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Análise da relação custo-efetividade do tratamento com DCI - Desfibrilador Cardioversor Implantável; Cost-effectiveness analysis of implantable cardioverter defibrillator therapy (ICD)

Matos, Afonso José de
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 23/03/2007 PT
Relevância na Pesquisa
66.06%
Objetivo: Análise da relação custo-efetividade do tratamento com o uso do DCI - Desfibrilador Cardioversor Implantável comparado com o tratamento clínico alternativo através de medicamentos. Revisão de literatura: O estudo contemplou a revisão da conceituação das técnicas de avaliação econômica e de apropriação de custos de procedimentos hospitalares, bem como experiências sobre a análise da relação custo-efetividade aplicadas às intervenções médicas consideradas na pesquisa. Métodos: O estudo utilizou a unidade de Custo por AVG - Ano de Vida Ganho, como expressão do indicador de custo-efetividade. A metodologia compreendeu a definição da perspectiva da pesquisa (Sistema Único de Saúde na qualidade de principal financiador do implante de DCIs, no Brasil), elaboração dos protocolos padrões de tratamento, cálculo dos custos totais dos tratamentos baseados em indicadores praticados por hospitais de referência, os quais encontram-se estimados para o período de dez anos e ajustados para valor presente à taxa de desconto de 6% ao ano. No âmbito da efetividade, foram utilizados parâmetros da literatura, os quais encontram-se baseados nos anos de vida ganhos do tratamento com o uso do DCI, em relação ao tratamento clínico. Resultados: O custo por AVG alcançado pelo estudo foi de R$ 20.530...

Saúde Pública no Brasil: proposta de um modelo de avaliação de custo-efetividade utilizando o IDSUS; Public Health in Brazil: a proposal for a cost-effectiveness evaluation model using IDSUS

Oliveira, Lilian Ribeiro de
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 18/06/2014 PT
Relevância na Pesquisa
76.09%
O Sistema Único de Saúde (SUS), modelo universalista que existe atualmente no Brasil, encontra-se em posição de destaque dentre as políticas sociais vigentes. Num contexto de aumento de recursos e crescimento da demanda, o SUS constantemente sofre alterações que visam aumentar a qualidade, o acesso e a efetividade do serviço prestado; dessa forma, são necessários instrumentos para acompanhar seu desempenho. Não obstante, este trabalho versa em seu marco teórico sobre a trajetória do Sistema Único de Saúde e as avaliações de políticas públicas em saúde, visto que a incorporação de novas ferramentas é incontestavelmente importante para a produtividade do recurso destinado à saúde pública no Brasil - cada vez mais, a utilização de novas tecnologias e processos contribuirá para a adequada tomada de decisão dos gestores, melhores políticas públicas de saúde e um sistema verdadeiramente universal e funcional. Uma das novas ferramentas utilizadas pelo SUS é o IDSUS, que se propõe a medir o desempenho de cada município e região em relação ao acesso e à efetividade do sistema. O índice é composto por 24 indicadores, em que 14 medem o acesso à saúde e 10 se referem à efetividade do sistema. Oportunamente...

Cost-effectiveness comparison between non-penetrating deep sclerectomy and maximum-tolerated medical therapy for glaucoma within the Brazilian National Health System (SUS)

Guedes,Ricardo Augusto Paletta; Guedes,Vanessa Maria Paletta; Chaoubah,Alfredo
Fonte: Conselho Brasileiro de Oftalmologia Publicador: Conselho Brasileiro de Oftalmologia
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/02/2012 EN
Relevância na Pesquisa
76.05%
PURPOSE: Non-penetrating deep sclerectomy (NPDS) has emerged as a viable option in the surgical management of open-angle glaucoma. Our aim is to assess the cost-effectiveness of NPDS and to compare it to maximum medical treatment in a 5-year follow-up. METHODS: A decision analysis model was built. Surgical (NPDS) arm of the decision tree was observational (consecutive retrospective case series) and maximum medical treatment arm was hypothetical. Maximum medical therapy was considered a three-drug regimen (association of a fixed combination of timolol/dorzolamide [FCTD] and a prostaglandin analogue [bimatoprost, latanoprost or travoprost]). Cost-effectiveness ratio was defined as direct cost (US dollars) for each percentage of intraocular pressure (IOP) reduction. Horizon was 5 years and perspective is from the public health care service in Brazil (SUS). Incremental cost-effectiveness ratio (ICER) was calculated. RESULTS: Direct cost for each percentage of IOP reduction in 5 years (cost-effectiveness ratio) was US$ 10.19 for NPDS; US$ 37.45 for the association of a FCTD and bimatoprost; US$ 39.33 for FCTD and travoprost; and US$ 41.42 for FCTD and latanoprost. NPDS demonstrated a better cost-effectiveness ratio, compared to maximum medical therapy. The ICER was negative for all medical treatment options; therefore NPDS was dominant. CONCLUSIONS: Despite some limitations...

Cost-effectiveness of prevention strategies for American tegumentary leishmaniasis in Argentina

Orellano,Pablo Wenceslao; Vazquez,Nestor; Salomon,Oscar Daniel
Fonte: Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz Publicador: Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/12/2013 EN
Relevância na Pesquisa
76.02%
The aim of this study was to estimate the cost-effectiveness of reducing tegumentary leishmaniasis transmission using insecticide-impregnated clothing and curtains, and implementing training programs for early diagnosis. A societal perspective was adopted, with outcomes assessed in terms of costs per disability adjusted life years (DALY). Simulation was structured as a Markov model and costs were expressed in American dollars (US$). The incremental cost-effectiveness ratio of each strategy was calculated. One-way and multivariate sensitivity analyses were performed. The incremental cost-effectiveness ratio for early diagnosis strategy was estimated at US$ 156.46 per DALY averted, while that of prevention of transmission with insecticide-impregnated curtains and clothing was US$ 13,155.52 per DALY averted. Both strategies were more sensitive to the natural incidence of leishmaniasis, to the effectiveness of mucocutaneous leishmaniasis treatment and to the cost of each strategy. Prevention of vectorial transmission and early diagnosis have proved to be cost-effective measures.

Cost-effectiveness of telbivudine versus lamivudine for chronic hepatitis B

Wiens,Astrid; Venson,Rafael; Correr,Cassyano Januário; Pontarolo,Roberto
Fonte: Brazilian Society of Infectious Diseases Publicador: Brazilian Society of Infectious Diseases
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/06/2011 EN
Relevância na Pesquisa
76%
BACKGROUND AND AIM: Chronic hepatitis B is a highly prevalent disease worldwide, leading to serious consequences if not properly treated. Six treatment options for chronic hepatitis B are currently provided by the Brazilian public health system. Telbivudine is a nucleoside analogue that is neither included in the Brazilian clinical protocol nor in the therapeutic guidelines for chronic hepatitis B. OBJECTIVE: The aim of this study was to evaluate the cost-effectiveness of telbivudine for the viewpoint of the Brazilian public system, comparing it to lamivudine. METHODS: A Markov model was used to project lifetime complications and costs of treatment with lamivudine or telbivudine for chronic hepatitis B in both HBeAg-positive and HBeAg-negative patients. To evaluate disease progression, probabilities and utilities of virologic response, virologic resistance, compensated cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, treatment, interruption of treatment, death and seroconversion were collected in systematic reviews. Costs were collected in DATASUS, ABC da Saúde and scientific literature. RESULTS: Higher rate of virologic response and seroconversion was obtained with telbivudine, and also higher values of quality adjusted life years. However lamivudine is associated with lower costs and also lower cost-effectiveness values. The incremental cost-effectiveness ratios for telbivudine...

Chronic Hepatitis C treatment for genotype 2 or 3 in Brazil: cost effectiveness analysis of peginterferon plus ribavirin as first choice treatment

Blatt,Carine Raquel; Storb,Bernd; Mühlberger,Nikolai; Farias,Mareni Rocha; Siebert,Uwe
Fonte: Universidade de São Paulo, Faculdade de Ciências Farmacêuticas Publicador: Universidade de São Paulo, Faculdade de Ciências Farmacêuticas
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/06/2014 EN
Relevância na Pesquisa
75.98%
Brazilian Guidelines to HCV treatment (2007) recommended that the first choice treatment for patients with chronic hepatitis C (CHC) and genotype 2 or 3 is interferon alpha (IFN) plus ribavirin (RBV) for 24 weeks. The aim of this study is compare the cost and effectiveness to Hepatitis C treatment in patients with genotype 2 or 3 of peginterferon alpha (PEG) as the first choice of treatment within PEG for those that do not respond to IFN. The target population is CHC patients with genotype 2 or 3 in Brazil. The interventions are: PEG-SEC (first IFN plus RBV for 24 weeks, after, for non-responders and relapsers subsequently PEG plus RBV for 48 weeks); PEG-FIRST24 (PEG+RBV for 24 weeks). The type of the study is cost-effectiveness analysis. The data sources are: Effectiveness data from meta-analysis conducted on the Brazilian population. Treatment cost from Brazilian micro costing study is converted into USD (2010). The perspective is the Public Health System. The outcome measurements are Sustained Viral Response (SVR) and costs. PEG-FIRST24 (SVR: 87.8%, costs: USD 8,338.27) was more effective and more costly than PEG-SEC (SVR: 79.2%, costs: USD 5,852.99). The sensitivity analyses are: When SVR rates with IFN was less than 30% PEG-FIRST is dominant. On the other hand...

Cost-effectiveness evaluation of an RCT in rehabilitation after lumbar spinal fusion: a low-cost, behavioural approach is cost-effective over individual exercise therapy

Søgaard, Rikke; Bünger, Cody E.; Laurberg, Ida; Christensen, Finn B.
Fonte: Springer-Verlag Publicador: Springer-Verlag
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
66.15%
Recently, Christensen et al. reported the clinical effects of a low-cost rehabilitation program equally efficient to a relatively intensive program of individual, physiotherapist-guided exercise therapy. Yet, the low-cost approach is not fully supported as an optimal strategy until a full-scale economic evaluation, including extra-hospital effects such as service utilization in the primary health care sector and return-to-work, is conducted. The objective of this study was to conduct such evalution i.e. investigate the cost-effectiveness of (1) a low-cost rehabilitation regimen with a behavioural element and (2) a regimen of individual exercise therapy, both in comparison with usual practice, from a health economic, societal perspective. Study design was a cost-effectiveness evaluation of an RCT with a 2-year follow-up. Ninety patients having had posterolateral or circumferential fusion (indicated by chronic low back pain and localized pathology) were randomized 3 months after their spinal fusion. Validated pain- and disability index scales were applied at baseline and at 2 years postoperative. Costs were measured in a full-scale societal perspective. The probability of the behavioural approach being cost-effective was close to 1 given pain as the prioritized effect measure...

Examining Methods Used to Evaluate the Cost-Effectiveness of Childhood Obesity Interventions

Wright, Davene
Fonte: Harvard University Publicador: Harvard University
Tipo: Thesis or Dissertation
EN_US
Relevância na Pesquisa
66.05%
This dissertation examines methods used to evaluate the cost-effectiveness of childhood obesity interventions in order to help decision-makers prioritize among competing health programs using standardized outcomes. Chapter 1 generates inputs for use in cost-effectiveness analyses (CEAs) of childhood obesity interventions. In Chapter 1.1, I use data from the Medical Expenditure Panel Survey to predict expenditures associated with obesity in childhood and adolescence. I found that obese children and adolescents have significantly different expenditures than their normal weight counterparts. I conclude that exclusion of obesity-related medical expenditures can potentially undervalue the cost-effectiveness of interventions. In Chapter 1.2, I use data from the Study of Early Child Care and Youth Development to examine the longitudinal trajectory of child weight. I derived probabilities of transitioning between weight classes that can be used in a decision-analytic model to extrapolate the effectiveness of childhood obesity interventions beyond childhood. I found that deviating from CDC BMI reference categories can more accurately capture the risk of future obesity. In Chapter 2, I evaluate the cost-effectiveness of a primary care-based obesity prevention program...

Protocol for evaluation of the cost-effectiveness of ePrescribing systems and candidate prototype for other related health information technologies

Lilford, Richard J; Girling, Alan J; Sheikh, Aziz; Coleman, Jamie J; Chilton, Peter J; Burn, Samantha L; Jenkinson, David J; Blake, Laurence; Hemming, Karla
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
EN_US
Relevância na Pesquisa
66.09%
Background: This protocol concerns the assessment of cost-effectiveness of hospital health information technology (HIT) in four hospitals. Two of these hospitals are acquiring ePrescribing systems incorporating extensive decision support, while the other two will implement systems incorporating more basic clinical algorithms. Implementation of an ePrescribing system will have diffuse effects over myriad clinical processes, so the protocol has to deal with a large amount of information collected at various ‘levels’ across the system. Methods/Design The method we propose is use of Bayesian ideas as a philosophical guide. Assessment of cost-effectiveness requires a number of parameters in order to measure incremental cost utility or benefit – the effectiveness of the intervention in reducing frequency of preventable adverse events; utilities for these adverse events; costs of HIT systems; and cost consequences of adverse events averted. There is no single end-point that adequately and unproblematically captures the effectiveness of the intervention; we therefore plan to observe changes in error rates and adverse events in four error categories (death, permanent disability, moderate disability, minimal effect). For each category we will elicit and pool subjective probability densities from experts for reductions in adverse events...

Cost-Effectiveness of Treatment for Tobacco Dependence : A Systematic Review of the Evidence

Ronckers, Sandy; Ament, Andre
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
EN_US
Relevância na Pesquisa
66.08%
Good decisions on which health interventions to invest can be facilitated by high quality evaluations of the cost-effectiveness of interventions. Although there are several reviews of evaluations of the cost-effectiveness of smoking cessation programs, the reviews have had little to say about the quality of the studies. The present study tries to fill this gap by thoroughly evaluating the quality of economic evaluations of interventions to reduc e tobacco consumption. First, the general characteristics of all the studies reviewed are described, and then the quality of epidemiological characteristics and of the economic evaluation is analyzed, using a criteria list proposed by Drummond et al. (1997). The analysis finds that the quality of many aspects of many of the studies leaves much to be desired, judged against the guidelines offered by Drummond et al. However, the studies do consistently conclude that stop-smoking interventions are cost-effective, and this conclusion is robust when sensitivity analyses are performed. The cost-effectiveness ratios estimated by the studies for smoking cessation interventions are much lower than most other health care treatments. The study this concludes that the broad conclusion that treatments to reduce the number of smokers are cost-effective at least in relative terms...

Cost-Effectiveness Measurement in Development : Accounting for Local Costs and Noisy Impacts

Evans, David K.; Popova, Anna
Fonte: World Bank Group, Washington, DC Publicador: World Bank Group, Washington, DC
EN_US
Relevância na Pesquisa
66.15%
As evidence from rigorous impact evaluations grows in development, there have been more calls to complement impact evaluation analysis with cost analysis, so that policy makers can make investment decisions based on costs as well as impacts. This paper discusses important considerations for implementing cost-effectiveness analysis in the policy making process. The analysis is applied in the context of education interventions, although the findings generalize to other areas. First, the paper demonstrates a systematic method for characterizing the sensitivity of impact estimates. Second, the concept of context-specificity is applied to cost measurement: program costs vary greatly across contexts -- both within and across countries -- and with program complexity. The paper shows how adapting a single cost ingredient across settings dramatically shifts cost-effectiveness measures. Third, the paper provides evidence that interventions with fewer beneficiaries tend to have higher per-beneficiary costs, resulting in potential cost overestimates when extrapolating to large-scale applications. At the same time...

A cost-effectiveness analysis of heroin detoxification methods in the Australian National Evaluation of Pharmacotherapies for Opioid Dependence (NEPOD)

Shanahan, M.; Doran, C.; Digiusto, E.; Bell, J.; Lintzeris, N.; White, J.; Ali, R.; Saunders, J.; Mattick, R.; Gilmour, S.
Fonte: Pergamon-Elsevier Science Ltd Publicador: Pergamon-Elsevier Science Ltd
Tipo: Artigo de Revista Científica
Publicado em //2006 EN
Relevância na Pesquisa
66.08%
Abstract This economic evaluation was part of the Australian National Evaluation of Pharmacotherapies for Opioid Dependence (NEPOD) project. Data from four trials of heroin detoxification methods, involving 365 participants, were pooled to enable a comprehensive comparison of the cost-effectiveness of five inpatient and outpatient detoxification methods. This study took the perspective of the treatment provider in assessing resource use and costs. Two short-term outcome measures were used—achievement of an initial 7-day period of abstinence, and entry into ongoing post-detoxification treatment. The mean costs of the various detoxification methods ranged widely, from AUD $491 (buprenorphine-based outpatient); to AUD $605 for conventional outpatient; AUD $1404 for conventional inpatient; AUD $1990 for rapid detoxification under sedation; and to AUD $2689 for anaesthesia per episode. An incremental cost-effectiveness analysis was carried out using conventional outpatient detoxification as the base comparator. The buprenorphine-based outpatient detoxification method was found to be the most cost-effective method overall, and rapid opioid detoxification under sedation was the most cost-effective inpatient method; http://www.elsevier.com/wps/find/journaldescription.cws_home/471/description#description; M.D. Shanahan...

Cost-effectiveness of induction of labour at term with a Foley catheter compared to vaginal prostaglandin E₂ gel (PROBAAT trial); Cost-effectiveness of induction of labour at term with a Foley catheter compared to vaginal prostaglandin E(2) gel (PROBAAT trial)

van Baaren, G.J.; Jozwiak, M.; Opmeer, B.; Oude Rengerink, K.; Benthem, M.; Dijksterhuis, M.; van Huizen, M.; van der Salm, P.; Schuitemaker, N.; Papatsonis, D.; Perquin, D.; Porath, M.; van der Post, J.; Rijnders, R.; Scheepers, H.; Spaanderman, M.; van
Fonte: Wiley Publicador: Wiley
Tipo: Artigo de Revista Científica
Publicado em //2013 EN
Relevância na Pesquisa
66.05%
Objective: To assess the economic consequences of labour induction with Foley catheter compared to prostaglandin E2 gel. Design: Economic evaluation alongside a randomised controlled trial. Setting: Obstetric departments of one university and 11 teaching hospitals in the Netherlands. Population: Women scheduled for labour induction with a singleton pregnancy in cephalic presentation at term, intact membranes and an unfavourable cervix; and without previous caesarean section. Methods: Cost-effectiveness analysis from a hospital perspective. Main outcome measures: We estimated direct medical costs associated with healthcare utilisation from randomisation to 6 weeks postpartum. For caesarean section rate, and maternal and neonatal morbidity we calculated the incremental cost-effectiveness ratios, which represent the costs to prevent one of these adverse outcomes. Results: Mean costs per woman in the Foley catheter group (n = 411) and in the prostaglandin E2 gel group (n = 408), were €3297 versus €3075, respectively, with an average difference of €222 (95% confidence interval −€157 to €633). In the Foley catheter group we observed higher costs due to longer labour ward occupation and less cost related to induction material and neonatal admissions. Foley catheter induction showed a comparable caesarean section rate compared with prostaglandin induction...

Análise de custo-efetividade do tratamento da hepatite C crônica genótipo 1: comparação da adição do boceprevir a terapia padrão (interferon-α peguilado e ribavirina); Cost-effectiveness analysis of treatment of genotype 1 chronic hepatitis C: comparison of boceprevir addition to standard of care (pegylated interferon alfa plus ribavirin).

Maia, Sarah Cristina Oliveira Machado
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 30/03/2015 PT
Relevância na Pesquisa
75.99%
A hepatite C afeta cerca de 150 milhões de pessoas no mundo e é a razão mais comum de transplantes de fígado. A erradicação viral, por meio de tratamento medicamentoso, é a única intervenção que pode deter a progressão da doença, reduzir a mortalidade e melhorar a qualidade de vida dos pacientes. Em 2011, foi aprovado o boceprevir, um inibidor de protease, que passou a ser adicionado à terapia padrão dupla (interferon peguilado e ribavirina) pelo Protocolo Clínico brasileiro para tratamento de Hepatite C genótipo 1 em pacientes com grau de fibrose maior que F2. Devido ao alto custo de aquisição deste medicamento e à produção cada vez maior de novas tecnologias para essa área terapêutica, foi proposta essa pesquisa que tem como objetivo analisar o custo-efetividade da terapia tripla em relação à terapia dupla, no tratamento da hepatite C crônica genótipo 1 em pacientes virgens de tratamento para todos os graus de fibrose. Para tanto, foi construído um modelo de Markov com 15 estados de saúde representando a história natural da Hepatite C crônica. O modelo seguiu uma coorte hipotética pela vida toda, em que os custos foram expressos em Reais e os desfechos em anos de vida ganhos. A perspectiva adotada foi a do SUS. A RCEI calculada...

Population Health Impact and Cost-Effectiveness of Tuberculosis Diagnosis with Xpert MTB/RIF: A Dynamic Simulation and Economic Evaluation

Cohen, Ted; Lin, Hsien-Ho; Menzies, Nicolas Alan; Murray, Megan Blanche; Salomon, Joshua A.
Fonte: Public Library of Science Publicador: Public Library of Science
Tipo: Artigo de Revista Científica
EN_US
Relevância na Pesquisa
66.05%
Background: The Xpert MTB/RIF test enables rapid detection of tuberculosis (TB) and rifampicin resistance. The World Health Organization recommends Xpert for initial diagnosis in individuals suspected of having multidrug-resistant TB (MDR-TB) or HIV-associated TB, and many countries are moving quickly toward adopting Xpert. As roll-out proceeds, it is essential to understand the potential health impact and cost-effectiveness of diagnostic strategies based on Xpert. Methods and findings: We evaluated potential health and economic consequences of implementing Xpert in five southern African countries—Botswana, Lesotho, Namibia, South Africa, and Swaziland—where drug resistance and TB-HIV coinfection are prevalent. Using a calibrated, dynamic mathematical model, we compared the status quo diagnostic algorithm, emphasizing sputum smear, against an algorithm incorporating Xpert for initial diagnosis. Results were projected over 10- and 20-y time periods starting from 2012. Compared to status quo, implementation of Xpert would avert 132,000 (95% CI: 55,000–284,000) TB cases and 182,000 (97,000–302,000) TB deaths in southern Africa over the 10 y following introduction, and would reduce prevalence by 28% (14%–40%) by 2022, with more modest reductions in incidence. Health system costs are projected to increase substantially with Xpert...

Cost-effectiveness of prevention strategies for American tegumentary leishmaniasis in Argentina; Coste-efectividad de estrategias de prevención contra la leishmaniasis tegumentaria americana en Argentina; Custo-efetividade de estratégias de prevenção contra a leishmaniose tegumentar americana na Argentina

Orellano, Pablo Wenceslao; Vazquez, Néstor; Salomon, Oscar Daniel
Fonte: Cadernos Saude Publica Publicador: Cadernos Saude Publica
Tipo: info:eu-repo/semantics/article; info:ar-repo/semantics/artículo; info:eu-repo/semantics/publishedVersion Formato: application/pdf
ENG
Relevância na Pesquisa
76.02%
The aim of this study was to estimate the cost-effectiveness of reducing tegumentary leishmaniasis transmission using insecticide-impregnated clothing and curtains, and implementing training programs for early diagnosis. A societal perspective was adopted, with outcomes assessed in terms of costs per disability adjusted life years (DALY). Simulation was structured as a Markov model and costs were expressed in American dollars (US$). The incremental cost-effectiveness ratio of each strategy was calculated. One-way and multivariate sensitivity analyses were performed. The incremental cost-effectiveness ratio for early diagnosis strategy was estimated at US$ 156.46 per DALY averted, while that of prevention of transmission with insecticide-impregnated curtains and clothing was US$ 13,155.52 per DALY averted. Both strategies were more sensitive to the natural incidence of leishmaniasis, to the effectiveness of mucocutaneous leishmaniasis treatment and to the cost of each strategy. Prevention of vectorial transmission and early diagnosis have proved to be cost-effective measures.; Fil: Orellano, Pablo Wenceslao. Ministerio de Salud de Misiones. Instituto Nacional de Medicina Tropical; Argentina;; Fil: Vazquez, n. Universidad de Buenos Aires. Facultad de Medicina; Argentina;; Fil: Salomon...

The cost-effectiveness of providing antenatal lifestyle advice for women who are overweight or obese: the LIMIT randomised trial

Dodd, J.M.; Ahmed, S.; Karnon, J.; Umberger, W.; Deussen, A.R.; Tran, T.; Grivell, R.M.; Crowther, C.A.; Turnbull, D.; McPhee, A.J.; Wittert, G.; Owens, J.A.; Robinson, J.S.
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
Publicado em //2015 EN
Relevância na Pesquisa
66.12%
BACKGROUND: Overweight and obesity during pregnancy is common, although robust evidence about the economic implications of providing an antenatal dietary and lifestyle intervention for women who are overweight or obese is lacking. We conducted a health economic evaluation in parallel with the LIMIT randomised trial. Women with a singleton pregnancy, between 10(+0)-20(+0) weeks, and BMI ≥25 kg/m(2) were randomised to Lifestyle Advice (a comprehensive antenatal dietary and lifestyle intervention) or Standard Care. The economic evaluation took the perspective of the health care system and its patients, and compared costs encountered from the additional use of resources from time of randomisation until six weeks postpartum. Increments in health outcomes for both the woman and infant were considered in the cost-effectiveness analysis. Mean costs and effects in the treatment groups allocated at randomisation were compared, and incremental cost effectiveness ratios (ICERs) and confidence intervals (95%) calculated. Bootstrapping was used to confirm the estimated confidence intervals, and to generate acceptability curves representing the probability of the intervention being cost-effective at alternative monetary equivalent values for the outcomes avoiding high infant birth weight...

Análise custo-efetividade e índice de qualidade da refeição aplicados à Estratégia Global da OMS; Cost-effectiveness analysis and diet quality index applied to the WHO Global Strategy

Machado, Flávia Mori Sarti; Simões, Arlete Naresse
Fonte: Universidade de São Paulo. Faculdade de Saúde Pública Publicador: Universidade de São Paulo. Faculdade de Saúde Pública
Tipo: info:eu-repo/semantics/article; info:eu-repo/semantics/publishedVersion; ; ; ; ; Formato: application/pdf
Publicado em 01/02/2008 POR
Relevância na Pesquisa
76.14%
OBJETIVO: Testar o uso da metodologia de análise custo-efetividade como instrumento de decisão na produção de refeições para inclusão das recomendações proferidas na Estratégia Global da Organização Mundial da Saúde. MÉTODOS: Cinco opções alternativas de cardápio de café da manhã foram analisadas previamente à implementação da refeição em unidade de alimentação e nutrição de uma universidade do estado de São Paulo, no ano de 2006. O custo de cada opção baseou-se em preços de mercado dos componentes de custo direto. Os benefícios em saúde foram calculados com base em adaptação do Índice de Qualidade da Refeição (IQR). Foram calculadas a razão custo-efetividade dos cardápios pela divisão dos benefícios pelos custos e a razão custo-efetividade incremental pelo diferencial de custo por unidade de benefício adicional. A escolha considerou unidades de benefício à saúde em relação ao custo direto de produção, assim como a efetividade incremental por unidade de custo diferencial. RESULTADOS: A análise resultou na opção mais simples com adição de uma fruta (IQR=64 e custo=R$1,58) como melhor alternativa. Observou-se maior efetividade das alternativas com uma porção de fruta (IQR1=64 / IQR3=58 / IQR5=72) sobre as demais (IQR2=48 / IQR4=58). CONCLUSÕES: O cálculo da razão custo-efetividade permitiu identificar a melhor opção de café da manhã com base na análise custo-efetividade e Índice de Qualidade da Refeição. Tais instrumentos agregam características de facilidade de aplicação e objetividade de avaliação...

Custo-efetividade dos análogos de nucleosídeos/nucleotídeos para hepatite crônica B; Costo-efectividad de los análogos de nucleósidos/nucleótidos para hepatitis crónica B; Cost-effectiveness of nucleoside/nucleotide analogues in chronic hepatitis B

Almeida, Alessandra Maciel; Silva, Anderson Lourenço da; Brandão, Cristina Mariano Ruas; Cherchiglia, Mariângela Leal; Andrade, Eli Iola Gurgel; Oliveira, Gustavo Laine Araújo de; Carmo, Ricardo Andrade; Acurcio, Francisco de Assis
Fonte: Universidade de São Paulo. Faculdade de Saúde Pública Publicador: Universidade de São Paulo. Faculdade de Saúde Pública
Tipo: info:eu-repo/semantics/article; info:eu-repo/semantics/publishedVersion; Artigo Avaliado pelos Pares Formato: application/pdf
Publicado em 01/12/2012 POR
Relevância na Pesquisa
76%
OBJETIVO: Conduzir uma análise de custo-efetividade das alternativas medicamentosas com terapia de resgate na recaída por resistência viral para tratamento de pacientes com hepatite crônica B (HCB). MÉTODOS: Coorte hipotética de pacientes com HCB, HBeAg negativo, sem evidência clínica ou histológica de cirrose, DNA do VHB detectável, diagnóstico histológico da doença, HBsAg positivo no soro por mais de seis meses, elevados níveis de alanina transferase (ALT) (duas vezes maior que o limite superior da normalidade [LSN]) e média de idade de 40 anos. Modelo de Markov foi desenvolvido para a hepatite crônica B (antígeno HBeAg negativo) com horizonte temporal de 40 anos. Custos e benefícios foram descontados em 5%. As taxas anuais de progressão, custos devido a complicações e a eficácia dos medicamentos foram obtidos da literatura. As incertezas foram avaliadas por análises de sensibilidade unidirecional e probabilística. RESULTADOS: Iniciar o tratamento com entecavir resultou em 0,35 ano de vida ganho em relação à lamivudina. A razão de custo-efetividade incremental foi de R$ 16.416,08 por anos de vida ganhos. Na análise de sensibilidade a razão de custo-efetividade incremental foi mais sensível à variação na probabilidade de transição de hepatite crônica B para cirrose compensada...

Cost-effectiveness of prevention strategies for American tegumentary leishmaniasis in Argentina

Orellano,Pablo Wenceslao; Vazquez,Nestor; Salomon,Oscar Daniel
Fonte: Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz Publicador: Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/12/2013 EN
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76.02%
The aim of this study was to estimate the cost-effectiveness of reducing tegumentary leishmaniasis transmission using insecticide-impregnated clothing and curtains, and implementing training programs for early diagnosis. A societal perspective was adopted, with outcomes assessed in terms of costs per disability adjusted life years (DALY). Simulation was structured as a Markov model and costs were expressed in American dollars (US$). The incremental cost-effectiveness ratio of each strategy was calculated. One-way and multivariate sensitivity analyses were performed. The incremental cost-effectiveness ratio for early diagnosis strategy was estimated at US$ 156.46 per DALY averted, while that of prevention of transmission with insecticide-impregnated curtains and clothing was US$ 13,155.52 per DALY averted. Both strategies were more sensitive to the natural incidence of leishmaniasis, to the effectiveness of mucocutaneous leishmaniasis treatment and to the cost of each strategy. Prevention of vectorial transmission and early diagnosis have proved to be cost-effective measures.