Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 513
Filtrar
1.
BMC Health Serv Res ; 19(1): 763, 2019 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-31660961

RESUMO

BACKGROUND: The aim of this study was to estimate the mean cost per caregiver of informal care during the first year after myocardial infarction event in France. METHODS: We used the Handicap-Santé French survey carried out in 2008 to obtain data about MI survivors and their caregivers. After obtaining the total number of informal care hours provided by caregiver during the first year after MI event, we estimated the value of informal care using the proxy good method and the contingent valuation method. RESULTS: For MI people receiving informal care, an annual mean cost was estimated at €12,404 (SD = 13,012) with the proxy good method and €12,798 (SD = 13,425) with the contingent valuation method per caregiver during the first year after myocardial infarction event. CONCLUSIONS: The present study suggests that informal care should be included more widely in economic evaluations in order not to underestimate the cost of diseases which induce disability.


Assuntos
Cuidadores/economia , Análise Custo-Benefício , Infarto do Miocárdio/terapia , Assistência ao Paciente/economia , Idoso , Cuidadores/estatística & dados numéricos , Pessoas com Deficiência/estatística & dados numéricos , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Sobreviventes/estatística & dados numéricos
2.
Eur Arch Otorhinolaryngol ; 276(11): 3173-3177, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31489494

RESUMO

PURPOSE: In acute epiglottitis (AE) or acute supraglottitis (AS), the management of the airway is crucial. We hypothesized that tracheotomized patients recover faster than intubated patients do. METHODS: We retrospectively reviewed all adult AE and AS patients, who underwent intubation or tracheotomy between 2007 and 2018 in a tertiary care center. Patient demographics, treatment, and complications were analyzed. RESULTS: The cohort comprised 42 patients. The airway was secured with intubation in 50% and with tracheotomy in 50%. All intubated patients (n = 21) and three tracheotomized patients were treated in the intensive care unit (p < 0.0001). Procedure-related complications were encountered in three intubated and eight tracheotomized patients (p = 0.892). Median overall treatment cost was 11.547 € and 5.856 € in the intubated and tracheotomized patient groups, respectively (p < 0.001). The median duration of sick leave after discharge from hospital was 13 days in the tracheotomy group and 7 days in the intubation group (p = 0.097). CONCLUSION: Tracheotomy resulted in a less expensive management in securing the airway in AE or AS, but tracheotomized patients had a trend towards more complications and longer sick leaves compared to intubated patients. LEVEL OF EVIDENCE: 2b.


Assuntos
Epiglotite , Intubação Intratraqueal , Assistência ao Paciente , Complicações Pós-Operatórias , Supraglotite , Traqueotomia , Doença Aguda , Adulto , Custos e Análise de Custo , Epiglotite/fisiopatologia , Epiglotite/cirurgia , Feminino , Finlândia , Humanos , Intubação Intratraqueal/efeitos adversos , Intubação Intratraqueal/economia , Intubação Intratraqueal/métodos , Masculino , Pessoa de Meia-Idade , Assistência ao Paciente/economia , Assistência ao Paciente/métodos , Assistência ao Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Supraglotite/fisiopatologia , Supraglotite/cirurgia , Traqueotomia/efeitos adversos , Traqueotomia/economia , Traqueotomia/métodos , Resultado do Tratamento
4.
Unfallchirurg ; 122(6): 490-494, 2019 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-31049611

RESUMO

The development of the healthcare system in Germany is increasingly approaching human and economic limits. A social consensus and a political concept at which point priorities are promoted and for which services the money should be primarily spent, do not exist on the whole. As soon as it becomes clear that resources are limited and that is now, prioritization has to be introduced to avoid the alternative threat of rationing of treatment benefits. The goal of prioritization is to rationally and optimally use the existing but limited resources. Medical progress and the relationship to the demographic development are the variables in the future. The individual care of the patient, patients' needs and dependence on access to treatment are the foundations of ethical actions. They must be at the center of attention for doctors and nurses because, after all they are the patient's advocates in the complex healthcare system. At the same time, unjustified claims for entitlement must be rejected just as a preservation of vested rights. Efficiency and economic considerations in diagnostics and treatment are not mutually exclusive. The physician acts as a mediator between the claims of the patient to be treated, the individual realization and the existing resources in the healthcare system.


Assuntos
Assistência à Saúde/economia , Alocação de Recursos para a Atenção à Saúde/economia , Prioridades em Saúde/economia , Recursos em Saúde/economia , Ortopedia/economia , Traumatologia/economia , Alemanha/epidemiologia , Humanos , Determinação de Necessidades de Cuidados de Saúde , Papel do Profissional de Enfermagem , Defesa do Paciente , Assistência ao Paciente/economia , Papel do Médico
6.
PLoS One ; 14(4): e0215965, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31022280

RESUMO

BACKGROUND: A study of a comprehensive HIV Care Coordination Program (CCP) showed effectiveness in increasing viral load suppression (VLS) among PLWH in New York City (NYC). We evaluated the cost-effectiveness of a scale-up of the CCP in NYC. METHODS: We incorporated observed effects and costs of the CCP into a computer simulation of HIV in NYC, comparing strategy scale-up with no implementation. The simulation combined a deterministic compartmental model of HIV transmission with a stochastic microsimulation of HIV progression, and was calibrated to NYC HIV epidemiological data from 1997 to 2009. We assessed incremental cost-effectiveness from a health sector perspective using 2017 $US, a 20-year time horizon, and a 3% annual discount rate. We explored two scenarios: (1) two-year average enrollment and (2) continuous enrollment. RESULTS: In scenario 1, scale-up resulted in a cost-per-infection-averted of $898,104 and a cost-per-QALY-gained of $423,721. In sensitivity analyses, scale-up achieved cost-effectiveness if effectiveness increased from RR1.11 to RR1.37 or costs decreased by 41.7%. Limiting the intervention to persons with unsuppressed viral load prior to enrollment (RR1.32) attenuated the cost reduction necessary to 11.5%. In scenario 2, scale-up resulted in a cost-per-infection-averted of $705,171 and cost-per-QALY-gained of $720,970. In sensitivity analyses, scale-up achieved cost-effectiveness if effectiveness increased from RR1.11 to RR1.46 or program costs decreased by 71.3%. Limiting the intervention to persons with unsuppressed viral load attenuated the cost reduction necessary to 38.7%. CONCLUSION: Cost-effective CCP scale-up would require reduced costs and/or focused enrollment within NYC, but may be more readily achieved in cities with lower background VLS levels.


Assuntos
Análise Custo-Benefício , Infecções por HIV/economia , Assistência ao Paciente/economia , Humanos , Modelos Biológicos , Reprodutibilidade dos Testes , Fatores de Risco , Resultado do Tratamento
7.
PLoS One ; 14(3): e0213889, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30893370

RESUMO

BACKGROUND: Chronic pain is among the most burdensome conditions. Its prevalence ranges between 12% and 30% in Europe, with an estimated 21% among Austrian adults. The economic impact of chronic pain from a societal perspective, however, has not been sufficiently researched. This study aims to provide an estimate of the societal costs for working-age adults with chronic pain in Austria. It explores the impact of sex, number of pain sites, self-reported pain severity, health literacy and private health insurance on costs associated with chronic pain. METHODS: A bottom-up cost-of-illness study was conducted based on data collected from 54 adult patients with chronic pain at three Viennese hospital outpatient departments. Information on healthcare costs including out-of-pocket expenses and productivity losses due to absenteeism and informal care were collected over 12 months. Resource use estimates were combined with unit costs and mean costs per patient were calculated in € for year 2016. RESULTS: Mean annual societal costs were estimated at EUR 10191. Direct medical costs were EUR 5725 including EUR 1799 out-of-pocket expenses (mainly pain relieving activities and private therapy). Productivity losses including informal care amounted to EUR 4466. Total costs for women and patients with three or more pain sites were significantly higher. No association with health literacy was found but there was a tendency towards higher out-of-pocket expenses for patients with complementary private health insurance. CONCLUSION: This study is the first to provide a comprehensive assessment of the individual and societal burden of chronic pain in Austria. It highlights that chronic pain is associated with substantial direct medical costs and productivity losses. Patient costs may show systematic differences by health insurance status, implying a need for future research in this area.


Assuntos
Dor Crônica/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Absenteísmo , Adulto , Idoso , Áustria , Efeitos Psicossociais da Doença , Eficiência/fisiologia , Europa (Continente) , Feminino , Gastos em Saúde/estatística & dados numéricos , Recursos em Saúde/estatística & dados numéricos , Humanos , Seguro Saúde/economia , Masculino , Pessoa de Meia-Idade , Assistência ao Paciente/economia , Adulto Jovem
8.
Blood Purif ; 48(1): 32-39, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30836351

RESUMO

Kidney disease is a global public health problem, affecting over 750 million persons worldwide. The burden of kidney disease varies substantially across the world. In many settings, rates of kidney disease and the provision of its care are defined by socioeconomic, cultural, and political factors leading to significant disparities. World Kidney Day 2019 offers an opportunity to raise awareness of kidney disease and highlight disparities in its burden and current state of global capacity for prevention and management. Here, we highlight the need for strengthening basic infrastructure for kidney care services for early detection and management of acute kidney injury and chronic kidney disease across all countries and advocate for more pragmatic approaches to providing renal replacement therapies. Achieving universal health coverage worldwide by 2030 is a World Health Organization Sustainable Development Goal. While universal health coverage may not include all elements of kidney care in all countries, understanding what is locally feasible and important with a focus on reducing the burden and consequences of kidney disease would be an important step towards achieving kidney health equity.


Assuntos
Efeitos Psicossociais da Doença , Acesso aos Serviços de Saúde , Disparidades em Assistência à Saúde , Nefropatias/epidemiologia , Política de Saúde , Mão de Obra em Saúde , Humanos , Nefropatias/diagnóstico , Nefropatias/terapia , Assistência ao Paciente/economia , Assistência ao Paciente/métodos , Terapia de Substituição Renal , Fatores de Risco
9.
PLoS One ; 14(2): e0210497, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30807573

RESUMO

BACKGROUND: In economic analyses of HIV interventions, South Africa is often used as a case in point, due to the availability of good epidemiological and programme data and the global relevance of its epidemic. Few analyses however use locally relevant cost data. We reviewed available cost data as part of the South African HIV Investment Case, a modelling exercise to inform the optimal use of financial resources for the country's HIV programme. METHODS: We systematically reviewed publication databases for published cost data covering a large range of HIV interventions and summarised relevant unit costs (cost per person receiving a service) for each. Where no data was found in the literature, we constructed unit costs either based on available information regarding ingredients and relevant public-sector prices, or based on expenditure records. RESULTS: Only 42 (5%) of 1,047 records included in our full-text review reported primary cost data on HIV interventions in South Africa, with 71% of included papers covering ART. Other papers detailed the costs of HCT, MMC, palliative and inpatient care; no papers were found on the costs of PrEP, social and behaviour change communication, and PMTCT. The results informed unit costs for 5 of 11 intervention categories included in the Investment Case, with the remainder costed based on ingredients (35%) and expenditure data (10%). CONCLUSIONS: A large number of modelled economic analyses of HIV interventions in South Africa use as inputs the same, often outdated, cost analyses, without reference to additional literature review. More primary cost analyses of non-ART interventions are needed.


Assuntos
Infecções por HIV/economia , Fármacos Anti-HIV/economia , Terapia Antirretroviral de Alta Atividade/economia , Custos e Análise de Custo , Infecções por HIV/epidemiologia , Infecções por HIV/terapia , Humanos , Modelos Econômicos , Assistência ao Paciente/economia , Educação de Pacientes como Assunto/economia , África do Sul/epidemiologia
10.
PLoS One ; 14(1): e0208076, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30629602

RESUMO

AIM: To examine the burden of out-of-pocket household expenditures and time spent on care by families responsible for children with Down Syndrome (DS). METHODS: A cross-sectional analysis was performed after surveying families of children with DS. The children all received medical care at the Hospital Infantil de México Federico Gomez (HIMFG), a National Institute of Health. Data were collected on out-of-pocket household expenditures for the medical care of these children. The percentage of such expenditure was calculated in relation to available household expenditure (after subtracting the cost of food/housing), and the percentage of households with catastrophic expenditure. Finally, the time spent on the care of the child was assessed. RESULTS: The socioeconomic analysis showed that 67% of the households with children with DS who received medical care in the HIMFG were within the lower four deciles (I-IV) of expenses, indicating a limited ability to pay for medical services. Yearly out-of-pocket expenditures for a child with DS represented 27% of the available household expenditure, which is equivalent to $464 for the United States dollars (USD). On average, 33% of families with DS children had catastrophic expenses, and 46% of the families had to borrow money to pay for medical expenses. The percentage of catastrophic expenditure was greater for a household with children aged five or older compared with households with younger children. The regression analysis revealed that the age of the child is the most significant factor determining the time spent on care. CONCLUSIONS: Some Mexican families of children with DS incur substantial out-of-pocket expenditures, which constitute an economic burden for families of children who received medical care at the HIMFG.


Assuntos
Síndrome de Down/economia , Gastos em Saúde , Hospitais , Assistência ao Paciente/economia , Doença Catastrófica/economia , Criança , Pré-Escolar , Características da Família , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , México , Análise de Regressão , Fatores de Tempo
11.
Pediatrics ; 143(1)2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30567715

RESUMO

BACKGROUND AND OBJECTIVES: Acute hematogenous osteomyelitis (AHO) causes significant morbidity in children. Quality improvement (QI) methods have been used to successfully improve care and decrease costs through standardization for numerous conditions, including pediatric AHO. We embarked on a QI initiative to standardize our approach to the inpatient management of AHO, with a global aim of reducing inpatient costs. METHODS: We used existing literature and local consensus to develop a care algorithm for the inpatient management of AHO. We used the Model for Improvement as the framework for the project, which included process mapping, failure mode analysis, and key driver identification. We engaged with institutional providers to achieve at least 80% consensus regarding specific key drivers and tested various interventions to support uptake of the care algorithm. RESULTS: Fifty-seven patients were included. There were 31 patients in the preintervention cohort and 26 in the postintervention cohort, of whom 19 were managed per the algorithm. Mean inpatient charges decreased from $45 718 in the preintervention cohort to $32 895 in the postintervention cohort; length of stay did not change. Adherence to recommended empirical antimicrobial agents trended upward. CONCLUSIONS: A simple and low-cost QI project was used to safely decrease the cost of inpatient care for pediatric AHO at a tertiary care children's hospital. A robust local consensus process proved to be a key component in the uptake of standardization.


Assuntos
Algoritmos , Custos de Cuidados de Saúde/normas , Osteomielite/diagnóstico por imagem , Osteomielite/terapia , Assistência ao Paciente/normas , Melhoria de Qualidade/normas , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Osteomielite/economia , Assistência ao Paciente/economia , Melhoria de Qualidade/economia , Estudos Retrospectivos , Adulto Jovem
12.
Eur J Health Econ ; 20(2): 303-316, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30121870

RESUMO

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


Assuntos
Cuidadores/economia , Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde , Neoplasias Hematológicas/economia , Assistência ao Paciente/economia , Assistência ao Paciente/métodos , Adolescente , Adulto , Idoso , Cuidadores/estatística & dados numéricos , Análise Custo-Benefício , Feminino , Neoplasias Hematológicas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Econométricos , Assistência ao Paciente/estatística & dados numéricos , Espanha , Transplante de Células-Tronco/economia , Inquéritos e Questionários , Adulto Jovem
13.
Int J Pharm Pract ; 27(2): 175-179, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30079985

RESUMO

OBJECTIVE: To evaluate the clinical and cost implications generated by a newly integrated ED pharmacist in a Canadian urban, university-affiliated tertiary care hospital. METHODS: A pharmacist documented all interventions that took place over a 5-week period. Interventions were assessed by a review panel for clinical significance and probability of harm had the intervention not occurred. Direct medication cost and cost avoidance as a result of interventions were calculated. KEY FINDINGS: The ED pharmacist made 421 interventions during the study period, 204 (48%) interventions were accepted at the time they were presented to the prescriber. After review, 53.9% of interventions were considered significant, and 52.9% were given a probability of patient harm of ≥50% had the intervention not occurred. Interventions resulted in an increase in direct medication costs of $1270, but generated a cost avoidance of $160 709. The projected direct medication cost estimate for one year was $13 208 with a cost avoidance of over $1.6 million. CONCLUSION: The integration of a pharmacist into a Canadian ED resulted in patient care interventions that were assessed as clinically significant, with a substantial projected cost avoidance.


Assuntos
Serviço Hospitalar de Emergência/organização & administração , Assistência ao Paciente/métodos , Farmacêuticos/organização & administração , Serviço de Farmácia Hospitalar/organização & administração , Idoso , Canadá , Custos de Medicamentos , Serviço Hospitalar de Emergência/economia , Hospitais Universitários , Hospitais Urbanos , Humanos , Pessoa de Meia-Idade , Assistência ao Paciente/economia , Farmacêuticos/economia , Serviço de Farmácia Hospitalar/economia , Papel Profissional , Estudos Prospectivos , Centros de Atenção Terciária
14.
Dementia (London) ; 18(1): 210-227, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27554789

RESUMO

Effective home support in dementia is key in delaying nursing home admission. However, home support is frequently not tailored to the individual needs of people with dementia. Staff allocating home support services may not identify important care needs, which only be recognised by informal carers. The purpose of this study was to explore the balance of informal and formal home support and their associated costs from the perspectives of both informal carers and paid staff. Five case vignettes of people with dementia were designed based on an existing English data set from a European study into transition into long-term care (the RightTimePlaceCare programme), representing 42 per cent of the English sample. In total, 14 informal carers and 14 paid staff were consulted in separate groups, as expert panels, regarding their recommendations for home care services for each vignette. Care recommendations of carers and staff were costed based on nationally available unit costs and compared. Informal carers allocated fewer hours of care than staff. Personal and domestic home care and day care centres were the most frequently recommended formal services by both groups, and some vignettes of people with dementia were recommended for care home admission. The ratio of costs of informal versus formal support was relatively equal for paid staff, yet unbalanced from the perspectives of informal carers with a greater proportion of formal care costs. Recommendations from this study can help shape dementia care to be more tailored to the individual needs of people with dementia and their carers.


Assuntos
Demência/economia , Serviços de Assistência Domiciliar/economia , Assistência ao Paciente/economia , Atitude do Pessoal de Saúde , Cuidadores/economia , Feminino , Humanos , Masculino
15.
PLoS One ; 13(11): e0206472, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30399184

RESUMO

BACKGROUND AND OBJECTIVES: People with personality disorders are prevalent in emergency and inpatient mental health services. We examined whether implementing a stepped care model of psychological therapy reduces demand on hospital units by people with personality disorder, in a cluster randomized controlled trial. METHOD: A total of 642 inpatients (average age 36.8, 50.5% female) with a primary ICD-10 personality disorder were recruited during 18 months baseline, then monitored during an 18 month active trial phase. In the active trial phase two equivalent sites were randomised to either treatment as usual (TAU), or a whole of service intervention that diverted people away from hospital and into stepped care psychological therapy clinics. The study design was cost neutral, with no additional staff or resources deployed between sites. A linear mixed models analysis evaluated outcomes. RESULTS: As predicted, demand on hospital services reduced significantly in the intervention compared to TAU site. The intervention site evidenced shorter bed days, from an average of 13.46 days at baseline to 4.28 days per admission, and patients were 1.3 times less likely to re-present to the emergency department compared to TAU. Direct cost savings for implementing the approach was estimated at USD$2,720 per patient per year. Limitations included not directly comparing individual symptom changes. CONCLUSIONS: Using a whole of service stepped care model of treatment for personality disorder significantly reduced demand on hospital services.


Assuntos
Assistência ao Paciente/métodos , Transtornos da Personalidade/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Custos e Análise de Custo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Assistência ao Paciente/economia , Resultado do Tratamento , Adulto Jovem
16.
J Alzheimers Dis ; 66(3): 1027-1040, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30372674

RESUMO

BACKGROUND: With 10.5 million people with dementia in Europe and $301 billion associated costs, governments face challenges organizing access to care. OBJECTIVE: To examine the costs related to formal and informal care use and quality of life for people with dementia in eight European countries, and explore the association with unmet needs. METHODS: Cross-sectional data from 451 persons with dementia and their informal caregivers of the Actifcare cohort study were obtained. Formal and informal care use was multiplied by country specific unit prices of services. Needs were measured using the CANE and health-related quality of life (HRQOL) of the person with dementia (both self- and proxy-rated) and informal caregiver's quality of life using EQ-5D-5L, ICECAP-O, DEMQOL-U, and CarerQol utility scores. The association between costs and country, European region, and unmet needs was assessed using multi-level linear regression. RESULTS: Self-rated EQ-5D-5L utility score was higher than proxy-rated (0.84 and 0.71, respectively). Informal caregivers' utility score was 0.84. Across eight countries annual mean costs of formal and informal care were approximately € 17,000. Unmet needs were not associated with annual costs of care, nor with proxy-rated HRQOL, but were associated with self-rated HRQOL. CONCLUSION: We found varying relationships between unmet needs and quality of life, and no association between unmet needs and care costs, although the results were sensitive to various factors. Future research should further investigate the relation between unmet needs, quality of life and costs to generate a better understanding of the effects of (un)timely access to care.


Assuntos
Demência/psicologia , Custos de Cuidados de Saúde , Assistência ao Paciente/economia , Qualidade de Vida/psicologia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Demência/economia , Europa (Continente) , Feminino , Humanos , Masculino
18.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 36(supl.1): 19-25, sept. 2018. graf, ilus
Artigo em Espanhol | IBECS | ID: ibc-177033

RESUMO

En este capítulo se revisa el modelo actual de atención a los pacientes con VIH y su impacto económico. Existen diferencias geográficas y clínicas en los cuidados que reciben los pacientes con VIH. Se detecta la necesidad de elaborar nuevos modelos de atención integral de la enfermedad por VIH. La infección por VIH en España es un problema de salud pública relevante y costoso. Los principales costes se deben al tratamiento antirretroviral, los costes indirectos y los costes de hospitalización, consultas y pruebas diagnósticas. Se pone de manifiesto una fuerte asociación entre gravedad y costes. Los pacientes con diagnóstico tardío presentan peor evolución clínica y mayor mortalidad, y emplean más recursos médicos y terapéuticos. La detección precoz de la enfermedad mejora considerablemente la evolución clínica de los pacientes. El incremento de los pacientes en tratamiento y su envejecimiento progresivo aumentarán los costes de la atención al VIH en los próximos años


This chapter reviews the current model of HIV patient care and its economic impact. There are clinical and geographical differences in the care HIV patients receive and a need to develop new models of comprehen-sive HIV care has been identified. HIV infection in Spain is an important and expensive public health problem. The main costs are due to an-tiretroviral therapy, indirect costs and the cost of admission, consultation and diagnostic testing. A strong correlation between severity and cost has been identified. Patients diagnosed late have a poorer clinical course, increased mortality and require more medical and therapeutic resources. Early detection of the disease significantly improves the clinical outcomes of patients. The increased number of patients receiving treatment and their progressive ageing will increase costs of HIV healthcare in the coming years


Assuntos
Humanos , Infecções por HIV/economia , Assistência ao Paciente/economia , Assistência ao Paciente/estatística & dados numéricos , Assistência à Saúde/economia , Assistência à Saúde/métodos , Espanha
19.
Rev Esp Salud Publica ; 922018 Aug 22.
Artigo em Espanhol | MEDLINE | ID: mdl-30129567

RESUMO

BACKGROUND: In the field of the economic evaluation (EE), there is an open debate on the most appropriate perspective to apply. Despite the relevance of the topic, there are hardly any studies that have analyzed the practical consequences of applying the social perspective vs. health care funder. The aim of this study was performed a systematic review of the available evidence to analyze whether the inclusion/exclusion of informal care and/or loss of productivity influence the results and conclusions of economic evaluations. METHODS: A systematic review of the literature was carried out using PubMed and Econlit databases, to determine the publications that contained EE on Alzheimer, Parkinson and Stroke. Inclusion criteria were: a) full EE of the diseases under study; b) from January 2006-July 2016; and c) in English or Spanish. RESULTS: 6,292 references were identified, of which 245 publications meet the selection criteria and were analyzed. After the full-text analysis, 20 references were selected, of which 27 full EE were obtained (20 corresponding to Alzheimer, 1 to Parkinson and 6 to Stroke). In 20 EE (74.1%) the change of the perspective modifies the results, becoming dominant or increasing the saving of the resources by comparing the alternatives from the social perspective. In the remaining 7, the inclusion of social costs involves an increase in the costs of the intervention evaluated against its control. In a single EE, the conclusions vary when including social costs. CONCLUSIONS: The inclusion of social costs can modify the results of EE but their impact on the conclusions is not relevant.


Assuntos
Efeitos Psicossociais da Doença , Eficiência , Custos de Cuidados de Saúde , Assistência ao Paciente/economia , Licença Médica/economia , Desemprego , Humanos , Fatores Socioeconômicos , Espanha
20.
Matern Child Health J ; 22(9): 1240-1246, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29948762

RESUMO

Purpose Hemophilia Treatment Centers (HTCs) provide integrated and comprehensive services to individuals affected with rare bleeding disorders, such as hemophilia and Von Willebrand disease. Through the 340 Drug Pricing Program, HTCs may use pharmacy income to support clinical staff and patient services. The objective of this study was to describe the impact of the 340B program funding on services and support provided by HTCs to persons affected by rare bleeding disorders. Description Federally designated comprehensive HTCs with established 340B programs were invited to participate in a mailed survey in 2014. Participants were requested to report on 340B program-funded staff and services in the calendar year 2013. Assessment The 31 of 37 HTCs responding served over 10,000 individuals, or one-third of the national HTC patient population. The majority of responding HTCs reported that 340B program income supported over 90% of staff such as nurses, social workers, and physical therapists. Conclusion The results from this survey of 31 centers with established programs demonstrates the HTCs' reliance on 340B program support for vital comprehensive services, that are otherwise non-reimbursable, and highlights the importance of the 340B program in sustaining the high quality of care and in increasing access for a geographically dispersed, medically vulnerable population.


Assuntos
Assistência Integral à Saúde/organização & administração , Custos de Medicamentos/legislação & jurisprudência , Hemofilia A/terapia , Assistência ao Paciente/economia , Medicamentos sob Prescrição/economia , Assistência Integral à Saúde/economia , Feminino , Humanos , Seguro de Serviços Farmacêuticos/economia , Masculino , Assistência Farmacêutica/economia , Assistência Farmacêutica/legislação & jurisprudência , Provedores de Redes de Segurança/economia , Inquéritos e Questionários , Estados Unidos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA