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5.
Drugs Today (Barc) ; 55(11): 713-718, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31840686

RESUMO

With 2019 shaping up to be another significant year for health economics and outcomes research, and increasingly innovative health technologies affecting both the cost and impact of healthcare decisions, rapid change is affecting healthcare systems in real time. The theme of this year's International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Europe annual meeting was centered on digital transformation of healthcare; over 4,000 attendees from over 90 countries spent the day in the discussion of the changing roles and shared responsibilities of increased digitization, which involves major changes not only in technology but also in the way care is organized and delivered.


Assuntos
Farmacoeconomia , Congressos como Assunto , Custos e Análise de Custo , Dinamarca
6.
J Law Med ; 27(1): 7-19, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31682337

RESUMO

Debates have taken place for many years internationally, including in Australia, about the therapeutic effectiveness and safety of complementary/alternative medicine (CAM). The issues raised in such disputation go beyond the capacity for patients to make choices informed by contemporary knowledge about the status of such disciplines and the accuracy of claims made by the various stakeholders. As government subsidises rebates under private health insurance for a number of modalities of health care, the entitlements of CAM disciplines to such rebates have become controversial. This editorial traces Australian reports since 2010 about the eligibility for insurance rebates of a number of CAM disciplines and calls for the current 2019-2020 review by the Chief Medical Officer to engage in a fair, rigorous and conclusive evaluative process, utilising as its yardstick contemporary evidence about treatment efficacy. Such a process has the potential to bring to an end disputation that has only served to confuse patient decision-making, cater to vested interests and incur for government costs that cannot properly be justified.


Assuntos
Terapias Complementares , Seguro Saúde , Austrália , Custos e Análise de Custo , Humanos
7.
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(9): 550-554, nov. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-184377

RESUMO

Introducción: La hipertirotropinemia aislada se describe como un a elevación de la hormona estimulante del tiroides (TSH) con niveles normales de hormonas tiroideas y autoinmunidad negativa en pacientes asintomáticos y sin hallazgos en la exploración. Dado el aumento no justificado del análisis de la función tiroidea en niños asintomáticos, el objetivo principal es analizar la evolución de estos pacientes. Como objetivo secundario se realiza un análisis de costes asociado. Material y métodos: Estudio longitudinal observacional retrospectivo de los pacientes derivados a endocrinología de un hospital de tercer nivel por hipertirotropinemia aislada (TSH 5-20 mUI/l). Se recogieron variables clínicas, analíticas, número de visitas hasta el alta, necesidad de tratamiento, tiempo de seguimiento, así como variables económicas. Resultados: Se obtuvo una muestra de 155 pacientes, con edad media de 7,8 años ± 3,6 DE. La derivación a endocrinología representó el 4% de las consultas de primera visita. La cifra media de TSH inicial fue de 7,8 mU/l (5,03-15,8 mU/l). Los niveles de TSH se normalizaron tras la primera repetición durante el mes posterior, en el 60% de los casos. En un intervalo máximo de 3años fueron dados de alta el 83,6%, con un seguimiento medio de 8,14 ± 6,8 meses y 2,4 visitas/paciente. Se obtuvo un coste medio de 251,27 €/paciente (rango 143,49-444,21 €). Conclusión: Es fundamental no generar alarma familiar ante una hipertirotropinemia, dado que se trata de una situación bioquímica que, en la mayoría de los casos, se normaliza. Este hecho, junto con el coste medio derivado de la asistencia especializada, pone de manifiesto que el primer paso debería ser la repetición de la misma en atención primaria


Introduction: Subclinical hypothyroidism is defined as elevation of thyroid-stimulating hormone (TSH) levels, with normal thyroid hormone levels and negative autoimmunity, in asymptomatic patients with no findings on examination. Because of the unwarranted increase in thyroid function tests in asymptomatic children, the main objective of this review was to analyze the course of these patients. Analysis of associated costs was a secondary objective. Material and methods: A longitudinal, observational, retrospective study of patients referred to the endocrinology department of a tertiary hospital for high TSH levels (TSH 5-20 mIU/L). Clinical and laboratory variables, number of visits until discharge, need for treatment, monitoring time, and economic variables were collected. Results: The study sample consisted of 155 patients with a mean age of 7.8 years ± 3.6SD. Referrals to endocrinology accounted for 4% of first office visits. Baseline mean TSH level was 7.8 mU/L (5.03-15.8 mU/L). TSH levels normalized after the first repeated measurement during the subsequent month in 60% of cases. A total of 83.6% of patients were discharged within a maximum of 3years, with a mean follow-up of 8.14 ± 6.8 months and 2.4 visits/patient. Average cost per patient was € 251.27 (range € 143.49-444.21). Conclusion: It is essential not to alarm the family when subclinical hypothyroidism is detected, because this is a biochemical situation which normalizes in most cases. This fact, together with the mean cost of specialized care, suggests that the first step should be repeated TSH measurements in primary care


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Evolução Clínica , Hipotireoidismo/economia , Atenção Primária à Saúde/economia , Tireotropina/sangue , Estudos Longitudinais , Estudos Retrospectivos , Autoimunidade , Custos e Análise de Custo
9.
West Afr J Med ; 36(3): 267-273, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31622490

RESUMO

BACKGROUND: Asthma is known to constitute a huge economic burden to its sufferers and their carers. There is a dearth of studies documenting this burden among asthmatics in Nigeria. OBJECTIVE: This study assessed the relationship between economic cost and psychiatric morbidity among stable Nigerian patients with asthma. METHODS: 85 patients with asthma completed a socio-demographic and illness-related questionnaire, the modified Economic Cost Questionnaire and General Health Questionnaire 12 (GHQ 12). Associations between socio-demographic characteristics, illness related variables, psychiatric morbidity and the direct, indirect and total costs in relation to asthma were assessed. RESULTS: The average annual total, direct and indirect cost were $309, $190.65 and $118.34 respectively per patient for subjects with asthma. Direct cost constituted 62.7% while the indirect cost was 38.3% of the total cost for asthma. Drugs and hospitalisation were leading contributors to direct costs for asthma. Psychiatric morbidity was found to be present in 35% of subjects with asthma, those with psychiatric morbidity had a higher economic burden. CONCLUSION: The economic cost of asthma is high, psychiatric morbidity increases this cost. The cost is largely due to drugs and hospitalisations for exacerbation. There is an urgent need to optimize means of helping to minimize this cost and increase measures for detecting and treating psychiatric morbidity.


Assuntos
Antiasmáticos/economia , Asma/economia , Gastos em Saúde , Hospitalização/economia , Transtornos Mentais/epidemiologia , Antiasmáticos/administração & dosagem , Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Asma/epidemiologia , Efeitos Psicossociais da Doença , Custos e Análise de Custo , Custos Diretos de Serviços/estatística & dados numéricos , Recursos em Saúde/estatística & dados numéricos , Humanos , Morbidade , Nigéria/epidemiologia , Qualidade de Vida
10.
Z Evid Fortbild Qual Gesundhwes ; 146: 28-34, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31570212

RESUMO

INTRODUCTION AND AIM: The ambulatory specialized care (ASV) act (Sect. 116b of the Social Code Fifth Book [SGB V]) is intended to enable patients with a rare disease or a special course of disease or patients needing a highly specialized treatment to get access to outpatient care by office-based as well as hospital doctors. Data concerning care, service performance and fees - in comparison to the usual contract with the statutory insurance or the former Sect. 116b SGB V - are lacking. We explored the question whether differences in reimbursement between ASV and the previous system exist and which factors are influencing them. METHODS: We analyzed ICD-10 diagnoses, performance parameters as well as budgets and service fees in the former care system of medical oncologists in the institutions of three ASV participants of two federal countries treating gastrointestinal malignancies. We compared the results (fees, remuneration) to those from the statutory contract system and the former ambulatory care of hospitals and calculated the differences. Data were analyzed descriptively and analytically using SPSS. RESULTS: The analyses showed significant differences in the reimbursement rates between both office-based teams due to different budgets in the statutory contract system of the different federal countries. This led to additional remuneration of 12.5 to 49 % in ASV. The increase in fees of the hospital-guided team was exclusively due to the ASV-only fees of chapter 51 of EBM since there were no limitations of budgets even in the former system. DISCUSSION AND CONCLUSION: Exemplified with the ASV subgroup GIT, our study shows for the analyzed medical specialty that the difference in reimbursement in ASV is mostly due to the federal country-specific budgets and that the increase in honoraria can be substantial. Due to differences in budgets and quota systems, there may be different results in other ASV indications and specialist groups as well as in other federal states. Irrespective of these arguments, further aspects need to be taken into account when participation in ASV is considered.


Assuntos
Instituições de Assistência Ambulatorial/economia , Neoplasias Gastrointestinais , Custos de Cuidados de Saúde , Reembolso de Seguro de Saúde , Assistência Ambulatorial/economia , Custos e Análise de Custo , Neoplasias Gastrointestinais/economia , Alemanha , Humanos , Oncologia , Mecanismo de Reembolso , Especialização
13.
Water Sci Technol ; 80(4): 762-772, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31661455

RESUMO

A comprehensive OPEX analysis for both municipal and industrial wastewaters has been conducted encompassing energy, critical component (membrane) replacement, chemicals consumption, waste disposal and labour. The analysis was preceded by a review of recent data on industrial effluent treatability with reference to published chemical oxygen demand (COD) removal data for four effluent types: food and beverage, textile, petroleum and landfill leachate. Outcomes revealed labour costs to be the most significant of those considered, contributing 50% of the OPEX for a 10,000 m3/day capacity municipal wastewater treatment works. An analysis of the OPEX sensitivity to 12 individual parameters (labour cost, flux, electrical energy cost, membrane life, feed COD, membrane cost, membrane air-scour rate, chemicals cost, waste disposal cost, mixed liquor suspended solids (MLSS) concentration, recirculation ratio, and transmembrane pressure) revealed OPEX to be most sensitive to labour effort and/or costs for all scenarios considered other than a large (100,000 m3/day capacity) works, for which flux and electrical energy costs were found to be slightly more influential. It was concluded that for small- to medium-sized plants cost savings are best made through improving the robustness of plants to limit manual intervention necessitated by unforeseen events, such as electrical/mechanical failure, foaming or sludging.


Assuntos
Eliminação de Resíduos Líquidos , Poluentes Químicos da Água , Análise da Demanda Biológica de Oxigênio , Reatores Biológicos , Custos e Análise de Custo , Resíduos Industriais , Águas Residuárias
14.
Am Surg ; 85(10): 1129-1133, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657308

RESUMO

Best management for acute appendicitis (AA) in adults with liver cirrhosis is controversial and needs more investigation. We aimed to examine the impact of different treatment modalities on outcomes in this complex patient population. The Nationwide Inpatient Sample database from 2012 to 2014 was queried to identify AA patients with no cirrhosis, compensated cirrhosis (CC), and decompensated cirrhosis (DC). Each cohort was further stratified according to the treatment type: nonoperative management, open appendectomy, and laparoscopic appendectomy (LA). Chi-square, ANOVA, and binary regression analyses were used to determine differences between groups and risk factors for mortality and complications, with P < 0.05 considered statistically significant. A total of 108,289 AA patients were analyzed; of those, 304 with CC and 134 with DC were identified. Compared with CC and no cirrhosis, DC patients had significantly higher mortality, higher cost, and longer hospital length of stay. LA is accompanied by higher survival, lower cost, shorter duration of hospitalization, and lower incidence of complications across all groups. We conclude that LA is the best management strategy for AA in cirrhotic patients. Even in decompensated cirrhotics, which are associated with worse clinical outcomes, LA is still a favorable option over open appendectomy and nonoperative management.


Assuntos
Apendicectomia/métodos , Apendicite/cirurgia , Laparoscopia , Cirrose Hepática/complicações , Doença Aguda , Adulto , Análise de Variância , Apendicectomia/efeitos adversos , Apendicectomia/economia , Apendicectomia/mortalidade , Apendicite/complicações , Apendicite/mortalidade , Distribuição de Qui-Quadrado , Conversão para Cirurgia Aberta/estatística & dados numéricos , Custos e Análise de Custo , Feminino , Preços Hospitalares , Mortalidade Hospitalar , Humanos , Incidência , Laparoscopia/economia , Laparoscopia/mortalidade , Tempo de Internação/economia , Cirrose Hepática/classificação , Cirrose Hepática/mortalidade , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Análise de Regressão , Fatores de Risco , Resultado do Tratamento
15.
Rev. Ciênc. Plur ; 5(2): 32-48, ago. 2019. ilus, tab
Artigo em Português | LILACS, BBO - Odontologia | ID: biblio-1021750

RESUMO

Introdução:A contabilidade de custos é uma etapa importante na gestão pública para otimizar os gastos e diminuir desperdícios, representando um indicador de eficiência econômica. Contudo, é uma atividade complexa, onde a maioria dos custos é de difícil obtenção, especialmente em Unidades de alimentação e nutrição (UANs), devido à variação no número de refeições e matéria prima, e indisponibilidade de custos indiretos individualizados. Objetivo:Apresentar uma proposta metodológica para cálculo do custo-refeição em UANs vinculadas a serviços públicos.Método:Esta proposta surgiu de um estudo prático realizado no restaurante da Escola Agrícola de Jundiaí/UFRN. Para a composição do custo-refeição foram observados os componentes dos custos diretos e indiretos. Os preços unitários por material/serviço foram obtidos por meio das atas de licitações e contratos.Resultados:A análise individual de cada componente permitiu verificar a necessidade de estabelecer diretrizes para os custos, obtendo-se os seguintes direcionamentos: gêneros de alimentação ­elaboração das fichas técnicas de preparação de, no mínimo, dois cardápios semanais completos e preços por gênero calculados por média ponderada; material de limpeza, telefonia, gás de cozinha e água mineral -análise do gasto trimestral; energia elétrica ­análise da potência, tempo e horário de funcionamento de cada equipamento e cálculo do gasto de energia conforme tarifas na "ponta" e "fora da ponta"; despesas com manutenção de equipamentos e instalações, material de expediente e descartável ­análise semestral e, todos os cálculos efetuados utilizando a média mensal. Por fim, a partir do custo com gêneros alimentícios foram calculados os pesos de cada refeição e gerada a unidade-refeição, obtendo-se o custo final por meio da soma do custo de cada refeição com o produto de seu peso vezes a unidade-refeição.Conclusão:A presente proposta apresenta uma perspectiva prática e fidedigna para o cálculo de custo-refeição (AU).


Introduction:Costs accountancy is an important step on public management to optimize expenses and reduce wasting, representing an economicalefficiency index. However, that is a complex activity, which the most of costs is hard to obtain, especially in Food Services due the variability on number of meals and raw material, and individualized indirect costs unavailable.Objective:To present a methodological proposal to compute meal-cost in public Food Services. Methods:This proposal emerged from a practical study performed in the restaurant of Jundiai Agricultural School (Escola Agrícola de Jundiai/UFRN). To compose meal-cost, direct and indirect components were observed. Material/services unitary prices were obtained through bidding and contracts records. Results:Individual analysis of each component allowed to verify the necessity of establishment guidelines for cost, obtaining the following directions: groceries -technical cards elaboration of, at least, two full weekly menus and groceries prices computed by weighted average; cleaning stuff, telephony, cooking gas and mineral water ­three months expenses analysis; electrical energy ­analysis of power, time and shift of working for each equipment and energy expenses calculation "on the tip" and "out of the tip"; equipment and installation maintenance expenses, office stuff and disposable stuff ­six months expenses analysis and, all calculations using monthly average. Finally, from groceries costs weighs were computed of each meal and the meal-unit was generated, obtaining the final cost by summing the cost of each meal with the product of its weight multiplied by the meal-unit. Conclusion:The present proposal shows a practical and reliable perspective for meal-cost calculation (AU).


Assuntos
Restaurantes/normas , Universidades , Custos e Análise de Custo , Alimentação Coletiva , Brasil , Relatos de Casos , Consumo de Alimentos , Refeições
17.
Environ Monit Assess ; 191(10): 616, 2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31493130

RESUMO

This study is the first meta-regression analysis of the economic value of regulating ecosystem services at the global level. Most of the regulating ecosystem services have not been properly estimated in terms of economic value and are also ignored in the everyday decision-making process. This study has reviewed 100 publications and included 275 economic value estimates. This study includes explanatory variables in the meta-analysis to account for these influences on the estimated economic value of regulating ecosystem services. This study has estimated the economic value of regulating ecosystem services at US$29.085 trillion for 2015. This study also has found that the values of climate and water regulations are the highest contributors to the total value of regulating ecosystem services. This study indicates that the results of meta-analysis might be helpful to decision-making with respect to three aspects: first, planning and management of urban green cover for sustainable cities; second, integration of the economic value of all the regulating ecosystem services; third, budget allocation for conservation and improvement of regulating ecosystem services for the present and future generations.


Assuntos
Conservação dos Recursos Naturais/economia , Conservação dos Recursos Naturais/legislação & jurisprudência , Ecossistema , Planejamento de Cidades/economia , Clima , Custos e Análise de Custo , Tomada de Decisões , Monitoramento Ambiental/economia , Recursos Hídricos
18.
Waste Manag ; 100: 219-229, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31546182

RESUMO

The mining industry is one of the world's massive scrap off-the-road (OTR) tire generators. Reverse logistics (RL) allows for a cost-effective treatment of residual items with environmentally friendly practices. This paper aims to design a RL network for large OTR tires discarded from scattered mining sites, which requires a substantial initial investment in tire downsizing equipment. Therefore, the on-site use of a single shared shredding resource set is proposed with a schedule of visits between mines. Our contribution is a mixed-integer linear programming model set to determine the OTR tires optimal network, including decisions regarding a tire-fuelled power plant location, tire shredding and transport amounts, and a shredding resource set schedule to maximize the profits of the RL network while considering whole waste tire stockpile limits per year. Results showed that the proposed RL network starting from mine shredding tires and supplying a power generation plant might be a profitable solution that could help mines to comply with the legal regulations and turn this waste into a positive economic value good. Environmental and social implications are the mitigation of scrap tires, an increased job demand triggered by power plants, and public health improvement in the vicinity of the mining sites.


Assuntos
Programação Linear , Custos e Análise de Custo
19.
Global Health ; 15(1): 57, 2019 09 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533850

RESUMO

In 2015, the World Health Organization (WHO) Expert Committee approved the addition of 16 cancer medicines to the WHO Model List of Essential Medicines (EML), bringing the total number of cancer medicines on the list to 46. This change represented the first major revision to the EML oncology section in recent history and reinforces international recognition of the need to ensure access and affordability for cancer treatments. Importantly, many low and middle-income countries rely on the EML, as well as the children's EML, as a guide to establish national formularies, and moreover use these lists as tools to negotiate medicine pricing. However, EML inclusion is only one component that impacts cancer treatment access. More specifically, factors such as intellectual property rights and international trade agreements can interact with EML inclusion, drug pricing, and accessibility. To better understand this dynamic, we conducted an interdisciplinary review of the patent status of EML cancer medicines compared to other EML noncommunicable disease medicines using the 17th, 18th, 19th, 20th, and 21st editions of the list. We also explored the interaction of intellectual property rights with the international trade regime and how trade agreements can and do impact cancer treatment access and affordability. Based on this analysis, we conclude that patent status is simply one factor in the complex international environment of health systems, IPR policies, and trade regimes and that aligning these oftentimes disparate interests will require shared global governance across the cancer care continuum.


Assuntos
Antineoplásicos , Comércio/organização & administração , Medicamentos Essenciais , Propriedade Intelectual , Cooperação Internacional , Políticas , Antineoplásicos/economia , Antineoplásicos/provisão & distribução , Custos e Análise de Custo , Medicamentos Essenciais/economia , Medicamentos Essenciais/provisão & distribução , Acesso aos Serviços de Saúde , Humanos , Neoplasias/tratamento farmacológico , Organização Mundial da Saúde
20.
Orthopade ; 48(11): 963-968, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31506824

RESUMO

Total knee arthroplasty (TKA) is a frequent operation in Germany and in 2017 a total of 191,272 interventions were carried out. These interventions are associated with high costs and involve complex clinical workflow organization and time-consuming instrument logistics. With this in mind, the aim of this study was to identify the economic potential of the instrument configuration in order to optimize the entire process in TKA. Changing the composition of the set of instruments used in the operating theater for TKA resulted in time and cost saving for the complete TKA procedure, including all personnel and off-shoot procedures. In addition, the operating time saved by the introduction of a patient-specific instrumentation set meant that the operating theater could be used for more or other surgical procedures, also generating additional revenue.


Assuntos
Artroplastia do Joelho/instrumentação , Salas Cirúrgicas/organização & administração , Osteoartrite do Joelho/cirurgia , Instrumentos Cirúrgicos/economia , Artroplastia do Joelho/economia , Artroplastia do Joelho/métodos , Redução de Custos , Custos e Análise de Custo , Eficiência , Alemanha , Custos Hospitalares , Humanos , Salas Cirúrgicas/economia
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