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ABSTRACT Objective: This study aims to assess cost-effectiveness of caudal epidural block with transforaminal nerve root block in the treatment of degenerative diseases of the lumbar spine. Methods: A total of 47 patients with lumbar sciatica symptoms were included. Low back pain and leg pain were assessed using the visual analogue scale (VAS), both in the pre-procedure and one week after. The cost-effectiveness and value required to improve each point on the VAS were estimated using addition, division, and rule of three calculations. Results: For low back pain, scores ranging from 2 to 10 were found before the procedure, with a mean of 7.5 ± 2.14 (95%CI: 6.8–8.1). A week after, these scores ranged from 0 to 10, with a mean of 3.1±2.8 (95%CI: 2.3–4.0; p < 0.0001). Regarding leg pain, scores ranging from 1 to 10 were noted before the procedure, with a mean of 6.8 ± 2.5 (95%CI: 6.1–7.4). A week after, these scores ranged from 0 to 9, with mean of 2.4 ± 2.5 (95%CI: 1.8–3.1; p < 0.0001). The cost of the materials used during the procedure was 214.72 BRL. Conclusion: Caudal epidural with transforaminal nerve root block were a cost-effective treatment modality for patients with degenerative diseases of the lumbar spine. Level of evidence III, Retrospective cohort study.

ABSTRACT Objective: This study assessed the cost-effectiveness of radiofrequency ablation compared with percutaneous ethanol injection in patients with early hepatocellular carcinoma in relation to the objective response rate and costs related to the procedure. Methods: This was a prospective single-center randomized trial. The primary outcome was cost-effectiveness. Secondary outcomes were the complete response rate according to the modified response evaluation criteria in solid tumors 60 days after randomization and the complication rate within 180 60 days. Results: Fifty patients were placed into the following groups: percutaneous ethanol injection (n=23) and radiofrequency ablation (n=27). Fifty-four nodules were randomized (mean follow-up: 205.37 days). The estimated mean hospital cost was US$ 1854.11 and US$ 2770.96 for the Radiofrequency Ablation and Percutaneous Ethanol Injection Groups, respectively. The incremental cost-effectiveness ratio was US$ -2674.59, which is advantageous for radiofrequency ablation. After 60 d, 28 of 29 nodules in the Radiofrequency Ablation Group achieved complete response versus 12 of 22 in the Percutaneous Ethanol Injection Group (RD, 42.01 [95%CI= 20.55–63.24]; p0.05), respectively. Conclusion: Radiofrequency ablation was more cost-effective and achieved higher complete response and lower complication rates than the Percutaneous Ethanol Injection Group within this cohort. Registry of Clinical Trials: NCT06450613

Abstract Background To evaluate the cost-effectiveness ratio and economic impact of the Rapid Antigen Test (TR-Ag) to replace RT-PCR for the detection of the new Coronavirus in the Unified Health System (SUS). Methods This is a cost-effectiveness analysis. Clinical protocols were used for the diagnosis of COVID-19 at the São José Municipal Hospital, located in the city of Itaberá-SP. The Incremental Cost-Effectiveness Ratio (ICER) was divided into two scenarios. In the first, the accuracy reported by the test manufacturers was included, and in the second, the cost resulting from a systematic review. Both were compared with the performance of the RT-PCR test. The increase in diagnoses was chosen as a health outcome and absenteeism was used as a criterion for assessing the economic impact. Results The analysis resulted in incremental cost-effectiveness ratios of R$ 42,136.67 and R$ 68,329.73 for every thousand tests, according to the accuracy of the manufacturers’ TR-Ag tests and what is reported in the literature in relation to RT-PCR, respectively. The average value found for the RT-PCR test (R$ 202.87) represents an increase of 165.32% in cost in relation to the value found for the TR-Ag. 4,305 tests were performed between April 2020 and December 2021 at the referral hospital. Also, maintaining the use of RT-PCR as the first choice for diagnosing COVID-19 and regulating absenteeism in the economically active population could have an impact of up to R$ 1,022,779.68 on municipal management. Conclusion It is concluded that the TR-Ag are configured as a cost-effective alternative for the SUS in the detection of the new Coronavirus. The strategy becomes economically favorable for the expansion of testing, combating the COVID-19 pandemic and reducing the impact on the local economy. However, studies are needed to validate the accuracy of the tests so that economic evaluations on the subject are more assertive.

Background: The medical care paradigm is face-to-face; however, technological development has led to the digital modality. Objective: To determine cost-effectiveness of digital care and face-to-face care at the first level of care. Material and methods: Cost-effectiveness study. 2 groups were integrated: the digital service and the face-to-face service. The sample size was calculated with the percentage formula for 2 groups, and the result was 217 per group. The effectiveness was evaluated in 3 dimensions: the satisfaction of the patient, of the doctor and of the medical assistant. In all 3 cases the Visual analogue scale was used. The cost corresponded to the fixed unit cost estimated with the technique of times and movements adjusted for the duration of care. The statistical analysis included averages, percentages and costeffectiveness ratio. Results: The cost of digital attention is $343.83 and face-toface attention is $171.91 (all estimated in Mexican pesos). From the patient's perspective, the effectiveness in digital care is $9.47 and in face-to-face is $9.25. The cost to reach effectiveness of 10 in face-to-face care is $185.85 and in digital care $363.20. From the physician's perspective, the cost to achieve effectiveness of 10 is $419.13 in digital care and $184.52 in face-to-face care. From the perspective of the medical assistant, to achieve effectiveness of 10, the cost in digital care is $468.43 and in face-to-face $179.83. Conclusions: Currently, the best cost-effectiveness ratio corresponds to face-to-face care; however, digital care is an option that will have to evolve. [ABSTRACT FROM AUTHOR]

Background: To evaluate the cost-effectiveness ratio and economic impact of the Rapid Antigen Test (TR-Ag) to replace RT-PCR for the detection of the new Coronavirus in the Unified Health System (SUS). Methods: This is a cost-effectiveness analysis. Clinical protocols were used for the diagnosis of COVID-19 at the São José Municipal Hospital, located in the city of Itaberá-SP. The Incremental Cost-Effectiveness Ratio (ICER) was divided into two scenarios. In the first, the accuracy reported by the test manufacturers was included, and in the second, the cost resulting from a systematic review. Both were compared with the performance of the RT-PCR test. The increase in diagnoses was chosen as a health outcome and absenteeism was used as a criterion for assessing the economic impact. Results: The analysis resulted in incremental cost-effectiveness ratios of R$ 42,136.67 and R$ 68,329.73 for every thousand tests, according to the accuracy of the manufacturers' TR-Ag tests and what is reported in the literature in relation to RT-PCR, respectively. The average value found for the RT-PCR test (R$ 202.87) represents an increase of 165.32% in cost in relation to the value found for the TR-Ag. 4,305 tests were performed between April 2020 and December 2021 at the referral hospital. Also, maintaining the use of RT-PCR as the first choice for diagnosing COVID-19 and regulating absenteeism in the economically active population could have an impact of up to R$ 1,022,779.68 on municipal management. Conclusion: It is concluded that the TR-Ag are configured as a cost-effective alternative for the SUS in the detection of the new Coronavirus. The strategy becomes economically favorable for the expansion of testing, combating the COVID-19 pandemic and reducing the impact on the local economy. However, studies are needed to validate the accuracy of the tests so that economic evaluations on the subject are more assertive. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the cost-effectiveness of anti–epidermal growth factor receptor (cetuximab and panitumumab) or anti–vascular endothelial growth factor (bevacizumab) monoclonal antibodies associated with conventional chemotherapy (CT) (fluorouracil and leucovorin with irinotecan) as a first-line treatment for unresectable metastatic colorectal cancer. A partitioned survival analysis model was adopted to simulate direct health costs and benefits comparing therapeutic options in a 10 years' time horizon. Model data were extracted from the literature and costs were obtained from Brazilian official government databases. The analysis considered the perspective of the Brazilian Public Health System; costs were measured in local currency (BRL) and benefits in quality-adjusted life-years (QALY). A 5% discount rate was applied to costs and benefits. Alternative willingness-to-pay scenarios, varying from 3 to 5 times the cost-effectiveness threshold established in Brazil, were estimated. The results were presented incremental cost-effectiveness ratio (ICER), and both deterministic and probabilistic sensitivity analyses were performed. The most cost-effective choice would be the association of CT with panitumumab, with an ICER of $58 330.15/QALY compared with isolated CT. The second-best option was CT with bevacizumab and panitumumab, with an ICER of $71 195.40/QALY compared with panitumumab alone. Although having higher costs, the second-best option was the most effective. Both strategies were cost-effective in part of the Monte Carlo iterations, considering the 3× threshold. The therapeutic option CT + panitumumab + bevacizumab represents the most significant effectiveness gain in our study. It is the second-lowest cost-effectiveness, and this option includes monoclonal antibodies association for patients with and without KRAS mutation. • To the best of our knowledge, this is the first study to estimate the cost-effectiveness of first-line treatment for unresectable metastatic colorectal cancer. The treatments options assessed were anti–epidermal growth factor receptor (cetuximab and panitumumab) or anti–vascular endothelial growth factor (bevacizumab) monoclonal antibodies associated with conventional chemotherapy with fluorouracil and leucovorin with irinotecan in the perspective of the Brazilian Unified Health System. • The presented model compared different drug incorporation alternatives for the 2 KRAS status types and seeks to represent actual decision making for resource allocation when comparing strategies and nonisolated treatments. The decision interpretation is also improved with cost-effectiveness frontiers and threshold analyses. • Regarding effectiveness, the present model adopts survival curves using robust data extrapolation methods, which are widely applicable to oncological models. The deterministic and probabilistic sensitivity analyses adequately dealt with parameter uncertainty. [ABSTRACT FROM AUTHOR]

Background: Fluoride varnish (FV) is a convenient way of professionally applying fluoride in preschoolers. However, its modest anticaries effect highlights the need for economic evaluations. Aim: To assess economic evaluations reporting applications of FV to reduce caries incidence in preschoolers. Design: We included full economic evaluations with preschool participants, in which the intervention was FV and the outcome was related to dentin caries. We searched in CENTRAL; MEDLINE via PubMed; WEB OF SCIENCE; EMBASE; SCOPUS; LILACS; BBO; and BVS Economia em saúde, OpenGrey, and EconoLit. Clinical trial registers, thesis and dissertations, and meeting abstracts were hand searched, as well as 11 dental journals. Risk of bias in the included studies was assessed using the Philips' and Drummond's (full and simplified) tools. Results: Titles and abstracts of 2871 articles were evaluated, and 200 were read in full. Eight cost‐effectiveness studies were included: five modeling and three within‐trial evaluations. None of the studies gave sufficient information to allow a thorough assessment using the bias tools. We did not combine the results of the studies due to the great heterogeneity among them. Four studies reported that FV in preschool children was a cost‐effective measure, but in one of these studies, sealants and fluoride toothpaste were more cost‐effective measures than the varnish, and three studies used limited data that compromised the generalizability of their results. The other four studies showed a large increase in costs due to the application of varnish and/or low cost‐effectiveness. Conclusion: We did not find convincing overall evidence that applying FV in preschoolers is an anticaries cost‐effective measure. The protocol of this systematic review is available at Open Science Framework (https://osf.io/xw5va/). [ABSTRACT FROM AUTHOR]

This paper presents a detailed analysis of the modified economic method ( F MCE ) for evaluating the performance of photovoltaic module (PV)-enhancing techniques, aiming to address existing research gaps. The impact of influential parameters on the F MCE is examined through illustrative examples. These parameters include the output power of a single solar cell without an enhancer, output power of a PV with an enhancer, manufacturing cost of the PV enhancer, one-watt cost of PV power, and maximum output power of a solar cell with an enhancer equivalent to maximum output power at standard test conditions (STC). The results of this study reveal that the output power of a single solar cell without an enhancer, number of solar cells with an enhancer in the PV, and manufacturing cost of the PV enhancer have a proportional relationship with the F MCE . As these parameters increase, the F MCE also increases, which negatively affects the cost-effectiveness of the PV enhancer, leading to lower performance. So, it is advisable to maintain the values of these parameters at lower levels. Conversely, the output power of a PV with an enhancer and the one-watt cost of PV power exhibit an inverse proportional relationship with the F MCE . As the output power of a PV with an enhancer and the one-watt cost of PV power increase, the F MCE decreases, which positively affects the cost-effectiveness of the PV enhancer, leading to higher performance. Hence, it is recommended to keep these two parameters high for optimal performance. In conclusion, the F MCE may have potential for application by designers and manufacturers of PV enhancers. [ABSTRACT FROM AUTHOR]

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Objective: To evaluate the financial impact and effectiveness of a navigation program in patients with colorectal tumors undergoing videolaryngoscopic rectosigmoidectomy. Material and Methods: Retrospective, case-control type study from May 2019 to December 2020 with patients 18 years-old or older; with sigmoid, retosigmoid junction or upper rectal tumors, submitted to elective laparoscopic sigmoidectomy or high anterior resection with high colorectal anastomosis. The main endpoints were: costs during the patients pathway; interval between first appointment and surgery; use of unit of intensive care (ICU) or not; use of emergency room after discharge. Categorical variables were compared by chi-square test, Fisher’s exact test, and Mann-Whitney. Results: 71 patients, with 49 (69%) not navigated and 22 (31%) navigated. In the diagnostic stage, navigated patients were more referred to physical therapy (81.8% vs. 46.9%, p=0.013) and nutrition specialist (81.8% vs. 57, p=0.081) and performed more diagnostic tests according to the institutional protocol (86.4% vs. 75.5%), contributing with an average revenue per patient 90% higher, p=0.01). The mean time from first visit to surgery, although shorter, had no statistical difference (26 vs. 28 days, p=0.794), as well as the length of stay (5.3 vs. 8.2, p=0.082) and visits to the emergency room within 30 days after discharge (18% vs. 22%, p=1.0). However, the percentage of patients in ICU was 73.8% lower in navigated patients (34.7% vs. 9.1%, p=0.05). 4.5% of navigated patients were cost-outliers vs. 36.5% of non-navigated patients, p=0.05. This resulted in a 18.5% lower cost of surgery and a 16% cheaper journey compared to the non-navigated patients. Conclusion: Navigated patients on oncology treatment have lower costs along the journey and better outcomes with shorter ICU stays, as well as more compliant with institutional protocols.

ABSTRACT Introduction For the reduction of PTH levels, two classes of drugs are available in the Brazilian market: non-selective and selective vitamin D receptor activators and calcimimetics. Among the mentioned drugs, the SUS provides oral calcitriol, paricalcitol and cinacalcet. Objectives: Develop cost-effectiveness (CE) and budgetary impact (BI) analysis of cinacalcet versus paricalcitol for patients on dialysis with SHPT, from the perspective of SUS. Methodology: A decision tree model was constructed for CE analysis, which considered the outcome of avoided parathyroidectomy and a time horizon of 1 year. As for the BI analysis, two scenarios were considered, one of which was measured demand and other epidemiological, based on data from the Brazilian Society of Nephrology (BSN). Results: The CE analysis showed that the use of cinacalcet results in one-off savings of R$1,394.64 per year and an incremental effectiveness of 0.08, in relation to avoided parathyroidectomy. The incremental CE ratio (ICER) was - R$ 17,653.67 per avoided parathyroidectomy for cinacalcet, as it was more effective and cheaper compared to paricalcitol. As for the BI analysis, it was estimated that the incremental BI with the expansion of the use of cinacalcet in the SUS will be between - R$ 1,640,864.62 and R$ 166,368.50 in the first year, considering the main and the epidemiological scenarios. At the end of 5 years after the expansion of use, an BI was estimated between - R$ 10,740,743.86 and - R$ 1,191,339.37; considering the same scenarios. Conclusion: Cinacalcet was dominant to avoid parathyroidectomies, being cost-effective.

Copyright of JBES: Brazilian Journal of Health Economics / Jornal Brasileiro de Economia da Saúde is the property of JBES: Brazilian Journal of Health Economics and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Wide-scale automatic monitoring based on the Normalized Difference Water Index (NDWI) and Mask Region-based Convolutional Neural Network (Mask R-CNN) with remote sensing images is of great significance for the management of aquaculture areas. However, different spatial resolutions brought different cost and model performance. To find more suitable image spatial resolutions for automatic monitoring offshore aquaculture areas, seven different resolution remote sensing images in the Sandu'ao area of China, from 2 m, 4 m, to 50 m, were compared. Results showed that the remote sensing images with a resolution of 15 m and above can achieve the corresponding recognition effect when no financial issues were considered, with the F1 score of over 0.75. By establishing a cost-effectiveness evaluation formula that comprehensively considers image price and recognition effect, the best image resolution in different scenes can be found, thus providing the most appropriate data scheme for the automatic monitoring of offshore aquaculture areas. [ABSTRACT FROM AUTHOR]

Copyright of JBES: Brazilian Journal of Health Economics / Jornal Brasileiro de Economia da Saúde is the property of JBES: Brazilian Journal of Health Economics and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Resumen: Introducción: El uso de ultrasonografía para la inserción de catéteres centrales ha mostrado ser coste-efectivo en adultos; en neonatos se desconoce esta información. El objetivo del estudio fue comparar el coste-efectividad de la cateterización venosa umbilical guiada por ultrasonografía con la cateterización convencional en un servicio de cuidados intensivos neonatales de un hospital universitario y público. Pacientes y métodos: Estudio observacional retrospectivo en recién nacidos que requirieron catéter venoso umbilical antes de cumplir las primeras 24 h de vida extrauterina; se conformaron 2 cohortes históricas, una con cateterización guiada por ultrasonografía y otra con cateterización convencional. La efectividad se midió con 2 variables: colocación de posición ideal e inserción sin complicaciones. Se estimó el coste de recursos humanos y materiales (fungibles y no fungibles), la razón coste-efectividad y la razón coste-efectividad incremental; y se realizó análisis de sensibilidad. Resultados: La obstrucción del catéter fue más frecuente en la cateterización guiada que en la convencional (7,7 vs. 0%, p = 0,04) y la disfunción del catéter fue superior en esta última (79 vs. 3,8%, p

Objective: This study aims to assess cost-effectiveness of caudal epidural block with transforaminal nerve root block in the treatment of degenerative diseases of the lumbar spine., Methods: A total of 47 patients with lumbar sciatica symptoms were included. Low back pain and leg pain were assessed using the visual analogue scale (VAS), both in the pre-procedure and one week after. The cost-effectiveness and value required to improve each point on the VAS were estimated using addition, division, and rule of three calculations., Results: For low back pain, scores ranging from 2 to 10 were found before the procedure, with a mean of 7.5 ± 2.14 (95%CI: 6.8-8.1). A week after, these scores ranged from 0 to 10, with a mean of 3.1±2.8 (95%CI: 2.3-4.0; p < 0.0001). Regarding leg pain, scores ranging from 1 to 10 were noted before the procedure, with a mean of 6.8 ± 2.5 (95%CI: 6.1-7.4). A week after, these scores ranged from 0 to 9, with mean of 2.4 ± 2.5 (95%CI: 1.8-3.1; p < 0.0001). The cost of the materials used during the procedure was 214.72 BRL., Conclusion: Caudal epidural with transforaminal nerve root block were a cost-effective treatment modality for patients with degenerative diseases of the lumbar spine. Level of evidence III, Retrospective cohort study. , Competing Interests: All authors declare no potential conflict of interest related to this article.

Copyright of Ciencia, Cuidado e Saude is the property of Universidade Estadual de Maringa and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: This study aimed to evaluate the uncertainty related to the use of common collection tools to assess costs in economic evaluations compared with an exhaustive administrative database.Methods: A pragmatic study was performed using preexisting cost-effectiveness studies. Patients were probabilistically matched with themselves in the French National Health Data System (Système National des Données de Santé [SNDS]), and all their reimbursed hospital and ambulatory care data during the study were extracted. Outcomes included the ratio of the number of each type of resources consumed using trial data (case report forms for ambulatory care and local hospital data for hospital care) versus the SNDS and the ratio of corresponding costs. Mean ratios and 95% confidence intervals (CIs) were calculated using bootstrapping. The impact of the collection tool on the result of the economic evaluation was calculated with the difference in costs between the 2 treatment arms with both collection methods.Results: Five cost-effectiveness studies were included in the analysis. A total of 397 patients had the SNDS hospital data, and 321 had ambulatory care data. Common collection tools underestimated hospital admissions by 13% (95% CI 8-20), corresponding costs by 5% (95% CI 2-14), and ambulatory acts by 41% (95% CI 33-51), with large variations in costs depending on the study. There was no change in the economic conclusion in any study.Conclusions: The use of common collection tools underestimates healthcare resource consumption and its associated costs, particularly for ambulatory care. Our results could provide useful evidence-based estimates to inform sensitivity analyses' parameters in future cost-effectiveness analyses. [ABSTRACT FROM AUTHOR]

Wide-scale automatic monitoring based on the Normalized Difference Water Index (NDWI) and Mask Region-based Convolutional Neural Network (Mask R-CNN) with remote sensing images is of great significance for the management of aquaculture areas. However, different spatial resolutions brought different cost and model performance. To find more suitable image spatial resolutions for automatic monitoring offshore aquaculture areas, seven different resolution remote sensing images in the Sandu’ao area of China, from 2 m, 4 m, to 50 m, were compared. Results showed that the remote sensing images with a resolution of 15 m and above can achieve the corresponding recognition effect when no financial issues were considered, with the F1 score of over 0.75. By establishing a cost-effectiveness evaluation formula that comprehensively considers image price and recognition effect, the best image resolution in different scenes can be found, thus providing the most appropriate data scheme for the automatic monitoring of offshore aquaculture areas.

Copyright of JBES: Brazilian Journal of Health Economics / Jornal Brasileiro de Economia da Saúde is the property of JBES: Brazilian Journal of Health Economics and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of JBES: Brazilian Journal of Health Economics / Jornal Brasileiro de Economia da Saúde is the property of JBES: Brazilian Journal of Health Economics and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Cystic fibrosis is an autosomal recessive genetic disease classified as a high-cost orphan disease. Objective: To determine the cost-effectiveness ratio of the diagnostic test of CFTR gene sequencing for asymptomatic family carriers in the first, second and third degree of consanguinity. Materials and method: A systematic search was carried out evaluating operative characteristics of the diagnostic test and decision tree models in cost-effectiveness studies. A decision tree model was elaborated having as a unit of analysis the prevention of future conceptions. The costs of the disease were obtained from the highcost report of the Ministry of Health of Colombia. The costs of the test were referenced by national laboratories. We carried out a deterministic and probabilistic sensitivity analysis with a third-payer perspective and a one-year horizon. Results: An ICER of $ 5 694,27 was obtained, as an incremental cost for obtaining a 10,89% more probability of avoiding the birth of a child with cystic fibrosis by a sifted partner. For family members in the second and third grades, an ICER of $ 21 848,78 and $ 63 033,19 was found. It was evidenced when applying the GDP per capita; this technology was cost-effective in 39%, 61,18% and 74,36% for 1, 2 and 3 GDP per capita in relatives of first degree of consanguinity. Conclusions: The genetic test for carrier detection for cystic fibrosis is cost effective depending on the threshold of availability to pay, the assumptions and limitations established in the model. [ABSTRACT FROM AUTHOR]

Copyright of Biomédica: Revista del Instituto Nacional de Salud is the property of Instituto Nacional de Salud of Colombia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of JBES: Brazilian Journal of Health Economics / Jornal Brasileiro de Economia da Saúde is the property of JBES: Brazilian Journal of Health Economics and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background Cutaneous leishmaniasis causes a high disease burden in Colombia, and available treatments present systemic toxicity, low patient compliance, contraindications, and high costs. The purpose of this study was to estimate the cost-effectiveness of thermotherapy versus Glucantime in patients with cutaneous leishmaniasis in Colombia. Methods Cost-effectiveness study from an institutional perspective in 8133 incident cases. Data on therapeutic efficacy and safety were included, calculating standard costs; the outcomes were disability adjusted life years (DALYs) and the number of patients cured. The information sources were the Colombian Public Health Surveillance System, disease burden studies, and one meta-analysis of controlled clinical trials. Incremental cost-effectiveness was determined, and uncertainty was evaluated with tornado diagrams and Monte Carlo simulations. Results Thermotherapy would generate costs of US$ 501,621; the handling of adverse effects, US$ 29,224; and therapeutic failures, US$ 300,053. For Glucantime, these costs would be US$ 2,731,276, US$ 58,254, and US$ 406,298, respectively. With thermotherapy, the cost would be US$ 2062 per DALY averted and US$ 69 per patient cured; with Glucantime, the cost would be US$ 4241 per DALY averted and US$ 85 per patient cured. In Monte Carlo simulations, thermotherapy was the dominant strategy for DALYs averted in 67.9% of cases and highly cost-effective for patients cured in 72%. Conclusion In Colombia, thermotherapy can be included as a cost-effective strategy for the management of cutaneous leishmaniasis. Its incorporation into clinical practice guidelines could represent savings of approximately US$ 10,488 per DALY averted and costs of US$ 116 per additional patient cured, compared to the use of Glucantime. These findings show the relevance of the incorporation of this treatment in our country and others with similar parasitological, clinical, and epidemiological patterns.

Abstract Background Metastatic colorectal cancer imposes a substantial burden on patients and society. Over the last years, progresses in the treatment have been made especially due to the introduction of monoclonal antibodies, such as bevacizumab which, on the other hand, has considerably increased the costs of treatment. We performed a cost-effectiveness analysis of bevacizumab plus XELOX in comparison with XELOX alone in metastatic colorectal cancer in first-line therapy, from the perspective of a public hospital school in Brazil. Methods This was a cost-effectiveness analysis performed by a decision tree and Markov models. Costs were expressed in local currency and outcomes were expressed in months of life gained. The model was constructed using the TreeAge Pro 2013® software. Results The incremental difference in years of life gained was 2.25 months, with an extra cost of 47,833.57 BRL, resulting in an incremental cost-effectiveness of 21,231.43 BRL per month of life gained. Conclusions Although the XELOX plus bevacizumab regimen is a more expensive and more effective treatment than XELOX, it does not fit the reimbursement values fixed by the public healthcare system in Brazil.

Abstract Background Home telemonitoring has developed considerably over recent years in chronic diseases in order to improve communication between healthcare professionals and patients and to promote early detection of deteriorating health status. In the nephrology setting, home telemonitoring has been evaluated in home dialysis patients but data are scarce concerning chronic kidney disease (CKD) patients before and after renal replacement therapy. The eNephro study is designed to assess the cost effectiveness, clinical/biological impact, and patient perception of a home telemonitoring for CKD patients. Our purpose is to present the rationale, design and organisational aspects of this study. Methods eNephro is a pragmatic randomised controlled trial, comparing home telemonitoring versus usual care in three populations of CKD patients: stage 3B/4 (n = 320); stage 5D CKD on dialysis (n = 260); stage 5 T CKD treated with transplantation (n= 260). Five hospitals and three not-for-profit providers managing self-care dialysis situated in three administrative regions in France are participating. The trial began in December 2015, with a scheduled 12-month inclusion period and 12 months follow-up. Outcomes include clinical and biological data (e.g. blood pressure, haemoglobin) collected from patient records, perceived health status (e.g. health related quality of life) collected from self-administered questionnaires, and health expenditure data retrieved from the French health insurance database (SNIIRAM) using a probabilistic matching procedure. Discussion The hypothesis is that home telemonitoring enables better control of clinical and biological parameters as well as improved perceived health status. This better control should limit emergency consultations and hospitalisations leading to decreased healthcare expenditure, compensating for the financial investment due to the telemedicine system. Trial registration This study has been registered at ClinicalTrials.gov under NCT02082093 (date of registration: February 14, 2014).

Abstract Background Mental disorders are associated with high costs for productivity loss, sickness absence and unemployment. A participatory supportive return to work (RTW) program was developed in order to improve RTW among workers without an employment contract, sick-listed due to a common mental disorder. The program contained a participatory approach, integrated care and direct placement in a competitive job. The aim of this study was to evaluate the cost-effectiveness and cost-utility of this new program, compared to usual care. In addition, its return on investment was evaluated. Methods An economic evaluation was conducted alongside a 12-month randomized controlled trial. A total of 186 participants was randomly allocated to the new program (n = 94) or to usual care (n = 92). Effect measures were the duration until sustainable RTW in competitive employment and quality-adjusted life years (QALYs) gained. Costs included intervention costs, medical costs and absenteeism costs. Registered data of the Dutch Social Security Agency were used to assess the duration until sustainable RTW, intervention costs and absenteeism costs. QALYs and medical costs were assessed using three- or six-monthly questionnaires. Missing data were imputed using multiple imputations. Cost-effectiveness analysis and cost-utility analysis were conducted from the societal perspective. A return on investment analysis was conducted from the social insurer’s perspective. Various sensitivity analyses were performed to assess the robustness of the results. Results The new program had no significant effect on the duration until sustainable RTW and QALYs gained. Intervention costs and medical costs were significantly higher in the intervention group. From the societal perspective, the maximum probability of cost-effectiveness for duration until sustainable RTW was 0.64 at a willingness to pay of about €10 000/day, and 0.27 for QALYs gained, regardless of the willingness to pay. From the social insurer’s perspective, the probability of financial return was 0.18. Conclusions From the societal perspective, the new program was neither cost-effective in improving sustainable RTW nor in gaining QALYs. From the social insurer’s perspective, the program did not result in a positive financial return. Therefore, the present study provided no evidence to support its implementation. Trial registration The trial was listed at the Dutch Trial Register (NTR) under NTR3563 on August 7, 2012.

A comparative cost-effectiveness performance evaluation of graphite, glassy carbon, irrudium coated titanium and titanium anodes during electro-kinetic removal (EKR) of Pb(II) ions from contaminated clay soil was investigated. The influences of catholyte concentration (0.2-1N), spacing between electrodes (15-25 cm), treatment time (1-3 weeks) and distance from anode(5-15 cm) on Pb (II) residual concentration were evaluated and optimized using Response Surface Methodology. The relative contribution of the operating conditions follows the order; treatment time > distance from anode > electrode spacing > catholyte concentration. All the anodes yielded high Pb(II) removal with graphite exhibiting slower performance. The electro-osmotic volumes collected at the catholyte compartments suggest electro-osmosis as dominant removal mechanism while Ir-coated titanium exerted the highest electroosmotic mobility coefficients of 0.0054 cm3s-1, 4.98 x 10-5 cm2V-1s-1 and 0.00208 cm2A-1s-1. The least energy expenditure of $46.21per kWh, $0.13 per kWhm-3and $49.74 per kWh.m-3mg-1was attributed to graphite, followed by titanium and then Ir-coated titanium. The most exorbitant glassy carbon considerably exhibited the least performance with $2134.64 per kWh, $6.15 per kWhm-3 and $2094.8 per kWh.m-3mg-1. This study underscores the relevance of taking anodic materials cost into considerations for better evaluation of EKR effectiveness for remediation of heavy metals contaminated-soils. [ABSTRACT FROM AUTHOR]

Objectives: Advances in health care due to the development and introduction of new drugs and medical devices have brought considerable benefits to people and patients in terms of upgraded quality of life and extended years of survival. However, some are concerned that the very advancement of health care would increase further the inflation of national healthcare costs. In response to these concerns, Japan's Central Social Insurance Medical Council ("Chuikyo") began in 2012 to examine how cost-effectiveness evaluation might be applied to the national health insurance system, and has been working toward establishing a system for its usage.Methods: Cost-effectiveness evaluation was adopted on a trial basis in fiscal year (FY) 2016, targeting seven drugs and six medical devices. Analyses and re-analyses were performed by manufacturers and a public expert organization, respectively. Based on these analyses, a cost-effectiveness evaluation expert organization conducted an overall assessment ("appraisal"). Results of the evaluation were used to adjust the prices of the target items.Results: Following the trial adoption of cost-effectiveness evaluation, price adjustments were performed for three items in April 2018. Meanwhile, a decision was also made to examine seven items for which technical requirements were identified due to differences in the understanding of analysis methods between involved parties.Conclusions: The Chuikyo will examine how to meet the newly identified technical requirements and discuss specific details with regard to establishing a system that incorporates cost-effectiveness evaluation. The Chuikyo plans to reach a conclusion by the end of FY 2018. [ABSTRACT FROM AUTHOR]

Objective: To estimate the cost-effectiveness of strategies for the treatment of VL in Brazil.Methods: Cost-effectiveness study comparing three therapeutic options: meglumine antimoniate (MA), liposomal amphotericin B (LAMB) and a combination of LAMB plus MA (LAMB plus MA), from public health system and societal perspectives. An analytical decision-making model was used to compare strategies for the following outcomes: early therapeutic failure avoided at 30 days, days of hospitalisation avoided and VL cure at 180 days. The efficacy and safety parameters of the drugs came from a randomised, open-label trial and the cost data came from a cost-of-illness study, both carried out in Brazil.Results: For all outcomes analysed, the LAMB strategy was more effective. The MA strategy was inferior to the LAMB plus MA strategy for the outcomes early therapeutic failure avoided and cure. When only LAMB and MA were compared from a societal perspective, a cost of US$ 278.56 was estimated for each additional early therapeutic failure avoided, a cost of US$ 26.88 for each additional day of hospitalisation avoided and a cost of US$ 89.88 for each additional case of cured VL, for the LAMB strategy vs. MA.Conclusion: In Brazil, the LAMB strategy proved to be cost-effective for treating VL, considering a GDP per capita as the willingness-to-pay threshold, for all of the outcomes analysed in comparison to MA. [ABSTRACT FROM AUTHOR]

Copyright of Cadernos de Saude Publica is the property of Escola Nacional de Saude Publica Sergio Arouca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of JBES: Brazilian Journal of Health Economics / Jornal Brasileiro de Economia da Saúde is the property of JBES: Brazilian Journal of Health Economics and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

ABSTRACT OBJECTIVE: To analyze the cost effectiveness of the diagnostic program for the germline mutation in BRCA1/2 genes and of preventative strategies for the relatives of patients diagnosed with ovarian cancer associated with this mutation. METHODS: The study analyzed the cost effectiveness by developing an analysis of the Markov decision process from the perspective of the National Health System. The strategies compared reflect upon the adoption of genetic testing and preventative strategies for relatives or the usual care currently proposed. The incremental cost-effectiveness ratio was expressed in terms of cost per case avoided. The sensitivity analysis was performed in a univariate and deterministic manner. RESULTS: The study showed increments for effectiveness and for costs when performing genetic testing and adopting prophylactic measures for family members. The incremental cost-effectiveness ratio was estimated at R$908.58 per case of cancer avoided, a figure considered lower than the study's cost-effectiveness threshold (R$7,543.50). CONCLUSIONS: The program analyzed should be considered a cost-effective strategy for the national situation. Studies in various other countries have reached similar conclusions. One possible ramification of this research might the need to perform a budgetary-impact analysis of making the program one of the country's health policies.

ABSTRACT OBJECTIVE To conduct a cost-effectiveness analysis of natural childbirth and elective C-section for normal risk pregnant women. METHODS The study was conducted from the perspective of supplemental health, a health subsystem that finances private obstetric care, represented in Brazil by health plan operators. The reference populations were normal risk pregnant women, who could undergo natural childbirth or elective C-section, subdivided into primiparous and multiparous women with previous uterine scar. A decision analysis model was constructed including choice of delivery types and health consequences for mother and newborn, from admission for delivery to maternity hospital discharge. Effectiveness measures were identified from the scientific literature, and cost data obtained by consultation with health professionals, health plan operators’ pricing tables, and pricing reference publications of health resources. RESULTS Natural childbirth was dominant compared with elective C-section for primiparous normal risk pregnant women, presenting lower cost (R$5,210.96 versus R$5,753.54) and better or equal effectiveness for all evaluated outcomes. For multiparous women with previous uterine scar, C-section presented lower cost (R$5,364.07) than natural childbirth (R$5,632.24), and better or equal effectiveness; therefore, C-section is more efficient for this population. CONCLUSIONS It is necessary to control and audit C-sections without clinical indication, especially with regard to primiparous women, contributing to the management of perinatal care.

Aims: The purpose of this systematic review was to evaluate the cost-effectiveness and acceptance of children and their parents of the Hall technique (HT) for dental rehabilitation in pediatric dentistry., Background: The approach of the HT is that of minimally invasive treatment of the dental element and is used exclusively on primary molars. Various studies in the literature point to HT as a restorative option well accepted by children and parents and quite predictable, with low retreatment rates and good cost-effectiveness for the management of primary molars with carious lesions. However, no systematic review in the literature has approached randomized clinical trials on these topics to produce a high level of evidence and help establish clinical HT protocols., Review Results: Eight articles were selected for the systematic review. The HT was more cost-effective than procedures using other restorative materials. Regarding acceptance, in terms of esthetics, high percentages of satisfaction were reported for parents and children, with a divergence between studies in the comparison of esthetic preference with atraumatic restorative treatment. However, when considering crown cementation pain, comfort, anxiety, preference, and satisfaction, the HT was generally better evaluated when compared to other restorative materials., Conclusion: The HT is an excellent restorative option when considering cost-effectiveness and acceptance and is recommended for use in daily clinical practice., Clinical Significance: Results indicate that HT is superior to other restorative materials regarding its acceptance by children and parents in terms of pain, comfort, anxiety, and crown preference and satisfaction. There were also high percentages of satisfaction with esthetics. Hall technique may initially appear expensive for dentists, but its effectiveness over time and the lesser need for consultations and reinventions ensure better cost-benefit than other restorative materials. How to cite this article: Valentim FB, Moreira KMS, Carneiro VC, et al . Cost-effectiveness and Acceptance in Children and Parents of the Hall Technique: Systematic Review of Clinical Trials. J Contemp Dent Pract 2023;24(12):1016-1025.

Objectives. To consider the burden of disease associated to tobacco consumption in Paraguay and to evaluate the potential economic and health effect of price increase through taxes. Materials and Methods. A Monte Carlo simulation model was designed incorporating natural history, costs, and quality of life of diseases associated to smoking for 2015. Also, several scenarios were considered for the impact of tax raises on the prevalence of smoking and fiscal collection. Results. In Paraguay, 3,354 people die every year as a consequence of smoking. Nineteen percent of deaths are due to cardiac ischemia, 15% due to stroke. 77% of deaths due to chronic obstructive pulmonary disease (COPD), and 83% of lung cancer can be attributed to smoking. These diseases in Paraguay represent an annual direct medical cost of more than 1.5 trillion PYG, while the tax collection from cigarette sales barely covers 20% of this expense. A 50% increase in the price of cigarettes via taxes could avoid 2507 deaths in ten years and generate resources by 2.4 trillion in savings in health expenses and tax of collection. Conclusions. The cost and the burden of disease associated to tobacco consumption is high in the health system in Paraguay. An increase in cigarette price through taxes could have significant health benefits and could offset health costs in part. [ABSTRACT FROM AUTHOR]

Background: Cutaneous leishmaniasis causes a high disease burden in Colombia, and available treatments present systemic toxicity, low patient compliance, contraindications, and high costs. The purpose of this study was to estimate the cost-effectiveness of thermotherapy versus Glucantime in patients with cutaneous leishmaniasis in Colombia.Methods: Cost-effectiveness study from an institutional perspective in 8133 incident cases. Data on therapeutic efficacy and safety were included, calculating standard costs; the outcomes were disability adjusted life years (DALYs) and the number of patients cured. The information sources were the Colombian Public Health Surveillance System, disease burden studies, and one meta-analysis of controlled clinical trials. Incremental cost-effectiveness was determined, and uncertainty was evaluated with tornado diagrams and Monte Carlo simulations.Results: Thermotherapy would generate costs of US$ 501,621; the handling of adverse effects, US$ 29,224; and therapeutic failures, US$ 300,053. For Glucantime, these costs would be US$ 2,731,276, US$ 58,254, and US$ 406,298, respectively. With thermotherapy, the cost would be US$ 2062 per DALY averted and US$ 69 per patient cured; with Glucantime, the cost would be US$ 4241 per DALY averted and US$ 85 per patient cured. In Monte Carlo simulations, thermotherapy was the dominant strategy for DALYs averted in 67.9% of cases and highly cost-effective for patients cured in 72%.Conclusion: In Colombia, thermotherapy can be included as a cost-effective strategy for the management of cutaneous leishmaniasis. Its incorporation into clinical practice guidelines could represent savings of approximately US$ 10,488 per DALY averted and costs of US$ 116 per additional patient cured, compared to the use of Glucantime. These findings show the relevance of the incorporation of this treatment in our country and others with similar parasitological, clinical, and epidemiological patterns. [ABSTRACT FROM AUTHOR]

Background: Metastatic colorectal cancer imposes a substantial burden on patients and society. Over the last years, progresses in the treatment have been made especially due to the introduction of monoclonal antibodies, such as bevacizumab which, on the other hand, has considerably increased the costs of treatment. We performed a cost-effectiveness analysis of bevacizumab plus XELOX in comparison with XELOX alone in metastatic colorectal cancer in first-line therapy, from the perspective of a public hospital school in Brazil.Methods: This was a cost-effectiveness analysis performed by a decision tree and Markov models. Costs were expressed in local currency and outcomes were expressed in months of life gained. The model was constructed using the TreeAge Pro 2013® software.Results: The incremental difference in years of life gained was 2.25 months, with an extra cost of 47,833.57 BRL, resulting in an incremental cost-effectiveness of 21,231.43 BRL per month of life gained.Conclusions: Although the XELOX plus bevacizumab regimen is a more expensive and more effective treatment than XELOX, it does not fit the reimbursement values fixed by the public healthcare system in Brazil. [ABSTRACT FROM AUTHOR]

Copyright of JBES: Brazilian Journal of Health Economics / Jornal Brasileiro de Economia da Saúde is the property of JBES: Brazilian Journal of Health Economics and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Home telemonitoring has developed considerably over recent years in chronic diseases in order to improve communication between healthcare professionals and patients and to promote early detection of deteriorating health status. In the nephrology setting, home telemonitoring has been evaluated in home dialysis patients but data are scarce concerning chronic kidney disease (CKD) patients before and after renal replacement therapy. The eNephro study is designed to assess the cost effectiveness, clinical/biological impact, and patient perception of a home telemonitoring for CKD patients. Our purpose is to present the rationale, design and organisational aspects of this study.Methods: eNephro is a pragmatic randomised controlled trial, comparing home telemonitoring versus usual care in three populations of CKD patients: stage 3B/4 (n = 320); stage 5D CKD on dialysis (n = 260); stage 5 T CKD treated with transplantation (n= 260). Five hospitals and three not-for-profit providers managing self-care dialysis situated in three administrative regions in France are participating. The trial began in December 2015, with a scheduled 12-month inclusion period and 12 months follow-up. Outcomes include clinical and biological data (e.g. blood pressure, haemoglobin) collected from patient records, perceived health status (e.g. health related quality of life) collected from self-administered questionnaires, and health expenditure data retrieved from the French health insurance database (SNIIRAM) using a probabilistic matching procedure.Discussion: The hypothesis is that home telemonitoring enables better control of clinical and biological parameters as well as improved perceived health status. This better control should limit emergency consultations and hospitalisations leading to decreased healthcare expenditure, compensating for the financial investment due to the telemedicine system.Trial Registration: This study has been registered at ClinicalTrials.gov under NCT02082093 (date of registration: February 14, 2014). [ABSTRACT FROM AUTHOR]

Background: Mental disorders are associated with high costs for productivity loss, sickness absence and unemployment. A participatory supportive return to work (RTW) program was developed in order to improve RTW among workers without an employment contract, sick-listed due to a common mental disorder. The program contained a participatory approach, integrated care and direct placement in a competitive job. The aim of this study was to evaluate the cost-effectiveness and cost-utility of this new program, compared to usual care. In addition, its return on investment was evaluated.Methods: An economic evaluation was conducted alongside a 12-month randomized controlled trial. A total of 186 participants was randomly allocated to the new program (n = 94) or to usual care (n = 92). Effect measures were the duration until sustainable RTW in competitive employment and quality-adjusted life years (QALYs) gained. Costs included intervention costs, medical costs and absenteeism costs. Registered data of the Dutch Social Security Agency were used to assess the duration until sustainable RTW, intervention costs and absenteeism costs. QALYs and medical costs were assessed using three- or six-monthly questionnaires. Missing data were imputed using multiple imputations. Cost-effectiveness analysis and cost-utility analysis were conducted from the societal perspective. A return on investment analysis was conducted from the social insurer's perspective. Various sensitivity analyses were performed to assess the robustness of the results.Results: The new program had no significant effect on the duration until sustainable RTW and QALYs gained. Intervention costs and medical costs were significantly higher in the intervention group. From the societal perspective, the maximum probability of cost-effectiveness for duration until sustainable RTW was 0.64 at a willingness to pay of about €10 000/day, and 0.27 for QALYs gained, regardless of the willingness to pay. From the social insurer's perspective, the probability of financial return was 0.18.Conclusions: From the societal perspective, the new program was neither cost-effective in improving sustainable RTW nor in gaining QALYs. From the social insurer's perspective, the program did not result in a positive financial return. Therefore, the present study provided no evidence to support its implementation.Trial Registration: The trial was listed at the Dutch Trial Register (NTR) under NTR3563 on August 7, 2012. [ABSTRACT FROM AUTHOR]

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, taxa de desconto e preço dos medicamentos (± 10%). Na análise de sensibilidade probabilística, a curva de aceitabilidade mostrou que iniciar com entecavir foi a alternativa mais custo-efetiva na comparação ao uso de lamivudina. CONCLUSÕES: A disponibilidade do entecavir é economicamente atrativa como parte do tratamento precoce para pacientes com hepatite crônica B sem coinfecção com o HIV.OBJETIVO: Analizar la tasa costo/efectividad de las alternativas medicamentosas con terapia de rescate en la recaída por resistencia viral en el tratamiento de pacientes con hepatitis crónica B (HCB). MÉTODOS: Cohorte hipotética de pacientes con HCB HBeAg negativo, sin evidencia clínica o histológica de cirrosis, DNA del VHB detectable, diagnóstico histológico de la enfermedad, HBsAg positivo en el suero por más de seis meses, elevados niveles de alanina transferasa (ALT) (dos veces mayor que el límite superior de la normalidad [LSN] y promedio de edad de 40 años. Se desarrolló el Modelo de Markov para la hepatitis crónica B (antígeno HBeAg negativo) con horizonte temporal de 40 años. Costos y beneficios se descontaron en 5%. Las tasas anuales de progresión, costos debido a complicaciones y la eficacia de los medicamentos se obtuvieron de la literatura. Las incertezas se evaluaron por análisis de sensibilidad unidireccional y probabilística. RESULTADOS: Iniciar el tratamiento con entecavir resultó en ganancia de 0,35 año/vida con relación a la lamivudina. El cociente de costo-efectividad incremental fue de R$ 16.416,08 por años de vida ganados. En el análisis de sensibilidad el cociente de costo-efectividad incremental fue más sensible a la variación en la probabilidad de transición de hepatitis crónica B para cirrosis compensada, tasa de descuento y precio de los medicamentos (±10%). En el análisis de sensibilidad probabilística, la curva de aceptación mostró que iniciar con entecavir fue la alternativa más costo-efectiva en comparación al uso de lamivudina. CONCLUSIONES: La disponibilidad del entecavir es económicamente atractiva como parte del tratamiento precoz para pacientes con hepatitis crónica B sin co-infección con el VIH.OBJECTIVE: To conduct a cost-effectiveness analysis of drug alternatives with rescue therapy in case of relapse due to viral resistance for the treatment of patients with chronic hepatitis B (CHB). METHODS: Hypothetical cohort of patients with CHB, HBeAg-negative, without clinical or histological evidence of cirrhosis, detectable HBV DNA, histological diagnosis of the disease, positive serum HBsAg for longer than six months, high levels of alanine aminotransferase (ALT) (twice as high as the upper limit of normality) and mean age of 40 years. A Markov model was developed for chronic hepatitis B (HBeAg- negative) with a 40-year time horizon. Costs and benefits were discounted at 5%. Annual rates of disease progression, costs due to complications and the efficacy of medicines were obtained from the literature. One-way and probabilistic sensitivity analysis evaluated uncertainties. RESULTS: Initiation of treatments with entecavir resulted in an increase of 0.35 discounted life-years gained compared to lamivudine. The incremental cost-effectiveness ratio was R$16,416.08 per life-years gained. In the sensitivity analysis, the incremental cost-effectiveness ratio was more sensitive to variation in the probability of transition from chronic hepatitis B to compensated cirrhosis, discount rate and medicine prices (± 10%). In the probabilistic sensitivity analysis, the acceptability curve showed that beginning treatment with entecavir was the most cost-effective alternative in comparison with the use of lamivudine. CONCLUSIONS: The availability of entecavir is economically attractive as part of early treatment for patients with chronic hepatitis B without HIV co-infection.

Objectives: To analyze the operative time, length of hospitalizationand cost, as well as the bleeding and pain observed during thepostoperative period, of thyroidectomy procedures using vesselsealing, harmonic scalpel or the conventional technique. Methods:Retrospective analysis of thyroidectomies performed between 2007and 2010 using either the conventional technique or minimallyinvasive techniques involving vessel sealing or a harmonic scalpel.Gender, age, primary diagnosis and procedure type were analyzed.The outcomes analyzed included the length of the procedure, lengthof hospital stay, need for blood product transfusions, pain andcost of hospitalization. The findings were based on a significancelevel of 5%, and statistical analyses were performed using the Rsoftware. Results: The use of the vessel sealing increased theduration of the surgery by approximately 47 minutes compared tothe conventional technique (p

The aim of this study was to present the contributions of the systematic review of economic evaluations to the development of a national study on childhood hepatitis A vaccination. A literature review was performed in EMBASE, MEDLINE, WOPEC, HealthSTAR, SciELO and LILACS from 1995 to 2010. Most of the studies (8 of 10) showed favorable cost-effectiveness results. Sensitivity analysis indicated that the most important parameters for the results were cost of the vaccine, hepatitis A incidence, and medical costs of the disease. Variability was observed in methodological characteristics and estimates of key variables among the 10 studies reviewed. It is not possible to generalize results or transfer epidemiological estimates of resource utilization and costs associated with hepatitis A to the local context. Systematic review of economic evaluation studies of hepatitis A vaccine demonstrated the need for a national analysis and provided input for the development of a new decision-making model for Brazil.O objetivo deste estudo foi apresentar as contribuições da revisão sistemática de avaliações econômicas para o desenvolvimento de um estudo nacional, o caso da vacinação infantil contra hepatite A. Foi realizada revisão da literatura nas bases de dados EMBASE, MEDLINE, WOPEC, HealthSTAR, SciELO e LILACS, no período de 1995 a 2010. A maioria dos estudos (8 em 10) mostrou resultados favoráveis de custo-efetividade. As análises de sensibilidade indicaram como parâmetros mais importantes para os resultados os custos da vacina, incidência de hepatite A e custos médicos da doença. Foi observada variabilidade nas características metodológicas e estimativas de variáveis-chaves dos 10 estudos revisados. Não é possível generalização dos resultados e transferibilidade de estimativas epidemiológicas, de usos de recursos e custos associados à hepatite A para o contexto local. A revisão sistemática dos estudos de avaliação econômica da vacina contra hepatite A demonstrou a necessidade de uma análise nacional e forneceu elementos para o desenvolvimento de um novo modelo de decisão para o Brasil.

FUNDAMENTOS: O câncer de maior incidência no Brasil é o de pele não-melanoma, que afeta aproximadamente 0,06% da população. Não existem políticas públicas para sua prevenção e o impacto econômico do seu diagnóstico não tem sido avaliado. OBJETIVOS: Estimar os custos do diagnóstico e tratamento do câncer de pele não-melanoma no Estado de São Paulo entre 2000 a 2007 e compará-los com os do melanoma cutâneo no mesmo período. MÉTODOS: Foi utilizado como modelo de procedimento o projeto diretriz Clinical Practice Guidelines in Oncology, (National Comprehensive Cancer Network), adequado aos procedimentos da Fundação SOBECCan - Hospital do Câncer de Ribeirão Preto - SP. Os custos estimados baseiam-se nos valores do tratamento médico pagos pelos setores público e privado em 2007. RESULTADOS: Os valores médios de custo individual do tratamento anual do câncer de pele não-melanoma são muito mais baixos do que os estimados para o tratamento do melanoma cutâneo. Entretanto, observados os gastos totais no tratamento do câncer de pele não-melanoma, percebe-se que os 42.184 casos deste câncer em São Paulo, no período estudado, fazem com que o custo total do seu tratamento seja 14% superior ao dos 2.740 casos de melanoma cutâneo registrados no mesmo período para o SUS. Porém, para o sistema privado, o gasto total é, aproximadamente, 34% menor para o tratamento do câncer de pele não-melanoma. CONCLUSÃO: O elevado número de casos de câncer de pele não-melanoma no Brasil - com 114 mil novos casos previstos para 2010, sendo 95% diagnosticados em estágios precoces - representa um impacto financeiro ao sistema público e aos sistemas privados de saúde de cerca de R$ 37 milhões e R$ 26 milhões ao ano, respectivamenteBACKGROUND: The most common form of cancer in Brazil is non-melanoma skin cancer, which affects approximately 0.06% of the population. There are no public policies for its prevention and the economic impact of its diagnosis has yet to be established. OBJECTIVES: To estimate the costs of the diagnosis and treatment of non-melanoma skin cancer in the state of São Paulo between 2000 and 2007 and to compare them with the costs associated with skin melanoma in the same period. METHODS: The Clinical Practice Guidelines in Oncology (National Comprehensive Cancer Network) was used as a procedure model, adapted to the procedures at the SOBECCan Foundation at the Ribeirão Preto Cancer Hospital in São Paulo. The estimated costs were based on the costs of medical treatment in the public and private sectors in 2007. RESULTS: The mean annual costs of each individual treatment of non-melanoma skin cancer were much lower than those estimated for the treatment of skin melanoma. Nevertheless, when the total costs of the treatment of non-melanoma skin cancer were taken into consideration, it was found that the total cost of the 42,184 cases of this type of cancer in São Paulo within the study period was 14% higher than the costs of the 2,740 cases of skin melanoma registered in the same period within the Brazilian National Health Service (SUS). However, in the private sector, the total cost was approximately 34% less for the treatment of non-melanoma skin cancer compared to melanoma. CONCLUSION: The high number of cases of non-melanoma skin cancer in Brazil, with 114,000 new cases predicted for 2010, 95% of which are diagnosed at early stages, represents a financial burden to the public and private healthcare systems of around R$37 million and R$26 million annually, respectively

OBJETIVO: Avaliar custos e conseqüências da assistência pré-natal na morbimortalidade perinatal. MÉTODOS: Estudo avaliativo com dois tipos de análise - de implantação e de eficiência, realizado em 11 Unidades de Saúde da Família do Recife, PE, em 2006. Os custos foram apurados pela técnica activity-based costing e a razão de custo-efetividade foi calculada para cada conseqüência. As fontes de dados foram sistemas de informação do Ministério da Saúde e planilhas de custos da Secretaria de Saúde do Recife e do Instituto de Medicina Integral Prof. Fernando Figueira. As unidades de saúde com pré-natal implantado ou parcial foram comparadas quanto ao seu custo-efetividade e resultados perinatais. RESULTADOS: Em 64% das unidades, o pré-natal estava implantado com custo médio total de R$ 39.226,88 e variação de R$ 3.841,87 a R$ 8.765,02 por Unidade de Saúde. Nas unidades parcialmente implantadas (36%), o custo médio total foi de R$ 30.092,61 (R$ 4.272,12 a R$ 11.774,68). O custo médio por gestante foi de R$ 196,13 com pré-natal implantado e R$ 150,46 no parcial. Encontrou-se maior proporção de baixo peso ao nascer, sífilis congênita, óbitos perinatais e fetais no grupo parcialmente implantado. CONCLUSÕES: Pré-natal é custo-efetivo para várias conseqüências estudadas. Os efeitos adversos medidos pelos indicadores de saúde foram menores nas unidades com pré-natal implantado. O custo médio no grupo parcialmente implantado foi mais elevado, sugerindo possível desperdício de recursos, uma vez que a produtividade das equipes é insuficiente para a capacidade instalada.OBJETIVO: Evaluar costos y consecuencias de la asistencia prenatal en la morbimortalidad perinatal. MÉTODOS: Estudio evaluativo con dos tipos de análisis: de implantación y de eficiencia, realizado en 11 Unidades de Salud de la Familia de Recife, Sureste de Brasil, en 2006. Los costos fueron mejorados por la técnica activity-based costing y la razón de costo-efectividad fue calculada para cada consecuencia. Las fuentes de datos fueron sistemas de información del Ministerio de la Salud y planillas de costos de la Secretaria de la Salud de Recife y del Instituto de Medicina Integral Prof. Fernando Figueira. Las unidades de salud con prenatal implantado o parcial fueron comparadas con relación a su costo-efectividad y resultados perinatales. RESULTADOS: En 64% de las unidades, el prenatal estaba implantado con costo promedio total de R$ 39.226,88 y variación de R$ 3.841,87 a R$ 8.765,02 por unidad de salud. En las unidades parcialmente implantadas (36%), el costo promedio total fue de R$ 30.092,61 (R$ 4.272,12 a R$ 11.774,68). El costo promedio por gestante fue de R$ 196,13 con prenatal implantado y R$ 150,46 en el parcial. Se encontró mayor proporción de bajo peso al nacer, sífilis congénita, óbitos perinatales y fetales en el grupo parcialmente implantado. CONCLUSIONES: El prenatal es costo-efectivo para varias consecuencias estudiadas. Los efectos adversos medidos por los indicadores de salud fueron menores en las unidades con prenatal implantado. El costo promedio en el grupo parcialmente implantado fue más elevado, sugiriendo posible desperdicio de recursos, dado que la productividad de los equipos es suficiente para la capacidad instalada.OBJECTIVE: To assess costs and consequences of prenatal care on perinatal morbidity and mortality. METHODS: Evaluation study using two types of analysis: implementation and efficiency analysis, carried out at 11 Family Health Units in the Recife, Northeastern Brazil, in 2006. The costs were calculated by means of the activity-based costing technique and the cost-effectiveness ratio was calculated for each consequence. Data sources were information systems of the Ministry of Health and worksheets of costs provided by the Health Department of Recife and Instituto de Medicina Integral Prof. Fernando Figueira. Healthcare units with implemented or partially implemented prenatal care were compared in terms of their cost-effectiveness and perinatal results. RESULTS: In 64% of the units, prenatal care was implemented with a mean total cost of R$ 39,226.88 and variation of R$ 3,841,87 to R$ 8,765.02 per healthcare unit. In the units with partially implemented prenatal care (36%), the mean total cost was R$ 30,092.61 (R$ 4,272.12 to R$ 11,774.68). The mean cost per pregnant woman was R$ 196.13 with implemented prenatal care and R$ 150.46 with partially implemented prenatal care. A higher proportion of low birth weight, congenital syphilis, perinatal and fetal deaths was found in the partially implemented group. CONCLUSIONS: Prenatal care is cost-effective for several studied consequences. The adverse effects measured by the health indicators were lower in the units with implemented prenatal care. The mean cost in the partially implemented group was higher, which suggests a possible waste of resources, as the teams' productivity is insufficient for the installed capacity.