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2.
PLoS One ; 16(3): e0248551, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33735206

RESUMO

INTRODUCTION: In 2016, under its new National Adherence Guidelines (AGL), South Africa formalized an existing model of fast-track HIV treatment initiation counselling (FTIC). Rollout of the AGL included an evaluation study at 24 clinics, with staggered AGL implementation. Using routinely collected data extracted as part of the evaluation study, we estimated and compared the costs of HIV care and treatment from the provider's perspective at the 12 clinics implementing the new, formalized model (AGL-FTIC) to costs at the 12 clinics continuing to implement some earlier, less formalized, model that likely varied across clinics (denoted here as early-FTIC). METHODS: This was a cost-outcome analysis using standard methods and a composite outcome defined as initiated antiretroviral therapy (ART) within 30 days of treatment eligibility and retained in care at 9 months. Using patient-level, bottom-up resource-utilization data and local unit costs, we estimated patient-level costs of care and treatment in 2017 U.S. dollars over the 9-month evaluation follow-up period for the two models of care. Resource use and costs, disaggregated by antiretroviral medications, laboratory tests, and clinic visits, are reported by model of care and stratified by the composite outcome. RESULTS: A total of 350/343 patients in the early-FTIC/AGL-FTIC models of care are included in this analysis. Mean/median costs were similar for both models of care ($135/$153 for early-FTIC, $130/$151 for AGL-FTIC). For the subset achieving the composite outcome, resource use and therefore mean/median costs were similar but slightly higher, reflecting care consistent with treatment guidelines ($163/$166 for early-FTIC, $168/$170 for AGL-FTIC). Not surprisingly, costs for patients not achieving the composite outcome were substantially less, mainly because they only had two or fewer follow-up visits and, therefore, received substantially less ART than patients who achieved the composite outcome. CONCLUSION: The 2016 adherence guidelines clarified expectations for the content and timing of adherence counseling sessions in relation to ART initiation. Because clinics were already initiating patients on ART quickly by 2016, little room existed for the new model of fast-track initiation counseling to reduce the number of pre-ART clinic visits at the study sites and therefore to reduce costs of care and treatment. TRIAL REGISTRATION: Clinical Trial Number: NCT02536768.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Análise Custo-Benefício , Aconselhamento/economia , Fidelidade a Diretrizes/economia , Infecções por HIV/tratamento farmacológico , Adolescente , Adulto , Assistência ao Convalescente/economia , Assistência ao Convalescente/organização & administração , Assistência ao Convalescente/normas , Assistência ao Convalescente/estatística & dados numéricos , Aconselhamento/organização & administração , Aconselhamento/normas , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , Infecções por HIV/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/economia , Padrões de Prática Médica/organização & administração , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos , África do Sul , Tempo para o Tratamento/economia , Tempo para o Tratamento/organização & administração , Tempo para o Tratamento/estatística & dados numéricos , Adulto Jovem
3.
Support Care Cancer ; 29(2): 619-625, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32415384

RESUMO

Cancer patients and their families experience a range of physical, psychological and financial adverse effects. Community-based cancer centres offer a range of services and interventions, free of charge, to support those affected by cancer. While shown to be effective, there is a lack of information on the costs of these services. Our aim was to estimate the resource impact of a community-based cancer support centre. Over a 7-month period, there were 2032 contacts with 238 clients whose average age was 60 years. The most frequently used services were transport to treatment (20%), complementary therapies (48%), exercise classes (10%) and counselling (9%). This cost analysis estimated total annual cost to provide all services was €313,744. Average annual cost per person was €1138. Current uptake at the centre represents 8% of all cancer incidences in seven counties surrounding the centre. If uptake increases by 10%, scenario analyses predict an increase in total costs increase to €429,043 and a decrease in costs per patient to €915. As cancer incidences increase, the need for supportive care is growing. Community-based services have been established to meet these needs and fill this gap in national health services. Long-term sustainability of these centres is uncertain as they are entirely reliant on donations and volunteers. This analysis estimates the costs of one such community-based cancer support centre, for the first time in Ireland. Findings can be used to inform future planning of cancer supportive care services, including establishing links between tertiary and community-based centres, and cost effectiveness analyses, nationally and internationally.


Assuntos
Institutos de Câncer/economia , Serviços de Saúde Comunitária/economia , Neoplasias/economia , Neoplasias/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Institutos de Câncer/estatística & dados numéricos , Serviços de Saúde Comunitária/estatística & dados numéricos , Terapias Complementares/economia , Terapias Complementares/estatística & dados numéricos , Análise Custo-Benefício , Aconselhamento/economia , Aconselhamento/estatística & dados numéricos , Feminino , Humanos , Incidência , Irlanda/epidemiologia , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia
4.
Afr J AIDS Res ; 19(4): 287-295, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33337980

RESUMO

HIV/AIDS is a major health issue faced by the world, generally, but particularly sub-Saharan Africa. Nigeria ranked third in the world by number of people living with HIV/AIDS in 2019. Despite prominent HIV counselling and testing (HCT) intervention programmes, Nigeria faces serious challenges, such as inadequate funding and low utilisation rates. Paucity of research into such a critical topic has restricted the capacity of policy makers to address the problem adequately. Consequently, a cross-sectional study was carried out using the contingent valuation method to assess the economic quantum of payment and determining factors associated with people's willingness to pay for HCT services. Data were collected from 768 people selected by convenience sampling of three local government areas - Alimosho, Ikorodu and Surulere in Lagos State, Nigeria. Data were analysed using descriptive statistics, chi-square, Mann-Whitney, and general linear regression model analysis. Findings show that 75% of respondents were willing to pay an average fee of N1 291 ($4.22) for HCT services. Significant determinants of willingness to pay were: income; knowledge of someone living with HIV or died of AIDS; worry about HIV infection; and fear of HIV-related stigma. The findings offer vital information germane to co-payment schemes aimed at financial sustainability of HCT and HIV/AIDS programmes in Nigeria.


Assuntos
Aconselhamento/economia , Financiamento Pessoal/estatística & dados numéricos , Infecções por HIV/economia , Programas de Rastreamento/economia , Adulto , Idoso , Atitude Frente a Saúde , Estudos Transversais , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/prevenção & controle , Infecções por HIV/psicologia , Humanos , Masculino , Programas de Rastreamento/psicologia , Pessoa de Meia-Idade , Nigéria/epidemiologia , Inquéritos e Questionários
5.
Monaldi Arch Chest Dis ; 90(4)2020 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-33169594

RESUMO

Quitlines are effective, evidence-based tobacco cessation interventions that help tobacco users quit through a variety of services. The present study was done to evaluate the cost effectiveness of the National Tobacco Quitline Service (NTQLS). We calculated twoyear program use and costs for establishment, salary of the staff, media promotions, intervention services, Quitline registration calls and the number of quitters since inception of NTQLS in the year 2016, we examined whether NTQLS is cost-effective or not. Out of 63,350 callers, 9420 (97.9% males) callers with the mean ±SD age at 37.5±12.6 years; were registered for tobacco cessation counselling services at the National Tobacco Quitline Services (NTQLS) between 30th May 2016 and 31st May 2018. 3012 (32%) quitted their tobacco use till the last proactive calls. Average cost per completed counselling was 22.37 US$. Our study concludes that Tobacco Quitline as a tobacco control intervention is an excellent investment and cost-effective measure in India. Average cost per quitter at 69.96 US$ is comparatively very low to other country's Quitline, representing the ideal utilization of funds.


Assuntos
Aconselhamento/economia , Avaliação de Programas e Projetos de Saúde/economia , Abandono do Hábito de Fumar/economia , Uso de Tabaco/prevenção & controle , Adulto , Publicidade/economia , Publicidade/métodos , Análise Custo-Benefício/economia , Aconselhamento/métodos , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde/estatística & dados numéricos , Abandono do Hábito de Fumar/métodos , Abandono do Hábito de Fumar/estatística & dados numéricos
6.
J Int AIDS Soc ; 23(9): e25612, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32909387

RESUMO

INTRODUCTION: HIV self-testing (HIVST) in outpatient departments (OPD) is a promising strategy for HIV testing in Malawi, given high OPD patient volumes and substantial wait times. To evaluate the relative cost and expected impact of facility-based HIVST (FB-HIVST) at OPDs in Malawi for increasing HIV status awareness, we conducted an economic evaluation of an HIVST cluster-randomized controlled trial. METHODS: A cluster-randomized trial was conducted at 15 sites in Malawi from September 2017 to February 2018 with three arms: 1) Standard provider-initiated-testing-and-counselling (PITC); 2) Optimized PITC (additional provider training and job-aids) and 3) FB-HIVST (HIVST demonstration, distribution and kit use in OPD, private kit interpretation and optional HIV counselling). The total production cost per newly identified positive and per person newly initiated on ART were calculated by study arm. These were calculated as the total cost of testing everyone divided by the number of newly identified positives; and the total cost of testing everyone divided by the number of those initiated on ART. Cost-outcomes were calculated under three cost scenarios: (1) full study costs, (2) routine implementation costs and (3) routine implementation + reduced cost for HIVST kits. RESULTS: The average cost per person newly diagnosed in the full study cost scenario was $101, $156 and $189, and cost per person initiated on ART was $121, $156 and $279 for Standard PITC, Optimized PITC and FB-HIVST respectively. In the routine implementation cost scenario, the average cost per person newly diagnosed was reduced to $83, and $93, and cost per person initiated on ART to $83, and $137 for Optimized PITC and FB-HIVST respectively. In the negotiated HIVST cost scenario, the average cost per person newly diagnosed was reduced to $55 and cost per person newly initiated on ART reduced to $81 in the FB-HIVST arm. CONCLUSIONS: While the cost per new ART initiation through FB-HIVST was higher than Standard PITC, FB-HIVST could become cost-saving compared to PITC if the cost of kits is reduced or if treatment linkage rate were increased in the FB-HIVST arm. For high volume OPDs, HIVST may increase facility capacity and increase the number of newly diagnosed positives.


Assuntos
Infecções por HIV/diagnóstico , Infecções por HIV/economia , Programas de Rastreamento/economia , Fármacos Anti-HIV/economia , Fármacos Anti-HIV/uso terapêutico , Análise Custo-Benefício , Aconselhamento/economia , Infecções por HIV/tratamento farmacológico , Humanos , Malaui , Programas de Rastreamento/métodos , Pacientes Ambulatoriais/estatística & dados numéricos , Autoteste
7.
J Int AIDS Soc ; 23 Suppl 3: e25522, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32602618

RESUMO

INTRODUCTION: Couples' voluntary HIV counselling and testing (CVCT) is a high-impact HIV prevention intervention in Rwanda and Zambia. Our objective was to model the cost-per-HIV infection averted by CVCT in six African countries guided by an HIV prevention cascade framework. The HIV prevention cascade as yet to be applied to evaluating CVCT effectiveness or cost-effectiveness. METHODS: We defined a priority population for CVCT in Africa as heterosexual adults in stable couples. Based on our previous experience nationalizing CVCT in Rwanda and scaling-up CVCT in 73 clinics in Zambia, we estimated HIV prevention cascade domains of motivation for use, access and effectiveness of CVCT as model parameters. Costs-per-couple tested were also estimated based on our previous studies. We used these parameters as well as country-specific inputs to model the impact of CVCT over a five-year time horizon in a previously developed and tested deterministic compartmental model. We consider six countries across Africa with varied HIV epidemics (South Africa, Zimbabwe, Kenya, Tanzania, Ivory Coast and Sierra Leone). Outcomes of interest were the proportion of HIV infections averted by CVCT, nationwide CVCT implementation costs and costs-per-HIV infection averted by CVCT. We applied 3%/year discounting to costs and outcomes. Univariate and Monte Carlo multivariate sensitivity analyses were conducted. RESULTS: We estimated that CVCT could avert between 54% (Sierra Leone) and 62% (South Africa) of adult HIV infections. Average costs-per-HIV infection averted were lowest in Zimbabwe ($550) and highest in South Africa ($1272). Nationwide implementations would cost between 7% (Kenya) and 21% (Ivory Coast) of a country's President's Emergency Plan for AIDS Relief (PEPFAR) budget over five years. In sensitivity analyses, model outputs were most sensitive to estimates of cost-per-couple tested; the proportion of adults in heterosexual couples and HIV prevention cascade domains of CVCT motivation and access. CONCLUSIONS: Our model indicates that nationalized CVCT could prevent over half of adult HIV infections for 7% to 21% of the modelled countries' five-year PEPFAR budgets. While other studies have indicated that CVCT motivation is high given locally relevant promotional and educational efforts, without required indicators, targets and dedicated budgets, access remains low.


Assuntos
Aconselhamento/economia , Infecções por HIV/prevenção & controle , Parceiros Sexuais , Adulto , África/epidemiologia , Análise Custo-Benefício , Feminino , Heterossexualidade , Humanos , Masculino , Modelos Econômicos , Estudos Retrospectivos
9.
Worldviews Evid Based Nurs ; 17(1): 24-31, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32017435

RESUMO

BACKGROUND: We now know that nurses are at greater risk for suicide than others in the general population. It is known that job stressors are prevalent in nurses who die by suicide. Yet, little is known about targeted suicide prevention for nurses. The first nurse-centric Healer Education Assessment and Referral (HEAR) suicide prevention program was piloted for 6 months in 2016. The HEAR program was effective in identifying at-risk nurses. AIM: The purpose of this paper is to report the 3-year sustainability and outcomes of this nurse suicide prevention program. METHODS: Descriptive statistics are provided of program outcomes over the course of 3 years. RESULTS: Over the 3 years, 527 nurses have taken advantage of the screening portion of the program. Of these, 254 (48%) were Tier 1 high risk, and 270 (51.2%) were Tier 2 moderate risk. A startling 48 (9%) had expressed thoughts of taking their own life, 51 (9.7%) had a previous suicide attempt, whereas only 79 (15%) were receiving counseling or therapy. One hundred seventy-six nurses received support from therapists electronically, over the phone, or in person; 98 nurses accepted referral for treatment. The number of group emotional debriefs rose from eight in 2016 to 15 in 2017 to 38 in fiscal year 2019. Many of the debriefs are now requested (vs. offered), demonstrating the development of a culture open to reaching out for mental health treatment. LINKING EVIDENCE TO ACTION: The initial success of this pilot program has been sustained. A nurse suicide prevention program of education, assessment, and referral is feasible, well-received, proactively identifies nurses with reported suicidality and facilitates referral for care. The HEAR program has provided service to physicians and residents for 10 years and now supports effectiveness in nurses. The HEAR program is portable and ready for replication at other institutions.


Assuntos
Aconselhamento/métodos , Enfermeiras e Enfermeiros/psicologia , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Suicídio/prevenção & controle , Aconselhamento/economia , Aconselhamento/normas , Humanos , Programas de Rastreamento/métodos , Papel do Profissional de Enfermagem/psicologia , Enfermeiras e Enfermeiros/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde/normas , Avaliação de Programas e Projetos de Saúde/métodos , Pesquisa Qualitativa , Fatores de Risco , Suicídio/psicologia , Suicídio/estatística & dados numéricos
10.
Schweiz Arch Tierheilkd ; 162(1): 23-36, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31899447

RESUMO

INTRODUCTION: The work of veterinarians is continuously undergoing structural changes. A shift from purely curative individual animal care towards herd-health management is observed worldwide in the livestock sector. To illustrate the practical implementation with all its advantages and disadvantages, an online survey was conducted among all practicing livestock veterinarians in the Canton of Fribourg. A link to the survey was sent by email, it was voluntary and possible to complete the questionnaire anonymously. The survey focused on four topics: Demographic data, herd-health management, billing of counselling and use of antimicrobial drugs. Forty veterinarians from at least 79.2% (n = 19) of all veterinary practices located in the canton of Fribourg (n = 24) responded. Of these, 67.5% were practice owners or partner (n = 27) and 32.5% were employed veterinarians (n = 13). In Fribourg, only herd fertility management is included in the herd-health management on a regular basis. The quality and quantity of advanced trainings in herd-health management for veterinarians was assessed as moderate to poor. There are various options for charging herd-health management services. The amount charged was variable. The most frequently used options were hourly rates (100-300 CHF/h), "rate per cow per year excl. visit rate" (22-75 CHF/cow/year) or "rate per cow per year incl. visit rate" (85-98 CHF/ cow/year). Only one veterinarian (2.5%) charges for advisory activities not included in the the herd-health management service, which was asked for separately. However, the time required for counselling (excluding herd-health management) was estimated to be between 5.0-70.0% of the total working time (median 15.0%, interquartile range = 10.0-32.5%). Veterinarians in Fribourg are reHauptluctant to follow the international trend towards a regular, integrated herd-health management. The majority of them do not charge for consultancy outside the herdhealth management service. A nationwide survey should be considered to better assess the situation all over Switzerland.


Assuntos
Anti-Infecciosos/uso terapêutico , Aconselhamento/economia , Gestão da Saúde da População , Médicos Veterinários , Animais , Demografia , Resistência Microbiana a Medicamentos , Honorários e Preços , Feminino , Fertilidade , Gado , Inquéritos e Questionários , Suíça , Fatores de Tempo , Médicos Veterinários/economia
11.
Musculoskelet Sci Pract ; 46: 102109, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31989965

RESUMO

OBJECTIVE: To evaluate the cost-effectiveness of deep tissue massage ('massage'), strengthening and stretching exercises ('exercises') or a combination of both ('combined therapy') in comparison with advice to stay active ('advice') for subacute and persistent neck pain, from a societal perspective. METHODS: We conducted a cost-effectiveness analysis alongside a four-arm randomized controlled trial of 619 participants followed-up for one year. Health-related quality of life was measured using EQ-5D-3L and costs were calculated from baseline to one year. The interventions were ranked according to quality adjusted life years (QALYs) in a cost-consequence analysis. Thereafter, an incremental cost per QALY was calculated. RESULTS: In the cost-consequence analysis, in comparison with advice, exercises resulted in higher QALY gains, and massage and the combined therapy were more costly and less beneficial. Exercises may be a cost-effective treatment compared with advice to stay active if society is willing to pay 17 640 EUR per QALY. However, differences in QALY gains were minimal; on average, participants in the massage group, spent a year in a state of health valued at 0.88, exercises: 0.89, combined therapy: 0.88 and, advice: 0.88. CONCLUSIONS: Exercises are cost-effective compared to advice given that the societal willingness to pay is above 17 640 EUR per year in full health gained. Massage and a combined therapy are not cost-effective. While exercise appeared to have the best cost/benefit profile, even this treatment had only a modest benefit and treatment innovation is needed. Advice to stay active remains as a good therapeutic alternative from an economical perspective.


Assuntos
Análise Custo-Benefício , Aconselhamento , Massagem , Exercícios de Alongamento Muscular , Músculos do Pescoço/fisiologia , Cervicalgia/terapia , Adolescente , Adulto , Idoso , Aconselhamento/economia , Feminino , Humanos , Masculino , Massagem/economia , Pessoa de Meia-Idade , Anos de Vida Ajustados por Qualidade de Vida , Suécia
12.
Public Health Nutr ; 23(1): 83-93, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31608841

RESUMO

OBJECTIVE: We aimed to estimate the cost-effectiveness of brief weight-loss counselling by dietitian-trained practice nurses, in a high-income-country case study. DESIGN: A literature search of the impact of dietary counselling on BMI was performed to source the 'best' effect size for use in modelling. This was combined with multiple other input parameters (e.g. epidemiological and cost parameters for obesity-related diseases, likely uptake of counselling) in an established multistate life-table model with fourteen parallel BMI-related disease life tables using a 3 % discount rate. SETTING: New Zealand (NZ). PARTICIPANTS: We calculated quality-adjusted life-years (QALY) gained and health-system costs over the remainder of the lifespan of the NZ population alive in 2011 (n 4·4 million). RESULTS: Counselling was estimated to result in an increase of 250 QALY (95 % uncertainty interval -70, 560 QALY) over the population's lifetime. The incremental cost-effectiveness ratio was 2011 $NZ 138 200 per QALY gained (2018 $US 102 700). Per capita QALY gains were higher for Maori (Indigenous population) than for non-Maori, but were still not cost-effective. If willingness-to-pay was set to the level of gross domestic product per capita per QALY gained (i.e. 2011 $NZ 45 000 or 2018 $US 33 400), the probability that the intervention would be cost-effective was 2 %. CONCLUSIONS: The study provides modelling-level evidence that brief dietary counselling for weight loss in primary care generates relatively small health gains at the population level and is unlikely to be cost-effective.


Assuntos
Aconselhamento/economia , Dieta Redutora/economia , Obesidade/prevenção & controle , Enfermagem de Atenção Primária/métodos , Atenção Primária à Saúde/métodos , Adulto , Análise Custo-Benefício , Aconselhamento/métodos , Dieta Redutora/enfermagem , Feminino , Custos de Cuidados de Saúde , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Nutricionistas , Obesidade/dietoterapia , Sobrepeso/dietoterapia , Sobrepeso/prevenção & controle , Anos de Vida Ajustados por Qualidade de Vida , Perda de Peso , Programas de Redução de Peso/economia , Programas de Redução de Peso/métodos
13.
BMC Public Health ; 19(1): 1700, 2019 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-31852536

RESUMO

BACKGROUND: The rate of tobacco use among people with mental illness is nearly twice that of the general population. Psychotropic medications for tobacco cessation are relatively expensive for most Kenyans. Behavioral counseling and group therapy are effective lower cost strategies to promote tobacco cessation, yet have not been studied in Kenya among individuals with concomitant mental illness. METHODS/DESIGN: One hundred tobacco users with mental illness who were part of an outpatient mental health program in Nairobi, Kenya were recruited and allocated into intervention and control groups of the study (50 users in intervention group and 50 users in control group). Participants allocated to the intervention group were invited to participate in 1 of 5 tobacco cessation groups. The intervention group received the 5As (Ask, Advise, Assess, Assist and Arrange) and tobacco cessation group behavioral intervention, which included strategies to manage cravings and withdrawal, stress and anxiety, and coping with depression due to withdrawal; assertiveness training and anger management; reasons to quit, benefits of quitting and different ways of quitting. Individuals allocated to the control group received usual care. The primary outcome was tobacco cessation at 24 weeks, measured through cotinine strips. Secondary outcomes included number of quit attempts and health-related quality of life. DISCUSSION: This study will provide evidence to evaluate the efficacy and safety of a tobacco cessation group behavioral intervention among individuals with mental illness in Kenya, and to inform national and regional practice and policy. TRIAL REGISTRATION: Trial registration number: NCT04013724. Name of registry: ClinicalTrials.gov. URL of registry: https://register.clinicaltrials.gov Date of registration: 9 July 2019 (retrospectively registered). Date of enrolment of the first participant to the trial: 5th September 2017. Protocol version: 2.0.


Assuntos
Terapia Comportamental/métodos , Análise Custo-Benefício/estatística & dados numéricos , Aconselhamento/métodos , Qualidade de Vida/psicologia , Abandono do Hábito de Fumar/métodos , Abandono do Uso de Tabaco/psicologia , Tabagismo/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Comportamental/economia , Aconselhamento/economia , Feminino , Humanos , Quênia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Abandono do Hábito de Fumar/economia , Abandono do Uso de Tabaco/estatística & dados numéricos
14.
Afr J AIDS Res ; 18(4): 341-349, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31779565

RESUMO

Objective: Explore facility-level average costs per client of HIV testing and counselling (HTC) and voluntary medical male circumcision (VMMC) services in 13 countries.Methods: Through a literature search we identified studies that reported facility-level costs of HTC or VMMC programmes. We requested the primary data from authors and standardised the disparate data sources to make them comparable. We then conducted descriptive statistics and a meta-analysis to assess the cost variation among facilities. All costs were converted to 2017 US dollars ($).Results: We gathered data from 14 studies across 13 countries and 772 facilities (552 HTC, 220 VMMC). The weighted average unit cost per client served was $15 (95% CI 12, 18) for HTC and $59 (95% CI 45, 74) for VMMC. On average, 38% of the mean unit cost for HTC corresponded to recurrent costs, 56% to personnel costs, and 6% to capital costs. For VMMC, 41% of the average unit cost corresponded to recurrent costs, 55% to personnel costs, and 4% to capital costs. We observed unit cost variation within and between countries, and lower costs in higher scale categories in all interventions.


Assuntos
Circuncisão Masculina/economia , Aconselhamento/economia , Infecções por HIV/diagnóstico , Infecções por HIV/prevenção & controle , Programas de Rastreamento/economia , Custos e Análise de Custo , Infecções por HIV/economia , Instalações de Saúde , Humanos , Masculino
15.
Afr J AIDS Res ; 18(4): 324-331, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31779570

RESUMO

More than 14.5 of the 36.7 million people living with HIV globally do not know their HIV status, making comprehensive testing interventions a critical step in ending the HIV/AIDS epidemic. Home-based testing and counselling (HBTC) involves small teams of community health workers with basic training going from door-to-door and offering services in people's homes. HBTC is effective in reaching individuals that are unlikely to test otherwise, but there is conflicting evidence on its costs and little insight into why estimates are different. We undertook a comparative review of existing costing studies of HBTC in sub-Saharan Africa. Yield or positivity rate, the number of persons tested positive among all tested, is an important metric to judge the efficacy of a testing campaign. We conducted descriptive analyses to test whether unit costs are associated with yield. Studies varied in size with a maximum of 264 953 and a minimum of 494 persons tested. The average "cost per person tested" across 14 studies was $22.8 (SD $14.5) with a minimum of $6 and a maximum of $55.4, and the average "cost per person tested HIV-positive' across 12 studies was $439.4 (SD $399.7) with a minimum of $66.2 and a maximum of $800.9. Correlations between unit cost estimates and yield were not statistically significant. Existant estimates of the costs of HBTC are conflicting, and it is likely that differences in the setting, design and implementation of the studies are responsible for the discrepancies. This makes it difficult to reliably estimate the costs and cost-effectiveness of HBTC.


Assuntos
Aconselhamento/economia , Infecções por HIV/diagnóstico , Serviços de Assistência Domiciliar/economia , Programas de Rastreamento/economia , África ao Sul do Saara/epidemiologia , Análise Custo-Benefício , Aconselhamento/estatística & dados numéricos , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Custos de Cuidados de Saúde , Serviços de Assistência Domiciliar/estatística & dados numéricos , Humanos , Programas de Rastreamento/estatística & dados numéricos
16.
BMC Geriatr ; 19(1): 279, 2019 10 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640576

RESUMO

BACKGROUND: Developing countries are experiencing rapid population ageing. Many do not have the resources or formal structures available to support the health and wellbeing of people as they age. In other contexts, the use of peer support programmes have shown favourable outcomes in terms of reducing loneliness, increasing physical activity and managing chronic disease. Such programmes have not been previously developed or tested in African countries. We piloted a peer-to-peer support model among vulnerable community-dwelling adults in a developing country (South Africa) to examine the program's effect on wellbeing and social engagement. METHODS: A pre-post, pilot design was used to evaluate targeted outcomes, including wellbeing, social support, social interaction, mood, loneliness and physical activity. A total of 212 persons, aged 60+ years and living independently in a low-income area in Cape Town were recruited and screened for eligibility by trained assessors. Participants were assessed using the interRAI CheckUp, WHO-5 Wellbeing index, and the MOS-SS 8 instruments before and after the 5-month intervention, during which they received regular visits and phone calls from trained peer volunteers. During visits volunteers administered a wellness screening, made referrals to health and social services; built friendships with clients; encouraged social engagement; promoted healthy living; and provided emotional and informational support. RESULTS: Volunteer visits with clients significantly increased levels of self-reported wellbeing by 58%; improved emotional and informational support by 50%; decreased reports of reduced social interaction by 91%; reduced loneliness by 70%; improved mood scores represented as anxiety, depression, lack of interest or pleasure in activities, and withdrawal from activities of interest; and increased levels of physical activity from 49 to 66%. DISCUSSION: The intervention led to demonstrable improvement in client wellbeing. Policymakers should consider integrating peer-support models into existing health programs to better address the needs of the elderly population and promote healthy ageing in resource-poor community settings. Longer-term and more rigorous studies with a control group are needed to support these findings and to investigate the potential impact of such interventions on health outcomes longitudinally.


Assuntos
Grupo Associado , Pobreza/economia , Pobreza/psicologia , Qualidade de Vida/psicologia , Apoio Social , Idoso , Idoso de 80 Anos ou mais , Aconselhamento/economia , Aconselhamento/métodos , Exercício Físico/psicologia , Feminino , Seguimentos , Envelhecimento Saudável/psicologia , Humanos , Solidão/psicologia , Masculino , Autorrelato , África do Sul/epidemiologia
17.
Int J Nurs Pract ; 25(6): e12782, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31512357

RESUMO

AIM: The aim of this study was to estimate the economic value of a family education and counselling service provided by critical care advanced practice nurses in South Korea utilizing a contingent valuation approach. METHODS: A double-bounded dichotomous choice contingent valuation method was utilized to estimate the public's willingness to pay value for an education and counselling service provided by critical care advanced practice nurses. A web-based self-administered survey was conducted. RESULTS: Median willingness to pay was 43 112 Korean won (35 US dollars). Higher income and younger age were associated with higher willingness to pay. CONCLUSION: This study captured the economic value of an education and counselling service provided by critical care advanced practice nurses that is not on the benefit list under the fee-for-service system of the Korean National Health System. Policy makers should consider including such services in the health care system.


Assuntos
Prática Avançada de Enfermagem , Aconselhamento/economia , Enfermagem de Cuidados Críticos , Honorários e Preços , Educação em Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Adulto , Idoso , Família , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia , Inquéritos e Questionários , Adulto Jovem
18.
BMJ Open ; 9(8): e030934, 2019 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-31420398

RESUMO

OBJECTIVES: The aim of this study was to conduct a cost-effectiveness analysis (CEA) of a high-intensity and a low-intensity smoking cessation treatment programme (HIT and LIT) using long-term follow-up effectiveness data and to validate the cost-effectiveness results based on short-term follow-up. DESIGN AND OUTCOME MEASURES: Intervention effectiveness was estimated in a randomised controlled trial as numbers of abstinent participants after 1 and 5-8 years of follow-up. The economic evaluation was performed from a societal perspective using a Markov model by estimating future disease-related costs (in Euro (€) 2018) and health effects (in quality-adjusted life-years (QALYs)). Programmes were explicitly compared in an incremental analysis, and the results were presented as an incremental cost-effectiveness ratio. SETTING: The study was conducted in dental clinics in Sweden. PARTICIPANTS: 294 smokers aged 19-71 years were included in the study. INTERVENTIONS: Behaviour therapy, coaching and pharmacological advice (HIT) was compared with one counselling session introducing a conventional self-help programme (LIT). RESULTS: The more costly HIT led to higher number of 6-month continuous abstinent participants after 1 year and higher number of sustained abstinent participants after 5-8 years, which translates into larger societal costs avoided and health gains than LIT. The incremental cost/QALY of HIT compared with LIT amounted to €918 and €3786 using short-term and long-term effectiveness, respectively, which is considered very cost-effective in Sweden. CONCLUSION: CEA favours the more costly HIT if decision makers are willing to spend at least €4000/QALY for tobacco cessation treatment.


Assuntos
Aconselhamento/economia , Assistência Odontológica/economia , Padrões de Prática Odontológica/estatística & dados numéricos , Abandono do Hábito de Fumar/economia , Adulto , Idoso , Atitude do Pessoal de Saúde , Terapia Comportamental/economia , Análise Custo-Benefício , Assistência Odontológica/métodos , Serviços de Saúde Bucal/economia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Suécia , Adulto Jovem
19.
Pharmazie ; 74(7): 439-442, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31288902

RESUMO

Chemotherapy for cancer is increasingly implemented in the outpatient setting. Pharmacists contribute to cancer treatment by conducting counseling during outpatient chemotherapy visits. They provide guidance on drug treatment, side effects, and side effect countermeasures on every visit. However, there have been few economic evaluations of pharmacist involvement in outpatient chemotherapy. Therefore, we performed a cost utility analysis. We assigned usual care (control) and pharmacist counseling to two groups of 19 patients receiving outpatient chemotherapy for breast cancer at Gifu Municipal hospital. Quality of life was measured at three timepoints before and during chemotherapy treatment using the EuroQol 5 dimension instrument (EQ-5D). EQ-5D values across the timepoints were 0.831, 0.757, and 0.791 for the control group, and 0.882, 0.883, and 0.921 for the pharmacist counseling group. The additional cost in the pharmacist counseling group was 2,227 yen per counseling session. The change in quality-adjusted life years (QALY) was a maximum of -0.021±0.186 in the control group and 0.007±0.199 in the pharmacist counseling group. The maximum cost for one QALY was 1,360,558 yen (≈12,460 US dollars). Pharmacists' counseling in outpatient cancer chemotherapy for breast cancer patients had an acceptable incremental cost-effect ratio, contributing to improved patient quality of life without significant additional expenditure to healthcare.


Assuntos
Antineoplásicos/administração & dosagem , Neoplasias da Mama/tratamento farmacológico , Farmacêuticos/organização & administração , Serviço de Farmácia Hospitalar/organização & administração , Adulto , Idoso , Análise Custo-Benefício , Aconselhamento/economia , Aconselhamento/métodos , Feminino , Humanos , Japão , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Farmacêuticos/economia , Serviço de Farmácia Hospitalar/economia , Papel Profissional , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida
20.
BMJ Open ; 9(5): e026973, 2019 05 14.
Artigo em Inglês | MEDLINE | ID: mdl-31092660

RESUMO

INTRODUCTION: Depression and alcohol use disorders are international public health priorities for which there is a substantial treatment gap. Brief mental health interventions delivered by lay health workers in primary care services may reduce this gap. There is limited economic evidence assessing the cost-effectiveness of such interventions in low-income and middle-income countries. This paper describes the proposed economic evaluation of a health systems intervention testing the effectiveness, cost-effectiveness and cost-utility of two task-sharing approaches to integrating services for common mental disorders with HIV and diabetes primary care services. METHODS AND ANALYSIS: This evaluation will be conducted as part of a three-armed cluster randomised controlled trial of clinical effectiveness. Trial clinical outcome measures will include primary outcomes for risk of depression and alcohol use, and secondary outcomes for risk of chronic disease (HIV and diabetes) treatment failure. The cost-effectiveness analysis will evaluate cost per unit change in Alcohol Use Disorder Identification Test and Centre for Epidemiological Studies scale on Depression scores as well as cost per unit change in HIV RNA viral load and haemoglobin A1c, producing results of provider and patient cost per patient year for each study arm and chronic disease. The cost utility analyses will provide results of cost per quality-adjusted life year gained. Additional analyses relevant for implementation including budget impact analyses will be conducted to inform the development of a business case for scaling up the country's investment in mental health services. ETHICS AND DISSEMINATION: The Western Cape Department of Health (WCDoH) (WC2016_RP6_9), the South African Medical Research Council (EC 004-2/2015), the University of Cape Town (089/2015) and Oxford University (OxTREC 2-17) provided ethical approval for this study. Results dissemination will include policy briefs, social media, peer-reviewed papers, a policy dialogue workshop and press briefings. TRIAL REGISTRATION NUMBER: PACTR201610001825405.


Assuntos
Alcoolismo/terapia , Aconselhamento/economia , Depressão/terapia , Diabetes Mellitus/psicologia , Infecções por HIV/psicologia , Serviços de Saúde Mental/economia , Atenção Primária à Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto , Alcoolismo/economia , Alcoolismo/epidemiologia , Análise por Conglomerados , Análise Custo-Benefício , Depressão/economia , Depressão/epidemiologia , Diabetes Mellitus/economia , Diabetes Mellitus/epidemiologia , Feminino , Infecções por HIV/economia , Infecções por HIV/epidemiologia , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Masculino , África do Sul/epidemiologia , Resultado do Tratamento
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