadura; curativo formado por 90% de colágeno bovino associado a 10% de alginato de cálcio. Foram analisados comparativamente os seguintes parâmetros: dor, tempo para epitelização, tempo de internação e custos. RESULTADOS: Foram estudados 30 pacientes, com idade variando de 12 e 60 anos. Quinze desses pacientes tiveram suas áreas doadoras cobertas com o curativo de colágeno e alginato de cálcio, os quais apresentaram redução dos níveis álgicos em 79,5% (p<0,01), menor tempo de internação e epitelização, média de 5,8 dias (p<0,01) e redução dos custos hospitalares em cerca de 47% (p<0,01) em comparação com o curativo de rayon. Nenhum apresentou infecção na área doadora. CONCLUSÃO: O curativo de colágeno e alginato apresentou melhor custo-benefício em relação ao rayon para cobertura de áreas doadoras, com importante redução da dor, do tempo de epitelização e de internação e dos custos.

OBJECTIVE: To evaluate the use of collagen calcium-alginate dressing for split-thickness skin graft donor sites in comparison with rayon dressing. METHODS: A prospective clinical study was conducted at Divisão de Cirurgia Plástica e Queimaduras do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo from 2010 to 2015. Patients were selected consecutively and randomly allocated into three groups according to the treatment used on the donor site: rayon soaked in 0.9% saline; rayon covered with sterile cotton gauze and bandage; 90% bovine collagen with 10% calcium-alginate dressing covered with transparent polyurethane film. Following parameters was comparatively analyzed: pain, time to epithelialization, length of stay and costs. RESULTS: We studied 30 patients, ranging from 12 to 60 years of age. Fifteen of these patients had their donor sites covered with collagen calcium-alginate dressing, which showed pain reduction of 79.5% (p<0.01), shorter hospital stay and epithelialization, average of 5.8 days (p<0.01) and reduction in hospital costs about 47% (p<0.01) in comparison with rayon dressing. None presented infection in the donor site. CONCLUSION: Collagen calcium-alginate dressing showed better cost-benefit than rayon to cover donor sites, with significant reduction of pain, epithelialization time, length of stay and costs.

Objetivo: Evaluar la utilización del apósito de colágeno con alginato de calcio en áreas donadoras de injerto de espesor parcial de la piel en relación a la curación con gasa tipo rayón. Método: Se realizó un estudio clínico prospectivo en la División de Cirugía Plástica y Quemadura, del Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo en el período de 2010 a 2015. Los pacientes fueron seleccionados de forma consecutiva y distribuida de forma aleatorizada en tres grupos de acuerdo con el tratamiento utilizado en la área donadora: rayón expuesto, embebido en suero fisiológico 0,9%; Rayón cubierto por gasa de algodón estéril y vendaje; apósito formado por un 90% de colágeno bovino asociado al 10% de alginato de calcio. Se analizaron comparativamente los siguientes parámetros: dolor, tiempo para epitelización, tiempo de internación y costos. Resultados: Se estudiaron 30 pacientes, con edad variando de 12 a 60 años. Quince de estos pacientes tuvieron sus áreas donantes cubiertas con el apósito de colágeno con alginato de calcio, los cuales presentaron reducción de los niveles álgicos en el 79,5% (p<0,01), menor tiempo de internación y epitelización, media de 5.8 (p<0,01) y reducción de los costos hospitalarios en 47% (p<0,01) en comparación con el apósito de rayón. Ninguno presentó infección en el área donante. Conclusión: El apósito de colágeno con alginato presentó mejor costo-efectividad en relación al rayón para cobertura de áreas donantes, con importante reducción del dolor, del tiempo de epitelización, de internación y de los costos

Resultados a corto plazo de la artroplastia total de cadera cementada / Short-term outcome after cemented totalhip replacement

Fundamento: a lo largo de los años la artroplastia total de cadera ha demostrado ser una de las cirugías más costo-efectivas, ya que permite restablecer el nivel de actividad física previa, lo que evita la morbilidad importante asociada con la falta de movilidad en pacientes con alteraciones en la cadera. Objetivo: evaluar los resultados a corto plazo de la artroplastia total de cadera cementada. Métodos: se realizó un estudio descriptivo prospectivo a un grupo de pacientes operados mediante la artroplastia total de cadera cementada, en el Hospital Militar Universitario Octavio de la Concepción y de la Pedraja de Camagüey, durante 24 meses desde enero de 2014 hasta diciembre de 2015 y el tiempo promedio de seguimiento de los pacientes fue de 10 meses (con un rango de seis a 24 meses). El universo y la muestra lo conformaron 24 pacientes con el diagnóstico de osteoartritis primaria de cadera u otra afección de la cadera operados mediante la artroplastia total cementada. Las variables de estudio fueron edad, sexo, diagnóstico previo a la intervención, las complicaciones posoperatorias y la evaluación según las dos escalas evaluativas utilizadas. Resultados: predominó el grupo de edades entre 70 y 80 años para un promedio de edad de 68 años (con rango de 42 a 80 años); el sexo más afectado fue el femenino, el diagnóstico preoperatorio más frecuente fue la osteoartritis primaria de cadera que se presentó una sola complicación, una infección superficial de la herida para un 4,10; al finalizar el trabajó se logró disminuir la Visual Analogue Scale 8,4 puntos como promedio y la Harris Hip Score mejoró 39 puntos; y los resultados de la artroplastia total de cadera cementada fueron excelentes y buenos en la totalidad de los pacientes. Conclusiones: el estudio concluyó que la artroplastia total de cadera cementada es un procedimiento seguro y con excelentes resultados.

Background: the total hip arthroplasty is one of the most effective orthopaedic surgeries that has been used for decades, is one of the most successful operations in medicine. The clinical result after surgery and compliance during rehabilitation are influenced by the patient's expectations. Objective: the aim of this study was to evaluate the results after cemented total hip arthroplasty in a short-term. Methods: a study was conducted on 24 patients who had cemented total hip arthroplasty primary, attended at Octavio of the Concepción and of the Pedraja Military Teaching Hospital of Camagüey, the patients were followed-up for a mean of 10 months (range, 6 to 24 months), from january 2014 to december 2015. Parameters, such as age, sex, reasons for the surgery, complications, and pre-operative and post-operative functional scores were recorded. Results: the most frequent group of age was from 70 to 80 years old for a 41,60 percent, with a mean of 68 years (range, 42 to 80 years); females with 58, 30 percent were more affected than males; only one case was recorded superficial infection for a 4,10 percent; the average Visual Analogue Scale improved from 9,5 points preoperatively to 1,1 points and the average Harris Hip Score was from 56 points preoperatively to 95 points at the final follow-up; and the results of the cemented total hip arthroplasty were excellent and goods in a 95,90 percent. Conclusions: The study concluded that cemented total hip arthroplasty is a secure procedure with excellent benefits.

[Optimizing resources to reduce costs to determine HIV viral load in limited resources settings].

INTRODUCTION: HIV viral load testing is a key factor to evaluate the accomplishment of the UNAIDS target of 90% of viral suppression among people receiving antiretroviral therapy. Pooled samples are a potentially accurate and economic approach in resource-constrained settings, but efficiency can be negatively affected by high prevalence rates of virological failure. OBJECTIVE: Strategies were assessed to increase the relative efficiency of pooled HIV viral load testing in resource-constrained settings. MATERIALS AND METHODS: We evaluated two strategies: a) plasma samples were not included in pools if patients had <12 months on antiretroviral therapy, patients had previous viral load >1,000 copies/ml, or were antiretroviral therapy naïve patients, and b) plasma pools were organized separately for first and second-line antiretroviral therapy regimens. Individual viral load tests were used to compare pooled results. RESULTS: Negative predictive values were similar for patients on first (100.0%; 95% CI 99.5 to 100.0) and second-line antiretroviral therapy regimens (99.4%; 95% CI 96.9 to 99.9). However, the incidence of virological failure among individuals on first-line antiretroviral therapy was lower than second-line antiretroviral therapy patients (p <0.01), resulting in greater savings in laboratory tests in patients on first-line antiretroviral therapy (74.0%; 95% CI 71.0 to 76.7) compared with the group of patients on second-line antiretroviral therapy (50.9%; 95% CI 44.4 to 57.3) (p<0.01). CONCLUSION: Selecting the samples to be included in the pools and selecting the pools according to ART regimens are criteria that could lead to decreased spending on laboratory tests for HIV viral load determination in resource-constrained settings.

Accounting solution of single medical equipment / 医疗卫生装备

Objective To propose an implementation scheme for single medical equipment accounting.Methods The running and benefit accounting of hospital medical equipment were analyzed,and then the method was discussed from the aspects of data statistics and benefit analysis.Results The scheme proved its practicability and feasibility,and could be used for single medical equipment accounting.Conclusion The hospital has to establish its own single medical equipment accounting scheme according to types of medical equipment and their management.

Pacientes con leishmaniasis cutánea tratados con antimoniato de meglumina en 2 municipios de Boyacá, Colombia 2013-2014 / Patients with Tegumentary Leishmaniasis Treated with Meglumine Antimoniate in 2 Municipalities of Boyaca, Colombia from 2013 to 2014 / Pacientes com leishmaniose cutânea tratados com antimonato de meglumina em 2 municípios de Boyacá, Colômbia 2013-2014

Introducción: La leishmaniasis es una de las enfermedades reemergentes de mayor importancia en salud pública, causa grandes costos y puede generar discapacidad. Objetivo: Evaluar el costo y la efectividad obtenida con el tratamiento de primera línea para leishmaniasis cutánea en los municipios de Otanche y Puerto Boyacá, Boyacá durante 2013-2014. Metodología: Estudio longitudinal retrospectivo de tipo descriptivo, se tomaron 86 pacientes que cumplían con los criterios de inclusión; se realizó un análisis de las características sociodemográficas, la efectividad del manejo de la patología con antimoniato de meglumina, los efectos adversos y los costos institucionales de los pacientes. Resultados: Se observó que los más afectados fueron los pacientes de 0 a 14 años, de género masculino (57%) y procedentes de zonas rurales. Las zonas corporales más comprometidas fueron los miembros superiores. El municipio de Otanche atendió el 86% de los pacientes reportados y en promedio el costo por paciente fue de 258,664 pesos. El municipio de Puerto Boyacá reportó el 14% de los casos y el costo promedio por paciente fue de 290,307 pesos; con una diferencia en costos por paciente de 31,643 entre los municipios. Conclusiones: Cuando la administración del medicamento se hace siguiendo las dosis recomendadas, la efectividad se encuentra alrededor del 90%. Los pacientes que recibieron dosis superiores a la indicada obtuvieron un mayor porcentaje de curación, sin embargo, no es necesario sobredosificar a los pacientes y elevar los costos para mejorar la curación. Los pacientes que recibieron dosis subterapéuticas generaron más costos debido a que es necesario brindarles servicios médicos de mayor complejidad. [Abril-Sánchez LR, Pachón-Abril E, Picón-Jaimes YA. Pacientes con leishmaniasis cutánea tratados con antimoniato de meglumina en 2 municipios de Boyacá, Colombia 2013-2014. MedUNAB 2017; 20(2): 165-173].

Introduction: Leishmaniasis is one of the most important reemerging diseases in public health and causes great costs and may generate a disability. Objective: To evaluate the cost and effectiveness obtained with the first line treatment for tegumentary leishmaniasis in the municipalities of Otanche and Puerto Boyaca, Boyaca during 2013 and 2014. Methodology: This is a retrospective longitudinal study of descriptive type. 86 patients who fulfilled the inclusion criteria were taken into account. Ananalys is of the sociodemographic characteristics, the effectiveness of the management of the pathology with meglumine antimoniate, the adverse effects and the institutional costs of the patients was carried out. Results: It was observed that the most affected with this disease were male patients (57%) from 0 to 14 years old and from rural areas. The most compromised body areas were the superior limbs. The municipality of Otanche treated 86% of the patients who were reported, and on average the cost per patient was $258,664 (Colombian pesos). The municipality of Puerto Boyacá reported 14% of the cases and the average cost per patient was 290,307 pesos; the difference in cost among the municipalities per patient was 31,643 pesos. Conclusions: The effectiveness rate when the administration of the drug is done following the recommended doses is around 90%. Patients who were treated with a higher dose than the indicated one obtained a higher percentage of curing; however, it is not necessary to dose patients and raise costs to improve curing. Patients who were treated with subtherapeutic doses generated more costs due to the need to provide them with more complex medical services. [Abril-Sánchez LR, Pachón-Abril E, Picón- Jaimes YA. Patients with Tegumentary Leishmaniasis Treated with Meglumine Antimoniate in 2 Municipalities of Boyaca, Colombia from 2013 to 2014. MedUNAB 2017; 20(2): 165-173].

Introdução: A leishmaniose é uma das doenças de maior importância que ressurge em saúde pública, causa grandes custos e pode gerar incapacidade. Objetivo: Avaliar o custo e a eficácia obtidos com o tratamento de primeira linha para leishmaniose cutânea nos municípios de Otanche e Puerto Boyacá, Boyacá, durante 2013-2014. Metodologia: Estudo longitudinal retrospectivo de tipo descritivo, foram atendidos 86 pacientes que preencheram aos critérios de inclusão; para o estudo se fez uma análise das características socio demográficas, da efetividade do manejo da patologia com antimonato de meglumina, dos efeitos adversos e os custos institucionais dos pacientes. Resultados: Observou-se que os mais afetados foram os pacientes de 0 a 14 anos de idade, masculino (57%) e os das áreas rurais. As áreas do corpo mais comprometidas foram os membros superiores. O município de Otanche tratou 86% dos pacientes relatados e, em média, o custo por paciente foi de 258.664 pesos. O município de Puerto Boyacá reportou 14% dos casos e o custo médio por paciente foi de 290.307 pesos; com uma diferença de custos por paciente de 31.643 entre os municípios. Conclusões: Quando a administração da medicação é feita seguindo as doses recomendadas, a eficácia aproximada é de 90%. O paciente que receberam maior dosagem que a indicada obtiveram maior porcentagem de cura, no entanto, não é necessário administrar maiores quantidades e aumentar os custos para melhorar a cicatrização. Os pacientes que receberam doses subterapêuticas geraram mais custos devido à necessidade de fornecer serviços médicos muito mais complexos. [Abril-Sánchez LR, Pachón-Abril E, Picón-Jaimes YA. Pacientes com leishmaniose cutânea tratados com antimonato de meglumina em 2 municípios de Boyacá, Colômbia 2013-2014. MedUNAB 2017; 20(2): 165-173].