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2.
J Med Econ ; 24(1): 524-535, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33851557

RESUMO

AIMS: The electrosurgical technology category is used widely, with a diverse spectrum of devices designed for different surgical needs. Historically, hospitals are supplied with electrosurgical devices from several manufacturers, and those devices are often evaluated separately; it may be more efficient to evaluate the category holistically. This study assessed the health economic impact of adopting an electrosurgical device-category from a single manufacturer. METHODS: A budget impact model was developed from a U.S. hospital perspective. The uptake of electrosurgical devices from EES (Ethicon Electrosurgery), including ultrasonic, advanced bipolar, smoke evacuators, and reusable dispersive electrodes were compared with similar MED (Medical Energy Devices) from multiple manufacturers. It was assumed that an average hospital performed 10,000 annual procedures 80% of which involved electrosurgery. Current utilization assumed 100% MED use, including advanced energy, conventional smoke mitigation options (e.g. ventilation, masks), and single-use disposable dispersive electrode devices. Future utilization assumed 100% EES use, including advanced energy devices, smoke evacuators (i.e. 80% uptake), and reusable dispersive electrodes. Surgical specialties included colorectal, bariatric, gynecology, thoracic and general surgery. Systematic reviews, network meta-analyses, and meta-regressions informed operating room (OR) time, hospital stay, and transfusion model inputs. Costs were assigned to model parameters, and price parity was assumed for advanced energy devices. The costs of disposables for dispersive electrodes and smoke-evacuators were included. RESULTS: The base-case analysis, which assessed the adoption of EES instead of MED for an average U.S. hospital predicted an annual savings of $824,760 ($101 per procedure). Savings were attributable to associated reductions with EES in OR time, days of hospital stay, and volume of disposable electrodes. Sensitivity analyses were consistent with these base-case findings. CONCLUSIONS: Category-wide adoption of electrosurgical devices from a single manufacturer demonstrated economic advantages compared with disaggregated product uptake. Future research should focus on informing comparisons of innovative electrosurgical devices.


Assuntos
Orçamentos , Eletrocirurgia/economia , Eletrocirurgia/instrumentação , Procedimentos Cirúrgicos Operatórios/classificação , Procedimentos Cirúrgicos Operatórios/economia , Análise Custo-Benefício , Administração Financeira de Hospitais/economia , Humanos , Tempo de Internação , Modelos Econômicos , Duração da Cirurgia , Avaliação da Tecnologia Biomédica
3.
Semin Vasc Surg ; 34(1): 59-64, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33757637

RESUMO

Chronic venous insufficiency (CVI) affects more than 25 million adults in the United States alone, and more 6 million with advanced stages of venous disease. The high incidence of CVI and the increasing costs of care, place a heavy financial burden on the US health care system. Recent studies estimate the total cost of care at more than $3 billion per year. These staggering numbers highlight the importance of timely diagnosis, treatment, and prevention of CVI. In this article, we review the epidemiology and prevalence of CVI, and its financial impact on national health care budget. Racial disparities in CVI and the impact of socioeconomic status on access to care are also discussed. Finally, we discuss CVI-related screening programs and the importance of preventative measures in venous disease.


Assuntos
Custos de Cuidados de Saúde , Insuficiência Venosa , Fatores Etários , Orçamentos , Doença Crônica , Efeitos Psicossociais da Doença , Feminino , Disparidades em Assistência à Saúde/economia , Humanos , Incidência , Masculino , Prevalência , Prognóstico , Fatores Raciais , Medição de Risco , Fatores de Risco , Fatores Sexuais , Determinantes Sociais da Saúde , Fatores Socioeconômicos , Estados Unidos/epidemiologia , Insuficiência Venosa/diagnóstico , Insuficiência Venosa/economia , Insuficiência Venosa/epidemiologia , Insuficiência Venosa/terapia
5.
Value Health ; 24(3): 388-396, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33641773

RESUMO

OBJECTIVES: Various strategies to address healthcare spending and medical costs continue to be debated and implemented in the United States. To date, these efforts have failed to adequately contain the growth of healthcare cost. An alternative strategy that has elicited rising interest among policymakers is budget caps. As budget caps become more prevalent, it is important to identify which features are needed to ensure success, both in terms of cost reduction and health improvement. METHODS: We explored the impacts of different features of budget caps by comparing hypothetical service level and global budget caps across 3 annual budget cap growth strategies over a 10-year timeframe in 2005-2015 for 8 of the most commonly occurring conditions in the United States. Health was assessed by a measure of disease burden (disability-adjusted life years). RESULTS: The results indicate that budget caps have the potential for creating savings but can also result in patient harm if not designed well. As a result of these findings, 5 principles were developed for designing budget caps and should guide the use of budget caps to address medical spending. CONCLUSIONS: As public discussion grows about the use of budget caps to constrain health spending, it is critical to recognize that the budget cap design and the resulting healthcare provider behavior will determine whether there is potential harm to public health. Budget cap design should consider variability at the condition level, including patient population, improvements in health, treatment costs, and the innovations available, to both create savings and maximize patient health. In assessing the impact of healthcare spending caps on costs and disease burden, we demonstrate that budget cap design determines potential harm to public health.


Assuntos
Orçamentos/estatística & dados numéricos , Alocação de Recursos para a Atenção à Saúde/organização & administração , Medicamentos sob Prescrição/economia , Controle de Custos , Alocação de Recursos para a Atenção à Saúde/economia , Gastos em Saúde/estatística & dados numéricos , Humanos , Estados Unidos
6.
BMC Health Serv Res ; 21(1): 222, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33711994

RESUMO

BACKGROUND: Innovative orphan drugs often have an incremental cost-effectiveness ratio (ICER) which is higher than the maximum threshold for reimbursement. Payers have limited budgets and often cannot pay the full price of a new product, but pharmaceutical and biotechnology companies require a minimum price to satisfy their investors. The objective of this study was to present a possible solution to bridge this pricing gap by having early phase price agreements, which reduce the risk for investors. METHODS: We used a Pricing Model, which determines the minimum (break-even) price of an innovative drug from an investor's perspective. This model is based on economic valuation theory, which uses the expected free cash flows and the required cost of capital. We selected two orphan drugs with a positive clinical assessment and an ICER higsher than the Dutch maximum threshold of €80,000 per QALY gained to use as examples in the model: Spinraza for spinal muscular atrophy and Orkambi for cystic fibrosis. RESULTS: The results show that early pricing agreements before phase III trials can substantially lower the drug price resulting from a lower cost of capital. The minimum price for orphan drugs can be reduced by 27.4%, when cost of capital decreases from 12 to 9%. An additional adjustment of other critical parameters due to early pricing agreements (lower probabilities of phase III failure and lower research and development (R&D) costs) can further reduce the minimal price by 62.8%. CONCLUSION: This study shows that earlier timing of price negotiations resulting in an agreement on drug price can substantially lower the minimal price of orphan drugs for the investor.


Assuntos
Custos de Medicamentos , Produção de Droga sem Interesse Comercial , Orçamentos , Análise Custo-Benefício , Humanos , Negociação
7.
Document officiel;358
Monografia em Francês | PAHO-IRIS | ID: phr-53365

RESUMO

Le Budget programme 2020-2021 constitue un « contrat » fondé sur les résultats entre le Bureau sanitaire panaméricain (BSP) et les États Membres de l’OPS, chacun s’engageant à prendre les mesures respectives nécessaires pour obtenir les résultats intermédiaires et les résultats immédiats en matière de santé qu’il contient. L’approbation, la mise en œuvre et l’établissement de rapports sur le présent budget programme sont les principaux moyens de reddition de comptes sur les activités programmatiques du BSP. L’aspect budgétaire du budget programme constitue l’un des deux principaux piliers de la responsabilisation financière (avec le rapport financier annuel du Directeur et le rapport du Commissaire aux comptes). À quelques exceptions notables près, la somme totale des activités du BSP pour les deux prochaines années est représentée dans le présent budget programme.


Assuntos
Organização Pan-Americana da Saúde , Cooperação Técnica , Orçamentos , Agenda de Prioridades em Saúde , Prioridades em Saúde , Gestão em Saúde
8.
Documento Oficial;358
Monografia em Português | PAHO-IRIS | ID: phr-53360

RESUMO

Este Orçamento por Programas 2020-2021 constitui um “contrato” baseado em resultados entre a Repartição Sanitária Pan-Americana (RSPA) e os Estados Membros da OPAS, cada qual realizando os esforços necessários para executar as respectivas ações exigidas para alcançar os resultados imediatos e intermediários relacionados à saúde aqui contidos. A aprovação, implementação e divulgação deste Orçamento por Programas são os principais meios de prestação de contas do trabalho programático da RSPA. O aspecto orçamentário do Orçamento por Programas constitui um dos dois pilares da responsabilidade financeira da Organização, juntamente com o Relatório Financeiro Anual da Diretora e o Relatório do Auditor Externo. Com algumas exceções notáveis, o somatório do trabalho da RSPA para os próximos dois anos está representado neste Orçamento por Programas.


Assuntos
Organização Pan-Americana da Saúde , Cooperação Técnica , Orçamentos , Prioridades em Saúde , Gestão em Saúde
9.
Documento Oficial;358
Monografia em Espanhol | PAHO-IRIS | ID: phr-53359

RESUMO

El Presupuesto por Programas 2020-2021 representa un “contrato” basado en resultados entre la Oficina Sanitaria Panamericana (“la OSP”) y los Estados Miembros de la OPS, de acuerdo con el cual cada parte se compromete a tomar las medidas necesarias para alcanzar los resultados intermedios e inmediatos en materia de salud establecidos en este documento. La aprobación, la ejecución y la presentación de informes de este Presupuesto por Programas es el medio principal de rendición de cuentas del trabajo programático de la Oficina. El aspecto presupuestario del Presupuesto por Programas es uno de los dos pilares principales de la rendición de cuentas financiera (junto con el informe financiero anual del Director y el informe del auditor externo). Con unas pocas excepciones notables, en este presupuesto por programas se presenta la totalidad del trabajo de la Oficina para los próximos dos años.


Assuntos
Cooperação Técnica , Organização Pan-Americana da Saúde , Orçamentos , Prioridades em Saúde , Gestão de Recursos
10.
Can J Public Health ; 112(2): 186-190, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33625685

RESUMO

Inspired by Fiset-Laniel et al.'s (2020) article entitled "Public health investments: neglect or wilful omission? Historical trends in Quebec and implications for Canada", we assessed public health investments since the establishment of the Nova Scotia provincial health authority in 2015. We analyzed Nova Scotia Department of Health and Wellness budgets from 2015-2016 to 2019-2020 and observed that less than 1% of funding was budgeted for public health annually, an amount well below the recommendation that 5-6% of healthcare funding be spent on public health. Healthcare spending has increased annually since 2015-2016, but proportions of funding to different programs and services have remained static. Specifically, we did not observe a change in investment in public health over time, suggesting that while the government does not necessarily spend too much or too little on healthcare, it spends far too little on public health. This chronic under-funding is problematic given the high rates of non-communicable diseases in Nova Scotia and health inequities experienced within the population. The 2020 COVID-19 pandemic has highlighted the importance of public health work, and the need for a pandemic recovery plan that prioritizes investment in all areas of public health in Nova Scotia.


Assuntos
Orçamentos/tendências , Financiamento Governamental/economia , Saúde Pública/economia , Disparidades nos Níveis de Saúde , Humanos , Doenças não Transmissíveis/epidemiologia , Nova Escócia/epidemiologia
12.
Rev. adm. pública (Online) ; 55(1): 140-150, Jan.-Feb. 2021. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1155660

RESUMO

Abstract Given the lack of governmental guidelines, this paper identifies and analyzes the statistical determinants associated with receiving the onetime monetary transfer in El Salvador ($300 dollars) as an economic measure to face the COVID-19 pandemic. A logistic regression was implemented (whether received the transfer or not) based on a probabilistic sample (n=1222) of surveyed people throughout the country. Independent variables were selected drawing upon key characteristics employed internationally in monetary transfers: age, gender, rural area, employment, family income, and education. The text identifies a statistically significant and negative relation between receiving the monetary transfer and two variables: family income and educational level. The need to increase coverage of the program is addressed as well as the importance of considering age, gender, rural areas, and employment as criteria for selecting the beneficiaries in such economic measures.


Resumo Dada a ausência de diretrizes governamentais, o texto apresenta uma análise exploratória e identifica quais são os fatores estatísticos determinantes que explicam a transferência única de renda ($300 dólares) como medida econômica para enfrentar a pandemia gerada pela COVID-19 em El Salvador. Para tal fim, utiliza-se uma análise estatística de regressão logística (receber ou não a ajuda) com base em uma amostra probabilística de respondentes em todo o país (n=1222). Como variáveis independentes emprega-se caraterísticas importantes utilizadas em programas de transferência de renda em todo o mundo: Idade, gênero, zona de procedência, emprego e renda familiar e nível educacional. O presente texto identifica que existe uma relação inversa e estatisticamente significativa entre essa ajuda pública com a renda familiar e o nível educacional. Finalmente, discute-se a necessidade de ampliação do programa econômico e a importância de considerar características como idade, gênero, zona de procedência e emprego nesse tipo de políticas econômicas.


Resumen Ante la falta de lineamientos gubernamentales, el presente texto muestra un análisis exploratorio e identifica cuáles han sido los determinantes estadísticos asociados a la recepción de la transferencia monetaria única ($300 dólares) como medida económica para enfrentar la pandemia de COVID-19 en El Salvador. Para tal efecto, se utiliza un análisis estadístico de regresión logística (recibir la ayuda o no) con base en una muestra probabilística de encuestados en todo el país (n=1222). Como variables independientes se emplean características cruciales utilizadas en programas de transferencias monetarias a nivel internacional: Edad, género, lugar de origen, empleo, ingresos familiares y nivel educacional. El presente texto identifica que existe una relación inversa y estadísticamente significativa entre la asignación de esa ayuda pública, los ingresos familiares y el nivel educacional. Finalmente, se discute la necesidad de ampliación del programa y la importancia de considerar aspectos como edad, género, lugar de origen y empleo en ese tipo de políticas económicas.


Assuntos
Humanos , Masculino , Feminino , Política Pública , Orçamentos , Infecções por Coronavirus , Economia , Políticas Públicas de Saúde
14.
Goiania; SES-GO; 21 jan. 2021. 1-3 p. mapas.
Não convencional em Português | LILACS, Coleciona SUS, CONASS, SES-GO | ID: biblio-1148393

RESUMO

O Sistema único de Saúde (SUS) tem o desafio de equilibrar uma crescente demanda de serviços de saúde de um país de proporções continentais como o Brasil, frente à necessidade de administrar recursos escassos, considerando a complexidade das instituições de saúde (DELA PASE, 2015), e enfrentando ainda limitações na qualidade da atenção, na incorporação de novas tecnologias, na gestão de seus recursos e na distribuição equitativa dos serviços (LAFORGIA, 2009, apud MPMA, 2017). Diante deste cenário, o Ministério da Saúde (MS) instituiu o Programa Nacional de Gestão de Custos (PNGC), tendo por objetivo promover a cultura de gestão de custos no âmbito do SUS, com foco na qualidade do gasto, oferecendo ferramentas e capacitação para auxiliar os gestores na melhoria dos processos, para produzir informação gerencial e apoiar a tomada de decisões (BRASIL, 2018).


The Unified Health System (SUS) has the challenge of balancing a growing demand for health services in a country of continental proportions such as Brazil, given the need to manage scarce resources, considering the complexity of health institutions (DELA PASE, 2015), and also facing limitations in the quality of care, in the incorporation of new technologies, in the management of its resources and in the equitable distribution of services (LAFORGIA , 2009, apud MPMA, 2017). Given this scenario, the Ministry of Health (MS) instituted the National Cost Management Program (PNGC), aiming to promote the culture of cost management within the SUS, focusing on the quality of spending, offering tools and training to assist managers in improving processes, to produce management information and support decision-making (BRASIL, 2018).


Assuntos
Orçamentos/métodos , Gastos em Saúde/normas , Custos e Análise de Custo/métodos
15.
BMC Health Serv Res ; 21(1): 90, 2021 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-33499854

RESUMO

BACKGROUND: Healthcare spending has grown over the last decades in all developed countries. Making hard choices for investments in a rational, evidence-informed, systematic, transparent and legitimate manner constitutes an important objective. Yet, most scientific work in this area has focused on developing/improving prescriptive approaches for decision making and presenting case studies. The present work aimed to describe existing practices of priority setting and resource allocation (PSRA) within the context of publicly funded health care systems of high-income countries and inform areas for further improvement and research. METHODS: An online qualitative survey, developed from a theoretical framework, was administered with decision-makers and academics from 18 countries. 450 individuals were invited and 58 participated (13% of response rate). RESULTS: We found evidence that resource allocation is still largely carried out based on historical patterns and through ad hoc decisions, despite the widely held understanding that decisions should be based on multiple explicit criteria. Health technology assessment (HTA) was the tool most commonly indicated by respondents as a formal priority setting strategy. Several approaches were reported to have been used, with special emphasis on Program Budgeting and Marginal Analysis (PBMA), but limited evidence exists on their evaluation and routine use. Disinvestment frameworks are still very rare. There is increasing convergence on the use of multiple types of evidence to judge the value of investment options. CONCLUSIONS: Efforts to establish formal and explicit processes and rationales for decision-making in priority setting and resource allocation have been still rare outside the HTA realm. Our work indicates the need of development/improvement of decision-making frameworks in PSRA that: 1) have well-defined steps; 2) are based on multiple criteria; 3) are capable of assessing the opportunity costs involved; 4) focus on achieving higher value and not just on adoption; 5) engage involved stakeholders and the general public; 6) make good use and appraisal of all evidence available; and 6) emphasize transparency, legitimacy, and fairness.


Assuntos
Assistência à Saúde , Alocação de Recursos , Orçamentos , Análise Custo-Benefício , Assistência à Saúde/economia , Países Desenvolvidos , Prioridades em Saúde , Humanos , Investimentos em Saúde , Avaliação da Tecnologia Biomédica
16.
Lancet Glob Health ; 9(2): e181-e188, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33482139

RESUMO

BACKGROUND: The Global Fund to Fight AIDS, Tuberculosis and Malaria is a robust vertical global health programme. The extent to which vertical programmes financially support health security has not been investigated. We, therefore, endeavoured to quantify the extent to which the budgets of this vertical programme support health security. We believe this is a crucial area of work as the global community works to combine resources for COVID-19 response and future pandemic preparedness. METHODS: We examined budgets for work in Kenya, Uganda, Vietnam, Democratic Republic of the Congo, Guatemala, Guinea, India, Indonesia, Nigeria, and Sierra Leone from January, 2014 to December, 2020. These ten countries were selected because of the robustness of investments and the availability of data. Using the International Health Regulations Joint External Evaluation (JEE) tool as a framework, we mapped budget line items to health security capacities. Two researchers independently reviewed each budget and mapped items to the JEE. Budgets were then jointly reviewed until a consensus was reached regarding if an item supported health security directly, indirectly, or not at all. The budgets for the study countries were inputted into a single Microsoft Excel spreadsheet and line items that mapped to JEE indicators were scaled up to their respective JEE capacity. Descriptive analyses were then done to determine the total amount of money budgeted for activities that support health security, how much was budgeted for each JEE capacity, and how much of the support was direct or indirect. FINDINGS: The research team reviewed 37 budgets. Budgets totalled US$6 927 284 966, and $2 562 063 054 (37·0%) of this mapped to JEE capacities. $1 330 942 712 (19·2%) mapped directly to JEE capacities and $1 231 120 342 (17·8%) mapped indirectly to JEE capacities. Laboratory systems, antimicrobial resistance, and the deployment of medical countermeasures and personnel received the most overall budgetary support; laboratory systems, antimicrobial resistance, and workforce development received the greatest amount of direct budgetary support. INTERPRETATION: Over one-third of the Global Fund's work also supports health security and the organisation has budgeted more than $2 500 000 000 for activities that support health security in ten countries since 2014. Although these funds were not budgeted specifically for health security purposes, recognising how vertical programmes can synergistically support other global health efforts has important implications for policy related to health systems strengthening. FUNDING: Resolve to Save Lives: An Initiative of Vital Strategies.


Assuntos
Organização do Financiamento/economia , Saúde Global/economia , Cooperação Internacional , Orçamentos , /prevenção & controle , Países em Desenvolvimento , Programas Governamentais/economia , Humanos , Pandemias/prevenção & controle , Estados Unidos
17.
J Gen Intern Med ; 36(4): 1067-1070, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33483809

RESUMO

Medicaid, which provides health insurance to low-income Americans, is a joint federal-state partnership that manifests as 50 unique state programs. States have policy flexibility to design programs within federal parameters. However, Medicaid also requires funding flexibility to encourage states to maintain services during times of crisis when more people need Medicaid. Currently, Medicaid's funding formula, the Federal Medical Assistance Percentage (FMAP), adjusts federal spending by state levels of economic development but fails to adjust for nationwide recessions. During economic contractions, the federal government should use its ability to run budget deficits to reimburse states at higher rates in exchange for maintaining services. In turn, during economic expansions, states should shoulder relatively more costs of Medicaid. Although the current FMAP boost provided under the Families First Coronavirus Response Act has reduced strain on state Medicaid programs, it does not account for the severity of state-specific downturns and is limited to the current emergency. Instead of ad hoc, across-the-board FMAP boosts to respond to each crisis, Congress should pass legislation making automatic adjustments based on changes in state unemployment rates.


Assuntos
Medicaid , Orçamentos , Governo Federal , Humanos , Estados Unidos
18.
Public Health ; 190: 116-122, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33450632

RESUMO

OBJECTIVES: We develop a patient prioritization scheme for treating patients infected with hepatitis C virus (HCV) and study under which scenarios it outperforms the current practices in Spain and Chile. STUDY DESIGN: We use simulation to evaluate the performance of prioritization rules under two HCV patient cohorts, constructed using secondary data of public records from Chile and Spain, during 2015-2016. METHODS: We use the results of a mathematical model, which determines individual optimal HCV treatment policies as an input for constructing a patient prioritization rule, when limited resources are present. The prioritization is based on marginal analysis on cost increases and health-outcome gains. We construct the Chilean and Spanish case studies and used Monte Carlo simulation to evaluate the performance of our methodology in these two scenarios. RESULTS: The resulting prioritizations for the Chilean and Spanish patients are similar, despite the significant differences of both countries, in terms of epidemiological profiles and cost structures. Furthermore, when resources are scarce compared with the number of patients in need of the new drug, our prioritization significantly outperforms current practices of treating sicker patients first, both in terms of cost and healthcare indicators: for the Chilean case, we have an increase in the quality-adjusted life years (QALYs) of 0.83 with a cost reduction of 8176 euros per patient, with a budget covering 2.5% of the patients in the cohort. This difference slowly decreases when increasing the available resources, converging to the performance indicators obtained when all patients are treated immediately: for the Spanish case, we have a decrease in the QALYs of 0.17 with a cost reduction of 1134 euros per patient, with a budget covering 20% of the patients in the cohort. CONCLUSION: Decision science can provide useful analytical tools for designing efficient public policies that can excel in terms of quantitative health performance indicators.


Assuntos
Antivirais/uso terapêutico , Hepacivirus/isolamento & purificação , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/tratamento farmacológico , Antivirais/economia , Orçamentos , Chile/epidemiologia , Estudos de Coortes , Análise Custo-Benefício , Feminino , Custos de Cuidados de Saúde , Hepacivirus/efeitos dos fármacos , Hepatite C Crônica/economia , Humanos , Programas de Rastreamento/economia , Modelos Teóricos , Método de Monte Carlo , Anos de Vida Ajustados por Qualidade de Vida , Espanha/epidemiologia , Resultado do Tratamento
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