Navegando por Palavras-chave "Costs And Cost Analysis"

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    Análise de custos no período pós-transplante hepático
    (Universidade Federal de São Paulo (UNIFESP), 2021) Silva, Deyvid Fernando Mattei Da [UNIFESP]; Roza, Bartira De Aguiar [UNIFESP]; Universidade Federal de São Paulo
    Introduction: Liver transplantation is a highly complex surgical procedure and indicated for patients with terminal liver disease, it consists in the extraction of the liver from a deceased or living donor in order to replace the inefficient liver of another person. It is a highly complex and costly procedure, performed in few hospitals in Brazil, with high demand from patients awaiting organ donation and at the same time with a scarce donor system. Objective: To analyze hospital costs in the post-liver transplant period. Methods: This was a retrospective cohort study with a quantitative approach, partial economic evaluation that used the methodology of micro-costing and macro-costing for evaluation of costs, carried out at the Transplant Hospital of the State of São Paulo, which had 153 beds and performed liver transplants. , data collected through multiprofessional records in the medical records of liver transplant patients from January to December of the year 2018 were analyzed, identified the relationships of the variables age, sex, Model of End-Stage Liver Disease, graft ischemia time, infection, death and costs. Results: The mean age of the patients was 57.7 years SD 10.7, the average Model of End-Stage Liver Disease score was 18.7 points and the sample consisted of 65% men. Most patients were transplanted for hepatitis C (37.5%). Of the 40 patients, 26 (65.0%) were discharged after the transplant and had no infection during hospitalization, 3 (7.5%) were discharged after an episode of infection, 3 (7.5%) died after an episode infection, 8 (20.0%) died without hospital infection. Patients who acquired infection had a higher Model of End-Stage Liver Disease score compared to patients who did not acquire infection. The addition of one hour of cold graft ischemia showed an average increase of 2.6 times in the chance of infection per hour, adjusted for age and Model of End-Stage Liver Disease. The patient who acquired infection and was discharged on average 52 days in hospital, the one who had infection and died 38.3 days, the patient who was discharged and had no infection stayed 25.8 days and the one who died and had no infection was in average 5 days hospitalized. Costs: the patient who was discharged without a post-transplant infection cost an average of R $ 58.2 thousand, those who died without infection cost R $ 17.9 thousand, while those who had an infection in the post-transplant period and were discharged they cost an average of 121.8 thousand reais, and if they had an infection and died in the hospital, they cost 148.4 thousand reais. Conclusion: The increase in hospital costs in the post-liver transplantation period is related to the presence of infection, time of elevated cold ischemia of the graft and risk of death from infection. The costs of hospitalizations in the Intensive Care Unit and infirmary were the most representative in the post-transplant period. The difference in the evaluation of the micro-cost and macro-cost analysis was minimally significant.
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    Costs of hospitalization in preterm infants: impact of antenatal steroid therapy
    (Soc brasil pediatria, 2016) Ogata, Joice Fabiola Meneguel [UNIFESP; Fonseca, Marcelo Cunio Machado [UNIFESP]; Miyoshi, Milton Harumi [UNIFESP]; Almeida, Maria Fernanda Branco de [UNIFESP]; Guinsburg, Ruth [UNIFESP]
    Objective: To estimate the costs of hospitalization in premature infants exposed or not to antenatal corticosteroids (ACS). Method: Retrospective cohort analysis of premature infants with gestational age of 26-32 weeks without congenital malformations, born between January of 2006 and December of 2009 in a tertiary, public university hospital. Maternal and neonatal demographic data, neonatal morbidities, and hospital inpatient services during the hospitalization were collected. The costs were analyzed using the microcosting technique. Results: Of 220 patients that met the inclusion criteria, 211 (96%) charts were reviewed: 170 newborns received at least one dose of antenatal corticosteroid and 41 did not receive the antenatal medication. There was a 14-37% reduction of the different cost components in infants exposed to ACS when the entire population was analyzed, without statistical significance. Regarding premature infants who were discharged alive, there was a 24-47% reduction of the components of the hospital services costs for the ACS group, with a significant decrease in the length of stay in the neonatal intensive care unit (NICU). In very-low birth weight infants, considering only the survivors, ACS promoted a 30-50% reduction of all elements of the costs, with a 36% decrease in the total cost (p = 0.008). The survivors with gestational age < 30 weeks showed a decrease in the total cost of 38% (p = 0.008) and a 49% reduction of NICU length of stay (p = 0.011). Conclusion: ACS reduces the costs of hospitalization of premature infants who are discharged alive, especially those with very low birth weight and < 30 weeks of gestational age. (C) 2015 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.
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    O impacto econômico da dependência química no contexto brasileiro: custos diretos e indiretos de usuários moderados e graves de drogas
    (Universidade Federal de São Paulo (UNIFESP), 2019-04-12) Becker, Paula [UNIFESP]; Razzouk, Denise [UNIFESP]; http://lattes.cnpq.br/2570757108117687; http://lattes.cnpq.br/2526225947636656; Universidade Federal de São Paulo (UNIFESP)
    The economic impact of substance-related disorders can be measured by the higher consumption of health services, lower productivity and spending on the purchase of drugs. In Brazil, there has been an increase in the prevalence of early onset of drug use. There is a lack of economic studies on the societal impact of the early onset of drug use in Brazil. Objectives: To evaluate the direct, indirect and total costs of people with moderate and severe drug use under society perspective and to verify what are their relationships with early and late onset of drug use and others psychosocial aspects such as quality of life, social participation, self-perception of family support and generalized anxiety, in the context of a Psychosocial Care Center for Alcohol and Drugs users (CAPS-ad). In addition, it was aimed to estimate the CAPS-ad total costs for the public health provider. Methods: It was a retrospective cross-sectional cost analysis from the societal perspective. The main hypothesis of the study was that the early onset of drug use contributes to a higher total cost of substance-related disorders in adulthood. It was interviewed 105 subjects with moderate and severe scores for at least one drug according to ASSIST. These subjects constituted a sample of the CAPS-ad users population. The groups were compared through the age of drug use onset: early exposure (younger than 15 years) and late exposure (15 years old or more). Direct and indirect costs were estimated with the application of the Client Socio demographic and Service Receipt Inventory- CSSRI. Direct costs were those related to health services use, medication and transportation to treatment. Indirect costs were those related to unemployment, absenteeism and amount spent in drugs purchase. Social participation, self-perception of family support, quality of life, sociodemographic profile and screening for generalized anxiety variables were analyzed to verify its possible interference on costs. Data analysis: For the descriptive analysis of the association between two categorical variables it was applied the Qui-square or the Fisher’s Exact tests, Student’s t-test was applied to compare treatment costs means with normal distribution and Mann-Whitney non-parametric teste for the other variables. After the descriptive analysis, an inferential analysis was conducted in which the effects of the predictor variables on the dependent variables, Direct Cost, Indirect Cost and Total Cost were studied through Generalized Linear Models. Results: Regarding CAPS-ad total costs for the public health system, the service’s mean monthly cost in 2015 was BRL 64,017.54, and federal government funded 62.1% of this cost, while municipal management absorbed the remaining 37.9%. The early exposure to drugs did not act as a predictive variable of the total costs of subjects with moderate or severe drug use in adulthood. The direct and indirect costs of moderate and severe drugs users did not showed variation according to early or late exposure to drugs. The monthly direct, indirect and total mean costs of subjects in the year 2015 were, ____________________________________________________________________________ - 10 - respectively, BRL 863.80, BRL 1,718.72 and BRL 2,349.61. Indirect costs represented 73.1% of substance-related disorders total costs. For each year later in which the onset of drugs use happens it was observed a 1.5% increase on direct costs of those users in adulthood. Marijuana, cocaine or crack dependents who were also alcohol abusers had a mean direct cost 2 times higher than alcohol addicts and 4.4 times higher than addicts that did not use alcohol. Subjects with early exposure to drugs developed greater severity of marijuana use in adulthood. The more severe the use of cocaine/crack, the greater the user's indirect costs to society. The indirect cost to society of each additional point in the final ASSIST-Cocaine score was R$18.90 in 2015. Cocaine/crack abuser’s total costs to society were 53% higher than subjects that did not use cocaine/crack. The younger the user, the higher the indirect costs. Users with generalized anxiety disorders symptoms presented higher indirect costs than those without the symptoms. Conclusions: Regarding the CAPS-ad II total costs, the results may support a better planning and management of both federal and municipal governments and point to the need for governmental agencies and the national academic community to focus mental health policies not only on expanding treatment coverage but on the best allocation of resources in terms of costs and outcomes. Adolescents aged 10 to 15 years may be the target population of public policies to prevent drugs dependence and other mental disorders in the country, especially regarding marijuana use. Public policies and action programs focused on the population orientation regarding the risks of problematic use of alcohol, marijuana and crack/cocaine, that acts in early diagnosis of anxiety disorders, and that help in the development of networks to support the treatment for drugs users can reduce the economic impact of mental and behavioral disorders related to drug use in Brazil.